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5 systems scramble to address nursing shortage


Here’s a look at how five hospital systems are recruiting and retaining nurses  to address the looming shortage in many places of registered nurses. Of course, nurses and other non-physician clinicians are taking on larger roles these days because of the financial incentives and punishments for healthcare institutions to move to  value-based population-health models and simply because nurses are paid less than physicians.

The flood of aging Baby Boomers is the major reason for the worry about a nurse shortage. Indeed, a surge of  retirements among Baby Boomer nurses will be part of the problem.

Among the incentives to get and keep nurses:  Bonuses and tuition reimbursement,  career-development opportunities and partnerships with educational institutions.

Marcia Faller, R.N., Ph.D., chief clinical officer at AMN Healthcare, said:  “{T]he harm to the healthcare industry  {of a nursing shortage} goes beyond the numbers. The loss of this intellectual asset may be acutely felt in terms of quality of care and patient satisfaction. To withstand this loss, healthcare providers need help in preparing for the nursing workforce of the future.”











Baby Boomers on Medicare: Living longer and sicker


For Kaiser Health News

After the last of the Baby Boomers become fully eligible for Medicare, the federal health program can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.

The typical Medicare beneficiary who is 65 or older then will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010, according to a report by the University for Southern California’s Schaeffer Center of Health Policy and Economics.

Adjusted for inflation, overall Medicare spending is projected to more than double between 2010 and 2030 to about $1.2 trillion. A massive influx of Baby Boomers into Medicare will be the main driver. With the last Baby Boomers turning 65 in 2029, Medicare rolls are expected to number 67 million Americans in 2030, the Schaeffer Center said.

But costs per beneficiary could grow by 50 percent over the same time due to longer life expectancies, shifting health trends and medical cost inflation, the report said. In inflation-adjusted dollars, Medicare is projected to spend 72 percent more for the remaining lifetime of a typical 65-year-old beneficiary in 2030 than a 65-year-old in 2010.

“It’d be one thing if there was an increase in life expectancy while maintaining health, but this is different. If you have more people that are disabled, it’s more costly, and we’re paying more because they’re living longer,” said lead researcher Dana Goldman at the University of Southern California.

“In some ways, we are victims of our success” in extending lives and preventing mortality, he said. “We’ve done such a good job of preventing cardiovascular disease that now we have more cancer and Alzheimer’s.”

The average life expectancy for 65-year-olds is projected to rise by almost a year from the 2010 norm, to 20.1 years in 2030. People with disabilities at 65 will extend their old ages, too – by more than a full year, to 8.6 years in 2030, the Schaeffer Center said.

Obesity is likely to surge, affecting 47 percent of Medicare elderly beneficiaries by 2030, up from 28 percent in 2010, according to the report.

“The people about to become eligible are more sick and obese [than past beneficiaries], even though there are treatments that will keep them living longer,” said Etienne Gaudette, a lead economist from the Schaeffer Center.

Significant increases in beneficiaries with these chronic conditions are also forecast by 2030:

  • Hypertension – 79 percent vs. 67 percent in 2010.
  • Heart disease – 43 percent vs. 36 percent.
  • Diabetes – 39 percent vs. 24 percent.
  • Three or more chronic conditions – 40 percent vs. 26 percent.

Smaller increases are forecast for elderly beneficiaries with cancer – 26 percent vs. 21 percent – and stroke – 19 percent vs. 14 percent in 2010. Lung disease is expected to see the slowest growth of all, about one percentage point to 16 percent.

That change is mostly due to Americans’ declining smoking habits. By 2030, 52 percent of Medicare’s beneficiaries will be lifelong non-smokers; only 43 percent were in 2010, the report said.

The Schaeffer Center’s report was published Nov. 28 in the Forum for Health Economics and Policy.

Hospitals on a hiring spree



To the surprises of many in the sector, hospitals and health systems are on something of a hiring spree, adding 15,900 in August, say preliminary figures from the Bureau of Labor Statistics. Indeed, the sector added more than 100,000 jobs in the first eight months of this year.

The additions to hospital payrolls this year has  been more than most other industry sectors.

What’s driving the hiring, of course, is increased admissions at many hospitals, particularly driven by the flood of aging Baby Boomers.


Research: Alzheimer’s far more a threat to women


Plaques  in the cerebral cortex of a person with Alzheimer’s disease.

Research presented Tuesday at the Alzheimer’s Association International heard about research that indicated women with mild memory impairment worsened about twice as fast as men.

The findings may be helpful to hospitals, clinicians and other parts of the healthcare system in planning for adequate resources for caring for people with Alzheimer’s — a population that will  surge in the next few years with the large cohort of aging Baby Boomers.

Nearly two-thirds of Americans with Alzheimer’s are women.

The Associated Press, which intensely covered the conference, reported that at age 65, “seemingly healthy women have about a 1 in 6 chance of developing Alzheimer’s during the rest of their lives, compared with a 1 in 11 chance for men. Scientists once thought the disparity was just because women tend to live longer — but there’s increasing agreement that something else makes women more vulnerable.”

“The men’s scores on an in-depth test of memory and thinking skills declined a point a year while the women’s scores dropped by two points a year.”

“Age, education levels and even whether people carried the ApoE-4 gene that increases the risk of late-in-life Alzheimer’s couldn’t account for the difference, said Duke medical student Katherine Lin, who co-authored a  study with Duke psychiatry professor Dr. P. Murali Doraiswamy. The study wasn’t large or long enough to tell if women were more at risk for progressing to full dementia,” the news service reported.

“Two other studies  offered additional hints of differences in women’s brains:

“A sample of 1,000 participants in the large Alzheimer’s Disease Neuroimaging Initiative compared PET scans to see how much of a sticky protein called beta-amyloid was building up in the brains of a variety of men and women, some healthy, some at risk and others with full-blown Alzheimer’s. Amyloid plaques are a hallmark of Alzheimer’s, and growing levels can help indicate who’s at risk before symptoms ever appear.

“’Overall, women have more amyloid than men,’ even among the cognitively normal group, said Dr. Michael Weiner of the University of California at San Francisco. The study couldn’t explain why, although it didn’t appear due to the risky ApoE-4 gene, which seemed to make a difference for men with Alzheimer’s but not women.”

Further, the AP reported, “Some seniors who undergo surgery with general anesthesia suffer lasting cognitive problems afterward, often expressed to doctors as, ‘Grandma was never the same after that operation.’ Tuesday, researchers reported that here again, women are at higher risk of getting worse.”



The 3 big reasons for insurers’ merger mania


Wendell Potter, a former executive of Cigna, the huge health insurer, writes that there are three main reasons f0r the wave of health-insurance mergers and none of them are the Affordable Care Act.

Writing on the Center for Public Integrity’s Web site, he says the three reasons are:

Size has long mattered: There’s 20 years of plenty of history of provider and insurance mergers that help explain the new ones.

Changing demographics: The swelling cohort of the Baby Boomers.

A shrinking employer-based health insurance market: “Although the vast majority of Americans with private health insurance get their coverage through the workplace, employers no longer present insurers with growth opportunities.”

But, Mr. Potter says,  “Obamacare appears to have halted this erosion {of employer-sponsored plans}. Membership in employer-sponsored plans has remained stable over the past couple of years, according to the Urban Institute researchers.”

He concludes:

“So the next time you hear a politician or pundit claim that Obamacare is to blame for the dwindling number of big for-profit insurers, know that they either don’t know what they’re talking about or they’re trying to mislead you. More than likely it’s some of both.”

Patient satisfaction drops, use rises




A new report from the American Consumer Satisfaction Index (ACSI) finds that overall patient satisfaction has dropped.

The ACSI uses data culled from the more than 70,000 consumer interviews it conducts annually to score industries on a scale of 0 to 100. The healthcare sector overall had a 75.1 in 2015, down  3.2 points from its 2014 score, which means that patient satisfaction is at its “lowest level in nearly a decade,” according to the report.

But while customer satisfaction may be down, demand for healthcare services is  up. Preliminary figures suggest that household healthcare spending rose nearly 6 percent in 2014, which would be the largest increase since the start of the 2008-2009 recession, the report states.

The influx of patients newly insured under the Affordable Care Act and the flood of aging and sickening Baby Boomers probably explain most of the increase.


HCA news may presage good year for hospitals


That  the  huge  national hospital operator HCA has raised its earnings guidance for the fourth consecutive quarter suggests that the sector as a whole will have a very good year as demand  for hospital care  surges with aging Baby Boomers and insurance expansion under the Affordable Care Act.

Of course, everyone wonders what will happen if the U.S. Supreme Court whacks the ACA in a June ruling. Will the outlook for hospitals then rapidly darken?


A series on Medicare at 50



President Johnson signs Medicare into law in 1965, with former President Harry Truman, 81, the first Medicare card holder, looking on.  Mr. Truman had long pushed for national health insurance.

As we approach the 50th anniversary of Medicare, MedPage Today starts a fascinating series looking at the achievements and problems — especially its spiraling costs — of the program.

Some of us at Cambridge Management Group well remember how the American Medical Association tried to stop the program from becoming law in the ’60s, asserting that it was “socialized medicine.”

It wasn’t but it did make many doctors and hospitals rich. Only in recent years have its reimbursements lagged physicians’ costs (and/or their financial expectations), leading to  major initiatives  aimed at bringing  its many wasteful aspects under control before it bankrupts America.

Meanwhile, even  many of the most ardent Tea Party conservatives like to talk about how evil would be cuts in Medicare benefits. But then, many Tea Party people are over or approaching Medicare age.

The original idea for Medicare goes back at least to Theodore Roosevelt in the sense of a national insurance plan. But Republican opposition has prevented a real universal, single-payer plan from being implemented.

Since the elderly vote in high numbers and because  age-related illnesses make it very difficult for most to get private insurance, they got what liberals  have wanted for the whole population. Politicians have generally worried more about old voters than, say, kids.

It will continue to be politically impossible to kill Medicare. Like Social Security, it’s too much a part of American life. But the flood of aging Baby Boomers and other factors ensure that it will continue to undergo change, some of them  wrenching.

Advice from a hospital’s young CEO



Hospitals & Health Networks notes that Baby Boomers are retiring in ever larger numbers and so hospitals must consider the need to bring along such youngsters in the C-suite as  Nicholas Tejeda, 35, the chief executive of Tenet’s Doctors Hospital in Manteca, Calif.

He says that hospitals should keep  young workers in the know about leadership opportunities, and everyone aware of  the need to seek out talents that the  current administration, led by older people,  may lack. And he discusses in a Q&A how to get along with a staff many of whose older members might be dismissive of a young leader.

He ranks among his biggest successes so far readmission rates that have dropped to 35 percent from as low as 12 percent and a 30 percent rise in outpatient surgery over the past few years driven by new service lines.

Tejeda  told H&HN that youthful hospital execs should play into the stereotype that they’ll be energetic and enthusiastic.

“That’s one of the preconceptions that should be taken advantage of. Allow yourself to be dynamic. Allow yourself to have that energy and enthusiasm. People will feel it. They will want it. People who have been at the hospital for a long time have wonderful ideas that need to be implemented, but they haven’t had that spark. They haven’t had someone who is the impetus to get things done. If they see that you have that energy, they will latch on and together you can accomplish wonderful things.”


Physicians’ new world of high deductibles


The new world of high deductibles to be paid by patients means that physicians must change their billing and communication practices, says this Medical Economics article.

“Operating successfully within this framework requires greater awareness of differences among insurance policies and discussions of treatment options that are sensitive to patients’ out-of-pocket expenses.”

“Doctors need to understand the landscape has changed. A doctor’s primary concern used to be whether a patient had insurance. Now, it’s the type of insurance,” Devon M. Herrick, Ph.D., a senior fellow at the National Center for Policy Analysis, told Medical Economics.

As for patients, they are already showing a disinclination to have as many healthcare-system interactions as they used to  now that the per-visit and per-procedure costs are becoming far less opaque and thus much more daunting.

This, understandably, scares many clinicians fearful of lower income.

Still, the “Silver Tsunami” of aging and thus ailing Baby Boomers probably ensures that business will remain generally good and that U.S. clinicians will remain by far the highest paid in the world.

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