National Health Expenditure Projections, 2021–30: Growth To Moderate As COVID-19 Impacts Wane: Each year, Health Affairs publishes the latest healthcare expenditures (in this case, 2020) and 10 year projections. The site is by subscription only, but over the next few days, undoubtedly there will be mentions of the findings in other, accessible, outlets. Here is a summary:
”National health spending growth is expected to have decelerated from 9.7 percent in 2020 to 4.2 percent in 2021 as federal supplemental funding was expected to decline substantially relative to 2020. Through 2024 health care use is expected to normalize after the declines observed in 2020, health insurance enrollments are assumed to evolve toward their prepandemic distributions, and the remaining federal supplemental funding is expected to wane. Economic growth is expected to outpace health spending growth for much of this period, leading the projected health share of gross domestic product (GDP) to decline from 19.7 percent in 2020 to just over 18 percent over the course of 2022–24. For 2025–30, factors that typically drive changes in health spending and enrollment, such as economic, demographic, and health-specific factors, are again expected to primarily influence trends in the health sector. By 2030 the health spending share of GDP is projected to reach 19.6 percent.”
In 2020, healthcare costs were $4,124 Billion or 19.7% of GDP.
About Covid-19
FDA says current dose of GSK-Vir COVID therapy unlikely to work against BA.2 variant: “The U.S. health regulator said on Friday the current authorized dose of GlaxoSmithKline and Vir Biotechnology's COVID-19 antibody therapy is unlikely to be effective against the Omicron BA.2 variant.
The agency pulled its authorization for the therapy, sotrovimab, in much of the U.S. northeast where the subvariant is dominant. The extremely contagious BA.2 causes about one-in-three COVID-19 cases in the United States now, according to government data earlier this week.”
Free COVID-19 tests ending for uninsured Americans: “Americans who don't have health insurance will now start to see some of the free COVID-19 testing options disappear, even if they are showing symptoms.
Quest Diagnostics, one of the largest testing companies in the country, told ABC News that patients who are not on Medicare, Medicaid or a private health plan will now be charged $125 dollars ($119 and a $6 physician fee) when using one of its QuestDirect PCR tests either by ordering a kit online or visiting one of the 1,500 Quest or major retail locations that administer the tests, such as Walmart or Giant Eagle.
More than 30 million Americans had no insurance during the first half of 2021, according to CDC estimates.”
About health insurance
Florida Suspends Centene Medicaid Enrollment, Penalizes Insurer for Technical Error: “The Florida Health Agency immediately suspended Medicaid and long-term care enrollment at subsidiary Centene and fined an insurance company nearly $9.1 million after a computer glitch caused Sunshine State Health Plan to mistakenly deny medical claims for more than 121,100 adults and children with low incomes.”
Florida doctor convicted in addiction treatment fraud scheme: “The medical director overseeing a pair of Florida addiction treatment facilities was convicted in an addiction treatment fraud scheme, the Justice Department said Thursday.
Jose Santeiro, 72, was part of a scheme that unlawfully billed approximately $112 million worth of addiction treatment services that were never rendered, or were medically unnecessary, the Justice Department said in a release.”
About hospitals and healthcare systems
Hospital Global Budgets: A Promising State Tool for Controlling Health Care Spending: From the Commonwealth Fund, a review of literature: “A flexible global budget pays hospitals based on their variable costs for incremental increases or decreases in volumes. This approach may help remove fee-for-service incentives that induce hospitals to provide unnecessary and low-value care, while at the same time giving states a tool to effectively constrain hospital expenditure growth for all payers. Such a payment system is also less complex than systems that set explicit prices or price caps for every service.”
Commentary: The problem with global budgets, as evidenced in Ontario, is that they do not allow hospitals to save any money to cope with financial crises, plan for capital investment, or budget for charitable care.
Global budgets are a feasible solution to the perverse incentives of fee-for-service, but the entire healthcare system needs to be restructured to make it work.
March 2022 National Hospital Flash Report: “Takeaways at a Glance:
1. 2022 is off to a bad start for U.S. hospitals and health systems.
Median hospital operating margins remained in the red for a second consecutive month in February, with most organizations experiencing declines in margins, revenues, and inpatient volumes in the aftermath of the Omicron surge.
2. Outpatient care signaled slow returns despite a steep decline in COVID-19 cases.
Consistent with past surges, delays in nonurgent care led to declines in outpatient metrics during Omicron. A moderate rise in surgery volumes showed some patients returned in February, but overall outpatient volumes and revenues remained low.
3. Inpatient volumes receded on the tail of the Omicron surge.
A drop in COVID-related hospitalizations contributed to sizable declines in inpatient volumes and lengths of stay in February, as fewer patients required care for severe symptoms of the virus following inpatient increases in January.
4. Hospitals got some temporary relief from rising expenses.
Expenses decreased across most metrics from January to February as pressures from the Omicron surge subsided, but nationwide labor shortages and global supply chain issues continue to drive up expenses compared to prior years.”
About the public’s health
Today’s “The Health 202” from The Washington Post has an excellent summary of national abortion law initiatives.
Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study: “In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally.”
Weekly U.S. Influenza Surveillance Report: “The percentage of outpatient visits due to respiratory illness increased slightly this week but is still below baseline. Influenza is contributing to levels of respiratory illness, but other respiratory viruses are also circulating. The relative contribution of influenza varies by location.
The number of hospital admissions reported to HHS Protect has increased each week for the past seven weeks.
The cumulative hospitalization rate in the FluSurv-NET system is higher than the rate for the entire 2020-2021 season, but lower than the rate seen at this time during the four seasons preceding the COVID-19 pandemic.
CDC estimates that, so far this season, there have been at least 3.1 million flu illnesses, 31,000 hospitalizations, and 1,800 deaths from flu.”
Walmart Stops Selling Cigarettes in Some Stores: “Walmart Inc. is ending cigarette sales in some U.S. stores after years of debate within the retail company’s leadership ranks about the sale of tobacco products, according to people familiar with the matter.
Cigarettes are being removed in various markets, including some stores in California, Florida, Arkansas and New Mexico, according to the people and store visits.”
Citing ‘outbreak,’ [Israeli] Health Ministry to launch polio vaccination drive, official says: “A top health official said Sunday that the Health Ministry will later this week launch a polio vaccination drive to counter what she called ‘a real outbreak’ of the disease.
The move comes after earlier this month health officials confirmed the first case of the potentially debilitating disease in the country in over 30 years…
She explained that during the years 2005-2013, polio vaccinations were cut back as the disease was vanquished in the country and many babies who have since gone through the health system did not get both doses.”
New study reveals why HIV remains in human tissue even after antiretroviral therapy: “Now, new research by University of Alberta immunologist Shokrollah Elahi reveals a possible answer to the mystery of why infected people can't get rid of HIV altogether.
Elahi and his team found that in HIV patients, killer T cells -- a type of white blood cells responsible for identifying and destroying cells infected with viruses -- have very little to none of a protein called CD73.
Because CD73 is responsible for migration and cell movement into the tissue, the lack of the protein compromises the ability of killer T cells to find and eliminate HIV-infected cells, explained Elahi…
‘This provides us the opportunity to come up with potential new treatments that would help killer T cells migrate better to gain access to the infected cells in different tissues.’”
About healthcare IT
DOJ joins whistleblower case against EHR vendor Modernizing Medicine and co-founder: “The US Department of Justice has filed notice that it intends to join a whistleblower lawsuit filed by Phillips & Cohen LLP against Modernizing Medicine and a co-founder alleging serious violations of the False Claims Act involving the company's electronic health records (EHR) software and illegal kickbacks to physicians.
ModMed sells a cloud-based electronic health records (EHR) system, through subscription services, to specialty medical practices, including, gastroenterology, orthopedics, ophthalmology, otolaryngology, pain management, plastic surgery, rheumatology, urology and dermatology practices. Medical practices use the software for clinical documentation, prescribing medications, telemedicine, billing and more.”
About healthcare personnel
Former nurse guilty of homicide in medication error death: “A former Tennessee nurse is guilty of criminally negligent homicide in the death of a patient who was accidentally given the wrong medication, a jury found Friday. She was also found guilty of gross neglect of an impaired adult in a case that has fixed the attention of patient safety advocates and nurses’ organizations around the country.
RaDonda Vaught, 37, injected the paralyzing drug vecuronium into 75-year-old Charlene Murphey instead of the sedative Versed on Dec. 26, 2017.”
This case raises many questions about individual versus system responsibility for errors.
Additional relevant facts:
” Leanna Craft, a nurse educator at the neuro-ICU unit where Vaught worked, testified that it was common for nurses at that time to override the system in order to get drugs. The hospital had recently updated an electronic records system, which led to delays in retrieving medications from the automatic drug dispensing cabinets. There was also no scanner in the imaging area for Vaught to scan the medication against the patient’s ID bracelet.”
Examining How the Social Drivers of Health Affect the Nation’s Physicians and their Patients: From a Physicians Foundation survey:
“• Six in 10 physicians (61%) feel they have little to no time and ability to effectively address their patients’ SDOH
• However, a majority of physicians (87%) want greater time and ability in the future
• Community resources not available, inadequate or difficult to access” (77%), ‘inadequate information about availability/access to community resources’ (77%), ‘lack of reimbursement for screening for or addressing SDOH’ (73%) and ‘existing payer reporting requirements taking time away from being able to address patients’ SDOH’ (73%) were also identified as top challenges
• Eight in 10 physicians (83%) believe that addressing patients’ SDOH contributes to physician burnout rates
• Six in 10 physicians (63%) report they often have feelings of burnout when trying to address their patients’ SDOH
• Six in 10 physicians (68%) also report managing patients’ SDOH has a major impact on physician mental health and wellbeing”
Female and Millennial Patients Most Likely to Worry about Provider Perceptions, New Research Finds: “The research, commissioned by athenahealth, found that more than half of female respondents of all ages (55%) and millennial respondents (61%), defined as Americans born between 1981-1996, report they have interacted with a provider who they felt did not take their health concerns seriously. Furthermore, a similar number of women (54%) and millennials (67%) surveyed say they have had health concerns they did not bring up to their doctor due to fear of appearing anxious, dramatic, or silly. In both cases, these were the highest percentages of all age and gender groups.
In addition, female and millennial respondents are the most likely to report mental and physical effects from the pandemic…”