Federal cash is flowing into Pa. neighborhood well being facilities, however leaders say there are too many limits on it

If she had her Druther, Cheri Rinehart would have every doctor and staff working in underserved communities wear a pin that said, “I’m vaccinated against Covid. Ask me about the vaccine. “

Rinehart, President and CEO of the Pennsylvania Association of Community Health Centers, said the pins would facilitate conversation and engagement about the COVID-19 vaccine and reduce vaccine reluctance in low-income communities.

Amid the urgency to vaccinate minorities and the small disparities in health care, the pins represent a small financial investment as community health centers have a significant impact on the health of underserved communities, especially during the coronavirus pandemic.

“We think this is a very gentle way to start a conversation when you bring someone back to the exam room or weigh them. If he sees a needle on your collar, he may be more open to talking to the person taking their blood pressure than even a doctor or nurse, ”said Rinehart.

Rinehart recently tabled a proposal for the lapel pins, just one item in a litany of needs and financial inquiries vying for the tens of millions of dollars in federal funding.

In fact, community health centers officials say there has been no shortage of funds to help them support impoverished urban or rural communities, especially since the pandemic began. But often the money comes with constraints that limit their options.

“We wish it wasn’t that specific. These uses weren’t that specific, ”said Jeannine Peterson, CEO of the Hamilton Health Center. “Of course the first pot was money to test and we tested a lot. When the vaccine hit the market in January, testing slowed down, but all that testing money is still there and you can’t use it for anything other than testing.

The most recent source of funding was released in June by the U.S. Centers for Disease Control and Prevention, which allocated $ 27 million to Pennsylvania specifically to address health inequalities in minority and rural communities. The state health ministry has not yet released the money but is completing a number of initiatives.

Nationwide qualified community health centers in Pennsylvania are on the verge of getting a sizable chunk of the money.

Peterson announced programs that would improve human resource development, recruitment, salaries for healthcare professionals and personnel, as well as a number of other initiatives, including infrastructure, that could affect the six locations under the Hamilton Health umbrella.

His missions, she says, are vital.

“The county has mental health and substance abuse responsibility, but it really has no health care responsibility, and that doesn’t exist anywhere in town,” said Peterson. “Things fell to the community health centers. We want to be there to answer. Here we lack the resources to meet the public health needs of the population. These are concrete things. The Covid money is plentiful, but what about everything else we have to do? “

the Hamilton Health Center provides free or discounted health care to more than 20,000 Harrisburg residents and rural communities in Dauphin and Perry counties. The center employs 160 people and provides medical, social, behavioral and dental services to tens of thousands of otherwise unmedically unsupervised residents. It operates on a budget in excess of $ 16 million.

The Hamilton Health Center and the other state-qualified health centers in Pennsylvania continue to benefit from the CARES bill. Much of this money is earmarked for COVID-19 tests and vaccinations. Part of the funding is determined by formulas, such as the number of patients treated in the last year.

In fact, most of the federal aid has yet to be used to help Pennsylvania recover from the COVID-19 pandemic. Pennsylvania received nearly $ 7.3 billion in federal aid through the US rescue plan; $ 1 billion is earmarked for the new state budget.

Regardless, the money is carefully scrutinized and channeled, and is generally targeted towards initiatives such as testing and vaccinations. There Peterson said she wished the flow of funding could be a little more flexible.

Community health centers are required to follow strict guidelines for the use of federal funds. Funds earmarked for testing cannot, for example, be used for vaccination programs or to meet staffing needs.

“It is very difficult to manage all of the funds … to make sure you are spending according to guidelines and having the impact you want to make in the community,” said Peterson.

Brian Lentes, director of operational excellence for the Department of Health, said state officials are working closely with regional ethnic and minority groups and health care providers in rural and urban settings to identify needs and provide the latest federal grants.

“This is a really exciting opportunity for the department to use federal funds to create opportunities for four major strategies,” said Lentes.

These strategies include funding field workforce training; Programs to address inequalities in rural health and the disabled population and initiatives within the ministry.

The funding stream has a designated pot of approximately $ 5 million to be used to address rural health care and inequalities there, and approximately $ 8 million is dedicated to Philadelphia.

“It comes from many different ideas that have been generated by grants to address health inequalities and their relation to COVID-19,” Lentes said. “We know that certain populations contracting COVID-19 have more severe consequences, and this is a great way to address those differences. How can you improve the response in the future? “

Pennsylvania is one of the states that does not provide state funding for community health centers. Health centers in the Commonwealth receive their funding largely from federal sources, including Medicaid and Medicare, as well as from critical grant funding streams.

Extensive studies have confirmed the difference that community health centers are making in their communities and the quality of care they provide, especially during the pandemic.

“We had health inequalities before the pandemic,” said Rinehart. “Many of these churches – where we see big differences in health – are the same churches where our most important workers had to work in the early days. Often they were dependent on public transport. They live in smaller neighborhoods with more people, which increases the risk of infection. It was important to give these people access to the vaccine as soon as possible. “

Nationwide Qualified Health Centers in Pennsylvania provided medical care to nearly 1 million Pennsylvania residents last year – in fact, 917,000 people received medical care at more than 330 clinic locations in 53 of the Commonwealth of Counties. Nationwide, this number is 29 million people.

The federal grant is available until 2023, a fact that, depending on your point of view, makes the situation even more urgent.

Lentes guarantees that the money will be paid out on time and carefully. Will it be enough to address and contain the persistent disparities?

“I think this is a very good place to start and it is appropriate at this point to keep looking at the additional options,” he said. “This is a great start, but there is always room for more. As we continue to address health inequalities and improve our response to Covid and underserved racial and ethnic groups, we are generally looking for additional funding to continue building existing programs but have other areas and agencies do the same. “

Rinehart said she was happy with the speed at which the state is processing the grants.

“I would prefer you to make a well-considered decision,” she said. “It’s a lot of money that has flowed out of it since the beginning.”

Peterson agrees: Funding was ample, if limited.

“If we had our Druther it would have been displayed differently,” said Peterson. “But it is what it is and we are very grateful. After all, we were able to bring initiatives that the community needs on the street. “

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In Alleged Well being Care ‘Cash Seize,’ Nation’s Largest Hospital Chain Cashes In on Trauma Facilities

After falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma Is Big Business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma Drama’ in Florida and Beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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In alleged well being care ‘cash seize,’ nation’s largest hospital chain cashes in on trauma facilities

After falling from a ladder and cutting his arm, Ed Knight said he found himself at Richmond’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight's wound and sending him home after a few hours, Chippenham Hospital's charges exceeded $50,000, according to a claims document in the case.Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight’s wound and sending him home after a few hours, Chippenham Hospital’s charges exceeded $50,000, according to a claims document in the case. [ JULIA RENDLEMAN | Julia Rendleman for Kaiser Health News ]

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years.

The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals. It operates trauma centers at 11 of its more than 40 Florida hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Related: How HCA turned trauma into a money-maker

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured compared with those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma is big business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available around the clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma drama’ in Florida and beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma-alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter-ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” councilwoman Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Riverfront Federal Credit score Union Grand Opens Branches and Operations Facilities | Cash

Riverfront Federal Credit Union Welcome to the grand opening of New branch and operations center June 16-19 at 2609 Kaiser Boulevard in Spring Township.

The ribbon cut ceremony will be held on June 16 from 2pm to 3pm in association with the Greater Reading Chamber of Commerce and will be hosted by Riverfront CEO Tim McLeod and Chief Executive Officer John Kline. The event of the day also includes training on the services of the new branch with lots of free gifts spread throughout the day.

June 17th is Give Back / Give Away Day. This day is dedicated to raising awareness of the Riverfront FCU’s ongoing citizen participation initiative and how its newest branch supports nonprofits in Berks County. Mark Goldstein from Blanket of hope Guest appearances in new places to draw attention to his organization and the resulting benefits. Customers can buy from the riverside Swag Wall and the proceeds will be donated to a local nonprofit. With a donation, you can apply for a raffle for technology gift boxes, including an iPad.

From 12:00 pm to 2:00 pm on June 18th, Fighting Phil’s mascot, Screwball, will be visiting in a local food truck. Event attendees can win even more fun prizes, including $ 1,000, smart TVs, and prizes from many Riverfront retailers.

On the riverside, end your week on June 19th from 9am to 12pm with a barbecue starter in the backyard. The first 50 people to visit the store that day will receive a gift card from Wyeth Market or Giant and can take part in the Yeti Cooler drawing with two hiking mugs.

The three-story, 34,000-square-foot building houses the following riverside services with a retail store design and an expanded operations center. The new branch focuses on self-service, combining technology with what members need to make it more convenient.

Riverfront Federal Credit Union Grand Opens Branches and Operations Centers | money

Source link Riverfront Federal Credit Union Grand Opens Branches and Operations Centers | money

Recreation on: NY’s indoor household leisure facilities reopen | Native Information

PLATTSBURGH – Indoor entertainment centers are welcoming families back here for fun and games after government-mandated COVID protocols left them playing the waiting game for more than a year.

New York State has authorized the industry to reopen on Friday, March 26, for the first time since Governor Andrew M. Cuomo’s March 2020 pause order.

Both Champy’s Fun City, connected to Comfort Inn and Suites on Route 3, and Champlain Center renter Champlain’s Kid Zone have since reopened with social distancing guidelines, mask mandates, temperature checks, hand sanitizing stations, and other safety protocols.

“We’re very happy,” said Hasham Ashraf, owner of the indoor bouncy park and the Champlain’s Kid Zone arcade. “We fought all year.”

CAPACITY LIMITS

Among other things, state guidelines limited the capacity of indoor amusement and family entertainment centers to 25 percent.

Terry Meron, owner of Champy’s Fun City, described the limit as extremely strict compared to other industries, for example the 75 percent capacity limit in restaurants.

He noted his adjoining company, Eclipse Fitness, which was due to reopen in August along with other health centers at 33 percent capacity. Meron said the two industries, indoor entertainment and health centers, are operating below capacity limits that “cannot break even”.

“They’re device-oriented in their makeup,” he said. “It is difficult to have an occupancy (limits) for companies because they are primarily fixed-cost companies. It is just not possible to break even.”

“Well, am I glad it’s finally open? Yes. Hopefully the occupancy maxima will continue to rise when we are all vaccinated, or when enough of us are vaccinated to achieve herd immunity.”

The percentage of limited capacity in Ashraf’s Kid Zone at 26, including himself and his wife Bushra Mazir. The owner said he was concerned about the limit and noted that since the reopening, customers “left when they weren’t ready”.

MASKS AND TEMPS

The tenant of the shopping center at the end of the Champlain Center on Kohl enforced the guidelines for social distancing, determined the temperatures of the guests, required hand disinfection and disinfected the arcade machines and their jumping structures every two hours.

They also have a strict “no mask, no entry” rule. Since the announcement on Facebook, several parents had asked what age the rule applies to.

“Masks start between the ages of 3 (years) and 12,” Ashraf said, noting that children between the ages of 1 and 2 do not need masking. “All of them have been good so far.”

Champy’s Fun City features a range of traditional arcade games, as well as a mini bowling alley, laser tag, bumper cars, mini put, laser maze, and a three-story game structure.

The space operated under similar guidelines as the Kid Zone, but Meron noted barriers separating games without a two-meter distance, multiple hand sanitizing stations, and said guests were asked to wipe equipment before and after using it.

He added that balls had been removed from the play structure’s ball pit for disinfection purposes, and that the structure itself would be refurbished frequently and, in accordance with state guidelines, temperatures and contact tracing information would be collected at the door.

MORE WORK, LESS patrons

Champy’s will reopen with limited hours, including Monday through Thursday from 4pm to 7pm, Friday from 4pm to 9pm, Saturday from 9am to 9pm and Sunday from 9am to 5pm

Meron said times would be adjusted as needed.

Additional security protocols required Champy’s increasing its staffing levels and hiring at least one person in addition to regular staff to check temperatures and several others to oversee the center’s various attractions.

“This is what really deepens the break-even analysis,” Meron said, noting that more employees meant that customers’ capacity limits would also decrease. “During the period from 4 to 7 p.m. I have no idea whether two or 20 customers will come in.”

STATE DIRECTIVES

The guide to indoor amusement and family entertainment centers in the state is posted on the New York Forward website.

It can be accessed here: https://tinyurl.com/6m73dpeh

Email McKenzie Delisle:

mdelisle@pressrepublican.com

Twitter: @McKenzieDelisle

Efficiency venues, leisure facilities put together for reopening

Some indoor New Mexico venues like Popejoy Hall are continuing to prepare. You can get up to 33% capacity in the state Turquoise reopening degree.

The employees are aiming for shows in the fall. They were busy making security changes and rescheduling services. They had to cancel some shows, but they also added musicals like Mean Girls, and Hamilton is on the calendar in January.

“We’re very optimistic, but we have to fill the Popejoy and that’s 1,985 patrons,” said Thomas Tkach, director of Popejoy Hall. “So we have to make sure of that, and of course we’ll keep an eye on that. We don’t open until the fall, so we’re very confident that things will change to our advantage. “

The early reopening stages aren’t that attractive to Popejoy.

“Financially, it really doesn’t make sense for Popejoy to do 25%,” Tkach said.

Non-subscribers can search for tickets from the end of March.

OTHER COMPANIES

Many indoor entertainment centers can reach up to 50% capacity in the turquoise reopening stage. A Meow Wolf representative in Santa Fe said he would have more details on reopening the plans next week.

Other places like bowling alleys, announced to KOB 4 that they are ready to do business again, and bars and nightclubs have been waiting for their return for a while.

Albuquerque Downs and Casino announced on social media that its casino will reopen on Saturday.

New purchasing facilities, leisure, and eating places; southwest valley developments anticipated to be prepared in 2022

LAS VEGAS (KLAS) – New shopping centers, offices and apartment complexes are being built in the southwestern part of the Las Vegas valley. There are several developments near the busy Durango Road and 215 driveways.

Community members 8 News Now joined in, saying it was exciting to see all of the growth in the area.

Large cranes can be seen from Durango and 215 as the construction workers build the “uncommons,” which include shopping, dining, and entertainment, as well as residential and office units.

“It’s fascinating; there are more shops and restaurants every time I’m here,” said David Belding, resident of the Southwest Valley. “My grandchildren love it here.”

The first phase of the uncommons should be completed by early 2022.

“I think it’s exciting,” said Andy St. John, resident of the Southwest Valley. “A great place to live; my daughter and I enjoy it. The southwest meets all of my needs.”

Real estate agents and development companies are noticing a growing interest in living space in the southwest valley. A new complex near 215 and Buffalo will house more than 600 families.

“I think it’s wonderful,” said David Belding, a resident of the Southwest Valley. “The more development here, the better, the better for everyone.”

While many people are excited, some residents want to see more city services to keep up with the rapid influx of families and traffic.

“It would be nice if we could get a signal over there,” said Suman Sharma, a resident of the southwest valley. “I’m happy to see the restaurants here, but it generates a lot of traffic which I’m not so happy about.”

“I think we need more and better schools to support this at this point, but we certainly have lots of parks and lots of places for children too,” said St. John.

Another major development in the area, The Bend, is still under construction. Shopping, dining, and entertainment can be found near Durango and Sunset.

At this point there is no set date for The Bend to open.

Household Leisure Facilities Put together For March Reopening Beneath New York’s Strict COVID Security Protocols – CBS New York

LEVITTOWN, NY (CBSNewYork) – Finally, family entertainment centers will be reopening soon new York completely closed after almost a year.

But how are they maintained? COVID Safety?

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The owners of Laser Bounce on long Island are more than ready to let the fun resume. You haven’t made a penny or seen a kid’s smile in almost a year but have poured more than $ 100,000 into safety from COVID.

“We have done everything we can to make sure our customers are safe and when they come here it will now be cleaner and safer than ever,” said Ryan Damico of Laser Bounce to Carolyn Gusoff of CBS2.

Indoor family entertainment centers can reopen on March 26th with strict protocols that include:

  • Check in to ensure contact tracking,
  • Face coverings,
  • social distancing,
  • Points of contact consistently disinfected,
  • Air filtration,
  • Hands-free payment,
  • and infrared temperature monitoring.

“It’s completely non-invasive. You walk right past it. You won’t even know you checked your temperature, ”said Damico.

Capacity is capped at 25% which some owners call an injustice.

“Bowling alleys were may open at 50%We’re at 25%. We can’t keep the doors open 25%, ”said Joe Damico, owner of Laser Bounce. “It’s a slap in the face to open at these numbers.”

The surrounding states allowed these companies to reopen what the owner of Urban air in Lake Grove said proves it’s safe.

CONTINUE READING: Brooklyn family woman murdered in 2017 wants officials guilty of “failure to conduct police operations”.

“In the past eight months, 4 million guests and employees have been served without a reported case being traced back to our park. We are safe, ”said David Wolmetz, co-owner of Urban Air.

Wolmetz is grateful for the green light, out of concern that it is too little too late. 45 indoor venues are still suing New York over the shutdown orders.

Outdoor venues are 33% allowed to reopen.

Jack Sterne, a spokesman for the Cuomo Administrationsaid in a statement to CBS2:

We understand that everyone wants to reopen as much as possible asap – and we share that goal as long as it can be safely done. We are still battling a deadly pandemic and any industry that reopens must follow detailed public health guidelines, including capacity constraints. This public health crisis is not over yet, and these rules are helping to stop the spread of COVID, save lives, and keep businesses open.

The owner of Advenureland says additional staff will be needed to keep COVID safe.

“It will be a whole new environment for our park, which has been there since 1962,” said Steven Gentile, owner of Adventureland. “It’s going to be a whole new business model, so to speak, and we’re prepared for it … and we’re excited to be doing it.”

Many of these companies received money from the federal paycheck protection program. But much of the money has to be paid back.

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They are calling for a federal scholarship program, like one that helps closed venues so they can get back on their feet too.