Becker's Hospital Review

14 CFO / FINANCE 10 hospitals laying off workers By Ayla Ellison S everal hospitals are trimming their workforces due to financial and operational challenges, and some are offering affected workers new positions. 1. Mercy Medical Center in Springfield, Mass., part of Trinity Health of New England, is trimming jobs. e hospital laid off 12 of its 380 unionized nurses, the Mas- sachusetts Nurses Association told Western Mass News in May. Translators and ancillary staff were also affected by the cuts. Trinity Health of New England, which declined to provide the number of workers affected by the layoffs, attributed the cuts to national disruption in the healthcare industry. In addition to the layoffs, Trinity Health of New England is also eliminating some positions that are currently vacant. 2. Claxton-Hepburn Medical Center in Ogdensburg, N.Y., and Carthage (N.Y.) Area Hospital both laid off 4 percent of their workforce on May 13. Richard Duvall, who serves as president and CEO of both hospitals, said the layoffs occured because the hospitals are feeling the financial effects of inflation and a decrease in COVID-19 hos- pitalizations. 3. Citing skyrocketing expenses and flat revenue, St. Charles Health System in Bend, Ore., will cut 181 positions, according to a May 18 announcement. e workforce re- duction includes laying off 105 caregivers and eliminating 76 vacant positions. e layoffs affect mainly nonclinical workers, including many leadership positions. e four-hospital health system said it took steps to address its financial challenges, but it ended the month of April with a $21.8 million loss. 4. MetroWest Medical Center in Framingham, Mass., eliminated live interpretation ser- vices in April and laid off an undisclosed number of employees, the MetroWest Daily News reported. Hospital leaders said a "minimal number of positions" were eliminated when the hospital ended the services. 5. Memorial Hospital at Gulfport (Miss.) laid off its chief medical officer and vice presi- dent of system development in April. Regarding the layoffs, Memorial Hospital at Gulf- port CEO Kent Nicaud said the hospital is facing financial challenges, such as increased labor costs, and is aiming to return to an organizational structure it had three or four years ago. 6. Toledo, Ohio-based ProMedica's health plan, Paramount, is laying off about 200 em- ployees in July aer losing a Medicaid contract. Anthem acquired Paramount's Medic- aid contract, and ProMedica and Anthem have been working to identify open roles for employees affected by the layoffs. 7. Greenwood (Miss.) Leflore Hospital announced in May that it will lay off 30 employ- ees to help offset losses. e layoffs, which include an undisclosed number of physicians, affect less than 4 percent of the hospital's workforce. Many of the affected employees were notified May 17. 8. St. Mary's Medical Center in West Palm Beach, Fla., laid off 49 employees, including 21 registered nurses, when it stopped providing mental health services in April, accord- ing to a notice filed with state regulators. 9. Coos Bay, Ore.-based Bay Area Hospital will close its inpatient behavioral health unit and lay off 56 temporary employees in response to financial challenges from COVID-19 and high labor costs. e cancellation of the workers' contracts and the closure of the unit will take place by the end of June, according to a May 25 news release. 10. MarinHealth Medical Center laid off 104 revenue cycle and supply chain employees in April aer entering into a contract with Optum to provide those services, according to a notice filed with state regulators in February. Greenbrae, Calif.-based MarinHealth said that as a result of the contract with Optum, all non-contractual revenue cycle and supply chain employees were terminated from employment with the hospital on April 9. Optum offered jobs to most workers affected by the layoffs. Employees who accepted an offer began employment with Optum on the first work day following separation from MarinHealth, a spokesperson for the hospital told Becker's Hospital Review. n • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021

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