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Hospitals Lost Jobs Last Month!

7/8/2013

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Picture
An old data series got new life, when the Brookings Institution issued a report that compared health care jobs growth versus all other industries.

It’s “a truly astonishing graph,” according to Derek Thompson at The Atlantic. “I knew health care had been the most important driver of national employment over the last few years, but I had never seen the case made so starkly.”

Thompson wasn’t alone in his surprise. (Hopefully, readers of The Health Care Blog would be less astonished.) But lost within the reaction—and even mostly overlooked within the industry—is that not all health care jobs are growing, or at least not growing at the same pace.

Take a look at the following chart. It resembles the Brookings data, with one major change: The hospital employment curve has been separated from all other health care jobs growth.

Notice how hospital employment essentially flatlined across 2009—a hard year for the sector, which was still insulated compared to the rest of the economy. But many organizations pared back on staff and sought to cut non-essential services to survive the Great Recession.

And while sector employment began to rebound in 2010, roughly in line with other industries, there’s been a surprising blip this year. Hospitals shed jobs in January, and according to the Bureau of Labor Statistics’ estimates, hospitals also lost nearly 6,000 jobs in May—on paper, the worst single month for the sector since February 2004.

It’s possible that when the new jobs report comes out on Friday, May’s number will be revised up. But the trend is unmistakable: Hospital job growth, which used to parallel the rest of the health care industry, is now following a slower curve.

Why the sector-wide slowdown? I spoke with several health economists and labor experts, and here are a few leading hypotheses.

Hypothesis: It’s because fewer people are seeking care in hospitals.

There’s increasing evidence that the long-anticipated care shift away from the inpatient setting and to less costly outpatient settings is finally underway.

For example, Martin Gaynor, an economist at Carnegie Mellon, cites the Health Care Cost Institute‘s recent study on how inpatient utilization is declining for the privately insured. And Fitch Ratings last week issued a report on the changing patterns in care delivery, ticking off the various reasons why hospital volumes are falling: patients paying for a greater share of their care, federal policies that reduce readmissions, and insurers incenting care in lower-cost settings, among other factors.

Hypothesis: Wary hospitals aren’t eager to hire.

Partly because of their weak volumes—and partly because of outstanding questions around the sequester, other potential reimbursement cuts, and broader economic concerns—the hospital labor market is basically in a “holding pattern,” according to John Workman, practice manager of the HR Investment Center and my colleague at the Advisory Board.

Workman points to his latest benchmarking data on hospital turnover and vacancy rates; while both indicators showed signs of a rebound through 2012, the rates have since been flat as hospital executives have held pat.

Hypothesis: It’s the effect of Obamacare.

The Affordable Care Act has added new financial pressures for hospitals, such as a push toward new payment models that don’t reward them for doing more procedures. But while this theory gets advanced when some hospitals announce major layoffs, the health law tends to be more convenient scapegoat than an actual culprit, economists agreed.

Hypothesis: It’s a result of the mega-mergers across the sector.

“There’s been a lot of consolidation in the health care industry,” says Amitabh Chandra, a health economist at Harvard University, with hospitals banding together to survive the Great Recession, or to maximize their power under the ACA. And that tends to lead to downsizing, as duplicate jobs get eliminated.

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New Year Wishes

12/31/2010

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When the clock strikes twelve on December 31st, people all over the world cheer and wish each other a very Happy New Year. For some, this event is no more than a change of a calendar. For others, the New Year symbolizes the beginning of a better tomorrow. So, if you look forward to a good year ahead, spread happiness with these wonderful New Year wishes.

Irish toast
In the New Year, may your right hand always be stretched out in friendship, never in want.

Minnie L. Haskins
And I said to the man who stood at the gate of the year: Give me a light that I may tread safely into the unknown. And he replied: Go out into the darkness and put your hand into the hand of God. That shall be to you better than light, and safer than a known way.

Movie: "When Harry Met Sally", Harry Burns
And I love that you are the last person I want to talk to before I go to sleep at night. And it's not because I'm lonely, and it's not because it's New Year's Eve. I came here tonight because when you realize you want to spend the rest of your life with somebody, you want the rest of your life to start as soon as possible.

Edith Lovejoy Pierce
We will open the book. Its pages are blank. We are going to put words on them ourselves. The book is called "Opportunity" and its first chapter is New Year's Day.

Charles Dickens
A merry Christmas to everybody! A happy New Year to the world!

Sydney Smith
Resolve to make at least one person happy every day, and then in ten years you may have made three thousand, six hundred and fifty persons happy, or brightened a small town by your contribution to the fund of general enjoyment.

Anonymous
Your Merry Christmas may depend on what others do for you. But your Happy New Year depends on what you do for others.

William Makepeace Thackeray
Certain corpuscles, denominated Christmas Books, with the ostensible intention of swelling the tide of exhilaration, or other expansive emotions, incident upon the exodus of the old and the inauguration of the New Year.

Aisha Elderwyn
Every new year people make resolutions to change aspects of themselves they believe are negative. A majority of people revert back to how they were before and feel like failures. This year I challenge you to a new resolution. I challenge you to just be yourself.

F. M. Knowles, A Cheerful Year Book
He who breaks a resolution is a weakling; He who makes one is a fool.

G. K. Chesterton
The object of a new year is not that we should have a new year. It is that we should have a new soul.

John Greenleaf Whittier
We meet today
To thank Thee for the era done,
And Thee for the opening one

T. S. Eliot
For last year's words belong to last year's language and next year's words await another voice. And to make an end is to make a beginning.

Emily Miller
Then sing, young hearts that are full of cheer,
With never a thought of sorrow;
The old goes out, but the glad young year
Comes merrily in tomorrow

Martin Luther
Glory to God in highest heaven,
Who unto man His Son hath given;
While angels sing with tender mirth,
A glad new year to all the earth

Walter Scott
Each age has deemed the new born year
The fittest time for festal cheer

Benjamin Franklin
Be always at war with your vices, at peace with your neighbors, and let each New Year find you a better man.

Edgar A. Guest
A happy New Year! Grant that I
May bring no tear to any eye
When this New Year in time shall end
Let it be said I've played the friend,
Have lived and loved and labored here,
And made of it a happy year.

William Arthur Ward
This bright new year is given me
To live each day with zest
To daily grow and try to be
My highest and my best!

Ella Wheeler Wilcox
What can be said in New Year rhymes,
That's not been said a thousand times?
The new years come, the old years go,
We know we dream, we dream we know.
We rise up laughing with the light,
We lie down weeping with the night.
We hug the world until it stings,
We curse it then and sigh for wings.
We live, we love, we woo, we wed,
We wreathe our prides, we sheet our dead.
We laugh, we weep, we hope, we fear,
And that's the burden of a year.

Charles Lamb
Of all sound of all bells, the most solemn and touching is the peal which rings out the Old Year.
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A Brief History Of The Thanksgiving Holiday

11/22/2010

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I want to personally take this opportunity to wish all of our current and future clients a very happy Thanksgiving holiday, and thought it appropriate to look back at its history.

Thanksgiving at Plymouth


In September 1620, a small ship called the Mayflower left Plymouth, England, carrying 102 passengers—an assortment of religious separatists seeking a new home where they could freely practice their faith and other individuals lured by the promise of prosperity and land ownership in the New World. After a treacherous and uncomfortable crossing that lasted 66 days, they dropped anchor near the tip of Cape Cod, far north of their intended destination at the mouth of the Hudson River. One month later, the Mayflower crossed Massachusetts Bay, where the Pilgrims, as they are now commonly known, began the work of establishing a village at Plymouth.

Throughout that first brutal winter, most of the colonists remained on board the ship, where they suffered from exposure, scurvy and outbreaks of contagious disease. Only half of the Mayflower’s original passengers and crew lived to see their first
New England spring. In March, the remaining settlers moved ashore, where they received an astonishing visit from an Abenaki Indian who greeted them in English. Several days later, he returned with another Native American, Squanto, a member of the Pawtuxet tribe who had been kidnapped by an English sea captain and sold into slavery before escaping to London and returning to his homeland on an exploratory expedition. Squanto taught the Pilgrims, weakened by malnutrition and illness, how to cultivate corn, extract sap from maple trees, catch fish in the rivers and avoid poisonous plants. He also helped the settlers forge an alliance with the Wampanoag, a local tribe, which would endure for more than 50 years and tragically remains one of the sole examples of harmony between European colonists and Native Americans.


In November 1621, after the Pilgrims’ first corn harvest proved successful, Governor William Bradford organized a celebratory feast and invited a group of the fledgling colony’s Native American allies, including the Wampanoag chief Massasoit. Now remembered as American’s “first Thanksgiving”—although the Pilgrims themselves may not have used the term at the time—the festival lasted for three days. While no record exists of the historic banquet’s exact menu, the Pilgrim chronicler Edward Winslow wrote in his journal that Governor Bradford sent four men on a “fowling” mission in preparation for the event, and that the Wampanoag guests arrived bearing five deer. Historians have suggested that many of the dishes were likely prepared using traditional Native American spices and cooking methods. Because the Pilgrims had no oven and the Mayflower’s sugar supply had dwindled by the fall of 1621, the meal did not feature pies, cakes or other desserts, which have become a hallmark of contemporary celebrations.

Thanksgiving Becomes an Official Holiday

Pilgrims held their second Thanksgiving celebration in 1623 to mark the end of a long drought that had threatened the year’s harvest and prompted Governor Bradford to call for a religious fast. Days of fasting and thanksgiving on an annual or occasional basis became common practice in other New England settlements as well. During the American Revolution, the Continental Congress designated one or more days of thanksgiving a year, and in 1789 George Washington issued the first Thanksgiving proclamation by the national government of the United States; in it, he called upon Americans to express their gratitude for the happy conclusion to the country’s war of independence and the successful ratification of the U.S. Constitution. His successors John Adams and James Madison also designated days of thanks during their presidencies.

In 1817,
New York became the first of several states to officially adopt an annual Thanksgiving holiday; each celebrated it on a different day, however, and the American South remained largely unfamiliar with the tradition. In 1827, the noted magazine editor and prolific writer Sarah Josepha Hale—author, among countless other things, of the nursery rhyme “Mary Had a Little Lamb”—launched a campaign to establish Thanksgiving as a national holiday. For 36 years, she published numerous editorials and sent scores of letters to governors, senators, presidents and other politicians. Abraham Lincoln finally heeded her request in 1863, at the height of the Civil War, in a proclamation entreating all Americans to ask God to “commend to his tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife” and to “heal the wounds of the nation.” He scheduled Thanksgiving for the final Thursday in November, and it was celebrated on that day every year until 1939, when Franklin D. Roosevelt moved the holiday up a week in an attempt to spur retail sales during the Great Depression. Roosevelt’s plan, known derisively as “Franksgiving,” was met with passionate opposition, and in 1941 the president reluctantly signed a bill making Thanksgiving the fourth Thursday in November.
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On Veterans Day, Saluting The Veterans’ Caregivers

11/11/2010

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United Health Foundation understands the value of America’s 62 million family caregivers of adults 18 years or older and the critical role they play in our health care system.

According to a recent national family caregiving study, 17 percent of caregivers of adults provide care for a veteran and 11 percent have served in the armed forces themselves. While there are many studies that have probed the needs of the veterans, the United Health Foundation in collaboration with the National Alliance for Caregiving has taken the first in-depth look at the family caregivers of our nation’s veterans.

The study, Caregivers of Veterans – Serving on the Homefront gives voice to caregivers who are caring for veterans across the age spectrum -- from combat eras dating from World War II to the more recent wars in Iraq and Afghanistan. While these caregivers face similar situations as national caregivers, including caring for someone with chronic illness or aging issues, they also have unique challenges such as dealing with physical disabilities and emotional and mental health issues. The study reveals how providing care affects caregivers’ lives, what organizations and information sources have been helpful to them, and what programs and services would support and assist them.

Key Findings from the study include:
  • Overwhelmingly, veterans’ caregivers are women (96 percent) - compared to national caregiving statistics overall which show 65 percent are women
  • Twice as many veterans’ caregivers (30 percent) said they have been caregiving for 10 or more years – compared to the national caregiving statistic where only 15 percent stated the same
  • Three times as many caregivers of veterans reported spending 40 hours a week or more providing care (43 percent) compared to the total number of caregivers nationally (13 percent)
  • Sixty-eight percent of veterans’ caregivers reported their situation as highly stressful compared to 31 percent of caregivers nationally who feel the same
  • 70 percent of caregivers reported that their veteran experiences depression or anxiety, and 60 percent report post traumatic stress disorder (PTSD), compared to only 28 percent of caregivers nationally whose care recipients suffer from mental or emotional health problems.
  • Of the 68 percent who were employed, almost half (47 percent) reported leaving work entirely or taking early retirement compared to national caregiver statistics who reported the same (9 percent)
  • As seen in other caregiving studies, caregivers feel their role is a labor of love; 94 percent of the veterans’ caregivers reported they are “proud to serve”
Note: *National caregiver statistical comparisons are from “Caregiving in the U.S.” (2009, NAC in collaboration with AARP) and they reflect the subset of caregivers who provide care to an adult age 18 or older.
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Study Shows Wide Gap Between Hospitals Nationwide

10/22/2010

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Patients at five-star rated hospitals had a 72 percent lower risk of dying when compared with patients at one-star-rated hospitals, according to a new independent study by healthcare ratings organization HealthGrades.

Experts say this is an enormous gap that has held steady over the past years even as overall mortality rates have improved.


The "Thirteenth Annual HealthGrades Hospital Quality in America" study analyzed objective mortality and complication rates at all of the nation's 5,000 nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services.


The study, the largest of its kind, identified national and state-level trends in hospital care quality and established quality ratings for each hospital, across 26 different procedures and diagnoses. The ratings are now online, allowing individuals to compare their local hospitals.


Looking at overall trends, the HealthGrades study found that hospital mortality rates, on average, have declined by 7.98 percent over the three-year period studied, from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, only two bucked the overall trend with increasing mortality rates – gastrointestinal surgeries and coronary intervention procedures.


As part of the study, HealthGrades rated individual hospitals with a one-star, three-star or five-star rating in each of 26 procedures and diagnoses, from bypass surgery to total knee replacements. A one-star rating means that the hospital performed below average, to a statistically significant degree, when compared with the other 5,000 hospitals. A three-star rating means the hospital's performance was average, and a five-star rating means the hospital outperformed the national average to a statistically significant degree.


Five-star rated hospitals had significantly lower risk-adjusted mortality across the three years studied. A typical patient would have a 72.47 percent lower risk of dying in a five-star rated hospital compared to a one-star rated hospital, and a 53.36 percent lower risk of dying by going to five-star rated hospital compared to the U.S. hospital average.


"We are encouraged by the steady improvement in mortality rates among America's hospitals, but there's an unacceptably wide gap that has persisted between the top-performing hospitals and all others in terms of patient outcomes," said Rick May, MD, an author of the study and a vice president with HealthGrades. "For hospital leaders as well as potential patients, it is essential that they understand – and act upon – these findings."


Key findings from the study include:

  • The nation's hospitals unadjusted mortality improved on average 7.98 percent from 2007 through 2009 across the 17 diagnoses and procedures studied.
  • All but two diagnoses and procedures saw reductions in the unadjusted mortality rates. Gastrointestinal surgeries and procedures and coronary interventional procedures were associated with an increase in unadjusted mortality of 8.76 percent and 9.26 percent respectively.
  • The highest unadjusted mortality rates are among sepsis, respiratory failure, and gastrointestinal surgeries and procedures (20.59 percent, 19.45 percent, 10.29 percent, respectively).
  • The most improvement in unadjusted mortality was seen in chronic obstructive pulmonary disease (18.73 percent), bowel obstruction (14.72percent), heart attack (13.68 percent), and stroke (13.50 percent).
  • If all hospitals performed at the level of a five-star rated hospital, 232,442 Medicare lives could potentially have been saved from 2007 through 2009.
  • Approximately 55.91 percent (129,949) of the potentially preventable deaths were associated with just four diagnoses: sepsis (48,809); pneumonia (29,017); respiratory failure (26,361); and heart failure (25,762).
  • On average, one in nine patients developed a hospital-acquired condition, across the nine procedures evaluated for in-hospital complications, from 2007 to 2009.
  • On average, a typical patient would have an 80.40 percent lower risk of developing one or more in-hospital complications by going to a five-star rated hospital compared to a one-star and a 63.64 percent lower risk of developing one or more in-hospital complications by going to a 5-star compared to the U.S. hospital average.
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Healthcare's Six Money-Wasting Problems

9/23/2010

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More than $1.2 trillion spent on healthcare each year is a waste of money. Members of the medical community identify the leading causes.

Down the drain: $1.2 trillion.

That's half of the $2.2 trillion the United States spends on healthcare each year, according to the most recent data from accounting firm PricewaterhouseCoopers' Health Research Institute.

What counts as waste? The report identified 16 different areas in which healthcare dollars are squandered. But in talking to doctors, nurses, hospital groups and patient advocacy groups, six areas totaling nearly $500 billion stood out as issues to be dealt with in the healthcare reform debate.

1. Too Many Tests

Doctors ordering tests or procedures not based on need but concern over liability or increasing their income is the biggest waste of health care dollars, costing the system at least $210 billion a year, according to the report. The problem is called "defensive medicine."

"Sometimes the motivation is to avoid malpractice suits, or to make more money because they are compensated more for doing more," said Dr. Arthur Garson, provost of the University of Virginia and former dean of its medical school. "Many are also convinced that doing more tests is the right thing to do."

"But any money that is spent on a patient that doesn't improve the outcome is a waste," said Garson.

Some conservatives have suggested that capping malpractice awards would help solve the problem.

President Obama doesn't agree; instead, his reform proposal encourages doctors to practice "evidence-based" guidelines as a way to scale back on unnecessary tests.

2. Those Annoying Claim Forms

Inefficient claims processing is the second-biggest area of wasteful expenditure, costing as much as $210 billion annually, the PricewaterhouseCoopers report said.

"We spend a lot of time and money trying to get paid by insurers," said Dr. Terry McGenney, a Kansas City, Mo.-based family physician.

"Every insurance company has its own forms," McGenney said. "Some practices spend 40% of their revenue filling out paperwork that has nothing to do with patient care. So much of this could be automated."

Dr. Jason Dees, a family doctor in a private practice based in New Albany, Miss., said his office often resubmits claims that have been "magically denied."

"That adds to our administrative fees, extends the payment cycle and hurts our cash flow," he said.

Dees also spends a lot of time getting "pre-certification" from insurers to approve higher-priced procedures such as MRIs. "We're already operating on paper-thin margins and this takes times away from our patients," he said.

Susan Pisano, spokeswoman for America's Health Insurance Plans, said "hundreds of billions" of dollars can be saved by standardizing procedures and using technology -- something the White House has mentioned as a key to health care reform.

"For that to happen, we need the technology," she said. "Doctors and hospitals must adopt the technology, and we have to develop rules for exchanging of information between doctors, hospitals and health plans."

Pisano said the industry is launching a pilot program later this year that will allow physicians to communicate with all health plans using a standardized process.

3. Using the ER as a Clinic

More insured and uninsured consumers are getting their primary care in emergency rooms, wasting $14 billion every year in health care spending.

"This is an inappropriate use of the ER," said Dee Swanson, president of the American Academy of Nurse Practitioners. "You don't go to the ER for strep throat."

Since emergency rooms are legally obligated to treat all patients, Swanson said providers ultimately find ways to pass on the cost for treating the uninsured to other patients, such as to those who pay out-of-pocket for their medical care.

Dees also took issue with consumers who don't get primary care for their diabetes or blood pressure on a timely basis, hence finding themselves in the ER.

"Going to the doctor for strep throat would cost $65-$70. In the ER, it's $600 to $800," he said.

The $787 billion stimulus bill signed passed by President Obama earlier this year includes allocates $1 billion for a wellness and prevention fund, including $300 million for immunizations and $650 million for prevention programs to combat the rapid growth in chronic diseases such as obesity and diabetes.

4. Medical "Oops"

Medical errors are costing the industry $17 billion a year in wasted expenses, something that makes patient advocacy groups irate.

"Do we have a good health IT system in place to prevent this?" asked Kim Bailey, senior health policy analyst with consumer advocacy group Families USA.

Bailey suggested that processes such as computerized order entry for drugs and use of electronic health records (EHR) could help ensure that patients get the correct dosage of medications in hospitals.

The stimulus bill calls for the government to take a leading role in developing standards by 2010 to facilitate the adoption of health information exchanges across the system, including patient electronic health records by 2014.

Obama has repeatedly said that the use of technology in the health sector will help boost savings, enhance the coordination of care and reduce medical errors and unnecessary procedures.

5. Going Back to the Hospital

Bailey suggested that processes such as computerized order entry for drugs and use of electronic health records (EHR) could help ensure that patients get the correct dosage of medications in hospitals. Discharging patients too soon is a "huge waste of money," said Swanson.

"This happens a lot with elderly patients who are discharged prematurely because of insurance, bed unavailability or ageism," she said.

Many times, patients also don't follow instructions for care after discharge. "So complications arise and they are readmitted in a week," Swanson said.

PricewaterhouseCoopers estimates the cost of preventable hospital readmissions at $25 billion annually.

Among the reform plans, one proposal being considered is for Medicare to potentially penalize hospitals who readmit patients within 30 days of discharge.

6. You Forgot to Wash Your Hands!

Those ubiquitous dispensers of hand sanitizer are in hospitals for a reason: PricewaterhouseCoopers estimates that about $3 billion is wasted every year as a result of infections acquired during hospital stays.

"The general belief is that hospitals are getting much better in managing this than they have in the past," said Richard Clarke, CEO of Healthcare Financial Management Association, whose members include hospitals and managed care organizations.

Something as simple as hand-washing often can reduce the problem.

"Sometimes doctors are the most difficult people to convince to do this," said Clarke. "The challenge here is that patients sometimes come in with infections which then spread in the hospital."

The stimulus bill signed by Obama earlier this year includes $50 million for reducing healthcare-associated infections.

Other areas of waste identified in the PricewaterhouseCoopers report included up to $493 billion related to risky behavior such as smoking, obesity and alcohol abuse, $21 billion in staffing turnover, $4 billion in prescriptions written on paper, and $1 billion in the over-prescribing of antibiotics. 
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