A periodic review of articles, newsletters, and podcasts that I found interesting, inspiring, or otherwise worth remembering.
Chas Roades and Lisa Bielamowicz, MD. Gist Healthcare. The Weekly Gist: March 11, 2021
Using segmentation to hone workforce benefit design: We recently convened human resource and nursing executives from our member health systems to share strategies they’re deploying to address the growing healthcare workforce crisis. Workforce remains the most critical issue facing health systems, as another wave of the pandemic subsides. The executives who joined us were charged with quickly developing and implementing tactics to boost recruitment and retention, and their top questions for their peers focused on prioritization: “Beyond raising salaries, there are so many things we could be doing, from wellness, to shift redesign, to expanding benefits. What will actually yield results?”
It struck us that the answer could be quite different for employees in different stages of their career, or in different life circumstances. Just as systems have enhanced consumer segmentation capabilities as they build out solutions that will foster loyalty among patients and customers, leaders should “segment” the workforce to understand which approaches might have the greatest impact.
Ben Thompson, Stratechery. Tech and War (March 7, 2022)
First, the public/private distinction that I just noted may not be so apparent to people outside of the U.S. or the West generally; one could certainly understand how other countries might interpret this collection of public and private sanctions as being different parts of a single whole. To that end, this collection of actions demonstrates the capability of effectively wiping an economy off of the map.
Second, to the extent that the public/private distinction is understood, it highlights the capability of private companies to impose sanctions, and their willingness to do so in pursuit of political goals — even if those political goals are to stop an unjust invasion and save lives.
Lenny Bernstein, The Washington Post. This is why it’s so hard to find mental health counseling right now (March 6, 2022)
According to the American Academy of Child and Adolescent Psychiatry, there are just 8,300 practicing child psychiatrists in the United States for the more than 15 million young people who need them. Pediatricians are doing initial assessments, [Boston Medical Center child psychiatrist Christine M.] Crawford said, with only the most severe cases reaching her. Children considered a danger to themselves or others are routinely held in hospital emergency rooms for a week or two waiting for beds in appropriate settings, she said.
Markian Hawryluk, KHN. Other States Keep Watchful Eye on Snags in Washington’s Pioneering Public-Option Plan (February 23, 2022)
Washington’s stumble out of the gate reflects the difficulty of lowering health care costs while working within the current system. Legislators originally wanted to cut payment rates to hospitals and other providers much more, but they raised the cap in the legislation so hospitals wouldn’t oppose the bill. Now, it’s unclear whether the payment cap is low enough to reduce premiums.
“That’s kind of the big trade-off,” said Aditi Sen, a health economist with the Johns Hopkins Bloomberg School of Public Health. “You are trying to lower premiums enough that people will enroll, but not so much that providers won’t participate.”
Bob Herman, STAT. A gap in new surprise billing law puts patients on the hook for pricey tests (March 8, 2022)
“When that doctor is telling you, for your convenience, you can just draw your blood down the hall, you’re just thinking this is part of your in-network visit,” [consumer group U.S. PIRG health care director Patricia] Kelmar said. “You don’t realize you probably should be asking before you head down the hall.”
The issue boils down to how “facilities” are defined under the law. Facilities covered under the [No Surprises Act] regulation include hospitals, hospital outpatient departments, and ambulatory surgery centers — but not physician offices and labs.
Many clinics are often converted into hospital outpatient departments after hospitals buy them, but the regulation doesn’t drill down into what hospital outpatient departments encompass.
Daniela J. Lamas, The New York Time. Why Do Some People Never Get Covid? (March 8, 2022)
When I started to think about genetics playing a role in this disease, I worried that in telling a story about our genes, we would shift our attention away from the social failures that have exacerbated the virus’s toll. Any scientist will tell you that observable factors like underlying conditions and age and environmental contributions that determine exposure play a major part. People who don’t have access to health care or are living in crowded, underserved nursing homes are likely at far greater risk than those with certain genetic markers who have the luxury of being able to keep themselves safe.
But that is not the only way to tell this story. Instead, the power of genetics is about making sense of randomness and understanding biology and in doing so, removing blame from the individual.
Anne MacDonald, STAT. Another way to empower nurses: Listen to them (March 11, 2022)
When I obtained my mother’s medical records and reviewed them with a doctor, I learned that her white blood cell count was climbing around the time that Lisa became alarmed. The doctors searched for the source of the infection, but they remained so focused on her colon that they failed to look elsewhere. The infection grew worse and sparked sepsis. If detected early enough, sepsis can be treated with antibiotics. But once it progresses to septic shock, as it did with my mother, it causes organ failure and death.
Like other complications, the earliest symptoms of sepsis can be nonspecific, such as confusion, fever, and shortness of breath. As they conduct daily assessments of patients, nurses are often the first to spot subtle but significant changes. In fact, a review of 18 studies found that nurses are sometimes able to identify the development of lethal complications before any change in the patient’s vital signs. But here’s the rub: Such vigilance requires adequate staffing so that nurses like Lisa have enough time to observe the patient.
Ed Yong, The Atlantic. How did this many deaths become normal? (March 8, 2022)
Stephan Lewandowsky, from the University of Bristol, presented a representative sample of Americans with two possible post-COVID futures—a “back to normal” option that emphasized economic recovery, and a “build back better” option that sought to reduce inequalities. He found that most people preferred the more progressive future—but wrongly assumed that most other people preferred a return to normal. As such, they also deemed that future more likely. This phenomenon, where people think widespread views are minority ones and vice versa, is called pluralistic ignorance. It often occurs because of active distortion by politicians and the press, Lewandowsky told me. (For example, a poll that found that mask mandates are favored by 50 percent of Americans and opposed by just 28 percent was nonetheless framed in terms of waning support.) “This is problematic because over time, people tend to adjust their opinions in the direction of what they perceive as the majority,” Lewandowsky told me. By wrongly assuming that everyone else wants to return to the previous status quo, we foreclose the possibility of creating something better.