The average premium for employer-sponsored plans rose $267, or 4.4% between 2016 and 2017, which is twice the increase recorded between 2015 and 2016.
Employees who get their health insurance through their job are paying a lot more now than just a few years ago in premiums, co-pays and deductibles, a new study finds.
The average annual premium for an individual health insurance policy offered by employers rose $267, or 4.4%, to $6,368 between 2016 and 2017—nearly twice the increase recorded between 2015 and 2016 (2.3%), according to a new analysis from the University of Minnesota’s State Health Access Data Assistance Center.
In addition, the SHADAC researchers saw significant increases in workers' deductibles and co-pays in 2017.
"Attention has been focused on cost increases in the federal and state insurance marketplaces, but most people get coverage through their own or a family member's employer and face rising costs," Lynn Blewett, director of SHADAC, said in a media release.
"While employers continue to offer insurance benefits to their employees, they are increasing the worker share of rising costs," Blewett said.
SHADAC researchers analyzed employer-sponsored health insurance among private sector workers between 2016 and 2017 using the most recent data available from the Medical Expenditure Panel Survey.
Nationwide, the analysis shows that the percent of eligible workers receiving health coverage through their job held steady in 2017, at 73.5%, representing nearly 60 million employees.
The analysis shows:
Annual premiums for single coverage increased in 15 states in 2017, with increases ranging from 5.2% in Pennsylvania to 11.5% in Wyoming.
Nationwide, the average annual deductible for single coverage rose to $1,808 in 2017 an increase of $112 or 6.6%. Nearly half of workers enrolled in employer-sponsored plans (48.7%) had a deductible at or above $1,300 for an individual or $2,600 for a family.
16.1% of employer-sponsored plan enrollees nationwide had a separate deductible for prescription drugs in 2017. In 10 states, more than 20% of employees (including 47.3% in Mississippi) faced such a deductible.
Average annual out-of-pocket limits for single-coverage work-sponsored plans rose to $4,246 nationwide, an increase of $147, or 3.6%, between 2016 and 2017. Required co-pays for office visits rose 2.4% for primary care and 4.2% for specialist care.
"Cost increases at this level aren’t sustainable and require a renewed commitment to improving the effectiveness and value of healthcare services, so insurance can be more affordable for everyone," said Mona Shah, a program officer at Robert Wood Johnson Foundation, which sponsored the study.
America's Health Insurance Plans spokesperson Cathryn Donaldson did not dispute the findings, but said that "premiums and deductibles track directly with the underlying cost of health care, which continues to rise overall."
Over the past decade, Donaldson says, employer health costs have moved in a narrow band and premium growth has been modest.
Donaldson said employer-sponsored health plans are also offering employees more coverage options, including high deductible plans with lower monthly premiums that can be coupled with tax-deductible health savings accounts.
"High deductible plans with HSAs offer consumers more financial protection, control over their health care dollars, and greater peace of mind," she said. "In fact, more Americans are now choosing a HSA with a high deductible plan than ever beforebecause it empowers them to make affordable health care choices that aligns with their health care needs."
Kalispell Regional Healthcare System 'strongly disagrees with the allegations' brought forward by a former executive, but is 'relieved to put this issue behind us.'
Montana-based Kalispell Regional Healthcare System and six subsidiaries will pay the federal government $24 million to settle whistleblower allegations that it paid kickbacks to physicians to entice patient referrals, theDepartment of Justice said.
The government alleges that the False Claims Act and Stark Law violations occurred between 2010 and 2018, and that, among other illicit behavior, KRH paid excessive full-time compensation to more than 60 physician specialists—many of whom worked far less than full-time—as a means of securing referrals.
In addition, six KRH subsidiaries— HealthCenter Northwest LLC, Flathead Physicians Group LLC, Northwest Horizons LLC, Northwest Orthopedics & Sports Medicine LLC, and Applied Health Services Inc.—conspired to pay physicians employed at Kalispell Regional Medical Center to induce referrals to HealthCenter.
The subsidiaries also conspired to charge below fair market value for administrative services provided to HealthCenter, which unduly profited the physician investors at Flathead, who had an ownership stake in HealthCenter, DOJ said.
Under the settlement, KRH will pay $21.2 million, Flathead Physician Group will pay $2.8 million.
"Financial arrangements that improperly compensate physicians who make referrals to a hospital drive up the cost of healthcare services for everyone," Assistant Attorney General Joseph H. Hunt for the Department of Justice's Civil Division said in a media release.
The settlement resolves whistleblower claims brought in two lawsuits filed by Jon Mohatt, a former CFO for KRH's Physicians Network, who will pocket $5.4 million as his share of the recovery in the two consolidated cases.
Kalispell Regional Healthcare issued a statement detailing the settlement, adding that while the health system "continues to strongly disagree with the allegations, we are relieved to put this issue behind us."
"The Board of Trustees carefully considered the ongoing costs and distraction that litigation would impose upon the system, our employees, and the communities we serve," KRH said.
"We believe that a settlement allows our system to put this difficult matter behind us and allows our physicians and employees to move forward and focus on providing the excellent care that our community expects," KRH said.
"During the government’s review, the quality of care our physicians and staff provide was never questioned nor was overutilization an issue."
Shareholders will consider the compensation packages on Oct. 29, when they vote on the proposed merger with RCCH HealthCare Partners.
LifePoint Health CEO Bill Carpenter could descend gently into retirement strapped to a $70 million golden parachute, according to proxy statements filed Thursday with the federal government.
Carpenter and three other top executives at the Tennessee-based for-profit hospital chain will receive a total of $121 million in golden parachute compensation, according to the document, which was filed with the Securities and Exchange Commission this week.
LifePoint shareholders are expected to vote on the compensation package and the merger on Oct. 29 at LifePoint's Brentwood, Tennessee headquarters.
Carpenter's retirement was announced on Wednesday, and it will take effect after the merger with RCCH HealthCare Partners is finalized later this year.
His successor, David Dill, LifePoint's current president and COO, will also get a plush golden parachute compensation valued at $25.5 million, according to information posted on Page 125 of the proxy statement.
Two other top executives at the company, CFO Michael S. Coggin, and CAO John P. Bumpus, will receive golden parachute compensation valued at $13.4 million and $11.4 million, respectively, the proxy statement said.
Carpenter has a long history with LifePoint, which specializes in hospital operations in non-urban settings. He was a founding employee when the company was formed in 1999, and has served as CEO since 2006 and was appointed chairman of the board in 2010.
"It has been an absolute privilege to lead LifePoint for nearly 13 years, and to be a part of the team since the company’s inception almost 20 years ago. I am incredibly proud of all the organization has accomplished during that time," said Carpenter.
"We’ve grown from 23 hospitals in 9 states, to nearly 70 hospitals in 22 states today, to a footprint that will soon span coast to coast, pending completion of our merger with RCCH HealthCare Partners," he said.
LifePoint and RCCH, both of which are headquartered in Brentwood, Tennessee, announced their merger in July. Dill will be the first CEO of the merged company, which will keep the LifePoint Health name.
The CMS administrator says the Trump administration is committed to giving states the flexibility they need to contain their Medicaid costs, even as some critics suggest that regulating the work requirement will cost more money than it saves.
Centers for Medicare & Medicaid Services Administrator Seema Verma on Thursday offered a robust defense of the Trump administration's work requirements for "able-bodied adults" on Medicaid.
"There is dignity and pride that is derived from work—for paying one's own way—and I believe it is the desire of nearly every American to achieve financial independence," Verma said in remarks before the 2018 Medicaid Managed Care Summit.
"Let me be clear, there is no shame in receiving extra help when it’s needed—that's why we have a safety net to care for folks on hard times," Verma told the summit. "But our default position must always be to help and encourage those who are able to lift themselves up and find their footing again."
In January, CMS put forward guidelines for states seeking waivers for Medicaid work requirements. So Far, CMS has approved work-requirement waivers for Arkansas, Indiana, New Hampshire, and Kentucky, although that state's waiver was later vacated by a federal court. CMS is reviewing waiver proposals from seven other states.
Critics of the work requirements dismiss them largely as either a stunt or a back doorway to pare the Medicaid rolls.
The Centers on Budget and Policy Priorities has said the work requirements will kick many low-income adults off Medicaid "including people who are working or are unable to work due to mental illness, opioid or other substance use disorders, or serious chronic physical conditions, but who cannot overcome various bureaucratic hurdles to document that they either meet work requirements or qualify for an exemption from them."
Verma said Thursday she has heard the criticism and faced resistance to the work requirements.
"But I reject the premise, and here is why: it is not compassionate to trap people on government programs, or create greater dependency on public assistance as we expand programs like Medicaid," she said.
"Community engagement requirements are not some subversive attempt to just kick people off of Medicaid," Verma said. "Instead, their aim is to put beneficiaries in control with the right incentives to live healthier independent lives."
Verma said the policies used to determine work eligibility for Medicaid enrollees "are not blunt instruments."
"We’ve worked carefully to design important protections to ensure that states exempt individuals who have disabilities, are medically frail, serve as primary caregivers, or have an acute medical condition that prevent them from successfully meeting the requirement," she said.
It's not clear how many Medicaid enrollees would be affected by the work requirements. A study from the Kaiser Family Foundation suggested in June that the impact would be negligible because only 6% of Medicaid enrollees targeted by the work requirements aren't already working and are unlikely to qualify for an exemption.
"Most working Medicaid enrollees are working full-time for the full year and are working in low-wage service jobs with limited benefits such as sick time or health coverage," the Kaiser study said.
Verma rejected that assertion.
"Some have argued that these demonstrations are unnecessary because nearly all Medicaid beneficiaries are already working," she said. "To that I say—great. Then this policy won’t impact them."
In addition, Kaiser said work requirements for Medicaid would also require states to establish complex and potentially expensive verification processes to track enrollees which could not be paid for with federal Medicaid funds.
In other words, the work requirements could potentially cost states more money than they save.
Verma noted that federal spending on Medicaid grew by more than $100 billion between 2013 and 2016, and is a top budget expenditure for many states.
"We have a responsibility to make sure that taxpayer dollars are spent only on qualified services for those who are truly eligible, even as we return greater control of the Medicaid program to the states," she said.
The Richmond-based health system says it discovered the overcharges during an audit of patient files, notified federal officials, and helped with the investigation.
Virginia Commonwealth University Health System Authority will pay the federal government and Virginia $4.6 million to settle self-disclosed overbillings to government health plans for radiation oncology services, the Department of Justice announced.
Richmond-based VCU discovered the overbillings to Medicare, Tricare, and the Federal Employees Health Benefits Plan, which had occurred from 2009 through 2014, while auditing patient files and claims data, took corrective action, notified federal regulators, and helped investigators, DOJ said.
VCU Medical Center issued this statement on the overbilling:
"During a 2013 internal compliance review, VCU Health System identified possible concerns with its Department of Radiation Oncology billing and documentation."
"This prompted VCU Health System to have an extensive external review conducted. The external review identified inaccurate payments from governmental payers, which VCU Health System voluntarily self-reported. There was no evidence of fraudulent activities discovered."
"VCU Health System agreed to repay roughly $4 million to the federal government to resolve the inaccurate payments, and has taken corrective action to address its radiation oncology billing practices. In addition, the review indicated approximately $640,000 in inaccurate payments that will be repaid to the Commonwealth."
The Tennessee-based hospital chain has announced that COO David Dill will become the company's new CEO when the merger with RCCH HealthCare Partners is finalized later this year.
LifePoint Health Chairman and CEO Bill Carpenter III will retire this year, after the for-profit hospital chain completes its merger with RCCH HealthCare Partners.
David Dill, LifePoint's president and COO, will take over as CEO and Carpenter will join the merged organization’s Board of Directors, LifePoint announced Wednesday.
Carpenter has a long history with LifePoint, which specializes in hospital operations in non-urban settings. He was a founding employee when the company was formed in 1999, and has served as CEO since 2006 and was appointed chairman of the board in 2010.
"It has been an absolute privilege to lead LifePoint for nearly 13 years, and to be a part of the team since the company’s inception almost 20 years ago. I am incredibly proud of all the organization has accomplished during that time," said Carpenter.
"We’ve grown from 23 hospitals in 9 states, to nearly 70 hospitals in 22 states today, to a footprint that will soon span coast to coast, pending completion of our merger with RCCH HealthCare Partners," he said.
LifePoint and RCCH, both of which are headquartered in Brentwood, Tennessee, announced their merger in July. Dill will be the first CEO of the merged company, which will keep the LifePoint Health name.
"I believe that LifePoint is better positioned than ever to be the leader in non-urban healthcare, and to help define what the delivery of community-based healthcare looks like in the future," Dill said.
Dill joined LifePoint as CFO in 2007. He was named COO in 2009 and appointed president and COO in 2011.
During Dill's tenure, LifePoint said it grew its revenues from $2.6 billion in 2007 to more than $6 billion projected for 2018 with the launch of the company's National Quality Program collaborative with Duke University Health System.
The $5.6 billion merger creates for Dill an assets portfolio that includes 85 non-urban hospitals in 30 states, regional health systems, physician practices, outpatient centers and post-acute providers, many serving as sole providers in the communities they serve.
A new institute will integrate the university's health and social services colleges, with a focus on improving care access and outcomes in underserved areas.
Humana Inc. and the University of Houston have launched what they're calling a long-term strategic partnershipto promote population health and value-based payment models for the next generation of clinicians.
A $15 million gift from the Louisville-based health insurer will establish the Humana Integrated Health System Sciences Institute at the University of Houston, which will include the university's colleges of medicine, nursing, pharmacy, social work and optometry.
The collaboration will create a pipeline of physicians, nurses, pharmacists and other healthcare professionals trained in population health, with a focus on primary care and improving care access and outcomes in low-income communities.
Humana's funding, to be doled out over 10 years, will defray start-up and operational costs for the soon-to-open College of Medicine, and fund endowed chairs for each of the five colleges.
Humana Chief Medical Officer Roy Beveridge, MD, called the University of Houston "an ideal partner" because of their shared commitment to "caring for individuals in underserved communities with the greatest health needs."
"This is an investment in the future of our healthcare system, which depends on clinical leaders who understand concepts like population health, the importance of social determinants of health and the need to emphasize value over the volume of health care services provided," Beverage said.
The College of Medicine is scheduled to admit 30 students in its inaugural class but awaits state and national accreditation.
University of Houston President Renu Khator said the establishment of the Humana Institute demonstrates that the university is "serious about an interdisciplinary, integrated approach to health education that will make a life-changing difference in Houston and beyond."
"This transformative gift clearly positions that dream to become a reality," she said.
The two South Carolina health systems, which merged last year, say the rebranding under one name reflects a unified commitment to improve care delivery in the Palmetto State.
Greenville Health System and Palmetto Health will finalize a consolidation that began last year and rebrand as Prisma Health, the two South Carolina health systems said Tuesday.
Since late 2017, the two systems have been affiliates in the largest not-for-profit health system in the state, operating under a parent company with the interim name of SC Health Company.
That parent company is being rebranded as Prisma Health and both health systems will adopt the new name in early 2019. However, the 13 hospitals in the combined system will retain their core name identities, such as Baptist, Greenville Memorial, Laurens County, Richland and Tuomey.
The two health systems said in a joint media release that coming together under one new brand reflects their commitment to South Carolina.
"This is a once-in-a-lifetime moment for our organization," said Prisma Health Co-CEO Charles D. Beaman Jr.
"With a motivated 30,000-team-member workforce, we’re confident we will continue to make strides to improve clinical quality, access to care and the patient experience for South Carolinians, while addressing the rising cost of healthcare," said Beaman, the former CEO of Palmetto Health.
South Carolina has some of the nation's highest rates of obesity, diabetes, stroke, and cardiovascular and pulmonary disease. With the merger, Prisma Health says it now has the scale, scope and resources to address those population health issues, while continuing to be a not-for-profit, mission-driven organization.
When the two systems merged last year, no name changes were planned. However, Prisma Health Co-CEO Michael C. Riordan said plans changed when leadership realized that a single health company with a unified culture needed to unite under one name.
"We've already learned so much from each other," said Riordan, the former CEO at Greenville Health. "What we’re doing now will pave the way for transformative changes to health care in South Carolina. And through our efforts, we've already identified ways to achieve more together by operating as one organization under a single name and brand identity."
Brad Haller, director of West Monroe Partners' Mergers & Acquisitions practice, says the consolidation has made sense for two health systems with a healthy footprint in South Carolina.
"Combining the two under one umbrella is a good geographic play in that it connects the western part of the state with the central part of the state. While these are the two largest health systems in the state, there is still a healthy amount of 'competition' from other providers," Haller says.
The deal is representative of larger M&A trends in the healthcare sector, where Haller says "everything is about cost take-out and building scale against the payers," which he says is the primary strategic driver for most consolidations.
"Prisma" is a variation on the "prism," which Merriam-Webster defined as "a medium that distorts, slants, or colors whatever is viewed through it."
Prisma Health said the new name "reflects the diverse, multifaceted nature of the organization and its team members, as well as the bright future that lies ahead."
The health system says "the name and distinctive logodistinguish Prisma Health from traditional healthcare systems and signal its intent to look at health, and health care, in a completely new way.
The existing GHS and Palmetto Health brands, including their names and logos, will be retired in early 2019. Additionally, both affiliates have replaced their mission, vision and values statements with a new Purpose Statement."
Review period extended two weeks. CMS says discovering the 2017 scoring errors indicates its targeted review process 'worked exactly as intended.'
The Centers for Medicare & Medicaid Services says it is extending by two weeks the review period for the 2019 Merit-based Incentive Payment System (MIPS) adjustment calculation after it identified and fixed "a few errors in the scoring logic" used in the 2017 assessments.
As a result, CMS moved the 2019 payment adjustment from September 30 to October 15 at 8 p.m. Eastern Time.
"The requests that we received through targeted review caused us to take a closer look at a few prevailing concerns," CMS said in a post on its website.
CMS said the concerns include "the application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study, and the addition of the All-Cause Readmission (ACR) measure to the MIPS final score."
"Based on these requests, we reviewed the concerns, identified a few errors in the scoring logic, and implemented solutions," CMS said.
Errors remedied, CMS says it saw "a very high 91% participation rate" for the first year of MIPS in 2017, which provides individual clinicians, and physician groups participating in Alternative Payment Models access to feedback on their final 2017 MIPS score, and 2019 MIPS payment adjustment.
CMS said identifying and fixing the errors also indicated that its targeted review process "worked exactly as intended."
"The incoming requests quickly alerted us to these issues and allowed us to take immediate action," CMS said. "Addressing and correcting for the above elements resulted in changes to the 2017 MIPS final score and associated 2019 MIPS payment adjustment for the clinicians who were impacted by the identified issues."
A longitudinal study tracking students from medical school through residency suggests the grueling process leaves many young physicians questioning their career choice.
Resident physicians concentrating on certain specialties are particularly prone to burnout, a Mayo Clinic-led study shows.
The longitudinal study, which appeared this month in JAMA, found that 45% of second-year resident physicians reported experiencing at least one symptom of burnout, which can include exhaustion and depersonalization of patients.
Urology, neurology, emergency medicine and general surgery residents were at the highest risk of burnout, but the study authors don't know why.
"That is a great question for a separate research study," says Liselotte Dyrbye, MD, a Mayo Clinic researcher and first author of the article.
"We know that at the beginning of medical school, there isn't much burnout. But even in medical school we start to see burnout develop after a couple of years. It starts early and continues from training into practice," she said.
The years-long study, which involves 50 medical schools and 3,600 medical trainees, is the first national study to follow medical students from the beginning of medical school into residency to track predictors of burnout.
Residents were asked about their specialty, ethnicity, educational debt and other demographics, and completed surveys to measure anxiety, emotional social support, empathy and burnout. The survey found that residents with burnout were three times more likely to regret becoming a physician.
Dyrbye says she can only speculate on why some specialties are more prone to burnout, but she's spotted a trend.
"We see high rates of burnout in resident physicians in urology, neurology, ER and general surgery and that mirrors our previous findings of physicians in practice that we conducted with the AMA a few years ago," she says.
"There may be something unique in the particular work environments related to workload, practice efficiencies, autonomy, control, work life balance," she says. "Another possibility could be that the supervising physicians who are impacting the learning environment in such a way that these residents-in-training are impacted and at higher risk of burnout."
"Maybe there is more harassment or belittlement going on in these specialty training programs relative to other specialty training programs, which probably more reflects the practice environment," she says. "When a supervising physician is working in the same practice environment as the resident, then it's not so much of a surprise that they are both impacted by work-related stresses that drive burnout."
In an interesting wrinkle, the study found that self-identified minority students were more likely to regret their specialty choices, and the study authors suggest that one reason might be that these time-strapped minority physicians are being pressed to serve in their institutions' diversity programs.
"There are a lot of initiatives at academic medical centers across the country to really improve diversity, because that improves the science, patient care and research," Dyrbye says. "As a result, we have all of these diversity committees looking at retention and recruitment and various issues and people of diverse backgrounds get overtaxed when they're asked to be on those committees. In addition to the stress of being a resident, now you're worried about getting tapped on the shoulder 'Oh would you mind? Pretty please!'"
"There is nothing else that goes off that resident's plate to accommodate that institutional service," Dyrbye says. "We speculate that it could be a bit too much for those residents it could contribute to some of their specialty choice regrets."
Dyrbye takes some comfort in knowing that, given the rigors of physician training, more than 50% of the survey respondents say they were happy.
"But we should be concerned about the prevalence of burnout. It shouldn't be that high," she says. "We know that burnout is associated with suboptimal patient care. If these resident physicians continue to struggle with symptoms of burnout, they are also more likely to quit or not see as many patients and that impacts all of our ability to access care."
