Texas has spent $7B in federal cash to pay short-term well being care staff throughout COVID pandemic

AUSTIN — The state is trying to wind down an expensive, federally paid program of hiring nurses and other health care professionals to keep its hospitals from buckling under staffing pressures and burnout caused by the COVID-19 pandemic.

But the plan could be upended by any spike in COVID-19 cases prompted by gatherings over the upcoming holidays. Already, the state decided to keep up surge staffing at hospitals in El Paso and the Panhandle because of recent outbreaks.

After three huge waves of hospitalizations – in each of the past two summers and the big daddy of them all, last December and January – the state has spent nearly $7 billion of federal COVID-19 money for temporary nurses, respiratory therapists and some doctors to maintain operations at hospitals and “alternate care sites.”

The state set up the alternate care sites, mostly at nursing homes and convention centers, to free up hospital beds for coronavirus patients.

The decision to begin ramping down the “medical surge staffing” could be premature. Some public health officials worry that many Texans will mingle indoors and maskless during the upcoming holidays, among them unvaccinated state residents, creating a spike in both seasonal flu and COVID-19 that strains hospitals to capacity.

The Texas Department of State Health Services has told the three vendors who provide the hospitals with temporary caregivers that it plans to stop doing that in most parts of the state over the next month or so, said spokesman Chris Van Deusen.

“Of course, we’re always flexible about that,” he said. “If the situation changes, we’ll change the direction we’re headed.”

Critics of Gov. Greg Abbott’s management of the public health crisis say he’s used hospital staffing support when he should have used a full range of mitigation measures that are far less expensive, such as mask and vaccine mandates.

While the staffing expense is covered 100% by the federal government, the extravagant spending distorted the marketplace for nursing labor, which was already in short supply, said Rep. Donna Howard, an Austin Democrat and retired nurse who has studied the state’s response closely.

‘Burden on the hospitals’

Early in the pandemic, Abbott ordered hospitals to postpone elective surgeries, which choked off vital revenue streams, Howard said. But the Republican governor only hesitatingly embraced a statewide masking and distancing order, which he fully lifted in early March, she noted.

More recently, Abbott has stressed state provision – again, thanks to Uncle Sam – of COVID-19 treatments and infusion centers, where infected patients receive monoclonal antibodies that reduce the severity of symptoms.

“Those are great,” Howard said. “But again, though, rather than trying to do things to prevent it from happening in the first place, the interventions have been after the fact. And it’s really been a burden on the hospitals.”

Abbott spokeswoman Renae Eze, noting that nearly 36 million shots have been administered to Texans, said Abbott has launched “innovative strategies” to combat the pandemic. She cited mobile vaccine clinics and a “Save Our Seniors” program he announced in March. Under the program, modeled on one in Corpus Christi given statewide attention by The Dallas Morning News, local first responders and other volunteers take shots to homebound seniors or set up central drive-through vaccine clinics.

“Governor Abbott has prioritized protecting the safety of Texans from COVID while also safeguarding their livelihoods and personal freedom,” Eze said in a written statement.

Abbott continues to work closely with state Health Services Commissioner John Hellerstedt and Emergency Management Chief Nim Kidd “to get shots in arms and provide support to communities across the state,” she said.

“While the vaccine has proven effective at reducing the severity of COVID cases and slowing the spread of COVID, Governor Abbott also recognizes the right of Texans to refuse the shot, especially those who have acquired immunity, have health conditions, or other reasons to not take the shot.”

Many Texans, though, are still resistant to the shot. Only 59% of Texans age 5 or older have been fully vaccinated against COVID-19.

Flu prospects

So far this flu season, Texans haven’t been catching influenza at an alarming rate. Of the nearly 39,000 who’ve been tested since early October, just 0.35% tested positive. At the peak of the 2018-2019 flu season, in February 2019, about one quarter of specimens tested positive for flu, noted epidemiologist Diana Cervantes of the University of North Texas Health Sciences Center at Fort Worth.

Still, on Wednesday, the federal Centers for Disease Control issued an alert warning of a recent increase in flu viruses detected in recent weeks, especially among young adults. The federal agency said it “also is aware of influenza outbreaks in colleges and universities in several states.”

Flu seasons in which the particular strain noticed in the recent uptick – A(H3N2) – is predominant “were associated with more hospitalizations and deaths in persons aged 65 years and older,” the alert said.

The CDC urged all Americans six months old and older – if they haven’t already, and many haven’t – to get flu shots.

UNT’s Cervantes explained public health officials’ concern.

“As the COVID vaccine has become available, there are many fewer restrictions and prevention measures directed at COVID prevention such as mask usage, physical distancing this year – so we may likely see a more active flu season compared to last year,” she said.

She continued, “There is a possibility that due to the holidays and increased travel and general contact with others, we could see an increase in COVID cases and flu cases jointly and unfortunately there are always severe cases of both that can require hospitalization leading to dual stresses on our health care system.”

With COVID-19 vaccine widely available and “no new variant of concern” at this point, “I am hopeful we will not see a spike of COVID like we experienced last winter,” Cervantes said.

The surge staffing began in July 2020 with just more than 3,500 visiting health care workers helping Texas hospitals. Peak deployment came after last winter’s surge of cases, with almost 14,000 temporary nurses and other workers used during one week in early February. Last summer, the numbers dwindled. From mid-May to mid-August, no surge staffing was needed.

But then deployments kicked back up with the spike of cases caused by the delta variant. By early October, the department’s three private vendors were supplying nearly 7,800 health care professionals a week. As of Nov. 17, that had dropped to 3,176.

A demobilization ‘pause’

In recent weeks, the department told its three vendors supplying the nurses and other front-line workers – San Antonio-based nonprofit BCFS Health and Human Services, San Antonio-based Angel Staffing Inc. and Columbia, Md.-based Maxim Healthcare Group – that it planned to stop all hospital support in early December.

A flare-up of positive cases in El Paso and the Panhandle has forced the department to keep providing the surge staffing to those two regions, even as it hopes to be able to stop providing nurses and therapists to hospitals in most of the state, said Van Deusen, the state health department spokesman.

“We’ve paused sort of demobilizing staff out in El Paso, for example, because they’ve seen things really start to go up more,” he said. “But yes, that’s been the idea,” to end the program as more Texans are vaccinated and severe cases of the disease taper off.

On Tuesday, the hospital regions where coronavirus patients are taking up the highest percentage of available beds were El Paso (13.3%), Amarillo (11.8%) and Lubbock (9.9%), according to the department’s coronavirus dashboard. Of the four major metros, Dallas had the highest share of its hospital beds devoted to COVID-19 patients – 4.9%. There were 768 people with COVID-19 hospitalized in the Dallas trauma service area’s hospitals. Of them, 94 had been admitted in the previous 24 hours.

From just over a year ago, Dallas has zoomed to account for 28% of the surge staffing statewide, from under 10%. South Texas, which in October 2020 drew 35% of the temporary workers helping Texas hospitals, now is using only 11%. As a share of the statewide deployment, Houston has tapered off (to 21% of the total, from 25% a year earlier), while Austin and Central Texas account for nearly 10% of the statewide staffing help, up from about 1% a year earlier.

President Joe Biden recently said that 100% reimbursement of states’ coronavirus-related response efforts, such as the hospital staffing, would continue through April 1.

Van Deusen said that leaving aside considerations about federal reimbursements, the need for the surge staffing has diminished.

Hospitalizations for COVID-19 in Texas have decreased dramatically from the delta variant-driven spike of confirmed cases in late summer. From nearly 14,000 in late August and early September, hospitalized patients have fallen to under 2,700 as of Tuesday.

“We had started ramping down earlier this month, with the idea that it would take probably four to six weeks to do that,” Van Deusen said.

‘Worth it to them’

Some of the health care workers, such as nurses, have commanded high prices to come work at Texas hospitals.

Howard said at one point, she was told by the state health department that nurses cost the state $100 an hour to $125 an hour. She said she didn’t know if that was the amount being paid to the vendor or the nurses. The online job site Indeed shows the average registered nurse in Texas commanding about $36 an hour, she noted.

Department officials and vendors have declined to discuss wages paid to the temporary hospital workers.

“You had nurses who left their jobs to become traveling nurses because they could make a heck of a lot more money,” said Howard, who said she’s heard from one of her staff members an anecdote about one who gambled on treating COVID-19 patients in order to get a piece of the American dream – a house.

“They knew that it was going to be short term, but it was worth it to them to leave where they were and go wherever they needed to be for the fairly short period of time and bring in an exorbitant salary,” Howard recounted.

“It allowed them to actually get a mortgage. That was out of out of sight for them before. They are now able to buy a house because of this, which is great for them. But the distortion in the market is that those very people who are leaving, now, the hospitals are having to find ways to increase what they pay in order to retain their nurses. They’re doing bonuses, they’re doing premium pay, they’re doing whatever they can do, to try to keep the nurses that they have.”

Texas Gov. Greg Abbott, who has received Regeneron’s monoclonal antibody treatment to help him fight COVID-19, said Saturday that he is wants to see antibody infusion centers opened across the state.

By far the biggest chunk of the nearly $6.9 billion spent since July 2020 has gone to BCFS – $5.3 billion, or 77%.

The state also processed invoices from Angel for $1.14 billion (17% of the total) and from Maxim, the former Medcall Medical Staffing, for $455 million (6%). Angel and Maxim are privately held, for-profit companies.

As of Nov. 15, BCFS had 1,945 medical personnel working in 235 Texas hospitals, said BCFS spokeswoman Evy Ramos. Except for about 300 respiratory therapists, they were all nurses, she said. None was a physician.

Of the $6.88 billion spent, just under $2.4 million was state funds, according to a spreadsheet of vendor payments obtained by The Dallas Morning News.

“The funds obligated are federal, FEMA and CARES Act dollars,” said state health department spokesman Doug Loveday, referring to the Federal Emergency Management Agency and the Coronavirus Aid, Relief and Economic Security Act of 2020.

Another $8.7 million of the money went to alternate care sites.

None of the money spent yet has come from the American Rescue Plan Act passed in March, though state lawmakers last month approved spending up to $2 billion of the American Rescue Plan money on hospital surge staffing, COVID therapeutics and infusion centers.

Texas soon will have spent more than $5.1 billion to hire nurses and other frontline health-care workers at premium rates to keep hospitals from being overwhelmed by COVID-19 patients and deter the disease at group residential settings such as nursing homes. The effort will eat up nearly two-thirds of the $8.1 billion in federal Coronavirus Relief Fund money the state has received. In February file photo, three nurses at Dallas' Parkland Memorial Hospital -- one a traveling nurse and two on-staff -- review an intubated COVID-19 patient’s oxygen levels.

Couturier represents cash effectively spent for Flyers – Delco Instances

When they won the Stanley Cup a second time in the first eight years of their existence, it was to be expected that the Flyers would build a stunning collection of championships.

That was 46 years ago.

Guess what: it won’t happen.

As for consolation prizes, however, the Flyers have not only been blessed by great players, but also by players who have done everything on and off the ice to bring pride and value to a community that played for both uniform and paycheck and were eternal sources of franchise and regional pride.

You’ve had too many lazy goalkeepers too, but that’s another issue.

But in the Brotherhood of Forever Flyers, and that membership role is thick, there must be room for Sean Couturier. Because of this, the six-year contract extension recently signed by the two-way hockey treasure was a well-spent $ 26,000,000.

Couturier is about to enter his 11th NHL season and is a three-time winner of the Bobby Clarke Trophy as MVP of the Flyers, received the Frank J. Selke Trophy in 2020 as the most effective defensive striker in the NHL, twice he was a 30-plus goalscorer, was an all -Star and has never wasted a shift on either end of the ice.

Had the choice been made, Cups would have picked out dignified professionals as the fans’ favorite collection. But in a chain of franchise treasures that are too long to go into detail, consider “coots” a strong and important link.

That’s not bad either.

• For the first time since 2016, the Flyers will expand their Franchise Hall of Fame. About time.

The list of ideal candidates is thick like a telephone directory, although the constellation has clearly been missing for too long, in alphabetical order Danny Briere, the Flyers Wives, Simon Gagne, Mike Keenan, Pelle Lindbergh, Lou Nolan, Mikael Renberg, Kimmo Timonen and Rick Tocchet .

But if the idea is to correct the longest-running situation first, then the choice for a likely one-man class by 2021-22 must be Paul Holmgren. An all-star, member of some great Flyers teams, and the strongest puncher in a long era of great Flyers fighters (a legitimate hockey value in its day), Holmgren had success as a player, assistant coach, head coach, scout, general manager and executive while they simultaneously demonstrate a deep, sincere appreciation for a proud organization and its importance to its community.

•• •

Those rolling billboards dragged through the streets of the city by gasoline-wasting trucks … I don’t understand them.

• • •

By the time the season is over, and it will happen soon enough, the Phillies will have earned two well-deserved but conflicting reputations.

They will have fought for the right to be remembered as late inning heroes who could ever win with rallies in the eleventh hour and an endearing refusal to surrender.

They will also have been tattooed as a team that burst 26 saves and played too many times with defensive disinterest for the last three innings of the game.

Both?

How is that possible?

One theory: baseball.

The sport is designed to reveal the truth after 162 games, and not after 161 either. For most teams, this will be a gradual revelation. For the rare ones, it will require more dramatic attractions. Either way, the system will work, the definitive record will be the definitive record, and how it eventually happened will be lost in the vortex of history.

In the meantime, enjoy the 2021 Phillies and their rarest abilities to both madden and entertain. It could be decades before such a collection of adrenaline teasers resurfaces.

• In recognition of a bipolar baseball season, here on Joe Girardi who has been criticized for months with good reason but managed to improve the Phillies’ overall defense, overcome an unreasonable wave of injuries and keep his team in an unlikely pennant race .

• • •

It’s hard to believe that these buttons stuck to the back of cell phones are necessary.

• • •

OK, OK, it’s OK: it’s impossible to win last-round NBA playoff games with Ben Simmons as point guard. He doesn’t shoot. etc. Got it. Required.

The problem for the Sixers, should they swap Simmons, and for dozens of reasons they have to: The regular season. While it is likely that they will acquire one in any trade with Simmons, they are not currently using an alternative, high quality point guard.

Tyrese Maxey is a formidable talent with editing skills, but lacks flavor and a reliable outside shot. Shake Milton can make quick attacks from the bench, but was always overwhelmed when he passed the ball as a starter. Seth Curry may be able to tinker with this, but at the expense of its more valuable presence on the grand piano.

It is September of a season that can extend through June. So it is time. But if Simmons is traded, there will be 82 lead guard games in the regular season.

Well, only one solution: box the process trust threefold.

• • •

Get the Notre Dame Leprechaun Hat?

• • •

Zach Ertz, who was spotted after a souvenir walk over the Linc last season, somehow got through the off-season and will open his ninth season as an eagle next Sunday.

Good for Ertz.

Good for the eagles.

While there is seldom any value in the continued employment of players in any sport for reasons of nostalgia (see: Phillies, 2011-15), there are also costs for unloading the glue types. Having a couple around is never a risky idea. It’s mandatory to keep them around while you try to move on to a sophomore quarterback and entry-level head coach.

• • •

That’s enough “Field of Dreams” for me, thank you very much.

Contact Jack McCaffery at jmccaffery@21st-centurymedia.com

Memphis not saying how cash might be spent on violent crime

New federal guidelines published in the last few days are the reason for delaying this proposal until the next meeting of the council in early August.

MEMPHIS, Tennessee – Memphis City officials said Tuesday morning they were not quite ready to come up with concrete ideas on how to spend the millions of dollars available from Washington to tackle local violent crime.

The city has approximately $ 63 million available from the Congress-approved American Rescue Plan Act – or ARPA – over the coming years.

Last month we told you that money could be used for things like hiring and more police officers in Memphis, working overtime on the beat, and hiring more mentors to help prevent crime.

New federal guidelines came late last week and details of what can be spent.

As a result, a scheduled presentation to the Memphis City Council setting out where the money will be spent on fighting crime has been postponed for another two weeks.

CONNECTED: Memphis is using federal funds to tackle local crime challenges in the coming months

“The good news is that we have some resources to invest in things like public safety, young people and community help, including replacing the city’s revenue and making sure we continue to serve citizens well “to follow,” said Doug McGowen, City of Memphis chief operating officer.

Memphis City Council could also optimize what money goes to where to fight violent crime.

The federal money is expected to be approved and approved by the fall.

College board has not spent cash frivolously

As a member of the Shelton Board of Education for over 10 years, I disagree with the recent comment by Vice Chairman Jimmy Orazietti, quoted in the Shelton Herald, saying that “depositing the excess funds in this account encourages the BOE to save, rather than output “. frivolously on non-essential things that were all too often practiced in the past. “

To say that we spent money frivolously couldn’t be further from the truth and it should be noted that this is the personal opinion of Mr. Orazietti, not the position of the majority of the BOE.

The Shelton Board of Education has been funded with lump or minimal funding for many years, which means that we have laid off more than 48 certified employees in the past four years, in addition to secretaries, supervisors, administrators and auxiliaries. Jobs were also cut through fluctuation and did not replace all resignations or retirements. Improvements to our schools and curricula have been postponed again and again due to lack of funds.

Orazietti wrongly gives the public the impression that we have not handled money responsibly. This year it is only thanks to the COVID funding from the American Cares Act that it is finally possible to make major technological upgrades and become a one-on-one district that lags far behind many neighboring districts. The public needs to be aware that your BOE spends money sparingly and wisely on quality education for our students. We are not reckless as assumed.

Additionally, in a recent letter to the editor written by Republican Carl Rizzo, he points to the decline in enrollments in recent years, especially last year when we had a decline of 248 students. What he doesn’t mention is that due to COVID, a large portion of these students have been withdrawn from Shelton Public Schools to either be homeschooled or enrolled in private schools that attended five days a week. We will likely see many of these students return in the fall.

Rizzo also cites an increase in spending per student, without mentioning the accompanying increase in the number of special schools from 12.3 percent of enrollments in 2014-15 to 16.9 percent last year. The increase in spending per student is not a direct result of a decrease in school enrollment or anything on the city side. The main reason for this number is the cost of special education, many of which require expensive outplacement.

Additionally, several of the BOE’s accomplishments in the past two years that he spearheads have not been city-funded, including laptops for teachers and staff, increased network speeds, one-to-one Chromebooks, and the new Wit and Wisdom Reading Program, all financed by funded money from the American Cares Act, as mentioned above.

“No fee for pre-k program” was just a course correction. When we introduced a fee for the Pre-k due to a lack of funding, the enrollment of regular education colleagues, which is required by law, decreased, so we did not charge any fees again. It should also be noted that “more than $ 5 million refunded dollars” was money that went into town rather than into the BOE coffers.

I warn citizens to double-check the “facts” they have read as this is actually an election year, or as a former colleague called it “silly time of year”.

Kate Kutasch (D)

Shelton Board of Education

The place’s Tampa Bay’s COVID aid cash being spent?

It has been almost four months since the American bailout plan was passed. Eight cities in the Tampa Bay area will receive direct funding.

ST. PETERSBURG, Fla. – In March, President Joe Biden signed a bill worth $ 1.9 trillion COVID relief plan.

Part of that plan includes that Child tax deduction This means that 39 million families will be entitled to monthly child payments as of July 15.

The help package called American rescue plan Billions of dollars pumped into the state of Florida.

When the plan was passed, 10 Tampa Bay received the state and local allotment estimate spreadsheet developed by the House Oversight & Reform Committee.

CONNECTED: American Bailout Plan: Who’s Got What in Tampa Bay?

State of Florida: The Sunshine State should get $ 17.6 billion. Of this, $ 10 billion will remain in Tallahassee and will be distributed according to state lawmakers’ decisions. The remaining $ 7 billion will be split between the state’s county and city governments.

Of that $ 10 billion goes to the county governments, here is the estimated breakdown in Tampa Bay:

Hillsborough: $ 285.48 million

Pinella: $ 189.09 million

Sarasota: $ 84.12 million

A Hillsborough County spokesman confirmed they received half of their reported stake of $ 142,956,264 from the U.S. Treasury Department on May 19.

The county expects to receive the remainder of the money from the American Rescue Plan (ARP) in May 2022.

Michelle Van Dyke, a Hillsborough spokeswoman, said via email: “Our executive team is developing an ARP investment plan that sets out the intended and allowable allocations in accordance with the Guiding Principles released by the BOCC on the 7th we will present our ARP investment plan to BOCC at the end of August. “

A Pinellas County spokesman said it was still working on investment plans and declined to provide details at the time.

Eight cities The Tampa Bay area will also receive direct funding from the stimulus package. Here is the breakdown:

St. Petersburg: $ 46.66 million

Lakeland: $ 24.38 million

Clear water: $ 20.87 million

Sarasota: $ 10.92 million

Bradenton: $ 10.90 million

Pinellas Park: $ 9.98 million

Now, nearly four months after the bill was passed, 10 Tampa Bay is asking questions about how money is being spent in our area.

A spokesman for the city of St. Petersburg confirmed that the leaders received about half of their share, about $ 22.5 million. You will receive the second half in 2022.

Mayor Rick Kriseman said the money is in the bank until they give the public time to express opinions on where that money should be spent.

“We’re really interested in getting a taste of the community, you know, is resilience and sustainability the most important thing? Is health equity the most important thing? Is transportation the most important thing,” said Kriseman.

Kriseman and the city council have developed a series of community feedback workshops to help prioritize which areas of impact will receive funding.

Community members can contribute to the following eight eligible areas of impact:

  1. Infrastructure
  2. Affordability of housing
  3. health equality
  4. economic development
  5. leisure offers
  6. public safety
  7. transport
  8. Resilience & sustainability

The three public workshops include presentations that outline the state of play for each area of ​​impact, followed by breakout sessions where community members can provide feedback.

Dates / locations for workshops are:

– Monday, July 26th, 6-8pm – Enoch Davis Center (1111 18th Ave. S.)

Tuesday, July 27th, 6-8pm – JW Cate Rec Center (5801 22nd Ave. N.)

– Wednesday, July 28th, 6-8pm – Willis S. Johns Rec Center (6635 Dr. MLK Jr. St. N.)

Another great aspect of the American rescue plan is about supporting American schools. The package labeled $ 130 billion for K12 education. Tampa Bay school districts should receive:

Hillsborough: $ 500 million

So far, spokesmen for the Pinellas and Polk districts have said they have not yet received funding.

CONNECTED: Federal judge blocks aid to minority farmers after Florida farmer complains
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Cape Coral legal professional’s assistant who spent aged consumer’s cash sentenced to 16 months

LEE COUNTY

A Cape Coral woman is spending 16 months in jail for misusing the credit card of someone who trusted her to pay her expenses.

Kristin Nicole Jordan, 40, was convicted Tuesday of exploiting an elderly person. The family of the victim, who died in May, was compensated.

The case dates back to 2019 when investigators from the Lee County Sheriff’s Office learned that the victim’s credit card was used in fraudulent charges for $ 42,276.

The eight-month investigation led to Jordan using the card to make purchases through 2017. She was employed as an assistant to a fiduciary attorney at the Musial law firm, which, according to its website, handles health care and long-term planning. for the elderly.

Records show Jordan bought numerous different things, including paying Comcast bills, buying groceries, shopping at Amazon, Victoria’s Secret, Nike, and several other retail stores.

Investigators said the victim found out that Jordan used her money to pay for all of that, including dinner, car payments, travel, cell phone bills, and school payments. The victim reported that she believed numerous transactions from her bank account were fraudulent.

Investigators said the victim eventually became suspicious of Jordan himself. WINK News spoke to Jordan shortly after her arrest, and she denied the charges, saying it was not true.

The law firm told investigators that they fired Jordan in May 2019.

In well being care, extra money is being spent on sufferers’ social wants. Is it working?

  • By Phil Galewitz/Kaiser Health News

June 21, 2021 | 12:14 PM

When doctors at a primary care clinic in Philadelphia noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help.

But the one-time complimentary ride didn’t reduce these patients’ 36% no-show rate at the University of Pennsylvania Health System clinics.

“I was super surprised it did not have any effect,” says Dr. Krisda Chaiyachati, the Penn researcher who led the 2018 study of 786 Medicaid patients.

Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment, or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.

It was not the first time that efforts by a health care provider to address patients’ social needs — such as food, housing and transportation— failed to work.

In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients’ social needs improves health and lowers medical costs.

But so far it’s unclear which of these strategies, focused on so-called social determinants of health, are most effective or feasible, according to several recent academic reports that evaluated existing research on the interventions. The reports were produced by experts at Columbia, Duke and the University of California-San Francisco.

The new reports found that even when such interventions show promising results, they usually serve only a small number of patients. Another challenge is that several studies did not go on long enough to detect an impact, or they did not evaluate health outcomes or health costs.

“We are probably at a peak of inflated expectations, and it is incumbent on us to find the innovations that really work,” says Dr. Laura Gottlieb, director of the UCSF Social Interventions Research and Evaluation Network. “Yes, there’s a lot of hype, and not all of these interventions will have staying power.”

But because health care providers and insurers are so eager to find ways to lower costs, the limited success of social-need interventions has done little to slow the surge of pilot programs — fueled by billions of private and government dollars.

Paying for health, not just health care

Across the country, both public and private health insurance programs are launching large initiatives aimed at improving health by helping patients with unmet social needs. One of the biggest efforts kicks off next year in North Carolina, which is spending $650 million over five years to test the effect of giving Medicaid enrollees assistance with housing, food and transportation.

California is redesigning its Medicaid program, which covers nearly 14 million residents, to dramatically increase social services to enrollees.

These moves mark a major turning point for Medicaid, which, since its inception in 1965, largely has prohibited government spending on most nonmedical services. To get around this, states have in recent years sought waivers from the federal government and pushed private Medicaid health plans to address enrollees’ social needs.

The move to address social needs is gaining steam nationally because, after nearly a dozen years focused on expanding insurance under the Affordable Care Act, many experts and policymakers agree that simply increasing access to health care is not nearly enough to improve patients’ health.

That’s because people don’t just need access to doctors, hospitals and drugs to be healthy, they also need healthy homes, healthy food, adequate transportation and education, a steady income, safe neighborhoods and a home life free from domestic violence — things hospitals and doctors can’t provide, but that in the long run are as meaningful as an antibiotic or an annual physical.

Researchers have known for decades that social problems such as unstable housing and lack of access to healthy foods can significantly affect a patient’s health, but efforts by the health industry to take on these challenges didn’t really take off until 2010 with the passage of the ACA. The law spurred changes in how insurers pay health providers — moving them away from receiving a set fee for each medical service, to payments based on value and patient outcomes.

As a result, hospitals now have a financial incentive to help patients with nonclinical problems — such as housing and food insecurity — that can affect health.

Temple University Health System in Philadelphia launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city. The program provides the 25 patients with free housing, and caseworkers to help them access other health and social services. For example, the caseworkers can help with furnishing the new apartments, setting up healthy delivered meals, and submitting applications for income assistance such as Social Security.

To qualify, participants had to have visited the emergency room at least four times in the previous year, with medical claims exceeding $10,000 for that year.

Temple has seen promising results when comparing patients’ experience before the study to the first five months they were all housed. In that time, the participants’ average number of monthly ER visits fell 75% and inpatient hospital admissions dropped 79%.

At the same time, their use of outpatient services jumped by 50% — an indication that patients are seeking more appropriate and lower-cost settings for medical care.

Living life as ‘normal people do’

One participant is Rita Stewart, 53, who now lives in a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood, home to many college students and young families.

“Everyone knows everyone,” Stewart says excitedly from her second-floor walk-up. It’s “a very calm area, clean environment. And I really like it.”

Before joining the Temple program last July and getting housing assistance, Stewart was living in a substance abuse recovery home. She had spent a few years bouncing among friends’ homes and other recovery centers. Once she slept overnight in the city bus terminal.

In 2019, Stewart had visited the Temple ER four times for various health concerns, including the flu, anxiety, and a heart condition.

Now, Stewart meets with her caseworkers at least once a week for help scheduling doctor appointments, arranging group counseling sessions and managing household needs.

“It’s a blessing,” she says from her apartment, with its small kitchen and comfortable couch.

“I have peace of mind that I am able to walk into my own place, leave when I want to, sleep when I want to,” Stewart says. “I love my privacy. I just look around and just — wow. I am grateful.”

Temple University Health System helped Rita Stewart get a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood. Stewart and other patients in Temple’s housing assistance program have since stabilized their lives and avoided unnecessary ER visits. (Kimberly Paynter/WHYY)

Stewart has sometimes worked as a nursing assistant and has gotten her health care through Medicaid for years. She still deals with depression, she says, but having her own home has improved her mood. And the program has helped keep her out of the hospital.

“This is a chance for me to take care of myself better,” she says.

Her apartment assistance is set to end next year, when the Temple program ends, but administrators say they hope to find all the participants permanent housing and jobs.

“Hopefully that will work out and I can just live my life like normal people do and take care of my priorities and take care of my bills and things that a normal person would do,” Stewart says.

“Housing is the second-most impactful social determinant of health after food security,” says Steven Carson, a senior vice president at Temple University Health System. “Our goal is to help them bring meaningful and lasting health improvement to their lives.”

Success with social interventions doesn’t come cheap

Temple is helping pay for the program; other funding comes from two Medicaid health plans, a state grant and a Pittsburgh-based foundation. A nonprofit human services organization helps operate the program.

Program leaders hope the positive results will attract additional financing so they can expand to help many more homeless patients.

The effort is expensive. The “Housing Smart” program cost $700,000 to help 25 people for one year, or $28,000 per person. To put this in perspective, a single ER visit can cost a couple of thousands of dollars. And “frequent flyer” patients can rack up health care bills many times that amount through ER visits and follow-up care.

If Temple wants to help dozens more patients with housing, it will need tens of millions of dollars more per year.

Still, Temple officials say they expect the effort will save money over the long run by reducing expensive hospital visits — but they don’t yet have the data to prove that.

The Temple program was partly inspired by a similar housing effort started at two Duke University clinics in Durham, North Carolina. That program, launched in 2016, has served 45 patients with unstable housing and has reduced their ER use. But it’s been unable to grow because housing funding remains limited. And without data showing the intervention saves on overall health care costs, the organizers have been unable to attract more financing.

Often there is a need to demonstrate an overall reduction in health care spending to attract Medicaid funding.

“We know homelessness is bad for your health, but we are in the early stages of knowing how to address it,” explains Dr. Seth Berkowitz, a researcher at the University of North Carolina-Chapel Hill.

Results remain to be seen

“We need to pay for health not just health care,” said Elena Marks, CEO of the Houston-based Episcopal Health Foundation, which provides grants to community clinics and organizations to help address the social needs of vulnerable populations.

The nationwide push to spend more on social services is driven first by the recognition that social and economic forces have a greater impact on health than do clinical services like doctor visits, Marks says. A second factor is that the U.S. spends far less on social services per capita compared with other large, industrialized nations.

“This is a new and emerging field,” Marks says, after reviewing the meta-evaluations of the many studies of social needs interventions. “The evidence is weak for some, mixed for some, and strong for a few areas.”

But despite incomplete evidence, Marks adds, the status quo isn’t working either: Americans generally have poorer health than their counterparts in other industrialized countries with more robust social services.

“At some point we keep paying you more and more, Mr. Hospital, and people keep getting less and less. So, let’s go look for some other solutions,” Marks says.

The COVID-19 pandemic has shined further light on the inequities in access to health services and sparked further interest in Medicaid programs to address social issues. Over half of states are implementing or expanding Medicaid programs that address social needs, according to a KFF study in October 2020. (The KHN newsroom is an editorially independent program of KFF.)

In many states, the Medicaid interventions are not intense: Often they involve simply screening patients for social needs problems or referring them to another agency for help. Only two states — Arizona and Oregon — require their Medicaid health plans to directly invest money into pilot programs to address the social problems that screenings reveal, according to a survey by consulting firm Manatt.

The Centers for Medicare & Medicaid Services, which is funding a growing number of efforts to help Medicaid patients with social needs, said it “remains committed” to helping states meet enrollees’ social challenges including education, employment and housing.

On Jan. 7, CMS officials under the Trump administration sent guidance to states to accelerate these interventions. In May, under President Joe Biden, a CMS spokesperson told KHN:

“Evidence indicates that some social interventions targeted at Medicaid and CHIP beneficiaries can result in improved health outcomes and significant savings to the health care sector.”

The agency cited a 2017 survey of 17 state Medicaid directors in which most reported they recognized the importance of social determinants of health. The directors also noted barriers to address them, such as cost and sustainability.

In Philadelphia, Temple officials now face the challenge of finding new financing to keep their housing program going.

“We are trying to find the magic sauce to keep this program running,” says Patrick Vulgamore, project manager for Temple’s Center for Population Health.

Sojourner Ahébée contributed to this report. She is the health equity fellow at “The Pulse,” WHYY’s health and science show.

This Shots story was produced as part of NPR’s health reporting partnership with WHYY and KHN (Kaiser Health News).

Islesboro teenagers spent years elevating cash for his or her senior journey. As a substitute, they used the cash to vaccinate the island.

ISLESBORO, Maine – For the students at Islesboro Central School, the class trip is a really big deal.

Teenagers who go to school on the tiny island of Maine have visited places as exotic as Iceland, Norway and Panama in recent years. The school trip is something that students dream of and work towards for years by running fundraising drives.

“It definitely means a lot to all students,” said Olivia Britton, 17, a Belfast graduate, this week.

But the coronavirus pandemic has shaken travel and fundraising plans for both classes in 2020 and 2021. So instead of packing their bags, the 13 high school graduates did something special this spring.

They decided to donate much of the money they raised before the pandemic – a total of $ 5,000 – to the Islesboro Community Fund, which will use it to set up vaccine clinics on the island and help islanders in need.

The student donation helped pay for the administrative aspects of running the vaccine clinics, including purchasing personal protective equipment, transportation costs, and paying overtime for workers. The efforts have paid off. Islesboro has a 99% vaccination rate for COVID-19, according to the Maine Center for Disease Control and Prevention.

“I think the engagement of the Islesboro seniors is heartwarming,” said Owen Howell, medical assistant at Islesboro Health Center, who ran the clinics. “I think it’s selfless from them. You show wonderful leadership qualities in times of COVID. I know they would have loved to go on their journey. But they make the most of it and do something important with all the sweat it has cost. ”

The teens said they wanted to share their money with the community because it was the community that helped them raise it in the first place. They bought the concessions that high school seniors sold at home games and bought tickets to the spaghetti and Thanksgiving dinners they hosted.

“The island has supported us all along,” said Britton. “They came to all of our dinners and were very nice and busy with us. They didn’t mind if we screwed it up. ”

Liefe Temple, 18, of Lincolnville, another graduate, said it didn’t feel right for students to try other ideas.

“When it became clear we couldn’t use the money on a school trip, it felt really weird to use the money on something else or keep it for ourselves,” she said. “That’s not what the community gave us for.”

So they gave a lot of it back.

Your generosity meant a lot to the islanders, not only for what the money did, but also for the impetus behind the donation.

The 70-year-old Islesboro Community Fund helps residents in need who may have difficulty paying medical, fuel, or utility bills. It also supports a scholarship program to help young Islesboro teenagers meet expenses for higher education or post-secondary education.

“We had a running list of organizations,” said Temple. “We thought the community fund would make sense because they did all this COVID relief and COVID was the main reason we couldn’t make the trip.”

Islesboro Community Fund president Fred Thomas said the Class of 2021 donation specifically helped islanders facing unforeseen medical expenses and food security issues due to the pandemic. It also helped offset the cost of running the COVID-19 vaccination clinic on the island.

Islesboro Central School seniors practice marching prior to graduation, which will take place on Sunday, June 13th. Photo Credit: Courtesy Olivia Britton

“Everyone is very proud of them,” said Thomas. “I think it’s more than generous. Not only does it show maturity beyond their years, it also shows that these students are aware of the need in their community and are ready to do something about it. ”

He and others will officially recognize the students’ gift on Sunday, June 13, just before their high school graduation ceremony.

“Adults, those over 50, usually complain about today’s youth,” said Thomas. “I think the opposite is the case with these guys at least.”

For their part, the students thought it was cool that their donation helped the islanders get vaccinated and hope that with the money they have reserved they can do something as a class, which John van Dis, a science teacher at Islesboro Central School and one of the Senior Class Advisors, the estimate is between $ 2,000 and $ 3,000.

It won’t be a trip to Italy or Greece. But for the 2021 class, it’ll be a chance to do something fun with their friends before they blow up and leave high school behind for good.

“Many seniors have missed a lot. It was part of that kind of shared experience of the absence of rites of passage, ”said Britton. “We said it would be fun to play bowling, play mini golf, and get pizza.”

Veterans Affairs solely spent about half of CARES Act cash to date, GAO says

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Twenty billion dollars is nothing to make fun of, even for a department the size of Veterans Affairs. But that’s how much extra VA got the CARES Pandemic Control Bill, which was passed last March. This year, however, VA did only about half committed the money. Sharon Silas, Director of Health at the Government Accountability Office, spoke with Federal Drive with Tom Temin about what else the surveillance agency found.

Tom Available: Sharon, good to have you back.

Sharon Silas: Great thanks for having me

Tom Available: So you’ve made up your mind, or I think you’ve been told, GAO was ordered by Congress to take a look at what happened to that 19.6 billion, to be precise, it wasn’t quite 20 billion. And only half committed a year later. Tell us more about what you looked at and what you found.

Sharon Silas: For sure. The CARES Act therefore required GAO to report on the ongoing monitoring and oversight of the federal government’s efforts in connection with the COVID-19 pandemic. Because of this, we try to understand how VA committed and expanded these additional funds, and then also to evaluate how VA monitored COVID-19 funding.

Tom Available: And so it seems like they got more money than they needed at that point in time.

Sharon Silas: Well, for fiscal 2020, VA’s annual budget was more than $ 200 billion. Most of that went into health care support administered by the Veterans Health Administration and then into benefits administered by the Veterans Benefits Administration. The CARES Act and the Families First Coronavirus Response Act, both passed in March 2020, provided additional funding of $ 19.6 billion. So that goes beyond the annual budget. And these funds should be specifically used to prevent, prepare for and respond to COVID-19. And to support COVID-19 testing during the pandemic. The bulk of this funding went to the Veterans Health Administration, followed by the VA Office of Information Technology.

Tom Available: Alright. By this point, as of March, when you actually looked, they had committed about $ 9 billion and spent about $ 8 billion. And what does it say about whether they need the other half of that money?

Sharon Silas: For sure. And you’re right, by the end of March 2021, VA had just spent more than half of that funding, about $ 9.9 billion out of $ 19.6 billion. One of the things that we saw while looking at VA’s commitment and spending of these funds is that there was some kind of time when they were ramped up in order to be able to monitor and track those funds. Some of the issues they had to deal with were setting up some new codes for their financial management system specifically aimed at tracking these additional funds. When VA initially attempted to launch and respond to COVID-19, they first coded a portion of the COVID-19-related expenses with obligations from annual funds. And so they later had to go back and re-code these to make sure they were actually headed for the extra funding. There were also some delays in the VA Office of Information Technology, which received the second largest portion of the funding from the adjuncts. However, the Information Technology Office for its delays and their process of recruiting additional staff also contributed to the slow growth in commitments and spending of funds. If you look at all of the year you can see that when they came up and started some of these processes, they were able to commit and spend some of that funds faster.

Tom Available: We speak to Sharon Silas, the director of health in the Government Accountability Office. But given the pace of a pandemic with fewer and fewer new cases emerging, frankly, they need fewer and fewer tests, do they need the other 9 or 10 billion that have not yet been signed?

Sharon Silas: For sure. Some of the funds that the Veterans Health Administration used during the period we studied went primarily towards community care, salaries and expenses, supplies and supplies, and helping homeless veterans. When we looked at what the Veterans Health Administration plans to use for the rest of the funds, they plan to use those funds to distribute vaccines, extra PPE, and keep doing COVID 19 tests. The Information Technology Office again received the second largest share of the funds – during the period we examined, they mainly committed funds for the operations and maintenance activities related to COVID-19 such as expanding telehealth for veterans and then teleworking for VA employees as well. With a view to their spending plans for the remainder of the fiscal year, they plan to use these funds for additional equipment, building network capacity, and purchasing software licenses. According to the spending plans and our discussions with VA officials, they plan to expand the remaining funds by the end of fiscal year 2021.

Tom Available: And of that total of 19.6 billion, how much was for the Information Technology Office?

Sharon Silas: About 11% of this funding went to the Office of Information Technology and 89% to the Veterans Health Administration. So the majority of the funds went into these two components of VA.

Tom Available: So about 2 billion, in other words

Sharon Silas: Yes.

Tom Available: And are you satisfied that the remaining spending you want to make is actually related to the pandemic – especially in the OIT?

Sharon Silas: Yes. As I mentioned earlier, when VA was responding to the COVID-19 pandemic, there were many attempts to predict where they would need these funds. And then, as the pandemic continued, they could make adjustments and better plan how to use those funds. So if you look at the spending plans for the rest of the fiscal year, it looks like the funding is being used appropriately.

Tom Available: And the coding problems and so on to make sure the right funds were booked in the right way. That’s kind of an OIT problem too, right, because they had to build the new codes and procedures into the accounting system – right?

Sharon Silas: Right, yes. Once they have the code in place and are also using the processes they already have, they have initiated or issued new guidelines to track these funds. All of these different elements were introduced during the pandemic and are now in place so they can properly track the funds as needed.

Tom Available: For sure. If it is a general concern of GAO, it may be outside the scope of the report. But I mean, it’s kind of a guise for GAO not to make sure that when agencies get a piece of capital S like this, they find an extra amount of money, no ways to spend it, to spend it, to spend it, but that they do really use what they need for the purpose of the hand for which it was used? And I should probably never say that out loud, but turn back a little.

Sharon Silas: I mean, for this review, at least, we did not assess how closely the VA components match the processes they developed to manage the additional funding. We have reviewed the VA financial management processes in the context of the federal standards for internal controls in terms of monitoring and communication. However, in the course of our review we looked at a non-generalized sample of VISNS, the networks and the financial coding for 10 national contracts and during the course of this review we found no non-compliance with their processes. However, in one report, we find that others have identified issues with VA’s financial management practices in the past.

Tom Available: So see any special recommendations from this look?

Sharon Silas: No, we didn’t have any recommendations for this review.

Tom Available: Alright. Sharon Silas is the director of health at GAO. As always, thank you very much.

Sharon Silas: Many Thanks.

Inside investigation into cash spent on Panama Metropolis Seaside park

PANAMA CITY BEACH, Florida (WJHG / WECP) – Improvements to a park in Panama City Beach resulted in an internal investigation by the city.

The same matter is also the subject of a whistleblower lawsuit by former Panama City Beach City manager Tony O’Rourke.

O’Rourke claims public funds have been spent to make major improvements to Popeye Park, which is privately owned. He also claims he was fired in February after raising concerns about mismanagement and abuse of public funds.

Holland and Knight law firm was hired by the city that month to conduct an internal investigation into the Popeye Park issue.

The results were announced at the city council meeting on Thursday. Summarizing the results, there was no evidence that employees knew of a property problem at the start of the park improvements.

The company continues that the park improvements are serving a public purpose; However, Holland and Knight say that part of city law has been violated when it comes to budget and procurement rules.

The law firm recommends that the city hire a pre-emptive procurement officer who has compulsory training on purchasing power and who disciplines, but does not finish, the city’s current director of parks and recreation, Jim Ponek.

Vice Mayor Geoff McConnell believes the internal investigation speaks for itself.

“It was very detailed and tedious,” said McConnell. “I think it clearly shows that the city has not violated any state or federal laws. I want to thank Holland and Knight for doing a fantastic job and being incredibly thorough. “

McConnell says he trusts current city administrator Drew Whitman to properly stop disciplining Ponek. He says a decision will be made in the next few weeks.

Holland and Knight did not investigate the circumstances and potential legal issues related to O’Rourke’s February 11 termination.

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