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By Heather Landi – Nov. 1, 2022 – FIERCE Healthcare

Among physician specialties, the biggest declines were seen within internal medicine, family practice and emergency medicine fields.

Nearly 334,000 physicians, nurse practitioners, physician assistants and other clinicians left the workforce in 2021 due to retirement, burnout and pandemic-related stressors, according to new data.

Physicians experienced the largest loss, with 117,000 professionals leaving the workforce in 2021, followed by nurse practitioners, with 53,295 departures, and physician assistants, with 22,704 departures. About 22,000 physical therapists also left the healthcare workforce and 15,500 licensed clinical social workers, according to a report from commercial intelligence company Definitive Healthcare.

Among physician specialties, the biggest declines were seen within internal medicine, family practice and emergency medicine fields. “Like clinicians and registered nurses, providers in these three specialties frequently worked on the frontlines during the pandemic, risking exposure and facing many of the same pressures and stressors as described earlier,” the report authors wrote.

In 2021, 15,000 internal medicine doctors left the workforce, followed by 13,015 providers who left family practice and 10,874 who left clinical psychology. Definitive Healthcare’s report leverages data from more than 2 million physicians and nurses, 9,200 hospitals and IDNs and 128,000 physician groups.

Among high levels of burnout, many healthcare providers are nearing retirement age, the report noted. According to Definitive Healthcare data, many physicians across several healthcare specialties are on the verge of retirement or will be near that age soon. Research from the American Association of Medical Colleges (AAMC) found that nearly 45% of doctors are older than age 55, and more than 40% of active physicians will be 65 or older in the next ten years. The average age of a nurse is 57, the report said.

To address staffing shortages, hospitals are spending more on pricey contract labor. According to a Kaufman Hall report, hospitals have seen their per-patient labor expense increase dramatically in recent years, from $4,009 in 2019 to $5,494 in 2022. In 2020, large hospitals with more than 250 beds spent nearly $11 million on average for contract labor, according to Definitive Healthcare’s data. 

Hospitals and health systems are spending more money to hire and retain healthcare workers, the report found. These facilities are increasing salaries, offering sign-on bonuses, and expanding benefits to lure in new workers. Hospitals nationwide spent a total of about $97.3 million on employees and physician salaries in 2020, compared with $82.7 million in 2016, according to data from the October 2021 Medicare Cost Report.

Rural hospitals are feeling the pressure from the ongoing current labor crunch. “As larger hospitals in urban areas lure nurses and other healthcare workers with hefty bonuses, rural hospitals are struggling to compete. In contrast, rural hospitals offer smaller salaries, further enhancing the attractiveness of pursuing opportunities elsewhere. Staffing shortages have pushed many small hospitals in rural areas to refuse the admittance of patients, close inpatient wards and limit or suspend outpatient services, the report authors wrote.

The report found that South Carolina experienced the highest level of staffing shortages, with almost 29% of hospitals reporting a critical staffing shortage. Similarly, about 20% of hospitals in Georgia, Vermont, Delaware, and Michigan, experienced critical staffing shortages in 2021.

Definitive Healthcare researchers offer a number of strategies to combat staffing shortages.

Healthcare organizations can invest in technologies and services like telehealth to keep doctors and nurses focused on what’s most important: treating patients. Providers can use telemedicine to treat patients with conditions that might not be severe enough to warrant an in-person visit, mitigating some of the negative consequences of staffing shortages. Treating patients over the phone or a video call has also been linked to a reduction in facility operating costs and lower readmission rates. 

Hospitals and healthcare facilities also can invest time and resources into programs that promote mental and behavioral health through education and training, according to the report. The Dr. Lorna Breen Health Care Provider Protection Act, which became law in March 2022, empowers healthcare entities through awarded grants to tackle these challenges right now.

The report’s authors also suggest fundamental changes to how Graduate Medical Education (GME) programs work to help the healthcare industry diversify and expand the workforce. “The availability and capacity of GME programs are capped by Medicare, which can be particularly detrimental to hospitals in rural areas. Raising the cap can help replenish the depleted healthcare workforce and offer providers the additional training they need to be better prepared to respond to the next pandemic,” the report authors wrote.

By Jacqueline LaPointe

September 21, 2022 – A new paper from the patient advocacy group Families USA is taking aim at hospitals and health systems. The report claims that high hospital prices are “bleeding Americans dry” as these organizations become more corporatized and put profits over patients.

“This paper exposes how the corporate hospital business model has fundamentally transformed into one that favors monopolies and setting high prices at the expense of our health,” Frederick Isasi, Families USA’s executive director, said in a public statement. “It’s time for us to address these pricing abuses head on to end the high hospital costs that are endangering families’ health and economic security.”

Hospital prices have increased by as much as 31 percent since 2015 and have grown over four times faster than workers’ wages, Families USA reports in the paper citing several studies. Not only have hospital prices increased, but they also continue to vary by location. Families USA says that the price tag and variation is just another way hospitals charge whatever they want for services, rather than pricing procedures and tests based on actual cost, efficacy, and quality.

Meanwhile, hospital CEOs are being paid millions of dollars while workers face higher insurance costs. What’s more, many of the highest-paid CEOs manage non-profit hospitals, making healthcare one of the highest-paying non-profit industries in the US, according to the paper. The paper even accused hospitals and health systems of exaggerating how much revenue they receive from value-based payment arrangements.   

“Across the nation, the vast majority of hospital payment arrangements are still anchored in fee-for-service economics,” the report states, pointing to the fact that many alternative payment models like pay-for-performance arrangements still reimburse providers using a fee-for-service model.

“Even more troubling, providers that engage in bundling often aggressively increase volume both in the Medicare and private sectors (for example, putting up billboards in their communities to advertise newly bundled knee replacement services) and have been able to easily “align” with doctors in the bundle and capture more and more market share,” the report continues.

Nearly 41 percent of healthcare payments are tied to value-based payment models, including pay-for-performance arrangements, according to the latest data from the Health Care Payment Learning & Action Network (LAN). Most of these value-based payments, however, are either tied to fee-for-service or do not include downside financial risk.

Families USA calls for a more competitive healthcare industry to make care more affordable. On their list of reforms to encourage greater competition are more price transparency requirements to unveil proprietary hospital pricing information and reformation of non-profit requirements to ensure non-profit hospitals are not making “undue revenue” as patients in their communities struggle to afford care.

The paper also recommends establishing a hospital global budget payment model and cost containment commissions so hospitals are held accountable for cutting costs and improving population health outcomes. “We must build the consumer movement around these policy solutions to ensure that consumers, employers, workers, health equity leaders and others are coming together as a counterweight to the entrenched business interests and political influence of the hospital industry,” the paper states.

 Hospital groups were not immediately available for comment.

Approximately 80% of seniors have at least one chronic disease, and 77% have at least two, according to the National Council on Aging. Managing these long-term and chronic conditions can be frustrating and time-consuming, but the improved quality of life is well worth the change to diet and exercise.

While the best place to begin moving down a healthy living path is by checking with your doctor, here are a few tips for managing some of the most prominent chronic conditions through diet and exercise.

Heart disease

Those with heart disease, which is the leading cause of death for men and women in the United States, can experience chest pain, shortness of breath, or pain in the arms and legs. This may make it difficult to exercise, but over time it can decrease blood pressure and improve breathing which can lessen these symptoms.

The best type of exercise for those with heart disease is cardio because it’s going to increase your oxygen intake and your heart rate. Simple ways to do this are walking or going up and down stairs. You should be moving fast enough to raise your heart rate and breathe harder, but still be able to talk while engaging in these activities.

Exercise is important for the heart but make sure you don’t overdo it. A healthy regimen is 30 minutes, 4 to 6 times a week, but you can work up to this if you need to. To prevent injuries, alternate your exercise days with rest days or days doing a very different type of exercise. If you lift weights, focus on resistance training using lighter weights and more repetitions.

For a healthy heart diet:

• Avoid trans fats and choose healthy fats like those found in avocados, olive oil, tuna, and salmon.
• Prepare meat healthfully by baking, broiling, and roasting. Trim any outside fat or skin before cooking.
• Don’t ignore serving sizes. They can help you keep your good habits in check.
• Use spices and herbs to flavor foods instead of salt which is bad for your blood pressure.

Dementia       

Loved ones of people with a dementia condition can find them slipping away. While dementia doesn’t have a cure, you or your loved one can live a better life with the implementation of simple diet and exercise tips.

People with dementia sometimes forget to eat or think they have already eaten which leads to not meeting their daily nutritional requirements. One way to combat this is by having a simple, but familiar table setting which can act as a prompt to encourage them to eat.

Remembering words for certain foods may become difficult and so communicating preferences might be frustrating. Using picture menu cards can help communicate food choices. These could be taken from their own cookbooks and stored in an album for later use.

Exercise doesn’t always have to look like exercise. Doing simple housework chores like dusting or vacuuming engages muscles and lends itself to routine, which can be helpful for those with dementia. Gardening is another relaxing and stimulating alternative to keep joints moving. Also, don’t forget to exercise the brain along with the body. Some non-strenuous activities that can help boost brain activity include listening to music, reading aloud, and playing musical instruments.

Diabetes

Individuals with diabetes are much more likely to develop other health conditions and complications.  Some of these risks can be mitigated with proper diet and exercise while also helping to manage the disease itself.

It goes without saying that controlling blood sugar should be a primary consideration for those with diabetes. A couple of simple tips for limiting your sugar intake:

• Eat sweets with a meal, rather than as a separate snack so that your blood sugar won’t rise as quickly.
• When cooking, you can reduce the amount of sugar by one fourth to one third and add sweetness with mint, cinnamon, nutmeg, or vanilla extract.
• Use recipes like these to manage your sugar and carbs.

A common issue of those with diabetes is nerve damage in the feet which causes numbness or painful tingling. Though this can make exercise difficult, there are a lot of exercises that you can do while seated that don’t put pressure on the feet, such as leg extensions and knee tucks. Whether you are doing seated exercises or not, you should check your feet daily for cuts or blisters that you might not be able to feel to ensure you don’t cause any damage.

Cancer

There are more than 100 types of cancer and about 38% of people will be diagnosed at some point in their lifetime. Oftentimes these cancers are treatable and can be managed despite the symptoms of the treatments.

Certain cancer treatments can weaken the immune system so it’s important to avoid foods that may contain foodborne illness. If you are eating out, be sure to avoid salad bars, sushi, and undercooked meat since they are more likely to have harmful bacteria. When cooking at home, keep foods at the correct temperatures using a thermometer.

If you are feeling fatigued, try doing only 10 minutes of light exercises to prevent muscle atrophy and reduce treatment side effects. Those with weak immune systems should avoid public gyms until their white blood cell counts return to safe levels. Since you might be losing fluid due to treatment side effects, be sure to drink lots of fluids to prevent dehydration regardless of your level of exercise intensity.

Arthritis

Arthritis could end up costing you independence along with medical expenses and potential lost wages, but you can reduce pain and financial burden by taking control of your health.

Getting the proper nutrients is important for any healthy diet, but can have a great impact on those with Arthritis, specifically omega-3 and vitamin D. Omega-3 helps with inflammation and because a good portion of arthritic pain is caused by inflamed joints, you can adjust your diet to include more foods that are naturally anti-inflammatory such as:

• Salmon
• Olive oil
• Soybeans
• Cherries
• Green tea

If you have arthritis, there are ways you can stay active without causing pain or further damaging your joints. The first key is to stretch every day in preparation, then do low-impact physical activities that are gentle and allow you to be active without the added pressure. This would include activities such as swimming, yoga, and tai chi.

Each person and each chronic condition is unique and has a separate set of guidelines that can take time, but investing in your physical health can reduce pain and improve living. The improved state of well-being you receive from regular healthy eating and exercising habits affords benefits like allowing you to engage in your hobbies and stay independent for longer.

By Kathleen Doheny – HEALTHY AGING

April 21, 2022

Better known to some as ”weed day,” is an annual celebration of recreational marijuana. However, for millions of people, including older adults, marijuana is lauded for its medical benefits. Here’s, an update.

Where is Marijuana Legal?

Medical marijuana is legal in 37 states and the District of Columbia; with recreational use in 18 states and the District of Columbia. However, it’s still classified as a Schedule I drug (most dangerous of 5 levels), with no accepted medical use and a high potential for abuse, under the federal Controlled Substances Act.

Marijuana Usage Trends

More and more older adults are using medical marijuana (with a recommendation from their doctor in states where it’s legal) and recreational marijuana. The number of adults age 65 and older who reported marijuana use in the previous year jumped from 2.4% in 2015 to 4.2% in 2018, according to a nationally representative survey.

As of 2019, one poll found the majority of Americans now favor marijuana legalization, including 63% of baby boomers (now ages 57-75).

Medical Uses of Marijuana

Older adults turn to marijuana for medical (versus recreational) purposes most often for arthritis and other pain, sleep problems, anxiety and depression, according to another survey asking 83 adults about cannabis use in the previous 3 years. Of the 15% who reported use in the previous three years, the majority said it helped “somewhat” or “very much” in managing symptoms.

Even so, says Alison Moore, MD, professor and chief of geriatrics at UC San Diego Health, who helped conduct that survey,  ”the evidence is not strong for any condition at present, as we are still in the early phases of using cannabis in randomized trials,” (viewed as the gold standard), “to understand its therapeutic potential.” Medical marijuana has been tested most often to help insomnia, loss of appetite and mental health conditions, she says.

The benefits often go beyond symptom relief, says Paul Armentano, deputy director of the National Organization to Reform Marijuana Laws (NORML) and the NORML Foundation, a nonprofit group advocating for reform of marijuana laws for both medical and non-medical use.”

The data seems to be most consistent that when older adults use cannabis they report significant improvement in their overall quality of life,” Armentano says. Here is one such study with that finding.  NORML has posted numerous other facts about marijuana use by older adults.

Some pain control experts suggest that medical marijuana could be an adjunctive treatment to opioids, increasing pain control and reducing the need for opioids. In one study, researchers followed 184 older adults using medical marijuana and found 85% reported improvement in their condition.

Caveats and Advice

“Start low, go slow” is a motto used by healthcare professionals when prescribing medications to older adults. It applies, also, to older adults using medical marijuana, Armentano says, and especially to first-time users.

It’s important to find out if there are any interaction issues

“When we talk about what are some of the potential unique issues with seniors,” he says, “they are likely already taking a number of other prescription drugs,” so it’s important to find out if there are any interaction issues.  Some users get dizzy, he adds, so it’s important to guard against falling.

“I think these products may well have therapeutic effects,” Dr. Moore says. However, with so many forms of marijuana, such as creams, inhalers, gummies, tinctures, dried flowers and more, ”it is difficult to make informed choices about the cannabis product that might work for an individual.” She advises people to wait for more scientific evidence – which she says will come soon.

By Mike Stobbe – The Associated Press

April 12, 2022

NEW YORK (AP) — 2021 was the deadliest year in U.S. history, and new data and research are offering more insights into how it got that bad.

The main reason for the increase in deaths? COVID-19, said Robert Anderson, who oversees the Centers for Disease Control and Prevention’s work on death statistics.

The agency this month quietly updated its provisional death tally. It showed there were 3.465 million deaths last year, or about 80,000 more than 2020′s record-setting total.

Early last year, some experts were optimistic that 2021 would not be as bad as the first year of the pandemic — partly because effective COVID-19 vaccines had finally become available.

“We were wrong, unfortunately,” said Noreen Goldman, a Princeton University researcher.

COVID-19 deaths rose in 2021 – to more than 415,000, up from 351,000 the year before – as new coronavirus variants emerged and an unexpectedly large numbers of Americans refused to get vaccinated or were hesitant to wear masks, experts said.

The coronavirus is not solely to blame. Preliminary CDC data also shows the crude death rate for cancer rose slightly, and rates continued to increase for diabetes, chronic liver disease and stroke.

Drug overdose deaths also continued to rise. The CDC does not yet have a tally for 2021 overdose deaths, because it can take weeks of lab work and investigation to identify them. But provisional data through October suggests the nation is on track to see at least 105,000 overdose deaths in 2021 – up from 93,000 the year before.

New research released Tuesday showed a particularly large jump in overdose deaths among 14- to 18-year-olds.

Adolescent overdose death counts were fairly constant for most of the last decade, at around 500 a year, according to the paper published by the Journal of the American Medical Association. They almost doubled in 2020, to 954, and the researchers estimated that the total hit nearly 1,150 last year.

Joseph Friedman, a UCLA researcher who was the paper’s lead author, called the spike “unprecedented.”

Those teen overdose deaths were only around 1% of the U.S. total. But adolescents experienced a greater relative increase than the overall population, even though surveys suggest drug use among teens is down.

Experts attributed the spike to fentanyl, a highly lethal drug that has been cut into heroin for several years. More recently it’s also been pressed into counterfeit pills resembling prescription drugs that teens sometimes abuse.

The total number of U.S. deaths often increases year to year as the U.S. population grows. But 2020 and 2021 saw extraordinary jumps in death numbers and rates, due largely to the pandemic.

Those national death trends affect life expectancy – an estimate of the average number of years a baby born in a given year might expect to live.

With rare exceptions, U.S. life expectancy has reliably inched up year after year. But the CDC’s life expectancy estimate for 2020 was about 77 years – more than a year and a half lower than what it was in 2019.

The CDC has not yet reported its calculation for 2021. But Goldman and some other researchers have been making their own estimates, presented in papers that have not yet been published in peer-reviewed journals.

Those researchers think U.S. life expectancy dropped another five or six months in 2021 – putting it back to where it was 20 years ago. A loss of more than two years of life expectancy over the last two years “is mammoth,” Goldman said. One study looked at death data in the U.S. and 19 other high-income countries. The U.S. fared the worst.

“What happened in the U.S. is less about the variants than the levels of resistance to vaccination and the public’s rejection of practices, such as masking and mandates, to reduce viral transmission,” one of the study’s authors, Dr. Steven Woolf of Virginia Commonwealth University, said in a statement.

Some experts are skeptical that life expectancy will quickly bounce back. They worry about long-term complications of COVID-19 that may hasten the deaths of people with chronic health problems.

Preliminary – and incomplete – CDC data suggest there were at least 805,000 U.S. deaths in about the first three months of this year. That’s well below the same period last year, but higher than the comparable period in 2020.

“We may end up with a ‘new normal’ that’s a little higher than it was before,” Anderson said.