Welcome back to the Weekly Muse – the latest trending healthcare stories and news articles from the last 7 days. Today’s edition covers the week of December 28, 2018. If you’re interested in getting these delivered straight to your inbox, go here. Happy New Year!
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5 Big Things
Referrals in the Spotlight
Although physicians aren’t technically told where they’re supposed to refer their patients for treatment, a recent study laid out the ways that certain health systems might pressure their employed physician groups into referring the groups’ patients to the hospital’s facilities rather than where the physician might think is best for that particular patient.
It’s a tricky issue. Obviously, the goal of healthcare should probably be to provide the highest quality of care in the least costly, and timeliest, way possible for the patient. But some factors, like hospital employment of physician groups, muddle the waters. Physicians want to be able to refer their patients wherever they desire, but the hospitals need a steady stream of referrals and subsequent volume to keep their lights on (especially since they probably paid a pretty penny for those physician practices). Since the physicians are paid by the hospital, they might ultimately feel a particular form of duty to their employer to refer patients to the hospital.
As hospitals and private equity groups continue to snatch up the highly fragmented physician practice industry, the cost of healthcare may continue to rise, as procedures are performed in higher cost settings on hospital campuses rather than physician offices. This trend may be something to keep an eye on in 2019, and may result in an even firmer push from CMS for site-neutral payments.
You probably had a better 2018 than these guys
A recent article highlighted the 10 worst performing healthcare services stocks of 2018, which gave a few interesting insights from some struggling industries. The Diagnostics and Dialysis industries topped the list for the worst sub-sectors to invest in 2018, as LabCorp and Quest expect softening demand in 2019, along with decreasing payments from Medicare over the same span. In fact, 23 of clinical labs’ top 25 tests will see reimbursement cuts of almost 10%. Yikes.
Not to be outdone, Dialysis is feeling the regulatory heat, as California tried to stuff a bill through its legislation that would cap dialysis payments. Luckily for them, the bill was vetoed. Needless to say though, this news, along with softening demand in the space, kept Dialysis company stock prices depressed during 2018.
Hospital Prices on Deck
Starting January 1, 2019, hospitals will be required to post the prices they charge for various procedures online in a ‘machine-readable’ format. Patients might not be able to glean too much information from the price postings right away, as they won’t necessarily be able to find out how much of a charge their insurance will cover, or what that contracted rate may be. Hospitals are preparing for the change in various ways, some even going above and beyond the required disclosures.
Still, despite somewhat of a mis-match, this regulation could be a significant step in the toward greater price transparency in the healthcare industry – something that many, including the current administration, have been calling for.
So Much for a Watchdog
So it turns out that hospital accreditation might not mean a whole lot after all. The Joint Commission, which is supposed to be a third party, independent accreditation agency for hospitals (basically, the peeps who tell you if the hospital is any good at caring for patients in a safe and sanitary environment), evidently isn’t doing a very good job. Two WSJ articles were published this week, covering hospitals that suffered instances of health violations, fines, and eventual LOSS of Medicare funding, which is a massive deal for any hospital.
But what remained constant throughout these trials and tribulations? Their full accreditation. Yup. These hospitals maintained their “Gold Seal of Approval” from the Joint Commission on their website despite rapes, suicides, and everything in between. Now, CMS is calling for a potential investigation into the Joint Commission, its relationships, and any potential conflicts of interest within the hospital industry and its $164-million-in-annual-revenue accrediting firm.
2018 in Review
As 2018 comes to a close, several news outlets covered their top stories from 2018, and included some potential trends to expect in 2019. I’ve listed a few of my favorites below:
Honorable Mentions
Our other favorite stories from the week
- John Stockman’s Medical Bills Topped $1 Million. What Happened?
- House Democrats Weigh Risks of Medicare for All Push in 2019
- Walgreens: Humana Senior Clinics May Be Primary Care ‘Template’ In Many Stores
- Special report: We’re safer 10 years after financial crisis
- What the Fall of the Roman Republic Can Teach Us About America
- Goodreads Best Books of 2018
- CVS Got Aetna. Next Up, Reimagining Health Care.
- Walmart’s Health Plan Is Way Ahead Of Amazon’s Buffett-JPMorgan Project
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