Denver Health cuts the gas 

Happy midday to you, Colorado, and welcome to another edition of The Temperature, where this week we explain why laughing gas is no laughing matter to planet Earth and we dive deep into newly revealed information about hospital prices.

The election is less than a week away — with major implications for health and climate issues — so the proverbial times are a’changin’. But the times are also literally changing this weekend with the annual end of daylight saving time and the return of standard time.

And that makes this the perfect moment to remind you that the socially popular — but also politically stalled — idea of making daylight saving time permanent comes with one major bug: It would mean we’d have super-dark mornings in winter. Let’s once more trot out this graphic showing sunrise times in Denver for 2023 if daylight saving time had been permanent.

In our darkest days of winter, permanent DST would make folks in Denver wait until roughly 8:20 a.m. before they saw the sun (and they’d still be driving home from work in twilight). Woof.

Speaking of changes, you may have noticed some here at The Temperature. Mike and I are experimenting with swapping weeks — he takes one week for just climate and environment news and I take the next week just for health news. Let us know what you think or if you prefer having both subjects together in each edition: newsletters@coloradosun.com.

And let’s get to it.

TEMP CHECK

HOSPITAL GASES

Getting the last laugh on laughing gas at Denver Health

Deep inside Denver Health’s main building, on a locked floor that even most doctors who work at the hospital have never visited, around giant tanks of oxygen and under low-hanging ductwork and plumbing, there is a cramped room with eight tall, blue cylinders of compressed gas.

The cylinders contain nitrous oxide — N₂O, the inhaled anesthetic known as laughing gas — and it is from this room that plumbing woven throughout the hospital carries the gas to operating rooms and other places where it may be used. Or at least it did.

Earlier this month, Denver Health switched from using nitrous oxide centrally piped from these always-open tanks to using smaller, portable tanks located in operating rooms that can be shut off when not in use. Dr. Amanda Deis, a pediatric anesthesiologist at the hospital, was among those who helped ceremonially twist the knobs on the cylinders closed.

“This was a pretty monumental day,” she said.

The reason for the switch is twofold. First, nitrous oxide is a potent greenhouse gas and destroyer of atmospheric ozone. And, second, hospitals across the country waste a ton of it.

When Deis did the math, comparing how much laughing gas the hospital bought to how much patients used, she found that almost 90% was lost to leaks throughout the hospital. That’s no joke.

These leaks — every coupling and valve in the system presents an opportunity for gas to escape — aren’t enough at any one place to trigger indoor air quality concerns. Hospitals test to make sure.

But they do mean that loose nitrous is a major factor in a hospital’s overall climate footprint. And this isn’t just a problem at Denver Health — hospitals across the globe have found similar rates of leakage.

Dr. Jodi Sherman, a professor of anesthesiology at the Yale School of Medicine who has become an expert in hospital climate impacts, said the health care sector accounts for nearly 9% of national greenhouse gas emissions. Within a hospital, the operating rooms are the most environmentally intensive areas, in part because of all the stuff that gets used and thrown out but also in part because of the climate impacts from anesthesia gas, she said.

Hospitals have tried to address this in part by cutting down on the amount of nitrous oxide that gets used. But Sherman said that’s not enough.

“Even if you’re using less, the system is just continuously leaking,” she said.

Hospitals can’t stop using nitrous oxide entirely because it still has areas where it’s needed, Deis said. She mentioned pediatric surgeries — some kids get sick if you give them injectable anesthesiology while they’re awake, so Deis said she will use nitrous to help a kid fall asleep before giving them other anesthesia.

That made turning off the central tanks and switching to portable tanks the best option.

Dr. David Abts, an anesthesiologist at Denver Health, said the hospital is the first large facility in Colorado to make the switch to portable nitrous tanks.

Combined with another change Denver Health has made — swapping out another anesthesia gas called desflurane that is an especially potent greenhouse gas for something more climate-friendly — the switch is expected to reduce the greenhouse emissions from Denver Health’s operating rooms by over 95%.

“To put some numbers on that,” he said, “that’s as though, every year, we are taking over 1,800 SUVs off the road driving from Denver to New York City.”

Those numbers mean Deis will breathe a little easier in the operating room.

“Knowing that I’m already contributing to that greenhouse warming problem, this feels so good,” she said, “knowing that we can make one system change to really minimize our footprint while still taking this medication available to patients.”

INSURANCE ANNOYANCE

Explaining PERA’s big health insurance rate increase

Tens of thousands of public sector retirees received an unwelcome notice this fall when the renewal rates for Medicare Advantage plans through the state’s pension plan hit their inboxes.

Two of the three plans offered will see huge increases for 2025 — one plan’s premium prices are increasing by 130%, while another plan is jumping by more than 200%. A third plan will see no change in premium prices.

The rate changes are the first time in three years that members of the Colorado Public Employees’ Retirement Association, or PERA, have seen increases in their health insurance bills. And that also explains the issue, said Andrew Roth, the pension’s executive director and CEO.

In 2021, when PERA added Medicare Advantage plans from UnitedHealthcare to its offerings for 2022, it struck a great deal. Not only did United offer rates that were below 2021 premiums but it locked in those rates for three years.

Now that the deal is up, Roth said PERA’s 2025 rates must “reflect what’s happening in the market overall.”

“Unfortunately, we don’t have a magic wand to lower premiums,” Roth said.

Medicare Advantage plans are essentially beefed-up versions of Medicare coverage that work like more traditional health insurance policies. That means they come with premiums, out-of-pocket expenses, coverage benefits and limitations, and specified medical provider networks.

PERA, like many other public pensions, has offered medical coverage to its beneficiaries for decades. Today, nearly 64,000 people — both public sector retirees and their partners or dependants — are enrolled in a Medicare plan through PERA.

The pension also offers health coverage for retirees who are not yet 65 years old, the age of Medicare eligibility. About 7,000 people are covered through that — and those plans, while costing a lot more than the Medicare plans, are generally not seeing big increases in premium prices.

Roth said PERA tries to offer its members health insurance plans with “richer” benefits. That means, in an actuarial sense, that there’s more bang for the buck. It’s just next year’s Medicare plans will cost a lot more bucks.

The increases are in two plans from UnitedHealthcare. One of the United plans is jumping to a $349 monthly premium in 2025 from a $152 monthly premium in 2024. The other United plan is rising to $169 per month from $52 per month.

PERA also offers a Medicare Advantage plan through Kaiser Permanente. That plan is holding steady at $170 per month.

Public retirees can receive a subsidy from PERA to help cut the cost of their premiums. The subsidy is $5.75 per month for every year of service — up to a maximum $115.

For reference, unsubsidized premiums for a 40-year-old who buys insurance on their own in Colorado average around $460 per month. But numerous retired state government workers have written to us here at The Temperature to say how the PERA increases will hurt their already strained fixed incomes.

PERA members could drop the pension’s plans and go with less costly Medicare Advantage plans available in the open market. But those plans may not offer the same level of benefits, or provide access to the same doctors.

Roth said he has heard from retirees, too, and he offered empathy for the hardship.

“We absolutely feel our members’ pain,” he said. “We’re aware that disruption for our retirees is difficult.”

MORE HEALTH NEWS

• “We have had multiple dairies refuse a site visit.” Internal emails reveal the struggle that public health workers — including those in Colorado — had in gaining access to dairy farms to fight outbreaks of bird flu there. Some farms refused to allow public health workers on-site. Others didn’t make their employees available for testing — or their employees declined testing. The challenges raise the possibility that far more people have been sickened with bird flu in the United States than known. On the other hand, a new Centers for Disease Control and Prevention study brings positive news: Blood testing of health care workers in Missouri did not find evidence of human-to-human transmission there.  
  — Kaiser Health News
• Wait, have drug overdose deaths actually increased 800%? ’Tis the season for political attack ads, and one circulating on the airwaves highlights this shocking statistic. In our latest fact brief, reporter Por Jaijongkit checks whether the stat is true and finds that it is — but the increase is for drug overdose deaths nationwide between 1999 and 2022. That means it spans five presidential administrations, both Democratic and Republican. The increase in Colorado between 2000 and 2023 is lower but still alarming: 655%. 
  — The Colorado Sun/Gigafact
• Climate change is making Los Angeles vulnerable to tropical disease. Just in time for spooky season, here’s a frightening story about how local transmission of dengue is an emerging health concern in Southern California as a warming climate makes the region more hospitable to the disease and the mosquitoes that carry it.
  — NPR
• Pythons sure do have big mouths. Mike Booth has lately taken to sending me every story he comes across about rapacious pythons in Florida consuming comically big meals — like this one with a picture of a giant snake swallowing an entire frickin’ deer. But what does this have to do with health, much less human health? Stay tuned for the Temp in two weeks to find out. (And, no, the answer is not that it would be bad for your health if a python ate you.)
  — ABC News

CHART OF THE WEEK

Because this passes for lively entertainment in The Temperature household, we’ve been having fun digging through the hospital price data available on the new ColoradoHospitalPrices.com website.

As expected, there are some truly wild fluctuations in what different insurance plans get charged for the same service at the same hospital — especially when you compare that to what Medicare pays the hospital for that service.

The graphic above shows the price for a standard single-view chest X-ray at UCHealth University of Colorado Hospital.

We chose that hospital, the largest in Colorado, for the analysis not because it’s an outlier but because it’s an … in-lier? The results look a lot like the results at most any other large hospital, and University happened to have contracts with a good variety of insurers, plus it reported the Medicare price and the price you’d pay if you walked in and paid cash without involving insurance.

(The “chargemaster” price at top is, as you can see, not a real price that anybody pays — though it may appear on an itemized bill — but more of a sticker price that is used as a starting point for negotiation.)

This phenomenon of insurers paying more than a hospital’s cash-pay price is common nationwide and one of the many headscratchers of our health care system.

We’re working on a how-to guide to the various hospital price transparency tools now available in Colorado. Watch ColoradoSun.com in the coming days for that story.

That’s it for us this week. Before we go, a big Temp congratulations to one of our favorite local health reporters, The Denver Post’s Meg Wingerter, as she embarks on family leave (as announced this week in her newsletter Checkup Denver). Best wishes to Meg and her family as they navigate life with a new baby.

Be sure to let us know what you think about this newsletter format — again, send any and all feedback to newsletters@coloradosun.com. Mike will be your ship’s captain next week, and I’ll see you after all the leaves have fallen in a couple of weeks.

May the next week bring you happy-Halloween scaries and not dreadful end-of-the-republic scaries. Or, either way, at least a lot of chocolate.

— John & Michael

Corrections & Clarifications

In the Oct. 16, 2024, edition of The Temperature, we wrote that the proposed 0.34% sales tax increase to support Denver Health came out to 34 cents on a $10 purchase. This is incorrect. It’s 3.4 cents on a $10 purchase. We regret the error.

Notice something wrong? The Colorado Sun has an ethical responsibility to fix all factual errors. Request a correction by emailing corrections@coloradosun.com.

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