It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, October 24, 2021
Tropical rainfall pattern will increase rainfall variability in Pacific Northwest
The tropical Madden-Julian Oscillation (MJO) rainfall pattern brings change to non-tropical parts of the United States.
DOE/US DEPARTMENT OF ENERGY
The Science
The Madden-Julian Oscillation (MJO) is a tropical rainfall pattern that excites waves of air in the atmosphere. The MJO can have a significant effect on weather outside of the tropics. Scientists have studied how the MJO might respond to a warming climate. However, they know much less about how warming temperatures might affect the “teleconnection” that causes the MJO to affect non-tropical weather. This research shows that the MJO teleconnection pattern observed in winters in far northern regions will likely extend further eastward over the North Pacific. This change will increase the effects of the MJO on the variability of rainfall in California.
The Impact
The eastward-extended teleconnection allows the MJO to exert more influence on the Northeast Pacific and the west coast of North America. The increased sub-seasonal variability poses challenges on regional resource management. It also creates challenges for how we prepare for extreme weather in these regions.
Summary
The MJO is a slow-moving tropical mode that produces a planetary-scale envelope of convective storms. By exciting Rossby waves—atmospheric waves that span the planet—the MJO creates atmospheric linkages called “teleconnections” that have far-reaching effects on extratropical circulation and weather. While recent studies have investigated the MJO's response to anthropogenic warming, scientists know less about potential changes in MJO teleconnection patterns. This new research shows that the MJO teleconnection pattern in boreal winter will likely extend further eastward over the North Pacific. This is due primarily to an eastward shift in the exit region of the subtropical jet, on which the teleconnection pattern is anchored, and additionally contributed by an eastward extension of the MJO itself. The eastward-extended teleconnection allows the MJO to exert a greater impact downstream on the Northeast Pacific and North American west coast. Over California, the multi-model statistical mean result projects an approximately 54 percent increase in MJO-induced precipitation variability by the year 2100 under a high emission scenario.
Funding
This work was supported by Berkeley Lab Laboratory Directed Research and Development (LDRD) funding provided by the Department of Energy (DOE) Office of Science; the DOE Office of Science, Office of Biological and Environmental Research, Climate and Environmental Sciences Division, Regional & Global Climate Model Analysis program (specifically, the Calibrated and Systematic Characterization, Attribution, and Detection of Extremes [CASCADE] project); the National Institute of Food and Agriculture; the Packard Fellowship for Science and Engineering; the National Science Foundation; and the National Natural Science Foundation of China.
IMAGE: BEEF CATTLE GRAZE ON A FAMILY FARM IN AUGUSTA COUNTY, VIRGINIA.view more
CREDIT: JOHN BENNER FOR VIRGINIA TECH
Rolling green pastures dotted with grazing cows are a common sight in Virginia. However, there’s more strategy behind those grazing cows than most people know, such as the impact on the land, water quality, and farm profitability.
In 2015 a small team of Virginia Cooperative Extension agents, farmers, and representatives from state and federal conservation agencies from Northern Piedmont and Northern Shenandoah Valley created the Graze 300 VA Initiative “to enable Virginia farmers to achieve 300 days of livestock grazing per year by facilitating better pasture management and environmental stewardship.” Since then, Graze 300 VA has grown to 30 Extension agents and specialists working together with farmers across Virginia.
This year, the Graze 300 VA movement is beefing up its mission — thanks to a grant from the Virginia Tech College of Agriculture and Life Sciences Strategic Plan Advancement Integrated Internal Competitive Grants Program and the Virginia Agricultural Experiment Station. Out of 71 proposals submitted, 32 projects were funded. Graze 300 VA was the only one led by Extension agents.
Virginia Cooperative Extension agents Carl Stafford, Bobby Clark, and John Benner, and Inga Haugen, University Libraries’ liaison to the College of Agriculture and Life Sciences, are leading the program’s efforts.
The grant will help build on existing Graze 300 VA successes, research social factors that influence farmer change, provide in-depth grazing management training, develop better educational resources for Virginia’s farmers, and broaden the use of technology, including designing a grazing app to advance the Graze 300 VA initiative.
Most farmers graze about 220 days per year, from spring until fall, and supplement with hay during the four-month cold season. Winter feeding can account for more than 50 percent of production costs due to the cost of making hay. Inflation and spikes in the cost of farm equipment, fuel, and fertilizer make traditional grazing less profitable than years past. Currently, only a handful of farmers in Virginia regularly reach a 300-day grazing season.
According to the team’s background work, if 20 percent of Virginia farmers adopt better grazing management practices and extend their grazing season closer to 300 days per year, Virginia farms could increase profitability by more than $6 million per year.
“We have collected several case studies of farmers who have successfully extended their grazing season and have become more profitable,” Benner said. “We continue to share these experiences with other farmers.”
The team said that although Graze 300 VA could have a huge impact, getting farmers to adopt the extended grazing movement won’t be easy. Farmers’ deep-seated traditions surrounding grassland and livestock management techniques are interwoven into the fabric of these communities. For example, traditions associated with hay baling and feeding hay are a rite of passage for young people in family farming operations.
To help create strategies to encourage farmers to adopt new practices, the team recruited colleagues from the College of Liberal Arts and Human Sciences.
“We believe there are traditional barriers to adopting this new way of farming that we don’t fully understand,” said Clark. “Thus we have engaged the Virginia Tech Sociology Department to help us better understand those factors.
"Farm profitability helps to ensure that Virginia’s rural communities are resilient and vibrant,” Clark continued. “Over the long term, farm profitability is a repetitive cycle. We teach farmers more profitable technologies, and as farmers adopt these technologies, it becomes the new normal. The net benefit of this cycle ensures citizens have a safe, affordable, and consistent supply of food.”
CAPTION
A falling plate meter is used to measure the amount of grass in a field so farmers have more precise readings in managing their grass.
CREDIT
Bobby Clark for Virginia Tech
They just need the technology to do it.
The team wants to utilize unique technologies like those developed in Ireland for improving farm and forage management. They will create similar tools that can connect with farmers and technical service providers, collect and monitor farm production data, and evaluate management decisions. This technology will integrate well with Graze 300 VA partners, the Center for Advanced Innovation in Agriculture and their SmartFarm Innovation Network (Sustainable Precision Animal Agriculture).
To create this technology, the team tapped the University Libraries’ DataBridge team to assist in scoping potential solutions and implementing a project plan. The goal is to allow Virginia cattle farmers to better capture information on their pastures and livestock and allow for more efficient use of their land and extend the grazing season further into the year. Essential data such as paddock usage to indicate cattle rotation, cattle health, and biologics will be considered for the app.
“This app can have a big impact on Virginia farmers,” said Jonathan Briganti, the manager for DataBridge. Briganti will scope “the diverse climate, cattle breeds, and workflows seen in American farms." Such an effort requires a deeply researched and carefully executed plan, which is why the principal researchers work methodically to bring the right domain experts in the room, Briganti added.
The application will assist producers tracking and managing forage output and grazing to reduce feed costs and improve environmental quality.
Extending the grazing season also has environmental and production benefits. In well-managed pastures, the sod is thicker. This reduces runoff, soil erosion, and nutrient losses. Therefore, farmers use less fertilizer. Additionally, because thicker sod captures more water in sudden rainfall events, the pastures are more productive during dry summers when occasional storms are the only source of moisture.
The team is also partnering with farmers, agribusinesses, and several agencies to improve water quality. According to Clark, extending the grazing season will improve water infiltration, nutrient use efficiency, and soil organic matter while encouraging fewer barren areas in fields. A longer grazing season also reduces the amount of sediment, nitrogen, and phosphorus that ends up in surface waters that could eventually run into streams and rivers.
“It’s economics and environment and doing what is best for the landscape," said Haugen, who was a grazing dairy farmer before she was a librarian. "A type of farming that works on flatlands, like vegetable or crop farming, might be a poor choice in the mountains. This program works with what folk are doing and helps them to be better in many areas. It benefits them and our communities that share the water, air, and soil, and then also our downstream neighbors.”
“This is the extension/outreach component of land-grant universities,” Clark said. “In this case, Virginia Cooperative Extension is helping to address three major issues across the commonwealth: ensuring a safe, affordable, and consistent food supply, helping Virginia sustain resilient communities, ensuring environmental health and stewardship, and ensuring water quality.
“This is a big deal,” Clark continued. “This initiative is improving farm profitability, environmental issues, and water quality. An enormous challenge the world faces is finding ways to have good water quality or improve water quality that do not cause a major financial burden on people or industry. In this case, we are achieving both better water quality and better farm profitability. It is a win-win situation.”
The team is seeking collaborators interested in helping with the Graze 300 VA Initiative. People interested in testing the app, learning more about grazing, supporting students in learning about data and grazing, or have questions in general are welcome to contact Haugen.
Project to study marine life in Gulf Of Mexico Reefs
Texas A&M-Galveston professor Jay Rooker will lead a $1.9 million effort to learn more about the Flower Garden Banks and the fish that inhabit the marine sanctuary.
The Gulf of Mexico is one of the most important areas in the world for marine life, and especially its natural banks and reefs that provide food, habitat and shelter for numerous species. It’s also home to a key marine protected area, and a Texas A&M University at Galveston marine biologist is heading a $1.9 million project to study how fish and marine life inhabit the region.
Jay Rooker will lead a team of 13 researchers from five universities hoping to answer many questions about marine life in the Gulf, especially those related to natural banks and the fishes that inhabit them.
One key area that will be examined is the Flower Garden Banks National Marine Sanctuary that was first discovered by snapper and grouper fishermen in the early 1900s. They named the banks after the corals, sponges, plants and other marine life that they could see on the brightly-colored reefs below their boats.
“Understanding how fish populations use the Flower Garden Banks and other banks in the expanded sanctuary boundaries will be the focus of our research,” Rooker said. “We will study a wide range of reef-associated fishes — including groupers, snappers, jacks, parrotfish and sharks — to determine their required habitats and how natural banks within the sanctuary are interconnected.”
The first scientific study of the area, located about 100 miles off the Galveston coast, did not occur until 1936 but numerous studies have been conducted in the area since then. Earlier this year, the sanctuary was expanded from 56 to 160 square miles and now includes 14 additional banks. Today, the Flower Garden Banks is the only national marine sanctuary in the Gulf of Mexico and is one of 14 federally designated underwater areas protected by NOAA’s Office of National Marine Sanctuaries.
Rooker and the team will use acoustic and satellite telemetry to track fish movements within and across banks. They will also use sound recordings to determine the timing of spawning activity to help show where the fish will end up as juveniles.
“Reef-associated fishes in the Gulf of Mexico reside in a complex mix of habitats and natural banks,” Rooker said. “The outer shelf of the northern Gulf of Mexico is characterized by a network of natural banks that extend eastward along the edge of the Texas-Louisiana shelf to the mouth of the Mississippi River. These natural banks — including the Flower Garden Banks — provide critical habitat for a variety of marine organisms. But our understanding of how fish use these natural banks is rather limited, and we hope to learn more about essential habitats of key components of this unique reef fish assemblage and improve our understanding of fish populations within the sanctuary.”
Although many Americans favor expanding background checks for gun purchases, gun-control measures in Congress have failed to garner enough votes to pass. In contrast, some state legislatures have enacted measures to reduce gun violence in their communities. A new study examined the impact changes to background checks and licensing policies has made on different types of violent crime in Massachusetts. The study found no immediate impact, suggesting that state lawmakers may want to ensure their legislation is being implemented as intended.
The study, by a researcher at American University (AU), appears in Justice Quarterly, a publication of the Academy of Criminal Justice Sciences.
“Gun violence remains at the forefront of the public policy debate when it comes to enacting new or strengthening existing gun legislation in the United States,” explains Janice Iwama, assistant professor of justice, law, and criminology at AU, who conducted the study. “Yet the political polarization and relatively limited scholarly research on guns and gun violence make it difficult for policymakers and practitioners to enact and implement legislation that addresses the public health and safety issues associated with gun violence.”
In 2014, Massachusetts passed new requirements related to background checks for firearms sold at gun shows or through private sales and created changes to firearm regulations by adopting new gun licensing procedures; the new law went into effect in January 2015. Research on the effects of gun legislation has yielded mixed findings and the effectiveness of Massachusetts’ law is unclear.
Iwama explored the differential effects of the new legislation on public safety outcomes, including violent crime, in Massachusetts counties from 2006 to 2016. She used data from the Firearms Records Bureau, a statewide agency that maintains a database of issued licenses and records of firearms sales by gun dealers, as well as private transfers of weapons.
The study used models to predict counts of violent crimes, using data from the FBI, and considering variables that represent the percentage of all denied applications, the percentage of denied applications due to unsuitability, and the percentage of denied applications due to statutory disqualification (e.g., criminal history record, mental health record, fugitive status) at the county level.
Based on the percent of firearms licenses, about 1 to 5 percent of adult residents had a firearms license in Massachusetts counties. But Iwama found no consistent effect of the new legislation on reducing four types of violent crime (murder or nonnegligent manslaughter, aggravated assault, robbery, rape).Her study did find that a one-percent increase in denied firearm licenses and denied firearm licenses following statutory disqualifications increased robberies 7.3 and 8.9 percent, respectively.
While the percentage of denied firearms licenses and firearms license applications had little to no effect on violent crimes, Iwama suggests state lawmakers revisit their legislation to ensure that it is being implemented as intended and address challenges identified. In particular, are these findings the result of a longer-than-expected lag in enforcement following passage of the legislation? Are they due to individuals obtaining firearms in nearby states with looser gun laws? Or is it possible that the 2014 law is being enforced differentially by county?
“It is important for policymakers, practitioners, and researchers to consider the magnitude of effects of their laws and how they may be influenced by different levels of enforcement in the state or by the lack of enforcement in surrounding states,” cautions Iwama.
Among the study’s limitations, Iwama notes that the data collected from the FBI was not complete because of changes in reporting practices. In addition, the percentage of firearms licenses, which she used as a proxy for gun ownership, represents neither a perfect measure of gun owners nor an accurate count of the number of firearms available by county. Finally, the small size of the study’s sample hindered the author’s ability to examine patterns across different counties in the state.
NIH/NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)
A new, retrospective study of medical and insurance records indicates health care costs for people with a rare disease have been underestimated and are three to five times greater than the costs for people without a rare disease. The study, led by the National Institutes of Health’s National Center for Advancing Translational Sciences (NCATS), provides new evidence of the potential impact of rare diseases on public health, suggesting that nationwide medical costs for individuals with rare diseases are on par with those for cancer and heart failure. The study’s results were published Oct. 21 in the Orphanet Journal of Rare Diseases.
Most of the approximately 7,000 to 10,000 known rare diseases disproportionately affect children, adolescents and young adults. Individually, most rare diseases might affect only a few hundred to a few thousand people worldwide. However, rare diseases are collectively common, affecting an estimated 25 million to 30 million people in the United States. Many of these diseases have a genetic cause, are serious or life-threatening and are hard to diagnose and treat.
The pilot study was a collaborative effort among NCATS; Eversana Life Sciences, Chicago; Oregon Health & Science University, Portland; Sanford Health, Sioux Falls, South Dakota; and a health insurer in Australia. Pariser and colleagues analyzed patients’ diagnosis information in medical records and billing codes. They used International Classification of Diseases (ICD) codes, which designate a disease diagnosis and other methods, to determine those individuals with rare diseases and their direct medical costs for 14 rare diseases in four health care systems compared to non-rare disease patients of a similar age.
The pilot study aimed to test the feasibility of this approach in analyzing data on rare diseases prevalence and costs. The 14 rare diseases represented a diverse set of disorders that differ in prevalence, organ systems affected, age of onset, clinical course, and availability of an approved treatment or specific ICD code. Examples of the selected rare diseases include sickle cell disease, muscular dystrophy and eosinophilic esophagitis.
The team determined approximate medical costs by examining healthcare system data from NCATS and Eversana. In every case, the cost per patient per year (PPPY) for those with a rare disease exceeded costs for non-rare diseases patients of the same age. According to the Eversana healthcare system database, which included estimates from commercial and insurance payors over nearly 15 years, PPPY costs ranged from $8,812 to $140,044 for rare diseases patients compared to $5,862 for those without a rare disease. The NCATS data, which drew from estimates mostly from Florida Medicaid information over five years, indicated PPPY costs ranging from $4,859 to $18,994 for rare diseases patients versus $2,211 for those without a rare disease.
The team reported that extrapolating the average costs estimate for the approximately 25 to 30 million individuals with rare diseases in the United States would result in total yearly direct medical costs of approximately $400 billion, which is similar to annual direct medical costs for cancer, heart failure and Alzheimer’s disease.
The researchers also used patient medical records to trace the diagnostic journeys of four people with a rare disease, including two individuals who had a form of Batten disease, an inherited neurological disorder, and two others with cystic fibrosis, an inherited disease that severely affects the lungs. The journey “maps” provided detailed descriptions of direct medical costs, such as for hospitalizations and procedures associated with these diseases, and provided insights into patient clinical management before and after disease diagnosis.
Such commonalities among rare disease patients could point to the potential use of machine learning techniques on healthcare system databases to improve diagnoses, said NCATS Acting Director Joni L. Rutter, Ph.D., a co-author on the study.
The research team also would like to determine if the methodologies they used for exploring the prevalence and associated costs for a small set of rare diseases could be scaled to thousands of other known rare diseases.
“Ultimately, to improve the lives of people with rare diseases,” said Rutter, “we need to find innovative ways, including new technologies, to help shorten the lengthy diagnostic odysseys so many patients and families experience and make more treatments available faster.”
About the National Center for Advancing Translational Sciences (NCATS): NCATS conducts and supports research on the science and operation of translation — the process by which interventions to improve health are developed and implemented — to allow more treatments to get to more patients more quickly. For more information about how NCATS helps shorten the journey from scientific observation to clinical intervention, visit https://ncats.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.
NIH…Turning Discovery Into Health®
JOURNAL
Orphanet Journal of Rare Diseases
METHOD OF RESEARCH
Data/statistical analysis
ARTICLE TITLE
The IDeaS initiative: pilot study to assess the impact of rare diseases on patients and healthcare systems.
ARTICLE PUBLICATION DATE
21-Oct-2021
US COVID-19 pandemic lockdowns sharply increased bicycle-related injuries; gun-related injuries rose too
Study results from trauma centers in four different regions may provide a roadmap for allocating trauma resources in the next pandemic
IMAGE: THE EFFECT OF CORONAVIRUS SHUTDOWNS ON NATIONWIDE TRAUMA PATTERNS. SCIENTIFIC FORUM PRESENTATION. AMERICAN COLLEGE OF SURGEONS CLINICAL CONGRESS.view more
CREDIT: AMERICAN COLLEGE OF SURGEONS
Key takeaways
Despite regional variations in COVID-19-related restrictions, trends in trauma center activity followed similar patterns in four trauma centers in different regions of the United States.
Trauma cases involving bicycle-related injuries increased 100 percent, and gunshot wounds increased 23.5 percent, during lockdown.
Study findings indicate allocating more resources for wellness may be a priority in future pandemic-related lockdowns.
CHICAGO: Despite regional variations in COVID-19-related restrictions last year during the lockdown phase of the pandemic, similar trends emerged in activity at Level I trauma centers in four different cities from the Southeast to the Northwest, according to research presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.
The data could help inform public policy decision-making for the next pandemic, study authors said.
A retrospective review of 27,652 trauma cases from 2019 to 2020 at four Level I trauma centers in Orange County, California; Portland, Oregon; Miami, Florida; and Tulsa, Oklahoma, found that overall activity followed similar patterns in these locations, with cases for motor vehicle collisions declining while those for gunshot wounds and bicycle accidents increased significantly.
“We were trying to assess if the different variations in COVID-19 shutdowns across the country affected trends,” said presenter Leonardo Alaniz, a third-year medical student at the University of California, Irvine. The findings bore out the study hypothesis—that trauma centers in four different cities with different levels of pandemic restrictions demonstrated similar trauma case patterns.
“Overall, what we discovered is that there was a substantial increase in bicycle-related trauma rates of about 100 percent,” he said (p < 0.01). “We also saw an increase in gunshot wounds (GSW) by about 23.5 percent. However, we did see a substantial reduction in motor vehicle crash (MVC)-related trauma rates, about 12.7 percent.” (p values for both GSW and MVC-related trauma are <0.01.)
The trend for GSW was somewhat unexpected, senior author Cristobal Barrios, Jr., MD, FACS, said. “We thought we might see an uptick in the percentage of GSW given the percentages of MVC were down and the percentages might need to go up to cover that mechanism of injury; but we were mildly surprised that not only did the percentage go up, but the actual raw numbers of gun injuries went up,” said Dr. Barrios, a health sciences clinical professor in surgery and assistant dean of admissions at UC Irvine. “That was true across all the trauma centers that contributed data to the study.”
While the percentage changes in those three metrics varied among the individual centers, the overall trends followed the same pattern. The changes at each individual site are:
In Orange County, GSW increased 55 percent (p < 0.01), MVC decreased 10.2 percent (p < 0.01), and bicycle injuries increased 30.8 percent (p = 0.01).
Dr. Barrios said the trends in MVC- and bicycle-related injuries during lockdown are understandable. “People weren’t going anywhere for any real large distances because there was nowhere to go during lockdown, but maybe they were utilizing their bicycles to get around a little bit, to get some exercise, and to get out of the house,” Dr. Barrios said. In June 2020, bicycle sales increased 63 percent over the same period in 2019, the market research firm NPD gGroup, Inc. reported.*
These findings may help clinicians and policy makers to better prepare if pandemic-related restrictions are necessary in the future, Dr. Barrios said.
“We did this research to shed light on what to expect during any possible next lockdown for a pandemic and where to potentially put resources for clinicians in terms of what types of injuries might present and that might increase or decrease,” he said. “Tailoring resources was one point.”
One of the take-home findings, Dr. Barrios noted, was that more resources should be applied to addressing issues of wellness, namely stress reduction and mental health. “That might be why people were using bicycles more; to get out and get exercise and reduce their stress,” he said.
Mr. Alaniz added, “Another big contributor would be to have more green spaces in these communities—spaces where people can go out and exercise in a safe environment. That would also play a huge role in preserving the mental health of our communities.”
Study coauthors are Juan P. Hoyos and Erika Tay Lasso, MD, of the UC Irvine Department of Surgery; Shevonne Satahoo, MD, of Jackson Memorial Miller School of Medicine, Miami; Gajal Kumar, MD, FACS, of Ascension Medical Group St. John Medical Center, Tulsa; and Megan Lundeberg, MD, of Legacy Emanuel Hospital and Health Center, Portland.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
The study authors have no relevant financial relationships to disclose.
Citation: Alaniz L, et al. The Effect of Coronavirus Shutdowns on Nationwide Trauma Patterns. Scientific Forum Presentation. American College of Surgeons Clinical Congress. 2021. ________________________ *Schwinn shifts marketing gears as bike riding surges during the coronavirus crisis. CNBC. Available at: https://www.cnbc.com/2020/08/29/coronavirus-bike-sales-surge-schwinn-pivots-marketing-plan.html (.) Accessed September 30, 2021.
# # #
About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
USA; FOR PROFIT HEALTHCARE
Hospitals sustained huge financial losses from lost revenues during COVID-19 pandemic as patients lost timely access to surgical services
Researchers provide lessons learned after nationwide pause of most elective operations during 2020
IMAGE: THE FINANCIAL IMPACT OF COVID-19 ON A SURGICAL DEPARTMENT: THE EFFECTS OF SURGICAL SHUTDOWNS AND THE IMPACT ON A HEALTH SYSTEM.view more
CREDIT: AMERICAN COLLEGE OF SURGEONS
Key takeaways
Curtailing surgical services for even a short time can seriously impact a hospital’s financial security
Maintaining access to surgical care is not all about revenue; it’s about how to efficiently manage surgical patients’ needs
Health care systems should make long-term preparations so they can safely provide elective surgical care during future peaks in COVID-19 caseloads
CHICAGO: Postponement of nonessential surgical procedures early in the coronavirus pandemic not only disrupted surgical care at U.S. hospitals, but also took away a large portion of hospitals’ total income, results from two studies reveal. These findings (from the two studies, which took place at the University of Pennsylvania, Philadelphia, and Children’s Hospital of Philadelphia) were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.
Surgical services are typically an important financial engine for hospitals, and the new study findings showed that curtailing surgical procedures for even two months can seriously impact a hospital’s financial security. Most elective, nonurgent operations in the country stopped from mid-March to early May 2020, to conserve resources for patients with coronavirus disease 2019 (COVID-19). Results of one study found that this two-month suspension cost a single university health care system 42 percent of its net revenue for five months.
Nationwide, hospitals lost $1.53 billion from missed elective pediatric procedures alone, the other study investigators estimated as part of their study, for approximately the same period, March to May 2020. Hospitals were slow to make up the surgical backlog and the lost income from children’s operations, with a median, or middle, time to recovery of one year, the investigators estimated.
As COVID-19 cases reportedly continue to remain high in many states, some hospitals are again triaging cases and delaying selected operations.1,2 Consequently, the researchers said their findings demonstrate the need for better long-term planning by hospitals to prevent further shutdowns to ensure patients have access to the surgical services that they need.
CAPTION
Hospital Financial Risk Due to Procedural Cancellations During the Covid-19 Pandemic.
CREDIT
American College of Surgeons
USAGE RESTRICTIONS
Reasons for not delaying surgical care
“Whenever possible, we should not delay surgical care for our patients,” said the first study’s lead investigator, Daniel M. Mazzaferro, MD, MBA, a plastic surgery resident at the Perelman School of Medicine at the University of Pennsylvania. “Surgery is a critical asset to the survivability of a health care system.”
Moreover, delays in surgical care also can lead to patients’ medical conditions worsening, affecting their quality of life, or sometimes even shortening it. Another result is patients may require more treatments, raising health care costs down the line, Dr. Mazzaferro noted.
The pandemic resulted in an unprecedented temporary postponement of many elective operations across the country, as recommended by the American College of Surgeons (ACS) and other organizations in March 2020 to free hospital beds and other resources for COVID-19 patients.3 The ACS provided guidance for how hospitals could triage surgical cases—that is, select which operations to prioritize and which to defer until after COVID-19 caseloads decreased.4
Financial impact
Dr. Mazzaferro and his coworkers calculated the net revenues of three hospitals in their health care system during the first surge, or “wave,” of COVID-19 cases from March to July 2020, compared with the same period in 2019. A total of more than $99 million of net revenue was lost from all surgical departments and $58 million from the department of surgery in the first wave. The researchers reported a median net revenue loss of $636,952 per month per division for the department of surgery in the first wave, using updated data presented during the virtual Clinical Congress. However, the system lost significantly less money—$274,626 each month for each division—during a second COVID wave between October 1, 2020, and February 29, 2021.
The surgical department did not suspend elective operations during the second surge, said Liza Wu, MD, FACS, senior investigator of this study and professor of surgery at the Perelman School of Medicine.
“We were in a better position than the first time around to continue with elective surgery,” Dr. Wu said. “We had more personal protective equipment or PPE, better COVID-19 therapies, and a better understanding of the virus, and we probably were able to get COVID patients out of the hospital faster.”
Their surgical department, she added, also began triaging elective surgical patients using a new scoring system called the Medically Necessary, Time-sensitive Scoring, or MeNTS, which University of Chicago physicians described in the Journal of the American College of Surgeons.5
After elective operations resumed in June 2020, surgeons quickly regained their productivity, Dr. Mazzaferro reported. He made this conclusion based on a measure of surgeon productivity that insurance payers use for reimbursement, called work relative value units (RVUs). Work RVUs decreased significantly less in the second COVID-19 wave than the first: 7.8 versus 13.2 percent.
For the second study, researchers led by Sourav Bose, MD, MBA, MSc, then a postdoctoral research fellow at Children’s Hospital of Philadelphia, assessed the financial impact of COVID-related pediatric procedural cancellations. To project lost surgical revenues, they used the 2016 Kids’ Inpatient Database, which represents approximately 80 percent of pediatric hospital admissions nationally.
Dr. Bose, a general surgery resident at Brigham and Women’s Hospital in Boston, said the nation’s children’s hospitals delayed or canceled an estimated more than 51,000 elective procedures from March to May 2020.
Lessons learned
“Our message isn’t all about revenue. It’s about how to efficiently manage surgical patients’ needs,” Dr. Bose said. “Hospital systems must assess their operations management strategies to optimize the availability of surgical resources for patients with the greatest need.”
He proposed that hospitals optimize any excess resource capacity that existed before the pandemic or increase their capacity for performing procedures based on their resources, such as expanding hours for operations.
Dr. Mazzaferro also recommended that health care systems make long-term preparations so they can safely provide elective surgical care during future peaks in COVID-19 caseloads. He suggested the following:
Increase hospital bed and resource capacity through alternate solutions, such as sending an overflow of surgical patients to other patient care units or facilities that can accommodate them.
Appropriately triage elective operations following ACS guidelines4 and other published surgical triage tools.
Ensure sufficient PPE for health care workers and patients.
Help keep staff healthy by mandating COVID-19 vaccines or frequently testing them against the virus.
Dr. Mazzaferro and Dr. Wu’s fellow University of Pennsylvania researchers were Viren Patel, Nelson Asport, MSHI, CPC, Robert L. Stetson, MHA, David Okawa, MBA, Deborah Rose, MBA, Natalie M. Plana, MD, Joseph M. Serletti, MD, FACS, and Ronald DeMatteo, MD.
Citation: Mazzaferro, DM, et al. The Financial Impact of Covid-19 on a Surgical Department: the Effects of Surgical Shutdowns and the Impact on a Health System. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.
Dr. Bose’s co-investigators were Serena Dasani, MD, MBA, Brandon White, MSE, Nick S. Adzick, MD, FACS, and William H. Peranteau, MD, FACS, all with Children’s Hospital of Philadelphia.
Citation: Sourav B, et al. Hospital Financial Risk Due to Procedural Cancellations During the Covid-19 Pandemic. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
The authors report no relevant disclosures.
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1 Advisory Board. Hospitals Are Delaying Elective Surgeries Again. But This Time, They're Doing It Differently. Daily Briefing. https://www.advisory.com/daily-briefing/2021/08/18/elective-surgeries. August 18, 2021. Accessed September 29, 2021.
2 Paavola A. 106 Hospitals Postponing Elective Procedures Amid the COVID-19 Resurgence. Beckers Hosp Rev. June 1, 2021. Accessed September 29, 2021.
5 Prachand VN, Milner R, Angelos P, et al. Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. J Coll Am Surg. 2020;231(2):281-288.
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About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
