The 1%
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John Arnold, Carnegie and other foundations have been brought together to support the “1%,” a group of health policy researchers led by Yale’s Zack Cooper and Fiona Scott Morton, who proffer solutions to current health cost problems, aiming at reform in areas calculated to spend 1% (or more) on the national health budget. “This project relies on the expertise of leading academics and health policy analysts. Each contributor has developed a rigorous, data-driven recommendation, based on their own scholarship, that describes a specific problem in the US health care system and proposed concrete steps to fix it.”
Working scholars (here) and representative initiatives (Chernew and Dafny on price controls, here; Cooper and Morton on hospital-based physicians, here; Cooper and Gaynor on hospital consolidation, here; Kessler on hospital ownership of physician practices, here; Einav, Finkelstein and Mahoney, on “LTACs A Case Study in Waste,” here) are all found on the 1% web site (here).
The 18%
That national health budget (NHE, National Health Expenditures, from a CMS report, here), published June 14, but based on 2021 results, grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP). “Medicare spending grew 8.4% to $900.8 billion in 2021, or 21 percent of total NHE. Medicaid spending grew 9.2% to $734.0 billion in 2021, or 17 percent of total NHE. Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28 percent of total NHE. Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10 percent of total NHE. Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14 percent of total NHE.”
“Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020. Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020. Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020.”
“The largest shares of total health spending were sponsored by the federal government (34 percent) and the households (27 percent). The private business share of health spending accounted for 17 percent of total health care spending, state and local governments accounted for 15 percent, and other private revenues accounted for 7 percent.”
“Between 2014 and 2020, U.S. personal health care spending grew, on average, 4.8 percent per year, with spending in Arizona growing the fastest (6.6 percent) and spending in Vermont growing the slowest (2.7 percent). In 2020, per capita personal health care spending ranged from $7,522 in Utah to $14,007 in New York. Per capita spending in New York state was 37 percent higher than the national average ($10,191) while spending in Utah was about 26 percent lower.”
“Health care spending by region continued to exhibit considerable variation. In 2020, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($12,728 and $12,577, respectively), or 25 and 23 percent higher than the national average. In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita ($8,497 and $8,587, respectively) with average spending 17 and 16 percent lower than the national average, respectively.”
“Between 2014 and 2020, average growth in per capita personal health care spending was highest in New York at 6.1 percent per year and lowest in Wisconsin at 3.0 percent per year (compared with average growth of 4.3 percent nationally). The spread between the highest and the lowest per capita personal health spending across the states has remained relatively stable over 2014-20. Accordingly, the highest per capita spending levels were 90 to 100 percent higher per year than the lowest per capita spending levels during the period.”
“Medicare expenditures per beneficiary were highest in Florida ($13,652) and lowest in Vermont ($8,726) in 2020. Medicaid expenditures per enrollee were highest in North Dakota ($12,314) and lowest in Georgia ($4,754) in 2020.”
Projections for the future from the NHE June 14 report:
“Over 2022-2031 average growth in NHE (5.4 percent) is projected to outpace that of average GDP growth (4.6 percent) resulting in an increase in the health spending share of GDP from 18.3 percent in 2021 to 19.6 percent in 2031.”
A popular meme from 2012 (here, here) reported that the American health care system, if a country, would have the fifth largest economy in the world. A decade later the proportion is unchanged. Who ya gonna call? Maybe the 1%.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Telemedicine, Retrospective Analysis
The American Journal of Accountable Care (here) reports that “Provider and patient perspectives on financial issues that influenced use of telemedicine differed. Provider concerns were associated with reimbursement, whereas patients were mainly concerned about out-of-pocket costs. Three major themes emerged: (1) relaxing reimbursement regulations alleviated the burden of uncompensated work for providers, (2) reimbursement will determine sustainability of telemedicine, and (3) telemedicine addresses some cost concerns for patients.”
Screening for Depression and Suicide Risk: Maybe Yes, Maybe No
The U.S. Preventive Services Task Force commissioned a study on screening of adult populations for depression. The report (here, in JAMA) finds “The USPSTF concludes with moderate certainty that screening for MDD in adults, including pregnant and postpartum persons and older adults, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on the benefit and harms of screening for suicide risk in adults, including pregnant and postpartum persons and older adults.”
Physician Turnover, Perhaps Not as Large as Feared
A study by Casalino and colleagues in the Annals of Internal Medicine (here) on “physician turnover” used billing locations for traditional Medicare to examine “Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another.”
Results: “Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital Prices and Payments Lower in Physician-Owned Hospitals
Bai and colleagues (here, in JAMA Network Open) examined hospital payments in physician owned hospitals (POHs), compared to non-physician owned (non-POHs). “We hypothesized that POHs would have higher prices than their competitors and examined this hypothesis using information available through the Hospital Price Transparency Rule.”
“This cross-sectional study found that nationwide median commercial negotiated prices and cash prices were lower for general acute-care POHs than for non-POHs in the same market for most common hospital procedures. POHs served fewer Medicaid patients and provided less charity care, which might enable them to accept lower commercial prices (these factors were controlled for in the regression models).”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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