Cost of Living Moderates, Including Health Costs
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The Bureau of Labor Statistics (here) reports that “The Consumer Price Index for All Urban Consumers (CPI-U) rose 0.4 percent in April on a seasonally adjusted basis, after increasing 0.1 percent in March . . . Over the last 12 months, the all items index increased 4.9 percent before seasonal adjustment.”
Not in the headlines: “The medical care index was unchanged in April, after falling 0.3 percent the previous month. The index for hospital services rose 0.5 percent over the month, after a 0.4-percent decline in March. The prescription drugs index increased 0.3 percent in April, while the physicians' services index was unchanged.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Pandemic? What Pandemic?
Politico West Wing Playbook reports (here) that “Just over a year ago, President Joe Biden introduced a comprehensive plan (here) to rein in Covid and harden the nation’s defenses against future public health threats. ‘We are not going to just ‘live with COVID,’ the plan vowed.” With today’s (May 11) end of the public health emergency, Politico says “The White House’s most ambitious proposals have been mothballed. Public health infrastructure constructed to track the virus is being dismantled. The money and enthusiasm for combating Covid and perils like it has long since run dry.”
Those mortality records still being collected show (here, and here) that, rather than living with COVID, 1,000 or so Americans are dying with COVID each week.
Maternal Morbidity and Mortality After Birth
The Joint Commission’s Journal on Quality and Patient Safety (here) reports on an effort at Parkland Hospital to address the problem that “A substantial proportion of maternal morbidity and mortality occurs after birth. However, little is known about the optimal design of programs to improve outcomes and decrease disparities during this period.”
“The authors created extending Maternal Care After Pregnancy (eMCAP), a community-based program, to address health care disparities and enhance access to care for the 12 months after birth. The team also evaluated the ability of Z codes (ICD-10 codes for social determinants of health) to identify patients with health-related social needs. Clinical improvement was recorded in hypertension, diabetes and associated lab values.”
Wrong Site Surgery: Failures in Following Protocol, Consulting Medical Records
The Joint Commission publication also reports (here) on closed claims concerning wrong site surgery (WSS), finding that “services most frequently responsible for these cases were: Orthopedic — 35.3%; Neurosurgery — 22.1%; Urology — 8.8%,” that “The most common types of procedures involving WSS were: Spine and intervertebral disc surgery — 22.1%; Arthroscopy — 14.7%; and Surgery on muscles/tendons (most commonly hand surgery) — 11.8%”
“Additionally, the researchers found the severity of claims was higher in the inpatient setting compared to the ambulatory care setting. The most common alleged injuries included the need for additional surgery (45.6%), pain (33.8%), mobility dysfunction (10.3%), worsened injury (8.8%) and death (7.4%). The top contributing factors to WSS were failure to follow policy/protocol (83.8%) and failure to review medical records (41.4%).” The importance of policy and standard operating procedure is noted in an essay in Becker’s (here), including this observation from a past board president of the ACHE: "Most medical errors occur because of flawed systems, not reckless practitioners, and systems should aim to proactively identify these factors — and learn from them."
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Hospital Acquired Infections Were Going Down, Then Went Up, Says Leapfrog
Becker’s (here) reports that “Data released as part of The Leapfrog Group's annual hospital rankings — which analyzed data from late 2021 and into 2022 — revealed a significant rise in healthcare-associated infections [HAIs]— a trend that was in decline prior to the pandemic.” The most significant increases were in central line bloodstream (CLABSI) and catheter associated urinary tract (CAUTI), as well as methicillin-resistant Staphylococcus aureus — “all of which showed rates that were the highest in five years.”
Hospital Layoffs in the News
Modern Healthcare reports (here) that “Health systems are shaving off dozens of non-clinical employees in an effort to mitigate rising expenses—and the cuts are reaching the top rungs. Headcount reductions are affecting employees at all levels, from back-office billing to the executive ranks. In some cases, systems are eliminating entire organizational layers and restructuring the remaining positions.”
Ambulatory Surgery Centers Remaining Independent
Becker’s reports (here) on consolidation, with specific attention to ambulatory surgery centers (ASCs). “The healthcare industry is increasingly consolidating as operation costs soar — physicians are migrating to employed models and private practices are being bought up by larger entities. Despite the consolidation, the ASC industry has remained fragmented, with independent surgery centers remaining in the majority as the driver of low costs.”
VMG’s annual healthcare M&A report for 2022 (here) notes that seventy percent of freestanding ASCs are independently owned and operated and says that “Healthcare prices rise when ASCs and physician practices are bought by hospitals or corporate entities. Physician medical groups, on the other hand, are increasingly consolidating. There were approximately 461 deals announced in the sector in 2021, a 145 percent increase from the 2020 volume.”
The report says that the current ASC industry was shaped by a series of "mega-mergers" made between 2015 and 2018. “These mergers, however, are less common than in other sectors of healthcare. The ASC industry is instead characterized by smaller buy-ups as ASC companies opt for smaller ASC chains to amass market share quickly. Additionally, hospitals see ASCs as a major opportunity for growth, but instead of investing in existing centers, they are opting to develop ASCs internally.”
Normalizing “Inauthenticity” in Health Care
Dr. Sachin Jain, chief executive of SCAN Health Plan, writes in Forbes (here) that “With years of hindsight, I now see in that health system what I see everywhere: an epidemic of inauthenticity and superficial execution. Pilots that fail to scale and disappear into oblivion. Persistent window-dressing of broken care process. Single-market results that are scaled to represent company-wide performance that aren’t close to being replicable. Regression to the mean being sold as evidence of impact. You could (and should) call it what it is: a hustle, of sorts.”
Dr. Jain adds, “Where we were once an industry that boasted high degree of trust with the public between management and the frontlines—cynicism and burnout are now the dominant feeling of far too many people in and around healthcare. A sort of fatigue that was borne of the normalized double-speak and dissonance of life inside of most healthcare organizations.”
“Healthcare seems only to get worse, while we are being told that it is getting better. We have normalized inauthenticity.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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