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| Sutter Health’s Request to Delay $575 Million Settlement Is Denied | Sutter Health’s Request to Delay $575 Million Settlement Is Denied |
| (5 days later) | |
| Despite citing the surge in coronavirus cases and economic fallout from the pandemic in California, Sutter Health failed to persuade a state judge on Thursday to delay the $575 million settlement it reached last December over accusations of price gouging and monopolistic practices. | Despite citing the surge in coronavirus cases and economic fallout from the pandemic in California, Sutter Health failed to persuade a state judge on Thursday to delay the $575 million settlement it reached last December over accusations of price gouging and monopolistic practices. |
| Sutter, which has already received hundreds of millions of dollars in federal coronavirus aid, argued it needed three more months to decide whether it should try to abandon the settlement terms. The sprawling health system in Northern California warned that the costs of the pandemic might force it to raise rates for patient care beyond caps set by the proposed settlement. | Sutter, which has already received hundreds of millions of dollars in federal coronavirus aid, argued it needed three more months to decide whether it should try to abandon the settlement terms. The sprawling health system in Northern California warned that the costs of the pandemic might force it to raise rates for patient care beyond caps set by the proposed settlement. |
| But Superior Court Judge Anne-Christine Massullo was not swayed. While sympathetic to concerns over the rising number of infections in California, the judge refused to give Sutter more time, scheduling a hearing next month on the preliminary agreement. Sutter Health could still try to block final approval of the settlement, which also prevents it from forcing insurers to include all of its health facilities in insurance policies rather than coverage for some. | But Superior Court Judge Anne-Christine Massullo was not swayed. While sympathetic to concerns over the rising number of infections in California, the judge refused to give Sutter more time, scheduling a hearing next month on the preliminary agreement. Sutter Health could still try to block final approval of the settlement, which also prevents it from forcing insurers to include all of its health facilities in insurance policies rather than coverage for some. |
| “Adjusting our entire integrated network to respond to Covid-19 has been an incredibly costly and difficult endeavor that will significantly impact us for years to come,” Sutter said in a statement after the hearing. | “Adjusting our entire integrated network to respond to Covid-19 has been an incredibly costly and difficult endeavor that will significantly impact us for years to come,” Sutter said in a statement after the hearing. |
| “Over the last few weeks, like the rest of the state, we’ve seen an uptick in cases of Covid-19, including hospitalizations that have pushed us to our highest surge levels,” it added. “This surge requires ongoing emergency response efforts across our integrated network as we continue to provide high quality care during these uncertain times.” | “Over the last few weeks, like the rest of the state, we’ve seen an uptick in cases of Covid-19, including hospitalizations that have pushed us to our highest surge levels,” it added. “This surge requires ongoing emergency response efforts across our integrated network as we continue to provide high quality care during these uncertain times.” |
| The agreement is the result of a lawsuit filed by California’s state attorney general, Xavier Becerra, who argued that Sutter had essentially cornered much of its market, corralling insurers and patients so they were unable to go somewhere else for less expensive or better treatment. Employers and patients paid much higher prices for care, Mr. Becerra contended. | The agreement is the result of a lawsuit filed by California’s state attorney general, Xavier Becerra, who argued that Sutter had essentially cornered much of its market, corralling insurers and patients so they were unable to go somewhere else for less expensive or better treatment. Employers and patients paid much higher prices for care, Mr. Becerra contended. |
| While Sutter did not admit any wrongdoing, the case represented an important victory for state regulators seeking to curb the power of large hospital groups, which through consolidation in recent years now dominate much of the country. Leemore Dafny, a Harvard health economist and former regulator, said, “What the California attorney general has succeeded in doing ought to inspire forward-looking attorneys general.” | While Sutter did not admit any wrongdoing, the case represented an important victory for state regulators seeking to curb the power of large hospital groups, which through consolidation in recent years now dominate much of the country. Leemore Dafny, a Harvard health economist and former regulator, said, “What the California attorney general has succeeded in doing ought to inspire forward-looking attorneys general.” |
| The settlement should be viewed separately from the economic impact of the virus on the hospitals, she said. | The settlement should be viewed separately from the economic impact of the virus on the hospitals, she said. |
| The Sutter case could also have a significant impact on how the pandemic reshapes the health care landscape. Hospitals have clearly sustained a financial blow from the pandemic, with losses expected to exceed $320 billion by the end of the year, according to one estimate. | The Sutter case could also have a significant impact on how the pandemic reshapes the health care landscape. Hospitals have clearly sustained a financial blow from the pandemic, with losses expected to exceed $320 billion by the end of the year, according to one estimate. |
| Many of these large systems have already received a major portion of the $175 billion in federal funds allocated by Congress to help hospitals during the crisis. | Many of these large systems have already received a major portion of the $175 billion in federal funds allocated by Congress to help hospitals during the crisis. |
| That federal aid has offset roughly a quarter of the loss of net patient revenues of the biggest hospitals in the state, according to a new analysis by researchers at the Petris Center at the University of California at Berkeley. Mr. Becerra’s office had requested the report, which was released on Thursday after the judge’s decision. | That federal aid has offset roughly a quarter of the loss of net patient revenues of the biggest hospitals in the state, according to a new analysis by researchers at the Petris Center at the University of California at Berkeley. Mr. Becerra’s office had requested the report, which was released on Thursday after the judge’s decision. |
| Sutter has received $317 million in those federal funds as well as other government money because of the crisis, according to the report. | Sutter has received $317 million in those federal funds as well as other government money because of the crisis, according to the report. |
| The big hospitals that have the largest portion of revenues from private insurers and that operate in highly concentrated markets, including Sutter, received the most money, the researchers found. The calculation was adjusted to take into account individual hospital patient populations. | The big hospitals that have the largest portion of revenues from private insurers and that operate in highly concentrated markets, including Sutter, received the most money, the researchers found. The calculation was adjusted to take into account individual hospital patient populations. |
| The hospitals’ “market power is giving them more reimbursement,” said Richard Scheffler, the director of the Petris Center. | The hospitals’ “market power is giving them more reimbursement,” said Richard Scheffler, the director of the Petris Center. |
| Weaker facilities and physician practices are struggling to keep their doors open, and many are expected to be scooped up by the largest systems, which would increase their leverage even more. | Weaker facilities and physician practices are struggling to keep their doors open, and many are expected to be scooped up by the largest systems, which would increase their leverage even more. |
| “This is the moment where strong antitrust enforcement is more important than ever,” said Jaime King, a senior scholar at the U.C. Hastings College of Law. | “This is the moment where strong antitrust enforcement is more important than ever,” said Jaime King, a senior scholar at the U.C. Hastings College of Law. |
| “The healthy systems are looking forward to the opportunity to make strong acquisitions,” she said. “Regulators should be matching them toe to toe.” | “The healthy systems are looking forward to the opportunity to make strong acquisitions,” she said. “Regulators should be matching them toe to toe.” |
| As a way of preventing even further consolidation, which could lead to higher prices and lower quality care, Mr. Becerra is seeking greater authority to review the deals under a proposed state law. | As a way of preventing even further consolidation, which could lead to higher prices and lower quality care, Mr. Becerra is seeking greater authority to review the deals under a proposed state law. |
| “This pandemic can’t be an excuse for ‘big fish’ hospital systems to swallow up their smaller but able competitors,” he said. “Increased market consolidation comes at a cost to consumers. | “This pandemic can’t be an excuse for ‘big fish’ hospital systems to swallow up their smaller but able competitors,” he said. “Increased market consolidation comes at a cost to consumers. |
| “As our nation confronts today’s health and economic crisis, we urgently need the tools to hold health care giants accountable to consumers and competition.” | “As our nation confronts today’s health and economic crisis, we urgently need the tools to hold health care giants accountable to consumers and competition.” |
| But some combinations in which a larger system keeps a struggling hospital open to meet community needs are not likely to meet much resistance, said Torrey McClary, a health care lawyer with King & Spalding. | But some combinations in which a larger system keeps a struggling hospital open to meet community needs are not likely to meet much resistance, said Torrey McClary, a health care lawyer with King & Spalding. |
| Updated July 7, 2020 | |
| The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | |
| While the number of deals fell after the pandemic hit, health systems are likely to begin considering mergers and acquisitions in the coming months, she said. “Those conversations are continuing,” Ms. McClary said. | While the number of deals fell after the pandemic hit, health systems are likely to begin considering mergers and acquisitions in the coming months, she said. “Those conversations are continuing,” Ms. McClary said. |
| In making its argument for a delay, Sutter described the current crisis as having “completely upended the health care system in Northern California,” according to its recent legal filings. It cited a $1 billion loss in the first three months of the year. | In making its argument for a delay, Sutter described the current crisis as having “completely upended the health care system in Northern California,” according to its recent legal filings. It cited a $1 billion loss in the first three months of the year. |
| Sutter contended that it might not be able to abide by the settlement terms, and raised the possibility that it would have to charge higher prices beyond the limits in the agreement because of surges in Covid-19 patients. | Sutter contended that it might not be able to abide by the settlement terms, and raised the possibility that it would have to charge higher prices beyond the limits in the agreement because of surges in Covid-19 patients. |
| In their report, however, the Petris Center researchers also pointed to the substantial financial cushion many of these hospitals have. They calculated that Sutter alone had more than $5 billion in financial investments and cash. | In their report, however, the Petris Center researchers also pointed to the substantial financial cushion many of these hospitals have. They calculated that Sutter alone had more than $5 billion in financial investments and cash. |
| Sutter responded by saying that the demands of the pandemic are forcing it to look beyond those assets. | Sutter responded by saying that the demands of the pandemic are forcing it to look beyond those assets. |
| “While we are fortunate to have this ability based on our reserves, we believe we cannot solely support Covid-19 efforts today without responsibly balancing our future community and patient needs,” the health system said in an emailed response. | “While we are fortunate to have this ability based on our reserves, we believe we cannot solely support Covid-19 efforts today without responsibly balancing our future community and patient needs,” the health system said in an emailed response. |
| Mark Miller, a former federal official who is now an executive at Arnold Ventures, a philanthropy that has been a sharp critic of high hospital costs, argued the big systems should be using their reserves rather than seeking to raise their prices. “We might expect them to draw on their own resources,” he said, noting that they are also getting federal funds to help with their losses. | Mark Miller, a former federal official who is now an executive at Arnold Ventures, a philanthropy that has been a sharp critic of high hospital costs, argued the big systems should be using their reserves rather than seeking to raise their prices. “We might expect them to draw on their own resources,” he said, noting that they are also getting federal funds to help with their losses. |
| “There is a legitimate fear they will use those funds to engage in further consolidation and further price increases,” he said. | “There is a legitimate fear they will use those funds to engage in further consolidation and further price increases,” he said. |
| Employers, which joined with unions and the attorney general to bring the case against Sutter, argued that it should not be allowed to use its market power to raise prices, despite the pandemic. “What Sutter seems to have overlooked is the people paying these bills,” said Elizabeth Mitchell, the chief executive of the Pacific Business Group on Health, which represents employers that purchase coverage for their workers. | Employers, which joined with unions and the attorney general to bring the case against Sutter, argued that it should not be allowed to use its market power to raise prices, despite the pandemic. “What Sutter seems to have overlooked is the people paying these bills,” said Elizabeth Mitchell, the chief executive of the Pacific Business Group on Health, which represents employers that purchase coverage for their workers. |
| The crisis has made it much more difficult for employers, including state governments, and individuals to afford care, she said. “We do not believe price gouging and continued inflation of prices beyond what is necessary is sustainable,” she said. “Families and business can’t absorb those costs.” | The crisis has made it much more difficult for employers, including state governments, and individuals to afford care, she said. “We do not believe price gouging and continued inflation of prices beyond what is necessary is sustainable,” she said. “Families and business can’t absorb those costs.” |