August Health Matters: Nebraska patients opted for telehealth visits during the pandemic
Kayla Northup's family is pretty healthy, but when her kids do get sick, it's often at an inconvenient time, such as on a vacation.
That's why she likes having the option of setting up a telehealth visit instead of going to an urgent care clinic or the emergency room.
Northup said she also sometimes uses telehealth when she's in town and could go into the doctor's office because she likes the convenience, especially when she has a good idea of what's ailing her or one of her kids.
"It's faster and easier and, honestly, cheaper," the Lincoln woman said. She noted that on her high-deductible health insurance plan, telehealth visits usually cost half as much as a traditional office visit.
Telehealth, whether done over the phone or via videoconferencing, has been around for several years, although it never really caught on as a regular practice before the coronavirus pandemic. But the pandemic changed the game, causing a rapid increase in its use, with some health care providers transitioning from barely using it to employing it exclusively.
´¡ÌýÌýdone last year by the U.S. Department of Health and Human Services found that the share of Medicare visits conducted through telehealth grew from approximately 840,000 in 2019 to 52.7 million in 2020, a 63-fold increase.
That same study showed Nebraska was among the five states with the lowest increase in telehealth use. In 2020, only Tennessee had a lower percentage of Medicare visits via telehealth than Nebraska's 2.9%.
That could have to do with Nebraska's largely rural population, as the study showed that telehealth adoption has lagged in rural states. But that doesn't mean health care systems and providers in Nebraska haven't embraced telehealth.
Nebraska Medicine in Omaha is a good example. In its 2018 and 2019 fiscal years combined, it did fewer than 3,500 telehealth visits. That jumped to more than 47,000 in fiscal year 2020 and grew to more than 100,000 in both fiscal 2021 and 2022.
"There was a rapid adoption of telehealth during the pandemic," said David Cloyed, Nebraska Medicine's applications director of connected health.
The necessity of switching to telemedicine in the early months of the pandemic to protect the health of patients and providers certainly drove up adoption, but other changes helped, Cloyed said. Those included a federal law that required health insurers to cover telemedicine visits the same as a regular visit while emergency health measures were in place.
Blue Cross Blue Shield of Nebraska, the state's largest health insurer, said it saw telehealth use increase 1,000% in March 2020 and 4,000% in April 2020, compared with February of that year.
The increased pandemic usage spurred it to process more than 150,000 telehealth claims in 2020, up from a little more than 1,600 in 2019. That number dropped to 110,000 in 2021 but has stayed relatively consistent at about 9,000 a month into the first half of this year.
The Nebraska Legislature last year also made changes to ensure people can receive telemedicine services in their home and that they can do so with verbal rather than written consent.
Jill Hull, executive director of operations for Bryan Telemedicine & Teledigm Health, said that in addition to forcing providers to use telemedicine, the pandemic also helped to show to patients, providers and regulators that the technology works.
"I think what COVID's done is it has increased confidence in the care that can be provided," she said.
Hull's job is focused on facilitating telehealth throughout the Bryan system and with partner hospitals rather than between providers and patients, so that's where she has seen the greatest effects.
For example, she said, increased use of telehealth has allowed Bryan specialists to greatly increase the number of patients they see in smaller communities.
Pulmonology is a good example of that.
Before the pandemic, Bryan offered acute care pulmonary services in just three hospitals outside of Lincoln and non-acute outpatient care at six clinics. Thanks to expanded use of telehealth services, Bryan now works with 10 additional hospitals in Nebraska and one in Iowa in offering acute care and has 13 outpatient clinics in Nebraska and one in Iowa.
Bryan's telemedicine program recently won a national award, the 2022 Teladoc Transformational Leadership award, for its work with rural hospitals to provide specialty care, outpatient care and support services that would otherwise be unavailable.
“Our specialists are available right in the patient’s room when they’re most needed,†said Dr. Brian Bossard, president and CEO of Bryan Telemedicine and Teledigm Health. “Patients in rural facilities can receive the same state-of- the-art care as someone in Lincoln or Omaha because they have immediate access to some of the top specialists in the country.â€
A number of Nebraska health systems have used telehealth in various ways to expand and transform how they deliver care.
CHI Health now offers virtual care 24 hours a day and is planning to incorporate an area at its new CHI Family Health Center being built in Lincoln at 40th Street and Yankee Hill Road, where patients can drive up to access a test or vaccine that they order online, said spokeswoman Taylor Miller.
At Nebraska Medicine, the emergency department now has a virtual waiting room where people can speak with a doctor via computer, something that can help speed up the process of receiving care and being admitted to the hospital.
Charity Swain, Nebraska Medicine's telehealth programs coordinator, said that though virtual visits can be utilized in any health care setting, some medical specialties are better suited to telehealth visits than others. Among the ones she mentioned are bariatrics, endocrinology and dermatology.
Telehealth services also have expanded in behavioral health.
´¡ÌýÌýby the Kaiser Family Foundation found that telehealth use in behavioral health has remained high, even as the overall use of the technology has waned since the early days of the pandemic.
According to the study, 40% of mental health and substance abuse visits nationwide from March through August of 2020 were via telehealth, while 11% of all other outpatient visits were conducted over the phone or via computer. A year later, 36% of mental health visits still were being conducted via telehealth, but only 5% of other visits were done virtually.
At CHI Health, only about 5% of its total patient visits are now done virtually, but 30% of behavioral health visits are done over the internet, Miller said. That's down from a high of 88% of visits during the early months of the pandemic, but higher than the 2% rate pre-COVID.
Blue Cross Blue Shield has seen behavioral health account for more and more of its telehealth claims as the pandemic has worn on. In 2020, 66% of its total telehealth claims processed were for behavioral health. That rose to 75% in 2021 and stands at 73% this year.
"Mental health is clearly an area where telehealth has been beneficial in helping patients get access to providers," said Dr. Josette Gordon-Simet, Blue Cross Blue Shield of Nebraska’s chief medical officer. "The pandemic has been hard on a lot of people, and we’re glad that we have been able to help people get the care they need.â€
Telehealth has been a lifeline for people like Jessica Olson, who switched to doing her therapy appointments virtually during the early months of the pandemic. She now sees her therapist in person but does telehealth visits with the doctor who prescribes her medication because it is more convenient.
"My experiences with it have been great," the Lincoln woman said. "It saves me the gas and time of driving 25 minutes across town to my doctor ... and was great when avoiding public places during peak COVID times."
Olson said she still prefers the in-person experience over telehealth, even for her medication appointments.
"If the office was closer, I wouldn't use telehealth at all unless I really had to," she said.
It's consumers, people like Olson and Northup, who ultimately will decide how widely accepted telehealth becomes, experts say.
"Really, what's driving a lot of the continued demand for this are patients," Cloyed said. "They continue to want to have access to their providers virtually."
Nebraska Medicine continues to see strong telehealth usage, with about 12-15% of visits done virtually, Cloyed said.
When public health emergencies were in place, health insurance companies were required to cover telehealth visits "at parity" with in-person visits, meaning they reimbursed the same amount or percentage of costs.
But Nebraska's public health emergency was rescinded more than a year ago, and some insurers have since reduced what they pay for telehealth visits.
That reimbursement disparity can lead health systems and providers to rethink how and when they provide telehealth.
"If reimbursement is in question, then health systems are not going to want to invest in telehealth," said Dr. Leslie Eiland, an endocrinologist at Nebraska Medicine.
Northup, who works as an employee benefits manager, said she thinks most health insurance companies are supportive of expanded use of telehealth and see the value of it in some settings.
"I think there is a strong push and incentive to use telehealth for the things that are appropriate," she said.
Gordon-Simet echoed that sentiment.
“When it is medically appropriate," she said, "we still want to continue to give patients a telehealth option."
Watch now: Health care sector in Nebraska works to rebuild, bolster workforce
OMAH´¡Ìý— As high school students, Camila Delgado Garcia and Joerdy Flores-Garcia both were interested in health care careers.Ìý
So the Omaha youths signed up for a health and wellness internship offered by the Latino Center of the Midlands and CHI Health. Their internships helped them decide what they wanted to do.
Both became certified nursing assistants through the program, which covered their costs. Both will be freshmen at the University of Nebraska at Omaha this fall and have their sights on becoming dental hygienists.ÌýFlores-Garcia plans to apply to work through college at CHI Health to help cover expenses.
Delgado Garcia said a lot of careers are available in health care that people don't know about. "If you don't like one, there's hundreds more that go into it," she said.Ìý
The program is one of a growing number of initiatives in Nebraska aimed at helping attract and connect young people to health care careers. The larger goal: Grow the state's health care workforce.
Even before the COVID-19 pandemic, the state had long-running shortages of many types of health care professionals. The pandemic has exacerbated those shortages, causing some health care workers to retire early or leave the profession. Others left for more lucrative traveling medical jobs. Hospitals, long-term care facilities and home health and hospice outlets all have struggled to maintain adequate staff.Ìý
Jeremy Nordquist, president of the Nebraska Hospital Association, said hospitals still are seeing a staff vacancy rate of somewhere between 10% and 15%, with some as high as 20%. Some larger systems still rely on a significant number of traveling medical professionals.Ìý
On the positive side, he said, some travelers are starting to return to their former employers. Rates charged by medical staffing agencies for travelers have begun to inch down. Anecdotal reports from large systems also indicate that some retired nurses are reassessing the impact of inflation on their finances and returning to the job.
But just as worker shortages have helped drive wage increases in other industries, employers in the health care sector also are seeing increased labor costs. Many hospitals and nursing homes have increased wages and offered bonuses to recruit and retain staff. They also have had to pay more for travelers to fill needed positions.
Those higher costs, combined with inflation, increased medication costs and other expenses are putting pressure on the bottom lines of hospitals, nursing homes and home health and hospice providers.
Reimbursements from Medicare and Medicaid, which make up 60% to 70% of a typical hospital's revenue, are set to increase only slightly, Nordquist said. But internal surveys of members indicate that labor costs for hospitals were up nearly 20% over the past two years, while supplies were up 15%, utilities 8% and medication 30% to 40%. Those numbers align closely with a national report prepared earlier this year by the Kaufman Hall consulting firm.
"It's a tough situation right now," Nordquist said. "We thought COVID would be the worst of the worst and we'd all be able to catch our breath. ... But hospitals are in a real tough spot now financially, and it's going to take some creative work to pull our way out of this. The big driving piece of it really is the limited workforce and the costs needed to keep up with workforce costs."Ìý
Many of the state's hospitals are trying different models to make nursing in particular more attractive and bring people back in. Meanwhile, health systems and health colleges are stepping up efforts to recruit young people to fill the pipeline, including offering more scholarships.
State lawmakers earlier this year put a share of the state's federal COVID relief dollars toward initiatives to bolster the health care workforce. The Legislature allocated $5 million to help rural health care providers pay off college loans, $5 million to provide scholarships for nursing students and $60 million for a rural health complex on the University of Nebraska at Kearney campus, a joint project with the University of Nebraska Medical Center. Also included was $60 million for capital projects at community colleges to grow the state's workforce, including in health care.
Those efforts are important, Nordquist said, because the state will face a tremendous demographic challenge over the next 10 years as practitioners in the baby boom bracket retire.ÌýÌý
According to the Nebraska Center for Nursing, Nebraska will face a shortage of 5,435 nurses by 2025.
A health care workforce report by UNMC, based on 2021 data, indicates that the number of nurse practitioners in the state had increased significantly and the number of pharmacists increased modestly since 2020.
However, rural areas of the state still lack needed health care professionals, including physicians. Nicole Carritt,Ìýdirector of the UNMC Office of Rural Health Initiatives, said the report doesn't capture the full impact of the pandemic. She said shortages have been exacerbated since the data was collected.
UNMC has two long-running, successful pathway programs in collaboration with UNK and state colleges focused on bolstering the rural health workforce, Carritt said. Studies show recruiting students from rural and underserved areas and training them close to those communities increases the likelihood that they will practice there.
Nordquist said the Legislature is conducting an interim study under a measure introduced by Sen. Terrell McKinney, who represents part of North Omaha, to look at ways to grow and diversify Nebraska's health care workforce.
The hospital association, he said, also is considering ways to collaborate with nursing schools to make sure they don't lose applicants.ÌýThe goal would be to make sure that applicants who are turned down by one nursing college are provided information about other programs or are enrolled in a program where they can earn an associate's degree.Ìý
Selene Espinoza, a surgical assistant with CHI Health, said she got involved in the Latino Center/CHI program last year when it added the CNA certification option. She wanted to make sure Latino students were exposed to health care settings and could see people like themselves in those workplaces.
She talks them through the training required for various careers, from CNAs to physicians, as well as their earning potential. She takes them on tours of hospitals and clinics, where they meet health professionals, don gowns and gloves and get their hands on equipment, including a surgical robot.
Espinoza moved to the United States from Mexico as a preteen. As a student at Omaha Bryan High School, Espinoza said she didn't think a career in health care was possible because of language and financial barriers. Her parents hadn't gotten a higher education and didn't know the U.S. education system. But she was exposed to career options in a program through CHI Midlands. She now serves on the hospital's community board and is a member of the Douglas County Board of Health.
"I feel like I've walked the path and can do a little bit of guidance," Espinoza said, noting that the pandemic also highlighted the need for health care workers who could speak patients' languages and understand their cultures.
Ricky Solis, a UNO junior who joined the program this year, had thought to one day work for an international health organization. But he has shifted his focus to local public health after working for the Central Public Health District in Grand Island during the pandemic and for the Latino Center/CHI program.Ìý
"I'm working on the stuff I've studied in college," he said.
Bolstering the existing workforce
While the staffing crunch for hospitals has eased since the last pandemic peak, hospitals still are busy, in part because they're catching up with delayed care.Ìý
Sue Nuss, chief nursing officer at Nebraska Medicine, said the health system had 450 employees out with COVID at the peak of the omicron surge in January and February. Both that and the number of patients ill with COVID have decreased significantly, although COVID continues to sideline some employees.Ìý
Since then, the health system, like many others, has increased compensation packages for bedside nurses. Like other health systems, Nebraska Medicine still employs travelers, although Nuss said it has fewer than at the pandemic peak. It also added 130 nursing school graduates and 90 nurse residents this spring.
But with projections indicating that the number of nurses never will be adequate, Nuss said, the health system is trying out different care team models. It has brought licensed practical nurses back to inpatient units, a role it had eliminated years ago, and also has some paramedics working in those units.Ìý
Rather than having one nurse alone oversee four or five patients, for instance, that nurse might instead cover eight or nine patients with the help of an LPN, nursing assistant and paramedic, Nuss said. While stretching nurse-to-patient ratios can impact quality of care, having a team allows nurses to delegate some tasks. By working together, a team may be able to care for more patients.
Tim Plante, chief nursing officer for CHI Health, said that health system also has focused on incentivizing nurses who have stayed and working to get new ones in the field.
A number of health care workers who left to travel have started to return, he said. So far, 100 practitioners, from nurses to respiratory therapists, have joined the health system's new internal travel pool. Some have come from across the country.
CHI Health also is trying several new programs aimed at increasing job flexibility, Plante said. Under a weekend option, instead of working every third weekend, the local standard, a nurse could work every weekend or every other weekend in exchange for additional pay. That option works for a lot of nurses with families who want to arrange child care around their shifts.
The health system also is incentivizing nurses to learn new skills and work in different areasÌý— say, the intensive care unit in addition to labor and deliveryÌý—Ìýand to work in different metro-area hospitals.Ìý
CHI Health also has two pilot programs that involve bringing pharmacists and occupational therapists onto floors to help nurses with tasks such as administering complex IV medications and helping patients with strength training.Ìý
Russ Gronewold, president and CEO of Lincoln-based Bryan Health, said the system is down to 470 open positions from a peak of 550 during the last pandemic surge. It's also down to 110 travelers of all types from a high of 170.Ìý
In the short term, Bryan has adjusted wages, offered retention bonuses and restored team-building activities such as company picnics and zoo nights. Health system officials are trying to figure out how to accommodate workers' desire for flexibility, which has increased as wages have increased.Ìý
The health system also has started an internal traveler pool, Gronewold said, and has been able to get some employees who had been traveling elsewhere to commit to moving among Bryan's hospitals in Lincoln, Grand Island, Kearney and Central City.
Gronewold said he also sees a role for more technology. Bryan is using artificial intelligence to extend staff in some areas, including working with a Lincoln software firm to monitor patients at risk of falling with 3D cameras and a fall-predicting algorithm. That has freed about 30 people a day who otherwise would be sitting with patients.
Other systems monitor incoming test results and alert nurses if interventions are needed right away and pre-sort lab results and CT scanner images to help practitioners pick up on any problems more quickly.
"These are things that make their job more efficient, but it doesn't replace the person who does the job," Gronewold said.Ìý
Ivan Mitchell, CEO of Great Plains Health in North Platte, said his hospital also is bringing back LPNs, medical assistants, certified nursing assistants and paramedics.
If a task doesn't have to be done by a nurse, he said, "we're having it be done by someone else." The same generally goes for physicians.Ìý
Mitchell and Gronewold said Nebraska practice standards required some professionals to perform tasks that could be done by others with lesser training. Making such changes would require legislation, and hospital officials are discussing the idea with state lawmakers.ÌýÌý
"There are no projections that suggest it's going to be anything but a long-term issue," Gronewold said of the shortages. "Simply increasing the folks going to nursing school by 10% or 20%, that still doesn't even address 50% of the shortage. We have to come up with other programs, of how do we use technology, how do we use other individuals."Ìý
Great Plains has taken a different approach to recruiting. Mitchell said the health system began recruiting nurses from the Caribbean, the Philippines and other nations after he arrived more than six years ago. The nurses all have passed the certification exams that allow them to practice. Since 2018, the hospital has employed about 175 international recruits.
Many move on after their three-year contracts run out, Mitchell said. But some stay. And while they're in North Platte, their children go to school there. They pay rent and shop in the community. If they move elsewhere in the U.S., they remain part of the larger pool of health care workers.
Nursing home challenges
Meanwhile, both nursing homes and home health and hospice outlets face workforce and financial challenges of their own. A side effect, Mitchell said, is increased length of stay for patients in hospitals because nursing homes don't have the staff to take them. Some nursing homes have closed.Ìý
Jalene Carpenter, president and CEO of the Nebraska Health Care Association, said a lot of nursing homes still are ending up in outbreak status due to COVID, meaning a single resident or employee has tested positive. Some employees have left due to requirements for testing and protective gear, which are stricter than in other industries.
A survey of 759 nursing home providers in mid-May by the American Health Care Association indicated that 98% of homes are having difficulty hiring staff. In addition, 73% are concerned about having to close their facilities over staffing woes.
In Nebraska, home operators have not only raised wages but also are looking at other strategies to grow their workforce, Carpenter said. At the national level, the association recently advocated for shortening the wait time for people in the country who are on certain visas to be eligible to work.
Still relatively new to the industry is an online labor platform for long-term care facilities calledÌý, which is in place in Omaha and Lincoln. It works a bit like an Uber program for staffing and is "seeing incredible success," Carpenter said.Ìý
With KARE, facilities can post available shifts, and caregivers interested in work can select the ones that work for themÌý— say, a four-hour shift on a Tuesday. Employers, rather than staffing agencies, set the wages. If the employer likes the worker, they can offer to hire the person.Ìý
"Those are the things that give me hope," Carpenter said. "Innovation comes from times of crisis, and we are seeing (people) coming up with new and innovative things."
Janet Seelhoff, executive director of the Nebraska Association for Home Healthcare and Hospice, said agencies are having to turn away patient referrals because they can't staff enough nurses and aides. That comes in the face of growing demand for such services.
"Need is greater than it's ever been," she said, "but at the same time, there are challenges in staffing." Costs have gone up with inflation, and home health and hospice agencies can't compete with the hiring bonuses and benefit packages hospitals and other health care settings are offering.Ìý
Building the pipeline
Meanwhile, the push continues to get more people into the health care pipeline, with the help of a host of programs, scholarships and loan repayment programs. Colleges and universities continue to reach out across the state to build programs in more locations.
Deb Carlson, president of Nebraska Methodist College, said the pandemic could have scared people away from the field, but it hasn't.Ìý
"People are saying they want to go into health care because they want to make a difference, they want to make an impact," she said, acknowledging that publicity about salary increases and loan payback programs also have helped spur interest. For those who don't want to work directly with patients, plenty of careers are available that aren't at the bedside.
Employers now are focused on how they can get students in the system even before they have degrees and are offering tuition assistance to help them continue their education once they're in the door, Carlson said.ÌýÌý
Nebraska Methodist College, for instance, offers a free Ìýthat allows people 16 and older to study to become nursing assistants at Methodist Hospital and get paid, on-the-job training with a two-year work commitment. The college also began offering its first full-ride scholarships last year for traditional bachelor's of nursing students.Ìý
Carlson said the college also is doing more to reach out to minority communities and has a free master's program for existing minority providers who want to go into nursing education, which also is a shortage area.
People who earn degrees in health care have no trouble finding jobs, she said. This year, for the first time, even junior nursing students were being hired.
Gronewold said Bryan is automatically offering jobs to junior nursing students at Bryan College of Health Sciences. The health system also is offering more tuition reimbursement for employees seeking additional education and just rolled out a program covering half the tuition for the children of employees who have been with the system for three years, as long as they stay with the system.
Over the course of the next few years, said Dr. Bo Dunlay, dean of Creighton University's medical school, Creighton will increase the number of graduating physicians from 600 to 1,000. The university also has created two physician assistant programs that eventually will add at least 100 practitioners to the workforce each year. The university also accelerated bachelor of nursing programs in Phoenix and Grand Island.
"It's created an opportunity for growth," he said of the expansion. "But the important thing is we've got clinical partners there whose missions are aligned with ours, and that's what makes it so successful."
Read previous stories in the Health Matters series
The pandemic accelerated a shift to more outpatient or same-day surgeries and sped the expansion of telehealth, among other changes, Nebraska health care leaders say.
We all have our headachesÌý— literal and figurativeÌý— but health care in the Heartland is something special. And it's something that's evolving all the time. That's why, starting today, we are pleased to launch Health Matters in the Heartland.
Suicide deaths in Nebraska dropped in the immediate wake of the pandemic. But, experts say rates often drop following major disasters, such as the 2019 floods in Nebraska, before experiencing an uptick.
Joanna Halbur of Project Harmony, a child advocacy center in Omaha, said noticeable changes in a child's behavior -- such as a normally outgoing child who is more reserved -- can be signs of anxiety or depression.
Just before the COVID pandemic broke out, the University of Nebraska Medical Center's Global Center for Health Security received a grant from the federal CDC to strengthen infection control training, education and tools.
The pandemic forced medical professionals, including Nebraska-based researchers and physicians, to innovate. Some innovations likely will be around for good.
Jeremy Nordquist, president of the Nebraska Hospital Association, said hospitals still are seeing a staff vacancy rate of somewhere between 10% and 15%, with some as high as 20%.
The percentage of visits still being done via telehealth is much lower than in the early months of the pandemic. Experts are evaluating its future applications.
Seven Nebraska organizations formed to take better care of their patients' health and reduce costs all performed better than the U.S. average on satisfaction and quality measures.
A Omaha mom who specializes in 3D imaging arranged to get a 3D rendering of the scans of her son's brain so her husband could see where the boy's tumor was situated.
A U.S. Department of Health and Human Services report found that the prices for more than 1,200 prescription medications increased an average of 31.6% from July 2021 to July 2022.
While patient surges linked to the pandemic have at times caused acute issues with hospital capacity, wider issues have exacerbated a more chronic problem that existed before COVID-19 hit.
Nebraska researchers help develop portable isolation units
Just before the COVID-19 pandemic broke out, the University of Nebraska Medical Center's Global Center for Health Security received a grant from the federal Centers for Disease Control and Prevention to strengthen infection-control training, education and tools.
The program was targeted to small, rural hospitals across the country that face some of the most persistent challenges in infection prevention and control, said Dr. Jana Broadhurst, director of UNMC's emerging pathogens laboratory.
Broadhurst said the nation doesn't have enough airborne isolation rooms to meet a surge in demand from the threat of an airborne pathogen. Keeping up with training for such situations, finding protective gearÌý— especially the complex kind needed for such high-risk pathogens as EbolaÌý— and disposing of or decontaminating it after use also pose challenges.
So the researchers partnered with a San Francisco-based engineering firm called Otherlab to develop new patient isolation care devices that addressed some of those challenges.
Some testing was done on an isolation tent device during the West Africa Ebola epidemic in 2014 to 2016. That device, however, didn't make it into development.
The researchers used that idea as a starting point. When COVID-19 arrived, the CDC expanded the scope of the program.
The researchers and engineers now have laid the groundwork for four products in a family of devices called ISTARI, or Isolation System for Treatment and Agile Response to high-risk infections. The first device now has undergone all the testing and validation required for federal regulatory review as a medical device. It is being marketed under the commercial name Carecube by a company called Carecubes.
"That's really exciting," Broadhurst said. "We feel close to having a revolutionary infection-control tool available, designed by intent for small rural critical-access hospitals across the country."
Specifically, the devices are negative-air pressure tents, with air filtered though HEPA-grade filters and exchanged the number of times needed to meet hospital requirements for airborne infection isolation rooms.
They have clear, flexible plastic walls so care providers, even family members, can interact with patients without protective gear. Also included are lean-in ports with arms and gloves and a hug suit, a full-length, flexible gown with its own filtration system that a provider can step into and reach the patient in the tent. The tent also has ports through which food, medication and other items can be passed without breaking containment and an interface for medical equipment that eliminates the need for complex decontamination or disposal.
The original unit, Broadhurst said, is sized to be set up inside a typical hospital room. Smaller units are designed to be set up in an emergency room, and a transport device fits in the back of an ambulance or helicopter.
Photos: 2 years of images tell the story of the pandemic
Pandemic forced Nebraskans to innovate
In the early months of the COVID-19 pandemic, researchers, clinicians, businesspeople and everyday men and women spun out new ways to deal with the coronavirus.
The result was a host of innovations, including new designs for masks and face shields, intubation shields for COVID-19 patients, ultraviolet disinfection methods for protective gear and 3D-printed nasal swabs. Along with those cameÌýa flurry ofÌýnew tests for the virus, some treatments and highly effective vaccines brought to market in record time.
Some of the innovations, including a UV disinfection system and the intubation shields, largely went by the wayside as supplies of protective gear improved and knowledge about the disease increased. But others — including the tests and vaccines — likely will be around for as long as COVID-19 itself.
Among the COVID-19 testsÌýwas a saliva-based versionÌýdeveloped by the University of Nebraska Medical Center's Emerging Pathogens Laboratory, directed by Dr. Jana Broadhurst. The test still is used on campus and by partners in the region, where access to high-quality testing remains a challenge.
Lab staff developed the test to both get around supply shortages that plagued the nasal swab and PCR-based testing early in the pandemic and meet the demand for screening programs in the community.
"That was a whole new regime of innovation that we and others around the country and world were grappling with during that really sustained high-volume testing phase of the pandemic," Broadhurst said.Ìý
Work continues on tests, treatments and vaccines. Another group of UNMC researchers has developed a nasal rinse device that is an alternative to the long nasal swabs used in many PCR tests.
Meanwhile, doctors, nurses and other providers came up with ways to perform procedures that were backlogged during the worst viral surges. They include expanding same-day surgeries such as knee and hip replacements and even some cardiac procedures. Similarly, bars and restaurants pivoted to takeout food and beverages and businesses shifted to remote or hybrid workplaces.
In a way, the boom in innovation is no surprise. When things are going well, there's little need for new solutions. But a pandemic, like other disruptions, drives people to seek better ways to get things done.Ìý
"Everyone wants to innovate and make things that solve problems," said Michael Dixon, president and CEO of UNeMed, which helps UNMC and the University of Nebraska at Omaha obtain patents and licensing.
Many researchers, he said, dropped what they were working on in other fields to pitch in on pandemic projects.Ìý
The same thing happened nationally. Surveys of scientists in 2020 and 2021 indicate that contributed to the effort, according to Scientific American.
Some of those efforts yielded products. Dixon said UNeMed saw more than twice as many new inventions — 73 — in the last two quarters of 2020 than in the first two quarters, marking the most productive six-month span in the organization's history.
Shortly after the virus emerged, Doug Hannah, assistant professor for strategy and innovation at Boston University, began tracking organizations that popped up across the country to address pandemic needs.Ìý
His database now includes 234 organizations reflecting about 500 innovations, including technologies such as UV disinfection and organizational innovations involving supply chains and the coordination of human capital.
The challenges at the start of the pandemic, he said, involved addressing the fast-emerging needs for protective gear and more complex medical devices in the face of long lead times and a small number of suppliers. On top of that came new demands for such items as hand sanitizer and ventilators.ÌýÌý
"Not only was it just replacing all the personal protective equipment and devices we couldn't get anymore but rather we needed to create new ones," Hannah said.
A particularly interesting aspect of the response, he said, was its grassroots nature. People in their homes — feeling powerless and seeking ways to protect themselves and their loved ones — made do with items they had on hand.Ìý
With millions of people experimenting with different ways to do things, using different supplies, Hannah said, "you're going to come up with really clever ideas." Examples include a plethora of mask and face shield designs. People sewed masks for themselves and health care systems. They churned out face shields in garages and fabrication shops.Ìý
"In some sense, the grassroots response to the pandemic was a heck of a silver lining," Hannah said. "It was one of the most impressive human mobilizations that we've had in two generations, and in some sense had a lot of parallels to the war effort 70 years ago."
The other impressive innovation, he said, were the systems developed to coordinate the efforts of thousands of people who wanted to help. One of the best examples involved mask donations, using a kind of reverse supply chain to collect masks from individuals and deliver them to health care systems.
The efforts, he said, ranged from individuals organizing on Facebook to , a national group that collected and delivered some 17 million pieces of protective gear to those in need between March 2020 and June 2021.
Hannah predicted that ventilation and clean air will continue to be important topics. A number of technologies of low-cost ventilation and air purification already have emerged from the pandemic. In March, the Biden administration launched a Ìýto improve indoor ventilation and reduce the spread of COVID-19 in buildings.
Early studies by researchers at UNMC involving patients who had returned from a COVID-stricken cruise ship contributed to the eventual recognition that the coronavirus spreads through the air.
The process by which innovations are brought to market also appears poised to change, Hannah said, with the Food and Drug Administration offering flexible funding and approval models that potentially could speed the process.Ìý
Joe Runge,Ìýassociate director of UNeTech, whichÌýcoordinates the creation of business startups from research at UNMC and UNO, said the pandemic also has changed how inventors innovate. One example is 3D printing, which allows inventors to quickly build prototypes that allow them to ask and answer questions in the course of developing a product in ways they couldn't before.Ìý
An example is a device called Microwash, a self-contained specimen container that can be used to squirt saline into a patient's nose and collect what drains out for testing for viruses. Designed in a year, it's now in clinical trials. Anticipating a fall surge of COVID-19, UNeTech is working to bring the product, invented by UNMC's Thang Nguyen and Dr. Michael Wadman, to market.Ìý
Here's a look at a few more pandemic-inspired innovations, some of which met an immediate need but are no longer used and others that are meeting ongoing needs and could spark other uses in the future:
Met an immediate need
Before testing was widely available for surgical patients, Drs. Thomas Schulte and Michael Ash designed a plastic shield to protect health care workers from infectious particles during intubation procedures. Schulte is an anesthesiologist and director of peri-operative services at Nebraska Medicine and Ash is a Nebraska Medicine vice president.
At the time, protective gear was scarce and was being conserved for nurses working with known virus patients, Schulte said. Anesthesiologists were concerned about being exposed to aerosolized virus particles when they intubated patients.Ìý
Researchers in China had developed a box-shaped shield. Schulte said their version was more angled and folded flat for storage. It served a great purpose in those early pandemic days, he said, but isn't used much anymore.
Still, Schulte said he would do the work all over again, even if he knew it wouldn't become a routine part of life in the operating room.
"It's innovating and using your creativity to solve a problem or make something easier ... or a better model of it," he said. "We were trying to do that."
Similarly, another group of UNMC researchers developed a method of decontaminating masks with UV radiation. Dixon said UNeMed no longer is licensing the technology.
"It solved a big problem at that time," he said. "They published the recipe, and people all over the world used it."
Still in use
While testing for COVID-19 was in short supply early in the pandemic, dozens of different tests now are available, including a multitude of at-home tests that look for the virus' proteins.Ìý
The emerging pathogens lab Broadhurst heads developed its saliva test, adapted from a Yale University design, by fall 2021. Not only is it still available for use by students, staff and faculty on campus, it's also offered through six partnerships with groups in Omaha, organizations serving immigrant groups in central and western Nebraska and the Oglala Sioux Tribe on the Pine Ridge Reservation.Ìý
Rather than having their nasal passages swabbed, users simply spit through a short straw into a small tube.ÌýTest kits, which cost less than $2, include a tube, a straw and alcohol wipes. Samples don't need preservatives or cold storage.
Broadhurst said the lab is now running a couple hundred tests a week. Demand was much higher during last winter's omicron surge, and the lab is prepared for future surges should they arise.
The lab initially partnered with Omaha Public Schools to conduct saliva testing in several South Omaha schools. Additional researchers led collection and testing of air, surface and wastewater samples.Ìý
While the OPS program has ended, wastewater surveillance continues in locations across the state under a Centers for Disease Control and Prevention-based initiative that's administered through state health departments.Ìý
"It's really neat to see that technology blossom into a large-scale program," Broadhurst said.
The researchers, working with UNMC's Dr. David Brett-Major, now are taking testing in a different direction. Through a recently launched Community Threat Assessment study, they're seeking to get a pulse on shifting COVID-19 risk in the community from another surge and from new variants. To do so, they're collecting information, finger stick blood samples and saliva specimens from volunteers out in the community, working under agreements with partners such as the Omaha City Parks, Recreation and Public Property Department, malls and other venues.
Through the study, Broadhurst said, the researchers hope to get an idea of how many infected people are moving around in the community and gauge the level of immunity in the community, among other measures.
Innovations in care
During surges of COVID-19, hospital beds were in short supply, and many elective procedures were canceled or postponed.Ìý
So some surgeons adapted their procedures to be performed on a same-day basis — without an overnight hospital stay — accelerating a shift that already was underway.Ìý
Dr. Clayton Thor, an orthopedic surgeon with CHI Health, recently estimated that most of his hip and knee replacement patients before the pandemic spent at least one night in the hospital. Now, roughly 80% to 85% go home the same day.Ìý
Dr. Andrew Goldsweig, medical director for structural heart disease at Nebraska Medicine, said he now is conducting same-day procedures for most operations to place devices that block off a potentially clot-producing appendage in the heart in patients with atrial fibrillation, or irregular heartbeats, and to patch holes between upper heart chambers. Both procedures are aimed at reducing stroke risk.
The key change has been in the imaging used to guide the procedures. Previously, that involved threading an ultrasound device into the patient's esophagus, which required general anesthesia and the help of another specialist. During surges, those specialists typically were busy intubating COVID-19 patients.
Now, Goldsweig is using a smaller device in a process called intracardiac echocardiography, or ICE. In it, the device is threaded into the heart through the same vein in the leg that Goldsweig is accessing to place the repair devices.
Similarly, he has shifted to placing most stents in heart arteries by going through an artery in the wrist. Most of those patients also go home the same day.Ìý
"We've moved everything to a less-invasive, same-day kind of platform," he said. "And less general anesthesia."
The shift toward using ICE for imaging in such cardiac procedures, meanwhile, is helping drive innovation in those devices. Goldsweig said he expects to be using new 3D ICE devices within the next couple of months.
"This made it happen faster," he said of the pandemic, "and it's here to stay. There's no reason to go back. We've got a better way now."
Into the future
The greatest innovation of the pandemic, however, were mRNA vaccines, which were based on a technology researchers began developing nearly 20 years ago.
What was unique about the vaccines was the ability of researchers to pivot to bring the technology to bear on the pandemic in such a short time, said Dr. Tyler Martin. A Nebraska native, Martin now runs the Lincoln-area biotechnology consulting firm . HeÌýspent much of his career developing protein vaccines and vaccine adjuvants, which are added to vaccines to further stimulate the immune system.
Teams that Martin led developed two of the four adjuvanted vaccines approved by the FDA, one against influenza and the other targeting hepatitis B.Ìý
Martin said he estimated at the start of the pandemic that vaccine makers would be lucky to produce a protein-based vaccine in two years.Ìý
"The fact that the mRNA vaccines worked so well and were so rapid to manufacture has really been a tremendous thing," he said.Ìý
That success has spurred researchers and companies to pursue mRNA vaccines for a number of other infectious diseases, including flu and HIV. The National Institute of Allergy and Infectious Diseases announced in March that it had launched a phase 1 clinical trial of three experimental HIV vaccines based on the mRNA platform.Ìý
Martin said he thinks the mRNA technology will be useful for other conditions. "It'll just be a matter of searching out where it is and where it isn't helpful," he said. "And that's going to take some time and some experimentation."
Researchers also are looking at using mRNA technology for cancer and gene therapy.Ìý
How the availability of COVID-19 treatments has changed throughout the pandemic
How the availability of COVID-19 treatments has changed throughout the pandemic
January 2020: SARS-CoV-2 sequence is made public
March 2020: Emergency authorization for hydroxychloroquine
May 2020: Emergency authorization for antiviral drug remdesivir
November 2020: First monoclonal antibody treatment receives authorization
December 2020: Pfizer, Moderna vaccines receive authorization
Summer 2021: Politicization of monoclonal antibody treatments
August 2021: Pfizer vaccine receives full FDA approval
November 2021: Children ages 5-11 become eligible for vaccination
December 2021: Two anti-COVID pills receive authorization
February 2022: Eli Lilly develops new monoclonal antibody treatment for Omicron
April Health Matters: Series intended to help Omaha World-Herald readers learn about health care changes
Health care is an important part of our lives, in big and small ways.
Sometimes, it’s as basic as taking our kids to a routine checkup. At the other extreme, it may involve the need for lifesaving treatment.
Health care often winds up taking a hefty slice of our personal finances, and it factors heavily into the budgets of employers and governments.
From a community perspective, health care has a huge impact on our economy — in hospital payrolls, support services and construction of new clinics and other facilities. In Omaha, for example, the Project NExT effort at the University of Nebraska Medical Center is poised to inject a massive amount of investment into an already growing part of town.
All that was true, of course, long before we ever heard about COVID-19. But the pandemic has brought additional attention to the health care world, exposing some of its challenges and forcing changes in the way things are done.
Today, as a way to help readers learn more about how health care is evolving, we are pleased to launch Health Matters in the Heartland.
This monthly series is a collaborative effort among Lee Enterprises’ Nebraska newspapers, including the Omaha World-Herald and Lincoln Journal Star. It’s brought to you with the help of presenting sponsor Blue Cross Blue Shield of Nebraska and a group of monthly sponsors.
Each installment will look at an aspect of health care, focusing on what consumers need to know. Besides an in-depth story, we’ll have multimedia content, additional coverage and features online at . As the series progresses, you’ll be able to find this content in a convenient central spot online.
Today’s article examines the forces that are driving care and costs after COVID. Next month, you will read about changes in mental health treatment. In future months, we’ll look at topics such as technology, employment, virtual care and the challenges of delivering top-notch service to every corner of the state.
The World-Herald been providing award-winning health coverage throughout the pandemic, just as we did for many years before that. This initial story is by our health reporter Julie Anderson, whose experience and knowledge allows her to put the trends and changes in local health care into clear context. Other reporters who work for The World-Herald, Journal Star and other Lee-owned Nebraska newspapers will provide later installments.
At The World-Herald, we appreciate our loyal subscribers who help us maintain our talented team of reporters, photojournalists and other staffers.
And we are grateful for the added support for this project from Blue Cross Blue Shield of Nebraska and our other sponsors.
Our goal is to be your best news source for information about health care. As we move forward with this series, feel free to reach out to us with questions and ideas about what matters to you.
Our best Omaha staff photos & videos of April 2022
Nebraska health care providers adapted during pandemic
OMAHA -- Freddie Warner Jr. couldn’t take it anymore.
His hip hurt, which caused him to put more pressure on his knee. That made his back hurt. He couldn’t sit or stand for long periods. The 51-year-old Omaha man gave up his job in lawn care, his occupation since high school.
On Dec. 1, Warner underwent surgery to replace his left hip. On Feb. 7, he had surgery on his right knee.Ìý
While hundreds of joint replacement surgeries are performed every day across the country, Warner’s operations came during a surge in COVID-19. At the time, staffedÌýhospital beds were in short supply, and many elective surgeries like Warner's had been postponed or canceled.
Instead of keeping Warner at least one night in the hospital after his surgeries, which had been theÌýmore common practice, his surgeon sent him home the same day.
After someÌýphysical therapyÌýand exercises at home, Warner was able to start a new lawn-care job at the end of March.Ìý
While a shift to more outpatient or same-day surgeries had been underway for some time, health system leaders say the pandemic accelerated it. It similarly sped the expansion of telehealth, which gave people access to clinicians when clinics were closed and many patients were leery of in-person encounters. It also provided remote support to staff at smaller hospitals, allowing them to keep more patients closer to their homes.
The pandemic also exposed the challenges facing the health care workforce and the gaps between the demand for such workers and educational programs' ability to produce them. And just as worker shortages have helped drive wage increases in industries from transportation to food service, health systems also are seeing increased labor costs.
“It’s about making sure we’re competitively paying people for the work they’re doing,†said Cory Shaw, chief operating officer for Nebraska Medicine. " ... We have to make sure we pay competitively for the difficult jobs they've got."
Steve Goeser, president and CEO of Methodist Health System, said some health care workers have retired or left the profession as a result of the pandemic. Others have moved to less stressful jobs. Some have left for more lucrative traveling medical jobs.
"So, yes, it's really accelerated salaries," Goeser said. "It's put a real strain on finances. I think we're fortunate in the staffing that we have and the people that stayed with us."
Shaw said Nebraska Medicine already has begun alerting insurers to its increased costs.ÌýReimbursements from Medicare and Medicaid, which make up 60%-70% of a typical hospital's business, fall well short of cost increases in a normal year and will lag even more as health systems seek to cover increased costs.
"It's going to force us to revisit with our health insurance partners and employers what they're paying for health care," Shaw said. That likely will eventually translate to higher premiums and out-of-pocket expenses.
Dr. Cary Ward, chief medical officer with CHI Health, said the cost of health care has gone up dramatically and will stay that way for some time. CHI Health spent $8.7 million on traveling nurses in February alone. Pre-COVID, that tab was about $1.8 million a month.
At the same time, the recent decline in the number of COVID patients, while good news, has meant a reduction in reimbursements for their care. And the cost of supplies and pharmaceuticals also has gone up.Ìý
"It's a very expensive time in health care," Ward said.
For many consumers, health care already was costly. Premiums for employer-sponsored family health coverages rose 4% in 2021, according to the Kaiser Family Foundation's annual survey, with workers on average contributing $5,969 toward the cost of family coverage. Since 2011, average family premiums have increased 47%, more than average wages — at 31% — or inflation — at 19%.Ìý
The federal government has taken steps during the pandemic to ease the financial impacts of the pandemic on Americans:
* Federal funding has covered out-of-pocket costs of COVID testing, vaccines and treatments.
* The public health emergency kept tens of thousands of people enrolled in Medicaid regardless of changes in their eligibility.
* The American Rescue Plan Act , the federal insurance marketplace. The number of Nebraskans enrolled in the marketplace increased by 12% to roughly 99,000, according to CMS.
What happens next, however, is up in the air. Federal funding for testing, vaccines and treatments for the uninsured is running out. An effort to provide an additional $10 billion in COVID assistance remains in flux. A Senate measureÌýwould allow the Biden administration to purchase more vaccines and therapeutics but would not replenish the program that pays for testing, treating and vaccinating the uninsured.
Meanwhile, the Biden administration has extended the public health emergency until mid-July. An earlier end could have causedÌýthousands of Nebraskans who remained on Medicaid during the pandemic to lose that coverage, Nebraska Appleseed says. The expanded tax credits are scheduled to expire at the end of the year, although efforts are underway to include them in future legislation.
Health system leaders say the pandemic drove greater collaboration within and among the state's health systems.ÌýSmaller hospitals, they say, managed patients with more serious conditions than they had before.
"Big or small, you still have to have those partnerships," said Kelly Driscoll, president and CEO of Faith Regional Health Services in Norfolk. "Those are key roles to provide the health care that we all want to provide."Ìý
The pandemic also required health systems to adapt quickly.Ìý
Goeser said Methodist staff knew the value of negative airflow rooms in preventing the spread of pathogens but never fathomed they would create whole floors with negative airflow for treating patients with COVID.ÌýDoing so meant nurses and other caregivers could gown up once for a shift rather than changing between each room.
Like other health systems, Methodist quickly expanded its intensive care unit to other areas and used pre- and post-operative areas for overflow. The health system set up a call center over a weekend to triage patients and send them to a designated COVID clinic to avoid overburdening its emergency rooms.Ìý
Ward said the acceleration of outpatient and same-day surgeries was a positive development that came out of the pandemic.ÌýWhen done with the right patient who has adequateÌýsupport at home, it's better for patients and lowers the cost of care.
"It's great," Ward said, "and we hope that will be a trend that will continue."ÌýÌý
Dr. Clayton Thor, an orthopedic surgeon with CHI Health, said most of his hip and knee replacement patients before the pandemic spent at least one night in the hospital. Now, roughly 80% to 85% go home the same day, as Warner did.
“COVID did the shift for me,†Thor said. “We had to cancel inpatient surgeries for such a long period of time, and multiple periods of time … to where patients were hurting bad enough, the only option was to do it that way.â€
Thor said he started shifting to same-day dismissals with younger, healthier, more active patients and gradually expanded his list. Patients with other significant health issues, such as cardiac histories or oxygen use, still are kept overnight.
Warner said he was happy to skip a night in the hospital. He had set a goal of getting back to work by May, which he beat by about a month. "I didn't think it would be this early," he said. "I feel brand new, like I have a lot of energy to go out and do things."Ìý
Shaw said Nebraska Medicine performed 24,000 surgeries five years ago, 10,000 of them inpatient procedures and 14,000 outpatient ones. For the fiscal year that ended June 30, the numbers stayed about the same but shifted to 15,000 outpatient surgeries and 9,000 inpatient ones. He expects the shift to continue during the current fiscal year.
One reason for the shift, which Shaw said was highlighted during the pandemic, was to make sure hospital beds were available for those who really need them.
And just as schools and businesses flipped to remote sessions on Zoom, health systems and clinics quickly expanded their telemedicine offerings to provide clinical and behavioral health visits and offer online consultations with other, smaller hospitals.Ìý
Faith Regional's respiratory therapists, for instance, trained staff at smaller hospitals to use BiPAP machines, Driscoll said. A noninvasive form of ventilation, BiPAP became an important treatment for COVID patients.Ìý
Shaw said telehealth made up a sliver of Nebraska Medicine's clinical activity before the pandemic. At the peak, it comprised 80% to 90%. Now it's back to 15% to 20%. Health systems with a greater share of primary care may be higher, he said.Ìý
Methodist peaked at about 250 virtual visits a week when some clinics were closed and now has dropped under 100, Goeser said. But the health system maintains robust virtual outreach to other hospitals and in behavioral health.
Ward said 32% of CHI Health's visits during the peak of the pandemic were virtual. That has since declined as patients have returned to more in-person visits. But Ward said virtual care still offers an alternative for many, such as those who don't feel well enough to come in and patients who live far from clinics.
"I think telehealth will play an increasingly important role in the future of health care," he said.Ìý
Drive-up care also caught on during the pandemic, Ward said. Three new CHI Health family health centers, one near CHI Immanuel in Omaha, one in Elkhorn and another in Lincoln, will have heated drive-thru bays that patients can access.
Dr. Michael Romano, chief medical officer for the Nebraska Health Network, said the shift toward more virtual care and outpatient procedures generally is a good thing because both are done in lower-cost settings. The cost pressures in health care, he said, will create incentives for providers to look at how they can do things differently.Ìý
"I don't necessarily look at the cost pressures as being a bad thing," Romano said. "I think we ultimately end up doing things better because the cost pressures have forced us to do things better."
The data on outcomes from virtual care, however, still is a few years away. "My gut feel is there are lots of situations where it's very effective, some others not so much," he said. "We need to be a little selective in how we use it."
Lee Handke, the network's CEO, said patient satisfaction with telehealth is high, which will make it difficult to reverse course. The health network, which formed in 2010, includes physicians in Nebraska Medicine, Methodist Health System and Fremont Health.Ìý
Eventually, Handke said, health plans will begin to steer members to providers and facilities with lower costs. What's still missing from that equation, however, are easy-to-use tools to help customers compare and shop. Recent federal pricing transparency rules require health systems to post pricing information. That raw data will become easier to use once software developers create new tools tapping the information.
Romano added that employees still will need some incentive, such as being able to share in the savings on out-of-pocket costs, to shop around.
Meanwhile, health system leaders say they're working to increase efficiencies.Ìý
Methodist, for instance, began using artificial intelligence to automate billing and claims in 2019 and since has increased the use of the technology. Jeff Francis, vice president of finance, said the automation saves about 1,400 hours of work a month that once was done by staff in claims alone.
Nebraska Medicine and the University of Nebraska Medical Center are developing an 18- to 25-bed inpatient unit on their campus as a futuristic setting where they can test different care team models and technologies. The goal is to have patients in the unit beginning in 2024.
Ward said CHI Health has looked at several different models of care intended to increase cost effectiveness and adjust to staff shortages.
One model, called iCARE, or Interprofessional Collaborative Alignment Resulting in Exceptional Patient Care Teams, involves bringing pharmacists onto floors to help nurses administer some medications, such as complex antibiotic infusions, and having occupational therapists assist nurses with tasks such as walking patients and strength training.
Shaw said the delaying of care during the pandemic is likely to have long-lasting effects. If patients avoided or didn't have access to cancer screenings, they later might be diagnosed with a more advanced disease that will cost more to treat than if it had been detected earlier.
Because of such concerns, health systems have been encouraging people to get in for screenings and other preventative care.Ìý
Handke said the health network worked with providers during the pandemic to focus on the most vulnerable patients during the pandemic. As an accountable care organization, the network's goal is to take good care of Medicare patients in order to improve their health and lower costs. Wellness visits for those patients during 2021 remained high.
Romano said some national data indicates that more strokes and heart attacks have occurred since the pandemic began. Cancer screenings and new diagnoses of cancer have fallen off, although it may take a few years before that impact is clear. "I don't think we know how that's going to hit," he said.Ìý
A brief look at American health care’s long, complicated history
A brief look at American health care’s long, complicated history
1781: First medical society established
1865: Medical division of Freedmen's Bureau is established
1929: First employer-sponsored health care plan in the US is made available to teachers
1943: IRS makes employer-sponsored health insurance tax-free
1945: Harry Truman’s proposal for a national health insurance fails
1950-1960s: American Medical Association lobbies against single-payer systems
1965: Medicare and Medicaid programs established
1970s: First bills for single-payer system are proposed in Congress
1996: Health Insurance Portability and Accountability Act passes
A Omaha mom who specializes in 3D imaging arranged to get a 3D rendering of the scans of her son's brain so her husband could see where the boy's tumor was situated.
The Lincoln-Lancaster County Health Department reported 458 cases last week, a more than 60% increase over the previous week and the highest weekly total since the week ending Sept. 3.
According to the Lincoln-Lancaster County Health Department, there were 365 positive COVID-19 tests reported for the week ending Saturday, down 20% from 458 the previous week.