Insight, analysis & opinion from Joe Paduda



Apr
29

Hospital goings on…

Couple things you need to track…

First, hospital mergers and acquisitions soared in the first three months of 2024.  From Fierce Healthcare…

Among the quarter’s 20 deals, four were “mega mergers” in which the smaller party had annual revenues exceeding $1 billion, per the report. This pushed total transacted revenue “near historically high levels” at $12 billion…

Kaufman Hall’s report is here.

Some of the big for-profit chains sold off lower-performing facilities; a few big not-for-profit system mergers were announced.

Unsurprisingly financials drove a lot of these deals; a lot of hospitals are on shaky financial ground while most of the big for-profits are making bank. Some not-for-profits’ numbers are improving although the sector as a whole is still struggling.

Meanwhile, giant for-profit HCA reported a big jump in earnings.

From Reuters:

HCA posted quarterly revenue of $17.34 billion, beating estimates of $16.78 billion and reported an adjusted profit of $5.36 per share for the reported quarter. Analysts on average had expected a profit of $5.01 per share, according to LSEG data.

What does this mean for you?

Facility costs are going up because not-for-profits (in general) are struggling, while for-profits (in general) are jacking up revenues. 


Apr
23

Dumbest law/regulation of the month – A tie!

Congratulations to Florida and Texas for passing new laws barring local governments from protecting workers from heat-related injuries!

This at a time when global warming is leading to record heat waves with temperatures hitting – and staying at – record highs for days on end.

Last week WorkCompCentral informed us that Florida is about to join Texas in prohibiting local governments from instituting heat protections from workers. This from a state with record high temperatures last summer…

Florida’s move is especially egregious; Florida does not have its own occupational health regulations but relies on OSHA and Federal regulations. But, the Feds continue to drag their feet on national protections for workers exposed to excessive heat…so the new law effectively prohibits ANY protections from heat-related injuries. 

Politicians in Florida and Texas are doing their best to kill more workers. That is NOT hyperbole…and is especially hypocritical because Florida passed legislation protecting student athletes from heat.

credit WaPo

But hey, in the air-conditioned offices in Tallahassee, with the brocade curtains drawn, one doesn’t see the workers outside the windows mowing lawns and doing landscaping.

Colorado, Oregon, and Washington have rules for outdoor workers.

Minnesota and Oregon also have indoor heat standards.

A committee in California’s State Senate passed a bill doing just that two weeks ago; hopefully that bill will be signed into law.

What does this mean for you?

More deaths, more heat injuries, higher premiums, and more devastated families.

Here’s hoping the industry’s “thought leaders” weigh in on this travesty. 


Apr
12

Good news Friday – protecting workers and an improving economy

Lots of good stuff to start your weekend…

First a California Senate Committee passed a bill to protect workers from heat-related injuries. SB1299 establishes a presumption that:

a heat-related injury that develops within a specified timeframe after working outdoors for an employer in the agriculture industry that fails to comply with heat illness prevention standards, as defined, arose out of and came in the course of employment.

Kudos to the Committee – this type of legislation is sorely needed – and should be promoted enthusiastically by anyone and everyone concerned about protecting workers.

And shame on the California Chamber of Commerce and APCA for their objections. The bill is clearly intended to encourage employers to comply with existing heat-related standards…yet these opponents are quibbling over minor definitional issues when they should be pushing their members hard to do the right thing.

More details on heat injuries here.

Hat tip to Workcompcentral.

Inflation – or not.

Wholesale prices edged up 2/10ths of a percent last month, significantly less than expected.

Reminder – retail price increases are closely related to increasing corporate profits. It is very clear indeed that big food is a major driver of consumer inflation.

Employment

Filings for unemployment benefits were also lower than expected, yet more evidence of a very solid jobs market.

 

 


Apr
10

What’s driving inflation?

There’s increasing evidence that higher corporate profits are driving inflation.

From the Hill:

Adjusted profits after taxes hit a record high of $2.8 trillion, beating the record of $2.7 trillion in the third quarter of 2022. Profits increased 3.9 percent on the quarter, above expectations of around 3.3 percent. [emphasis added]

This news preceded today’s announcement that inflation ticked up 0.4% in March, a number higher than expected. Annualized the rate is 3.5%, higher than wanted but much lower than this time last year.

Consumer goods prices have gone up much more than other goods and services, with prices for packaged foods and drinks noticeably higher.

So…corporate profits AND consumable prices are increasing, with both higher than expected.

The good news is wages are still trending higher than inflation, despite the profiteering of big corporations. 

What does this mean for you?

Wages are up – which means consumers are holding their own, but increases will affect WC premiums and indemnity expenses.

 

 

 


Apr
9

Consolidation among health systems and hospitals continues apace, and with it comes higher costs, more utilization, and longer disability durations.  Get the details from WCRI’s much-watch webinar on the impact of vertical provider integration on prices, medical utilization and outcomes.

It’s on Thursday May 2 at 2 pm eastern.

You can access the written report (free for members) here.

Another major factor that will greatly affect a state’s health, outcomes and costs is Medicaid expansion. A thorough yet simple discussion of implications of one state’s refusal to expand Medicaid is here.

The benefits of Medicaid expansion are broad, deep, and impactful.

Among the findings

  • A 2020 national study found that expansion was associated with a significant 3.6% decrease in all-cause mortality,
  • Two studies found significant declines in maternal mortality
  • expansion is associated with improvements in access to care and outcomes related to substance use disorder (SUD) as well as other mental health care.
  • hospitals in non-metropolitan areas and small hospitals experienced improved profit margins
  • Analyses find effects of expansion on numerous economic outcomes, including state budget savings, revenue gains, and overall economic growth
  • rural hospitals experienced particularly substantial improvements in financial performance following expansion

KFF on Texas’ uninsured population [note Texas is just one of 10 states yet to expand Medicaid]…

(a) significant proportion of adults in the coverage gap are employed unless they are elderly or disabled. The most common jobs among adults in the coverage gap are construction laborer, cashier, cook, waiter, house cleaner, retail salesperson, and janitor. These workers usually do not have access to employer-based health insurance and cannot afford plans on the federal insurance exchange. [emphasis added]

Crossover

Most of the non-expansion states:

  • have major problems with rural hospital cutbacks and closures
  • have significantly worse health outcomes
  • have healthcare access challenges

What does this mean for you?

Pay attention to the real drivers of healthcare outcomes and costs – they have more impact on duration and ultimate costs than anything else.

 


Apr
5

Another April snowstorm here in New Hampshire…weather is getting weirder by the week.

Not to worry  – we are keeping the just-arrived birds well fed!

Jobs…

WOW. This just in from BLS

Total nonfarm payroll employment rose by 303,000 in March, and the unemployment rate changed
little at 3.8 percent, the U.S. Bureau of Labor Statistics reported today. Job gains occurred 
in health care, government, and construction.
March's growth was significantly higher than the average monthly
gain of 231,000 over the prior 12 months.

Payroll company ADP predicted booming private sector job growth with an estimated 184,000 new jobs created last month – a big jump over the forecasted growth of 148,000 jobs.

Construction, financial services, and manufacturing sectors saw significant job growth.

Women’s NCAA tournament

Is breaking every record in sight…ticket prices for the semis are more than twice that for the men’s, viewership is off the charts, and everyone with a pulse knows who Caitlin Clark is.

Gotta love the increasing exposure for women’s sports – this will have incalculable impact on girls for generations to come.

Medicare – is NOT about to go bankrupt.

It is highly likely Medicare funding will be more than sufficient to its pay bills for decades to come. Merril Goozner provides a summary of funding’s vagaries, concluding government policy changes and economic ups and downs bounce around, but nonetheless the Trust Fund survives.

Junk fees..

Cost Americans billions as big finance companies hoover dollars out of our pockets.

Good news – efforts to drastically reduce credit card payment late fees got a big boost when a financial industry challenge to those limits was moved to a court much more likely to protect consumers.

Medicare drug prices

About 60 million folks are covered by Medicare – including your author.

Government action is helping reduce drug costs…the cost of insulin for diabetics on Medicare is limited to $35 per month, a huge drop…

From PBS…

The three major manufacturers we’re talking about, Sanofi, Novo Nordisk, and Eli Lilly, who cap their co-pays at $35, make up more than 90 percent of the insulin market. And the Medicare provisions in the Inflation Reduction Act mean that now about 1.7 million Medicare beneficiaries stand to benefit from that $35 monthly co-pay cap on their insulin. [emphasis added]

But wait…there’s more!

  • prescription costs of certain drugs for Medicare recipients is going to be capped at $3,300 annually.
  • In September the new list prices of 10 major drugs are going to be made public. That was made possible by the Inflation Reduction Act’s provision allowing Medicare to negotiate drug prices with manufacturers. Those prices go into effect in 2026
  • The annual cap on prescription costs will drop to $2,000.

The net – Medicare recipients will save big bucks.

 


Apr
3

For those I caught with my April Fool’s post…I hope you took it in the spirit in which it was intended…

Okay, back to reality (oh no….)

Hospital closures and cutbacks

Another hospital in a non-Medicaid expansion state is closing its ER and shuttering its inpatient care facility. The facility was acquired by a competitor a mile away a few years back…if this goes like most acquisitions folks around Anniston Alabama will likely have poorer outcomes and pay higher prices…

Ignore the corporate happy speak from the owners…this is the same stuff every exec that buys a rival hospital says.

Oh, and here’s research showing the link between Medicaid expansion and hospital closures.

Consolidators are doing just fine…the CEO of CHS just “earned” $8.3 million in pay and perks.

Obamacare…aka the ACA.

Remember way back when folks got all worked up about the ACA, how it was going to kill off old folks, destroy the “best healthcare system in the world”, cost millions of jobs and bankrupt thousands of small employers…and lots of people hated it?

News flash – Americans like it.  A lot.

That’s because:

  • Pre-existing conditions are covered.
  • Kids can be covered under the parent(s)’ insurance till they are 26.
  • 45 million Americans get insurance thru Obamacare and/or benefit from its provisions.
  • Provisions ensure adequate benefits for mental health, emergency care, maternity and child care and seven other key healthcare needs.
  • People who actually had Obamacare plans realized it saved lives.

Oh, and since people with health insurance are healthier than those without, if they’re hurt on the job, they recover faster and employers don’t have to pay to treat co-morbidities. 

We’re going to dive deep into the ACA in a coming week…stay tuned for more facts.

Change Healthcare cyber attack

It isn’t over. Owner United Healthcare recently stated patient data had been stolen by hackers.

This is a much bigger story – with much wider implications – than many think.

What does this mean for you?

More stuff affects you and your business than you may think. 


Mar
27

They lied to you.

A really scary study was just published…one that shows just how deadly healthcare misinformation is.

Not “can be”, but is.

Remember those politicians promoting hydroxychloroquine as a cure for COVID – AFTER studies showed it had little to no benefit – and was dangerous?

Well, they have blood on their hands.

A very well done meta-analysis (rigorous review of all available research studies)  estimated there were 16,990 hydroxychloroquine related deaths in hospitalized patients in six countries.

One of the studies, known as the RECOVERY trial, showed a significant increase in cardiac mortality among patients receiving hydroxychloroquine (HCQ). 

The study published in PubMed this February is here.

Two things.

First, anyone willfully lying – or passing along someone else’s lies – to people terrified of a deadly disease has much to apologize for. Would these people tell friends and family to eat rat poison?

Drive drunk?

Inject fentanyl?

Of course not – yet by pushing HCQ misinformation out to friends and family, they did much the same thing.

Second, in a case before the Supreme Court, some politicians are trying to argue that spreading misinformation – like “hydroxychloroquine cures COVID” is “protected free speech.”

What utter BS. Again, is it okay to tell kids – “hey, vaping is good for you!”… or “Sure, unprotected sex is fine!” or “No car seat needed – just carry your baby sister in your lap!”

Tobacco companies and the opioid business are just two examples of industries forced to pay billions for publishing lies.

 

As noted in yesterday’s post, thousands of us are dying from preventable causes…that’s really, really bad…what’s much worse is politicians legitimizing deadly disinformation. 

What does this mean for you?

Spreading deadly misinformation is NOT “free speech”. It is a cynical and disgusting abuse of power.

 

 

 


Mar
22

Good news, Friday!

Here it is, spring at last.

Well…not here in central New Hampshire where we’re going to get somewhere from 21″ of snow to…3-6″.  Gotta love the northeast in “spring”!

Income vs Inflation

Things continue to improve with worker income increases outpacing inflation.

From USAToday:

the average salary in the U.S. has grown by 5.4%, there was a gain of 3.2% in the Consumer Price Index for All Urban Consumers. This indicates that the average income increase is also an increase in people’s real income — taking into account their spending power.

Workers have seen steady increases in earnings over the last two years…

Two other items of note:

  • Black unemployment fell beneath 5 percent for the first time in history this last April.
  • There are 6 million more jobs today than in December 2019.

Innovation

The CHIPS Act – bipartisan legislation that funded development of domestic computer chip research and manufacturing – is creating tens of thousands of new jobs, many in Ohio, Arizona and Nevada.

And that’s just the start.

Today, a total of zero computer chips are manufactured here…in less than 6 years, 20% of the world’s most advanced chips by 2030 will be made in the USA.

That is great news indeed for workers, families, national defense, and our position in the world as the leading innovator of next-gen technology.

Kudos to politicians on both sides of the aisle.  

Innovation

One of the issues with healthcare research is studies, findings, and interpretation thereof may not factor in differences between male and female conditions, treatments, reactions to those conditions and treatments, long-term complications, and diseases and medical issues specific to either sex.

To address these disparities, The Administration announced a “new NIH-wide effort that will direct key investments of $200 million in Fiscal Year 2025 to fund new, interdisciplinary women’s health research…”

As more than half of Americans are female, this is very welcome news.

What does this mean for you?

We are getting wealthier and healthier.

 


Mar
20

Deconstructing Comp Pod!

Friends and colleagues Yvonne Guibert and Rafael Gonzalez went waaaay out on a limb and asked me to do another podcast.

I was all over the place, but Yvonne and Rafe were kind enough – and smart enough to rein me in when I diverged away from what was supposed to be the focus – impact of economics and the upcoming election on workers’ comp.

A deep dive into the economy started things off – how the House of Representatives affects physician reimbursement – and how that affects workers’ comp.

and how Medicaid dis-enrollment affects workers’ comp.

and how wage increases have outpaced inflation.

Listen on!


 

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