Here’s a quick tour of what else happened this week…
First, let’s just relax about Ebola. Yes, a physician in NYC – who treated patients in Africa – has come down with the disease. Yes, he traveled on the subway and went bowling before he was diagnosed. No, this doesn’t mean there’s a nascent epidemic, the City needs to go into lockdown, and residents should panic.
Ebola is hard to catch – a symptomatic victim has to share bodily fluids with another person for the virus to be transmitted.
You don’t get it from a bowling ball or subway seat.
Oh, and the two nurses in Dallas are recovering nicely; one is virus-free and the other improving steadily.
And, of the eight people treated for Ebola in this country, one – Mr Duncan – died, six recovered (or are recovering) and one (Dr Spencer) is in treatment now.
Last word – the nasty, over-the-top criticism of the CDC from critics as diverse as Mitch McConnell and Bill Maher is completely off base. Dinging the CDC because a hospital in Dallas didn’t immediately understand a potential Ebola patient had presented and wasn’t thoroughly prepared for that (remote) possibility is just ludicrous; as is the vitriol directed at the hospital.
okay, back to the real world. or what passes for it in the US health care non-system.
First up, a piece in JAMA finds patient care delivered by hospital-physician organizations costs more than physician organizations.
After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3 percent higher than did physician-owned organizations, according to the study. Organizations owned by multi-hospital systems incurred expenditures 19.8 percent higher than physician-owned organizations.
Let’s not read too much into this – JAMA is a doc-run publication, but it does have the ring of truth to it; billing practices change when hospitals/health care systems own doc practices, and they don’t get cheaper. Abstract is here.
Coincidentally, Fitch recently published a study indicating for-profit hospitals are doing quite well, thank you! Seems “the financial headwind of caring for uninsured patients has lessened, evidenced by markedly lower adjusted bad debt expense for large hospital companies.” This is ‘more true’ in Medicaid-expansion states, but is also happening in non-expansion states.
Less need to cost shift to work comp…
A few years back we were hearing how ACA would cause large employers’ health care costs to explode, leading them to drop coverage. Hasn’t happened.
From Bloomberg; “Employers and their workers have benefited in the form of lower premium increases for their insurance plans. Other than a spike in 2011, after the law required plans to cover children until age 26 and eliminated cost limits on care, premium increases have averaged less than 5 percent a year since 2010, according to Kaiser. ”
Notably, a big part of this is due to employers raising insureds’ copays, deductibles, and cost-sharing. That was going on before ACA, but now it’s capped.
Sources indicate Aetna is proceeding with efforts to recontract the Coventry Work Comp network onto Coventry “paper”. However, those efforts seem to be rather lackadaisical; negotiators aren’t pushing hard for discounts, seemingly more interested in “dots than discounts.” That is, there’s much more focus on getting contracts signed then on the discount itself.
No details on how successful those efforts are; will keep you posted as we hear.
Time to get to work – enjoy the weekend – away from work!
Joe, some perspective on the AMA study you shared that patient care delivered by hospital-physician organizations costs more than physician organizations. Several sources have reported that hospitals and health systems lose significant money on each physician they employ. For example, Modern Healthcare on 2/22/14 reported, “Bon Secours’ acquisition of physician practices hasn’t been without bumps. In its fiscal 2013, ended Aug. 31, the not-for-profit system took $158 million in losses as a result of its physician employment strategy, according to Moody’s Investors Service. Employing more physicians has meant a 5.2% increase in salary and benefit expenses, as well as added costs related to renting and staffing office space.” Later in that same article, “The median loss for employing a physician in 2012 was $176,463, according to a 2013 report from the Medical Group Management Association.” Recently, I’ve heard $150k – $175K per physician from clients and other system / hospital CEOs and Chief Medical Officers in my network. To my eye we are very early on the integration path to realize the hoped for benefits of collaboration. It will be interesting to see in the coming 3-4 years if health systems / hospitals have the ability and commitment to stick with their integration strategies.