Healthcare Reform ERs in Trouble

February 14, 2023

Feb 14, 2023

Happy Valentine’s Day Healthcare Advocates

Since hearts are involved it’s a good day to check your blood pressure, go for a walk, and recover from all the snacks on Super Bowl Sunday.

I am so thankful for all of you and for the actions you take to move us towards a universal healthcare system. Some of the topics in work are:

The current state of healthcare providers and the potential impact of Universal Healthcare on them
How Universal Healthcare affects the insurance industry (it’s not what you think)
Rural healthcare challenges
Hospice Fraud revisited - this is worse than was reported

Please send topics to me via the chat button and I will research and report. If you need assistance in other ways, lectures, presentations, etc. Just let me know, I’m happy to help.

Current State - How are ERs doing?

Last week we discussed how private equity firms can manipulate healthcare providers and extract profits. Emergency rooms in hospitals are one of those functions that is frequently outsourced in a hospital to save money.

There is a trend in emergency medicine to replace doctors in emergency rooms with lesser trained staff including physician assistants and nurse practitioners. American Physician Partners, who runs numerous ERs in 17 states, is now employing fewer doctors as a cost saving measure to increase earnings. Here is a link to one of their presentations to lenders where they identify that as a strategy to increase profits.

National Public Radio and Kaiser Health News recently highlighted a story about a mom who was miscarrying her pregnancy and went to the ER and was not seen by a doctor. She was sent home. Day 2 the same. Day 3 She finally gets to see a doctor who determines she is in serious trouble. Not only days of pain and worry, but now the ER gets to bill her three times. I’ve had my own problems with PAs operating above their skill level delaying needed surgery for me by months because they did not have sufficient training.

Ok we can always find negative stories but is it really serious for most people? Here is a link to a working paper by David C. Chan Jr. and Yiqun Chen, October 2022, at the National Bureau of Economic Research. They compare the productivity of physicians to nurse practitioners at the VA. They analyzed 1.1 million visits to 44 VA ERs. They found that nurse practitioners were indeed more productive but with worse outcomes for patients. Visits to a nurse practitioner resulted in a 7% increase in cost of care with an 11% increase in the length of stay in the ER. Sadly, a full 20% of patients seen by a nurse practitioner were readmitted to the hospital for a preventable reason within 30 days.

Their paper is not an indictment of nurse practitioners but does highlight the need to employ nurse practitioners as support not replacements for doctors. Here is a link to the full research paper.

Saving money in the ER is tempting since according to the US government ER physicians earn about $310,000 and a physician assistant under $120,000. The ER can bill for the PA services at 85% of the physician. You can see that this situation is ready for exploitation.

Nearly $1 trillion has been invested in healthcare and medical firms in the last 10 years by private equity firms. They need to generate quick, sizable profits to keep investors. There are only three ways to do that

1) increase customers (hard to make people hurt or sick),
2) charge more,
3) spend less.

#2 and #3 are the favorites for private equity firms.

It’s clear that we have a problem. Doctors are discouraged and leaving the profession, private equity firms are scooping up the profits, and patients suffer.

That’s not how healthcare is supposed to work. I won’t pretend designing a healthcare system is a simple task or that it is enough to just say let the government be the insurance company. As you design the system all of these problems can be addressed.

It’s time we had an executive working group at the national level begin that design. Let’s tell them.

What You Can Do

You can cut and paste the text below into an email the president or use it in a phone call. (feel free to personalize it) or use RESISTBOT to send an email to President Biden.

RESISTBOT Text “SIGN PGWCGD” to 50409

We all deserve a healthcare system that works for all of us, patients and providers. Private equity firms are replacing doctors in ERs with mid-level practitioners to turn a quick buck at the cost of patient health. A recent National Bureau of Economic Research working paper, #30608, study of 1.1M visits to ERs demonstrates that care declines when there are fewer doctors in the ER. We can’t afford a system that sacrifices patients for money. We need universal healthcare and I want you to commission an executive committee to begin the design of that system now. Thank you.