PS Last week was Patient Safety Awareness Week—regrettably the same week “probationary employees” in the Agency for Healthcare Research and Quality which analyzes safety programs the in hospitals, medical practices and post-acute facilities were fired.
Context: “In-hospital mortality rates increased overall during the COVID-19 pandemic, from 2.0% of discharges in 2019 to 3.1% in 2021.
AHRQ categorizes in-hospital mortality rates into hospitalization types: neonatal, mental health/substance use, injury, surgical, medical, and maternal (shown below), which are based on the principal diagnosis of the hospitalization stay. As in-hospital mortality rose for medical, surgical, and injury hospitalizations, neonatal rates remained steady in 2021 while mental health in-hospital mortality rates decreased slightly. It’s not clear to what extent the increase in in-hospital mortality rates represented a change in quality of care, or instead was a direct product COVID-19 illness and an indirect product of its strain on resources. “
It's a familiar theme these days in federal health agencies. DOGE pink slips have been handed out at the NIH, CMS, FDA, VA and more. As a recently fired CMMI employee observed: I grew up in a family that valued public service: my dad was a teacher. I never saw the government as a path to personal enrichment, but rather as a way to serve my fellow Americans. I think of the John F. Kennedy quote, "Ask not what your country can do for you, but what you can do for your country."
And yet, we've lost that idea over the past 60 years, and now seem to revere money and internet fame more than the consistent, middle-class work of giving back to your country through civil service. I'm confident that
the 6,700 people who run Medicare, Medicaid, CHIP, and the federal Affordable Care Act marketplace are motivated not by the promise of profits, but rather by the idea of serving their fellow Americans and making healthcare programs run better.
Beyond my personal disappointment and loss, I am deeply concerned about what this hollowing out of public servants means for the future of government programs like Medicare and Medicaid. Who will want to serve in these roles if they are continually vilified? Instead, the government will most likely shift more and more work to private contractors who will run programs like businesses -- serving those who can pay the most and neglecting rural areas, people with disabilities, low-income communities, and other vulnerable populations as they are not profitable markets...”
At Little-Known Health Agency, DOGE Ends Dream ‘To Make A Difference Forbes March 13, 2025
https://www.forbes.com/sites/michaelmillenson/2025/03/13/at-little-known-health-agency-doge-ends-dream-to-make-a-difference/
How has the quality of the U.S. healthcare system changed over time? Peterson/KFF Health System Tracker March 11, 2025
https://www.healthsystemtracker.org/chart-collection/how-has-the-quality-of-the-u-s-healthcare-system-changed-over-time/
My Firing Represents the Death of Public Service: Who will want to serve in these roles if they are continually vilified? Medpage March 7, 2025
https://www.medpagetoday.com/opinion/second-opinions/114537
Quotables
Andrews on hospital price transparency: “Price transparency, the most notable healthcare policy of the current White House administration, makes value for money a viable, and much more American, alternative to solve healthcare’s cost crisis. Before opening Pandora’s box with price controls, state legislators and policymakers might want to consider what they might unknowingly and unintentionally unleash.”
“No Good Deed Goes Unpunished, Healthcare Edition: Price Controls for Hospitals, the Only Health Economy Stakeholder with Unlimited Downside Risk” Hal Andrews, Trilliant Health March 16, 2025
rillianthealth.com/no-good-deed-goes-unpunished-part-1
Milbank on state actions to increase access to primary care: “More people in the United States are struggling to find appointments with a primary care doctor or clinic for checkups and sick visits. In fact, 30% of adults and more than 12% of children do not have a usual source of care, the highest rates in a decade. To address these primary care
workforce shortages and to help keep care more affordable, a growing number of states are engaged in efforts to strategically invest in primary care — a core component of a strong health system proven to keep populations healthier and promote more equitable access to care. Studies demonstrate that high-quality primary care leads to
better health outcomes and longer lifespans; it also is
more cost-effective.
But, while
more than 35% of health care visits nationally are to primary care physicians, only about
5% of health spending goes toward primary care services. Additionally, primary care spending has been falling since 2018 and is much lower than that seen in other developed nations, including many that
rank higher on health care outcomes than the United States…
Smart investments in primary care services, such as higher compensation for providers and steady prospective payments for primary care practices, could help attract and retain more primary care clinicians. So too could additional funding for nurse practitioners, physician assistants, and others delivering
team-based care, which may alleviate physician burnout and result in high-quality care for patients.
Nearly 20 states have initiatives related to primary care expenditure, ranging from multipayer collaboratives to define and measure primary care spending to specified spending targets.”
Five States Leading Efforts to Increase Primary Care Spending Millbank March 12, 2025
https://www.milbank.org/publication...ead-efforts-to-increase-primary-care-spending
AEI on distinctions between WEIRD and Non-WEIRD societies: “…work by
Joseph Henrich and others has shown that, while cognitive biases are universal, there are important differences, especially in relation to trust, between individuals in WEIRD (Western, educated, industrialized, rich, and democratic) and non-WEIRD countries. Henrich hypothesizes that for the WEIRD countries to become EIRD (the W being a catchall summarizing the combined effects and geography) they have had to develop institutions that enabled relative safety and security when engaging and trading with strangers. Whereas in the non-WEIRD countries, individuals place high trust in relationships with close contacts (friends, family, neighbors, proximate communities, etc.), WEIRD individuals place less emphasis on interpersonal trust and much more on the formal institutions that have evolved alongside (and enabled) growth in material prosperity. While it is impossible to assign causality in this coevolving environment, the apparently greater success in democratic countries in industrializing and educating their populations to create greater wealth demarcates both the countries and—by experimental demonstration—the cognitive psychological programming of their citizens.”
American Enterprise Institute “WEIRD Attitudes Toward Artificial Intelligence—And Its Regulation?” March 7, 2025
https://www.aei.org/technology-and-innovation/weird-attitudes-toward-artificial-intelligence-and-its-regulation
Prevalence of covid vs. drug addiction: “The 2020s have inarguably been Covid-19’s decade. Since the coronavirus outbreak was acknowledged as a
pandemic exactly five years ago, the pandemic has killed well over 1 million Americans, derailed the global economy, and sparked political upheaval that continues today. It also yielded what many hail as the greatest scientific accomplishment in human history: the development of effective vaccines in under a year.
Yet in dominating the early 2020s, Covid-19 also distracted from what is arguably a more significant public health emergency. Even at the height of the pandemic, more young Americans died of drug overdose than Covid. And in the last year, the overall death toll from the country’s drug crisis has exceeded the Covid-19 pandemic as the deadliest health event this generation…
Over 1.25 million people have died of non-alcohol drug overdose between 1999 and 2024, according to data from the Centers for Disease Control and Prevention, putting the crisis a tick ahead of overall U.S. deaths from Covid-19. With roughly 85,000 overdose deaths still occurring annually, the gap is sure to grow.
The $18 billion vaccine effort, known as Operation Warp Speed and executed in partnership with Pfizer, Moderna, Johnson & Johnson, and other drug companies, stands in stark contrast to the continued lack of funding for overdose prevention and new addiction treatment medications.”
Five years of Covid exacted a terrible toll. Another epidemic has claimed even more lives: ‘We lost sight of the fact that more young people were dying from drug overdoses than from Covid’ StatNews March 11, 2025
https://www.statnews.com/2025/03/11/covid-5-year-anniversary-compare-pandemic-response-to-opioid-overdose-epidemic
AEI on education system effectiveness: “By now, the awful results from the 2024 National Assessment of Educational Progress (NAEP)1 have been publicized, chewed over, and digested—and they are already moving into the rearview mirror as states, school districts, and teachers fall back into the comfortable routine of doing the same thing over and over again…Here are a few key takeaways from the 2024 NAEP results:
- We’re Not out of the Woods…The NAEP results make clear that American students have failed to bounce back despite the infusion of over $180 billion in federal money aimed at “rescuing” our education system from the pandemic’s worst effects.
- Reading Continues to Pose a Vexing Challenge. The continuing decline in fourth-grade reading proficiency is particularly concerning…. There is cause for optimism on this front, as more than 40 states have now passed “science of reading” laws mandating evidence-based, science-informed instruction. But it may take years for the effects of those laws to show up in NAEP results.
- There Is No Magic Bullet. States across the board showed declines in student performance. As such, there is little to no political valence to the results… Even in states with robust school choice programs, public schools continue to retain the vast majority of market share.
- We Don’t Know What Does and Doesn’t Work. Perhaps the most important takeaway is this: Our current approaches to education don’t appear to be working, and we don’t really know how to fix them…
Conclusion: The 2024 NAEP results reveal that we are not even close to recovering from the destructive forces COVID unleashed on our students. Despite students being back at school for two full years, test scores have continued to fall. While state leaders may be tempted to dismiss 2024 NAEP scores as an aberration, that would be a mistake. Instead, they should look long and hard at their schools’ performance and improve their practices.”
American Enterprise Institute “Many Children Left Behind: The 2024 National Assessment of Educational Progress Results Indicate a Five-Alarm Fire” March 2025
https://www.aei.org/wp-content/uploads/2025/03/RPT_Schneider-Many-Children-Left-Behind-31.pdf?x85095
Axios on Trump administration: “Five years after the coronavirus pandemic turned the world on its head,
Donald Trump is doing the same thing…. This time, it's on purpose. The lives of thousands —
possibly millions — are at stake. There's a massive geostrategic
reconfiguration, an unprecedented flood of government spending (
albeit in Germany) and, underneath it all, the hope and possibility that by burning everything down, something better will be able to grow in its place.”
The Second Great Disruption, Axios March 12, 2025
https://www.axios.com/newsletters/axios-markets-
Warren letter to CMS’ Director nominee Mehmet Oz: "You have deep ties to companies that could profit from your decisions at CMS. You also use your public platforms — including your website, TV show, TikTok, and Instagram pages — to promote drugs, such as Ozempic, produced by pharmaceutical companies that are currently seeking expanded CMS coverage approval and that are subject to government drug negotiations — which you would be responsible for conducting."
Sen. Elizabeth Warren (D-MA) letter to CMS nominee Mehmet Oz
New York Times on life expectancy for women: “Women outlive men, by something of a long shot: In the United States,
women have a life expectancy of about 80, compared to around 75 for men.
This holds true regardless of where women live, how much money they make and many other factors. It’s even
true for most other mammals…But the reasons women live longer are complicated and less established — and the fact that they are outliving men doesn’t necessarily mean they are
living better. Women tend to
have shorter health spans (the number of healthy years a person lives) than men, said Bérénice Benayoun, an associate professor at the U.S.C. Leonard Davis School of Gerontology. Women are generally
more physically frail than men in old age; they’re also more vulnerable, particularly after menopause, to developing cardiovascular issues and
Alzheimer’s disease, in part because age itself is a risk factor for those conditions, Dr. Benayoun said.”
Why Do Women Live Longer Than Men? NY Times February 25, 2025
https://www.nytimes.com/2025/02/25/well/longevity-women-versus-men
Barnes on PointClickCare information blocking court decision: “In a huge win for data analytics companies seeking access to patient records, a federal appeals court held that PointClickCare (“PCC”), a large electronic healthcare records company, cannot prevent Real Time Medical Systems, a small data analytics firm that helps skilled nursing facilities, from accessing patient records on PCC’s electronic healthcare records platform. In a 58-page ruling, the court
agreed with Real Time’s allegation that PCC was illegally blocking access to its platform. This case is a lesson in how
the information blocking rule works.”
Note: PointClickCare recently introduced a "Transitions of Care" solution aimed at helping Medicare Advantage plans improve care transitions and boost CMS Star Ratings, and has also been involved in legal disputes regarding alleged information blocking practices.
Julie Barnes Maverick Health Policy
www.maverickhealthpolicy.com
KennyCap on Jobs market: “The labor market is far from healthy- absurd that some folks are just now realizing that’s the case. Below are the reasons for unemployment as a share of the labor force, shown a couple of different ways. As a stacked bar chart, it is actually the unemployment rate (U3), which registered 4.5% not seasonally adjusted in Feb 25. Reentrants and permanent job losers account for the bulk of it and they are sending textbook recessionary signals.”
KennyCap on economic trends
https://kennycapphd.substack.com/
Corporate Announcements from Last Week
UnitedHealth Group: On March 8, UnitedHealthcare (UHC)
announced it would no longer require prior authorization for some home health services in 36 states representing a 10% cut to the company’s prior auth volume.
CVS introduces new retail model: CVS Health has opened 12 new stores with limited retail and full-service pharmacies, each occupying less than 5,000 square feet of space -- less than half the size of a traditional location. These smaller locations still offer over-the-counter medicines, but do not carry groceries, cosmetics, greeting cards, or other staples.
Noom, Hims & Hers: “As branded GLP-1 drugs fell into shortage over the last two years, hundreds of telehealth companies popped up to prescribe compounded copies. But as branded GLP-1 drugs come back into supply,
threatening the business of compounded copies, dozens of telehealth companies are now shifting to offer hormone replacement therapies.Noom, best known for its weight loss app and more recent GLP-1 offering, launched a hormone therapy program for menopause in late February, and telehealth company Hims & Hers plans to roll out at-home testing over the next year to enable care for low testosterone, perimenopause, and menopause.”
Telehealth companies pivot from GLP-1s to hormones
Hinge Health, Function Health: Hinge Health, a digital physical therapy startup, filed to go public on the New York Stock Exchange last week.
“The IPO will be the testing case for other digital health startups eyeing a public listing. Hinge Health is in a comparatively strong position, despite it running at a small net loss of $11.9 million. It brought in total revenue of $390 million in 2024, up 33% year-over-year, and recorded gross profits of $299.9 million.
VCs have pulled back heavily from investing in consumer-facing digital health companies since 2022, having been burnt by aggressive valuations and as digital ad spending cut into companies’ margins…However, newly buzzy upstarts like
Function Health have cut through the skepticism, potentially making room for a revival in the space.
Consumer fitness apps have had a particularly challenging few years, as consumers returned to in-person classes and gym sessions as fears of contracting Covid-19 faded away.
Peloton, for one, has laid off over 3,000 employees since 2022, and its stock price has fallen by more than 96% since its peak in December 2020.
Hinge Health’s largest shareholders are Insight Partners,
Atomico, 11.2 Capital,
Coatue Management and
Tiger Global. The latter two firms led its 2021 funding round at a $6.2 billion valuation.”
Insight-backed Hinge Health, a virtual physical therapist app, files for IPO March 10, 2025
Economy
Glassdoor index of workforce mood: Based on its monthly average of 50,000-60,000 employee ratings:
“Employee confidence — as measured by workers' confidence in their employer's business outlook — fell to a record low in February: from 47% in February 20 to peak of 56% in 2022 to 44% in February 2025. No sector saw a steeper drop than government and administration.
Confidence among those workers declined nearly 5% last month, as the Department of Government Efficiency has "thrown the future of the federal workforce into disarray," Glassdoor said in a release. The eroding confidence extends beyond DOGE anxiety: Employee confidence increased in fewer than half (10) of the 24 sectors tracked by Glassdoor in February, including health care, which has been responsible for a significant share of job gains in recent months.
Key consumer sentiment indicators:
- The New York Fed survey of consumer expectations showed respondents believe tougher economic conditions are ahead.
- The average respondent said there is nearly 40% chance the unemployment rate will be higher a year from now, an increase of more than 5 percentage points compared to January.
- The odds of missing a debt payment in the months ahead is the highest since April 2020.
Talk of layoffs across Glassdoor reviews is on the upswing. The share of reviews that mention "layoff" is up 5% from the same period a year ago. Callouts of inflation are down 13% from a year ago.
Glassdoor Index
www.glassdoor.com
BLS’ jobs report for 2024: The Bureau of Labor Statistics year-end adjusted healthcare employment report: Overall:
- Job Growth: The U.S. economy added an average of 186,000 jobs per month in 2024, which was lower than the 251,000 monthly average in 2023.
- Industry Highlights: Health care continued to be a strong contributor, adding an average of 57,000 jobs per month, consistent with 2023. Retail trade saw fluctuations, with notable gains in December 20241.
- Unemployment Rate: The unemployment rate in December 2024 was 4.1%, reflecting a slight increase compared to earlier months.
- Wage Growth: Average hourly earnings rose by 4% over the year, indicating steady wage growth.
Healthcare:
- With revisions, overall healthcare employment increased year-over-year by just under 680,000. But that's 19,100 fewer after revisions.
- Nursing and residential care facilities overall saw a year-over-year increase of 136,400 to 3.4 million, with revisions making up 34,300 of the increase.
- Ambulatory care services employment increased by 332,600 year-over-year, 46,900 fewer after revisions.
- Hospital employment increased 210,900 year-over-year, 6,500 fewer after revisions.
- Medical and diagnostic laboratories was the only healthcare sector that shed jobs in 2024, continuing a trend that started in 2022. After hitting 322,000 in June 2022, employment has shrunk by 16,300, with most of the losses coming in 2024.
US Bureau of Labor Statistics
www.bls.gov
Covid 19 impact on healthcare workforce: “The COVID-19 pandemic was declared a national emergency by the Trump administration on March 13, 2020, and shutdowns related to the public health emergency quickly meant the loss of almost 1.6 million healthcare jobs…
Healthcare employment fell 9.6% by April 2020, with ambulatory healthcare services — which includes offices of physicians, dentists and medical laboratories — experiencing the biggest percentage drop of 16.8%. Employment levels in some areas began to recover after a few months. It took 13 months for ambulatory health services jobs to reach the level they had been at in January 2020. Jobs losses at nursing homes and residential care facilities didn't hit a low until January 2022, and didn't get back to where they had been in January 2020 until the beginning of 2025.”
March 11, 2025
https://www.modernhealthcare.com/labor/covid-pandemic-healthcare-jobs
Deloitte Financial well-being index: March 2025 “The global financial well-being index decreased to 102.4 in February, down from 103.1 last month, and down from 103.0 a year ago 79% of US respondents are concerned about rising prices for everyday purchases, up from 73% six months ago (2/25). Non-discretionary categories were recategorized to include housing, transportation, groceries, and health care. -2% in March 2025.”
Consumer Signals Deloitte March
https://www2.deloitte.com/us/en/insights/industry/retail-distribution/consumer-behavior-trends-state-of-the-consumer-tracker.
Bureau of Labor: CPI report: Consumer prices were up 2.8% for February compared to a year earlier, just slightly beating economists’ predictions. The CPI increased 0.2% in February from January, less than consensus estimates of a 0.3% increase, and slowing from the prior month’s 0.5% gain. Annual headline and core inflation eased slightly to 2.8% and 3.1%, respectively, also slightly slower than projected.
Inflation slowed last month. That may not matter to the Fed Quartz March 11, 2025
https://qz.com/february-cpi-inflation-fed-interest-rates-trump-tariffs-
Altarum Health Sector Economic Indicators (HSEI): Highlights of year end 2024:
- Initial data for all of 2024 suggest that national health spending grew by 7.4% for the year, while personal health care spending grew by 7.9%. representing 18.1% of GDP.
- Personal health care spending growth in December was 7.1%, year over year, with utilization growth continuing to outpace price growth.
- In January 2025, the overall Health Care Price Index (HCPI) fell to 2.7% from the revised December 2024 year-over-year value of 3.0%.
- Among the major health care categories, prices for prescription drugs were the fastest-growing at 4.5%. This is a sharp increase from an average of 1.4% throughout 2024 and is the highest year-over-year increase since March of 2017. This was followed by hospitals (2.4%) and nursing home care (2.2%). Physician services was the slowest-growing at 1.6%.
- For major payers, year-over-year private insurance prices growth for services (3.7%) overtook Medicaid (2.3%). Medicare service prices increased 1.6%.
- The implicit measure of health care utilization growth was 4.1% year over year in December, down from the revised November value of 4.5%.
Altarum March 4, 2025
https://altarum.org/news-and-insights/february-2025-health-sector-economic-indicators-briefs
Hospitals
Urban Institute: Impact of Medicaid cuts: “Under the Affordable Care Act, Congress covers 90% of costs for states that expanded Medicaid. Researchers examined the effect of eliminating this financial support, also known as the enhanced Federal Medical Assistance Percentage (FMAP). Previous research has shown nearly 11 million people who benefited from changes in eligibility criteria would lose coverage.
If all states were to eliminate Medicaid expansion due to reduced federal funding, the U.S. would see a
$80 billion decrease in overall healthcare spending in 2026. Hospitals would bear the brunt of this loss, experiencing a $31.9 billion reduction in revenue and a $6.3 billion spike in uncompensated care costs, according to the report.”
Similarly, costs of uncompensated care, which are services that hospitals must provide under law but are not reimbursed by an insurer, would increase by nearly $19 billion. Hospitals would experience the largest loss in revenue in 2026 ($31.9 billion), as well as the largest increase in uncompensated care ($6.3 billion). Reductions in healthcare spending would vary widely by state. Eight states (Ariz., Ind., N.M., N.Y., N.C., N.D., Okla., Ore.) would see cuts in spending for healthcare services of more than 6%.
Researchers say the effects of reducing federal Medicaid support provided to expansion states by eliminating the enhanced match would be widespread, threatening state economies, healthcare providers’ finances, and people’s access to care.”
Uban Institute-RWF March 11, 2025
https://www.rwjf.org/en/insights/our-research/2025/03/hospital-revenue-losses-and-increased-uncompensated-care-if-medicaid-funding-is-cut.html
Kaufman Hall: Hospital M&A: “The number of announced hospital deals in 2024 involving facilities located in the South was nearly double the next-highest region… Of the 72 announced hospital merger and acquisition proposals, 27 were in the South, including Birmingham, Alabama-based UAB Health acquiring five Ascension St. Vincent hospitals in Alabama, compared with 14 in the Northeast.
Some investors, such as private equity firms that are the
target of several state merger review laws, focus their company portfolios on the Southeast, in part because those states don't have
corporate practice of medicine laws, she said. The laws prevent corporations from owning or controlling medical practices.
States in the West, Northeast and Midwest have introduced legislation this year to widen the scope of existing merger notification and review laws, potentially creating a bigger gap in oversight between the states that have those laws on the books and those that do not.
The laws, which vary by state, can require up to 180-day review periods, detailed requests regarding ownership structure and approval from attorneys general. Some states only require 30-day reviews and minimal, if any, transaction-related data.”
How hospital merger oversight is shifting deal-making March 12, 2025
https://www.modernhealthcare.com/providers/hospital-mergers-south-oversight
AHA-Press Ganey workforce survey: 2019 (pre-covid)-2024 trends: Key findings based on Press Ganey’s data from 2430 hospitals:
Patient safety: 2019-2024 Medical surgical, critical care: Negative/Positive
- catheter-associated urinary tract infection (CAUTI): 0.98 to 0.82 (+0.16), 0.94 to 0.66 (+0.28)
- central line associated bloodstream infection (CLABSI): 0.79 to 0.83 (-0.4), 0.82 to 0.81 (+0.01)
- patient falls that result in harm: 2.63 to 2.65 (-.02), 1.31 to 1.27 (+.04)
- the # of patients who develop hospital-acquired pressure injuries (HAPI/bed sores): 4.64 to 4.71 (-0.04), 1.38 to 1.57 (-0.21)
Patient experience: “Likelihood to recommend” 2019 to 2024: Negative/Positive
- Ambulatory surgery: 83.6 to 85.3 (+1.7)
- Medical practice: 82.2 to 84.7 (+2.5%)
- Inpatient: 72.3 to 69.3 (-3.0)
- Emergency department: 67.5 to 66.8 (-0.7)
Note: Inpatient and ED user experiences have declined while patient safety appears relatively stable: improvement in CAUTI is notable but decline in critical care HAPI problematic.
“
Improvement in Safety Culture Linked to Better Patient and Staff Outcomes,” March 2025
https://www.aha.org/guidesreports/2025-03-11-improvement-safety-culture-linked-better-patient-and-staff-outcomes
Wipfli Rural Health survey: “Wipfli’s national survey gathered information and insights from 75 leaders at rural healthcare organizations, the vast majority of which (84%) were critical access hospitals. The organizations in our sample were located throughout the Midwest, West and South, which closely resembles the geographical distribution of rural healthcare organizations throughout the United States.”
Key findings (PK note: this sampling methodology is not projectible to the entire population of rural health organizations)
- Financial stability vs. 1 year ago: Higher/Lower: 2024 38%/33% vs. 2025 45%/22%
- Financial stability vs. 3 years ago: Higher/Lower: 2024 43%/32% vs. 2025 58%/25%
- Workforce staffing stability: Better/Worse 2024:35%/23% vs. 2025 40%/15%
- 78% say are “not likely at all” to merge with another organization.
- 41% say said financial concerns/reimbursements are a significant challenge.
- 65% said cybersecurity is a top concern — up from about 50% in prior years.
- 81% have increased their investment in cybersecurity technologies in the past 12 months.
- 32% are using AI tools
“While the intensity has waxed and waned over time, concerns about staffing and reimbursements have consistently been top of mind among survey respondents over the last several years of our research. What’s new in this year’s data was a strong emphasis on cybersecurity, digital tools and AI.”
Wipfli, State of the rural healthcare industry 2025 research report, February 2025
Mayo clinic settlement re: charity care policies: Mayo Clinic settled a 2022 legal dispute with the Minnesota Attorney General's office about its charity care and debt collection practices. As part of the settlement, Mayo Clinic agreed to:
- Provide charity care to patients with incomes up to 200% of the federal poverty level and partial discounts for those up to 400%.
- Streamline the charity care application process to make it more accessible.
- Avoid suing patients for medical debt except in extraordinary circumstances.
The health system estimates its Minnesota locations have provided more than $600 million in financial assistance since 2019.
Minnesota Attorney General Ellison
www.ag.state.mn.us
Insurers
Health systems file suit against Blues: “Blue Cross Blue Shield (BCBS) agreed to pay $2.8 billion to settle a class action antitrust lawsuit brought by hospitals and healthcare providers who allege they were underpaid by BCBS. The $2.8 billion settlement includes both cash payments and new improvements to the BlueCard program overall. While agreeing to the settlement, Blue Cross denied any wrongdoing. The final hearing to approve the deal has been scheduled for late July before Chief Judge R. David Proctor of the U.S. District Court for the Northern District of Alabama.
Now, in a new twist, hundreds of hospitals and healthcare providers have not only rejected the deal but gone one step further by filing a new antitrust lawsuit. With this recent maneuver, doctors and hospitals have opened up a new battlefront in their legal war against BCBS.
In this latest move, the plaintiffs allege BCBS underpaid them by billions of dollars and charge the giant insurance companies with antitrust violations and collusion.
The new class action lawsuits rejecting the $2.8 billion settlement were filed in federal courts in three states: California, Illinois and Pennsylvania. The plaintiffs allege an illegal conspiracy among BCBS that violated federal antitrust law, resulting in higher insurance costs and lower reimbursements for patients.”
BLUE CROSS BLUE SHIELD FACES NEW LAWSUITS FROM HEALTHCARE PROVIDERS EVEN AFTER AGREEING TO $2.8 BILLION SETTLEMENT Law Commentary March 13, 2025
www.lawcommentary.com
Polling
eHealth: Attitudes about the health system: Results from eHealth’s
2025 Healthcare Pulse Survey of 1000 US adults conducted in February 2025:
- 72% give the US healthcare system a C grade or lower: (9% A, 19% B, 34% C, 21% D, 17% F)
- 57% say there's too much government regulation of healthcare (79% Republican v. 42% Democrats
- Blame for current state of US healthcare: insurance companies (66%), pharmaceutical companies/drug costs (60%), politicians (42%), 34% fraud, waste, and abuse (34%) and blamed providers (23%).
- 83% say they should be able to pick a health plan that excludes benefits they don't believe they'll use, if it will save them money
- 56% say that people who maintain an unhealthy lifestyle should pay more for their health insurance
eHealth. 2025 Healthcare Pulse Survey: eHealth Original Research March 2025. 2025.
https://news.ehealthinsurance.com/_ir/68/20251/Healthcare_Pulse_Survey_2025.pdf
Gallup: opinions about health status: “Americans' assessments of their mental and physical health are the least positive they have been in Gallup’s 24-year trend, reflecting a decadelong decline that began around 2013 and accelerated sharply with the onset of the COVID-19 pandemic in 2020.
Three in four U.S. adults in Gallup’s latest annual reading rate their mental health (75%) and, separately, their physical health (76%) as either “excellent” or “good.” This contrasts with a record-high 89% rating their mental health positively as recently as 2012, and a high of 82% for physical health in 2003.
As fewer Americans have rated their mental and physical health positively, most of the change has been in the percentages rating each aspect “excellent” -- shrinking to 31% for mental health and 24% for physical health.” Report highlights:
- Mental Health Ratings Sharply Lower Among Women 18 to 29: “The percentage of 18- to 29-year-olds reporting excellent mental health has dropped 27 points to 24%, and the percentage among 30- to 49-year-olds is down 16 points to 30%. This contrasts with single-digit declines among the older groups, those 50 to 64 (down six points to 37%) and those 65 and older (down four points to 40%). Reported mental health has worsened slightly more among women overall (down 15 points to 29%) than men (down 12 points to 37%)”
- Mental Health Struggles Also Tied to Other Demographic Subgroups: “Historically, White and Black adults, college graduates and middle- and upper-income Americans have reported better mental health than have their counterparts. But perhaps because they had more distance to fall, these groups show somewhat steeper declines than others over the past decade. Whereas nonreligious Americans were as likely as Protestants and Catholics (the two leading U.S. religious groups) to rate their mental health as excellent in 2010-2014, they have since become significantly less likely to do so. By contrast, Republicans have consistently been more likely than Democrats and independents to report excellent mental health, and that has remained the case as the rate of excellent mental health has declined by a similar degree among all three-party groups.
- Physical Health Ratings Differ by Gender and Age: Reports of physical health vary across gender/age groups, from a high of 38% of men aged 18 to 29 reporting they are in excellent physical health to a low of 18% among 65-year-old men. However, there is relatively little differentiation in the declines seen since 2010-2014, varying from a 10-point drop in excellent health ratings among young men between the two time periods to three-point drops among young women and 50- to 64-year-old men. Older women buck the pattern, with their reports of being in excellent physical health increasing slightly, from 17% to 21%. Longer term, since 2001-2004, reports of optimal physical health have declined slightly more among young men (-9 points), young women (-8) and women aged 30-49 (-7) than is seen among older adults in the two time periods, or in contrast to the improvement among senior women. Note: In Gallup’s December 6, 2024 poll about the health system, 54% said it has major problems, 16% said it is in a state of crisis, 25% say the system has minor problems, and 3% think it has no problems. “Americans’ rating of the quality of U.S. healthcare has fallen to the lowest reading in 24 years, and views of healthcare coverage nationally remain broadly negative. These views likely play into the belief that the U.S. healthcare system has major problems or is in a deep state of crisis. Cost is named as the most urgent healthcare problem in the country. Despite their widespread negativity when it comes to healthcare in the U.S., Americans largely rate their own healthcare positively.”
Pandemic's Effects Linger in Americans' Health Ratings March 13, 2025
www.gallup.com
Survey: Perception of food as medicine: “Poor nutrition in the US causes more than 600,000 deaths and an estimated $1.1 trillion in health care spending and lost productivity annually, as well as profound health disparities. Food Is Medicine interventions, which incorporate nutrition-related services in medical care as part of a care plan to prevent or treat disease, can advance nutrition security, health, and equity. But little is known about public awareness and perceptions of these interventions. We conducted the first national survey on knowledge, perceptions, and experiences around Food Is Medicine during February–April 2023. Fewer than half of respondents said that they received clear food- and nutrition-related advice from their primary health care providers, but a majority expressed interest in participating in Food Is Medicine interventions. More than two-thirds felt that Medicare and Medicaid should help pay for Food Is Medicine programs in health care, and more than half said that private insurance should do so. These results suggest a need for increased nutrition-related training of health care professionals, development of Food Is Medicine accreditation standards for health care organizations, and new regulatory incentives and contract requirements for Medicare Advantage and Medicaid managed care plans to encourage Food Is Medicine interventions in care delivery.”
“Food Is Medicine in the US: A National Survey of Public Perceptions of Care, Practices, And Policies March 12, 2025
https://doi.org/10.1377/hlthaff.2024.00585
Population Health
Axios on home ownership doom loop: “Rising prices, exacerbated by a shortage of affordable homes, put homeownership out of reach for many, driving them to a rental market that's also seen remarkable cost increases. It's a doom loop. A
shortage of affordable homes means that buyers compete fiercely for the cheapest ones, in turn pushing up prices.
Prices for the bottom third of homes are up 124% since 2015, while the top third increased 77%, per an analysis by Moody's Analytics.
The most desirable cities are becoming affordable only to the wealthy, while many of those of more modest means are forced into longer commutes, creating more traffic, more environmental strain, and greater social division… The paper endorses legislation set to be reintroduced this morning by Sen. Elizabeth Warren (D-Mass.), the top Democrat on the Senate Banking Committee. The American Housing and Economic Mobility Act of 2025 would provide more than $500 billion over the next decade to build more homes, funded by an increase in the estate tax. The money would be used to incentivize localities to cut regulations that impede building and would also go to first-time homebuyers. Congress has little appetite for spending on folks in need these days, as lawmakers ponder slashing Medicaid in order to extend the 2017 tax cuts. Affordable housing funding
appears to be stalled by the administration.”
“Elizabeth Warren Advocates for her Bill to Address the Nation’s Housing Shortage” March 12, 2025
www.forbes.com
Prescription Drugs
Study: potential savings under IRA: “The inflationary rebate provisions of the Inflation Reduction Act (IRA) of 2022 require pharmaceutical manufacturers to pay money back to Medicare if they raise prices faster than the rate of inflation. Opportunities now exist for Congress and the states to extend inflationary rebates to commercial plans. We demonstrate the potential savings from applying inflationary rebates to prescriptions filled in commercial plans by simulating savings under several policy design options. We estimate that a policy mimicking the IRA’s design could have saved as much as $8.1 billion in 2021 by imposing rebates on 1,100 drugs. To minimize the administrative burden of assessing inflationary rebates, Congress or states could restrict rebates to certain high-cost drugs and still garner substantial savings. For example, including only drugs costing more than $830 per month or ranked in the top 300 drugs by total spending could halve the number of rebate-eligible drugs yet capture 96 percent of estimated savings that could be available under a policy that mimics the IRA design ($7.7 billion). Restricting eligibility to the top 300 drugs by total spending could capture 85% of those potential savings ($6.9 billion), imposing rebates on just 194 drugs.”
Estimated Savings from Extending Prescription Drug Inflationary Rebates to All Commercial Plans Health Affairs March 2025
https://www.healthaffairs.org
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Regulation
This week, Senate committee hearings for Mehmet Oz (CMS) and Marty Makary (FDA) will continue with both expected to be confirmed. And comments by new HHS Secretary RFK Jr. about the efficacy of the measles vaccine will sustain attention to the outbreak in Texas. Other notable regulatory items…
Shorter ACA enrollment period proposed:
The Trump administration is proposing to limit the time frame for people to enroll in health insurance through Affordable Care Act exchanges potentially decreasing the number of people in these types of plans. The annual deadline for people to enroll in health insurance plans is currently Jan. 15, but the Trump administration is proposing regulations that would shorten the 2026 enrollment window by a month, to close on Dec. 15 instead. The Centers for Medicare and Medicaid Services, which oversees the insurance marketplaces, will also propose canceling a monthly opportunity for people with incomes below 150% of the federal poverty line to enroll.
DOGE: The
U.S. Department of Health and Human Services (HHS) has extended a $25,000 buyout offer to the majority of its 80,000 employees, aiming to reduce the federal workforce in line with
President Donald J. Trump’s budgetary directives. The buyout proposal was sent to a “broad population of HHS employees” via email. HHS agencies include the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). HHS, which operates with an annual budget of approximately $1.7 trillion, is responsible for overseeing major health care programs like
Medicare and Medicaid. The department’s workforce is integral to disease research, food safety inspections and the administration of public health services.
HHS:On March 3, HHS Secretary Robert F. Kennedy Jr.
filed a notice in the Federal Register to rescind its policy on Public Participation in Rule Making, also known as the Richardson Waiver (1971), and instead realign its procedures with the Administrative Procedure Act (APA) on “matters relating to agency management or personnel or to public property, loans, grants, benefits, or contracts” to public notice and comment periods.
FTC: President Trump's new FTC chair
Andrew Ferguson told a group of big business CEOs on Tuesday that he wouldn't let proposed deals "die on the vine," but warned them not expect automatic approval for big mergers. Last month, the FTC announced that it would keep the Biden
administration's merger guidelines in place, raising concerns in the business and banking community that Trump's White House might be more hostile to big mergers than they would have preferred.
CMMI: The
Centers for Medicare & Medicaid Services (CMS) Innovation Center is shutting down several Medicare alternative
payment models ahead of schedule — including two focused on primary care. The move, first reported by
Axios, is part of the agency’s efforts to align CMS’s portfolio with the goals of the “
Make America Healthy Again” movement. Among the programs being cut are Primary Care First (
PCF) and Making Care Primary (MCP) — both designed to test alternative payment structures for primary care providers. Other models facing early termination include the End-Stage Renal Disease Treatment Choices initiative and the Maryland Total Cost of Care model.
CMS estimates these changes will save taxpayers nearly $750 million by the time they conclude on December 31, 2025.
CMS to end key primary care payment models prematurely, citing cost and effectiveness
www.democracydocket.com
paulkeckley.com
Years ago, I taught an introductory class at Vanderbilt’s Owen Graduate School of Management to medical students also pursuing an MBA degree. Its intent was to equip future caregivers with the aptitude to lead healthcare organizations in the development of strategies for growth and innovation.
