National Health Expenditure Projections, 2022-2031
Health Affairs periodically updates expenditure projections and provides an analysis for them.
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About health insurance/insurers
Appeals court grants partial stay in ACA preventive care case “A panel of judges at the Fifth Circuit Court of Appeals issued a stay Tuesday that partially halts a lower court ruling striking down the mandate. As part of the order, the Biden administration can continue to enforce the preventive service mandate nationwide aside from against the case's named plaintiffs.”
Medicare Advantage Enrolls Lower-Spending People, Leading to Large Overpayments “Key Takeaways
Beneficiaries with lower-than-average expenditures than those with similar risk factors were significantly more likely to switch from Fee-for-Service (FFS) to Medicare Advantage (MA).
As a result, risk-score-adjusted expenditures for the 16.9 million beneficiaries who switched from FFS to MA between 2006–2019 were substantially below average. Plans were overpaid because MA rates are intended for beneficiaries with average—not systematically below average—expenditures.
MA plans in 2020 were overpaid by 14.4% due to this favorable selection phenomenon; when combined with the 6% overpayment reported by MedPAC for coding intensity and other factors, total MA overpayments were on the order of 20%.
Basing MA payment benchmarks on FFS expenditures is increasingly problematic as FFS enrollment continues to decline – underscoring the need for reforming how MA payments are set such as by decoupling MA payments from FFS benchmarks or instituting competitive bidding.”
Bottom line is that overpayments in MA could top $75 billion in 2023, or 20%.
Older adults are finally catching up on delayed surgeries. That means pain for health insurers, gains for hospital operators. “The trend was revealed by executives at Dow component UnitedHealth Group Inc. at a Goldman Sachs investor conference held on Tuesday. The revelation dented UnitedHealth shares by 5.6% in premarket trade, while shares of rivals also saw steep declines. Humana Inc. shares dropped 8% premarket, while Elevance Health Inc. shares dropped 4.8% and Cigna Group fell 4%.
Shares of hospital and surgical-center operators, meanwhile, profited from insurers’ pain. Shares of Surgery Partners Inc. , an operator of surgical facilities and related services, gained 7.4% premarket, while shares of hospital operator Community Health Systems Inc. jumped more than 10% and shares of hospital giant HCA Healthcare Inc. gained 3%.”
About hospitals and healthcare systems
No nonprofit health systems downgraded in May, S&P Global says “While there were some outlook revisions, no nonprofit healthcare system was downgraded in May, the first time that has happened since October 2021, S&P Global said.
There were also three upgrades during the month on two health systems and one standalone hospital, the ratings agency said. Two of those ratings were due to the strength of the newly consolidated Charlotte, N.C.-based Advocate Health following the combination of Downers Grove, Ill., and Milwaukee-based Advocate Aurora Health and Charlotte-based Atrium Health, according to S&P Global.”
About pharma
Pfizer expects to run out of some antibiotic supply for children soon “Supply of the pediatric version of the drug, Bicillin L-A, is expected to be exhausted by the end of this quarter, the company said in a letter to the U.S. health regulator dated Monday. Pfizer said in an email on Tuesday that the pediatric formulations of the antibiotic are not widely used.”
Top 20 Most Commonly Prescribed Medications FYI
About the public’s health
Racial, Ethnic, and Socioeconomic Differences in Food Allergies in the US “In this survey study of 51 819 households, Asian, Black, and Hispanic individuals were more likely to report having food allergies compared with White individuals. The prevalence of food allergies was lowest among households in the highest income bracket.”
About healthcare personnel
Demand for behavioral health services outstrips supply of providers, driving higher costs, analysis finds “In the first year of the pandemic, the global prevalence of anxiety and depression increased by a massive 25%, according to research from the World Health Organization. The pandemic also catalyzed investments in digital health capabilities, such as expanding virtual therapy and e-prescribing, in response to unprecedented demand.
Despite increased awareness and attention to behavioral health challenges, there continues to be a shortage of mental health providers. According to data from the Kaiser Family Foundation, 47% of the U.S. population in 2022 was living in a mental health workforce shortage area, with some states requiring up to 700 more practitioners to remove this designation.”
Comparison of Work Patterns Between Physicians and Advanced Practice Practitioners in Primary Care and Specialty Practice Settings “Question How do work patterns of physicians and advanced practice practitioners (APPs; ie, nurse practitioners and physician assistants) vary by specialty?
Findings In this cross-sectional study of 217 924 clinicians, medical and surgical specialty physicians saw 6.7 and 7.4 percentage points more new patient visits, respectively, than their APP counterparts, whereas primary care physicians saw 2.8 percentage points fewer new patient visits compared with APPs. Medical and surgical physicians spent 34.3 and 45.8 fewer minutes per day, respectively, using the electronic health record than did APPs in their specialties, whereas primary care physicians spent 17.7 more minutes per day than did APPs.”
About health technology
Federal advisory group rejects proposal to make medical device tracking easier “Every medical device has its own unique code, allowing manufacturers to keep track of their products once they enter the market. But while these codes are critical for recalling faulty devices or issuing updates, they rarely make their way into health records.
For years, experts have argued for a simple fix: adding device identifiers to insurance claims forms, which doctors use to request reimbursement for medical services. That, they say, would make it easier to reach patients at risk of flawed devices, and allow long-term study of device efficacy, safety, and cost.
But the idea is being held up by the slow-moving process of updating Medicare claims forms. It suffered another setback on Wednesday when the National Committee on Vital and Health Statistics, a group that advises the federal health department, voted not to recommend a slew of updates to claims forms — including the device identifier addition.”