Source: Geoffrey Propheter, Public Budgeting and Finance, Early View, First published: March 25, 2019
From the abstract:
This study estimates the property tax expenditure for nonprofit hospitals (NPHs) in New York City using Medicare and IRS data from 2011 through 2013. After comparing the estimates to various definitions of community benefits, it is concluded that NPHs generally earn their property tax break. Evidence is also presented that using book values is a reasonably accurate method for estimating the property tax expenditure nationwide. Finally, econometric analyses reveals that net income is negatively associated with community benefits, suggesting justification for taxing higher net income hospitals and reallocating the funds to similarly sized but lower net income hospitals.
Source: Mattie Milner, Stephen Rice, The Conversation, May 7, 2019
Medical robots are helping doctors and other professionals save time, lower costs and shorten patient recovery times, but patients may not be ready. Our research into human perceptions of automated health care finds that people are wary of getting their health care from an automated system, but that they can adjust to the idea – especially if it saves them money.
Hospitals and medical practices are already using a fair amount of automation. For instance, in one San Francisco hospital and other places, delivery robots – about the size of a mini-fridge – zip through the hallways delivering pills, bringing lunch to patients and ferrying specimens and medical equipment to different labs. Some hospitals are set up for delivery robots to open remote-control doors and even use elevators to get around the building.
Source: Rita Sverdlik, Nansis Hayek, Lisa Goldstein, Kendra M. Smith, Moody’s, Not-for-profit and public healthcare – US, Sector Profile, April 25, 2019
Not-for-profit and public hospitals are showing signs of stability with profitability margins holding relatively steady and leverage metrics slightly improving, per our preliminary 2018 medians. The revenue growth rate edged ahead of expenses for the first time since 2015,driven by M&A, steady patient volumes and revenue cycle improvements. Cost-cutting initiatives and lower increases in drug prices contributed to a slower expense growth rate. A weak equity market in 2018 contributed to a slowdown in absolute cash growth while days cash on hand declined.
U.S. Not-For-Profit Health Care Rating And Outlook Change Drivers, First-Quarter 2019
Source: S&P Global Ratings, April 30, 2019
S&P Global Ratings performed a review of factors and how they influenced, positively or negatively, the credit profile of the U.S. not-for-profit health care providers it reviewed in the first quarter of 2019. From Jan. 1 to March 31, operating performance was a driver in 57% of the total 35 rating actions, followed by affiliations or deepened integration of already-affiliated organizations (23%), business position and utilization trends (17%), and balance sheet metrics (17%).
Source: Kaiser Family Foundation, April 26, 2019
To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.
To view this data in a table format, click here. To download a Powerpoint slide of the expansion status map, click here.
Source: Thomas Aaron, Timothy Blake, Moody’s, Sector In-Depth, April 11, 2019
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.
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.
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
Source: Teresa Dousay, Bailey Childers, Madison Cole, Tara Hill and Charles Rogers, Morehead State University, (undated)
• 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
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…..
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. ….
Source: Johanna Catherine Maclean, Brendan Saloner, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
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.
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.
Source: Robert B Handfield, Jaikishen Venkitaraman, Shweta Murthy, Journal of Strategic Contracting and Negotiation, OnlineFirst, April 4, 2019
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.