Technology breakthroughs, legislative changes and a shift toward patient-centered treatment are all driving the U.S. healthcare sector's extraordinary evolution.
Employers are using transparency data to try to slow growth of their healthcare costs, and "the last thing you want to do is start over," said James Gelfand, president and CEO of the ERISA Industry Committee, which represents large employers who finance their own health plans. His group is among the organizations still pressing Congress to act next year. "Congress' failure to act is deeply disappointing, but employers and other advocates will redouble our efforts," Gelfand said. "This will get done." While there are reports that many hospitals are not fully complying with transparency rules, federal regulators have sent thousands of warning letters to hospitals and fined just over a dozen. The rules require hospitals to list the prices they accept from all insurers for thousands of items and services, from stitches to delivery room costs to X-rays. For consumers, hospitals must also provide a list of 300 "shoppable" services, including bundled prices accepted for common services such as having a baby or getting a hip replacement. Insurers in July 2022 were similarly required to list their negotiated prices, not only for care at hospitals, but also surgery centers, imaging facilities, laboratories, and doctors' offices.
Mass General Brigham, the state's largest health care system, remained on solid financial ground in 2024, a news release Wednesday showed, running counter to a drumbeat of concern that the state's hospitals are all in financial jeopardy. In all, the MGB system found itself $2 billion richer in the year ending in September, almost doubling the $1.2 billion net margin the system reported the year prior. Nearly all of the profit came from the system's investment portfolio, gains that largely exist on paper, whereas its core operations operated at nearly break-even. From just its core operations, the health system reported a $46 million operating margin.
The Department of Justice announced a lawsuit on Wednesday accusing pharmacy chain CVS of filling illegal opioid prescriptions and billing federal health insurance programs, contributing to a nationwide epidemic of opioid addiction and overdose. The newly unsealed complaint in Providence, Rhode Island, federal court alleges that, from October 2013 to the present, CVS violated the federal Controlled Substances Act by filling prescriptions for dangerous quantities of opioids and dangerous combinations of drugs. It said the company regularly filled prescriptions from doctors running so-called pill mills, dispensing large quantities of opioids without legitimate medical reason. The Justice Department said the violations were driven by company-mandated performance metrics that led to red flags being ignored, and that in some cases patients died of overdoses shortly after filling illegal prescriptions. "We have cooperated with the DOJ's investigation for more than four years, and we strongly disagree with the allegations and false narrative within this complaint," CVS said in a statement. CVS agreed in 2022 to pay close to $5 billion over 10 years to settle thousands of similar claims by state, local and Native American tribal governments. It did not admit wrongdoing under the deal, which was one of a series of nationwide settlements by pharmacies, drugmakers and distributors totaling about $46 billion.
Across the U.S., nurse practitioner students face the same problem. Like medical doctors, they need to complete clinical rotations to graduate. Unlike doctors, they don't have access to federal funding to support that training, and their schools often leave them to find their own clinical preceptors. The stakes are high. For many students, it's the only time they'll work with real patients as an NP before entering the workforce. And if they can't get the hours, their graduation will be delayed. So students beg on Facebook for placements, drop off cookies at front desks for potential preceptors—and, when they find someone who's willing, often pay the person themselves. For the public, the ramifications are greater. Even some hospital leaders acknowledge there's so little quality control that patients can't be sure their NP is properly trained to treat them. Struggling to ensure they're prepared to handle the duties assigned them, students have few places to find help.
Why the higher prices? Hospitals and doctors' offices are paying more for workers, in large part due to labor shortages, rising wages and high turnover. Prices have also been pushed higher by consolidation among hospitals. Over the past couple of decades, the price index for what the Labor Department classifies as medical care—which includes visits to doctors, hospital stays, prescription drugs and medical equipment—has risen roughly 40% faster than the overall pace of inflation. Healthcare tends to rise more quickly than overall inflation because of high labor costs in the sector, as well as advancements leading to new and more expensive drugs and treatments. Demand for healthcare is also increasing as the population ages. The average worker pays a premium of $114 a month out of pocket for their share of employer-provided insurance, or $525 a month for family coverage. Both figures are up roughly 30% from a decade ago.