Insight, analysis & opinion from Joe Paduda

Nov
5

Enough obsessing…here’s what the election means for healthcare.

Like many, I’ve been spending far too much time obsessing over election results.

It’s a waste of time and energy…and completely useless; rather than dive into Maricopa County absentee ballot trends, time is far better spent figuring out the election’s implications.

I’ll stipulate that come January there will be a Democrat in the White House, a Democratic majority in the House of Representatives, and probably a very narrow Republican majority in the Senate (although that depends on Georgia’s Ossoff – Purdue results and the Warnock – Loeffler runoff).

Here’s what this means for healthcare.

The ACA is here to stay – whether it gets fixed is up to the Senate.

The Affordable Care Act needs work, but gridlock may keep it stumbling along.

Biden’s wish list includes:

  • lowering the eligibility age for Medicare to 60,
  • allowing the federal government to negotiate with pharmaceutical companies over prescription drug prices,
  • spending $775 billion on caregiving to address the need for home health,
  • expanding financial assistance for health insurance,
  • creating a “public option” government health plan, and
  • changing the individual mandate to ensure folks are incentivized to get health insurance.

Without a Democratic Senate, much of the list (lowering Medicare age, public option, $ for caregiving) is unlikely to happen...but Biden can use Executive Orders to address some key problems.

Expect a slew of Orders on issues including:

  • expanding family planning services;
  • expanding value-based care to – perhaps – include pharma (a backdoor way to partially address drug costs);
  • free and expanded testing for COVID,
  • transparency on medical billing, and
  • a mechanism to address surprise bills.

A Biden Administration will double down on the opioid crisis, taking much more aggressive action to make profiteers such as Purdue pay huge penalties. Criminal charges may well be levied against those profiteers along with efforts to reclaim dollars parked overseas by the Sackler family (owners of Purdue).

Of course, this depends on the Georgia runoff, scheduled for January 5 with early voting starting December 20.

What does this mean for you?

Its a lot more productive to focus on the implications and how they may affect you, your family, your community and your business than to worry about stuff we can’t control.


Nov
3

here’s hoping this ends soon.

We interrupt this healthcare blog to bring you a few moments of humorous relief…

Here’s for enthusiastic voters…

Gotta love Steve Schmidt et al…

Colbert is always so helpful!

Yeah, I don’t get it either…

Ouch.

And calls, and posters, and signs, and…

 

Oh God NOOOOOOOO!!!!!

What does this mean for you?

Everything.


Oct
30

It’s not a good time to be a hospital.

Lots happening this week, much of which was lost in the pre-election madness.

From Becker’s, a list of the 16 rural hospitals that shut their doors this year; over the last decade 133 have closed.  Most are in the South.

States that didn’t expand Medicaid figure prominently, accounting for 12 of the 16 closures. More than two dozen hospitals in Kentucky are at risk; the state’s decision to expand Medicaid took effect in June of this year, but the years of financial hardship will prove to be too much of a burden for some.

Expect more closures in the coming months.

One small contributor; now that PPE manufacturing is moving stateside, facilities’ costs will increase. That adds another straw to the camel’s back.

What does this mean for you?

Longer drives to get care if you live in a rural area, and hospitals looking everywhere for revenue to make up for losses.


Oct
28

The Sturgis Superspreader Event

Increasing evidence points to August’s Sturgis motorcycle rally as a major contributor to the big increase in infections throughout the upper midwest.

With 400,000 folks spending days talking, drinking, eating, recreating, socializing, dancing, singing, and generally having a great time – mostly without masks, sanitizer and obviously with no social distancing, this should come as no surprise.

Sturgis’ Meade County has experienced a major jump in case infection rates, helping to steepen South Dakota’s infection curve.

Using phone tracking data, researchers found:

counties that contributed the highest inflows of rally attendees experienced a 7.0 to 12.5 percent increase in COVID-19 cases relative to counties that did not contribute inflows.

Sturgis’ location in South Dakota was problematic as the state has done little to encourage responsible behavior, choosing to allow individuals and local entities to decide on public health measures.

The study has been met with some criticism, however other reports indicate outbreaks linked to Sturgis attendees happened in Colorado, Minnesota, Washington, New Jersey, North Dakota and other states.

One can argue about the validity of this study or pick apart specific issue, but one cannot justify 400,000 maskless people mashing together in the midst of a pandemic.

None of us like to be told what to do – me included. The idea of someone telling me what to wear, where I can and cannot go, things I can and cannot do…is why I’ve worked for myself for 25 years.

With that freedom comes responsibility, and the freedom-loving folks who went to Sturgis likely robbed thousands of others of their freedom to live COVID-free.

What does this mean for you?

We are all in this together – for good or ill.

Thanks to Pete for inspiring this post.

 

 


Oct
27

More hospital consolidation = higher prices

The only demonstrable impact of facility consolidation is higher prices.

There’s also solid evidence that more concentrated health care markets are associated with lower health care quality.

While the number of deals dropped by about 21% in the first half of this year as everyone’s attention focused on COVID and the impact thereof, a number of transactions still took place.  Conversely, several deals in process totaling around $23 billion were abandoned, victims of a variety of challenges.

Consolidation may actually accelerate as facilities hammered by the financial impact of COVID19 seek safe harbors.

The latest consolidation is in the north-central part of the nation, with 2 not for profit systems working on an a deal driven in large part of a desire to help the systems expand their footprint.

I’d expect more, although the increasing number of facility closures may well put a damper on deals as some run out of time.

This is particularly damaging in rural areas, where over a hundred hospitals have shut their doors over the last decade.

From Bob Shepard, UAB

What does this mean for you?

There will be fewer hospitals tomorrow than today, which likely means higher prices.


Oct
22

COVID update – where we are today v2

Had a posting issue yesterday; email notifications did not go out to all subscribers – reposting this  – apologies if you already received this.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
21

COVID update – where are we today.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
20

WCRI’s latest and greatest

For decades WCRI’s CompScope reports have provided deep insights into workers compensation in many states. The information is germane not only to those focused on specific states, but for anyone looking to understand what works and what doesn’t, how regulatory changes affect stakeholders, and how systems adapt to those changes.

The latest versions are the 21st edition, adding new depth and detail. Streamlined access to specific information and data via quick tabs is a big plus.

I took a deep dive into WCRI’s Florida report, and came away with two key takeaways.

  • If you are a facility, you should love the fee schedule.
  • If you are a medical provider, you should hate it.

Medical providers – docs, PTs, specialty providers – are paid about 30% less than the median state, with PTs at 28% less, E&M codes at 21% less, and x-rays reimbursed at a rate 45% less than the median.

Hospitals are making huge bucks off workers comp – especially for inpatient visits.  Recent data indicates well over half of all inpatient episodes are “outliers”. Once claims incur more than $59k in charges, reimbursement switches from per diem to percent of charges, more accurately known as “license to steal.”

I get why hospitals are desperate to make huge dollars charging Florida’s employers and taxpayers outrageous amounts: the state didn’t expand Medicaid and has the second highest percentage of non-elderly folks without health insurance (Texas is tops).

Florida hospitals have to treat a lot of folks without health insurance, and they are looking to workers’ comp to help pay for that treatment.

Oh, and COVID’s fallout is adding to hospitals’ financial woes. (take the info above with a grain of salt; it was put out by the Florida Hospital Ass’n.)

The result – hospitals are getting killed financially.

What does this mean for you?

Make time to read and understand solid research. It will determine your future.


Oct
16

COVID update – statistics, your state, treatment, and misinformation

It’s been a while since we dove into the latest research on COVID. Here’s a summary of where things stand.

“Cures”

Today there are no “cures” for COVID19. More accurately, no drugs or treatments have been proven to “cure” the disease.

A just-released study found that four drugs commonly used to treat hospitalized patients – anti-viral Remdesivir, hydroxychloroquine, Interferon, and Lopinavar:

appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay.”

The study was international in scope, used a randomized control format (a rigorous and well-regarded methodology), and enrolled over 11 thousand patients. Note the study has NOT yet been peer-reviewed

Gilead – manufacturer of remdesivir – disputed the study’s findings, which found:

no drug or combination reduced mortality, the chances that mechanical ventilation would be needed, or time spent in the hospital, compared with the patients without drug treatment. (NYTimes)

There are some indications that remdesivir may provide some benefit if administered early in an infection where it can tamp down the body’s immune response – which can be counter-productive.

Data

The US has administered over 119 million tests. About 8 million of us have been infected.  And 210,000 have died.

Black people are dying at more than twice the rate of White people. Other minorities are also dying at a far higher rate.

You can track infections, tests, and deaths in your state here.

The infection rate is climbing – again – especially in the Dakotas, Montana, Nebraska, Wyoming, Rhode Island, and New Mexico. (the darker the color, the higher the infection rate)

Debunking the claim that COVID death rates are “inflated”

Some have claimed that COVID death rates are inflated as many folks that died of COVID had other major health conditions – COVID deniers have been spreading this lie in an attempt to downplay the disastrous effects of COVID.

The CDC’s definition of the underlying cause of death is “the condition that began the chain of events that ultimately led to the person’s death.”

Think of it this way – if a person infected with COVID gets hit by a truck and killed, the cause of death will be listed as Motor Vehicle Accident – NOT COVID.

Similarly, if a person with COVID, hypertension and diabetes falls down the stairs and dies, the cause of death will be listed as “accidental fall”, NOT COVID

So, if a person with COVID, hypertension and diabetes dies after being admitted to the hospital, placed on a ventilator, given remdesivir, and administered oxygen dies, the cause of death will be listed as COVID.

What does this mean for you?

Wear a damn mask. Wash your hands.


Oct
14

Hospitals – it’s not just about the cost

All hospitals are NOT alike – and there’s a quick and highly credible way to identify the facilities highest-rated for quality – and those on the other end of the scale.

The Center for Medicare and Medicaid Services (CMS) has an online tool that allows you to review hospitals’ overall Star ratings. CMS uses a 1-5 star rating metric with the more stars the better.

Here’s how hospitals within 25 miles of Tampa FL stack up.

The overall rating is based on a set of specific ratings that address key measures including:

  • clinical outcomes;
  • patient safety;
  • patient engagement; and
  • cost.

There are a number of “sub-measures” that make up each category, one of particular interest may be facility-associated infections and other safety indicators. Information on timeliness and effectiveness of care is here.

You can download data on each and every hospital reporting to CMS or just pick the facilities of interest; the data is here.

CMS just completed a broad and deep assessment of patient impressions of hospital outpatient services and Ambulatory Surgery Centers; you can find results for individual outpatient facilities here and ASCs here.

For those seeking highly credible data on hospital costs, RAND’s latest research makes data highly accessible.

What does this mean for you?

If you aren’t assessing facilities’ quality, you should be.


Joe Paduda is the principal of Health Strategy Associates

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