Category Archives: Health Care

Cyberattacks pose growing operational and financial risks for hospitals

Source: Jennifer Barr, Lisa Goldstein, Leroy Terrelonge, Jonathan Kanarek, Kendra M. Smith, Jessica Gladstone, Moody’s, Sector In-Depth, September 12, 2019
(subscription required)

Many cyberattacks result in data breaches and, in the most critical cases, endanger revenue, posing a material risk to financial performance. Small hospitals are the most vulnerable to attack with lesser financial resources.

Related:
Smaller Medical Providers Get Burned by Ransomware
Source: Adam Janofsky, Wall Street Journal, October 6, 2019
Cyberattacks are pummeling doctors, dentists and community hospitals around the U.S., causing some to turn away patients and others to shut down

2019 Employer Health Benefits Survey

Source: Kaiser Family Foundation, September 25, 2019

From the press release:
Annual family premiums for employer-sponsored health insurance rose 5% to average $20,576 this year, according to the 2019 benchmark KFF Employer Health Benefits Survey released today. Workers’ wages rose 3.4% and inflation rose 2% over the same period.

On average, workers this year are contributing $6,015 toward the cost of family coverage, with employers paying the rest.

Despite the nation’s strong economy and low unemployment, what employers and workers pay toward premiums continues to rise more quickly than workers’ wages and inflation over time. Since 2009, average family premiums have increased 54% and workers’ contribution have increased 71%, several times more quickly than wages (26%) and inflation (20%).

Sections include:

Trends in State-Level Opinions toward the Affordable Care Act

Source: Julianna Pacheco; Elizabeth Maltby, Journal of Health Politics, Policy and Law, Volume 44, Issue 5, October 2019
(subscription required)

From the abstract:
Context:
This article argues that the devolution of the Affordable Care Act (ACA) to the states contributed to the slow progression of national public support for health care reform.

Methods:
sing small-area estimation techniques, the authors measured quarterly state ACA attitudes on five topics from 2009 to the start of the 2016 presidential election.

Findings:
Public support for the ACA increased after gubernatorial announcement of state-based exchanges. However, the adoption of federal or partnership marketplaces had virtually no effect on public opinion of the ACA and, in some cases, even decreased positive perceptions.

Conclusions:
The authors’ analyses point to the complexities in mass preferences toward the ACA and policy feedback more generally. The slow movement of national ACA support was due partly to state-level variations in policy making. The findings suggest that, as time progresses, attitudes in Republican-leaning states with state-based marketplaces will become more positive toward the ACA, presumably as residents begin to experience the positive effects of the law. More broadly, this work highlights the importance of looking at state-level variations in opinions and policies.

Death by a Thousand Cuts: The Embattled ACA

Source: Diane M. Soubly, Benefits Law Journal, Vol. 32, No. 2, Summer 2019
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In its first seven years, the Patient Protection and Affordable Care Act (ACA), now almost a decade old, decreased the number of uninsured persons who used highly expensive emergency care as primary care and curtailed double digit medical inflation. In the first two years of the Trump Administration, the President, the Executive Branch and Congress have devised ACA’s death by a thousand cuts. As former Solicitor General Donald Verrelli observes at page 2 of the Opening Brief submitted by Intervenor-Appellant The U.S. House of Representatives in the appeal from the Texas district court decision holding ACA unconstitutional, “Despite all that the Act has achieved, its political opponents have made repeated efforts to repeal it or to disable it through litigation.” This article updates employee benefits plan designers and litigators about those continuing efforts in the legal battle for the death of ACA…..

Michigan Supreme Court Denies Lifetime Benefits To Governmental Employees

Source: Amelia Dantzer, Employment Alert, Volume 36, Issue 18, September 4, 2019
(subscription required)

The Michigan Supreme Court has held in a ruling that governmental employees were not entitled to lifetime health benefits because their collective bargaining agreements (CBA) did not create a vested right to lifetime coverage. The court found that none of the relevant bargaining agreements included express language providing for vested, lifetime health benefits, and all the agreements contained “durational” clauses providing that the terms are only in effect for three years. Specifically, the court held that “[t]he CBAs contain a general three-year durational clause, and no provision specifies that the benefits in dispute are subject to any different duration. If the parties meant to vest healthcare benefits for life, they easily could have said so in the CBAs, but they did not.”

The Relationship Between Health Spending And Social Spending In High-Income Countries: How Does The US Compare?

Source: Irene Papanicolas, Liana R. Woskie, Duncan Orlander, E. John Orav, and Ashish K. Jha, Health Affairs, Ahead of Print, August 14, 2019
(subscription required)

From the abstract:
There is broad consensus that the US spends too much on health care. One proposed driver of the high US spending is low investment in social services. We examined the relationship between health spending and social spending across high-income countries. We found that US social spending (at 16.1 percent of gross domestic product [GDP] in 2015) is slightly below the average for Organization for Economic Cooperation and Development (OECD) countries (17.0 percent of GDP) and above that average when education spending is included (US: 19.7 percent of GDP; OECD: 17.7 percent of GDP). We found that countries that spent more on social services tended to spend more on health care. Adjusting for poverty and unemployment rates and the proportion of people older than age sixty-five did not meaningfully change these associations. In addition, when we examined changes over time, we found additional evidence for a positive relationship between social and health spending: Countries with the greatest increases in social spending also had larger increases in health care spending.

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Source: Devan Hawkins, Cora Roelofs, James Laing, Letitia Davis, American Journal of Industrial Medicine, Early View, July 26, 2019
(subscription required)

From the abstract:

Background:
Thousands of people in the United States continue to die from opioid overdoses every year. Work‐related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid‐related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work‐related factors that might contribute to these differences.

Methods:
We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work‐related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD.

Results:
Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD.

Conclusions:
These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest

Source: Jordan M. Harrison, Linda H. Aiken, Douglas M. Sloane, J. Margo Brooks Carthon, Raina M. Merchant, Robert A. Berg, Matthew D. McHugh, Health Affairs, Vol. 38 No. 7, July 2019
(subscription required)

From the abstract:
In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association’s Get With the Guidelines–Resuscitation registry (for 2013–18), RN4CAST-US hospital nurse surveys (2015–16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing.

Growth Of Public Coverage Among Working Families In The Private Sector

Source: Douglas Strane, Genevieve P. Kanter, Meredith Matone, Ahaviah Glaser, and David M. Rubin, Health Affairs, Vol. 38 No. 7, July 2019
(subscription required)

From the abstract:
Working families have increasingly enrolled their children in Medicaid or the Children’s Health Insurance Program in recent years. Parents’ place of employment affects the availability and cost of family health insurance, making it a determinant of pediatric public insurance enrollment. We examined that enrollment in the period 2008–16 in families working full time and earning more than 100 percent of the federal poverty level at three types of employers. Among low-income families (100–199 percent of poverty), children’s public health insurance coverage was highest for those with parents employed at small private firms, increasing from 53 percent to 79 percent, while the public insurance coverage rate also increased among children with parents working for large private firms (from 45 percent to 69 percent). Among moderate-income families (200–299 percent of poverty) working at small private firms, public coverage increased from 21 percent to 64 percent. Increases in the number of working families with pediatric public insurance were driven by employees of large private firms. Maintaining high pediatric insurance coverage rates will require policies that recognize the changing role of public insurance for working families as the cost of employer-based coverage grows.