Catholic Health World - March 15, 2022 by Catholic Health Association

The Catholic Church is listening 2 Executive changes 7 Unequal treatment 8 PERIODICAL RATE PUBLICATION

MARCH 15, 2022

VOLUME 38, NUMBER 5

Pandemic-prompted surge in telehealth is here to stay, doctors predict By LISA EISENHAUER

The COVID-19 pandemic has been the catalyst for an explosion in telehealth and physicians who oversee aspects of virtual care at three Catholic health systems say the platform has proven its value across specialties. They fully expect its popularity to endure after the health emergency ends. “I think the patient adoption of it, the changing demographics of patients, the technology is really setting the tone to make this basically a permanent fixture in health care,” said Dr. Carter Fenton of Mercy. He directs a virtual acute care program for the fourstate system based in subFenton urban St. Louis. Mercy has been building its virtual medicine capacity for about 15 years. A report from the U.S. Department of

Tim Lorimer, a telehealth clinical program manager, trains a group of workers at South Peninsula Hospital in Homer, Alaska, on delivering virtual care. Providence St. Joseph Health worked with the hospital to provide telehealth services for its patients. The use of telehealth technology has surged since the start of the COVID-19 pandemic and its popularity is expected to remain high.

Ministry foundations double down on health equity By JULIE MINDA

En Vogue entertains during a virtual Concert for Humankindness presented by the CommonSpirit Health Foundation in September. The event raised more than $1 million to support health equity in communities served by the health system.

Ministry health systems and facilities are increasing their efforts on health equity, social determinants of health and mental health and their foundations are helping fuel that work. Fred Najjar, executive vice president and chief philanthropy officer for Chicago-based CommonNajjar Spirit Health, says that system and its hospitals and their foundations always have sought to be upstream of health concerns, and that is true as they increase their focus on social and health care justice and mental health. “We saw in the pandemic that there is inequity, and that inequity contributes to poor health and

Health and Human Services in December stated that the number of Medicare visits conducted through telehealth increased from about 840,000 in 2019 to 52.7 million in 2020. The nonprofit FAIR Health, which tracks private health insurance claims, reported that telehealth went from 0.15% of claims in April 2019 to 13% in April 2020. The growth spike was driven by pandemic exigencies. There were strict safety protocols in place early in the COVID-19 outbreak that limited in-person medical care including for the chronically and acutely ill. Federal regulators relaxed restrictions for Medicare-paid telehealth visits in March 2020. The waiver extends until the end of the public health emergency. Federal officials encouraged states and private insurers to provide similar flexibility for telehealth coverage, and many of them did. Continued on 6

Catholic nursing schools preparing future nurses to advocate for good Curriculum covers racial justice, health equity, care of vulnerable

Continued on 4

Promoting health equity in communities of color is matter of faith By MARY DELACH LEONARD

At Greater Christ Temple Church in Tacoma, Washington, Bishop Prentis V. Johnson looks out for the health care needs of his 300 parishioners, along with their spiritual well-being. The apostolic Pentecostal church was among the first three to join FaithHealth in Action, an innovative program developed by the nonprofit Carol Milgard Breast Center to address high rates of breast and prostate cancer in communities of color in Tacoma. The breast center is jointly owned by MultiCare Health System and Virginia Mason Franciscan Health. Virginia Mason Franciscan is part of CommonSpirit Health, a Chicago-based Catholic health system that includes Catholic Health Initiatives and Dignity Health. FaithHealth in Action partners with churches to form ministries that bring health care resources directly to Continued on 5

Nursing students Deanna Ibrahim, left, and Tina Davis simulate a patient visit as part of family practice coursework at Franciscan Missionaries of Our Lady University in Baton Rouge, Louisiana. By JULIE MINDA

Breast cancer survivors, from left, Geraldine Brooks, Ameedah Hasan, and Dorothy Brantley participate in the Mahogany Circle of Hope Cancer Support Group’s pre-pandemic breast cancer awareness event at the Shiloh Baptist Church in Tacoma, Washington. Brooks is a health minister at the church. Shiloh Baptist takes part in the FaithHealth in Action program, which provides health resources to African American, Pacific Islander and Hispanic churches in the Tacoma area.

There’s a growing recognition in the health care sector that nurses must be adept not just at delivering high-quality clinical care but also at advocating for change. This includes advancements around racial justice, health equity and root causes of illness. Catholic nursing schools have been enhancing their programming and curriculum to ensure they are preparing students for this work. Administrators say their schools long have pursued social justice aims. And as Continued on 3

CATHOLIC HEALTH WORLD March 15, 2022

Ministry providers can take part in worldwide church synod By JULIE MINDA

The Catholic Church has embarked on a synod, or a “journeying together,” to learn how the Holy Spirit is moving in today’s church, how people are experiencing the church and what is needed to fulfill the church’s mission in the future. In October Pope Francis called upon the entire church to take part in the “Synod on Synodality.” The goal, according to a handbook from the Secretary General of the Synod of Bishops at the Vatican, is for people around the world to discern how best to seek God’s will and to “pursue the pathways to which God calls us — towards deeper communion, fuller participation, and greater openness to fulfilling our mission in the world.” The synod is in the listening phase, and dioceses around the globe are gathering people’s input. The dioceses will provide summaries of what they learn to their bishops’ conferences. The United States Conference of Catholic Bishops will gather all of the U.S. input for the synod by late June. The information will be used to create a U.S. national synthesis, which is due to go to the Vatican’s general secretariat for the synod of bishops by Aug. 15. The U.S. will then work with Canada for the continental phase of the synod. That content will be part of the global report presented to the Vatican’s Dicastery for Promoting Integral Human Development. A Vatican convening of bishops will discuss the fruits of the process in October 2023. Lucas Swanepoel, CHA director of government relations, says that taking part in the Synod on Synodality is one way Catholic health systems and facilities can have a dialogue with their church contacts in the

Correction

Laurie Kelley is chief philanthropy officer at Providence St. Joseph Health. She leads the Providence National Foundation and helps coordinate the efforts of the 40-plus foundations across Providence. Her title was incorrect in a story published in the March 1 edition of Catholic Health World.

Catholic Health World (ISSN 87564068) is published semimonthly, except monthly in January, April, July and October and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to CHA Service Center, 4455 Woodson Road, St. Louis, MO 63134-3797; phone: 800-230-7823; email: servicecenter@chausa.org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members free, others $29 and foreign $29. Opinions, quotes and views appearing in Catholic Health World do not necessarily reflect those of CHA and do not represent an endorsement by CHA. Acceptance of advertising for publication does not constitute approval or endorse ment by the publication or CHA. All advertising is subject to review before acceptance. Vice President Communications and Marketing Brian P. Reardon

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says the listening in and of itself is a goal. “A hoped-for outcome is that the listening will be an encounter that is inspiring and meaningful.” Coll notes that “part of the emphasis is on reaching the peripheries — those whose voices are not usually heard.” Coll and McStravog say the outcome will be based on where the Holy Spirit leads the discussions over the next year and a half.

This illustration for the Synod on Synodality represents how Christ, crucified and risen unites humanity with God the Father. The Holy Spirit is pictured as a dove inside the chalice that is held by Christ’s mother Mary.

communities they serve. He encourages providers to get in touch with their dioceses or archdioceses to determine how they are undertaking the listening phase and how the Catholic health care facilities can provide input. Brian Smith, CHA vice president of sponsorship and mission services, notes that CHA is exploring how it might also contribute to the synod on a national basis.

dioceses, archdioceses and other organizations to invite their participation in the synod, under the guidance of Fr. Michael Fuller, USCCB general secretary. Coll and McStravog say that there is great variation in how dioceses and archdioceses are carrying out the listening portion of the synod, and that is by design. The synod is intended to be a very organic engagement, eliciting countless perspectives. McStravog notes that the Catholic Church has undertaken numerous synods over time, but this one is different from the others in its universal scope. “This is for all the people of God, it is an inclusive invitation” for all those touched by the church, including people who are not Catholic. She

Diocesan- and archdiocesan-driven Richard Coll, executive director of the USCCB’s Department of Justice, Peace and Human Development in Washington, and consultant Julia McStravog are helping to coordinate the USCCB’s synod work. The duo are providing guidance to all U.S.

‘Grassroots level’ Patrick McCruden is chief mission integration officer of St. Louis-based SSM Health, and an ordained permanent deacon in the Catholic Church. He says that SSM Health believes it is being led to take part in the synod because the synod is important to the church as a whole. SSM Health operates 23 hospitals and a network of other health care facilities in Illinois, Missouri, Oklahoma and Wisconsin. McCruden says while SSM Health is encouraging each of its hospitals to get involved in the synod, the system is not being prescriptive when it comes to how its local sites do so. The SSM Health sites are getting in touch with their local diocesan and archdiocesan contacts to learn how they are undertaking the listening sessions and how they can plug into the process. McCruden notes each diocese and archdiocese is unique in its approach. For instance, the Archdiocese of St. Louis is conducting its gathering of perspectives through a renewal process it already had underway called “All Things New: Steadfast in Faith, Forward in Hope.” McCruden anticipates that the synod will point toward a new vision for the church and new ways to share Jesus. “The church is listening at the grassroots level and seeing where people think the church is moving. “This is a wonderful opportunity for us to be in dialogue, not just within Catholic health care, but with the Catholic Church generally.” jminda@chausa.org

Upcoming Events from The Catholic Health Association Catholic Ethics for Health Care Leaders: A Deeper Dive into the Key Concepts of Catholic Health Care Ethics

Online: Tuesdays, March 29 – May 3 1 – 3 p.m. ET In-Person Meeting: May 10 (A), May 16 (B) and May 18 (C) St. Louis

Long-Term Care Networking Zoom Gathering April 20 | 3 – 4 p.m. ET Members only

In-Person Meeting: Ecclesiology and Spiritual Renewal Program for Health Care Leaders Invitation Only May 1 – 6

Global Health Networking Zoom Call May 4 | Noon ET

In-Person Meeting: 2022 Catholic Health Assembly June 5 – 7

Diversity & Disparities Networking Zoom Call June 23 | 1 – 2 p.m. ET

Long-Term Care Networking Zoom Gathering July 12 | 3 – 4 p.m. ET Members only

United Against Human Trafficking Networking Zoom Call July 14 | Noon ET

Faith Community Nurse Networking Zoom Call July 20 | 1 – 2 p.m. ET

A Passionate Voice for Compassionate Care®

chausa.org/calendar

March 15, 2022 CATHOLIC HEALTH WORLD

Catholic nursing schools From page 1

the nation has turned its attention to racial justice and socioeconomic disparities in recent years, they’ve been reassessing how their schools are taking on these issues. Marcia R. Gardner is dean of the Barbara H. Hagan School of Nursing and Health Sciences at Molloy College, a Catholic school in Rockville Gardner Centre, New York. She says, “We want to give students the opportunity to address social determinants of health. And we want to ensure our curriculum is preparing them to be health equity advocates and to take action to address health inequities and to understand underlying structural issues that affect health care.” She says nurses “are a powerful voice to help people in need.”

‘Future of Nursing’ The movement toward expanded roles for nurses was detailed in “The Future of Nursing 2020 – 2030: Charting a Path to Achieve Health Equity,” a study released in May 2021 by the National Academies of Sciences, Engineering, and Medicine. An overview says the report is “aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people’s ability to achieve their full health potential.” “By leveraging (nurses’ capacity and expertise), nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone,” the overview says. Grounded in mission Catholic nursing school leaders say those goals are aligned with the charisms and missions of their schools. Amy M. Hall is professor and dean of the school of nursing at Franciscan Missionaries of Our Lady University Hall in Baton Rouge, Louisiana, part of Franciscan Missionaries of Our Lady Health System. The school and health system carry the name of the order of women religious who founded and sponsor the institutions. Hall says the mission the sisters set out for the nursing school requires it to groom students to be servant leaders. At Molloy College’s nursing school, the focus is on graduating nurses ready to demonstrate love of neighbor through service to patients and the community, says Catherine Tully Muscente, vice president of the college’s office of Muscente mission and ministry. Community, service, study and prayer are the pillars of the Dominican Sisters of the Congregation of the Holy Cross Amityville, which founded the college and the nursing school. Mary Ellen Smith Glasgow is dean of Pittsburgh’s Duquesne University School of Nursing and vice provost for Glasgow research and the office of research and innovation for the university. She explains that Duquesne University’s identity is a modern expression of the Spiritan tradition of its founders, the Fathers of the Holy Spirit. “We believe in building community, having a global vision, promoting academic excellence, and fostering a general commitment to service,” she says, adding that all Duquesne students learn to apply the Spiritan principles of justice, peace

A Duquesne University’s nursing school faculty member monitors the way nursing students respond to the mock cardiac arrest of a medical manikin. During the early days of the pandemic, when it was more difficult for nursing students to do clinical rotations in health care facilities, the school increased its use of simulations in clinical training.

and the integrity of creation in their personal and professional lives.

Inclusivity The deans say ensuring racial, ethnic and thought diversity is a top priority of their campuses. They are working to increase the diversity of their nursing school faculty and student populations. Hall says it is essential to Franciscan Missionaries of Our Lady University that faculty and student makeup reflects the broader Baton Rouge community, which she says is very diverse, and that students see faculty who look like them. Glasgow says Duquesne’s nursing school connects prospective students who are from a minority population with current students of the same ethnic or racial background to deepen a sense of community among them. The nursing school also holds in-person and online student

ble populations — in their clinical training and volunteer experiences. Glasgow says Duquesne faculty and students have vaccinated people in Pittsburgh group homes and senior living residences, and administered COVID-19 tests. Duquesne faculty and students also

“We help (students) understand they can improve the system. They can look beyond themselves and be good servant leaders and translate the skills they have in order to make a difference for others.” — Marcia R. Gardner

Nursing students assist with on-campus COVID-19 testing at Duquesne University in October 2020.

recruitment events to attract the attention of more people of color. To foster a culture where everyone feels welcome, the nursing school has hosted a diversity in nursing movie night and staff development sessions on social justice topics including the racial divide and gender expansive youth.

Broad experience Gardner, Glasgow and Hall all say their respective nursing schools continually evaluate curriculum for relevance to many different populations, including racial and ethnic minorities. And they make sure that curriculum addresses the perspectives of these diverse populations. Students get exposed to many different patient populations — and particularly vulnera-

staffed vaccination clinics in Pittsburgh’s Hill District, a historically Black community. And faculty, alumni and graduate students provide health care services on an ongoing basis as volunteers at a health care clinic for those who are poor. The nursing school is starting a fellowship for undergraduate nursing students, to teach them to understand and address systemic inequities that contribute to poorer health outcomes for Black mothers and their babies. Participants will learn to promote health equity and collaborate with community stakeholders. They will tune in to how cultural differences in communication styles can affect care. They’ll be taught to listen attentively and communicate effectively and compassionately with mothers of color, who may feel

dismissed or manipulated by the medical system. Sr. Rosemary Donley, SC, the Jacques Laval Chair for Justice for Vulnerable Populations at Duquesne school of nursing, is charged with organizing community service projects for the nursing school students to increase health care access for vulnerable Sr. Donley populations. Sr. Donley also furthers research related to health care access and quality including through an annual symposium for practicing and student nurses on social justice issues in health care.

Cross-culture training Hall says Franciscan Missionaries of Our Lady University has a course that challenges nursing students to look beyond the immediate medical conditions of patients to the social determinants of health impacting those patients’ health. Additionally, every nursing student does clinical rotations in facilities that treat a diverse population of people who may struggle to access health care, due to socioeconomic barriers. This can include federally qualified health centers and rural clinics. Gardner says Molloy ensures its nursing students do rotations in clinical settings where they interact with people from an array of cultures and races. Here too, students get experience assessing patients’ clinical and socioeconomic needs. Many faculty and students volunteer to staff a mobile van that provides care to people without a medical home. They see firsthand the barriers some of the most vulnerable community members face in attempting to access health care services and they learn to recognize and help to address those barriers, including by referring patients to social service providers. Gardner says the goal of nursing education at Catholic schools is to form future nurses who are equipped to advocate for people so they can improve their lives. “We help (students) understand they can improve the system. They can look beyond themselves and be good servant leaders and translate the skills they have in order to make a difference for others.” She says this perspective “is why I love working in a Catholic college. It’s about taking the opportunities we have and paying it forward.” jminda@chausa.org

CATHOLIC HEALTH WORLD March 15, 2022

Ministry foundations

Nation sees jump in giving toward racial justice

From page 1

bad outcomes,” he says. Philanthropy dollars are essential to funding ministry efforts to counter health inequity and to advance racial justice, says Najjar, who also is chair of the board of directors of the Association for Healthcare Philanthropy.

Access expansion Ministry foundations are raising money to improve health care access and economic prospects for underserved populations, including people of color; and they are supporting efforts to increase diversity in the ranks of professional and support staff in health care facilities. Fran Petonic is senior vice president of philanthropy for Trinity Health. She says donors want to make more transformational gifts related to racial justice and health equity. Currently such gifts have come mainly from corporate donors Petonic giving tens of thousands of dollars apiece, but the system’s foundations are working to match high net worth individuals and corporate donors wishing to give more with big initiatives in these areas too. Trinity Health recently funded a $16 million effort to reduce inequity in 10 communities of color within its service area and is encouraging philanthropists to contribute to that effort. Trinity Health foundations also are aligning their campaigns to support the system’s strategic priorities having to do with improving health care outcomes for racial and ethnic minorities including by directing more resources to maternal and

From left, Lionel Terrell, Donovan Fletcher and Shakira Franklin gather in a hoop house at Bon Secours Community Works Urban Farm in Baltimore, which has programming supported in part by the Bon Secours Baltimore Foundation. Terrell and Franklin are employed by Bon Secours Community Works, a nonprofit engaged in housing, youth programming and community development.

infant health. Petonic says Trinity Health foundations are looking for opportunities to collaborate with other organizations in this health equity work. Partners could include churches, community centers and schools. Petonic says Trinity Health foundations prioritize underserved communities of color in funding decisions. Foundation dollars have gone toward strengthening safety net clinics, increasing access to telehealth and expanding COVID testing and vaccination efforts in minority and other underserved communities.

Tying the knot Health care leadership and donors alike “are realizing that racism is a public health concern, and philanthropy can play a huge role in addressing it,” says Petonic. Alice Ayres, president and chief executive of the Association for Healthcare Philanthropy, says, “I think this is one of the most exciting moments we’ve seen in some time in health care philanthropy, because we have the opportunity to be the fuel behind this important work. There are few jobs in life that allow you to make this incredible connection Keb’ Mo’ performs during a September virtual concert presented by between amazingly CommonSpirit Health Foundation. The funds raised will promote health generous people and equity. important work like

Health care foundations looking to diversify their own ranks I

n the 28 years Tim Koder has been fundraising, “there has not been much diversity in the profession.” While this is beginning to change, staff is still overwhelmingly white. “There is still a huge gap and so we’re exploring how to recruit” a more diverse slate of candidates to foundation jobs, says Koder, who heads up Bon Secours Mercy Health Foundations at Bon Secours Mercy Health of Cincinnati. To prime the candidate pipeline, the Bon Secours Mercy Health foundations are exploring partnerships with universities to offer students paid internships and eventually employment, with a focus on students from underrepresented groups. Koder says the system’s foundations are making a concerted effort to increase the diversity of their boards including by ethnicity, race, gender and age. Fran Petonic is senior vice president of philanthropy for Trinity Health. She is co-chair of the Association for Healthcare Philanthropy’s conference in Chicago in October. The other chair is Birgit Smith Burton, founder of the African American Development Officers Network. That organization has a goal of bringing 1,000 new fundraisers of color into the profession by 2030. Petonic and Burton are ensuring that the topic of staff diversity is front and center at the conference. Petonic notes that about 70% of jobs in health care philanthropy are held by white women but executive roles in the field are disproportionately held by white men. She says the predominance of men in leadership roles may be due to implicit bias — male board members may select leaders who look like them. And similarly, white female staff members may choose candidates who look like them when hiring. She says donors generally have a say in how their dollars are spent. She says if foundation staffs become more diverse, foundations may be better able to court minority donors and also to get more input from people in minority communities about where and how foundation dollars are spent. —JULIE MINDA

this. It’s very difficult but rewarding work. “And the last two years have only further crystalized how important this work and its outcomes are.” Ayres Najjar says Common– Spirit is using foundation dollars to improve care access. Its foundations helped bring in through grant-writing nearly $6.2 million in federal grants along with other funding to expand telehealth. The money is supporting the purchase of Internet-connected remote patient monitoring equipment and subsidizing video visits and remote treatment for vulnerable populations, especially low-income rural residents in medically underserved areas. Laurie Kelley is chief philanthropy officer at Providence St. Joseph Health. Kelley helps coordinate the efforts of the 40-plus foundations across Providence and leads the Providence National Foundation. She says Providence Kelley St. Joseph Health’s system-level and local foundations have been funding care access expansions in the service areas of that Renton, Washingtonbased system. This too includes telehealth expansions into rural areas and offering telehealth on patients’ smartphones to reduce patient travel times and provide convenient access to specialty care. Providence foundations also have been investing in genomics and data analysis projects that pinpoint minority populations with specific diagnoses and then develop interventions to assist them, Kelley says. For instance, a study underway at Portland, Oregon’s Providence Brain Institute Multiple Sclerosis Center is exploring how best to address particular barriers faced by patients of color who have multiple sclerosis.

Social determinants Tim Koder is president of Bon Secours Mercy Health Foundations at Bon Secours Mercy Health of Cincinnati — that system resulted from the 2018 combination of Bon Secours Health System and Mercy Health. Koder says the system and its two legacy organizations Koder always have directed their foundations’ investments to the poor and underserved. To tackle socioeconomic conditions that lead to the development of chronic disease and shorten life spans, the foundations support initiatives that undergird safe housing and neighborhoods, educational opportunity, job training and the like. Many systems have community partners in their work to address basic human needs. Najjar says CommonSpirit foundation dollars have gone toward bolster-

lice Ayres, president and chief executive of the Association for Healthcare Philanthropy, says in the last few years more large health systems are explicitly making racial justice and health equity focal areas for their foundations. This emphasis within health care philanthropy reflects a larger movement in giving generally in the U.S. In an Oct. 5, 2020, article titled “Racial justice giving is booming: 4 trends,” Una Osili writes for The Conversation news site that “we are seeing an outpouring of donations from individuals, corporations and foundations that began to grow as soon as protests and other activities in support of racial and social justice started to spread across the country.” Osili is a professor of economics and philanthropic studies and associate dean for research and international programs at Indiana University – Purdue University Indianapolis. She writes that the outpouring includes record donations related to crowdfunding for victims of racial injustice, direct support for grassroots organizations and funding for historical Black colleges and universities. Osili says donors have given many billions of dollars to such causes since the 2020 police killing of George Floyd in Minneapolis. — JULIE MINDA

ing Connected Community Networks, online hubs that link people in need with social service providers working in homelessness, food insecurity, transportation access, and education.

Diversity in hiring The systems’ foundations also are getting behind efforts to ensure that clinical staff more closely mirror the racial and ethnic composition of the patient community. Some of Providence’s local foundations fund scholarships for highachieving employees in low-wage positions who have a high potential to advance. These are staff who may not otherwise have the means to attain the education and training to move into clinical roles such as phlebotomist, medical technician, radiology technician and registered nurse, says Kelley. And CommonSpirit’s corporate foundation is supporting the system’s $100 million initiative with Morehouse School of Medicine, a historically Black institution, to graduate more minority doctors and other clinicians. Mental health programming Ayres says that many foundations also are increasing their fundraising for mental health programming. Donors “are coming out of the woodwork” to support mental health fundraising campaigns, particularly in recognition of the toll the pandemic has taken on people’s mental well-being, she says. CommonSpirit and Providence corporate foundations are among those in the ministry that have explicitly named community mental health and well-being a funding priority. In support of this effort, CommonSpirit won a $2.25 million grant to expand medication-assisted treatment for opioid use disorder at several of its facilities in California. And a Providence foundation in Alaska is funding a partnership with Anchorage schools to address teen mental health concerns. jminda@chausa.org

March 15, 2022 CATHOLIC HEALTH WORLD

FaithHealth

this program,’’ Tupou said. “We had the buy-in of leaders from these communities before we launched.’’

From page 1

congregations. The program, which started in 2016, initially focused on African American churches, but a three-year, $337,803 grant from the CHI Mission and Ministry Fund allowed FaithHealth in Action to expand its outreach in 2018 to include Hispanic and Pacific Islander communities and to broaden the scope of its health topics. Bishop Johnson represents the Tacoma Ministerial Alliance on the steering committee that Johnson developed FaithHealth in Action and believes it is making a difference. One of his congregants is alive today because his prostate cancer was detected early at a screening, Bishop Johnson said. And Bishop Johnson’s wife had a mammogram that detected a small benign lump that was surgically removed. “I grew up in Tacoma,’’ said Bishop Johnson, 67. “This is my community — my people that I want to help. My parishioners are predominately African Americans, and the rate of breast cancer and prostate cancer is very high among us. We want to help people be proactive instead of reactive. Give people information, and then let them make their decisions based on facts.”

Built by community collaboration FaithHealth in Action began as a one-year program for African American churches to provide resources on breast health, prostate health, nutrition and patient advocacy, said Queena Tupou, coordinator of the program and marketing and outreach specialist for the Carol Milgard Breast Center. Tupou Initial funding was contributed by health care groups that partner

Pastors and health ministers get tips on building and strengthening their health programming at a FaithHealth in Action training in 2018. A three-year grant from the CHI Mission and Ministry Fund has allowed the program developed by the Carol Milgard Breast Center in Tacoma, Washington, to expand its duration, content and reach. The trainings of church leaders have continued online during the pandemic.

with the breast health center. The CHI grant enabled the center to expand its outreach and to provide a second year of resources along with a congregational health needs assessment to each church. Those additional resources address behavioral health, heart health and spiritual health topics. Since its inception, the program has served 30 churches with combined attendance of more than 8,000 people. In 2018, the first year of the CHI grant, FaithHealth in Action trained 34 English- and/or Spanish-speaking health ministers and had its educational materials translated into Spanish and Samoan. In the fiscal year ended June 2021, the program reached about 2,500 people who participated through 13 churches. Tupou said 16% of female church members reported having a mammogram and 6.5% of men reported having a prostate exam because of the program in FY 2021. People reported that they were exercising more, eating healthier and monitoring their blood pressure.

Churches designate the leaders of their health ministries, who may be called health ministers or health leaders. “Some of our churches have their pastors and pastors’ wives taking the lead,’’ Tupou said. “Some might have a member who likes to work out and cook healthy food.” Bishop Johnson said the health leader at his church was trained as a registered nurse. Carol Milgard Breast Center’s board of directors got the ball rolling in 2011 when it commissioned an epidemiology report together with the Tacoma-Pierce County Health Department to assess gaps in mammogram screenings. The study found that African American women in Pierce County had the highest rate of death from breast cancer and were more likely to die at a younger age from the disease than other women. The breast center began a community engagement project to address the disparities. “One of the things that I always highlight is the community collaboration that built

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Entering the circle of trust As coordinator of congregational health ministries at Virginia Mason Franciscan Health in Tacoma, Debbi Saint supports the health ministries of more than 70 churches. “Rather than asking people to come to us, we’re going to their church — their circle of trust. And Saint that makes a difference,’’ Saint said. FaithHealth in Action is a Carol Milgard program, stressed Saint. She is grateful that the CHI grant allowed CHI’s Congregational Health Ministries to partner with FaithHealth in Action in making inroads into underserved communities. But she knows it will be a challenge to provide longterm support for the ministries. Virginia Mason Franciscan provides support to over 70 religious congregations around South Puget Sound through Congregational Health Ministries. Most of the churches that currently belong are primarily white, Saint said, and their needs differ from the congregations served by FaithHealth in Action. “After churches complete the two-year FaithHealth in Action program, they can be part of Congregational Health Ministries. But will they?” Saint said. “We’re going to have to do something different. And I want to hear what ideas they have.’’ Although the CHI grant was slated to end in 2021, enough funding remains to pay for an additional year, Saint said. “We are continuing to look for sustained funding because that is going to be the issue — how to keep this rolling along,’’ Saint said. Building awareness and trust FaithHealth in Action churches tailor their programming to their congregations, which vary in size from 30 people to several hundred. The program provides a $2,000 stipend to churches, a small stipend to health ministers and a small grant for hosting special events, like health fairs. At the onset of the pandemic, FaithHealth in Action was able to shift funding to move its training program online for health ministers and to provide resources to churches for COVID-19. That also included donations from community partners of masks, and thermometers used to screen congregants before in-person services. Some churches reopened for in-person services as quickly as they could after the shutdown because they have no access to videoconferencing technology. Testimonials gathered by FaithHealth in Action illustrate its impact: “Working with FaithHealth in Action has helped our church realize how little we know, or how misinformed we are about the major diseases plaguing our community,’’ said one minister. Another credited FaithHealth in Action for helping undocumented people overcome fears of participating in health screenings. FaithHealth in Action is a vital bridge between African American communities and health care organizations, said Bishop Johnson of Greater Christ Temple. “Many African American men and women are not inclined to go to any doctor,’’ he said. “It’s part of our culture that we don’t trust physicians because, in times past, doctors have not done us well as a race. Sharing the testimonies of church members about their experiences with health care helps build awareness and trust.’’ For Tupou, the success of FaithHealth hinges on listening to communities and adapting to meet their unique needs. “I’m Samoan and that’s been key in working with Pacific Islander churches,’’ she said. “It matters to them to see someone like themselves working in an organization like ours. I am a product of this community, and I understand not all but some of the experiences that they’re struggling with.’’

CATHOLIC HEALTH WORLD March 15, 2022

Telehealth From page 1

Receptive market Physicians at Catholic systems said the embrace of remote care continued to grow after restrictions began to ease on nonemergency appointments and procedures in the late spring of 2020. COVID Care @ Home, started in 2020 by Mercy, had enrolled 70,000 outpatients across the multistate system by early 2022 and is the source of about 600 telehealth visits a day. The program gives patients around-the-clock access for 14 days to emergency medicine physicians via texts and audio and video calls to ask questions and get consults on their symptoms. The program is part of Mercy Virtual’s vAcute, which is led by Fenton. “We’re able to provide real time care and set real expectations for what we think needs to be done to get the patients the most appropriate care,” he said. In Fenton’s view, vAcute is a complement to Mercy’s primary care services. Primary care doctors are notified of patients’ vAcute visits and take over follow-up treatment. “We actually are driving, hopefully, much more appropriate utilization of inpatient and in-person care,” he said. The vAcute program is just one part of Mercy’s telehealth care operation, which began well before the pandemic and has seen astronomical gains in popularity since. In 2019 Mercy tallied 10,000 virtual visits. Since the start of the pandemic in 2020 through mid-January, that count rose to 800,000. Mercy recently got a $2.2 million federal grant to add and upgrade telemedicine carts and monitors at facilities in Missouri, Oklahoma and Arkansas so that staff, especially those in the system’s COVID and critical care units, can teleconference with off-site specialty caregivers. The grant was part of more than $458 million that has been appropriated nationwide so far by the Federal Communications Commission to help health care providers deliver connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. Sudden growth, lasting embrace Providence St. Joseph Health, which operates in five western states, also reports skyrocketing use of telehealth services. In 2019, the system recorded 70,000 telehealth visits; in April 2020, when in-

Christine Storm, who contracted COVID-19 early this year, uses her smartphone to connect with providers through Mercy’s COVID Care @ Home. The telehealth program that the health system started in 2020 gives patients 24/7 access to a team of emergency medicine physicians who monitor patients’ well-being via daily texts, video consults and phone calls.

person nonemergency medical services were curtailed, it had that number of telehealth visits every week. “We’re still doing about 100,000 visits a month,” Dr. Todd Czartoski, chief medical technology officer at Providence, said in midFebruary. “It’s roughly just under 20% of our Czartoski clinic visits.” Czartoski said while Providence patients and providers are not required to use telehealth, the platform has gained favor on both sides. One specialty where telehealth use has been particularly high, he said, is behavioral health, with about 50% of visits now virtual. Czartoski is a neurologist and he spent a decade evangelizing for the use of telehealth after he saw the effectiveness of a network he helped develop to care for stroke patients. “It was a lot like rolling a boulder uphill,” he recalled of his advocacy efforts, with many colleagues not just uninterested but convinced that telehealth was not a legitimate way to practice medicine. That changed when the pandemic hit and clinics temporarily closed, cutting doctors off from their patients. “Many of the same doctors who were lecturing me on how this wasn’t real medicine were instantly now demanding that they have access to all these different tools so they can do telehealth,” he said. Because Providence had been ramping up its telehealth services for years, Czartoski said the system was able to expand those services fairly quickly to all

Location of Medicare Telehealth Visits in 2020

(originating site where beneficiary is located)

1% 6%

92%

Beneficiary’s home Hospital Skilled nursing facility Transfers & hospice N=52.7 million Medicare telehealth visits in 2020 Source: “Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location,” U.S. Department of Health and Human Services, December 2021.

of its 15,000 care providers. In one week in March 2020, it brought 7,000 of them online.

Technology plus resources While not all patient needs can be addressed by a remote provider, Czartoski said a great many can. In addition to technology to do audio or video evaluations, Providence providers have access to resources to help them direct patients to the nearest labs for testing or facilities

CHA, Ascension urge Congress to support permanent telehealth expansion

n response to the global COVID-19 pandemic and as part of the public health emergency, federal regulators in March 2020 put in place a number of waivers and revised reimbursement policies to allow greater access to telehealth services. The waivers only extend for the duration of the declared public health emergency. Many health care providers and advocacy groups are pushing for the waivers to be extended to provide time for the development of thoughtful public policy governing telemedicine. CHA was among dozens of healthrelated organizations that in January sent a letter to congressional leaders urging that they establish a pathway for comprehensive telehealth oversight that allows the public to reap the benefits of the technology. The letter says access to virtual care has been transformational and “Americans now expect that the future of our health care system includes telehealth as a key way to access health care services.” The signatories ask Congress to continue through 2024 the waivers that lifted geographic and originating site restrictions (meaning patients had to be seen in a clinical space) for Medicare-reimbursed

telehealth. They say that extension will provide time to evaluate the impact the wider use of virtual care has had and time to use that research to craft policy. The letter urges Congress to pass “permanent, evidence-based” telehealth legislation in 2024. Lucas Swanepoel, a CHA director of government relations, said there is reason to be hopeful that telehealth legislation will Swanepoel pass. Lawmakers in both chambers and on both sides of the aisle have submitted dozens of bills to address various aspects of telehealth, Swanepoel said. “What we’re seeing now, because we’re getting more studies and more research and of course we’re getting closer to potentially the end of the public health emergency, is more effort to coalesce the very small ideas into one more all-encompassing approach to address the extension of telehealth waivers,” he said. In both chambers there is bipartisan support for that effort, he noted, a key to passage of any legislation in a Congress strongly divided along political lines.

Many Catholic health systems, including St. Louis-based Ascension, are advocating for telehealth legislation, too. Dr. Baligh Yehia, president of Ascension Medical Group, called congressional action crucial for patients who have come to rely on telehealth. “Telehealth is improving access to care by lowering barriers for the underserved and those in rural areas who face challenges getting the care they need,” Yehia said. “It’s also helping lower health care costs by offering immediate access to care that would have otherwise resulted in an emergency department or urgent care visit.” In addition to providing patients continued access to telehealth, Yehia said Ascension is urging Congress to address licensing-related issues that can prevent telehealth practitioners from providing care across state boundaries. At a minimum, the system wants Congress to pass a pending measure that would grant temporary licensure reciprocity during public health emergencies. — LISA EISENHAUER

for X-rays if those services are needed. The results go into patients’ electronic medical records where providers can access them. The system’s video visit technology also has embedded interpreter services so that providers and patients can communicate even if they don’t speak the same language. Czartoski said Providence looked into how many patients came into a clinic or hospital for in-person care within 72 hours of a telehealth visit and found it was “well under 1%.” “Our experience tells me that it is effective and it’s not additive; you’re not doing both a virtual visit and then an in-person visit,” he said. “If done properly, a virtual visit can replace an in-person visit.”

Widespread use People in rural and urban areas and across socioeconomic categories such as age, gender, race and income are opting for televisits, Czartoski said, rather than coming to emergency rooms and clinics. “The convenience factor in access is huge,” he said. An issue brief from the Department of Health and Human Services in February similarly noted widespread use of telehealth. It cites surveys consistently showing that about one-fourth of Americans have had a telehealth visit in any given four weeks. The figure tends to be higher for some populations, such as those who are Medicaid or Medicare beneficiaries, and lower for some, such as those who are uninsured. The surveys showed significant disparities in terms of audio versus video telehealth use, with those who have lower household incomes being more likely to have audio rather than video telehealth visits. One of the issue brief’s conclusions is: “Investments in Internet access, videoenabled devices, and culturally competent care are needed to ensure equitable use of telehealth services.” At CommonSpirit Testa Health, Dr. Nicholas Testa is the chief physician executive for California. He said that while limited access to technology is probably a barrier to aspects of telehealth for some patients, anyone with a phone can get access to quality remote care through his system. “It’s been a really strong tool through the pandemic,” Testa said. He pointed to CommonSpirit Health’s Dignity Health St. Mary Medical Center CARE Center in Long Beach, California, which serves the LGBTQ community and is part of his division. The CARE Center ramped up its behavioral telehealth outreach programs early in the pandemic as virus-related concerns limited in-person interactions. The demand for virtual therapy from the CARE Center spiked and it has stayed high. “I really think it tells the story of the fact that telehealth has opened a door to better care,” Testa said. No letup in sight He said that across the 21 states that CommonSpirit serves, the system has accommodated more than 2 million telehealth visits since the start of the pandemic. Testa said CommonSpirit has found patients are much more likely to keep appointments for follow-up care if they can do them by phone. “There’s a lot fewer no-shows,” he said. He suspects that is because patients don’t have to worry about issues like transportation and child care that can be hurdles to getting to inperson appointments. Testa is confident virtual visits aren’t a fleeting fad. “I don’t foresee them going away,” he said. “I think patients like them. I think providers like them. I think it’s in the best interest of care.” leisenhauer@chausa.org

March March15, 1,2022 2022 CATHOLIC HEALTH WORLD

Sr. Lucille Marie Dean was longtime educator and health care leader Sr. Lucille Marie Dean, SP, a longtime educator and a board member for Providence Health & Services who helped oversee its merger with St. Joseph Health into Providence St. Joseph Health, died Feb. Sr. Dean 18 at St. Joseph Residence, a home for women religious in Seattle. She was 86. Sr. Dean spent many of her 67 years as a Sister of Providence teaching in Catholic schools and in school administration, start-

ing in Yakima, Washington, in 1957. She also served at schools in Burbank, California, and Anchorage, Alaska. In 2015-2016, Sr. Dean served as the interim president of University of Great Falls in Montana, her alma mater. The school is now known as the University of Providence. She held many leadership positions with her order. In the 1980s, she was provincial superior of Sacred Heart Province that encompasses western Washington, Oregon, California and Alaska. Sr. Dean took a leadership role in Providence Health & Services, the health sys-

tem founded by the Sisters of Providence. She was a member of the system’s board for many years and served as chair for two. During her time on the board, the system added Swedish Health Services, Kadlec Regional Medical Center and Pacific Medical Centers as secular partners. In 2016, when Providence Health & Services merged with St. Joseph Health to form Providence St. Joseph Health, Sr. Dean was appointed a trustee for the new system. Providence St. Joseph Health is one of the largest health systems in the nation. In 2018, Sr. Dean was a nominee for

CHA’s Lifetime Achievement Award for her service to the Catholic health ministry. “The consummate leader, Sister Lucille has helped her organization confidently manage change and embrace new partnerships that strengthened her health system and ultimately Catholic health care,” the nomination noted. A vigil for Sr. Dean was set for March 11 in Seattle, her funeral Mass was to be there March 12. Memorial services are planned March 29 in Great Falls and April 10 in Burbank.

and Louisiana State University, as well as on statewide advocacy. Beth O’Brien, chief strategy officer of FMOLHS, is interim market president. Kyle Grate to president of SSM Health – St. Clare Hospital in Fenton, Missouri. He was vice president of operations and interim president at SSM Health St. Joseph Hospital – Lake Saint Louis, Missouri. Facilities within CommonSpirit Health have announced these changes: Dr. Scott Neeley to president and chief executive of Sierra Nevada Memorial Hospital in Grass Valley, California. He was vice president and

chief medical officer of St. Joseph’s Medical Center in Stockton, California. Michael Schnieders has retired as president of CHI Health Good Samaritan in Kearney, Nebraska. Timothy Charles plans to retire as president and chief executive of Mercy Medical Center in Cedar Rapids, Iowa, effective Dec. 31. Karl Keeler, MercyOne Central Iowa president, and Phil Harrop, MercyOne Central Iowa interim chief operating officer, are leaving the MercyOne system to pursue other opportunities. As MercyOne seeks new leadership, Mike Wegner, executive vice president, chief financial and operations officer, is interim MercyOne Central Iowa president; and Dr. Hijinio Carreon, chief medical executive, is interim MercyOne Central Iowa chief operating officer. Both Wegner and Carreon will continue in their roles during the transition.

KEEPING UP

Schnieders

Hessami

PRESIDENTS AND CEOS Scott Wester has transition from Franciscan Missionaries of Our Lady Health System market president for Baton Rouge, Louisi-

RIchter

Ivanjack

ana, and president of Our Lady of the Lake Regional Medical Center of Baton Rouge. He now is a system executive focused on the new strategic partnership between FMOLHS

ADMINISTRATIVE CHANGES Dr. Andrea Teague to vice president of cancer services for CHRISTUS Health of Irving, Texas. Organizations within CommonSpirit Health have made these changes: Dr. Sam Hessami to chief medical officer of Dignity Health–St. Bernardine Medical Center of San Bernardino, California. Cindi Richter to director of the CHI Health Good Samaritan Foundation, which is affiliated with CHI Health Good Samaritan in Kearney, Nebraska. Dr. Lisa Ivanjack to chief medical officer of PeaceHealth Medical Group, Vancouver, Washington. CHA has made these changes: Jill Fisk to director, mission services; and Margaret Kriso to governance administrator/board liaison.

ANNIVERSARY French Hospital Medical Center, San Luis Obispo, California, part of CommonSpirit Health, 75 years.

GIFTS PeaceHealth of Vancouver, Washington, has received a $50 million donation from Peter H. Paulsen to help expand PeaceHealth St. Joseph Medical Center in Bellingham, Washington. The gift is the largest in PeaceHealth history. A future proposed Peter Paulsen Pavilion at the hospital will significantly expand health care access with a new emergency department and advanced care for women, children and newborns. Paulsen is a retired real estate developer. Paulsen made his gift through PeaceHealth St. Joseph Medical Center’s newly launched Stronger Together fundraising campaign. French Hospital Medical Center of San Luis Obispo, California, has received a $500,000 gift for the Beyond Health campaign from John Couch, a former Apple executive and author. The donation will go toward the hospital’s $150 million expansion project, which includes the addition of a new patient care tower.

CATHOLIC HEALTH WORLD March 15, 2022

Findings of landmark report on disparities unheeded, equity scholar says By LISA EISENHAUER

Almost 20 years after the release of a national study he collaborated on showed that racism contributes to disparities in health care, Brian Smedley says little has changed. Smedley was the lead editor of “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” a study produced by the Institute of Medicine (now Smedley the National Academy of Medicine) in 2003 at the request of Congress. It found that racial and ethnic minorities experienced higher rates of morbidity and related mortality. The study stated: “The reasons for these health status disparities are complex and poorly understood, but may largely reflect socioeconomic differences, differences in health-related risk factors, environmental degradation, and direct and indirect consequences of discrimination.” The authors offered several suggestions for follow-up studies to figure out how to address the inequities. The report prompted headlines and calls for action that Smedley says have largely gone unheeded. “Despite all of the attention directed toward the ‘Unequal Treatment’ report, despite the many recommendations that were offered in that report, we as a nation have not made significant progress toward eliminating these health care disparities and unfortunately for many patients, this is a matter of life and death,” says Smedley, who is now an equity scholar with the Urban Institute. He reviewed the study’s findings during a webinar Feb. 23 sponsored by the Center for Health Journalism at the University of Southern California. He is co-writing a book following up on the study called “Unequal Health: Anti-Black Racism and the Threat to American Health” that is set for release later this year. Smedley discussed more recent research that shows the disparities cited in “Unequal Treatment” persist. Among them is the annual report on disparities and quality produced by the Agency for Healthcare Research and Quality, a federal agency within the Department of Health and Human Services. The agency said of the findings in its 2021 report: “While Black, Hispanic, American Indian, and Alaska Native communities have experienced substantial improvements in health care quality, significant disparities in all domains of health care quality persist. Even when rates of improvement in quality exceeded those experienced by white Americans, the improvements have not been enough to eliminate disparities.” The forces behind the disparities are many, according to Smedley. They include separate and inequitable health care systems, with those serving largely communities of color often lacking specialty providers and the latest medical technology. A second factor in disparities is variations in health insurance, including in covered services and reimbursements. Another key factor he cited is physician bias that includes racial stereotyping. He mentioned a 2016 study that showed more than 70% of white medical students believe there are biological differences in pain perceptions between Blacks and whites. The study found that such beliefs could be at the root of disparities in the provision of pain medications. Also at play in health care inequities, Smedley said, is the lack of diversity among health care professionals. He noted that racial concordance between care providers and patients has been shown to improve health outcomes. He cited a study from 2020 that looked at

Source: “Disparities in Health and Health Care Among Black People,” Kaiser Family Foundation, Feb. 24, 2022.

1.8 million hospital births in Florida from 1992 to 2015. It found that when Black doctors did the delivery, the mortality rate for Black babies was halved. Smedley said that while health care disparities affect the health and life spans of minorities, they take a toll on the nation overall. Not providing preventive care and early interventions for a significant part of the population, for example, means those patients are likely to need more expensive care later, which drives up medical costs for everyone. The strongest argument for addressing care disparities in Smedley’s view is basic fairness. “We as a society have a moral imperative to ensure that health care is equitable for every patient according to patient need,” he said. “Widespread disparities should not exist and in fact are antithetical to our beliefs as a nation in terms of our egalitarian ideals.”

Source: “Disparities in Health and Health Care Among Black People,” Kaiser Family Foundation, Feb. 24, 2022.

leisenhauer@chausa.org

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Complete searchable version of the Ethical and Religious Directives for Catholic Health Care Services

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Glossary of important ethics terms

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Collection of relevant articles and resources addressing important clinical issues in Catholic health care