Today's News and Commentary

About healthcare professionals

4 Physician Assistant Trends to Watch in 2019: The US faces uneven physician shortages: by specialty and geography. One way we are attempting to address this problem is by using what used to be called “physician extenders,” such as nurse practitioners and physician assistants. One of the areas of need is primary care. Yet only about 20% of physician assistants are in family medicine and general practice. As this growing field saturates, we will see if these professionals help fill the specialty shortage needs. It is unclear how they will address the geographic problem.

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Dealmaking stayed hot in 2018, with a focus on physician practices: Most of the healthcare deals last year focused on hospital, insurance and pharma mergers/acquisitions. Physician practices were also a hotbed of activity. Purchasers ranged from hospitals systems to insurance companies to private equity firms. This article provides a good overview of this trend, which is on track to continue in the coming years.

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About insurance

House Democrats plan to hold hearings on Medicare for All: Liberal Democrats have been talking about this program for sometime. Now, new (returning) House Speaker Pelosi has given her endorsement to the idea of holding hearings on the matter. No one disagrees that everyone should have health insurance. The problem is when they realistically come up with the costs of an open-ended system that is based on volume of services rendered and with no consideration of evaluations of the benefits of new technology. By the way, future liability for Medicare is $29.2 trillion and Social Security is $19.8 Trillion. Neither are “funded,” meaning it is a future promise without the current money to deliver.

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Final enrollment numbers show drop due to cancellations: While analysis about the details is a couple months away, CMS says ACA exchange enrollment was down 4% from the previous year- about 2.1 million new customers and about 6.3 million renewals. As mentioned in a previous blog, it is unknown whether these figures are good or bad news. Are people opting out of insurance entirely or signing up for short term coverage, or are more people covered by employer-sponsored plans due to increased employment? Wait until March to find out.

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DOJ Reclaimed $2.5 Billion from Healthcare-Related False Claims Cases in Fiscal 2018: Healthcare fraud continues as an important added expense of our healthcare system. It is one more result of the fact that we largely pay by volume rather than value. As a thought experiment, think about how you would commit fraud in a capitated system.

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House Democrats vote to defend ACA in court — and jam Republicans: Continuing yesterday’s post about the House’s intent to join in the appeal over the ACA, representatives voted to make the action official.

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About hospitals

AHA data show hospitals' outpatient revenue nearing inpatient:The gap between hospital inpatient and outpatient revenue has narrowed over a number of years. Those figures are now closer than ever. There are many reasons for this trend: inpatient revenues have decreased or been flat as outpatient revenues (particularly diagnostics) have grown rapidly. Further, technology had allowed more procedures to be done on a same-day basis. According to The American Hospital Association's 2019 Hospital Statistics report (which analyzes 2017 data), “hospitals' net outpatient revenue was $472 billion and inpatient revenue totaled nearly $498 billion… creating a ratio of 95%, up from 83% in 2013." Many people expect outpatient revenue to surge past inpatient revenue in the near future. Is the core function of inpatient services now intensive care?

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Hospitals See Opportunity in Bringing Care Facilities to Patients: Many hospitals and healthcare systems have expanded through merger and acquisition. But what if the hospital has a market niche that precludes such tactics? Past examples have included the Mayo Clinic and Cleveland Clinic expansions to other locales. This article focuses on the Hospital for Special Surgery (HSS) in NY City. In contrast to the general capabilities of the Mayo and Cleveland Clinics, the HSS’s expertise is orthopedic care. This article analyzes its strategy to open facilities in other markets. It is an interesting move since “6% of patients who visit the primary Upper East Side Hospital for Special Surgery campus come from the immediate neighborhood. Some 94% of patients who are seen by the hospital drive in or fly to the hospital.”

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About pharma

The 20 most expensive pharmacy drugs in 2018, featuring names big and small: Enough has been said about the high cost of branded pharmaceuticals. This article gives you the facts about the 20 therapies that topped the list.

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About information technology

Most U.S. patients not using online medical portals: Healthcare providers rely on patient portals as a secure method of communication. Despite this feature being a requirement for “meaningful use” of electronic records, most patients are not using this method to connect with healthcare providers. According to this article, which draws on research published in Health Affairs [Subscription required]: “Overall, 63 percent of survey participants reported not using a patient portal during the past year, and 60 percent reported not having been offered access to a portal. Nonusers were more likely to be men, aged 65 or older, to be unemployed, live in a rural location, have public insurance through Medicaid, have a high school diploma or less education and to lack a regular doctor. Similar characteristics, as well as being non-white, were seen among people who said they weren’t offered access to a patient portal.”
This article also brings to mind many studies about how an overwhelming percent of people now prefer to use online tools to access medical care and communicate with providers. If available, the methodology description of those studies will reveal that they generally rely on….yes, online surveys.

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