Nitric oxide to treat COVID-19? Google-Apple project; convention center as hospital

Boston Convention and Exhibition Center has been transformed (temporarily!) into a medical center for COVID-19 patients.

From The New England Council (newenglandcouncil.com)

As our region and our nation continue to grapple with the Coronavirus Disease (COVID-19) pandemic, The New England Council is using our blog as a platform to highlight some of the incredible work our members have undertaken to respond to the outbreak.  Each day, we’ll post a round-up of updates on some of the initiatives underway among Council members throughout the region.  We are also sharing these updates via our social media, and encourage our members to share with us any information on their efforts so that we can be sure to include them in these daily round-ups.

You can find all the Council’s information and resources related to the crisis in the special COVID-19 section of our website.  This includes our COVID-19 Virtual Events Calendar, which provides information on upcoming COVID-19 Congressional town meetings.

Here is the Aug. 13 roundup:

Medical Response

• Massachusetts General Hospital Studying Possible Treatment – Researchers at Massachusetts General Hospital (MGH) are investigating whether the gas nitric oxide can help treat—or even prevent—COVID-19 infections. The gas, widely used for patients in respiratory failure, has been known to provide additional antiviral effects. The trial at MGH is the only in the country and one of few worldwide. Read more from WBUR.

• Google Developing Contact-Tracing Technology – Google, in partnership with Apple, is working to develop technology to alert individuals if they have come into contact with someone infected with COVID-19. The technology will use contact tracing via Bluetooth signals to determine users that may have been in contact with infected individuals. To maintain privacy, the app would not record GPS location data or personal information. BBC News has more.

• Sanofi Donates 100 Million Doses of Potential Treatment to 50 Countries – After its drug hydroxychloroquine emerged as a potential treatment for COVID-19, drugmaker Sanofi has pledged 100 million doses of the antimalarial drug across 50 countries. In addition to increasing production capacity of the drug, Sanofi has called for coordination and stabilization along the supply chain of the drug to quadruple production should hydroxychloroquine emerge as an effective treatment. More from Reuters.

• Boston Convention and Exhibition Center Transformed into Medical Center – The Boston Convention and Exhibition Center—owned by the Massachusetts Convention Center Authority (MCCA)—has been transformed into a new medical center for COVID-19 patients. The facility, renamed Boston Hope Medical Center, will provide 1,000 beds and other resources for the city’s infected, and will be managed by Partners HealthCare and Boston Health Care for the Homeless. Read more in The Boston Globe.

Economic/Business Continuity Response

• Dell Provides Early Payouts for Development Projects – To assist its research and development partners, Dell Technologies is offering cash payouts for development projects, as well as free training for services necessary to maintain operations. In addition, the tech company is providing no-interest loans and up to nine months of payment deferrals for its customers. CRN has more.

• AT&T Technology Used to Help Disinfect Hospitals – AT&T, using its Internet of Things (IoT) technology, is partnering with technology companies to destroy viruses, bacteria, and spores on surfaces in hospitals. The connectivity from AT&T allows the technology to use ultraviolet (UV) rays to disinfect surfaces and helps the technology optimize performance, lower healthcare costs, and maximize patient and worker safety in hospitals. Read more.

Community Response

• Boston Colleges Offer Residence Halls to Exposed Workers – Supporting a wide variety of employees from facilities ranging from the Pine Street Inn and Brigham and Women’s Hospital, Boston-area colleges are offering their residence halls and campus facilities to workers who might have been exposed to the novel coronavirus. Northeastern University, Emmanuel College, Boston University, Simmons University, and Massachusetts College of Art and Design are some of the schools offering support to workers across multiple industries to protect them. Read more from WBUR.

• Veolia Donates 40,000 Masks to Hospitals –Environmental services company Veolia has donated 40,000 masks to hospitals across the United States and Canada, drawing from its existing stockpile. The masks will provide exposed workers with the protective equipment they need to remain safe while working. The Post Star has more.

Stay tuned for more updates each day, and follow us on Twitter for more frequent updates on how Council members are contributing to the response to this global health crisis.

Partners and GE team up in AI project

The word "robot" was coined by Karel Čapek in his 1921 play R.U.R., the title standing for "Rossum's Universal Robots"

The road to artificial intelligence: This ontology represents knowledge as a set of concepts within a domain and the relationships between those concepts.

From The New England Council (newenglandcouncil.com)

“Partners HealthCare and General Electric, both based in Boston, have announced that they are in the midst of obtaining FDA approval for deployment of their newly developed artificial intelligence (AI) to hospitals and health systems across the world. Partners and GE Healthcare have been partnering to develop the AI program for nearly three years.

“As a baseline, the health-care providers’ new platform seeks to couple data results from GE imaging equipment with electronic medical record inputs, and then use the AI to aid clinicians in making treatment decisions. The new technology’s approach differs from less accurate and overreaching ones currently on the market, using contextual data from imaging equipment and aiming to help clinicians make decisions, rather than making the decisions for them. In addition, the AI and its data would be a shared platform, allowing the system to improve itself by exploring a wider range of information. The software’s design gives all clinicians navigable access to patients’ medical records that can be utilized and acted upon in the midst of day-to-day work.

“‘What we are doing now is we’re actually taking the capabilities of these platforms, and you’re going to expose these to the external world, from our developer community perspective so that you know developers across the globe could use some of these features, and that cross-section that we have created, to rapidly develop applications,’ said Amit Phadnis, chief digital officer for GE Healthcare.’’

Elizabeth Rosenthal: How your nice hospital helps drive health costs into stratosphere

Main entrance of Massachusetts General Hospital, in Boston. MGH is the flagship of Partners HealthCare, which is well known for its very high costs.

From Kaiser Health News

As voters fume about the high cost of health care, politicians have been targeting two well-deserved villains: pharmaceutical companies, whose prices have risen more than inflation, and insurers, who pay their executives millions in salaries while raising premiums and deductibles.

Although the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass to arguably a primary culprit behind runaway medical inflation: America’s hospitals.

Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than the gross domestic product, inflation and wage growth. Spending on hospitals represents 44% of personal expenses for the privately insured, according to the Rand Corp.

A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42% from 2007 to 2014 for inpatient care and 25% for outpatient care, compared with 18% and 6% for physicians.

So why have politicians on both the left and right let hospitals off scot-free? Because a web of ties binds politicians to the health care system.

Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.

As hospitals and hospital systems have consolidated, they have become the biggest employers in numerous cities and states. They have replaced manufacturing as the hometown industry in a number of Rust Belt cities, including Cleveland and Pittsburgh.

Can Kamala Harris ignore the requests of Sutter Health, Kaiser Permanente, UCLA or any of the big health- care systems in California? Can Elizabeth Warren ignore the needs of Partners HealthCare, Boston’s behemoth? (Bernie Sanders may be somewhat different on this front because Vermont doesn’t have any nationally ranked hospitals.

Beyond that, hospitals are often beloved by constituents. It’s easy to get voters riled up about a drugmaker in Silicon Valley or an insurer in Hartford. It’s much riskier to try to direct their venom at the place where their children were born, that employed their parents as nurses, doctors and orderlies, that sponsored local Little League teams, that was associated with their Catholic Church.

And, of course, there’s election money. Hospital trade groups, medical centers and their employees are major political donors, contributing to whichever party holds power — and often to the out-of-power party as well. In 2018, PACs associated with the Greater New York Hospital Association, and individuals linked to it, gave $4.5 million to the Democrats’ Senate Majority PAC and $1 million to their House Majority PAC. Its chief lobbyist personally gave nearly a quarter of a million dollars to dozens of campaigns last year.

Sen. Sanders has called on his competitors for the Democratic nomination to follow his lead and reject contributions from pharma and insurance. Can any candidate do the same for hospitals? The campaign committees of all 10 candidates participating in the upcoming Democratic debate have plentiful donations linked to the hospital and health care industry, according to Open Secrets.

But the symbiosis between hospitals and politicians operates most insidiously in the subtle fueling of each other’s interests. Zack Cooper, a health economist at Yale, and his colleagues looked at this life cycle of influence by analyzing how members of Congress voted for a Medicare provision that allowed hospitals to apply to have their government payments increased. Hospitals in districts of members who voted “yea” got more money than hospitals whose representatives voted “nay,” to the collective tune of $100 million. They used that money to hire more staff and increase payroll. They also spent millions lobbying to extend the program.
Members who voted yea, in turn, received a 25% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in their home states. It was a win-win for both sides.

To defend their high prices, medical centers assert that they couldn’t afford to operate on Medicare payments, which are generally lower than what private insurers pay. But the argument isn’t convincing.

The cost of a hospital stay in the United States averaged $5,220 a day in 2015 — and could be as high as over $17,000, compared with $765 in Australia. In a Rand study published earlier this year, researchers calculated that hospitals treating patients with private health insurance were paid, overall, 2.4 times the Medicare rates in 2017, and nearly three times the rate for outpatient care. If the plans had paid according to Medicare’s formula, their spending would be reduced by over half.

Most economists think hospitals could do just fine with far less than they get today from private insurance.

While on paper many hospitals operate on the thinnest of margins, that is in part a choice, resulting from extravagance.

It would be unseemly for these nonprofit medical centers to make barrels of money. So when their operations generate huge surpluses — as many big medical centers do — they plow the money back into the system. They build another cancer clinic, increase CEO pay, buy the newest scanner (whether it is needed or not) or install spas and Zen gardens.

Some rural hospitals are genuinely struggling. But many American hospitals have been spending capital “like water,” said Kevin Schulman a physician-economist at Stanford. The high cost of hospitals today, he said, is often a function of the cost of new infrastructure or poor management decisions. “Medicare is supposed to pay the cost of an efficient hospital,” he said. “If they’ve made bad decisions, why should we keep paying for that?”

If hospitals were paid less via regulation or genuine competition, they would look different, and they’d make different purchasing decisions about technology. But would that matter to medical results? Compared with their European counterparts, some American hospitals resemble seven-star hotels. And yet, on average, the United States doesn’t have better outcomes than other wealthy nations. By some measures — such as life expectancy and infant mortality — it scores worse than average.

As attorney general in California, Kamala Harris in 2012 initiated an antitrust investigation into hospitals’ high charges. But as a senator and presidential candidate, she has been largely silent on the issue — as have all the other candidates.

As Uwe Reinhardt, the revered Princeton health economist who died in 2017, told me, “If you want to save money, you have to pay less.” That means taking on hospital pricing.

So fine, go after drugmakers and insurers. And, for good measure, attack the device makers who profit from huge markups, and the pharmacy benefit managers — the middlemen who negotiate drug prices down for insurers, then keep the difference for themselves.

But with Congress returning to Washington in the coming days and a new Democratic debate less than two weeks away, our elected officials need to address the elephant in the room and tell us how they plan to rein in hospital excesses.

Elisabeth Rosenthal: erosenthal@kff.org, @rosenthalhealth

Elizabeth Rosenthal is a reporter at Kaiser Health News.

Let behemoths bargain with behemoths

Behemoth and Leviathan, watercolor by William Blake from his Illustrations of the Book of Job.

From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

So consolidation of New England’s health-care biz continues apace. Two big Massachusetts-based health insurers – Harvard Pilgrim Health Care and Tufts Health Plan -- plan to merge. This follows Beth Israel Deaconess Medical Center and Lahey Hospital merging this year into the very big Beth Israel Lahey Health, and Rhode Island-based CVS taking over health insurer Aetna. And huge Partners HealthCare, the Boston-based hospital and physicians network group (Massachusetts General Hospital, etc.), made a run this year at taking over Rhode Island-based Care New England. And the latter outfit was in failed talks to merge with Lifespan, a merger that economics might still force – to be followed by that merged creature being eaten by a Boston group, producing a flock of golden parachutes for redundant executives?

The economics of the health-care business mean that there will be more such mergers. Big will get bigger. This may include Partners coming back to Rhode Island to try to gobble up Care New England or Lifespan or both. Or maybe Beth Israel Lahey Health will try to invade the Ocean State.

With the huge economic power – especially pricing power – and lobbying clout of the new insurance behemoths, state regulators will have their hands full trying to regulate them. Still, the merger, which would affect several million New England customers and their families, would create an entity with impressive bargaining weaponry to curb the very high prices enabled by the size and global prestige of the hospital behemoths. So let ‘em merge.

Boston gobbling up Providence

The Warren Alpert Medical School at Brown University, in Providence's old Jewelry District. The building used to be a factory.

Adapted from Robert Whitcomb's "Digital Diary,'' in GoLocal24.com

Brown University says it will continue its links with Care New England (CNE), which has medical school  teaching hospitals, even if Boston-based behemoth Partners HealthCare takes it over. Well, of course Brown would have to: It needs nearby teaching hospitals!

The PR on this is that the medical school  would remain Care New England’s primary research and teaching affiliate. Well, maybe. The financial and research clout of Partners (with such world-renowned hospitals as Massachusetts General and Brigham and Women’s hospitals) is such that that we can expect a lot of  CNE stuff now being done in Rhode Island – much of it administrative but some of it clinical work and research --  will end up being done in Boston. A lot of jobs will disappear around here, but some might be added, too, maybe even from Boston:

Greater Providence will continue to have the advantages of being a cheaper and easier place to work in.

Next stop: Partners might also buy Lifespan, the biggest Rhode Island hospital system, thus becoming a statewide monopoly. An alluring opportunity to jack up prices.

Boston sucking in the health-care biz; better trains, please

Main entrance of Massachusetts General Hospital, in Boston. MGH is the flagship of Partners HealthCare.

It’s unclear what precisely is going on with the new talks among Partners HealthCare, the giant Boston-based  hospital system, and Rhode Island’s Care New England (CNE) and Lifespan. Partners of course has been trying to take over CNE, and now it may be trying to take over Lifespan, too. The participants’ statement that they are assessing how “they might work together to strengthen patient care delivered in Rhode Island’’ is smoke that may camouflage what might really be going on: a plan for Partners to take over most of the Ocean State’s hospitals.  (Who knows what might happen with South County Hospital, which is still independent. Westerly  Hospital is part of the Yale New Haven Health System.)

The effect of a takeover by Partners would be that much (most?) of Rhode Island’s health care  would be run from Boston, one of the most important medical centers on Earth. It would mean that, more and more, complex procedures for  Rhode Islanders’ very serious illnesses and injuries would be performed in Boston, because of the efficiencies of scale and the density of specialists there, and not in Rhode Island, which would offer mostly primary and behavioral- and mental-health care.

It’s unclear what the impact would be on the  Brown Medical School. Butler, Bradley, Hasbro Children’s, Miriam, Rhode Island and Women & Infants’ hospitals, as well as the VA Medical Center in Providence, are all teaching institutions for Brown. Partners’ facilities are teaching hospitals for the behemoth Harvard Medical School.  Tough competition.

A Partners takeover of CNE and Lifespan, besides providing very lucrative golden parachutes for CNE and Lifespan executives – bosses of enterprises being acquired love mergers because they make a personal killing -- would leave an enterprise with huge pricing power. You can be pretty sure that it would take full advantage of this by jacking up prices, just as Partners has done in Greater Boston. That has drawn much scrutiny from Massachusetts regulators and long investigative pieces from The Boston Globe.

Rich and powerful Greater Boston often seems to suck up a lot of oxygen in New England. Still,  overall, Rhode Island benefits from being so close to a world city, with its massive wealth creation and cultural richness. Indeed northern Rhode Island is  increasingly part of Greater Boston – a cheaper  residential and workplace option for people who need to be close to, especially, downtown Boston/Cambridge. Consider that Rhode Islanders will soon be able to apply for some of the 2,000 jobs that the increasingly monopolistic Amazon has just announced it will add in Boston, which is also still a candidate for the company’s much-hyped “second headquarters.’’ (Will the massive coastal flooding that seems to be an increasing threat to Boston’s Seaport District scare them away?)

The improvements in Boston-Providence MBTA commuter rail service promoted by a group called TransitMatters would improve the benefits to Greater Providence of being close to Boston. Few if any projects enrich a metro area like good mass transit.

To read the TransitMatters.org on this, please hit this link:

http://transitmatters.org/regional-rail-doc

Among the organization’s many recommendations is for trains on the Boston-Providence line to run every 15 minutes at peak times and every half hour in off-peak times, as well as free transfers among commuter trains, buses and subways. The aim is also to cut the MBTA train time between Providence and South Station, in Boston, by, say 20 to 25 minutes.

This may all seem pie in the sky until you see that Europe and East Asia already have such service – actually, some of it is even better. A major reason is that they see  state-of-the-art passenger train service as crucial for the socio-economic health of their metro regions and are willing to levy the taxes needed to provide it, unlike in private-opulence-public-squalor America.

Brown U. tries to fend off expansionist Partners HealthCare

Part of the Warren Alpert Medical School, aka the Brown Medical School, in Providence.

Adapted from Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com:

Brown University’s plan to join with for-profit Prospect Medical Holdings to buy Care New England to fend off Partners HealthCare’s bid for CNE is motivated by a very reasonable fear. Partners is joined at the hip with the Harvard Medical School. Letting the Partners behemoth into Rhode Island would result in  many patients and clinicians who might otherwise stay in Rhode Island going to Partners’ famous Harvard-affiliated hospitals in Greater Boston, perhaps ravaging the small Brown Medical School in the process.

Indeed, Partners would suck a lot of oxygen out of the Ocean State’s health-care sector. But the takeover looks full-steam ahead. Partners’ Massachusetts General Hospital and Brigham and Women’s Hospital may well already be planning to welcome many new patients from Little Rhody.

Will hospital merger mania continue?

Excerpted from Robert Whitcomb's "Digital Diary,'' in GoLocal24.

The collapse of affiliation talks between Care New England,  the Rhode Island hospital chain, and Southcoast Health, in southeastern Massachusetts, as did the collapse of Lifespan and Care New England talks a few years back, raises the question of when we’ll see another hospital chain merger around here, given the inevitable turf battles.

With the drive for economies of scale and for sharing access to the best care and research, will the latest collapse lead to a big Boston-based chain coming in and taking over? Partners HealthCare, whose hospitals include Massachusetts General Hospital and Brigham & Women’s, might eye expansion in these parts because Massachusetts regulators think that it has gotten too big and powerful in Greater Boston. The Brown Medical School would presumably not like a Partners invasion because Partners is joined at the hip with the Harvard Medical School behemoth. Maybe given the size and executive salaries of hospitals these days, affiliating with the Harvard Business School would be appropriate.

Many hospital chains want to merge to strengthen their bargaining power with huge insurance companies. Maybe in 10 years, we’ll have “Medicare for all,’’ which will make much of this moot.

In the meantime, we have something to learn from those independent hospitals, such as South County Hospital,  in southern Rhode Island, that have maintained their independence and high-quality care in the face of the massive disruption that that healthcare sector is now undergoing.