Buying a new car every year would be a very impractical expense. It would also be cheaper than a year’s worth of health care for a family.
Why it matters: The cost-shifting and complexity of health insurance can hide its high cost, which crowds out families’ other needs and depresses workers’ wages.
The market designed to create competition for biologics — typically our most expensive drugs — has been slow to take off, but some experts say that even its best-case scenario doesn’t do enough to lower drug prices.
Why it matters: While wonks debate the future of biosimilars in policy journals and on editorial pages, the argument is reflected in the political divide over whether enhanced drug competition or price regulation is the best way to address drug prices.
https://www.axios.com/the-provider-lobby-takes-on-congress-57d2acc6-b26b-4b57-aa64-a75606e612b8.html
Ending surprise medical bills inspires bipartisan kumbaya in a way nearly unheard of these days, and yet a brutal lobbying and public relations blitz by doctor and hospital groups is threatening to kill the entire effort.
Driving the news: Provider-backed groups are spending millions of dollars to sway lawmakers and the public opinion against Congress’s efforts to ban surprise billing, according to a handful of recent reports.
THE MANAGEMENT REGRETS THAT
IT HAS COME TO THEIR ATTENTION
THAT EMPLOYEES DYING ON THE
JOB ARE FAILING TO FALL DOWN.
THIS PRACTICE MUST STOP,
AS IT BECOMES IMPOSSIBLE TO
DISTINGUISH BETWEEN DEATH AND
NATURAL MOVEMENT OF THE STAFF.
ANY EMPLOYEES FOUND DEAD IN AN
UPRIGHT POSITION WILL BE DROPPED
FROM THE PAYROLL.
As the popularity of programs such as Medicare Advantage grows, it’s important to understand the spending ramifications and whether the program is yielding any savings for taxpayers.
More and more seniors are choosing coverage options outside of traditional Medicare. Together, Medicare Advantage and the Medicare Shared Savings Program cover about half of all Medicare beneficiaries. In a six-year period, Medicare Advantage alone grew by 57% and as of 2018 covered nearly 20 million seniors.
Medicare Advantage allows private insurers to contract with the federal government to care for eligible Medicare beneficiaries. Private plans receive a fixed payment — typically a per member, per month allotment — to coordinate care for beneficiaries who choose MA plans.
It’s these “predictable” payments that allow MA plans to invest in unconventional coverage options such as meal delivery and transportation to appointments, the authors said.
But despite the program’s popularity, it’s not yielding the savings that was originally expected.
“When a beneficiary joins MA, Medicare spends more, on average, than it would have if the patient had remained in traditional Medicare. We find the opposite in the MSSP: When a patient joins the Medicare ACO program, Medicare costs fall,” according to Health Affairs.
There are also differences between the two programs that should be fixed, the authors said.
The MSSP is only punitive, which is not true for the star-rating program for MA. One way to achieve a more equitable ratings system is to “radically” reduce the number of quality measures, which have become a burden for physicians, the authors said.
“We propose limiting quality measurement to five measures that are outcome oriented: hospital and ER use, patient satisfaction, and diabetes A1c and blood pressure control.”
It’s also important to find a risk adjustment model that can be used for both MA and MSSP populations, the authors said.
CMS has committed itself to reducing the amount of burden on payers and providers, and paring down quality ratings overhead is a key part of that. The agency’s removed a number of measures across its reporting programs in 2018 as part of its “Meaningful Measures” initiative, and is currently looking at others in MSSP, MA and the Merit-based Incentive Payment System.
‘All of us have allowed this crisis to grow,’ he wrote in a letter published Thursday in The New York Times.
Healthcare CEOs should put pressure on politicians without resorting to ‘blatant partisanship,’ he said.
Northwell Health President and CEO Michael J. Dowling isn’t done pushing fellow leaders of healthcare provider organizations to take political action in the aftermath of deadly mass shootings.
Dowling addressed healthcare CEOs in a “call to action“ published online last week by the Great Neck, New York–based nonprofit health system. Now he’s published a full-page print version of that letter in Thursday’s national edition of The New York Times, while reaching out directly to peers who could join him in a to-be-determined collective action plan to curb gun violence.
“To me, it’s an obligation of people who are in leadership positions to take some action, speak out, and prepare their organizations to address this as a public health issue,” Dowling tells HealthLeaders.
Wading into such a politically charged topic is sure to give some healthcare CEOs pause. Even if they keep their advocacy within all legal and ethical bounds, they could face rising distrust from community members who oppose further restrictions on firearms. But leaders have a responsibility to thread that needle for the sake of community health, Dowling says.
“I do anticipate that there’ll be criticism about this, but then again, if you’re in a leadership role, criticism is what you’ve got to deal with,” he says.
Dowling argues that healthcare leaders have successfully spoken out about other public health crises, such as smoking and drug use. But they have largely failed to respond adequately as gun violence inflicts considerable harm—both physical and emotional—on the communities they serve, he says.
“It is easy to point fingers at members of Congress for their inaction, the vile rhetoric of some politicians who stoke the flames of hatred, the lax laws that provide far-too-easy access to firearms, or the NRA’s intractable opposition to common sense legislation,” Dowling wrote in the print version of his letter. “It is far more difficult to look in the mirror and see what we have or haven’t done. All of us have allowed this crisis to grow. Sadly, as a nation, we have become numb to the bloodshed.”
His letter proposes a four-part agenda for healthcare leaders to tackle together:
The letter notes that the U.S. has nearly 40,000 firearms-related deaths each year and that several dozen people have died in mass shootings thus far in 2019, including 31 earlier this month in separate shootings in El Paso, Texas, and Dayton, Ohio.
The way for-profit companies think about their relationship with the communities in which they operate has been shifting for some time. The most recent evidence of that shift came earlier this week, when the influential Business Roundtable released a revised statement on the principles of corporate governance, responding to criticism over the so-called “primacy of shareholders.”
The 181 CEOs who signed onto the new statement said they would run their business not just for the good of their shareholders but also for the good of customers, employees, suppliers, and communities. There’s some similarity between that updated notion of corporate responsibility and the sort of advocacy work Dowling wants to see from his for-profit and nonprofit peers alike.
Every single organization has a social mission, and large organizations that have sway in a local community have a responsibility to the community’s health, Dowling says.
“A healthy community helps and creates a healthy organization,” he says.
One major factor that may be pushing more CEOs to take a public stance on politically sensitive issues—or at least giving them the cover to do so confidently—is the generational shift in the U.S. workforce. Although most Americans overall say CEOs shouldn’t speak out, younger workers overwhelmingly support such action, as Fortune‘s Alan Murray reported, citing the magazine’s own polling.
Dowling says he has received hundreds of letters, emails, and phone calls from members of Northwell Health’s 70,000-person workforce expressing support in light of his original letter published online last week.
“The feedback has been absolutely universal in support,” he says.
Even among healthcare professionals who agree it’s appropriate to speak out on politically charged topics, there’s sharp disagreement over which policies lawmakers should enact and whether those policies would infringe on the public’s Second Amendment rights.
The group Doctors for Responsible Gun Ownership (DRGO) rejects the premise of Dowling’s argument: “Firearms are not a public health issue,” the DRGO website states, arguing that responsible gun ownership has been shown to benefit the public health by preventing violent crime.
Dennis Petrocelli, MD, a psychiatrist in Virginia, wrote a DRGO article that called Virginia’s proposed red flag law “misguided” and perhaps “the single greatest threat to our constitutional freedoms ever introduced in the Commonwealth of Virginia.” His concern is that the government might be able to take guns away without any real evidence of a threat.
While gun rights advocates may see Dowling as merely their latest political foe, Dowling contends that he’s pushing for a cause that can peaceably coexist with the constitutional right to bear arms.
“You can have effective, reasonable legislative action around guns that still protects the essence of what many people believe to be the core of the Second Amendment,” Dowling says. “It’s not an either/or situation.”
Dowling isn’t, of course, the only healthcare leader speaking out about gun violence.
On the same day last week that Northwell Health published Dowling’s online call to action, Ascension published a similar letter from President and CEO Joseph R. Impicciche, JD, MHA, who referred to gun violence in American society as a “burgeoning public health crisis.”
“Silence in the face of such tragedy and wrongdoing falls short of our mission to advocate for a compassionate and just society,” Impicciche wrote, citing the health system’s Catholic commitment to defend human dignity.
The American Medical Association (AMA) and American College of Emergency Physicians (ACEP) each issued statements this month calling for public policy changes in response to these recent shootings, continuing their long-running advocacy work on the topic.
American Hospital Association 2019 Chairman Brian Gragnolati, who is president and CEO of Atlantic Health System in Morristown, New Jersey, said in a statement this month that hospitals and health systems “play a role in the larger conversation and are determined to use our collective voice to prevent more senseless tragedies.”
Outpatient volume growth helped push Advocate Aurora Health’s revenue higher in the second quarter of 2019, according to unaudited financial documents released Aug. 22.
Advocate Aurora Health, which was formed in April 2018 and has dual headquarters in Downers Grove, Ill., and Milwaukee, reported revenue of $3.2 billion in the second quarter of 2019, up from $3 billion in the same period a year earlier. Patient service revenue climbed 8.8 percent year over year partially due to increased outpatient volume. The health system said capitation revenue dropped 9.9 percent year over year due to the conversion of a full-risk arrangement to fee-for-service.
After factoring in a 4.7 percent year-over-year increase in expenses, Advocate Aurora posted operating income of $132.3 million in the second quarter of 2019. That’s up from $107.2 million in the same period a year earlier.
The 28-hospital system reported nonoperating income of $286 million in the second quarter of this year, which includes investment income of $194.4 million. Advocate Aurora ended the second quarter of 2019 with net income of $418.4 million, up from $158.7 million a year earlier.
A U.S. bankruptcy court approved Tulare (Calif.) Local Health Care District’s Chapter 9 plan on Aug. 16. The district, which includes a 101-bed hospital, is now set to emerge from the bankruptcy process, according to The Porterville Recorder.
Tulare Regional Medical Center, the district’s hospital, entered Chapter 9 bankruptcy in 2017 and closed for a year. The hospital reopened in October 2018 and entered into a lease agreement with Roseville, Calif.-based Adventist Health. The hospital, now called Adventist Health Tulare, recently opened a birth center and plans to add a sleep lab and mammography services.
Adventist Health Tulare President Randy Dodd is pleased the court approved the healthcare district’s bankruptcy plan.
“This is the resolution we have all been hoping for,” he said, according to The Porterville Recorder. “The partnership we began with Tulare in 2018 is a perfect fit with Adventist Health’s commitment and service to the Central Valley. We are glad to be able to extend our excellent healthcare system to this underserved market.”
The merger of Sandy Springs, Ga.-based Northside Hospital and Lawrenceville, Ga.-based Gwinnett Medical Center will be official Aug. 28.
Northside Hospital, a three-hospital system, and Gwinnett Medical Center, a two-hospital system, will create a combined organization with 1,636 inpatient beds, more than 250 outpatient locations and nearly 21,000 employees.
Several of Gwinnett’s facilities, including its two hospitals, will be renamed once the merger is finalized. Gwinnett Medical Center-Lawrenceville (Ga.) will be renamed Northside Hospital Gwinnett, and Gwinnett Medical Center-Duluth (Ga.) will be renamed Northside Hospital Duluth.
HENRY KOTULA 