Category Archives: Health Care

Pensions and retiree healthcare challenge some of the largest mass transit enterprises

Source: Thomas Aaron, Timothy Blake, Moody’s, Sector In-Depth, April 11, 2019
(subscription required)

Pensions and retiree healthcare pose a credit risk for some of the largest mass transit enterprises. Transit enterprises with material unfunded liabilities face budget challenges that can limit capital reinvestment, contribute to rising debt loads and/or lead to lower service levels.

2019 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds

Source: Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, April 22, 2019

From the press release:
Today, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds — the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D. The report found that the HI Trust Fund will be able to pay full benefits until 2026, the same as last year’s report.  For the 75-year projection period, the HI actuarial deficit has increased to 0.91 percent of taxable payroll from 0.82 percent in last year’s report. The change in the actuarial deficit is due to several factors, most notably lower assumed productivity growth, as well as effects from slower projected growth in the utilization of skilled nursing facility services, higher costs and lower income in 2018 than expected, lower real discount rates, and a shift in the valuation period.

Related:
Medicare’s fiscal outlook deteriorates as 2026 funding cliff looms, Trump administration says
Source: Jeff Stein, Washington Post, April 22, 2019

Medicare, Social Security face shaky fiscal futures
Source: Andrew Taylor, Associated Press, April 22, 2019

Lower Nurse-to-Patient Ratio: Higher Patient Satisfaction

Source: Teresa Dousay, Bailey Childers, Madison Cole, Tara Hill and Charles Rogers, Morehead State University, (undated)

Objectives
• Determine if lower nurse to patient ratio improved patient satisfaction
• To assess how nurse-to patient ratios and nurse work hours affect the patients hospital stay.
• To determine whether nurse staffing in California hospitals, where state mandated minimum nurse to patient ratios are in effect, differs from Kentucky with no mandated ratio

Abstract:
The issue of nursing care and patient staffing ratios is not new to medical-surgical nurses. It took national importance in 1996 with the release of an Institute of Medicine (IOM) report that evaluated nursing and patient safety. Patient’s conditions have become complex and require more nursing attention than before, yet, hospitals have become more economically focused and business oriented. Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as “variable patient or family caregiver state, condition, or perception responsive to nursing intervention”. Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are more likely documented in the medical record (Stanton, 2004, p. 2). This project focuses on positive nursing sensitive outcomes such as patient satisfaction, shortened inpatient length of stay and decreased hospital readmissions. The purpose of this paper is to reinforce the hypothesis that lower nurse-to-patient ratio results to higher patient satisfaction…..

Related:
Mandated Nurse-to-Patient Staffing Ratios: Benefits at the Bedside and Beyond
Source: Advanced Medical Reviews, February 28, 2019
….Adequate nurse staffing can reduce medical errors, patient mortality, length of stay, preventable events such as patient falls, healthcare-associated infections (HAIs), pressure ulcers and central line infections. It also may reduce patient care costs by avoiding readmissions. ….

The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

Source: Johanna Catherine Maclean, Brendan Saloner, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
(subscription required)

From the abstract:
We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid‐reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event‐study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post‐expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.

State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA

Source: Linda J. Blumberg, Matthew Buettgens, John Holahan, Clare Wang Pan, Urban Institute, March 26, 2019

From the abstract:
This analysis provides information on some of the consequences should a case pending before the US Court of Appeals for the 5th Circuit be decided in favor of the plaintiffs. The plaintiffs argue that the entire Affordable Care Act be eliminated due to the fact that he individual mandate penalties were set to $0 beginning with plan year 2019. We estimate the state-by-state implications of full ACA repeal for insurance coverage and government funding of health care in 2019. Our estimates take into account 2019 marketplace enrollment and premiums as well as recent Medicaid data.

Do prices vary with purchase volumes in healthcare contracts?

Source: Robert B Handfield, Jaikishen Venkitaraman, Shweta Murthy, Journal of Strategic Contracting and Negotiation, OnlineFirst, April 4, 2019
(subscription required)

From the abstract:
Hospitals are facing severe increases in the cost of clinical supplies, and a common strategy is to drive economies of scale achieved by hospital consolidation. The supply strategy of “volume leveraging” involves sourcing through contracts with Group Purchasing Organizations (GPOs) for commercial distributors and manufacturers of medical products. This study seeks to document the empirical benefits associated with volume leveraging, through analysis of purchasing data from three large hospitals. The dependent variables include a number of factors that are used to justify volume leveraging approaches, yet the study finds no significant explanatory factors that determine price variation related to the volume purchased. Interviews with physicians and clinicians suggest that poor data quality leads to lack of transparency, and an inability to aggregate volumes across inventory SKUs may be preventing volume-based cost savings from materializing. The results also suggest that lack of transparency results in low levels of utilization, which increases costs.

Medicaid spending set to consume a greater share of the US economy, despite flat enrollment

Source: Genevieve Nolan, Nicholas Samuels, Emily Raimes, Timothy Blake, Moody’s, Sector Comment, April 3, 2019
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Over the coming decade, demographic trends will play a role in driving up Medicaid costs as the US population both ages and lives longer, while growing healthcare costs and changing state policies will also contribute to rising expenditures.

Opioid settlement to benefit Oklahoma State University, local governments

Source: Adebola Kushimo, Susan I Fitzgerald, Leonard Jones, Moody’s, Sector Comment, April 5, 2019
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The agreement will bolster research funding in a growing area and position the university to enhance its brand and boost philanthropic support. In addition, it will benefit Oklahoma cities and counties, which will split $12.5 million as they grapple with a growing social risk.

Tracking Federal Funding to Combat the Opioid Crisis

Source: Bipartisan Policy Center, March 2019

From the summary:
In 2017, more than 70,000 people in the United States died from a drug overdose, with almost 50,000 of these deaths involving an opioid. The United States is facing a devastating opioid epidemic, and the federal government has responded by investing billions of dollars into prevention, treatment, and recovery efforts over the past two years. This includes efforts to curb the supply of both illicit opioids and unnecessary prescription opioids and to improve access to evidence-based treatment for opioid use disorder. Despite these actions, addiction policy experts believe that the end of the epidemic is not yet in sight.

Considerable attention has focused on the drivers of the opioid epidemic. However, less attention has been paid to whether the federal investments to address the issue are being effectively targeted to the communities most affected and to those with the highest overdose deaths. An effective response requires policymakers to know how resources are allocated and to use that information to minimize duplication and maximize the efficiency of limited resources. The federal government has not previously produced or made available a document that provides this information to the public or policymakers.

OPEB Brief: The Credit Impacts Of OPEB Obligation Bonds

Source: S&P Global Ratings, March 11, 2019
(subscription required)

Other postemployment benefit (OPEB) underfunding of obligations is pervasive across U.S. state and local governments, and costs are likely to continue to rise rapidly. Although, compared with pensions, these obligations may have some more flexibility in how they’re provided, we recognize that funded levels are almost universally lower than those of pensions and could quickly become a challenge to budgets if not addressed. With the implementation of Governmental Accounting Standards Board (GASB) Statements Nos. 74 and 75, many governments are seeing large new OPEB liabilities on their balance sheets that are growing due to insufficient contributions (see “Credit FAQ: New GASB Statements 74 And 75 Provide Transparency For Assessing Budgetary Stress On U.S. State & Local Government OPEBs,” published March 14, 2018, on RatingsDirect). In response, governments are looking to OPEB obligation bonds (OOBs) as a way to address funding concerns. Depending on the circumstances surrounding the OOB, issuance could have rating implications.