Healthcare Golden Goose
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Happy Thursday Advocates
I would like to encourage comments and suggestions from you if you have time. If there is a special topic you’d like to see please let me know. Please use the comment button below. By the way lots of deep breaths help.
Private Equity and Healthcare
We have discussed how private equity and healthcare do not work well together. Investors make money and patients suffer with lower quality care.
Thanks to Judy for pointing me to a webinar hosted by Physicians for a National Health Plan that discusses the problem in detail. The title was “How Private equity Makes us Sicker” At this link you can find the webinar, transcript and slideshow package. I recommend it to you.
When private equity (PE) owners take hold of medical facilities, their goal is to make money. Remember, as my friend Barbara points out, private equity firms have not taken an oath to do no harm. They are there to make money.
In short, here is how it works:
PE creates a private investment fund and promises its investors ‘outsized returns’ -- that substantially ‘beat the stock market’
To provide ‘outsized returns,’ they buy up healthcare providers to extract wealth -- not to provide healthcare services
The techniques used are fairly standard
Load up the facility with debt,
Reduce the services offered
Monopolize a market when you can (we saw this with the FTC and ASAP anesthesia a couple of days ago)
Sell/leaseback properties at high rates - here this is a vertical integration technique whereby they sell the property to a company they own then lease it back from their own company at high rates
Force cost cutting to service the debt by short staffing & reduced supplies
Pay extra high dividends to investors
Keep the facility providing as much as possible to investors as quickly as possible
The goal is to exit the market in three to five years, selling the medical group to an even larger private equity firm at a huge profit.
So let’s look at an example in the nursing home industry. Mortality rates in PE-owned nursing homes were 10 % higher than the overall average. Medicare billing is 11% higher in such facilities. Frontline nurses spend fewer hours with patients. Bill more, cut expenses, make more money, more patients drop dead. What a concept!!
The latest tactic involves urging ER physicians to over-test and over-treat patients, prioritizing the priciest services. A recent study concluded that “high-intensity billing” for expensive emergency services has gone up 400% in the past 15 years. What a money maker!!
Another technique is to use physician assistants or nurse practitioner instead of doctors. You can charge 75% of what a doctor bills out for for a physician assistant and you can pay a physician assistant far less than what a doctor makes. This may work in some nominal primary situations but it is likely not ideal for the patient in complicated settings like an ER or when complicated issues present. Personally I found that it to waste a tremendous amount of time and require multiple office visits until I could get a physician to look at the data instead of a lower level practitioner without sufficient experience.
It is now wonder we spend 50% more than most of our peer industrialized countries. The system is being rigged to squeeze every dime out of it from patients and from insurance companies and the government.
Cancer Research
Recall that the Biden Administration took on the goal of cutting cancer deaths in half. The new biomedical research agency, the Advanced Research Projects Agency for Health, or ARPA-H, announced Tuesday that its first two hubs will land in the Dallas and Boston areas. The agency is using a “hub-and-spoke” model rather than centering all activity in one city. Part of the agency’s charter was that it would not be located in Washington, D.C., and members of Congress have spent years jockeying to bring the agency and subsequent STEM jobs to their districts.
Telehealth
According to Axios, Costco is joining big retailers' push into primary care by offering members $29 telehealth visits, as well as lab testing and virtual mental health services.
The big picture: It's part of a broad effort to use digital tools to create more customizable patient experiences that's also drawn the likes of Amazon, Walmart, CVS and Dollar General.
The retailers believe they're better positioned to tap into consumers' tastes — and frustrations with the traditional health system.
What's happening: Costco is teaming with the online platform Sesame to offer same-day $29 virtual primary care visits with no wait times.
A standard lab panel and consult will cost $72, while a virtual therapy visit will be $79. Costco members could start booking services on Monday in every state.
Sesame operates outside of insurance networks, catering to people with high-deductible plans who pay out of pocket for basic care and to the uninsured.
Bottom Line - probably suitable if you have no insurance or a high deductible/copay plan.
BTW $29.00 is the value of the primary care televisit - and they all make money on it. Keep that in mind.
Update on Healthcare Worker Safety - Not Good
Thanks to Irene fo sharing this from the Annals of Medicine and Surgery June 2022.
Another reason nurses leave the business is due to assaults on the job. "Although violence in the workplace affects almost all sectors and groups of workers, it is apparent that violence in healthcare settings provides a significant risk to public health and an occupational health issue of growing concern. The healthcare and social service industries have the greatest rates of workplace violence injuries, with workers in these industries being five times more likely to be injured than other workers. In addition, workplace violence in the health sector is estimated to account for about a quarter of all workplace violence . Workplace violence is constantly on the rise in the health industry due to rising workloads, demanding work pressures, excessive work stress, deteriorating interpersonal relationships, social uncertainty, and economic restraints."
A contributing situation is that patients and their families often feel that they have completely lost control of their bodies and the situation. The staff is overloaded and cannot respond as quickly to requests for help as expected, and people, when frustrated, act out and hurt others. Never an excuse, just an observation (from an insider).
Nursing Update
Thanks to Karen, a nursing professor who observes that Nursing diploma programs are being phased out, as the complexity of patient’s care require a more extensive grounding in the sciences. There are fewer than 100 left in the US, and most hiring agencies will require a commitment to completing a BS in Nursing within a certain block of time. https://www.nursingexplorer.com/diploma
A BS in Nursing is considered the ideal standard for nursing education, and has been encouraged for decades.
One of the infrastructure problem we have is that there are insufficient training opportunities.
ACTION
Let’s remind our senators to cosponsor S.2840 — 118th Congress (2023-2024) The Bipartisan Primary Care and Health Workforce Act. It provides for additional training for nurses to get 60,000 in place in the next few years!! Their contact info is here.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Plan
Reproductive Health
NARAL - Pro Choice America
Charley. NARAL’s abortion resource
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Alan,
There is another important contributor to violence in healthcare settings. MAGA Republicans have done everything they could during the pandemic to sow distrust in government mandates to wear masks and for healthcare workers and others to be vaccinated. Right wing social media platforms also promoted and even encouraged the dissemination of disinformation as clickbait and to indoctrinate people against trusting medical experts and the so-called “deep state” that is comprised of people with expertise who enforce public safety regulations.
So, for political gain, far too many people receive ongoing messaging to distrust the expertise of healthcare workers, even including physicians. And for those who struggle from paycheck to paycheck, too many consider physicians to be a blameworthy, moneyed elite instead of separating out bad actors and looking at the high cost of a profit-making healthcare “industry.“
I recently had a visit to the emergency department and I’m now OK. I was struck by a sign in treatment rooms warning. patients about a zero tolerance policy for violence and abuse. I asked the nurse about what it is like to work under these conditions. She said that she had not signed up for this but loves doing what she is good at doing.
This is a situation that we see too often. A system corrupted by those seeking political power, or to make unseemly profits from the suffering of others, have increasingly made healthcare settings places where it is harder for dedicated workers to do what they love, and for patients to receive life-saving services.