Plunge in Birth Rate, Impact on Families, the Economy and Hospitals
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The National Center for Health Statistics reports this month (here) that “The provisional number of births for the United States in 2022 was 3,661,220 . . . the number of births declined by an average of 2% per year from 2014 through 2020, including a decline of 4% from 2019 through 2020, and rose 1% from 2020 to 2021.”
A profile of current birth rates in The Wall Street Journal (here) noted that “To maintain current population levels, the total fertility rate—a snapshot of the average number of babies women have over their lifetime—must stay at a ‘replacement rate’ of 2.1 children per woman. In 2021, the U.S. rate was 1.66. Had fertility rates stayed at their 2007 peak, the U.S. would now have 9.6 million more kids.”
“A World Bank report shows that the 2020s could be a second consecutive ‘lost decade’ for global economic growth, in large part because of worsening demographics. By 2026 or 2027 . . . the growth rate of the working-age population in the entire high-income and emerging-market world will turn from slightly positive to slightly negative, reversing a durable driver of economic growth since the Industrial Revolution.”
Historically, the U.S. has had approximately 3.7 million births per year. The New York Times in 2009 reported (here) that “More babies were born in the United States in 2007 than in any other year in American history . . .The 4,317,000 births in 2007 just edged out the figure for 1957, at the height of the baby boom. The increase reflected a slight rise in childbearing by women of all ages, including those in their 30s and 40s, and a record share of births to unmarried women.”
“But in contrast with the culturally transforming postwar boom, when a smaller population of women bore an average of three or four children, the recent increase mainly reflects a larger population of women of childbearing age.”
The WSJ report noted “The gap between women’s intended number of children and their actual family size has widened considerably . . . by the time women born in the late 1980s were in their early 30s, they had given birth, on average, to about one child less than they planned. That is roughly double the size of the shortfall for women born two decades earlier, and it is likely too large to be erased by a spurt of childbearing in their late 30s.”
“These findings reflect a growing consensus among demographers that for many Americans, economic and social obstacles have become intractable deterrents to having children.” For hospitals, obstetric volume is often a key to pediatric and young adult hospital usage, a gateway to well-insured commercial populations. The March of Dimes reported in 2022 (here) on maternity care “deserts” in the U.S., NPR report here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Cost of Measuring “Quality”
Federal quality metrics, frequently irksome to clinicians because of their number and irrelevance to medical care, are examined for their cost in a study (here) in JAMA. “The annual cost to acute care hospitals of measuring and reporting quality metric data, independent of resources spent on quality interventions, is not well known.”
“A total of 162 unique metrics were identified, of which 96 (59.3%) were claims-based, 107 (66.0%) were outcome metrics, and 101 (62.3%) were related to patient safety . . . Significant resources are expended exclusively for quality reporting [more than $5 million per year in the hospital studied], and some methods of quality assessment are far more expensive than others.”
Modern Healthcare reports (here) on the balance of revenue (from reporting to federal requirements) and expense for such metrics. Facilities that perform poorly as part of the Hospital-Acquired Condition Reduction Program and Hospital Readmissions Reduction Program have the potential to lose millions of dollars in annual funding from CMS. Those programs evaluate hospitals' overall performance on certain quality measures and reduce federal payments if there are lapses. . . As a result, many systems choose to invest just enough in their quality infrastructure to avoid a low ranking.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Finances Still Iffy in Pandemic Recovery
The May KaufmanHall “Flash Report” on hospital finances (here) found that “The median operating margin for hospitals was 0% in April, leaving most hospitals with little to no financial wiggle room,” that “Hospital volumes dropped across the board—including inpatient and outpatient. Emergency department volumes were the least affected,” that “Hospitals experienced increases in bad debt and charity care” which “could illustrate the effects of the start of widespread disenrollment from Medicaid following the end of the COVID-19 public health emergency,” and that “Labor costs jumped in April and the costs of goods and services continued to be well above pre-pandemic levels.”
“Though expenses generally fell in April, revenues declined at a faster rate.” Becker’s reports (here) that the 0% overall operating margin in May among the 900 surveyed hospitals was a slight improvement over the .3% loss in April. Investment losses at many larger health systems overwhelmed modest operating gains.
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Senators Weigh In on Increasing Medicare Revenue
Thirty-four Senators (press release here, letter here) have urged CMS to increase payment rates under the proposed FY 2024 Inpatient Prospective Payment Rule, in recognition of the perilous condition of hospital finances. “We are concerned that the proposed payment updates do not fully account for the current cost of care and will result in an overall payment reduction for hospitals in FY2024.”
“Conditions like the ones currently facing hospitals require a heightened review of payment policy. We respectfully request that CMS consider using its special exceptions and adjustments authority to make a retrospective adjustment to account for the difference between the market basket update that was implemented for FY 2022 and what the market basket actually is for FY 2022,” added the senators. According to the press release, “The letter also states the productivity update included in the proposed rule assumes hospitals can replicate the general economy’s productivity gains, while hospitals and health systems struggle with productivity declines.”
DRUGS & DEVICES
Confirmatory Studies of Drugs Safety and Efficacy Often Late
A study in JAMA Internal Medicine (here) examined “accelerated approval” of new drugs. “Under the accelerated approval pathway, the US Food and Drug Administration (FDA) may approve a drug based on surrogate end points that are reasonably likely to predict clinical benefit . . . the accelerated approval pathway has received growing criticism due to manufacturers’ delays in completing these studies. One potential source of delays is that confirmatory studies are often not underway at the time of accelerated approval.”
The study found that 16% of cancer drug approvals and 37% of other drug approval studies were not even underway at the time of the accelerated approvals.
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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