by George Chapman, GW Chapman Consulting
Malpractice alternative. Patients seeking damages would present their grievance to a panel of experts and an administrative law judge. Rather than wait years for a settlement, the claimant would be quickly compensated should their case have merit. This would ameliorate if not eliminate the adversarial relationship the current malpractice system creates between physician and patient. It would also allow providers to acknowledge an error without fear of litigation. This Alternative Patient Compensation System model is being contemplated in Georgia, Florida, Tennessee, Maine and Montana.
Hospital jobs on the rise. According to the Bureau of Labor Statistics, hospital employment is at just over 5 million people. Hospitals added a net 188,000 jobs in 2015. Most of the growth is attributed to acquisitions of medical practices, increased demand for outpatient services and gearing up for population health management. The entire healthcare sector employs almost 19 million workers. Employment was down in dental offices and laboratories.
Hundreds of US rural hospitals in jeopardy. One third of all US rural hospitals are in danger of closing. 70% of them have had negative operating margins for years. The loss to a community is more economic than clinical. While clinical care is typically available at other facilities in the area, rural hospitals are often one of the largest employers in the county. States with the most distressed rural hospitals are Texas and Mississippi. There are about two dozen small/rural hospitals in danger of closing in NYS. Two senators have introduced legislation, “Save Rural Hospitals Act”, to provide funding to keep the doors of rural hospitals open.
Without special funding, most rural hospitals will close unless they affiliate with a larger hospital or join a hospital system.
Happy Danes. Like most western nations, Denmark has a universal healthcare system. Danes are very happy with their lives and their healthcare because the bureaucracy that is typically associated with universal systems has been vastly reduced. The Danish system emphasizes locally focused control. A lot of value is placed on close, unfettered relationships between patients and their primary physician. Danes average seven contacts (in person, phone, electronic) per year with their primary care provider. The US average is less than four contacts. The main goal in Denmark is to catch problems early and treat. Danish per capita costs are about $5,000 compared to about $9,000 in the US.
Employer sponsored plans cause concern. Large employers can avoid a lot of insurance regulation and requirements by forming and designing their own plans. The hospital association is lobbying congress to close loopholes in coverage requirements. In a letter to CMS, the AHA expressed concern over the fact that that some employer plans are not covering outpatient surgery in order to cut costs. The AHA argues this puts employees at risk both clinically and financially, meeting neither the spirit nor mandate of the Affordable Care Act which is to insure safe, affordable, accessible and comprehensive care to all Americans. The AHA suggests that CMS establish minimum coverage standards for all categories of care including surgery.
Healthcare advertising on the rise. The industry, providers and drug companies, spent $14 billion on ads in 2014, up 20% over 2011. Competition for patients and market share is fierce, causing concern among consumer groups about over utilization and higher prices to pay for the increased ads.
Moratorium on hospital mergers. While mergers can save vulnerable hospitals and/or improve services, many have resulted in nothing more that monopolies which typically lead to price hikes. Connecticut governor Dan Molly has placed a moratorium on hospital mergers in his state. He issued this statement, “ We need balance. Fewer healthcare systems mean fewer choices for consumers, and that can dramatically affect both the quality of care and costs. It’s time we take a holistic look at the acquisition process.” In the same vein, many are questioning the impact of insurance company mergers on eventual premiums.
Medicare Advantage plans. Last year, over 17 million seniors (about one third of Medicare eligibles) chose to enroll in an Advantage plan offered by a private commercial insurer. Advantage plans attract seniors by offering more benefits than traditional Medicare. The feds entice private insurers to offer Advantage plans with more than $3 billion in incentives and bonuses. The insurer must reinvest monies earned into additional benefits and new approaches to manage chronic conditions like hypertension, diabetes and obesity. United Health, for example, could earn over $1 billion in bonuses this year. Overall, commercial insurers have done well under the ACA.
March awareness. Sleep, nutrition, brain injury, developmental disabilities.