Category: Health Care Costs

QSS: Dramatic Drop In Hospital Profitability in 3rd Quarter

The latest Quarterly Services Survey (QSS) showed a dramatic turnaround in hospitals’ fortunes. Quarterly revenues dropped two percent from the 2nd quarter, while offices of physicians and home health services grew over three percent (see Table I). Hospital revenue grew only 5.3 percent from 2014 Q3 to 2015 Q3, but that was still significantly lower than growth for most other health services.

TI

In the previous QSS, I discussed the healthy rise in hospital margins. That has changed dramatically. The Q3 data is subject to revision. Nevertheless, it indicates a dramatic change in hospitals’ fortunes (see Table 2).

PPI: Pharmaceutical Prices Finally Tame In November

BLSNovember’s Producer Price Index (PPI) finally saw a slowdown in pharmaceutical price increases, which increased 0.3 percent, month on month. This was the same as the overall PPI increase. Price increases for health goods and services were very slight, compared to general PPI. Indeed, two categories (X-Ray & electromedical equipment and biological products including diagnostics) actually experienced price deflation (see Table I).

Hospitals Dominate Health Jobs In November

BLSThe November Employment Situation Summary came in as expected, with 211,000 nonfarm civilian jobs added. Last month’s report was dominated by health jobs, which was not the case today. The increase of 24,000 health jobs comprised only 11 percent of the payroll hike, and both health and non-health jobs rose by 15 percent on the month (Table I).

TI

However, hospital jobs, which increased 13,000, comprised over half the growth in health jobs. This is something we view with concern. We prefer to see health jobs grow in ambulatory settings, because hospitals are the most expensive location of care. Hopefully, technology will move more health services out of the hospitals.

GDP: Health Services Accounts for 30 Percent of Services Spending Growth

BEAToday’s second estimate of Gross Domestic Product for the third quarter indicates growth in health services spending is maintaining a disproportionate share of still slow GDP growth.

Spending on health services grew faster (5.0 percent, annualized, in current dollars) than spending on non-health services (3.9 percent) or non-health personal consumption expenditure (3.0 percent) from the second quarter (Table I). The growth in health services spending ($25.1 billion, annualized) accounted for 17 percent of all GDP growth ($151.0 billion), one fifth of personal consumption expenditure ($130.2 billion), and 30 percent of all services spending ($85.5 billion).

Hospital Ownership of Physicians Drives Up Costs

New research published in the JAMA Internal Medicine journal supports, with rigorous data analysis, that hospital ownership of medical practices drives up costs:

Among the 240 Metropolitan Statistical Areas, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs. For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean increase of $75 per enrollee in annual outpatient spending from 2008 to 2012, a 3.1% increase relative to mean outpatient spending in 2012). This increase in outpatient spending was driven almost entirely by price increases because associated changes in utilization were minimal (corresponding change in price-standardized spending, $14). Changes in physician-hospital integration were not associated with significant changes in inpatient spending ($22 per enrollee) or utilization ($10 per enrollee).

(Note: I have edited out the measures of statistical significance from the abstract, for ease of reading.)

CPI: Medical Prices Rose Three Times Faster Than Other Prices; Hospitals Stand Out

BLSOctober’s Consumer Price Index (CPI) confirms medical prices continue to spring ahead of prices for other goods and services. Overall CPI increased 0.2 percent on the month and also 0.2 percent, year on year. Medical prices, on the other hand, increased 0.7 percent on the month and 3.0 percent, year on year (Table I).

20151117 CPI

PPI: Health Prices Continue to Rise Faster Than Others

October’s Producer Price Index declined 0.4 percent, month on month, and dropped 1.6 percent, year on year. Mild deflation continues to take hold in the general economy. However, it is not so in health care. Of the 14 sub-indices for health-related goods and services, only three declined month on month. Only six declined year on year (see Table I).

20151113 PPIa

Health Jobs Dominate Great Jobs Report

BLSObservers cheered the October Employment Situation Summary, which reported 271,000 civilian nonfarm jobs added. This is a big turnaround from the September report, which was very disappointing. Nevertheless, the two months have one thing in common: Jobs in health services dominated the growth in jobs. Whether job growth overall is strong or weak, health care keeps increasing its share.

Health care accounted for 45,000 of the 217,000 jobs added overall in October (Table I). That’s a rate of growth of 0.29 percent, much higher than 0.18 percent growth in non-health jobs. Jobs in ambulatory facilities accounted for 27,000 of the increase, which hospital jobs only increased by 18,000. Ambulatory jobs now account for a significantly higher share of health jobs than hospitals do. This change is positive, because hospitals are inefficient and overly expensive facilities for many procedures.

20151105 Health Workforce TI

Yet Another and then Another Health Insurance CO-OP Bites the Dust

Last Summer I wrote, “Consumer Operated and Oriented Plans… are slipping into insolvency.” Last week I wrote, “Obamacare health insurance cooperatives are falling by the wayside like drunken ice skaters on a frozen pond.” The pace of failure is accelerating!

The latest two failures are the CO-OPs in Utah and South Carolina. In the past week, Consumers’ Choice Health Insurance Company in South Carolina and Utah’s Arches Health Plan are the latest CO-OPs to announce they will close. CO-OPs in New York, Nevada, Tennessee, Louisiana, Colorado, Iowa, Oregon and Kentucky have either closed or announced they were not continuing into 2016.

Health Services Accounts for One Fifth of Weak Q3 GDP Growth

BEAToday’s advance estimate of Gross Domestic Product for the third quarter indicates growth in health spending is maintaining a disproportionate share of weak GDP growth. Commenters noted that the weak estimate was largely due to shrinking inventories. This explains why personal consumption expenditure (PCE) growth ($135.7 billion) was actually higher than GDP growth ($121.1 billion), quarter on quarter (Table I).

20151029 GDP T