On average, healthcare created 25,000 jobs each month in 2017. Even though that pace is off from 2016, the sector remains the most powerful job creator in the U.S. economy.
Healthcare job growth slowed in 2017, but it still accounted for 15% of the 2 million new jobs created in the U.S. economy last year, Bureau of Labor Statistics data show.
Preliminary figures from BLS show that the healthcare sector employed nearly 16 million people at the end of 2017, and created 300,000 new jobs over the past 12 months, including: 206,000 new jobs in ambulatory care: 76,000 jobs in hospitals; and 18,000 in nursing and residential care.
In 2016, healthcare created nearly 380,000 jobs, averaging more than 31,000 new jobs each month.
Susan Salka, president and CEO of San Diego-based AMN Healthcare, said the healthcare sector continued to see strong job growth in 2017 in the face of significant headwinds.
"Last year was rife with uncertainty about healthcare policy, but much greater pressures are driving demand forward," Salka says. "We are facing a future of significant healthcare workforce shortages, and the industry must face that challenge."
Salka says the continued robust job growth "shows that the most important workforce issues for our industry are the long-range drivers of healthcare demand, which include the aging of the U.S. population, the improving U.S. economy, and the shortages of almost all types of healthcare workers."
Healthcare job growth numbers may fluctuate in the months and years ahead, Salka says, but the overall trajectory is still going up.
"Our aging population, improving economy, increasing healthcare job openings, and the Baby-Boomer retirement tsunami hitting our industry will push up job growth in 2018 and beyond," she says. "So, whether or not there are slight fluctuations in growth, the future for healthcare jobs is very high demand and not enough supply to fill that demand."
Travis Singleton, a senior vice president at Dallas-based Merritt Hawkins & Associates, is not so sure that growth can continue at the current pace.
"It is unrealistic to think that healthcare job growth could continue on its impressive trajectory with the uncertainty created by the partial dismantling of the Affordable Care Act along with no detailed replacement," he said. "This puts healthcare dollars in question and that will blunt expansion."
Singleton says the uncertainty over the direction of healthcare has put many systems in a holding pattern. "Expansion in particular is a hostage to potential sources of reimbursement," he says. "The industry is waiting to see where the dollars are coming from particularly with Medicare/Medicaid and indigent care."
"The one exception tends to be the safer fee-for-service care that you would typically see in ambulatory settings," Singleton says. "You also see similar growth patterns in segments like retail and telehealth as they are less reliant on reimbursement."
Salka says she expects that the fastest area for job growth within healthcare will remain in ambulatory care, the ongoing trend for several decades. In 2017, ambulatory care averaged 17,000 new jobs each year, compared with 6,300 new jobs in the hospital sector.
"Healthcare is changing to value-based care to prevent people from being hospitalized, and you can see it throughout the industry," she says. "We will continue to see the greatest jobs growth in urgent care, clinics, home healthcare, diagnostic centers and similar providers. However, hospital employment grew every month last year and will continue to be a major employer."
Singleton says the continued hiring in the face of so much uncertainty shows that patient demand trumps other concerns.
"If most hospitals and health systems could just tap the breaks all together and wait for a certain direction they would, but the shear patient demand dictates that they still add personnel," he says.
"The economy, aging demographics, the push to meet patients where they live (convenient care), and the expansion of healthcare coverage mean a fairly healthy industry overall."
Federal regulators say a bill in the Pennsylvania House of Representatives that would allow nurse practitioners to practice independently and write prescriptions would spur competition, improve access to healthcare and benefit consumers.
The Federal Trade Commission has once again sided with nurse practitioners in their long-simmering feud with physicians on scope-of-practice.
At the request of Pennsylvania State Rep. Jesse Topper (R-Bedford), FTC staff this week submitted comments on the competitive impact of a legislative proposal(HB100) that would eliminate a state requirement that APRNs enter collaborative agreements with physicians after they've completed three years of practice, and 3,600 hours of training, under a physician.
The bill also allows APRNs to write prescriptions independently, and eases practice restrictions on APRNs moving into the state.
"Undue regulatory restrictions on APRN practice can impose significant costs on healthcare consumers – patients – as well as both public and private third-party payors," the letter said.
"Removing existing supervision requirements to permit independent APRN-CNP prescribing and practice has the potential to benefit Pennsylvania consumers by increasing competition among health care providers, which likely would improve access to care, contain costs, and expand innovation in health care delivery," the letter said.
The bill is opposed by the Pennsylvania Medical Society. In a strongly worded rebuttal to a recent editorial written by the PennLive Editorial Board, Society President Theodore Christopher, MD, blasted suggestions that nurse practitioners should be given more autonomy.
“Physicians and nurse practitioners (NPs) are neither professionally equivalent nor interchangeable. And, it is careless to suggest that maintaining the current collaborative relationship between physicians and NPs somehow involves an issue of "freedom," Christopher wrote. "Rather, the current relationship between these two professionals serves to ensure that patients receive the best possible care."
FTC has analyzed APRN regulations in several states. While deferring to the will of state legislatures, FTC staff has been consistently supportive of states' efforts to reduce regulations that restrict scope of practice in healthcare and other professions.
In 2017, the FTC created the Economic Liberty Task Force which the commission said is "examining professional licensing issues and ways to promote entrepreneurship by avoiding costly and burdensome regulations that harm competition without offering countervailing benefits to consumers."
The Department of Health and Human Services’ Office of the Inspector General serves up a year-end review of its greatest hits for 2017.
Federal auditors identified an estimated $4.4 billion in misspent Medicare, Medicaid and human services program dollars in fiscal 2017, the Department of Health and Human Services Office of Inspector General said in a semiannual report to Congress.
"We continue to cultivate a workforce with the skills and talents to excel in data-driven oversight," HHS Inspector General Daniel R. Levinson said in remarks accompanying the report.
"By leveraging advanced analytic techniques to detect potential vulnerabilities and fraud trends, we are better able to target our resources at those areas and individuals most in need of oversight, leaving others free to provide care and services without unnecessary disruption," Levinson said.
The OIG report shows that for FY 2017, $296 million was returned based on program audit findings over six months, and about $4.1 billion in "investigative" receivables for the full fiscal year. Investigative receivables include recoveries from criminal actions, civil and administrative settlements, civil judgments, and administrative actions by OIG.
OIG brought criminal actions against 881 people in 2017, and an additional 826 civil actions, including false claims and unjust-enrichment lawsuits, civil monetary penalty settlements, and administrative recoveries related to self-disclosures.
The agency booted 3,244 people and entities from participating in federal healthcare programs.
Some highlights from 2017:
OIG was involved in the largest national healthcare fraud takedown in history. More than 400 defendants across the nation were charged with participating in fraud schemes involving about $1.3 billion in false billings to Medicare and Medicaid. Opioid-related charges were brought against 120 people, including 27 doctors.
OIG identified concerns about extreme use and questionableprescribing of opioidsin Medicare Part D. In 2016, half a million beneficiaries received high amounts of opioids through Medicare Part D, and almost 90,000 of them were at serious risk of opioid misuse or overdose. Moreover, 401 prescribers had questionable prescribing patterns.
Mylan Inc. agreed to pay $465 million toresolve False Claims Act liabilityfor allegedly improperly classifying EpiPen as a generic drug with the Medicaid drug rebate program, resulting in underpaid rebates to Medicaid and overcharges to entities participating in the 340B Drug Discount Program.
eClinicalWorks, LLC, and three of its senior executives agreed to pay $155 million for allegedly causing healthcare providers to submit false claims in connection with the Medicare and Medicaid Electronic Health Record Incentive Programs by concealing from ECW's customers that ECW's software did not comply with the requirements for "meaningful use" certification.
OIG's review of emergency room visits foundthat the injuries of 134 Medicare beneficiaries residing in skilled nursing facilities may have resulted from potential abuse or neglect. More than a quarter of these incidents may not have been reported to law enforcement at the time. OIG referred all 134 incidents to law enforcement.
OIG estimated that CMS paid $730 million to providers who did not meet federal requirements formeaningful use. CMS also made $2.3 million in incentive payments for the wrong payment year when providers switched between incentive programs.
Limitations in claims data impede CMS's ability to identify Medicare's costs for replacement of devices that were recalled or that failed. OIGestimated costs totaled $1.5 billion for Medicare and $140 million for beneficiaries over the 10-year period ending on Dec. 31, 2014, for seven recalled and failed cardiac devices.
OIG found that the Medicare Shared Savings Programshows potential to reduce spending and improve quality. Most Accountable Care Organizations in the MSSP reduced spending and improved quality of care during the first three years of the program. A small subset of ACOs showed substantial reductions in Medicare spending for key services.
The nation's Baby Boomer physician workforce is aging along with the larger population. Forty-three percent of all physicians are age 55 or older. Specialists are on average older than are primary care doctors.
It's not just primary care physicians who are in short supply.
A white paper from physician recruiters Merritt Hawkins says it’s time to acknowledge the growing shortage of medical specialists, too.
"The notion that we should be training more primary care physicians while maintaining or reducing the supply of specialists is a grave miscalculation," said Mark Smith, president of Merritt Hawkins. "We should be training more of both types of physicians."
Since 2011, about 10,000 Baby Boomers each day turn 65 in the United States. Seniors 65 or older comprise 14% of the population but account for 34% of inpatient procedures and 37.4% of diagnostic treatments and tests.
"It is primarily specialists such as cardiologists, orthopedic surgeons, neurologists, rheumatologists, pulmonologists, vascular surgeons and many others who care for the declining health and organ systems of elderly patients," Smith said. "A growing number will be needed as the population ages."
The nation's Baby Boomer physician workforce is aging along with the larger population. Forty-three percent of all physicians are age 55 or older. Specialists are on average older than are primary care doctors. For example, 73% of pulmonologists and 60% of psychiatrists are age 65 or older, compared with 40% of internists and 38% of family practitioners, the white paper said.
The study relies on data from Merritt Hawkins' physician search assignments conducted for hospitals and other healthcare providers that demonstrate the growing demand for medical specialists. It also cites Merritt Hawkins' physician surveys which show that 80% of specialists are overextended or are at capacity, while only 20% have time to see more patients or take on new duties.
Citing a 2017 Merritt Hawkins' survey, the white paper notes that the time it takes to schedule appointments with medical specialists such as cardiologists, dermatologists, orthopedic surgeons and obstetricians/gynecologists has increased significantly since 2014.
"In certain medical specialties, vascular surgery being just one, there are only a few thousand physicians, while patients with the conditions they treat number in the tens of millions," Smith said. "The data indicate that medical specialists will be in increasingly short supply, and this should be a serious concern for healthcare policy makers and the public."
One of the last independent hospitals on Long Island will become Northwell's 23rd hospital, and its fifth in Suffolk County.
Norwell Health has acquired Mather Hospital, a 248-bed community teaching hospital in Port Jefferson, NY. The acquisition is expected to take effect in January, the two hospitals said in a joint statement.
"This month Mather Hospital celebrates 88 years of service to our community. So it is auspicious that at this time Mather officially becomes a member hospital of Northwell Health. This is a once-in-a-century event that fortifies us for future growth," Mather President Kenneth Roberts said.
"While we are now a member of one of the country's premier health systems, our mission remains the same – to provide our community care to the best of our ability, showing compassion and respect and treating each patient in the manner we would wish for our loved ones," he said.
Mather Hospital began merger discussions with several health systems in early 2016. Mather had been one of only two hospitals on Long Island that had not joined or announced plans to join a larger system.
The merger is the end result of a due-diligence process that began in July. Representatives from both hospitals met over the past five months to iron out the details of the acquisition.
Mather’s service lines include bariatrics, neurosurgery, orthopedics, pulmonology, robotic surgery, breast health, mental health and emergency services. It also operates the advanced radiosurgery program Precision CyberKnife of New York.
Mather’s Graduate Medical Education program offers residencies in internal medicine, psychiatry, radiology and transitional year. The hospital has more than 2,600 employees and more than 600 staff and affiliated physicians. The hospital cared for more than 12,500 inpatients and over 40,000 emergency patients last year. Mather physicians performed more than 3,800 inpatient surgeries and 10,500 outpatient surgeries.
Northwell Health is New York State's largest health system and private employer, with 23 hospitals, more than 600 outpatient facilities, 63,500 employees, and nearly 15,000 affiliated physicians.
Federal prosecutors say the retailer offered discounted generic drug prices to cash-paying customers but knowingly failed to disclose those prices when reporting to federal health programs.
Kmart Corp. will pay the federal government $32.3 million to settle allegations that its pharmacies failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, the Justice Department announced.
The settlement ends a nearly 10-year legal battle and stems from a 2008 lawsuit, filed by whistleblower James Garbe, which alleged that Kmart pharmacies offered discounted generic drug prices to cash-paying customers but knowingly failed to disclose those prices when reporting to federal health programs its usual prices, which are used to establish reimbursement rates.
"Pharmacies that are not fully transparent about drug pricing can cause federal health programs to overpay for prescription drugs." said Acting Assistant Attorney General Chad A. Readler for the Department’s Civil Division.
"This settlement should put pharmacies on notice that there will be consequences if they attempt to improperly increase payments from taxpayer-funded health programs by masking the true prices that they charge the general public for the same drugs," Readler said.
The settlement is a part of a $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. Garbe, who litigated the case after the government declined to intervene in the action, will receive $9.3 million.
“The settlement shows we were right to continue to pursue the case on behalf of taxpayers, despite the government’s decision not to join the qui tam lawsuit,” said Erika A. Kelton, a whistleblower attorney and partner at Phillips & Cohen. “Not only did we recover funds for taxpayers, we also stopped a practice that would have been an improper drain on government healthcare funds.”
Kmart tried to get the case dismissed after it was unsealed seven years ago, taking it all the way to the US Supreme Court. However, the US Supreme Court declined in January to hear Kmart’s appeal of a lower court decision in 2015 that ruled against Kmart and denied the company’s request to dismiss the case.
According to the whistleblower’s complaint, Kmart sold a 30-day supply of a generic version of a popular prescription drug for $5 to customers who registered for a discount program but Kmart sought reimbursement from the government for $152 for the same drug for Medicare customers, which Kmart claimed was the “usual and customary” price.
Garbe worked for a Kmart pharmacy in Ohio when he discovered that Kmart was charging Medicare customers significantly more for generics than it was charging customers enrolled in its cash discount program. He had filled a personal prescription at the pharmacy and saw that Kmart claimed to his Medicare Part D insurer that the prescription cost $60 rather than the much lower price of $15 that it charged cash-paying customers in its discount program, the complaint alleged.
Kmart argued in court that it could exclude the lower prices that it charged members of its discount program when determining the proper price – known as the “usual and customary price” – to charge government healthcare programs. But the 7th US Circuit Court of Appeals disagreed.
“The 'usual and customary' price requirement should not be frustrated by so flimsy a device as Kmart's 'discount programs,'" the court wrote in its opinion.
In a statement emailed to HealthLeaders Media, Kmart said: "We're pleased to put this case behind us so that we can focus on the needs of our members and customers, and our company's transformation."
Prosecutors said Bertha Blanco tipped off healthcare facilities operators about surprise inspections and patient complaints in exchange for more than $500,000 in bribes.
A career employee with Florida's Agency for Health Care Administration was sentenced to more than four years in prison after pleading guilty to soliciting more than $500,000 in bribes from skilled nursing facilities, home health agencies, and assisted living facilities, Florida state and federal officials said.
In exchange for the bribes, prosecutors said Bertha Blanco, 66, of Miami, provided the purchasers with sensitive, nonpublic AHCA reports and information related to their facilities, from at least 2007 through 2015.
The information included the schedules of future unannounced inspections by AHCA surveyors and previously undisclosed patient complaints filed with AHCA.
AHCA’s Division of Health Quality Assurance oversees licensure and regulation of healthcare facilities in Florida that receive Medicare and Medicaid funds, including skilled nursing facilities, assisted living facilities and home health agencies.
Blanco, who had worked at AHCA for 30 years, knew that the information she provided in exchange for bribes could be used to falsify medical paperwork and to temporarily remedy deficiencies so that AHCA would not discover lapses in patient care and revoke the licenses of the facilities that had received the information, prosecutors said.
Blanco, who pleaded guilty to one count of bribery on Oct. 13, was also ordered to pay $441,000 in restitution and to forfeit $100,000, which represents the gross proceeds traced to Blanco’s commission of the offense.
In addition to Blanco, six facilities operators were charged with various counts of healthcare fraud, wire fraud, money laundering, bribery and obstruction of justice in connection with the scheme. Five of the defendants have already pleaded guilty, and one awaits trial.
When the charges against Blanco were unsealed last summer, the Miami Herald’s Jay Weaver described her as “a small cog in the complicated operation” that “has been touted as the nation’s biggest Medicare fraud case.” Blanco made less than $32,000 per year, while healthcare mogul Philip Esformes made millions, his enterprise allegedly aided by Blanco’s information.
Esformes was indicted separately and is scheduled for trial in March.
The company allegedly paid kickbacks to Medicare and Medicaid beneficiaries, and billed the federal government for prescription drugs that were never shipped.
DaVita Rx LLC will pay the federal government $63.7 million to resolve whistleblower and self-disclosed allegations that it paid kickbacks to Medicaid and Medicare beneficiaries and improperly billed the federal programs, the Justice Department said.
Coppell, TX-based DaVita Rx, a nationwide pharmacy that specializes in serving patients with kidney disease, said in a statement provided to HealthLeaders Media that it self-disclosed the illegal activity, takes "full ownership" of its misdeeds, "and (will) continue to embrace transparency and rigorous compliance."
According to federal prosecutors, DaVita Rx billed Medicaid and Medicare for prescription medications that were never shipped, that were shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent.
DOJ said the settlement also resolves allegations that DaVita paid kickbacks to Medicare and Medicaid beneficiaries, a violation of the Anti-Kickback Statute.
"Specifically, DaVita Rx allegedly accepted manufacturer copayment discount cards in lieu of collecting copayments from Medicare beneficiaries, routinely wrote off unpaid beneficiary debt, and extended discounts to beneficiaries who paid for their medications by credit card," DOJ said. "These allegations relating to improper billing and unlawful financial inducements were the subject of self-disclosures by DaVita Rx and a subsequently filed whistleblower lawsuit."
DOJ's Civil Division Acting Assistant Attorney General Chad Readler said the settlement "reflects not only our commitment to protect the integrity of the healthcare system, but also our willingness to work with providers who review their own practices and make appropriate self-disclosures."
DaVita said it is "proud that its team discovered and self-disclosed these issues to the federal government in 2015 and 2016 and cooperated with the government in resolving them."
DaVita Rx repaid $22.2 million to Medicaid and Medicare following its self-disclosure and will pay an additional $38.3 million to the federal government. In addition, $3.2 million has been allocated to cover Medicaid claims by states participating in the settlement.
"The conduct being resolved in this matter presents serious program integrity concerns," said C.J. Porter, special agent in charge for the Office of Inspector General of the Department of Health and Human Services. "DaVita Rx's cooperation in the investigation of this matter was necessary and appropriate to reach this resolution."
The FTC and North Dakota Attorney General’s Office say the deal would hurt competition in the Bismarck area and ultimately result in higher healthcare costs for consumers.
The suit was brought by the North Dakota Attorney General's Office and the Federal Trade Commission, which contend that the acquisition would adversely affect competition in the Bismarck service area and increase the cost of healthcare for consumers.
The injunction issued this week follows a four-day hearing in U.S. District Court in Bismarck that heard from 16 witnesses and included more than 1,600 exhibits, and halts the acquisition until a Federal Trade Commission administrative hearing on Jan. 17.
Mid Dakota Clinic employs 61 physicians and 19 advanced practice practitioners and operates six clinics in Bismarck, a women’s health center, and an ambulatory surgery center. The proposed merger was announced in June and immediately drew the attention of state and federal regulators.
The FTC and state officials contend that the acquisition would create a physician group controlling at least 75% to 85% of market for adult primary care, pediatrics, and obstetrics and gynecology services. The merged clinic also would be the only physician group offering general surgery services in the area, and could stifle efforts by other providers to enter or expand in the service area, the complaint states.
Sanford and Mid Dakota said the complaint fails to consider the leveraging power of Blue Cross Blue Shield of North Dakota, the region’s largest commercial payer, which would preclude anticompetitive effects that might result from the acquisition.
Sanford Health spokesman Jon Berg said the health system is "disappointed" with the ruling but that an appeal is in the works.
"With all due respect, we believe that the court is wrong on the law and wrong on the facts," Berg said. "Put simply, the government’s case rests on theories that are at odds with reality here in North Dakota. Sanford and Mid Dakota Clinic are committed to letting Mid Dakota Clinic follow the course that it has selected for maintaining and building on the care it provides to its patients."
"The court’s decision will delay the realization of improved access and the introduction of new services we can achieve together," Berg said. "But this is not the end of the road. We are committed to fighting for the communities we serve, and look forward to bringing this case to the U.S. Court of Appeals for the Eighth Circuit as quickly as possible."
North Dakota Attorney General Wayne Stenehjen said he was "very pleased with the court’s decision and feel confident that the Court recognized the potential negative consequences for patients in the Bismarck-Mandan area. Today’s decision is in the best interests of the community."
Federal Trade Commission Acting Bureau of Competition Director Bruce Hoffman called the injunction "good news for patients and their families in the Bismarck and Mandan metropolitan area."
"We look forward to proving at trial that this merger would likely reduce competition, resulting in higher prices and lower quality of adult primary care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in that area of North Dakota," Hoffman said.
Jay L. Levine, an antitrust attorney with Porter Wright, and a disinterested observer in the case, says the FTC has to prove the merger will reduce competition in the form of higher prices, reduced output, lower quality and less innovation.
"If the FTC can prove that the merger will result in one entity controlling the market for physician services, such that no managed care company can create a network without including the merged entity, it probably satisfies its burden," Levine says.
Sanford could have a more difficult time making its case, Levine says.
"Sanford can either defend the merger showing that the FTC's allegation of control over the physician market is not accurate, or can try and demonstrate that even despite such control, the merger would not give rise to any of the anti-competitive effects predicted," he said. "They could also try to show that the merger’s efficiencies outweigh any of the harmful competitive effects the merger is likely to cause. All of these options will be difficult for Sanford."
Sanford, the largest health system in the state, has an extensive presence in the Bismarck area that includes a 217-bed general acute care hospital and a network of primary care and specialty clinics, employing 160 physicians and 100 non-physician healthcare providers.
The payment will resolve Stark Act and False Claims Act allegations against the Florida-based provider, which self-disclosed the violations and cooperated with the government investigation.
Physician-led 21st Century Oncology Inc. will pay the federal government $26 million to resolve False Claims Act allegations of inflated attestations for electronic health records, and alleged Stark Act violations involving kickbacks for referring physicians, the Department of Justice said.
The allegations were self-disclosed by 21st Century Oncology, and also brought forward in a whistleblower lawsuit, DOJ said.
"The Justice Department is committed to zealously investigating improper financial relationships that have the potential to compromise physicians' medical judgment," said Acting Assistant Attorney General Chad A. Readler in DOJ's Civil Division. "However, we will work with companies that accept responsibility for their past compliance failures and promptly take corrective action."
HealthLeaders Media’s request for comment from Ft. Myers, FL-based 21st Century Oncology were not returned.
The settlement announced this week resolves separate allegations against 21st Century Oncology involving falsified EHR attestation, and kickbacks and kickbacks for physician referrals.
First, 21st Century Oncology admitted that it "knowingly submitted, or caused the submission of, false attestations to the Centers for Medicare & Medicaid Services concerning employed physicians' use of EHR software," DOJ said.
"The company further reported that, in support of the attestations, its employees falsified data regarding the company’s use of EHR software, fabricated software utilization reports, and superimposed EHR vendor logos onto the reports to make them look legitimate," DOJ said.
Secondly, 21st Century Oncology admitted to Stark Law violations that involved submitted claims for services that were generated by referrals from physicians with whom they had improper financial relationships.
The Stark Law allegations were originally brought in a whistleblower lawsuit filed by Matthew Moore, 21st Century Oncology’s former Interim Vice President of Financial Planning. Moore will receive $2 million as his share of the recovery.
In addition to the settlement, 21st Century Oncology has entered into a five-year Corporate Integrity Agreement with federal auditors.
21st Century Oncology owns and operates 143 centers in 17 states, and 36 centers in seven Latin American countries.
