Uninsured Rise Could Hurt Non-Profit Hospitals

The recent growth in the number of uninsured Americans could be especially harmful to non-profit hospitals and health systems, according to S&P Global Ratings.

As reported by Healthcare Dive, S&P believes that because non-profit hospitals serve larger proportions of uninsured patients, they are more vulnerable to increases in the number of uninsured people.  Healthcare Dive also notes that

In particular, S&P warns of a credit negative for nonprofits as patients who started in a care plan with health insurance seek to continue treatment without it.  Many hospitals already are struggling as volumes and reimbursement decline and more care shifts to outpatient settings.

S&P anticipates higher levels of bad debt for hospitals in the near future.

Learn more about some of the challenges non-profit hospitals may soon face in this Healthcare Dive article.

 

ACA Has Increased Primary Care Utilization

A new study found that the increase in the number of insured Americans as a result of the Affordable Care Act has resulted in increased utilization of primary health care services.

According to a study by the National Bureau of Economic Research, primary care utilization rose 3.8 percent, mammograms 1.5 percent, HIV tests 2.1 percent, and flu shots 1.9 percent over a three-year period.  The study suggests that preventive care increased between 17 and 50 percent.

The study attributes all of the gains to improved access to private insurance and none to Medicaid expansion.

These results are based on self-reported information gathered from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.

Learn more about these and other study findings in the National Bureau of Economic Resarch report  “Effects of the Affordable Care Act on Health Behaviors after Three Years” or see this summary on the Healthcare Dive web site.

Senators Push IRS on Non-Profit Compliance

Two prominent senators have written to the Internal Revenue Service seeking information about what the agency is doing to ensure that non-profit hospitals comply with the requirements for providing sufficient community benefits to justify their tax-exempt status.

Senators Orrin Hatch (R-UT), chairman of the Senate Finance Committee, and Chuck Grassley (R-IA), a senior member of that committee, have asked the IRS to provide their committee with specific information about how the IRS evaluates non-profit hospitals’ Form 990 Schedule H; about guidance the IRS provides regarding how hospitals define their communities and their communities’ needs; about the performance and outcome of IRS reviews of individual non-profit hospitals’ compliance with legal tax-exemption requirements; and about the status of the IRS’s anticipated report to Congress on tax-exempt and public hospitals.

Go here to see the senators’ news release about their letter and the letter itself.

ED Myths Exposed

Hospital buildingThe uninsured do not use emergency rooms more than the insured.

And the expansion of health insurance coverage increases rather than decreases ER use.

So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.”  Find the study here.

AMA: Health Insurance Concentration in Urban Areas Threatens Competition

Too much market share by insurers in urban areas can inhibit competition, and according to the American Medical Association, there is too little competition among insurers in too many urban markets today.

According to a new AMA study,

  • 69 percent of 389 metropolitan statistical area-level markets are “highly concentrated”
  • in 89 percent of MSAs, at least one insurer issues at least 30 percent of commercial health insurance policies
  • in 43 percent of urban MSAs, a single insurer owns at least 50 percent of the market

In a statement accompanying release of the report, an AMA spokesperson explained that

After years of largely unchallenged consolidation in the health insurance industry, a few recent attempts to consolidate have received closer scrutiny in the past…Previous versions of the AMA study played a key role in efforts to block the proposed mega-mergers by helping federal and state antitrust regulators identify markets where those mergers would cause anti-competitive harm.

See a Healthcare Finance News report on the AMA study here and go here for a link to the AMA study itself, titled Competition in Health Insurance: A Comprehensive Study of U.S. Markets, 2017 Update.

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey.

The survey also found that:

  • More than half of the uninsured are insured through their employer.
  • Nearly one in four insured through their employer are underinsured.
  • More than one in four Medicaid recipients were underinsured.
  • Half of the underinsured report problems paying their medical bills.
  • Individuals with higher deductibles are more likely to report problems paying their medical bills.
  • More than 45 percent of the underinsured report skipping care they need because of cost.
  • Low-income people and those with chronic health problems are more likely to be underinsured.

Learn more about the survey’s findings, its implications, and possible means of addressing these problems in the Commonwealth Fund report How Well Does Insurance Coverage Protect Consumers from Health Care Costs?, which can be found here.

Helping With Homelessness Reduces ER Costs

Hospitals are finding that helping homeless, frequent emergency room visitors find housing can reduce their unreimbursed ER costs.

Throughout the country, hospitals are investing money – in some cases, millions of dollars – in housing programs for the homeless.  What they are finding when they do so is that the stability of reliable housing – coupled with supportive social services – appears to be reducing the frequency with which such individuals appear in their ERs.

Examples of such programs can be found in a number of urban areas:  Sacramento, Orlando, Portland, New York City, Los Angeles, and elsewhere.

Learn more about what hospitals are doing, why they are doing it, and what they think their efforts are accomplishing in this Kaiser Health News story.

 

 

 

 

NAUH Urges Senators to Oppose Graham-Cassidy Bill

NAUH has declared its opposition to the Graham-Cassidy proposal to partially repeal and replace the Affordable Care Act.

In a message to senators, NAUH stated that its opposition is based on the millions of people the bill would leave uninsured, its lack of federal protection for individuals with pre-existing medical conditions, its failure to repeal massive Affordable Care Act cuts in Medicare and Medicaid payments, and its proposal to reduce the limit the ability of states to levy provider taxes to finance some of their share of their Medicaid costs.

NAUH’s message to senators explained that the association

…welcomes proposals that would enhance access to care in an affordable and responsible manner but we do not believe this legislation offers such potential.

See the full text of NAUH’s message to senators here.

Overutilization of ERs May Not be as Great as Perceived

Far fewer hospital emergency room visits are for medical problems better addressed in other settings, according to a new study.

In a review of six years worth of data encompassing 424 million ER visits, researchers found that only 3.3 percent of those visits were truly “avoidable,” with the avoidable visits mostly involving problems ERs are not equipped to address, such as dental and mental health issues.

This finding flies in the face of the conventional wisdom that people turn too quickly to hospital ERs for routine medical problems or use ERs because they lack access to more appropriate care.

Learn more about the study and its findings in this Fierce Healthcare article or go here for a link to the study “Avoidable emergency department visits: a starting point,” which was published in the International Journal for Quality in Health Care.

 

Defining “Success” in Addressing Social Determinants of Health

With a growing number of programs designed to address the social determinants of individuals’ health care challenges, the question arises as to how to define “success” in those approaches.

A recent article on the Health Affairs Blog addresses this question by illustrating the many variables that go into determining what constitutes “success” and suggesting that success be viewed from a number of perspectives, including:

  • success for entire communities
  • success from the perspective of individual patients
  • success based on the effectiveness of addressing specific social needs (such as housing, transportation, or food security)

The article also describes the different ways that success can be defined and measured.

This is an especially important matter for urban safety-net hospitals because so many of these new programs will be launched in the generally low-income communities they serve.

Learn more by reading the article “Defining Success In Resolving Health-Related Social Needs,” which can be found here.