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For Profit Healthcare: Is It Healthy? What is the alternative?

For Profit Healthcare: Is It Healthy? What is the alternative?. Ed Weisbart, MD, CPE, FAAFP Physicians for a National Health Program Chair, MO Chapter. Medicare for All? What’s So Great About Medicare?. What’s So Great About Medicare?. You’re in control Much less waste Longer lives.

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For Profit Healthcare: Is It Healthy? What is the alternative?

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  1. For Profit Healthcare: Is It Healthy?What is the alternative? Ed Weisbart, MD, CPE, FAAFP Physicians for a National Health Program Chair, MO Chapter

  2. Medicare for All? What’s So Great About Medicare?

  3. What’s So Great About Medicare? You’re in control Much less waste Longer lives 52 years of successand American pride

  4. Medicare Means You’re in control • Physicians in practice in USA • Physicians opting out of Medicare • Medicare’s “directory” • 685,000 • 9,539 • 98% • of practicing physicians Go to any doctor or hospital Anywhere in the United States You’re back in control. 2013 data from Fiscal Times http://www.thefiscaltimes.com/Columns/2013/09/04/Are-Doctors-Really-Ditching-Medicare Accessed July 16, 2017

  5. Medicare Means Stop Wasting Our Money on Bureaucracy Insurance Overhead Q1 2016 Source: Day, Himmelstein, Broder, Woolhandler– Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q12016) Overhead = (Premium revenue – Medical Expenses) / Premium Revenues 2016 Medicare Trust Fund Report at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2017.pdf

  6. Medicare Means Healthier Americans We have the world’s best doctors, hospitals, nurses, etc. Medicare is a crown jewel of America. USA Rank Age 65 Women Men Institute of Medicine. Shorter Lives, Poorer Health. Fig 1-9: Ranking of US mortality rates by age group among 17 peer countries, 2006-2008. 2013 Peer nations are Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, Netherlands, United Kingdom Age

  7. “Medicare for All” Is Elegantly Simple “Single Payer” Improved Medicare for all Americans

  8. HR 676:Medicare for All Improve Medicare Expand Medicare • Fix the benefit gaps • Add coverage for dental, hearing, glasses, etc. • Eliminate financial barriers • No more deductibles, copays, etc. • Include every American, including Congress • Eliminates wasteful overhead • Creates the largest “risk pool” • Resists legislative damage Entirely eliminates any role or market for Medicare Advantage (“Part C”)

  9. Medicare for AllMakes Economic Sense 25 independent studies, at the state and federal level, confirm that the savings would fund full coverage. http://www.pnhp.org/facts/single-payer-system-cost Accessed 2/25/2017

  10. Medicare for AllMakes Economic Sense $ Billions Negotiated prices for drugs and devices Admin costs to providers (hospitals and physicians) Increased utilization (home health, dental, etc.) Covering the uninsured Health insurance admin Medicaid Rate Adjustment Gov. admin ($23B) New Costs New Savings Analysis of HR676 Friedman, G. Dollars & Sense. March/April 2012

  11. Proven strategy to control hospital costs: Global Budgeting from One Payer Maximizes Administrative Savings Reduces Disparities • Eliminates per-patient billing • Eliminates incentives for upcoding • Reduces internal cost accounting • Eliminates profitability of particular patients based on insurance • Eliminates profitability of specific services (e.g. psych vs. ortho)

  12. Source: Sanofi Hospital/Systems Digest, 2016 Independent Hospitals Are Disappearing System-Owned Proportion of Hospitals That Are System-Owned vs. Independent Independent

  13. Hospitals Are Gobbling Up Other Hospitals Number of Acquired Hospitals 16% of US hospitals have been acquired since 2008. https://www.managedcaremag.com/archives/2017/12/hospital-consolidation

  14. In healthcare business modelsConsolidation Has Become a Defining Factor Economies of Scale Increased Market Share Boost Clinical Standardization • Tighten operations • Streamline services • Stronger negotiating • Reduced cost of capital • Evidence-based care • Drive towards best practice “2.5% reduction in annual operating expenses per admission at acquired hospitals” - Report from the American Hospital Association http://www.healthleadersmedia.com/leadership/benefits-hospital-consolidation-detailed-aha-funded-report

  15. Self-Reported Improvements in Quality After Acquisitions % of survey respondents noting improvements Patient satisfaction as measured by HCAHPS Deloitte, “Hospital M&A: When Done Well, M&A Can Achieve Valuable Outcomes,” 2017

  16. Market Consolidation Increases Prices Price to Treat An Adult with Common Cold % of Community’s PCP Practices Owned by Hospitals http://petris.org/wp-content/uploads/2018/03/CA-Consolidation-Full-Report_03.26.18.pdf https://www.brookings.edu/testimonies/health-care-market-consolidations-impacts-on-costs-quality-and-access/

  17. Market Consolidation Increases Prices http://petris.org/wp-content/uploads/2018/03/CA-Consolidation-Full-Report_03.26.18.pdf https://www.brookings.edu/testimonies/health-care-market-consolidations-impacts-on-costs-quality-and-access/

  18. Market Consolidation Increases Prices The same patterns are found wherever you look. Breast, Cervical, and Colon Cancer Screening Sore Throat treatment Kidney Stone treatment Outpatient Orthopedics procedures Outpatient Cardiology procedures Knee Ligament injuries Hematology/Oncology procedures Fibroid surgery Wrist, hand, or ankle fracture/dislocation/sprain Coronary Artery Bypass surgery Partial Hip Replacements Premature babies http://petris.org/wp-content/uploads/2018/03/CA-Consolidation-Full-Report_03.26.18.pdf https://www.brookings.edu/testimonies/health-care-market-consolidations-impacts-on-costs-quality-and-access/

  19. Market Consolidation Increases Prices Larger hospitals can negotiate higher rates than small independent groups. How does this happen? “Must have” hospitals in a multi-market system = higher rates for system hospitals elsewhere. Anti-trust enforcement agencies look at markets separately. https://www.brookings.edu/wp-content/uploads/2016/07/Ginsburg-California-Senate-Health-Mar-16-1.pdf

  20. ”Investors making a profit from health care is contrary to the Gospel call to heal the sick… Catholic hospitals cannot be sold to for-profit companies.” Pope John Paul II Vatican statement on sale of St. Louis University Hospital to Tenet – Dec. 1997

  21. For-Profit Hospitals Cost 19% More Meta-analysis of 8 studies across 1,978 hospitals CMAJ 2002;166:1399; updated study in progress

  22. For-Profit Hospitals Death Rates Are 2% Higher Meta-analysis of 14 studies of 36 million patients CMAJ 2002;166:1399; updated study in progress

  23. For-Profit Hospitals Lack Translation Services Percent with Translation Services Health Affairs 2016;35:1399 Need defined by % of population in service area not English proficient: Low = <5%; moderate = 5-10%; high = >10%

  24. Lower Quality Hospitals More Likely to be For Profit Non-Profit / Gov For-Profit Health Affairs 2011;30:1904. Quality rating based on Medicare’s Hospital Compare data

  25. Tenet’s Track Record 1985-1993: Recurrent criminal activity (bribery, kickbacks, kidnapping) 1994-1995: Insurance fraud, kickbacks ($579M fines and settlements) 2002-2003: FBI raids Tenet hospitals re: unnecessary heart surgery ($449M settlement) 2006: Medicare outlier fraud, improper tax deductions ($1.2 B fines) 2015: DOJ investigating 56 Tenet hospitals for kickbacks and inappropriate defibrillator implants 2016: Kickbacks for Obstetric referrals ($516M fine) Tenet was formerly known as ”National Medical Enterprise” or “NME” Mod Hlthcr 3/29&4/26/85, 9/6/93, 7/4/94, 11/4/02, 1/16/06, 11/26/06, 5/18/15 USA Today 8/26/02; NYT 10/22/91, 7/31/94; 11/1/02; 6/30/06; Atlanta Bus Chronicle 8/1/16

  26. HCA’s 20th Century History Closed the only hospital in Destin FL Closed the only rehab unit in Austin TX Pressured physicians to admit insured pts Pressured physicians to exclude uninsured pts Widespread charges of inadequate nurse staffing Convicted of unfair labor practices Convicted of conspiracy to defraud business partners NYT 3/29, 5/11, &4/6/97; Jenks 9/24/97; Mod Hlthcr 6/29/93, 10/17/94, 10/30/95, 4/15/96; Columbus Dispatch 3/19/97; WSJ 7/29/97

  27. HCA’s 21st Century Practices Multiple settlements or judgments of fraud against government, insurers, patients, and investors. 2004: Record settlement for Medicare fraud: $1.7 billion 2015: “Routinely performed unnecessary cardiac procedures.” $215 million judgment. …Too many others to list https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.htm https://www.rgrdlaw.com/cases-schuh-v-hca-holdings-inc.html

  28. Are Hospital Acquisitions Good or Bad? Economies of Scale For Profits Pay Local Taxes May Fund Independent Foundations • Synergies • Higher rates • Reduced staffing and services • Rates drive premiums • Property tax • Sales tax • Ultimately derived from patient care • Transitions may fund a foundation • Local investments • Their functionality should not be a work-around but core to the national strategy.

  29. We Love Our Hospitals. Canadians Love Theirs Too. Toronto General Hospital University of Alberta Hospital McGill University Health Centre Alberta Children’s Hospital

  30. Physicians for National Health Program Membership open to everybody – not only to physicians! www.pnhp.org Facebook: DoctorsForSinglePayer Twitter: @pnhp

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