• Healthcare providers were notified in mid-December about low vaccination rates against influenza, COVID-19 and RSV, potentially leading to more severe disease and increased healthcare capacity strain in the coming weeks. Now hospitals in at least eight states are requiring masking.
• Recent legal developments have put the U.S. Supreme Court on track to decide how the Emergency Medical Treatment and Labor Act applies to medical decision-making when the life of a pregnant woman is at immediate risk.
• The median loss per physician for system-affiliated medical groups is now more than $249,000, as operating expense increases outpace revenue gains, per 2023 survey results.

Over the past few weeks, I have found these recent industry news stories that should be of interest to healthcare finance professionals.

1. CDC urges providers to boost flu, COVID-19 and RSV immunizations; mask mandates return for some healthcare facilities  

“As the new year takes off, CDC continues to track the rise of JN.1 across the country,” stated a Jan. 5 Centers for Disease Control and Prevention (CDC) update, referring to a newly identified COVID-19 variant. “An offspring of BA.2.86, JN.1 is now the most widely circulating variant of SARS-CoV-2 in the United States and globally. As of January 5, 2024, JN.1 is estimated to account for approximately 62% (range 55-68%) of all currently circulating SARS-CoV-2 variants.”

An increase in respiratory illnesses was expected as people gathered for winter holidays, especially considering the “low vaccination rates against influenza, COVID-19, and RSV,” noted a Dec. 14 CDC health advisory. 

An ‘urgent need’ for immunizations

The advisory warned healthcare providers that the low rate of vaccinations “could lead to more severe disease and increased healthcare capacity strain in the coming weeks,” noting an “urgent need” to increase immunization coverage for Influenza, COVID-19 and RSV.

A CDC weekly snapshot on Jan. 5 noted, “The amount of respiratory illness (fever plus cough or sore throat) causing people to seek healthcare is elevated or increasing across most areas of the country. This week, 39 jurisdictions experienced high or very high activity.”

The spread was more regionalized three weeks earlier, when the CDC noted that “the highest respiratory disease activity in the United States was occurring across the southern half of the country, with increasing activity in northern states.”

Latest CDC respiratory illness report

The Jan. 5 CDC snapshot (the latest information as of Jan. 12) noted the following about the three main respiratory illnesses:

• For COVID-19, test positivity, emergency department visits and hospitalizations remain elevated nationally, with ED visits “highest among infants and older adults” and “also elevated for young children.”
• Multiple indicators of influenza activity — including test positivity, emergency department visits and hospitalizations — are elevated.
• RSV activity remains elevated in many areas of the country, though decreases have been observed in some areas. Hospitalization rates remain elevated, particularly among young children and older adults.

Hospitals mandate mask wearing

As of Jan. 9, hospitals in at least eight states and Washington, D.C., were requiring masking.

As the incidences of respiratory illnesses have increased, hospitals have brought back mandatory mask wearing “for selected people in medical settings,” according to a Dec. 29 Newsweek article. California, Illinois, Massachusetts, New York and D.C. at the time had implemented the mask mandates “to mitigate the spread of COVID-19 and other respiratory viruses,” stated the article.

Penn Live Patriot News on Jan. 8 reported, “As of Monday, Philadelphia-based Penn Medicine said it is requiring face masks in some but not all areas in response to an increase in COVID cases in our region.’” Penn Medicine posted its face mask rules on its website.  

Some Wisconsin hospitals were requiring masking at their facilities, according to a Dec. 20 Wausau Pilot & Review article. And on Dec. 28, Cape Fear Valley Hospital in North Carolina began requiring masks for all patients and visitors in waiting rooms and other areas of the ED, according to WRAL News.

The New Hampshire Hospital Association said some hospitals had implemented mask mandates but “did not identify which hospitals have resumed mask requirements or are considering it,” according to a report in the Jan. 10 New Hampshire Bulletin.  

According to author Annmarie Timmins, the association said, “The change comes as hospitals are nearly full due to an increase in respiratory illnesses among patients and staff, including flu, COVID-19, and RSV.”

Additional HFMA content

• Read the April 21, 2023, article “Why more is needed to address America’s most prevalent ‘illness,’” by David Wheeler, MBA, MS.
• Listen to the Feb. 13, 2023, Voices in Healthcare Finance podcast episode “Vaccination: Good for the community, the industry and your bottom line,” where Jacob Braude, a principal at ZS, discussed his firm’s latest research on vaccine hesitancy.

2. Supreme Court to decide how EMTALA applies to medical decision-making regarding abortions

The U.S. Supreme Court is set to rule on whether the Emergency Medical Treatment and Labor Act (EMTALA) requires clinicians to provide abortions in emergency scenarios.

In August 2022, a district court in Idaho issued a partial injunction of a state law that would make providing abortion a criminal act except in narrow circumstances. The court said the law should be enjoined because the federal government likely would prevail in a pending case about whether EMTALA should take precedence over state statutory language.

On Jan. 5, the Supreme Court granted the state’s request to stay the injunction until the high court can weigh in on the matter — most likely by mid-year.

That decision will have implications for whether EMTALA holds sway in states that have passed laws restricting abortion in the wake of the Supreme Court’s 2022 Dobbs ruling, which established that abortion is not a constitutional right.

One such state is Texas, which on Jan. 2 prevailed at the appellate level in litigation about federal guidance stating that physicians must provide abortions if needed as a stabilizing procedure for an emergency medical condition.

What’s at issue

The U.S. Department of Health and Human Services (HHS) issued the guidance in July 2022 following the Dobbs decision. Texas sued, saying the guidance should not override state law. The state won last year in district court and this month at the Fifth Circuit Court of Appeals.

HHS’s guidance sought to clarify that physicians must provide an abortion if they believe the procedure is necessary as a stabilizing treatment to resolve an emergency medical condition. The guidance states: “When a state law prohibits abortion and does not include an exception for the life of the pregnant person — or draws the exception more narrowly than EMTALA’s emergency medical condition definition — that state law is preempted.”

The appeals court backed the initial decision nullifying the guidance, in part because “[t]he question before the court is whether EMTALA, according to HHS’s guidance, mandates physicians to provide abortions when that is the necessary stabilizing treatment for an emergency medical condition. It does not. We therefore decline to expand the scope of EMTALA.”

That decision effectively would be overruled, however, if the Supreme Court upholds the lower-court ruling in the Idaho case.

The high court’s forthcoming decision “will be the most impactful abortion policy case since its 2022 Dobbs decision and could have far-reaching consequences with respect to the intersection of EMTALA preemption and abortion policy,” attorneys with the law firm of Foley Hoag wrote in an analysis.

— Nick Hut, HFMA senior editor

3. Medical groups faced 4 challenges in 2023, including operating expenses that outpaced revenue gains, says survey

“Medical groups are facing challenges related to providing quality, cost-effective care in an ever-changing healthcare environment, including operating expenses that outpace revenue gains, labor shortages, access issues, and revenue cycle optimization,” according to survey results reported a Dec. 18 American Medical Group Association news release.

Mike Coppola, MBA, AMGA consulting COO, was quoted in the release as saying: “Survey results indicate that ongoing external pressures — such as cost of labor, staffing shortages, CMS fee schedule and regulatory changes — are impacting medical group performance. Today’s leaders are continually focused on improving operational efficiencies through more virtual visits, patient self-scheduling, care team redesign, the use of AI to automate and drive process improvements, and other strategies.”  

Additional findings

Key findings from the 2023 Medical Group Operations and Finance Survey are based on data from 5,700 individual clinics and more than 15,000 providers, and include:

• The median total revenue per physician increased from $608,639 to $719,901, while median total expenses per physician increased from $905,283 to $1,036,238.  
• Staffing constraints for physicians, advanced practice clinicians and clinic staff are forcing groups to look at process changes, care model changes and automation to drive efficiencies.  
• There’s a need for tools to manage revenue cycle performance, including external benchmarks and insight into internal trends.  

HFMA bonus content

• Read the Winter issue of hfm magazine, including the Expert Reviewed article “4 steps healthcare CFOs can take to improve interoperability,” by Michael Gould; the David W. Johnson column “Efforts to revitalize healthcare on Chicago’s South Side underscore a critical national challenge”; and the Chapter News column “Puerto Rico Chapter signs collaborative agreement,” by Crystal Milazzo.
• Listen to the latest Voices in Healthcare Finance podcast episode, “Alleviating stress on patients, families and clinical staff through a palliative care doula volunteer program,” hosted by Erika Grotto. This episode’s guest is Amy Levine, educator, author and consultant in the fields of aging, serious illness and end-of-life care.
• Read HFMA’s summary of a proposed federal rule affecting the definition of employer with respect to association health plans.
• Read HFMA’s fact sheet breaking down 2024 changes in relative weights and Medicare payment rates for ambulatory surgical centers.