Author Archives: henrykotula

Margins remain narrow for US hospitals

Posted on by • Posted in Economic Recovery, Economic Stimulus, Health System, Hospital, Hospital Industry, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue • Leave a comment
https://www.beckershospitalreview.com/finance/margins-remain-narrow-for-us-hospitals.html?origin=CFOE&utm_source=CFOE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Facing a financial squeeze, hospitals nationwide are cutting jobs

Not including federal relief aid, hospital operating margins remained narrow in March at just 1.4 percent, according to a recent report from healthcare consulting firm Kaufman Hall. Including federal relief aid, the median hospital operating margin was 2 percent. 

Although margins remained narrow in March, hospitals saw year-over-year margins starkly increase. In particular, operating margin increased 14.5 percentage points year-over-year in March, without federal relief aid. 

The sharp increase was attributed to measuring March 2021 performance against the same period last year, when hospitals faced losses amid national shutdowns of elective procedures. 

Kaufman Hall noted that the median operating earnings before interest, taxes, depreciation and amortization margin also rose 13.3 percentage points in March, compared to March of 2020. 

“We expect to see additional margin gains in the months ahead, especially in comparison to record-poor performance in the early months of the pandemic,” said Jim Blake, managing director at Kaufman Hall. “Over the course of 2021, however, we project hospital margins could be down as much as 80 percent, and revenues down as much as $122 billion compared to pre-pandemic levels, as hospitals continue to feel the dire repercussions of COVID-19.”

Hospitals also saw their adjusted discharges, emergency room visits, adjusted patient days and average length of stay increase year over year in March, Kaufman Hall noted. 

The Goal of a Health Care System

Posted on by • Posted in Access & Quality of Healthcare, Goal Setting, Goals, Health Insurance Coverage Adequacy, Health Policy, Medicare for All, Outcomes, Public Health, Quality, Quality Measures, Quality of Care, Universal Coverage, Universal Healthcare System • Leave a comment
May be a Twitter screenshot of 1 person and text that says 'Robert Reich @RBReich The goal of a health care system should not be to make people rich. It should be to make people well. This is obvious to every other industrialized country in the world.'

Cartoon – Preventable Diseases

Posted on by • Posted in Cartoon, Centers for Disease Control & Prevention (CDC), Community Spread, Coronavirus, Coronavirus Mutation, Herd Immunity, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Preventable Disease, Public Health, Scientists, Sign of the Times, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • 1 Comment
Sack cartoon: Vaccinations | Star Tribune

Cartoon – Trailing with the Sheeples

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Herd Immunity | Cartoon | mtexpress.com

Cartoon – No Vaccine for Stupidity

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Anti-Vaxxers vs. Reality | KQED

‘Distancing isn’t helping you’: Indoor COVID-19 exposure risk same at 6, 60 feet, MIT researcher says

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Community Spread, Coronavirus, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Social Distancing, World Health Organization (WHO) • Leave a comment
https://www.beckershospitalreview.com/infection-control/distancing-isn-t-helping-you-indoor-covid-19-exposure-risk-same-at-6-60-feet-mit-researcher-says.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Risk of COVID-19 indoors is the same at 6 feet and 60 feet apart even when wearing a mask | Daily Mail Online

People who maintain 60 feet of distance from others indoors are no more protected than if they socially distanced by 6 feet, according to a peer-reviewed study published April 27 in the Proceedings of the National Academy of Science of the United States of America.

Cambridge-based Massachusetts Institute of Technology professors Martin Bazant and John Bush, PhD, developed a model to calculate indoor exposure risk to COVID-19 by factoring in the amount of time spent inside, air filtration and circulation, immunization, variant strains, mask use, and respiratory activity such as breathing, eating or talking.  

“We argue there really isn’t much of a benefit to the six-foot rule, especially when people are wearing masks,” Mr. Bazant told CNBC. “It really has no physical basis because the air a person is breathing while wearing a mask tends to rise and comes down elsewhere in the room so you’re more exposed to the average background than you are to a person at a distance.”

As with smoking, even people wearing masks can be affected by secondhand smoke that makes its way around the enclosed area and lingers. The same logic applies to airborne droplets of the virus, according to the study. However, the study did note that mask use by both infected and susceptible people reduces “respiratory plumes” and thus increases the amount of time people may safely spend together indoors. 

When crafting guidelines, the CDC and World Health Organization have overlooked the amount of time spent indoors, Mr. Bazant claims.  

“What our analysis continues to show is that many spaces that have been shut down in fact don’t need to be,” Mr. Bazant said. “Oftentimes, the space is large enough, the ventilation is good enough, the amount of time people spend together is such that those spaces can be safely operated even at full capacity, and the scientific support for reduced capacity in those spaces is really not very good.”  

Opening windows or installing new fans to keep air moving may be just as effective or more effective than purchasing a new filtration system, Mr. Bazant said.

The CDC currently recommends staying at least 6 feet away from other people and wearing a mask to slow the spread of COVID-19, citing the fact that the virus spreads mainly among people who are in close contact for a prolonged period.  

“The distancing isn’t helping you that much and it’s also giving you a false sense of security, because you’re as safe at six feet as you are at 60 feet if you’re indoors. Everyone in that space is at roughly the same risk, actually,” Mr. Bazant said. 

After three rounds of peer review, Mr. Bazant says he hopes the study will influence social distancing policies.

Private equity rolls up veterinary practices, with predictable results

Posted on by • Posted in Access & Quality of Healthcare, Animal Healthcare, Consumer Advocacy, Consumer Engagement, Consumer Focus, Consumer Preferences, Consumer Trust, Consumerism, High Drug Prices, High Prices, Market Consolidation, Market Power, Mergers & Acquisitions, Out of Pocket Expenses, Private Equity, Value, Venture Capital • Leave a comment

https://mailchi.mp/da8db2c9bc41/the-weekly-gist-april-23-2021?e=d1e747d2d8

Amazon.com: The Private Equity Playbook: Management's Guide to Working with Private Equity (9781544513263): Coffey, Adam: Books

Given regulatory barriers and structural differences in practice, private equity firms have been slow to acquire and roll up physician practices and other care assets in other countries in the same way they’ve done here in the US. But according a fascinating piece in the Financial Times, investors have targeted a different healthcare segment, one ripe for the “efficiencies” that roll-ups can bring—small veterinary practices in the UK and Ireland.

British investment firm IVC bought up hundreds of small vet practices across the UK, only to be acquired itself by Swedish firm Evidensia, which is now the largest owner of veterinary care sites, with more than 1,500 across Europe. Vets describe the deals as too good to refuse: one who sold his practice to IVC said “he ‘almost fell off his chair’ on hearing how much it was offering. The vet, who requested anonymity, says IVC mistook his shock for hesitation—and increased its offer.” (Physician executives in the US, take note.) IVC claims that its model provides more flexible options, especially for female veterinarians seeking more work-life balance than offered by the typical “cottage” veterinary practice. 

But consumers have complained of decreased access to care as some local clinics have been shuttered as a result of roll-ups. Meanwhile prices, particularly for pet medications like painkillers or feline insulin, have risen as much as 40 percent—and vets aren’t given leeway to offer the discounts they previously extended to low-income customers. And with IVC attaining significant market share in some communities (for instance, owning 17 of 32 vet practices in Birmingham), questions have arisen about diminished competition and even price fixing. 

The playbook for private equity is consistent across human and animal healthcare: increase leverage, raise prices for care, and slash practice costs, all with little obvious value for consumers. It remains to be seen whether and how consumers will push back—either on behalf of their beloved pets, or for the sake of their own health.  

Asking the wrong questions about telemedicine’s impact

Posted on by • Posted in Access, Access & Quality of Healthcare, Consumer Care Consumption Patterns, Consumer Focus, Consumer Preferences, Consumer-Centered Care Pathway, Consumerism, Health Policy, Health System, Hospital, Hospital Industry, Pent-up Demand, Primary Care, Primary Care Delivery Model, Primary Care Strategy, Telemedicine, Virtual Care Strategy, Virtual Healthcare, Virtual Visit • Leave a comment

https://mailchi.mp/da8db2c9bc41/the-weekly-gist-april-23-2021?e=d1e747d2d8

Telemedicine – Creating Positive Impact in Healthcare – iPatientCare

A new study out this week revived an old argument about whether telehealth visits spur more downstream care utilization compared to in-person visits, potentially raising the total cost of care. Researchers evaluated three years of claims data from Blue Cross Blue Shield of Michigan to compare patients treated for an acute upper respiratory infection via telemedicine versus an in-person visit, finding that patients who used telemedicine were almost twice as likely to have a related downstream visit (10.3 percent vs. 5.9 percent, respectively).

They concluded that these increased rates of follow-up likely negate any cost savings from replacing an in-person encounter with a less costly telemedicine visit. 

Our take: so what? The study failed to address the question of whether a telemedicine visit was easier to access, or more timely than an in-person visit. Further, it evaluated data from 2016-2019, so the results should be caveated as pertaining to the “pre-COVID era”, before last year’s explosion in virtual care. Moreover, it’s unsurprising that patients who have a telemedicine visit may need more follow-up care (or that providers who deliver care virtually may be more aggressive about suggesting follow-up if symptoms change).

This focus on increased downstream care as a prima facie failure also ignores the fact that telemedicine services likely tap into pent-up, unmet demand for access to care. More access is a good thing for patients—and policymakers should consider that limiting reimbursement for virtual access to primary care (which accounts for less than 6 percent of total health spending) is unlikely to deliver the system-wide reduction in healthcare spending we need.

Virtual care for mental health is here to stay

Posted on by • Posted in Behavioral Health, Health System, Hospital, Hospital Industry, Isolation, Mental Health, Privacy, Private Equity, Telemedicine, Uncertainty, Virtual Care Strategy, Virtual Healthcare, Virtual Visit • Leave a comment

https://mailchi.mp/da8db2c9bc41/the-weekly-gist-april-23-2021?e=d1e747d2d8

The uncertainty and isolation of the pandemic has taken a heavy toll on mental health. Over a third of adults are currently experiencing anxiety or depression—more than three times as many as early last year. And with access to behavioral health services already challenged before the pandemic, many patients have been turning to telemedicine for support.

Health insurer Cigna found that while use of virtual care for both non-behavioral and behavioral healthcare services peaked in spring 2020, consumers have continued to use telemedicine for mental health needs, while demand for other virtual services tapered off. As of December, about 70 percent of behavioral health claims were for care rendered virtually, compared to just 20 percent across all other services.
 
The recent surge in demand for virtual mental health services has spurred an influx of investment into digital solutions. A recent Rock Health analysis found investments in the space have more than tripled since 2015. The injection of funds extends to both “generalist” companies (focused on a wide range of virtual services, including behavioral health) and “specialist” companies (focused solely on virtual behavioral health solutions). 

Virtual behavioral health not only provides much needed access to care, but patients also prefer the privacy and ready access offered by telemedicine. Moving forward, telemedicine may become the preferred alternative for patients seeking support for mental health needs.