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Caring for a loved one is a balancing act, and too often it’s the caregivers’ health that’s neglected!

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The Associated Press-NORC Center for Public Affairs Research, found about a third of caregivers have gone without a routine physical or dental care, skipped or didn’t schedule a test or treatment or even forgot to fill a prescription or failed to see a doctor for their own illness or injury because they were too busy with their caregiving duties.

Four in 10 Americans have provided long-term care to an older relative or friend, a volunteer workforce that’s growing as the population ages. The AP-NORC survey found that for nearly a quarter of them, especially caregivers who are over 40, the amount of time spent on caregiving duties is equivalent to a full-time job.

Nearly 40 percent of caregivers have a health problem, physical disability or mental health condition that impacts their daily life or limits their activities, the poll found. More than a quarter of caregivers say it’s difficult to manage their own health along with the caregiving duties. Even more, who have chronic conditions, 40 percent, find it a struggle.

The vast majority of caregivers accompany the person they assist to medical appointments, usually going into the exam rather than staying in the waiting room. Yet fewer than 40 percent gleaned advice on caregiver resources during those visits. Caregivers and their charges “should be treated simultaneously,” said University of Pittsburgh aging specialist Richard Schulz. “They should be looked at as a unit,” because if the caregiver burns out, the patient may have no one left.

 

Millennials would rather use clinics and EDs than Primary Care Physicians

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The 83 million millennials are turning their backs to primary care providers (PCP) over the convenience, fast service, connectivity and price transparency of clinics or urgent care centers. A national poll of 1,200 randomly selected adults conducted in July by the Kaiser Family Foundation found that 26% said they did not have a PCP. There was a pronounced difference among age groups: 45% of 18- to 29-year-olds had no primary-care provider, compared with 28% of those 30 to 49, 18% of those 50 to 64 and 12% age 65 and older.
Waiting several days for an appointment when you’re sick is not super attractive to young people:
  • “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed,” Harvard professor Ateev Mehrotra told the Washington Post.
  • “Now people say, ‘That’s crazy, why would I wait that long?’” Mehrotra said.

PCPs are supposed to be the people at the center of our care, keeping tabs on patients’ health and helping to coordinate our needs. But if you’re only using the health care system when something is acutely wrong, going to urgent care or a clinic might seem more logical — and more affordable than the emergency room, which used to fill those after-hours needs.

The care may not be as good; in a recent study, half the people treated for a simple cold or flu at an urgent care clinic left with an unnecessary and potentially harmful prescription for antibiotics, compared with just 17% of those treated by a PCP, according to the Washington Post.

(Steve Debenport/iStock)

Healthcare takes a larger bite out of workers’ compensation!

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The average cost of employer health coverage rose in 2018 to almost $20,000 for a family plan and to $7,000 for single coverage, according to the Kaiser Family Foundation’s annual review of those plans. In addition, over the past 10 years, employees have ended up covering their own health care bills with more out of pocket cost and deductibles. Those costs are rising faster than inflation and faster than wages.

  • The average family premium has increased by 55% since 2008 and 20% since 2013
  • For single coverage employees are paying an average of about $1,200 per year in premiums. That’s 65% more than what they paid in 2008
  • The bigger story is deductibles which are growing in every way. The average deductible is up — 212% since 2008, and the number of employees with above-average deductibles is also up
  • The increases in premiums and deductibles both outstrip increases in wages

There’s evidence that employers have just about maxed out their ability to shift more costs onto employees — meaning that once price increases start to pick up steam again, businesses and workers will both feel the pain quickly.

Breakdown of worker’s compensation and health insurance benefit

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The table below compares what companies and government have been paying their employees over the past 20 years: the percent share of employer costs for worker compensation and health benefits.

The table shows they paid more in benefits and less in wages and salaries, and that is especially the case among people who work for the unionized public sector.

Of all the different types of benefits, the cost of health insurance has consumed the most of the average worker’s compensation — representing 8.2 cents of a dollar in pay today versus 5.8 cents of a dollar in 1998.

source: Bureau of Labor Statistics

Plenty of blame to go around for high health costs

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Health care costs remain a leading issue ahead of this year’s midterms, and voters have plenty of blame to go around, according to the Kaiser Family Foundation’s (KFF) latest tracking poll.

KFF health tracking poll of 1,201 US adults (Aug/2018) asked whether certain factors are a “major reason” health care costs are rising.

  • Blame for the potential political culprits — the ACA and the Trump administration — was split about evenly
  • But there’s a broader bipartisan agreement that industry is to blame: > 70% faulted drug companies, hospitals, and insurers
  • Doctors caught a break, at 49%
  • Partisanship reigns, though, on the question of whether President Trump will help
  • 13% of Democrats are at least somewhat confident that Americans will pay less for prescription drugs under the Trump administration, compared with a whopping 83% of Republicans. Independents generally share Democrats’ skepticism
  • Roughly a quarter of Democrats and roughly two-thirds of Republicans think Trump’s public criticism of drug companies will help bring down prices
  • Surprise hospital bills haven’t attracted the same political uproar as prescription drug costs, but the Kaiser poll provides more reason to believe they could be the next big controversy
  • 67% said they’re “very worried” or “somewhat worried” about being unable to pay a surprise medical bill
  • 53% fear they won’t be able to pay their deductible
  • 45% are afraid of the tab for their prescription drugs
  • 39% experienced a surprise bill in the past year

 

A little-known windfall for some hospitals, now facing big cuts

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Research corroborates that hospitals aren’t using the 340B program as intended.

  • The 340B program may have raised costs by encouraging care in 340B-eligible hospitals that could have been provided less expensively elsewhere
  • The program also encourages providers to use more expensive drugs
  • Medicare lowered the prices it pays for 340B drugs by 27%. But it does little to address how much insurers and individuals pay for prescription drugs or the value they obtain from them

How to tame healthcare spending? Look for 1% solutions

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A working paper published Monday proposes one possible fix. In the 1980s, Congress carved out a small group of hospitals from its normal rules for payment. These “long-term care hospitals,” which treated patients with tuberculosis and chronic diseases, could earn far more money than traditional hospitals and nursing homes if they cared for patients who stayed with them for an average of 25 days. Since then, the number of these hospitals has mushroomed, from a few dozens to more than 400, most run by two for-profit chains.

For years, analysts and policymakers have wondered about the value of these hospitals, which tend to treat very sick patients who need a lot of care, such as mechanical ventilation or dialysis. Several analyses have suggested that Medicare may be overpaying for their services. And Congress has made some small changes to limit the number of patients who are eligible for such care.

The new paper, from researchers at the Massachusetts Institute of Technology, Stanford University, and the University of Chicago, took a close look at what happened to patients as new long-term care hospitals opened around the country in places that had none.

The study, covering 1990 to 2014, found that when such a hospital opened, the odds increased that very sick patients leaving a normal hospital would end up going next to a long-term care hospital, generating a growing bill for both Medicare and the patients themselves. But the researchers found no benefit when it came to patients’ chances of dying or going home within 90 days.

The researchers concluded that the healthcare system could probably save a lot of money — around $5 billion a year — by paying the long-term care hospitals the same prices that are paid to skilled nursing facilities, the places that most long-term patients end up in when there is no long-term care hospital nearby.

Hospitals heavily increased prices from 2015 to 2016

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Axios combed through and combined spreadsheets of hospital charges and Medicare payments, which the Centers for Medicare & Medicaid Services posts annually and found:

  • For joint replacements, like hip and knee surgeries, prices are still all over the map. However, Medicare pays less than $13,000 on average for a joint replacement.
  • For-profit companies own (or used to own in 2016) nine out of the 10 hospitals with the highest list prices for joint replacement surgeries.
  • Memorial Hospital of Salem County, a small hospital in New Jersey owned by the publicly traded Community Health Systems, had the highest joint replacement price in the country in 2016 at $267,726.
  • HCA Healthcare, another for-profit hospital chain, owns two facilities that each charged more than $200,000 for joint replacements in 2016.
  • Many well-known not-for-profit hospital systems, like Cedars-Sinai in Los Angeles, also rank among the highest-charging hospitals for joint replacements.

Aside from the wide distribution in what hospitals charge for joint replacements, many hospitals also heavily increased prices from 2015 to 2016.

 

 

  • St. Francis Medical Center in New Jersey raised prices for joint replacement surgeries the most of any hospital in the country in 2016 — a 77% hike to more than $135,000.
  • More than 400 hospitals raised joint replacement prices by at least 10% in 2016.

Hospitals set prices at whatever level they want, well above what Medicare pays. While those prices often aren’t what patients pay, they still dictate what society at large pays for health care.

The large variation in hospital pricing gained awareness in 2013 when a Time article about hospital charges led the federal government to released data on hospital and physician payments. In addition, new studies show how market concentration factors into pricing. Hospitals have argued that charges are misleading because private and public health insurers don’t pay those amounts, but they still matter a lot. List prices are starting points, with no relation to cost, that is used in negotiations with private insurers. They also are the baseline for uninsured patients and people who have to deal with out-of-network bills — like this infamous case of a teacher in Texas.

 

 

 

To change nursing assignments and transform workforce management, hospitals need to plan differently!

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Massachusetts, New Jersey, Ohio, and Pennsylvania are getting ready to vote on legislation to mandate nurse-patient ratios like California did.

We learned from California that without a sound workforce planning methodology that can be consistently executed, hospitals won’t obtain the benefits of the increased staff [1].

The Nash Group SDM20/20™ planning methodology is proven to:

  • reduce labor cost $2M-$8M
  • dismantle consumption of premium dollars
  • advance patient placement and aggregation
  • improve patient disposition and reduce length of stay
  • increase staff retention 20%-40% and improve recruitment cycles
  • make workforce operations and schedules sustainable

[1] Petsunee Thungjaroenkul, Greta G. Cummings, Amanda Embleton, “The Impact of Nurse Staffing on Hospital Costs and Patient Length of Stay: A Systematic Review”, NURSING ECONOMIC$/Sep-Oct 2007, Vol. 25, No. 5

To lower cost, healthcare providers need to plan differently!

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Unrealistic workforce management plans cost healthcare organizations millions of dollars in labor. As this cost continues to be pass to consumers through increases in insurance premiums, they are demanding sustainable changes.
Execution cost that normally accounts for 20% of the bottom-line of hospitals and 35% of outpatient facilities is where sizeable labor changes need to be acquired.
A workforce management planning methodology (see below) that can be consistently executed and that delivers between $2M and $8M in labor savings is mandatory to meet sustainable labor operations.