By George W. Chapman
A recent survey by the American Medical Association (AMA) revealed 20% of physicians and 40% of nurses are inclined to retire or quit, earlier than planned, within two years. In addition to early retirement, about a third of these providers intend to decrease their hours until then in order to reduce stress, get their lives back and avoid potential infection or illness. Industry observers, the AMA and the ANA, are predicting new medical and nursing school graduates will not fill the near future deficit. The AMA estimates the annual impact of earlier retirement and reduced hours to be $4.6 billion. The No. 1 complaint after burnout among providers is feeling undervalued. While employers can adopt strategies to mitigate stress and burnout, both nurses and physicians cited the drastic increase in non-compliant, belligerent, demanding and abusive consumers, especially among the unvaccinated, as a major reason for feeling undervalued.
Perhaps in anticipation of negotiating prices with Medicare, drug manufacturers raised prices on 434 common drugs an average of 5.2%. Leading the way with higher than average increases were vaccine producers Pfizer, Moderna and BioNtech. Apparently, they really need the money. According to consumer advocate People’s Vaccine Alliance, based on financials released by these three drug manufacturers, collectively they will earn $34 billion in pretax profits. That comes to $65,000 profit a minute or $93 million a day. Nearly all (99%) of their vaccine supplies have been sold to wealthy countries, leaving the poorer countries to fend for themselves. Despite more than $8 billion in R&D funding from the US taxpayers, all three drug companies have outright refused to share their technology or know–how with struggling countries. The US has struck a “deal” to purchase 20 million doses of Pfizer’s anti-viral drug, Paxlovid, for more than $10 billion. The anti-viral pill and vaccines will result is sales between $50 billion and $60 billion.
No More Surprises
Effective January 2022, you will no longer be liable for what has been deemed “surprise medical bills.” These are bills from contract physician companies that are considered out of network by your insurance companies. These bills typically emanate from services provided to you via your local emergency room. Unsuspecting consumers, who correctly go to their in-network emergency department, unknowingly receive services from an out-of-network contract physician company. Sometimes, these bills come from the company that supplies the hospital with emergency room physicians. When it comes to out of network services, your insurance company will often pay you directly based upon what it would have paid an in-network physician. You then get the “surprise” bill from the out of network company leaving you to make up the difference between their bill and the check you received from your insurance company. It is often a difference of hundreds of dollars. In fairness to hospitals, especially rural and isolated ones, it is difficult if not impossible to attract and retain certain physicians, so they are forced to use outside contract groups. Contract groups will either have to accept in-network payments from local insurers or go to arbitration to settle with insurers. In any case, the consumer is now held harmless.
Total healthcare spending increased a staggering 9.7% in 2020. (It increased 4.3% in 2019. The jury and data are still out for 2021.) But that is misleading as most of the 9.7% increase was not due to claims. The majority of the increase was due to CMS providing needed financial support to hospitals, clinics, nursing homes, testing sites, physician practices and every state to weather the crisis. If this emergency funding for providers is excluded, the net increase in healthcare spending due to claims was about 2%. Compared to normal non-COVID-19 years, a 2% increase in costs due to claims is relatively low. That can be attributed to people still delaying care and hospitals having to cancel elective surgeries again. Consequently, because of profit limits established by the ACA, commercial insurers rebated over $2 billion to consumers via premium credits, check or debit cards in 2020. The rebate was $1.3 billion in 2019. The omicron variant is the monkey wrench making it difficult for industry analysts and actuaries to predict 2022 costs. Once again, as in 2020, hospitals and surgery centers are forced to cancel elective surgeries in reaction to the continuing pandemic and staffing shortages. A recent survey by the Kaiser Family Foundation revealed almost half of us did not bother to seek care due to household financial constraints and high out-of-pocket costs.
A federal circuit court will review a unique complaint, filed under the federal anti-terrorism act, against drug manufacturers Pfizer, AstraZeneca, J&J and Roche. The complaint, filed on behalf of the 395 Americans either killed or wounded in Iraq, alleges the pharmaceutical companies won contracts by bribing officials in the terrorist-controlled (Jaydsh al-Mahdi) Iraq health ministry. The funds were then used to finance attacks on Americans. The four companies have denied the charges.
In September 2020, the Criminal Division’s Health Care Fraud Unit organized and led a historic national takedown, in collaboration with USAOs, HHS-OIG, FBI, the Drug Enforcement Administration and other federal and state partners. Assistant Attorney General Brian Rabbitt announced this nationwide enforcement action, which involved 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals. These defendants were collectively charged with submitting more than $6 billion in allegedly false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to schemes that involved telemedicine fraud, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country. This enforcement initiative included cases charged during an unprecedented national health emergency.
Climate Change and Health
The healthcare industry knows that curing cancer and saving lives on one hand is all for naught if on the other hand carbon emissions are killing more than saved. Five percent of global carbon emissions are from healthcare. (That’s more than the aviation industry.) In the US, healthcare accounts for 10% of carbon emissions. For the first time, the 2021 U.N Climate Change Conference listed public health as a priority. The Health Care Without Harm advocacy group is lobbying Washington to establish an Office of Climate Change and Health Equity. HCWH president Gary Cohen succinctly summarizes their philosophy proclaiming “You can’t have healthy people on a sick planet.” The advocacy group has established a formal coalition of 600 hospitals to develop climate change solutions for the industry and the government.