Payer mix in the nation’s top 19 hospitals

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Becker’s calculated the payer mix within the nation’s top ranked hospitals to determine the share of their patients covered under commercial plans, Medicare, Medicaid, Medicare Advantage, uninsured/bad debt and charity care.

The 2019 data released April 5 is from the coverage, cost and value team at the National Academy for State Health Policy in collaboration with Houston-based Rice University’s Baker Institute for Public Policy.

Payer mix in the nation’s top 19 hospitals:

(1) Mayo Clinic Hospital — Rochester, Minn.

Commercial: 50 percent 

Medicare: 33 percent 

Medicare Advantage: 9 percent 

Medicaid: 7 percent

Charity care: 1 percent 

Uninsured / Bad debt: 0 percent 

(2) Cleveland Clinic Hospital

Commercial: 45 percent 

Medicare: 24 percent 

Medicare Advantage: 17 percent 

Medicaid: 12 percent 

Charity care: 1 percent 

Uninsured / Bad debt: 1 percent 

(3) Ronald Reagan UC Los Angeles Medical Center

Commercial: 45 percent 

Medicare: 27 percent 

Medicaid: 18 percent 

Medicare Advantage: 8 percent 

Charity care: 0 percent 

Uninsured / Bad debt: 0 percent 

(4) Johns Hopkins Hospital — Baltimore

Commercial: 46 percent 

Medicare: 28 percent 

Medicaid: 22

Medicare Advantage: 2 percent

Uninsured / Bad debt: 2 percent 

Charity Care: 1 percent 

(5) Massachusetts General Hospital — Boston

Commercial: 48 percent 

Medicare: 32 percent 

Medicaid: 11 percent 

Medicare Advantage: 7 percent

Charity care: 1 percent 

Uninsured / Bad debt: 1 percent 

(6) Cedars-Sinai Medical Center — Los Angeles

Commercial: 42 percent 

Medicare: 41 percent 

Medicaid: 10 percent

Medicare Advantage: 6 percent

Charity care: 1 percent 

Uninsured / Bad debt: 0 percent 

(7) NewYork-Presbyterian Hospital — New York City

Commercial: 34 percent

Medicaid: 25 percent 

Medicare: 22 percent 

Medicare Advantage: 17 percent 

Charity Care: 1 percent 

Uninsured / Bad debt: 1 percent 

(8) NYU Langone Hospital — New York City

Commercial: 42 percent 

Medicare: 25 percent 

Medicaid: 19 percent 

Medicare Advantage: 6 percent 

Charity care: 1 percent 

Uninsured / Bad debt: 0 percent 

(9) UC San Francisco Medical Center 

Commercial: 42 percent

Medicaid: 25 percent 

Medicare: 25 percent 

Medicare Advantage: 5 percent 

Charity Care: 1 percent  

Uninsured / Bad debt: 0 percent

(10) Northwestern Memorial Hospital — Chicago

Commercial: 52 percent  

Medicare: 27 percent 

Medicaid: 11 percent 

Medicare Advantage: 7 percent 

Charity care: 2 percent

Uninsured / Bad debt: 1 percent

(11) Michigan Medicine — Ann Arbor

Commercial: 53 percent 

Medicare: 20 percent 

Medicaid: 14 percent 

Medicare Advantage: 11 percent 

Charity care: 1 percent 

Uninsured / Bad debt: 1 percent 

(12) Stanford Hospital — Palo Alto, Calif.

Commercial: 46 percent 

Medicare: 34 percent 

Medicaid: 13 percent 

Medicare Advantage: 7 percent 

Charity care: 0  

Uninsured / Bad debt: 0 

(13) Penn Presbyterian Medical Center — Philadelphia

Commercial: 46 percent

Medicare: 29 percent 

Medicaid: 13 percent 

Medicare Advantage: 12 percent 

Uninsured / Bad debt: 1 percent 

Charity Care: 0 

(14) Brigham and Women’s Hospital — Boston

Commercial: 53 percent 

Medicare: 30 percent

Medicaid: 10 percent

Medicare Advantage: 6 percent 

Charity Care: 1 percent 

Uninsured / Bad debt: 1 percent

(15) Mayo Clinic Hospital — Phoenix

Commercial: 51 percent

Medicare: 42 percent 

Medicare Advantage: 4 percent 

Medicaid: 3 percent 

Charity Care: 1 percent 

Uninsured / Bad debt: 0 percent 

(16) Houston Methodist Hospital

Commercial: 43 percent 

Medicare: 33 percent 

Medicare Advantage: 18 percent 

Charity care:3 percent 

Medicaid: 2 percent 

Uninsured / Bad debt: 1 percent

(17 — tie) Barnes-Jewish Hospital — St. Louis

Commercial: 43 percent 

Medicare: 29 percent

Medicare Advantage: 13 percent

Medicaid: 10 percent

Charity care: 4 percent 

Uninsured / Bad debt: 1 percent 

(17 — tie) Mount Sinai Hospital — New York City

Commercial: 33 percent 

Medicaid: 28 percent 

Medicare: 22 percent 

Medicare Advantage: 15 percent 

Charity care: 1 percent

Uninsured / Bad debt: 0 percent 

(18) Rush University Medical Center — Chicago

Commercial: 41 percent 

Medicare: 31 percent  

Medicaid: 20 percent 

Medicare Advantage: 6 percent 

Charity care: 2 percent

Uninsured / Bad debt: 1 percent

(19) Vanderbilt University Medical Center — Nashville, Tenn.

Commercial: 47 percent  

Medicare: 20 percent 

Medicaid: 18 percent 

Medicare Advantage: 10 percent

Charity care: 4 percent

Uninsured / Bad debt: 1 percent 

7 hospitals laying off workers

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

1. Watsonville (Calif.) Community Hospital is preparing to lay off 658 workers, according to a notice filed with the state and shared with Becker’s Hospital Review. The hospital, which filed for Chapter 11 bankruptcy in December, expects the layoffs to occur between May 16 and May 23. 

2. 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.

3. NYC Test & Trace Corps, the city’s initiative for COVID-19 testing and contact tracing, is ending universal contact tracing by the end of April. NYC Health + Hospitals, which leads the program in collaboration with the city’s department of health and other agencies, is planning to lay off 874 workers when the program scales back, according to a notice filed with state regulators March 4. The health system said affected temporary employees will be laid off at the end of April. Managerial employees affected by the layoffs will have their employment terminated between May 13 and May 27, according to the notice. 

4. MarinHealth Medical Center is laying off 104 revenue cycle and supply chain employees in April after entering into a contract with Optum to provide those services, according to a notice filed with state regulators in February. Greenbrae, Calif.-based MarinHealth said that as a result of the contract with Optum, all non-contractual revenue cycle and supply chain employees will be terminated from employment with the hospital on April 9. Optum is offering jobs to most workers affected by the layoffs. Employees who accept an offer will begin employment with Optum on the first work day following separation from MarinHealth, a spokesperson for the hospital told Becker’s Hospital Review. 

5. St. Mary’s Medical Center in West Palm Beach, Fla., is laying off 49 employees, including 21 registered nurses, when it stops providing mental health services in April, according to a notice filed with state regulators.

6. West Reading, Pa.-based Tower Health closed Brandywine Hospital in Coatesville, Pa., on Jan. 31. As a result of the closure, 534 employees were laid off Feb. 7, according to a notice filed with state regulators. 

7. Community Hospital Long Beach (Calif.) shut down and surrendered its acute care license to the state in December, according to the Long Beach Post. The hospital laid off 328 employees early this year, according to a notice filed with state regulators. The hospital said the layoffs would begin Feb. 1 and may come in stages. The hospital’s owner is planning to transition the facility into a behavioral health and wellness campus.

Tower, Drexel need help covering children’s hospital’s expenses

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Due to financial struggles, West Reading, Pa.-based Tower Health is looking for other health systems to take over St. Christopher’s Hospital for Children, which it co-owns with Drexel University, rather than renew its $85 million line of credit to the hospital, The Philadelphia Inquirer reported April 8.

Tower Health’s credit line was set to expire March 31, but Drexel University renewed its line of credit to the Philadelphia hospital for the next four years. 

Philadelphia-based St. Chris has been struggling financially, but has recently improved. Its projected loss was $23.6 million for the year ended June 30, compared to $97.6 million in fiscal year 2021, Drexel University President John Fry told the Inquirer.

“We will stand behind this hospital and we will find a solution. We just need more help than the help that Drexel and Tower can provide,” Mr. Fry told the paper.

The hospital was part of the American Academic Health System bankruptcy in 2019. It was previously owned by Dallas-based Tenet Healthcare.

Tower Health has also been dealing with financial problems, with operating losses of more than $900 million in the last four and a half fiscal years, according to the paper.

Temple University Health System confirmed to the Inquirer that it is in discussions to help support the hospital.

Read more here.

Why insurers, health systems are breaking up

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Insurers and health systems across the U.S. have been at odds during the most recent cycle of contract negotiations, and terminated contracts are affecting thousands of patients.

As hospitals continue to recover financially from the COVID-19 pandemic and deal with higher supply costs and employee wages, many organizations have tightening margins and hope to negotiate higher rates with insurers as a result. Hospitals are also pointing to rising inflation as a reason for needing higher rates.

One recent example is Fort Lauderdale, Fla.-based Broward Health’s public breakup with UnitedHealthcare. Thousands of the insurer’s beneficiaries went out of network with Broward April 1 after the two sides failed to agree on a new contract. Broward reportedly asked UnitedHealthcare for a pay increase to the same level UnitedHealthcare pays other South Florida health systems.

UnitedHealthcare said Broward’s rate increase request would amount to 88 percent higher reimbursement for its providers in the next four years, which the insurer said was “unreasonable.” Negotiations continue, but patients are out of network in the meantime.

Blue Cross & Blue Shield of Mississippi and the University of Mississippi Medical Center let their contract expire April 1 after they failed to agree on pay rate increases, according to the Clarion Ledger. The medical center treated more than 50,000 patients in the 18 months before the contract expiration.

LouAnn Woodward, MD, vice chancellor for health affairs and dean of the medical center’s school of medicine, said the health system wants “fair reimbursement” from Blue Cross & Blue Shield to reinvest in its facilities and programs. The insurer said the medical center wanted a 30 percent overall rate increase, including a 50 percent increase for some services, according to the newspaper report.

Physician groups and surgery centers aren’t immune from insurer conflicts. Blue Cross Blue Shield of Illinois terminated its contract with Springfield (Ill.) Clinic late last year, knocking 100,000 beneficiaries out of network.

Providence hit with credit downgrade after Hoag split

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Moody’s Investors Service has downgraded the ratings on Providence’s revenue bond debt to “A1” from “Aa3.” 

“The downgrade to ‘A1’ is driven by the disaffiliation with Hoag Hospital, and the expectation that weaker operating, balance sheet, and debt measures will continue for the time being,” Moody’s said in an April 5 release. 

Renton, Wash.-based Providence and Newport Beach, Calif.-based Hoag ended their affiliation Jan. 31. The two organizations cut ties at a time when Providence is facing several challenges, including operating pressures, variable utilization and reliance on temporary labor, Moody’s said. 

The “A1” rating and stable outlook also reflect Providence’s strengths, including a large service area, a large revenue base of more than $25 billion and a leading market share in all of its markets. 

Moody’s said it expects Providence to continue to grow its operating platform and generate additional revenue growth. 

Viewpoint: It’s the Great Aspiration, not Resignation

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Those who left their jobs during the Great Resignation did so out of more than just frustration, but instead used it as an opportunity to follow their dreams and aspirations, writes Whitney Johnson, CEO of Disruption Advisors, a talent development company, in the Harvard Business Review April 6.

The pandemic forced many people to reevaluate many facets of their lives, from where to live to how to spend more time with family. Ms. Johnson argues that workers’ thoughts on changing the way they work is a good thing, giving workers agency to discover new aspirations and proactively seek them. 

“The Great Resignation appellation is, I believe, mistaken. Most workers are not simply quitting. They are following a dream refined in pandemic adversity. They are aspiring to grow in the ways most important to them,” she writes.

Even for those who have been forced out of the workforce, like working mothers and caregivers, Ms. Johnson argues that it will lead to a boom of innovative new businesses, created by those resourceful workers who find another way to work outside the realms of traditional industry. 

She also states that this “great aspiration” is beneficial for employers too, who can make the most of a fresh pool of talent, full of newly motivated employees who are dedicated and searching for meaning. 

Stanford, Packard nurses greenlight strike

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Thousands of nurses at Stanford and Lucile Packard Children’s hospitals in Palo Alto, Calif., have authorized the union representing them to call a strike. 

In an April 8 news release, the Committee for Recognition of Nursing Achievement said more than 4,500 nurses at Stanford and Packard, or 93 percent of all nurses eligible, voted in favor of strike authorization. They are calling on hospital management to adequately address staffing, citing consistent overtime and nurses’ complaints of inadequate resources, training or staff. They also seek improved access to mental health counseling, as well as competitive wages and benefits.

“The decision by members to overwhelmingly authorize a strike shows that we are fed up with the status quo of working conditions at the hospitals,” Colleen Borges, union president and a nurse in the pediatric oncology department, said in the release. “We need contracts that allow us to care for ourselves and our families so we can continue providing world-class care.”

Nurses authorized the strike after bargaining for the last 13 weeks and are working without contracts. The vote does not mean a strike will occur, but it gives the union the ability to issue an official strike notice. 

In a statement shared with Becker’s, Stanford expressed its support for negotiations rather than a strike.

“We are committed, through good faith bargaining, to reach agreement on new contracts that provide nurses a highly competitive compensation package, along with proposals that further our commitment to enhancing staffing and wellness benefits for nurses,” the statement said.

The hospital also said it is taking the steps to prepare for the possibility of a strike, while hoping a strike is averted.

“Given the progress we have made by working constructively with the union, we should be able to reach agreements that will allow us to continue to attract and retain the high caliber of nurses who so meaningfully contribute to our hospitals’ reputation for excellence,” the statement read. 

Economy adds 431K jobs in March, unemployment down to 3.6 percent

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Economy adds 431K jobs in March, unemployment down to 3.6 percent

The U.S. added 431,000 jobs and the unemployment rate dropped to 3.6 percent in March, according to data released Friday by the Labor Department.

Job growth fell slightly short of expectations, as consensus estimates from economists projected a gain of roughly 490,000 jobs in March and a decline in the jobless rate to 3.7 percent.

But resilient consumer spending and historically strong demand for workers helped power the U.S. economy to another study job gain.

The Labor Department also revised the January and February job gains up by a combined 95,000, bringing the total of jobs added by the U.S. economy in 2022 up to 1,685,000 million.

More Americans who left the workforce during the pandemic appeared to be returning to the job hunt in March, a promising sign as businesses struggle to fill a record number of openings. The labor force participation rate ticked higher to 62.4 percent and the employment-population ratio—the proportion of working-age adults in the labor force—rose to 60.1 percent.

Wage growth also accelerated in March with average hourly earnings rising 5.6 percent over the past 12 months, up from 5.1 percent in February. 

The wage growth comes as inflation batters the Biden administration and Democrats politically, contributing to the president’s approval ratings being stuck in the low 40s. This has contributed to the anxiety in his party in a midterm election year, as Democrats are worried they could lose both the House and Senate majorities in this fall’s elections.

Gas prices have risen further with the Russian war in Ukraine and the international sanctions on Moscow. President Biden on Thursday announced he would be released 1 million barrels of oil a day from the nation’s strategic reserves to try to offer some help to lower gas prices.

The administration has touted the strength of the job market and the overall economy in the face of attacks from Republicans on inflation. And the March report offered more good news.

Overall, job-seekers continued to enjoy ample opportunities to find work at businesses across the economy even in the face of the highest annual inflation in 40 years. And businesses hit hardest by the pandemic-driven recession were among the top job-gainers in March.

The leisure and hospitality industry added 112,000 jobs in March, with restaurants and bars adding 61,000 jobs and accommodation businesses adding 25,000. Employment in the sector is still down 1.5 million from the onset of the pandemic.

Professional and business services companies gained 102,000 jobs in March and retailers added 49,000 employees, pushing both sectors well above their pre-pandemic employment levels.

The manufacturing, construction, and financial sectors also saw strong jobs gains last month.

The strong March job haul is the latest in a string of stellar employment reports. The U.S. has gained an average of 562,000 jobs each month in 2022—the same rate as in 2021, when the country added a record-breaking 6.8 million jobs

Even so, steady monthly job growth has done little to bolster Biden’s approval ratings and voters’ views about his handling of the economy. While job growth, consumer spending, the stock market and property values rebounded rapidly from the recession, a 7.9 percent annual increase in prices has wiped out the political benefit of a strong economy otherwise.