Will health systems see the usual end-of-year spike in elective care? 

Posted on by • Posted in Elective Care, Elective Care Demand, Elective Health Conditions, Elective Procedures, Elective Surgery, Health Insurance Coverage Adequacy, High Deductible Health Plans, Labor Shortages, Labor Spend Management, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue, Operating Room, Out of Pocket Expenses, Underinsured • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

2022 has disproven the old trope that “healthcare is recession-proof”. With the average family deductible nearing $4,000, a significant portion of healthcare services are exposed to consumer concerns about affordability. Reflecting the impact of the recession, health systems nationwide have reported sluggish volumes, particularly for elective cases, in the second half of the year.

One COO recently shared, “We’re 15 percent off where we expected to be on elective cases…We didn’t see the usual pick-up in early fall, after summer vacation. I’m not sure if it’s related to the economy, or whether demand changed during COVID, but this decline has eroded any possibility of a positive margin for the quarter.” The recession hit just as providers mostly finished working through the backlog of cases delayed by COVID in 2020 and 2021. 

To determine whether demand declines are related to the current economic environment, or signal real shifts in care patterns, health systems are looking closely to see if the usual end-of-year swell of demand for elective care materializes, as patients max out their deductibles. But even if the demand is there, some systems are worried about being able to accommodate it: “We’ve been so short-staffed for nurses and surgical techs, we’ve had to intermittently take some ORs and units offline…If we get a big December spike in elective care, I’m not sure we’ll have the staff to accommodate it.” Facing the triple threat of sky-high costs, sluggish demand, and a worsening payer environment, the ability to accommodate this demand will be critical to securing margins as providers move into 2023. 

Many insured Americans still struggle to afford care 

Posted on by • Posted in ACA, Affordability, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, Medicaid, Medicaid Expansion, Out of Pocket Expenses, Public Health Emergency (PHE), Uncompensated Care, Underinsured, Uninsured • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Driven by the steady progress of Medicaid expansion and pandemic-era policies to ensure access to health insurance coverage, the US uninsured rate hit an all-time low of 8 percent in early 2022. Since the Affordable Care Act passed in 2010, the US uninsured rate has been cut in half, with the largest gains coming from Medicaid expansion. 

However, using data from Commonwealth Fund, the graphic below illustrates how this noteworthy achievement is undermined by widespread underinsurance, defined as coverage that fails to protect enrollees from significant healthcare cost burdens. A recent survey of working-age adults found that eleven percent of Americans experienced a coverage gap during the year, and nearly a quarter had continuous insurance, but with inadequate coverage. 

High deductibles are a key driver of underinsurance, with average deductibles for employer-sponsored plans around $2,000 for individuals and $4,000 for families. 

Roughly half of Americans are unable to afford a $1,000 unexpected medical bill. Americans’ healthcare affordability challenges will surely worsen once the federal COVID public health emergency ends, because between 5M and 14M Medicaid recipients could lose coverage once the federal government ends the program that has guaranteed continuous Medicaid eligibility. 

The process of eligibility redeterminations is sure to be messy—while some Medicaid recipients will be able to turn to other coverage options, the ranks of uninsured and underinsured are likely to swell.

More health systems are charging patients to message their physicians

Posted on by • Posted in Consumer Centered Experience, Consumer Engagement, Consumer Experience, Consumer Needs, Consumer Preferences, Customer Focus, Customer Service Portal, Digital Front Door Platform, Health System, Hospital, Hospital Industry, Patient Portal - Electronic Communication • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

 A growing number of health systems have begun to bill for certain electronic communications with patients via portals like MyChart. The systems instituting these practices, including Cleveland Clinic and Chicago-based Northwestern Medicine, have justified the billing based on the time demands placed on their providers to answer messages involving additional efforts, including extensive patient chart review. Northwestern shared that fewer than one percent of MyChart messages incurred fees, which are typically covered by insurance, and require patient consent before billing. 

The Gist: In a time of significant margin pressure, we understand the instinct to seek additional revenue by collecting whatever reimbursement is available. However, in the ongoing transition to technology-enabled hybrid care, this practice has the potential to confuse, or even drive away, patients, who finally began to embrace virtual provider communication during the pandemic. 

Viewing portal messaging as a “digital front door” for patients, rather than a revenue-generating service in and of itself, may prove more fruitful in the long run.

Hospice Industry Awash with For-Profit Bad Actors

Posted on by • Posted in Exploitive Practices, False Claims Act, For-Profit, Fraud and Abuse, Health Policy, Hospice, Private Equity, Unnecessary Care • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

An unsparing piece published this week in the New Yorker examines the unscrupulous and exploitative practices of AseraCare and several other for-profit hospice providers, who have gone from controlling 30 percent of the hospice market to more than 70 percent across the last decade. The article outlines the companies’ playbook of delivering the least amount of care to the greatest number of patients, many of whom are not actually in need of hospice services at all.

In order to game Medicare’s policy to extract repayments from hospice providers whose average patient stay exceeds six months, many of these companies have employed strategies ranging from recruiting “last breath” patients from oncologists to lower their average length of stay, to “graduating” an absurd 70 percent of enrolled patients once they reach their six-month limit. 

The Gist: While it only takes a few bad apples spoil the bunch, the US hospice industry appears to be in a thoroughly rotten state. Caring for the elderly and dying is already a difficult (and expensive) proposition, and the questionable practices detailed in this piece further undermine the good work being done by those providers committed to helping patients and their families during extraordinarily difficult times. 

Currently subject to only minimal federal oversight, the hospice industry is in dire need of stronger regulation, which might take its cue from California, which recently issued a licensing moratorium for hospice providers while redesigning its auditing process.

Twitter no longer policing COVID misinformation

Posted on by • Posted in Coronavirus, Coronavirus Misinformation, Irresponsible, Misinformation, Mislead, Misleading, Mistrust, Public Health, Public Opinion, Public Perception, Social Platform, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Supply • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Amid a flurry of policy changes initiated by Elon Musk since his takeover of the social media company last month, Twitter has ceased its formal efforts to combat COVID misinformation. To date, Twitter had removed over 100K posts for violating its COVID policy. The company will now rely on its users to combat disinformation through its “Birdwatch” program, which lets users rate the accuracy of tweets and submit corrections. Many of the 11K accounts suspended for spreading COVID misinformation, including those of politicians like Rep. Marjorie Taylor Greene (R-GA), have also been reinstated. 

The Gist: We’ve seen the damage caused by inaccurate or deliberately misleading COVID information, which has likely played a role in the US’s lower vaccination rates compared to other high-income countries. Around one in five Americans use Twitter, far fewer than Facebook or YouTube, but the platform is seen as highly influential, both for the reach of its content and also its moderation decisions. 

This policy change is worrisome, not only because COVID is still taking the lives of hundreds of Americans daily, but also because COVID misinformation catalyzes broader healthcare misinformation, including antivax sentiments and an overall mistrust of medical experts.

U.S. economy adds 263,000 jobs in November

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https://www.axios.com/2022/12/02/jobs-report-november?stream=top&utm_source=alert&utm_medium=email&utm_campaign=alerts_all

The jobs market stayed strong last month: Employers added 263,000 jobs, while the unemployment rate held at 3.7%, near the lowest level in a half-century, the Labor Department said on Friday.

Why it matters: The figures are the latest signal of a roaring labor market that continues to defy fears of a recession.

  • November’s payroll gains are above the addition of 200,000 jobs that economists had expected.

By the numbers: Job growth last month was slightly slower than the 284,000, added in October, which was revised up by 23,000. In September, the economy added 269,000 jobs, 46,000 fewer than initially estimated.

  • Average hourly earnings, a measure of wage growth, rose by 0.6% in November — faster than the prior month, when earnings rose by 0.5%. Over the past year ending in November, average hourly earnings increased by 5.1%.
  • The share of people working or looking for work, known as the labor force participation rate, ticked down to 62.1%, compared to 62.2% in October.

The backdrop: Economists have been bracing for cracks in the labor market that have yet to appear.

  • It has been an ugly stretch for layoffs in a handful of sectors like technology, with large-scale job cuts announced at Meta, Amazon and Twitter.

But overall, the booming job market has continued for workers, even in the face of ultra-aggressive efforts by the Federal Reserve to try to cool demand for labor to help put a lid on inflation.

  • Last month, Fed chair Jerome Powell said that employers bidding up wages to attract workers is not “the principal story of why prices are going up.”
  • Still, the labor market may point to clues about how inflation will evolve in certain categories, including industries within the services sector where wages make up the biggest costs for businesses, Powell said on Wednesday.

Virus roundup: There are new dominant Covid-19 strains in the US

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Coronavirus Omicron Subvariant BQ.1, Coronavirus Omicron Subvariant BQ.1.1, Infectious Virus, Monkeypox, Personal Protective Equipment (PPE), Public Health • Leave a comment
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Monkeypox cases in women and non-binary people may be getting misdiagnosed as sexually transmitted infections (STIs), daily Covid-19 hospital admissions are expected to increase for the first time since July, and more in this week’s roundup of monkeypox and Covid-19 news.

Monkeypox:

  • Monkeypox may be getting misdiagnosed as STIs in women and non-binary people, according to a new study published in The Lancet. For the study, researchers gathered data from 69 cisgender women, 62 transgender women, and five nonbinary people assigned female at birth with confirmed monkeypox cases between May 11 and Oct. 4 across 15 countries. The study found that 73% of monkeypox infections among this group were likely acquired from sexual contact. While nearly all monkeypox infections among trans women were likely acquired through sexual contact, roughly 24% of cis women and nonbinary people were believed to have acquired an infection outside of sexual contact, such as household or occupational exposure, according to the researchers. In addition, the researchers found that around 33% of cisgender women were misdiagnosed before being diagnosed with monkeypox—and almost half received a delayed diagnosis. “It’s very likely that infections have been missed and not picked up at all,” said Chloe Orkin, a physician and researcher at Queen Mary University of London. “The lesson here is that everybody needs to know about this,” Orkin noted. While public health messages have been primarily directed toward men who have sex with men, “it’s important to recognize this is not the only group,” she added. (Mandavilli, New York Times, 11/21; Hart, Forbes, 11/17)

Covid-19:

  • CDC is forecasting an uptick in Covid-19 hospitalizations for the first time since July, according to national disease modeling. In the coming weeks, CDC’s ensemble forecast from 15 modeling groups is projecting a nationwide increase in daily Covid-19 hospital admissions, with a forecasted 2,000 to 9,000 new daily admissions on Dec. 9. As of Nov. 11, the seven-day average of new hospital admissions for Covid-19 was 3,330—a slight decrease from 3,374 the previous week. In addition, modeling from Mayo Clinic is projecting a 51.5% increase in daily Covid-19 cases over next two weeks, with average daily cases projected to increase from 37,912.7 cases on Nov. 18 to 57,441 on Dec. 2. However, CDC’s ensemble forecast from 13 modeling groups projects that Covid-19 deaths will remain stable or follow an uncertain pattern over the next month. (Bean, Becker’s Hospital Review, 11/21)
  • Earlier this month, omicron subvariants BQ.1 and BQ.1.1 surpassed BA.5 as the dominant strains of the coronavirus in the United States. Currently, BA.5 accounts for roughly 25% of new Covid-19 cases, and BQ.1 and BQ.1.1 account for an equal proportion of around 48% of cases. As BQ.1 and BQ.1.1 become more dominant, many experts are voicing concern over low vaccine uptake and evidence that suggests the dominant strains are not as susceptible to current treatments. For instance, FDA earlier this month updated its guidance for two monoclonal antibody treatments—bebtelovimab and Evusheld—warning that BQ.1 and BQ.1.1 showed significant declines in susceptibility to the treatments. (Choi, The Hill, 11/18)
  • A new study published in JAMA Network Open found that almost 15% of 62,525 hospitalized Covid-19 patients had a medical contradindication after taking Paxlovid’s antiviral combination of nirmatrelvir and ritonavir. To evaluate Paxlovid eligibility among hospitalized Covid-19 patients, researchers used a list of individual contraindications created by FDA. The patients were hospitalized in Paris University hospitals between Jan. 24, 2020, and Nov. 30, 2021. In total, over 9,100 patients—or 14.6%—experienced a medical contraindication to Paxlovid, making the treatment inadvisable. Notably, contraindication rates were higher among men (18%) than in women (11.3%). Among older patients, contradiction rates were 26.9%. “The most prevalent contraindications were severe kidney impairment and use of medications dependent on CYP3A for clearance,” researchers said. 

Cooper University Health Care credit rating up to A-, its highest ever

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https://www.beckershospitalreview.com/white-papers/cooper-university-health-care-credit-rating-up-to-a-its-highest-ever.html?utm_medium=email&utm_content=newsletter

S&P Global Ratings raised Cooper University Health Care’s credit rating from “BBB+” to “A-“, the highest rating in the Camden, N.J.-based system’s 135-year history, roj-nj.com reported Nov. 28.

The rating is for bonds issued by Camden County Improvement Authority. S&P praised Cooper for its focus on cost containment, revenue improvement, expanding market share and developing key services to gain more tertiary referrals and limit outpatient migration to Philadelphia academic medical centers, according to the report.

“Today’s credit rating upgrade is validation of Cooper’s financial strength, our prudent growth strategies and the tremendous work by our dedicated team members who tirelessly serve our patients, their families and each other to produce our current and future success,” co-CEO Kevin O’Dowd said.

Cooper is expected to begin construction on a $2 billion expansion of its Camden, N.J., campus in 2023.

More pain, no gain for hospitals’ operating margins

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https://www.beckershospitalreview.com/finance/more-pain-no-gain-for-hospitals-operating-margins.html?utm_medium=email&utm_content=newsletter

Hospitals are nearing the end of an exceptionally difficult year for finances with a slight downturn to their operating margins and smaller likelihood of ending the year in the black. 

Kaufman Hall’s November “National Hospital Flash Report” — based on data from more than 900 hospitals — found hospitals’ median operating margin was -0.5 percent through October. Operating margins dropped 2 percent from September and 13 percent from October 2021.

High expenses continued to outpace revenues, particularly labor expenses. Total labor expenses are up 10 percent year to date and up 3 percent from September to October alone. Total non-labor expenses are up 5 percent year to date and held flat from September to October. 

Hospitals saw a 3 percent boost in emergency department visits and 2 percent boost in operating room minutes in October, with a 2 percent increase in gross operating revenue from the month prior. 

At the same time, hospitals struggled to discharge patients in October due to shortages of labor both internally and in post-acute settings, which resulted in a 3 percent increase in length of stay that did not translate to additional revenue. 

Increased ED traffic could strain hospitals’ workers if staff shortages complicate or prevent patient admissions, leading to ED boarding. A dozen medical groups recently alerted President Joe Biden to ED boarding reaching a “crisis point” and becoming a public health emergency.

“Every aspect of patient care — from being admitted, to treatment, to discharge — is affected by the labor shortage and as we head into the virus season and potential new waves of COVID-19 the pressures on hospitals and their staff could mount,” Erik Swanson, senior vice president of data and analytics with Kaufman Hall, said. 

In September, Kaufman Hall noted that expense pressures and volume and revenue declines could force hospitals to make “difficult decisions” about service reductions and cuts. 

COVID Cases to Jump 80%; Surgery by Flashlight; Flu Hospitalizations Rising

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https://www.medpagetoday.com/infectiousdisease/covid19/101953?xid=nl_mpt_morningbreak2022-11-29&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=MorningBreak_112922&utm_term=NL_Gen_Int_Daily_News_Update_active

Daily COVID-19 cases in the U.S. are projected to jump 80% in the next 2 weeks, according to forecasts from the Mayo Clinic. (Becker’s Hospital Review)

Most U.S. COVID deaths are occurring in older adults, with 9 out of 10 fatalities in people age 65 and up. (Washington Post)

After protests broke out in China over COVID lockdowns, the country eased some virus restrictions but maintained its “zero-COVID” strategy. (PBS)

Chinese authorities have started inquiries into people who attended protests against the COVID lockdowns. (Reuters)

Shanghai Disneyland announced it will remain temporarily closed to comply with COVID prevention measures. (Reuters)

Surgeons in Ukraine operated on a patient in the dark using only a flashlight after Russia unleashed a missile barrage on the nation’s power grid. (NBC News)

Pharma industry groups and CVS Health expressed skepticism over a plan proposed by the FDA that would allow certain generic drugs to pick up over-the-counter indications. (Endpoints News)

Marketing biosimilars with skinny labels — labels for biosimilars or generics that include a smaller set of indications than the brand-name drugs — saved Medicare $1.5 billion from 2015 to 2020, 5% of what it spent on five biologics during that period. (JAMA Internal Medicine)

Flu hospitalizations are up nearly 30% from last week, as scientists and public health experts express concern about the virus spreading during holiday gatherings. (CNBC)

As the CDC prepares to announce nearly $4 billion to improve public health infrastructure, most of which will be allocated to local health departments, community-based health groups say they’re being left out of funding. (CNN)

A doctor in the San Francisco area pleaded guilty to using misbranded products that she sold as genuine Botox and Juvederm, the Department of Justice announced.

Houston lifted the boil water notice it had issued after a power outage led water pressure levels to dip below safe levels. (Houston Chronicle)

Roche Pharmaceuticals has withdrawn the U.S. indication for atezolizumab (Tecentriq) to treat a form of bladder cancer, after a clinical trial failed and the drug could not move from accelerated to regular approval.

The U.S. is looking to developing countries for a new paradigm of mental health care. (Vox)

A resurgence of polio cases in Indonesia has sparked a mass vaccination campaign in the country. (AP)