Hospitals Still in Financial Trouble, the Smaller, the More Troubled
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
Click here to support DCMedical News.
The outlook for the financial health of small to medium sized hospitals and health systems remains grim, in recovery from the reduced volume and increased expenses experienced in the pandemic.
Fitch reports (here) that “Hospitals faced 'worst operating year' ever in 2022” and that 2023 is a "make-or-break year" for many. Bloomberg and Becker’s report (here) that “Several financial challenges contributed to hospital margins suffering steep declines last year, including labor costs and staff shortages, inflation, higher cost of capital, investment losses and the end of federal pandemic-related funds. While the need for high-cost travel nurses has declined, basic wages have increased, and inflation remains at elevated levels.”
Reports of statewide hospital distress (California, here and here; Kansas, here) are frequent. High and even record profits among the major for-profit chains (HCA, here) cloud appeals for financial relief from the government. Analysts reviewing (here) the proposed acute care hospital Inpatient Prospective Payment System rule for FY 2024 are pessimistic that it will provide such relief.
Congress appears torn between responding to the industry and responding to financial pressure on the Medicare Trust Fund. A renewed move to the hospital-at-home (here) may prove to have mixed results for hospitals, and for patients. Some believe (here) that government flexibilities and assistance during the pandemic were a high point of public assistance, European style social services, with inevitable decline to follow.
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
Clinical Trials: 40% of Results of Registered Trials Don’t Appear for Three Years or More
A report in JAMA (here) examines the proportion and timing of results dissemination for registered trials, analyzed by data source (i.e., ClinicalTrials.gov and PubMed) and funder type. “39% of trials lacked results availability on ClinicalTrials.gov or PubMed after a minimum follow-up of 36 months following primary completion date. Nearly a quarter of all identified trial results were solely available on ClinicalTrials.gov, and 40% with available results were first available on ClinicalTrials.gov. Non-NIH federal agency–funded trials had the highest overall proportion with results available (71/100 trials), while industry-funded trials had the lowest.”
An unrelated piece (here) in the same edition discusses the often-cited gap between new knowledge and its application in clinical practice, and the extent to which “implementation science” may narrow that gap. “Chasm might be a better word to describe the gap between research and practice. A frequently cited estimate puts that gap at 17 years on average, and even then, only 1 in 5 evidence-based interventions make it to routine clinical practice . . . In historically marginalized populations, the evidence-to-practice gap is often even more yawning.”
A primer on implementation science was published (here) in JAMA Surgery in 2020, part of a series in that journal on clinical research methods.
National Survey of Practitioner Billing
The recruiting firm AMN reports (here) its 2023 survey of billing by physicians, NPs and CRNAs. “Through the tests and treatments they order, the drugs they prescribe, and the range of services they provide, physicians generate bills to third-party payors, including commercial insurance companies and government-subsidized health insurance providers such as Medicare.
In this report, AMN Healthcare tracks billing to commercial payors generated by 18 types of physicians as well as by two types of advanced practice professionals: nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs).”
The results:
“The average annual billing amount generated by all physicians and advanced practitioners tracked in the report to commercial payors is $3.8 million.”
“The highest average annual physician billing to commercial payors is $11,669,016, generated by general surgeons. The lowest annual average physician billing to commercial payers is $1,323,104, generated by pediatricians.”
“Among advanced practitioners tracked in the survey, certified registered nurse anesthetists (CRNAs) generate an annual average of $1,750,281 in billing to commercial payors. Nurse practitioners (NPs) generate an annual average of $777,393 in billing to commercial payors.”
“Physicians who practice in diagnostic, surgical, and internal medicine specialties typically generate higher average billing to commercial payors than do primary care physicians. The average billing amount to commercial payors generated by specialist physicians is $4,650,750, compared to $1,770,564 for primary care physicians (defined as family medicine physicians, general internal medicine physicians, and pediatricians.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
HHS Proposes to Include DACA Residents in Health Plans
CMS is publishing in today’s Federal Register (here, “fact sheet” here) a notice of proposed rulemaking that would expand access to health care by reducing barriers for Deferred Action for Childhood Arrivals (DACA) recipients.
The proposed rule would remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs. If the rule is finalized as proposed, it could lead to 129,000 previously uninsured DACA recipients receiving health care coverage.
The proposed rule would amend the definition of “lawfully present” to include DACA recipients for the purposes of Medicaid and CHIP. In effect, this would extend Medicaid and CHIP coverage to children and pregnant women in states that have elected the “CHIPRA 214” option for children and/or pregnant individuals, the Basic Health Program, and Affordable Care Act Marketplace coverage. Coverage in The Washington Post, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 27, 28
May 9, 10, 11, 12, 15, 16, 17, 18
June 6, 7, 8, 11, 12, 13, 14, 20, 21, 22, 23
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
© 2023 Fred Hyde & Associates, All rights reserved.
Editor: Jane Guillette; Systems and Distribution: Colby Miers, Los Angeles