By George W. Chapman
Well, not really.
The administration has declared an end to the public health epidemic as of this May. The government is not saying the clinical pandemic is over, although it is on the decline. The declaration officially puts an end to the PHE originally declared by the previous administration in 2020 in response to COVID-19. The PHE has been extended several times since 2020. Among other things, it authorized expanded telehealth services and improved payment for providing services (paid same as in-person visit). The PHE also expanded Medicaid eligibility to cover more of the indigent. So, the end of the PHE in May will at least create confusion, if not chaos. States will be forced to reconsider and reconfigure Medicaid eligibility. Physicians and hospitals may lose improved payment for telehealth services. (As of this writing, Medicare is extending behavioral telehealth for seniors through 2024.) While PHE declarations only impact Medicare and Medicaid, commercial insurers typically follow suit. Late night TV comedians have tongue in cheek made light of “government declares pandemic over!” Funny, but not.
2022 Bad for Hospitals
Last year was the worst year for financially ravaged hospitals since the onslaught of the pandemic.
A study published by industry advisory group Kaufman Hall revealed the average hospital started off the year with operating margins hovering around minus 3.5%. Hospitals gradually dug their way out negative operating margins by December 2022, but about half of the nation’s 7,000 hospitals finished in the red for the year in total. Analysts predict some improvement or relief in 2023 due to better management of staffing issues, improvement in the supply chain, continuing leveraging of outpatient services, increased alliances or ventures with physicians and stronger commercial payer negotiations. Related to the bad year fiscally: 50% of hospital-based physicians and nurses reported job-related distress and 25% reported depression.
Private Equity in Rural Hospitals
Desperate for capital, rural hospitals are easy pickings for aggressive profit- at- all- costs private equity (PE) companies. They approach financially vulnerable hospitals with management and consulting contracts with no investment or assuming any risk. PE firms own or manage about 130 rural hospitals mostly in southern states like Texas, Kentucky and North Carolina. The purely for- profit firms typically strip out many needed services, close beds, slash staffing and all but eliminate charity care. They quickly turn around the profit and loss statement, grab their fees and get out. This has put additional pressure on surrounding urban and suburban facilities that end up providing the care discontinued at the rural hospital. Medicare, state Medicaid agencies and provider organizations are investigating the negative impact of PE on their rural providers.
Long COVID-19 Decreasing
good news is the number of individuals suffering with long COVID-19 declined from 19% in June of last year to 11% this year. In addition, 17% of those who had long COVID-19 no longer have symptoms. The Kaiser Family Foundation report was based on analyzing CDC data. The issue, however, remains a serious concern. The bad news is the best practices to treat long COVID-19 have yet to be finalized. There is no singular test to definitively determine if long COVID-19 is caused by covid alone. Post COVID-19 conditions are NOT due to just one illness. Your health history plays an important factor. It is estimated that 500,000 to 4 million individuals in the workforce have long COVID-19.
Behavioral Health Crisis Among Our Young
Behavioral healthcare has long been besieged by the opioid epidemic (suicides, addiction, depression). Then COVID-19 struck three years ago, further highlighting the shortcomings of our behavioral health system.
COVID-19 (along with social media) has had the most negative impact on our young. A survey of parents, conducted The Pew Research Center, revealed they now rank their children’s mental health status as a primary concern (anxiety, depression, suicide). The study also revealed what many employers are experiencing: the mental health of children directly impacts the well-being and productivity of their parents. All agree that government and commercial insurers must expand the access to, quality of, and affordability of behavioral health. Regulatory barriers must be removed, including anachronistic–redundant state licensing requirements that make it unnecessarily complicated for professionals to provide telehealth services across state lines. The nonprofit National Alliance of Healthcare Purchasers Coalition, which represents 12,000 employers and purchasers covering more than 45 million employees, is dedicated to promoting effective programs and strategies to improve our behavioral healthcare system for all and especially for the young.
CVS–Aetna Expand Mental Health
This alliance and similar commercial ventures and alliances, continue to distance themselves from traditional hospital and provider-based delivery systems by pioneering innovative, consume-friendly delivery systems. CVS–Aetna has been offering basic virtual and in person primary care services since May of 2022. Effective spring 2023, CVS–Aetna will be expanding telehealth behavioral health services to Aetna members, including appointments with licensed therapists and psychiatrists (MDs). Currently, the average appointment for a virtual, in person or at home primary care visit is out 24 days. The average appointment for an in person behavioral health service, before telehealth is introduced, is out 48 days. Time will tell how popular and effective these corporate healthcare delivery systems are.
US Healthcare Again Fares Poorly
The recent report from the Commonwealth Fund once again illustrates how poorly we are doing when compared to 37 other wealthy countries. Here are some of the low points. As of 2020, our average life expectancy was 77. The average life expectancy among our 37 counterparts was three years more at 80. We have the highest rate per 100,000 of avoidable deaths, infant and maternal deaths and gun related deaths. The latter being 7.4–100,000 versus 2.7–100,000 average in the other 37 countries. We spend, by far, more than any of our counterparts. The US spends close to 18% of its GDP on healthcare. That’s just over TWICE the average of the other 37 countries. The closest to our 18% of GDP were Germany at 13% and France at 12%. The major difference? Most of the 37 countries that clearly outperformed us in just about every category have single-payer healthcare systems.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.