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Daily Briefing Blog

Boston Marathon: Horror, heroism, and takeaways for hospitals

April 21, 2014

Dan Diamond, Managing Editor

Even a year later, it's hard to find words to accurately capture last spring's terrible events at the Boston Marathon.

On the one hand, the day's horror is still fresh when looking at photos of wounded spectators or reading interviews with the surgeons who saved them. At the same time, there's already been so much coverage, and the Daily Briefing team discussed how best to sensitively cover the anniversary.

Health care providers say there's an important message that resonates in the community—a message that still needs to get out. Through providers' focus and perseverance, and bystanders who bravely became first responders, many critically injured patients were saved.

In the days after the marathon tragedy, doctors and hospital staff who lived through the week's events began to share their lessons: How they responded, why so many injured spectators survived the day, and what they hope providers will know to do differently. We captured some of those takeaways in articles for the Daily Briefing, and in several cases, spoke directly with participants.

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Women outnumber them 10:1. So why do male nurses get paid more?

April 10, 2014  | Comments (2)

Dan Diamond, Managing Editor

The gender gap in health care is well-documented. Male doctors get paid more than female doctors. Male researchers get more medical literature published than female researchers.

But looking at salary data, I learned something new on "National Equal Pay Day" this week: Even in nursing, which is dominated by women—male nurses are outnumbered almost 10:1—men make more. The average salary per year in 2011 was nearly $61,000 for a male nurse, and just $51,100 for a female nurse.

Drawing on Census data, you can see how this broke out across different levels of nursing. (Update: See comment here.)

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What it takes to qualify for Medicaid in each state

April 7, 2014

Juliette Mullin, Editor

As originally written, the Affordable Care Act (ACA) would have made every American under 138% of federal poverty level (FPL) eligible for Medicaid. It also would have downsized special Medicaid assistance for safety-net hospitals starting this year.

The reality is proving much more complicated.

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Health care still in 'slowth' mode

April 4, 2014

Dan Diamond, Managing Editor

Friday's jobs report had heartening news for the health care industry—and hospitals and home health in particular—but the latest economic estimates suggest that the sector's slowing growth continues.

According to the Bureau of Labor Statistics projections, health care added 19,400 jobs in March. And all of them—and then some—came at outpatient care employers and hospitals. How does that figure? Because the agency estimates:

  • Ambulatory care employers gained 19,500 jobs; and
  • Hospitals added 4,000 jobs; but
  • Nursing care facilities lost 4,100 jobs.

BLS also revised upward its January and February numbers, concluding that health care employers gained an extra 10,000-plus jobs those months.

New data not a cure-all—but does dull some pain for employers

Taken together, these latest hiring numbers suggest that health care jobs growth may not be slowing quite as rapidly as some have suggested. (Note Charles Roehrig's quote in this good Peter Orszag piece.) For example, December, January, and February had appeared to be the worst three-month hiring stretch that the health care sector had seen in years; it now appears that the period may have just been a mild trough.

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A look at hospital infection rates in your state

April 2, 2014

Juliette Mullin, Editor

CDC last week offered the most comprehensive look to date at health care-acquired infection rates. In a broad look at national rates published in NEJM, the agency revealed that one in 25 hospital patients acquires an infection during their stay in 2011. An alarming satistic—but it's getting better, says the agency.

A separate CDC report also released last week showed progress on most infections:

  • Central line-associated bloodstream infections (CLABSIs) decreased by 44% from 2008 to 2012;
  • Infections from common surgical procedures declined by 20% over the same period;
  • Hospital-onset MRSA bloodstream infections decreased by 4% from 2011 to 2012; and
  • Hospital-onset Clostridium difficile infections decreased by 2% from 2011 to 2012.

However, CDC did find an increase in the rates of catheter-associated urinary tract infections (CAUTIs), which rose by 3% from 2009 to 2012.

Take a more detailed look at the national data

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Obamacare is more than exchanges: A look at the law, in three charts

March 31, 2014

Dan Diamond, Managing Editor

The Affordable Care Act's first open enrollment period is closing down, and sign-ups in the exchanges are surging. And that's prompted a surge in assessments of whether the law's been successful, too.

But in too many places, pundits and politicians' focus on "grading Obamacare" has come down to simply grading exchange enrollment.

There are several problems with this approach.

First, it's too soon, as Charlie Ornstein points out at ProPublica. We still lack the full context and don't have the right metrics, like how many previously uninsured Americans used the exchanges to get coverage.

It's also too simple. Whether final exchange enrollment falls closer to the CBO's initial prediction of seven million sign-ups or nearer to its revised prediction of six million likely doesn't matter much for insurers, providers, or even the law's long-term success.

And, frankly, it's too easy. National enrollment figures are absolutely worth tracking, but the better story is a harder one: Delving into the trickier-to-figure-out aspects of the law.

Don't forget; the ACA isn't just insurance exchanges. Yes, the law has a comprehensive set of reforms intended to expand coverage—but also to lower cost and boost quality too, all part of the "affordable" and "care" elements of reformers' vision.

"The components of the Triple Aim are not independent of each other."

And these provisions are interwoven, perhaps more than is commonly acknowledged. "The components of the Triple Aim are not independent of each other," Don Berwick and two co-authors wrote in Health Affairs in 2008, laying out the philosophy that would come to underpin the ACA. "Changes pursuing any one goal can affect the other two, sometimes negatively and sometimes positively."

For example, the law's massive coverage expansion will likely end up increasing national health spending, which is currently growing at a historically slow pace. It could even harm care quality, if providers don't have enough capacity to promptly and comprehensively treat these new patients.

So how can we better understand Obamacare's launch? By quickly examining the following three provisions: Medicaid, ACOs, and readmissions. Each is getting much less press than the exchanges right now, but there's a pressing reason to focus on each.

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Not just physician pay: Three big changes included in the 'doc fix' deal

March 27, 2014  | Comments (3)

Juliette Mullin, Editor

Congressional leaders on Wednesday announced a bipartisan deal to avert a 24% reduction in Medicare doctor payments, which were slated to begin on April 1. The House passed the deal on Thursday, and the Senate is expected to vote on it Friday.

As of Daily Briefing press time on Thursday, it remained unclear whether the deal would be voted into law, with some lawmakers and industry groups mounting campaigns against it.

The bipartisan deal was brokered between House Speaker John Boehner (R) and Senate Majority Leader Harry Reid (D), and does not achieve the permanent reform that appeared within reach just a month ago. But in addition to averting a massive pay cut for doctors, the deal would bring three policy changes for providers: A delay to ICD-10, a postponement to Medicaid cuts for safety-net hospitals, and another change in the enforcement timeline of the controversial "two-midnight" rule.

As the Federation of American Hospitals CEO Chip Kahn puts it: "This is likely to be the last train out of town on Medicare changes for a while. That's why this was a train that has a lot of cars between the engine and the caboose."

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Justices hear case against the contraception mandate

March 25, 2014

Dan Diamond, Managing Editor

A seemingly divided Supreme Court on Tuesday heard arguments in Sebelius v. Hobby Lobby, a case that turns on whether the Affordable Care Act's contraception mandate is constitutional.

The case was something of a rematch of the battle over the ACA two years ago—the same panel of justices; the same prominent lawyers—if for smaller stakes this time. And it was incredibly fast-paced, with arguments touching on a range of legal opinion and law, but centering on the 1993 Religious Freedom Restoration Act.

Hobby Lobby's case

Paul Clement—who again represented a challenger to the law, albeit a different plaintiff than the National Federation of Independent Business—had barely begun his opening remarks before being aggressively questioned by Justices Sonia Sotomayor and Elena Kagan. The two justices were quickly joined by Justice Ruth Bader Ginsburg, and the three women combined to push Clement on a key issue: If the Court ruled for Hobby Lobby, what other procedures could qualify for religious exemptions? Vaccinations? Blood transfusions?

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