Mary O'Connor, MD Oly

Full Medicaid expansion needed to retain Georgia’s physicians Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia. It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse. Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million. These three states that refused to expand Medicaid are not surprisingly red. It is also unsurprising that the states with the greatest percentage of unhealthy residents are red. Hopefully, Georgia who thought they had a better way of expanding access to care with their own plan that squandered $26 million to cover 3,500 residents will realize that retaining physicians requires a more sensible approach to expanding access to care. #expandinghealthacess, #accesstocare, #limitingcoveragetoresidents https://lnkd.in/eefqH-9Y

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🤔 How do (US) hospitals spend money 101? Salaries, Wages, Benefits: 45-55% Professional Services: 12-22% Supplies: 12-18% Depreciation/Amortization: 3-6% Other Expenses: 5-20% 8 key insights: n°1. Hospitals consume 31% of US healthcare spending: Despite being the largest spending category, many hospitals struggle with low operating margins, often below 2%. n°2. Labor costs dominate hospital expenses: Salaries, wages, and benefits account for 45-55% of a hospital’s expenditures, with front-line staff making up 75-82% of the workforce. n°3. Contract labor adds significant costs: Hospitals often resort to staffing agencies due to labor shortages, paying 2-3 times more for contract workers compared to employed staff. n°4. Supplies account for 12-18% of expenses: This includes medical equipment, drugs, and personal protective equipment. n°5. For-profit vs. non-profit hospitals: For-profit hospitals tend to manage costs more efficiently, keeping salaries and expenses lower, but often at the expense of services like Medicaid or charity care. n°6. Economies of scale in larger health systems: Larger systems benefit from negotiating better prices for supplies and services. n°7. Rural hospitals face unique challenges: Limited access to talent and capital means rural hospitals must rely more heavily on expensive outsourced labor and struggle to offer high-margin services. n°8. Staffing shortages remain a key issue: Despite financial recovery post-COVID for many hospitals, staffing shortages continue, driving hospitals to explore different revenue models and operational changes to sustain profitability.​ Great post by the Out-Of-Pocket team Nikhil Krishnan & Ben Chao #healthcare

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For all the talk about value-based care, progress still is very slow. Advisory Board data shows the small amount of progress made from 2017 to 2022, which varies drastically by line of business. Medicare Advantage is the primary segment driving VBC, mainly due to aligned incentives where plans and providers could get paid more through upcoding (or "appropriate coding") of patients to drive more revenue & margin through the entire system. That drove penetration of VBC in MA, and CMS has paid attention, releasing significant headwinds (v28, RADV, Stars) aimed at reducing these perceived overpayments. In other segments, VBC has been very slow to grow. Commercial VBC arrangements were essentially stagnant. Anecdotally, this is starting to change. Plan sponsors (employers) -- especially large, sophisticated ones -- are demanding more from their carriers. They want to see network arrangements that impact quality & cost. Will that be enough to drive VBC activity in the commercial space? We'll see. Employers -- the customers -- will be the ones who will drive VBC forward here. TPAs alone don't have the incentive to make changes. I remain hopeful, but skeptical. #valuebasedcare #healthtech #digitalhealth

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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Bigger isn't always better in healthcare. Just look at the graphic below. Some of the largest health systems in the country are underperforming. They've entered (or operate in) bad markets, hold bloated cost structures, and struggle to hold leverage against payors. As it turns out, and as I'm often reminded, market performance matters. It doesn't matter that you're just big and can absorb a vast swath of overhead. As a health system, the way you throw your weight around in markets is more important than ever. This is the key concept of density and having the right assets in the right markets. CVS, HCA, Tenet, and others all have mentioned the importance of market density in 2024. Density - and being dense in attractive markets - is primarily what separates -3.9% from 10%+ operating margins. I should have paid attention in physics!! PS: if you like graphics and analysis like this, subscribe to my newsletter Hospitalogy here with 34k+ others: https://lnkd.in/gniNmHvz

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The healthcare system is at a breaking point. (Corporatization is eating it up) Corporate and government-led systems prioritize profits and bureaucracy over patient outcomes. And it leaves independent physicians struggling to maintain their autonomy. But physicians are not powerless. WE remain to be the bridge between patients and an increasingly convoluted system. It’s time to leverage that position and reclaim our role as patient advocates. 📌 Check out the 5 key strategies to strengthen independent practices and restore influence: 1) Shared Ownership of Vendors 2) Building Alliances for Strength in Numbers 3) Educating the Public 4) Innovating Through Independence 5) Claiming a Seat at the Table This isn’t just a fight for physician autonomy—it’s a fight for better healthcare for all. Where do you see healthcare going from this point? How do we fight corporatization? 🤔 #healthcare #corporatization #healthcaresystem #physicians #sharedownership #patientcare

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What does health insurance do? The conversation in the attached screenshot sums it up. We have a distorted market in healthcare. For drugs, there is a middleman called PBM between the insurance and the drug companies. The PBM negotiates a higher rate than the cash price - usually 2x or 3x and then receives an under the table rebate from the drug company. It passes of portion of this rebate to the insurer. The end effect is that the bottom price for the consumer is increased. The consumer believes that their insurance saved them a lot of money. #healthcare

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Here's what caught my eye in the Kidneyverse this month! 🤩 https://lnkd.in/exQUavXr Across the Kidneyverse is my monthly recap of top headlines, research, market insights, funding, and perspectives from the kidney community. This month we’re marking major milestones in xenotransplant, biopharma M&A, frictions from CKCC payment cuts, lessons from RPA, and a number of startup financings you should have on your radars. My goal in writing these monthly updates is leave you feeling more curious, optimistic, and knowledgeable about this space. If you find it helpful, please share it with your networks and let us know what you're following! But enough writing, more exploring... This month's Across the Kidneyverse features insights from: Mass General Brigham American Society of Nephrology Benjamin Hippen, MD, FASN, FAST Dr. George Hart Frank Maddux MD, FACP Paul D. Gordon Centers for Disease Control and Prevention Interwell Health Renal Physicians Association Vertex Pharmaceuticals Alpine Immune Sciences, Inc. Biolinq Reshma Kewalramani, MD FASN Mozarc Medical IKONA Health Lifeliqe World Health Organization International Society of Nephrology PitchBook Carta Silicon Valley Bank Centers for Medicare & Medicaid Services Healio Charlotte Dixon Liz F. The New York Times Uptal Patel Eric Topol, MD DaVita Kidney Care Blake Madden Ian Koons Yubin Park, PhD Signals From [Space] #healthtech #innovation #digitalhealth #valuebasedcare #kidneyverse *** What else should people know about? Let us know! 👇🏻

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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In this week's episode of What in the Hot Hell is Happening in Healthcare: Northwell is now an entertainment studio Ummmm, say what now? Let's check the financials: FY 2023 $16.9B revenue $198M op income $1.3B cash from ops Hope none of the $156M in CARES and FEMA funding are going to the studio Maybe just some of this? $11.8B total assets exl. PPE and op leases $6.2B unrestricted cash $7.5B current assets $7.2B net assets I don't know, could be some of this... $140M grants and contracts $35M rental income $31M GPO revenue Could be the $7.9M parking income New York parking is expensive after all Probably just using it's $422M endowment Definitely not using its $774M invested in hedge funds and private equity And definitely not taking away from the 19% increase in General and Admin salary (while health care services salary increased 7%) Glad to see tax dollars going to good use Northwell is tax-exempt after all And generates about 50% of it's revenue from Medicare and Medicaid Can't wait to see the movies they make It's going to be awesome P.S. If you liked this little breakdown, you'll love The Healthcare Breakdown, where we look at numbers and stuff so you can get an idea for what makes healthcare so bananas Check it out here: https://lnkd.in/gVRtQGZN See you out there!

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What I learned this week - we're off to see the wizard, the wonderful wizard of Oz and part of $1.5 trillion of acute care revenue w/us. HC is setting up to be a literal remake of one of the most iconic movies. Personally I can't get over the metaphorical similarlities between the healthcare industry in the movie. HC is a tornado, people continue to visit the Emerald City seeking the answer from the one behind the curtain, flying monkeys have taken a friend away w/witches galore (I've even had to melt one myself), so the question is, can we finally do what we know we need to do and go home (back to health)? Cast of characters - I'm super sad Casey Means, MD is missing from this list 👨‍⚕️ FDA picks up surgeon Marty Makary M.D., M.P.H. author of the hot book Blind Spots When Medicine Gets it Wrong - outspoken about food pyramid and chronic disease (YAY!) 👩‍⚕️ Dr. Janette Nesheiwat of Fox News for General Surgeon she supports vaccines and is medical director of CITYMD in NY/NJ 👨‍⚕️ CDC to get physician & former Rep. Dave Weldon looking to end the chronic disease epidemic (again music to my ears) 🧙‍♂️ Oz at Centers for Medicare & Medicaid Services. "America's Doctor", HC investor/entrepeneur/inventor (w/conflicts) criticized for weight loss drugs ($5.25M settlement). Vaccine stance - get them but question necessity and schedule w/spacing. Pushed "Medicare Advantage for All". But has he read the ACO REACH PA end to end? For those in despair, Andrey Ostrovsky, MD, FAAP pointed out agency career staff will hopefully fill the knowledge gap 🦁 RFK Jr - STAT by Rachel Cohrs Zhang (Deborah Williams) shared a possible proposal to upend how physicians are paid. Isn't that what we've been asking for? More facts and less fodder look to Andrew Schwab, Mike Lee & Melissa Newton Smith Emerald City or Witches & flying monkeys? 📱 Is EPIC's MyChart strategy leveraging dominance to drive a consumer platform akin to Apple? Seth Joseph Matthew Holt Brendan Keeler 🏥 General Catalyst ($8B of new capital raise last month, $750M HC), details of the HATCo- Summa Health acquisition- total cash outlay $1B >7 years incl $485M purchase & $200M earmarked for 'strategic and transformative investments and to drive innovation' Blake Madden Wizard's hot air balloon 💊 GLP-1s, Novo Nordisk, NYT Tomas Weber reported "Ozempic could crush the junk food industry. But It Is Fighting Back" citing "OzemPatients on GLP-1 drugs have reported losing interest in ultraprocessed foods". Should I predict now that next year the title will read "Ozempic is crushing the hospital industry. And it can't fight back"Lonnie Hirsch Ron Stout MD MPH. Meanwhile hims & hers announced a meal replacement weight-loss solution set addition. 💤 Sleep wearble ŌURA Tom Hale Dorothy Kilroy (she/her) secured $75M from Dexcom - hello lifestyle disease reversal Moral of the movie "we already have what we need” (food/lifestyle) 👩‍🌾 Support Jimmy Emmons for Secretary of Ag 👀Learn lifestyle med & #regenag

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Proof of Purpose; PDPs kept afloat Good for Manufacturers, too? The intricacies of IRA Part D benefit redesign dramatically reshape the OOP for millions of beneficiaries, reducing financial toxicity and raising utilization (I will post to past non adherence figures in comments) Unlike MA PDPs, freestanding PDPs can’t shuttle money over from the medical benefit to moderate premium increases, so some speculated that PDPs would fail. I commented several times that given this administrations view of the private market exemplified by MA that was highly unlikely. And after all PDPs are holding up half the benefit. CMS moves forward. “CMS is also announcing a voluntary demonstration program for standalone prescription drug plans (PDPs). The Part D Premium Stabilization Demonstration is designed to test whether additional policy changes stabilize year-over-year changes in premiums for participating standalone PDPs, leading to more predictable options for beneficiaries during the initial implementation of the IRA’s) benefit improvements, creating more gradual enrollment changes… Under the voluntary demonstration, there will be a reduction in the base beneficiary premium of $15 for all participating PDPs, combined with a year-over-year plan premium increase limit of $35 and narrowed risk corridors..” Thanks Tom Thoughts on implications, such as spillover from reducing headwinds, moderating adoption of narrower formularies and networks? If so possible plus for Phrma —not to mention if it slows down MA train with attendant Part B drug prior auths. #PartD #PDPs

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Alot of bad actors and a few good actors. $2.5T HC capital raised & $1T invested by PE in last decade. $31B in 2013 vs. $217B in 2021. We know the story. Misaligned incentives - unrealistic multiples, short-term profit focus, aggressive cost-cutting, unrealistic scaling, misunderstood market dynamics, just to name a few. However, our industry needs money. But our industry is more infrastructure asset class than tech start-up (James Nicholls gave me that epiphany). Mic drop on the lyrical genius of Alex Fair of MedStartr Ventures as he literally gives the whole story poetic justice as he reads HIS POEM on this "On The Road at VIVE" episode of The Reverse Mullet Healthcare Podcast w/BP2 Health. This is the perfect episode for a Friday afternoon! He and Paulo J Machado donned the actual reverse mullets and joined us back in February at #VIVE2024 to talk about the need for REAL change in healthcare, startup focus and investor expectations. It was one to remember and one that is in desperate need of a full-length follow-up episode. Give us a like and a watch or a listen https://lnkd.in/e4w4mjkv https://lnkd.in/egmK3kMB

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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For most Americans, an aspect of their lives designed to enhance their health — their health insurance — may be actively harming it instead. One physician recently published her opinion in The Hill, where she described the myriad of ways that private healthcare is leading to poor health outcomes for Americans. https://lnkd.in/ezbevQnC

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