California Wildfire Worsens Health Care Workforce Shortage

Stories that caught our attention this week

A pebble is seen at a donation fair for fire evacuees camping at a parking lot in Chico, California, on November 14, 2018. Photo by JAVIER TOVAR/AFP/Getty Images
A hopeful message on a painted stone on display at a donation fair in Chico, California, for evacuees from the nearby Camp Fire on November 14, 2018. Photo: Javier Tovar/AFP/Getty Images.

When the Camp Fire consumed the town of Paradise, California, last month, Adventist Health Feather River Hospital went down with it. Because of severe damage, Feather River, the area’s sole hospital and biggest employer, is unlikely to reopen before 2020, if at all.

Paradise is located in Butte County, which before the wildfire had a shortage of physicians — 45 primary care physicians per 100,000 people, compared to the Greater Bay Area’s 64 per 100,000. Now that the smoke has cleared and the town can begin to rebuild, decisions have to be made about how to address gaps in health care access for residents who plan to return, as well as what to do about Feather River’s 1,000 employees.Essential Coverage

In the San Francisco Chronicle, Catherine Ho writes that Adventist Health, which operates Feather River, has agreed to pay all employees’ salaries through February 5, 2019, and to continue employer-sponsored health benefits through May 2019. Employees are scrambling to figure out their next steps. Some are applying to work at other Adventist Health hospitals in the region, others are moving away in search of employment and more affordable housing.

Theodore Muller, MD, an emergency department physician at Feather River, writes on the Center for Health Journalism Member Blog that after narrowly escaping the Camp Fire, he returned to his primary home in Lincoln, California, about 70 miles south of Paradise. Muller and his wife owned a second home in Paradise, but it was among the more than 11,000 destroyed in the fire. “With the obliteration of Paradise, there is no longer a community for the hospital to serve,” he writes. “I have picked up part-time work at a number of nearby hospitals and feel grateful for that.”

Hillary McDaniel, who worked at Feather River’s call center, wasn’t so lucky, Ho reports. McDaniel lost her home to the fire and has struggled to find a new home and a job. She now lives in Oregon, where she, her husband, and their five-year-old son found an RV park offering one month of free housing to Camp Fire victims.

Health IT Enables Care in a Disaster

Meanwhile, patients of Feather River should be able to receive seamless service at other hospitals thanks to a successful health information technology (IT) disaster response. Politico’s Arthur Allen reports that California’s federally supported state effort to enable health IT in disasters is setting the pace nationally. “Since 2013 the state’s Emergency Medical System has been working with the federal Office of the National Coordinator for Health Information Technology to create the Patient Unified Lookup System for Emergencies, or PULSE, which enables clinicians to link to health information exchanges and download simple patient information anywhere there’s a Wi-Fi signal,” Allen writes.

PULSE failed in its first real-world deployment — the 2017 Tubbs Fire in Napa, Sonoma, and Lake counties — due to spotty Wi-Fi and a lack of clinician education. But the system has improved significantly since then. By the time the Camp Fire broke out in early November 2018, Elizabeth Steffen, director of a local health information exchange, was able to successfully enable connections for two hospitals that received patients evacuated from Paradise. In the chaos of the fire, no-one collected data on the impact of the exchange, but Steffen has some anecdotes: Providers avoided giving antibiotics to a newborn baby based on information from his records that he had a viral infection, and a woman seen recently at Feather River gave birth without incident at a hospital in Chico after her records were electronically located.

Coverage Gains at Risk from Vanishing Resources, Policy Changes 

Remember when the National Guideline Clearinghouse (NGC) went missing from the Agency for Healthcare Research and Quality’s website in July? The Sunlight Foundation’s Web Integrity Project, which reported on the NGC’s disappearance, now details the removal of yet another important health care resource. This time it’s from the Centers for Medicare & Medicaid Service’s (CMS’s) Health Insurance Marketplace website.

According to Sunlight, CMS deleted “Marketplace Outreach: Best Practices for Outreach to Latino Communities” about one month before the start of the 2019 open enrollment period. Rachel Bergman, director of the Web Integrity Project, explains that the content was intended to train insurance navigators on outreach to Latino communities. “The slides included information about the challenges Latinos might face when enrolling for coverage, such as fear of immigration enforcement, and best practices for assistance, such as making services culturally and linguistically appropriate.” Navigators are vital for helping consumers, especially those in underserved communities, understand and choose insurance plans.

An archived version is available here (PDF), but the CMS move is noteworthy at a time when Latino communities already face a confluence of factors that could dissuade or prevent them from enrolling for health coverage. The Trump administration has cut the budget for the navigator program by about 84% since taking office.

The administration has proposed changes to the public charge rule that many health care and philanthropic organizations, including the California Health Care Foundation, fear will have a “chilling effect” on immigrants accessing public benefits like Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The UCLA Center for Health Policy Research estimates that 765,000 immigrants in California could disenroll from Medi-Cal and CalFresh (California’s Medicaid and SNAP programs, respectively) as a result of the proposed changes. Nearly 70% of those losing benefits would be children.

Altogether, these changes may reverse the gains that have resulted for Latinos since the implementation of the Affordable Care Act (ACA). In a letter to CMS, Senator Catherine Cortez Masto (D-Nevada) wrote, “Prior to the ACA, the uninsured rate among Latinos was 43%. By 2016, that figure had plummeted to under 25%. . . . Despite this important progress, Latinos still have the highest uninsured rates of any racial or ethnic group within the United States.”

A CMS spokesman told the Washington Post that the removal of the outreach resource was part of routine “updates and maintenance of, which sometimes includes the revision and removal of content that is not current or underutilized.” However, Bergman challenged this explanation, emphasizing that only one small portion of the content in the navigator presentation was outdated.

Essential Coverage will be on holiday break until the week of January 7, 2019. In the meantime, give me some health policy stories to read — tweet at me with #EssentialCoverage or email me. Happy holidays!

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