British Medical Journal on American Health Challenges
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Massive Study on Private Equity Investment in American Health Services
The BMJ (research report here, editorial here) has undertaken to summarize the state of research on the impact of private equity investment in American health services. Researchers found “Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality,” and that “PE ownership was associated with reduced nurse staffing levels or a shift towards lower nursing skill mix” and that “No consistently beneficial impacts of PE ownership were identified.”
In the editorial accompanying the research, legendary health journalist Merrill Goozner noted “The review of studies evaluating costs to patients or payers was unequivocal: nine of 12 studies showed higher costs at health facilities owned by private equity firms, three were neutral, and none showed lower costs,” and “Study findings on quality and outcomes were similarly skewed toward worse results for patients at providers acquired by private equity firms.”
He added, “Unfortunately, it is much harder to identify legislative solutions to quality problems at provider organizations owned by private equity firms. Consumer oriented solutions, such as public posting of hospital and nursing home ratings by government agencies, have had little impact on driving patients to better performing facilities. For many communities in the US the local hospital after a private equity takeover may be the only source of acute care.”
Patient Safety: 795,000 Diagnostic Errors Per Year in American Health Services
In a separate study, also in the BMJ (Quality & Safety), researchers estimate 795,000 serious diagnostic errors per year in American medicine (study here, 76 pages of extended online study materials here, Radiology Business coverage here).
“This study provides the first national estimate of permanent morbidity and mortality resulting from diagnostic errors across all clinical settings, including both hospital-based and clinic-based care . . . An estimated 795,000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. Just 15 diseases account for about half of all serious harms, so the problem may be more tractable than previously imagined.”
Modern Healthcare reports (here) that American schools of nursing are placing renewed emphasis in the curriculum on patient safety.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Business Insurance (here) reports that “The California Supreme Court has reinstated a lawsuit against Aetna Inc. alleging that the insurer threatened to fire or terminate physicians who referred patients to out-of-network providers . . . The court ruled that the California Medical Association, which brought the lawsuit, has standing to sue because the insurer's policy has caused the association to lose money.”
“CMA, a nonprofit professional association representing California physicians, sued Aetna Health of California Inc. alleging that Aetna violated the unfair competition law (UCL), Cal. Bus. & Prof. Code 17200 et seq., by engaging in unlawful business practices. At issue was whether Aetna satisfied the UCL's standing requirements by diverting its resources to combat allegedly unfair competition. The Supreme Court held (1) the UCL’s standing requirements are satisfied when an organization, in furtherance of a bona fide, preexisting mission, incurs costs to respond to perceived unfair competition that threatens that mission, so long as those expenditures are independent of costs incurred in UCL litigation or preparations for such litigation; and (2) the trial court erred in granting summary judgment for Aetna on the ground that CMA lacked standing.” Opinion, here.
HOSPITALS, ASCs, SKILLED NURSING AND OTHER HEALTH CARE FACILITIES
Facility Fees
The Georgetown Center on Health Insurance Reform has a new study (here) on “facility fees,” the additional charges levied by hospitals in outpatient facilities—including physician offices—they have acquired, over and above the fee which would have been paid to the physician.
The fees, the source of hospital promises to increase the compensation of physicians whose practices have been so acquired, have evoked variable responses from State governments (study here), and may develop to a consistent site-of-service policy in Medicare reimbursement.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
A Pause in Trimming the Medicaid Rolls
InsideHealthPolicy reports (here) that “Nine states have agreed to pause procedural terminations as they address potential violations of Medicaid renewal requirements . . . the Biden administration has approved mitigation plans for a total of 35 states that must address various issues, particularly with renewal forms and with confirming Medicaid eligibility ex parte, to comply with federal renewal requirements . . . States that agreed to hold procedural enrollments to address problems identified by CMS include Delaware, Idaho, Iowa, Maine, Minnesota, Mississippi, New York, West Virginia and Wyoming.”
“Nearly 20 states did not let their beneficiaries renew using all modalities -- phone, mail, in-person or online -- and eight states requested more information on their requests for renewal than is needed to determine eligibility . . . Twenty-six states entered a mitigation plan in part because they were not conducting renewals ex parte, which is where a beneficiary’s eligibility is confirmed administratively with third-party data, like participation in the Supplemental Nutrition Assistance Program. Experts say renewing coverage via ex parte reduces paperwork, potentially saving enrollees from losing Medicaid coverage because of a missing form or they didn’t return a renewal request on time.”
The Kaiser Family Foundation reports (here) that “At least 3,092,000 Medicaid enrollees have been disenrolled as of July 19, 2023, based on the most current data from 33 states and the District of Columbia. Overall, 40% of people with a completed renewal were disenrolled in reporting states while 60%, or 4.1 million enrollees, had their coverage renewed,” and that “There is wide variation in disenrollment rates across reporting states, ranging from 82% in Texas to 10% in Michigan.”
Medicare Advantage, Patient Disadvantage
Four Democratic Members of the House of Representatives will hold a news conference today “to call for action to stop wrongful delays and denials in private Medicare Advantage plans, to end fraudulent overpayments, and to mandate accountability for the worst actors who hurt patients." The four, Rep. Katie Porter, Rep. Lloyd Doggett, Rep. Barbara Lee and Rep. Pramila Jayapal will be joined by the daughter of a patient “who died after being denied care through his naviHealth (United Healthcare) Medicare Advantage plan.”
Reviewing current health policy proposals in Congress, KFF Health News laments (here), “Everything Old Is New Again? The Latest Round of Health Policy Proposals Reprises Existing Ideas.”
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July 26, 27, 28
August, No editions
September 12, 13, 14, 18, 19, 20, 21, 26, 27, 28, 29
October 17, 18, 19, 20, 23, 24, 25, 26
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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