Private equity (PE)-backed physician practices increase healthcare spending and utilization

https://mailchi.mp/6a3812741768/the-weekly-gist-september-9-2022?e=d1e747d2d8

A recent JAMA study of 578 US dermatology, gastroenterology, and ophthalmology practices acquired by PE firms from 2016 to 2020 found a steady rise in spending in the two years after acquisition, indicating that the average charge per commercial claim increased 20 percent, and the average allowed amount per claim rose 11 percent. It also found that, compared to a large control group with similar patient risk scores, PE-acquired practices saw new patient visits increase by 38 percent and total visit volume increase by 16 percent. 

The Gist: While the study’s authors note that these findings could be explained by changes in practice operations or management, they point out they could also be caused by an overutilization of profitable services not tied to an increase in value or benefit to the patient. 

We think the latter is likely the case here, and that this study provides evidence of PE-induced overutilization aimed at meeting aggressive growth targets.

But this is just the latest wave of ownership-induced overutilization: 20 years ago the same spotlight was on physician-owned imaging, cardiac, and other outpatient diagnostics, with several studies then documenting higher utilization in these facilities. Nonetheless, this latest trend is an important one to document and quantify, as the number of physicians working in PE-backed organizations continues to rise.

How hospitals are cutting back to reduce costs

Despite efforts to curtail high expenses, rising inflation and declining federal aid have led many hospitals to begin laying off workers and cutting certain services, Katheryn Houghton writes for Kaiser Health News.

Hospital costs have skyrocketed during the pandemic

At the beginning of the pandemic, hospitals’ financial challenges were largely related to the costs of responding to Covid-19 and missed revenue due to delayed care. However, hospital leaders now say their financial situations are a result of the omicron surge, rising inflation, and growing staffing challenges.

Many hospitals received millions of dollars in federal aid during the pandemic, but much of that money has since dwindled. For example, Bozeman Health said it received $20 million in aid in 2020, but this decreased to $2.5 million in 2021 and around $100,000 in 2022.

Many health systems say low surgery volumes, high supply costs, higher acuity patients, and languishing investments have all contributed to their declining revenues and growing expenses. In particular, labor costs have increased significantly during the pandemic, particularly as staffing shortages pushed hospitals to use more contract workers.

“If you talk with just about any hospital leader across the country, they would put workforce as their top one, two, and three priorities,” said Akin Demehin, senior director of quality and patient safety policy for the American Hospital Association.

According to Brad Ludford, CFO at Bozeman Health, the system spent less than $100,000 a month on contract workers before the pandemic, but that has now increased to roughly $1.4 million a week. Overall, the health system’s labor costs have increased around 12% from the same time last year, reaching around $20 million a month, during the first half of the year.

John Romley, a health economist and senior fellow at the Schaeffer Center for Health Policy and Economics at the University of Southern California, said some hospitals are likely now losing money, particularly with less federal aid coming in and growing inflation on top of their already high expenses.

For example, Bozeman Health president and CEO John Hill said the health system spent $15 million more than it earned in the first six months of the year. Several other health systems, including Providence, have also reported net operating losses this year.

Hospitals lay off workers, cut services to help reduce expenses

To reduce expenses, many hospitals are beginning to lay off workers and cut certain services, which has forced some patients to travel farther to receive care.

For example, Bay Area Hospital in Oregon recently ended 56 contracts with travel nurses and cut its inpatient behavioral health services due to the high costs of quickly filling vacant positions. Hospitals in California, Mississippi, New York, Oregon, and other states have also had to reduce the sizes of their workforces.

St. Charles Health System, headquartered in Bend, Oregon, laid off 105 workers and eliminated 76 vacant positions in May. The system’s CEO at the time, Joe Sluka, said, “It has taken us two pandemic years to get us into this situation, and it will take at least two years for us to recover.”

Similarly, Bozeman Health has laid off 28 workers in leadership positions and has not been able to provide inpatient dialysis at its largest hospital for months.

According to Hill, Bozeman took several other measures before deciding to cut jobs, including stopping out-of-state business travel, readjusting workloads, and reducing executive compensation. At the same time, it worked to transition contract workers to full-time employees and offered existing staffers a minimum-wage increase.

However, “[i]t still has not been enough,” Hill said. The health system currently has 487 open positions for essential workers.

According to Vicky Byrd, an RN and CEO of the Montana Nurses Association, hospitals should be offering longtime employees the same incentives they use to recruit new workers, such as bonuses for longevity and premium pay for taking extra shifts, to increase retention.

“It’s not just about recruiting — you can get anybody in the door for $20,000 bonuses,” Byrd said. “But how are you going to keep them there for 10 or 20 years?”

Going forward, some hospitals are considering automating more of their services, such as allowing patients to order food through an iPad instead of an employee, and are trying to adjust workloads, including having more flexible schedules, to retain their current workers.

“Now that we’ve adapted to life with covid in many regards in the clinical setting, we are dealing with the repercussions of how the pandemic impacted our staff and our communities as a whole,” said Wade Johnson, CEO of St. Peter’s Health

Hospitals need ‘transformational changes’ to stem margin erosion

https://www.healthcaredive.com/news/Fitch-ratings-nonprofit-hospital-changes/627662/

Dive Brief:

  • Nonprofit hospitals are reporting thinner margins this year, stretched by rising labor, supply and capital costs, and will be pressed to make big changes to their business models or risk negative rating actions, Fitch Ratings said in a report out Tuesday.
  • Warning that it could take years for provider margins to recover to pre-pandemic levels, Fitch outlined a series of steps necessary to manage the inflationary pressures. Those moves include steeper rate increases in the short term and “relentless, ongoing cost-cutting and productivity improvements” over the medium term, the ratings agency said.
  • Further out on the horizon, “improvement in operating margins from reduced levels will require hospitals to make transformational changes to the business model,” Fitch cautioned.

Dive Insight:

It has been a rough year so far for U.S. hospitals, which are navigating labor shortages, rising operating costs and a rebound in healthcare utilization that has followed the suppressed demand of the early pandemic. 

The strain on operations has resulted in five straight months of negative margins for health systems, according to Kaufman Hall’s latest hospital performance report.

Fitch said the majority of the hospitals it follows have strong balance sheets that will provide a cushion for a period of time. But with cost inflation at levels not seen since the late 1970s and early 1980s, and the potential for additional coronavirus surges this fall and winter, more substantial changes to hospitals’ business models could be necessary to avoid negative rating actions, the agency said.

Providers will look to secure much higher rate increases from commercial payers. However, insurers are under similar pressures as hospitals and will push back, using leverage gained through the sector’s consolidation, the report said.

As a result, commercial insurers’ rate increases are likely to exceed those of recent years, but remain below the rate of inflation in the short term, Fitch said. Further, federal budget deficits make Medicare or Medicaid rate adjustments to offset inflation unlikely.

An early look at state regulatory filings this summer suggests insurers who offer plans on the Affordable Care Act exchanges will seek substantial premium hikes in 2023, according to an analysis from the Kaiser Family Foundation. The median rate increase requested by 72 ACA insurers was 10% in the KFF study.

Inflation is pushing more providers to consider mergers and acquisitions to create economies of scale, Fitch said. But regulators are scrutinizing deals more strenuously due to concerns that consolidation will push prices even higher. With increased capital costs, rising interest rates and ongoing supply chain disruptions, hospitals’ plans for expansion or renovations will cost more or may be postponed, the report said.

NorthBay Health plans to eliminate 7% of its workforce

Fairfield, Calif.-based NorthBay Health announced July 11 that it will cut 7 percent of its workforce following continued financial strains, the Daily Republic reported July 12. 

“The harsh reality is a number of factors contributed to NorthBay’s economic headwinds, including reduced volumes; skyrocketing prices for supplies, drugs and medical devices; the continuing need to rely on expensive temporary workers; and the rising number of Medicare and Medi-Cal patients whose care is not fully covered by government payments,” B. Konard Jones, president and CEO of NorthBay Health, said in a press release shared with the Daily Republic

This 7 percent encompasses full-time positions or multiple part-time positions that equate to full-time hours. NorthBay Health said that 190 full-time positions will be cut in total

Mr. Jones added that the healthcare system has a plan in place to get its budget back on track, but details of that plan have not been revealed at this time. 

So far, NorthBay Health has already cut senior management positions by 20 percent. It is likely more positions will be cut in the future, according to the Daily Republic

NorthBay Health is an independent, nonprofit healthcare system with a medical center in Fairfield, Calif., a hospital in Vacaville, Calif., and multiple specialty care clinics throughout Solano County. It was formerly known as NorthBay Healthcare. 

OhioHealth to eliminate 637 jobs, its biggest layoff ever

Columbus-based OhioHealth is eliminating 637 jobs, its biggest layoff ever, according to The Columbus Dispatch. The move is part of a plan to engage external partners to provide some services the system currently provides in house. 

Over the next three to five months, the system will eliminate those jobs in information technology and revenue cycle management. Of those, 567 are in information technology. It informed workers of the cuts on July 7.

“We are committed to providing a high-level of support to all associates affected by this change,” Colin Yoder, director of media and public relations at OhioHealth, told Becker’s in a statement. “This includes outplacement support, a job fair specifically for those displaced, temporary salary and benefits continuation after their OhioHealth employment ends and upskill training for those in Information Technology.”

OhioHealth said the IT work will be handled by the professional services company Accenture, and AGS Health will handle the revenue cycle business. 

The layoffs, according to OhioHealth, are intended to improve patient care and services and position the healthcare system for a future where patients rely more on telemedicine and cellphones to obtain their healthcare. 

“This strategy will enable us to secure the skills, technology, expertise and innovation required to deliver a best-in-class, patient-centric, personalized healthcare experience without taking away from investments we are already making at the bedside,” Mr. Yoder said. 

The IT workers will remain on payroll until Jan. 3 and will be given the opportunity for training that could make them eligible for other jobs at the company. The other workers will be laid off Nov. 4. 

8 hospitals laying off workers

Several hospitals are trimming their workforces due to financial and operational challenges, and some are offering affected workers new positions.

1. Santa Cruz Valley Hospital in Green Valley, Ariz., closed June 30. The closure resulted in 315 workers losing their jobs. CEO Steve Harris said the decision to close Santa Cruz Valley Regional Hospital was made after it was unable to secure emergency department staffing for the Fourth of July weekend. The hospital issued a Worker Adjustment and Retraining Notification Act notice June 20, which gave the hospital’s 315 workers notice of the mass layoff. 

2. Claxton-Hepburn Medical Center in Ogdensburg, N.Y., is cutting approximately 5 percent of its 800-person workforce as it makes changes aimed at improving revenue cycle functions. The hospital said in late June that it is planning to outsource revenue cycle functions and lay off revenue cycle staff. 

3. Sturgis (Mich.) Hospital said it is planning to lay off 194 employees in July as it scales back services or closes. The hospital subsequently secured a loan to keep it open through July, according to WTVB

4. Bristol (Conn.) Health on June 16 eliminated 31 positions, including 10 that were filled and 21 that were vacant. The majority of those laid off were in management. 

5. Citing skyrocketing expenses and flat revenue, St. Charles Health System in Bend, Ore., will cut 181 positions, according to a May 18 announcement. The workforce reduction includes laying off 105 caregivers and eliminating 76 vacant positions. The layoffs affect mainly nonclinical workers, including many leadership positions. The 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.

6. Toledo, Ohio-based ProMedica’s health plan, Paramount, is laying off about 200 employees in July after losing a Medicaid contract. Anthem acquired Paramount’s Medicaid 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 employees to help offset losses. The 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. Mercy Medical Center in Springfield, Mass., part of Trinity Health of New England, is trimming jobs. The hospital laid off 12 of its 380 unionized nurses, the Massachusetts 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. 

6 WAYS TO REDUCE FINANCIAL DISTRESS IN HEALTHCARE

Welcome to the second installment of Pulse on Healthcare. This month’s issue takes a look at the issues causing financial distress for healthcare organizations, and how CFOs can take action to relieve it.

According to the 2022 BDO Healthcare CFO Outlook Survey, 63% of healthcare organizations are thriving, but 34% are just surviving. And while healthcare CFOs have an optimistic outlook—82% expect to be thriving in one year—they’ll need to make changes this year if they’re going to reach their revenue goals. To prevent and solve for financial distress, CFOs need to review and address the underlying causes. Otherwise, they might find themselves falling short of expectations in the year ahead.

Here are six ways for CFOs to address financial distress:

1.      Staffing shortages: 40% of healthcare CFOs say retaining key talent will be a top workforce challenge in 2022.

How can you avoid a labor shortage? Think about increasing wages for your frontline staff, especially your nurses. You could also reconsider the benefits you’re offering and ask yourself what offerings would be attractive for your frontline staff. For example, whether you offer free childcare could mean the difference between your staff staying and walking out for another employment opportunity. Additionally, consider enhancing or simplifying processes through technology to relieve some strain from day-to-day tasks.

2.      Budget forecasting: Almost half (45%) of healthcare organizations will undergo a strategic cost reduction exercise in 2022 to meet their profitability goals.

 How else can you cut costs? One option is to adopt a zero-based approach to budgeting this year. This allows you to build your budget from the ground up and find new areas to adjust costs to free up resources. Consider some non-traditional cost reduction areas, like telecommunication or select janitorial expenses, which are overlooked year after year. Cost savings in these areas can be substantial and quick to implement.    

3.      Bond covenant violations: 42% of healthcare CFOs have defaulted on their bond or loan covenants in the past 12 months. Interestingly, 25% say they have not defaulted but are concerned they will default in the next year.

 How can you avoid violations? The first step to take is to meet with your financial advisors, especially if you are worried you’re going to default on your bond or loan covenants. You want to get their counsel before you default so you can prepare your organization and mitigate the damage. Ideally, they can help you avoid a default altogether.

4.      Supply chain strains: 84% of healthcare CFOs say supply chain disruption is a risk in 2022.

How can you mitigate these risks? Supply chain shortages are a ubiquitous problem across industries right now, but not all of the issues are within your control. Focus on what is, including assessing your supply chain costs and seeing where you can find the same or similar products for lower prices. Identifying alternative suppliers may end up saving you a lot of frustration, especially if your regular suppliers run into disruptions.

5.      Increased cost of resources: 39% of healthcare CFOs are concerned about rising material costs and expect it will pose a significant threat to their supply chain.

How can you alleviate these concerns? Price increases for the resources you purchase — including medical supplies, drugs, technology and more — could deplete your financial reserves and strain your liquidity, exacerbating your financial difficulties. You may be able to switch from physician-preferred products to other, most cost-effective products for the time being. Switching medical suppliers may even save you money in the long run. Involving clinical leadership in the process can keep physicians informed of the choices you are making and the motivation behind them.

6.      Patient volume: 39% of healthcare CFOs are making investments to improve the patient experience.

How can you satisfy your patient stakeholders? As hospitals and physician practices get closer to the new normal of care, patients are returning to procedures and check-ins they put off at the height of the pandemic. Patients want a comfortable experience that will keep them coming back, including a safe and clean atmosphere at in-person offices.

They also want access to frictionless telehealth and patient portals for those who don’t want to or can’t travel to receive care. Revisit your “Digital Front Door Strategy” and consider ways to improve and streamline it. These investments can also go toward improving health equity strategies to ensure everyone across communities is receiving the same level of care.