Time Magazine Finds “More Than 70% of Americans Feel Failed by the Health Care System”
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Time reports (here) that “The new Harris Poll survey, which was conducted from February to March 2023 and commissioned by the American Academy of Physician Associates, shows that patient satisfaction is also suffering due to the high costs, inaccessibility, and confusing logistics of U.S. medical care.”
“More than half of the roughly 2,500 U.S. adults who took the survey graded the U.S. health care system a “C” or below. When asked about factors that prevent people in the U.S. from getting care, cost was the most common criticism, followed by the system’s focus on profits, inaccessibility of insurance coverage, and confusion around what is covered by insurance.”
“Only 27% of people who took the survey said the U.S. medical system meets all of their needs, while the rest listed complaints including how long it takes to get an appointment (31% of respondents), high costs (26%), limitations of insurance coverage (23%), and subpar focus on preventive care and wellness (19%).”
“More than 70% said they want stronger relationships with their providers, and more than 65% said they believe their health would improve if they regularly worked with a trusted provider—responses that suggest Americans haven’t totally given up on the system, despite their frustrations.”
CBO Updates Federal Spending for Health
The Congressional Budget Office has delivered an update on current and projected federal spending on health care (here). Among the points made, “Health care spending in the United States has grown over time. Since 1960, it has more than tripled as a percentage of GDP,” federal outlays for health programs are projected to grow from less than 6% to more than 8% of GDP, “As a percentage of GDP, federal subsidies for employment-based coverage are projected to grow over the coming decade,” and the post-pandemic issues CBO is monitoring include “Demand for services, Telehealth, Workforce issues and their role in supply of care, Mental health and substance use, [and] Continuous eligibility and redetermination in Medicaid.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AHRQ Publishes the 2023 Patient Safety Chartbook
Among the findings of the annual publication (here, at pg. 41), “Among women who gave birth in 2019, those aged 25 to 34 years were nearly twice as likely to die during a delivery hospitalization (5.2 deaths per 100,000 hospitalizations) as those aged 18 to 24 (2.6 deaths per 100,000 hospitalizations). Women aged 35 to 55 years were more than three times as likely to die (9.5 deaths per 100,000 hospitalizations). Compared with females ages 12-17, females ages 18-24, 25-34, and 35-55 were all more likely to die during delivery hospitalization (2.6, 5.2, and 9.5, respectively, vs. 0.0).”
This chartbook includes summaries of trends across measures of patient safety, figures illustrating select measures of patient safety, and supplemental descriptions and data on patient safety measures, with specifics on age, race, income and gender.
“Through 2020, across a broad spectrum of healthcare quality measures, less than half (44%) showed improvement.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More Flexibility Sought for Hospitals to Acquire “Critical Access Hospital” (CAH) Designation
An effort in the Senate (here) is aimed at this problem: “More than 135 rural hospitals have closed nationwide in the past dozen years, and an estimated 51 percent of rural hospitals ran operating losses last year and 450 hospitals are facing closure risk.”
“Under CAH status, hospitals are paid a higher Medicare rate—101 percent of their actual costs, rather than set rates per service, as long as they have fewer than 25 inpatient beds; are located 35 miles from other hospitals; maintain patient length of stays less than 96 hours; and offer 24/7 emergency care.”
“The Rural Hospital Closure Relief Act would support and stabilize rural hospitals by providing flexibility around the 35-mile distance requirement and enabling states to certify a hospital as a ‘necessary provider’ in order to obtain CAH designation. This authority ended in 2006, but today’s bill would re-open this financial lifeline.”
Texas is one of many states with rural hospitals closing. A television news report (here) on Wharton, TX, notes “13 Investigates found Wharton is not the only small Texas town crippled by hospital closures and lack of local healthcare access. Over the last decade, 26 rural hospitals have permanently or temporarily closed across the state, according to data from the Texas Organization of Rural & Community Hospital. Statewide, 69 rural counties do not have a hospital. Our investigation found 77 of Texas’ 254 counties that do have rural hospitals do not have a labor or delivery unit.”
The TV news feature is entitled “Why a small hospital is better than none.”
Another Big City Mayoral Candidate Runs on Saving Safety Net Hospitals
In Philadelphia, the demise of Hahnemann (here) is an issue in the Mayoral race, as it was in New York City for then-candidate Bill DeBlasio in 2013. “Hahnemann sat on valuable real estate in Center City Philadelphia. And other hospitals wouldn’t throw their weight behind saving Hahnemann, eager to absorb its patient population and lucrative medical residencies. The CEO of Thomas Jefferson University, the city’s second-largest hospital network, Stephen Klasko, wrote an email in April 2019 — prior to Hahnemann’s bankruptcy and subsequent closure — saying, ‘No, we don’t need Hahnemann. In fact, we need many less hospitals.’”
“Today . . . ER wait times are about a half hour longer than the average hospitals in Pennsylvania . . . Health care workers around the city reported that ERs near Hahnemann became burdened with additional patients in the immediate aftermath of the hospital’s closure. Previous closures of hospital maternity wards in Philadelphia had led to increases in infant mortality as high as 50 percent, researchers from the Children’s Hospital of Philadelphia found in 2012.”
The Wall Street Journal (here) reported “In 2013, when Bill de Blasio was the city’s public advocate and campaigning for mayor, he was arrested at a demonstration over the possible closure of Long Island College Hospital [LICH] in Brooklyn. ‘This is about fighting for our hospitals,’ Mr. de Blasio said as he was led away in disposable plastic handcuffs. Now, as a developer brings forward two proposals to rebuild and expand the LICH site, Mr. de Blasio’s administration has been publicly and privately supportive of one of the plans, which would include new affordable apartments. Both proposals include tall towers in the low-rise Cobble Hill neighborhood, but neither include a full-service hospital.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
House Health Leader Presses CIGNA on Automated Denials Report From ProPublica
Rep. Cathy Rodgers, Chair of the Energy and Commerce Committee, has pressed (letter here, Committee press release here) CIGNA CEO David Cordani on reports of “automated denials” by the insurer. “In Cigna’s Medicare Advantage plans nearly one in five prior authorization denials were appealed . . . [and] 80 percent of denials were overturned.” Rep. Rodgers said, “It would suggest that the PXDX [procedure-to-diagnosis] review process is leading to policyholders paying out-of-pocket for medical care that should be covered under their health insurance contract.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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