By George W. Chapman
CMS has released its 2017 star ratings for US hospitals. CMS is constantly tweaking the rankings to make them more meaningful for both hospitals and consumers. More than 3,700 hospitals were ranked from one star to five stars. The rankings break down as: one star, 7 percent; two stars, 21 percent; three stars, 32 percent; four stars, 31 percent; and 5 stars, 9 percent. The number of five-star hospitals tripled to 337 from just 102 in 2016. You can get the star rating for any hospital at www.medicare.gov/hospitalcompare. Enter either the zip code or name of the hospital.
ACA Individual Mandate
The Affordable Care Act has not been “repealed” with the recent removal of the individual mandate requiring all citizens to have health insurance or else pay a penalty. The individual mandate made insurance premiums more affordable for all ages by including younger and healthier people in the risk pool. With the termination of the individual mandate, many younger and/or healthier people will stop buying insurance, thereby leaving the risk pool with a higher mix of older and/or less healthy members. All insurance premiums, not just those sold on the exchange, will be negatively impacted. The Congressional Budget Office estimates that the removal of the individual mandate will: increase the uninsured by 13 million, increase premiums by at least 10 percent and reduce the federal deficit by $338 billion over the next 10 years. (The deficit decreases because the government will be subsidizing fewer premiums.) Despite the removal of the individual mandate, at the last count, 8.8 million people enrolled for insurance on the federal exchange, down slightly (4 percent) from 9.2 million at the end of 2016. The number of additional people insured by the ACA through expanded Medicaid is around 15 million.
For the first time in history, the number of women entering medical school has exceeded the number of men. According to the Association of American Medical Colleges or AAMC, 51 percent of incoming students are women, which is a culmination of the slight trend over the past few years. This class of medical students is also more diverse: 13 percent African American, 15 percent Latino. However, despite these encouraging numbers, the number of overall applicants to medical schools was the lowest in 15 years fueling the concern about a physician shortage. The AAMC continues to lobby congress to authorize Medicare to pay for more residency slots. Congress has not increased the number of US residency slots since the mid-’90s.
Millennial Point of View
Currently, there is an equal number of millennials and baby boomers. At 75 million people apiece, they are the two largest segments of the US population. This is significant for both political and economic reasons. The highest uninsured rate is in the 26 to 34 age cohort. (Parents can cover their children up to 26.) This uninsured rate is sure to increase with the removal of the individual mandate. One can’t blame millennials for going without insurance. The world today is far different for millennials than it was “back in the day” for boomers. In 1980, when boomers were still young, 80 percent of insurance was paid by employers. Today, employers pick up an average 50 percent of the premium. Consequently, a lot of millennials can’t afford insurance, let alone the high deductibles and copays that are part of today’s insurance policies. Many figure the deductibles (out of pocket) attached to today’s premiums are so high, insurance won’t even kick in. Millennials are just one catastrophic event from bankruptcy. On average, millennials have more medical debt than older boomers who have enjoyed better coverage for most of their lives. The actuarial problem is clear: by not purchasing insurance, younger and healthier people are not diluting the risk pool. If health insurance is not to be mandatory, there has to be a solution/incentive for millennials.
MD Job Creation
Always overlooked in discussions about the cost and effectiveness of care is the number of jobs created by physicians. According to a study by the American Medical Association, physicians are responsible for 12.6 million jobs, generating about $2.3 trillion in economic activity. The study measured the impact of 737,000 physicians based on four economic indicators: employment, wages and benefits, and state and local taxes. Every dollar from physician services supports another $2.64 in other business activity. The American Hospital Association claims it supports one in nine jobs.
The number of osteopathic physicians (DO vs. MD) is increasing rapidly. There has been a 68 percent increase in their numbers in the last 10 years. There are now more than 108,000 practicing DOs in the US or about one in seven physicians. Osteopaths are fully licensed physicians and practice in every specialty. They emphasize treating the whole person with a focus on prevention. They receive special training in the musculoskeletal system which is comprised of nerves, muscles and bones. More than half of DOs are in primary care. Currently, about 25 percent of all medical students are enrolled in a college of osteopathic medicine. MDs are technically “allopathic” physicians.
Be a Better Patient in 2018
1. Understand how your insurance works. It’s your responsibility, not your providers’. Four in 10 of us don’t understand our benefits or what the policy pays. 2. Be an active partner in your care. Busy providers prefer an involved and responsible patient vs. an uninvolved and passive patient. Don’t be afraid to ask questions. 3. Be compliant. Once you have agreed upon an approach to your care, stick with the game plan. 4. Keep your own records. You do for everything else. 5. Review your bill. If it confuses you, call the office. 6. Take advantage of preventive care. Most insurances will pay for it. 7. Never be afraid to get a second opinion. Your physician will not be offended. 8. Don’t be a “no show.” If you can’t make an appointment, be sure to call at least 24 hours ahead to reschedule. Considering the lead time to get an appointment, it is an expensive waste to have the slot go unused.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at email@example.com.