💲Hopsital finances are stabilizing

Future MA plan market share, Telehealth prescribing extensions, UnitedHealth ratings drop, and more!

Author

Pulse Points
October 08, 2024

In this edition:

  • 💲Hopsital finances are stabilizing

  • 💊Many want telehealth prescribing extensions

  • ⭐️ UnitedHealth sues over rating drop

  • 👆 MA plans could reach 64% of market

  • And more!

Hospital finances are stabilizing

Hospital financial performance remains stable halfway through 2024, according to the latest "National Hospital Flash Report" from healthcare consulting firm Kaufman Hall.

The report analyzed actual and budget data from more than 1,300 hospitals.

Overall, Kaufman Hall determined a median monthly operating index of 3.8% in July 2024. The monthly operating index grew slightly from June's 3.3%, after falling from 4.3% in May.

Key indicators like outpatient revenue and average lengths of stay show continued improvement, with shorter stays also contributing to reduced expenses.

"The theme of 2024 has been stability," Erik Swanson, senior vice president of data analytics at Kaufman Hall, said in an email statement for RevCycleManagement. "We're seeing improvements across the board, especially in outpatient revenue and shorter average length of stay."

Many want telehealth prescribing extension

Following reports that the DEA plans to limit telehealth prescriptions for controlled substances, hundreds of healthcare stakeholders are urging lawmakers to intervene.

More than 330 organizations signed letters to both branches of Congress and the White House asking lawmakers to extend telehealth prescribing flexibilities for controlled substances that were enacted during the COVID-19 pandemic.

Prior to the pandemic, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 required healthcare practitioners to conduct in-person medical evaluations before prescribing controlled substances through telehealth.

This requirement was waived during the pandemic.

UnitedHealth sues over rating drop

Affiliates of one of the nation’s largest Medicare Advantage plans sued the Biden administration claiming that their quality rating was unreasonably downgraded after one customer service phone call.

The complaint filed Monday by subsidiaries of insurance giant UnitedHealth Group Inc. alleges the Centers for Medicare & Medicaid Services downgraded the company’s “Star Ratings” based on an “arbitrary and capricious assessment of how Plaintiffs’ call center handled a single phone call that lasted less than ten minutes.”

The plaintiffs asked the court to act urgently with an injunction to correct the CMS rating, as open enrollment is set to begin Oct. 15.

Whooping Cough cases up 5 times from last year

The US has recorded a minimum of 15,661 whooping cough cases this year, about five times higher than last year, bringing the country back to prepandemic levels, when more than 10,000 cases were recorded annually, according to the CDC. Mid-Atlantic states recorded the most cases by region, with nearly 4,000 cases, while Pennsylvania and New York had the highest number of cases among US states, with 2,087 and 1,781 cases, respectively

Emergency departments need to be better at handling kids

A study published in Health Affairs found that most US emergency departments are not highly prepared to treat children, as 80% of EDs are not at high pediatric readiness. Researchers noted that better pediatric preparedness may cut the mortality rate among young patients seeking emergency care by 42% and that maintaining high pediatric readiness for all EDs could save the lives of thousands of children each year for $244,000 per life. Read more

MA plans could reach 64% of market by 2033

Medicare Advantage makes up 54% of overall Medicare enrollment, with 64% penetration estimated by 2033. But will 10% growth over the next nine years be enough for today's market leaders?

Plan executives at Aetna, Centene and Humana have either already announced or anticipate MA market exits and/or membership declines for the upcoming enrollment year.

Meanwhile, significant growth continues in select markets and plan categories. In advance of AEP 2025, the Kaiser Family Foundation has published its August update of Medicare Advantage in 2024: Enrollment Update and Key Trends.

MA as a percentage of total enrollment eclipsed 50% in 2023 when its market share was 51%. This is up from just 19% in 2007. Since then, MA penetration has grown from 1-3% annually and was at its highest, 4%, from 2020 to 2021.