Tag: "Hospitals"

Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years

Confident DoctorsA new survey by the Physicians Advocacy Institute and Avalere Health, a consulting firm, shows a significant increase in the number of physicians leaving independent practice and joining hospital-based health systems:

  • From July 2012 to July 2015, the percent of hospital-employed physicians increased by almost 50 percent, with increases in each six-month period measured over these three years.
  • In 2012, one in four physicians was employed by a hospital.
  • By 2015, 38 percent of physicians were employed by hospitals.

Good or bad? Well, color me skeptical. This acquisition spree is driven by new payment models which seek to reward providers for “accountable” care (which I suppose is better than unaccountable care.) So far, the results of payment reform in Medicare have been trivial.

PPI: Health Prices (Except Pharmaceuticals) Stay Tame As Other Prices Rise

BLSSeptember’s Producer Price Index rose 0.3 percent, a significant pick up. However, prices for most health goods and services grew slowly, if at all. Eleven of the 15 prices for health goods and services reported grew slower than the headline PPI. The major exception was prices for pharmaceutical preparations, which increased 1.2 percent, resuming a trend which I had hoped was breaking down. Further, prices of medicinal and botanical chemicals dropped 0.7 percent. So, price increases for pharmaceutical preparations are not coming from the ingredients.

However, over the last twelve months, prices of health goods and services have increased faster than overall PPI, which grew 0.7 percent. The tables are turned: 11 of 15 health categories experienced larger price increases than PPI did. Pharmaceutical preparations continue to stand out dramatically, having grown 8.1 percent. Nursing homes, for which prices rose 2.4 percent, might replace drug makers as the whipping boy for high health prices, but they have a long way to go.

(See Table I below the fold.)

Health Facilities Construction Growth Up Amidst General Decline in August

Census2Construction of health facilities significantly outpaced other construction in August. Overall, health facilities construction starts increased 1.2 percent in August, versus a drop of 0.8 percent for other construction. Further, both private and public health facilities construction grew.

Construction of private health facilities grew 0.6 percent, versus a drop of 0.4 percent for other private construction. Construction of public health facilities increased a whopping 3.6 percent, versus a drop of 2.2 percent for other public construction. Is this what they mean by “infrastructure” spending – broken bridges and roads, while more VA and county hospitals spring up?

See Table I Below the fold:

PPI: Health Prices Up Among Zero Overall Inflation

BLSAs with July’s Producer Price Index, health price inflation is no longer eye-popping, but still higher than overall PPI, which was flat in August. Hospital outpatient care stands out, with prices having risen 1.1 percent, monthly. Other price increases were moderate, but only prices of X-Ray machines and electromedical equipment declined.

This is also true over the last twelve months. Pharmaceutical prices especially stand out, even though they have risen moderately for a few months. It will take a while for the trend of high prices hikes from a few months ago to break down. Nursing homes, for which prices rose 3.0 percent, might replace drug makers as the whipping boy for high health prices, but they have a long way to go.

(See Table I below the fold.)

QSS: Strong Health Services Revenue Growth in 2nd Quarter

Census2This morning’s Quarterly Services Survey showed strong revenue growth in health services. Overall, revenues grew 3.6 percent in Q2 versus Q1 and 6.7 percent versus Q2 2015. For the first half, revenues grew 5.9 percent versus H1 2015. Growth was positive in all sectors except specialty hospitals. Physicians’ offices led the growth, at 4.5 percent. This is a turnaround from Q1. Perhaps most surprising was medical and diagnostic labs, for which revenue grew 4.0 percent. Labs have shed jobs, so increasing revenue suggests productivity improvements.

See Table I below the fold:

Significant Divergence in Private Vs. Public Health Facilities Construction in July

Census2The divergence between private and public health facilities construction continued in July. Overall, health facilities construction starts increased 0.3 percent in July, versus zero for other construction. However, there was a significant difference between the private and public segments.

Construction of private health facilities dropped 0.3 percent, versus an increase of 1.0 percent for other private construction. Construction of public health facilities increased a whopping 2.5 percent, versus a drop of 3.2 percent for other public construction (Table I).

Is this what they mean by “infrastructure” spending – broken bridges and roads, while more VA and county hospitals spring up?

CPI: Medical Prices Continue Upward March

BLSThe Consumer Price Index for July was flat. Medical prices, however, continued their upward march, increasing by one half of one percentage point. If prices for medical care had been flat, the CPI would have declined by 0.1 percent. Prescription drugs, physicians’ and other medical professionals’ services, and health insurance stand out even within medical care.

Over the last twelve months, prices for medical care have increased almost seven times faster than prices for non-medical items in the CPI. Price increases for medical care have contributed 40 percent of the overall CPI increase.

Many observers of medical prices decline to differentiate between nominal and real inflation. Because CPI is flat, even relatively moderate nominal price hikes for medical care are actually substantial real price hikes. Consumers are seeing no relief from high medical prices.

Incentives Matter: Medicare’s Hospital Readmissions Penalties Are Having An Impact

cmsIn 2012, Medicare began to penalize hospitals which had too many readmissions. For a small number of targeted conditions, the program compares actual readmissions within 30 days to what an acceptable readmission rate should be. This is an important part of the drive to “pay for value, not volume.”

For example, if a patient who had a knee replacement is readmitted within 30 days because the implant was poorly implanted, the hospital used to profit from that readmission because the extra costs would just be submitted to Medicare for reimbursement.

Evidence so far suggests reducing readmission was low-hanging fruit. In the program’s fourth year, Medicare will penalize over half the nation’s hospitals a total of $528 million, an increase of $108 million over last year. It is a significant increase, but not a money-maker for taxpayers, amounting to just 0.18 percent of Medicare’s expected hospital spending of $287.1 billion in 2016.

Health Construction Shrinks Twice As Fast As Other Construction in June

Census2The see-saw in health facilities construction continues. Health construction starts dropped 1.4 percent in June, versus a drop of 0.6 percent for other construction (Table I). However, there was a significant difference between the private and public segments.

TI

Chemotherapy Payment Reform: Medicare Is Missing the Elephant in the Room

cigarettes-2Last May I wrote about the uproar over Medicare’s proposed changes to how it will pay doctors who inject drugs in their offices. This largely concerns chemotherapy. Currently, physicians buy the drugs and Medicare reimburses them the Average Sales Price (ASP) plus 6 percent. The proposed reform would cut the mark-up to 2.5 percent and add a flat fee of $16.80 per injection.

I did not think the reform would have a positive impact, but I also thought criticism was overblown. Well, Medicare has managed to irritate all the affected interest groups to such a degree that it is likely to toss the proposal and go back to the drawing board.