Skip to main content
The Keckley Report

Frontline Voices: What Artificial Intelligence and Value-based Models mean for Not-for-Profit Hospitals and Health Systems

By April 10, 2023No Comments

On Monday, April 3 in Chicago, 11 C suite executives from some of the most prestigious not-for-profit health systems in the country convened to discuss their future. The group included Chief Medical, Officers, Chief Strategy Officers, Chief Operating Officers and Chief Information Officers with broad responsibilities and much at stake.

Lumeris, the St. Louis based value-based enablement company (, convened the gathering—the 14th in its Frontline Voices listening tour. I served as Moderator. In this session, two topics were discussed: the current and future role generative AI will play in healthcare delivery, and prospects for pursuing value-based models in the near future.

Topic One: Generative AI and its Future in Health Delivery

Context: Although Artificial intelligence has been around for 50 years and has experienced several starts and stops, the last 5 to 10 years have seen a considerable uptick in adoption, especially in healthcare. It’s embedded now in machine learning that enables faster and more precise imaging studies, clinical decision support tools in electronic medical records systems and many more. In recent months, its potential to play a bigger role, possibly replacing physician judgement among others, has received added attention.

The November 2022, the announcement of OpenAI’s ChatGPT platform drew widespread attention with speculation it might displace clinicians in diagnosing and treatment planning for patients. On March 22, 2023, tech moguls Elon Musk, Steve Wozniak and Andrew Yang called for a 6-month moratorium on generative AI stating: “Should we develop nonhuman minds that might eventually outnumber, outsmart, obsolete and replace us? Should we risk loss of control of our civilization? We call on all AI labs to immediately pause for at least 6 months the training of AI systems more powerful than GPT-4.” (1)  To date, more than 13,000 have signed on to their appeal. Per Lumeris CTO Jean-Claude Saghbini “Putting aside our own opinions as to whether or not a moratorium should be implemented, our recent experience of the last three years in the inability to have effective cross-governmental alignment on policy to fight the COVID pandemic suggests that global alignment on AI policy will be impossible”.

There’s widespread belief generative AI and GPT-4 are game changers in healthcare. How, what, when and how much ($$$) are the big questions. The near-term issues associated with implementation–data-security, workforce usefulness, regulation, investment costs—are expected to be resolved eventually. Thus, it is highly likely that health systems, medical groups, health insurers and retail and digital health solution providers will operate in a widely-expanded AI-enabled world in the next 3-5 years.  

Questions: What role will AI and ChatGPT play in hospitals/health systems and other provider settings? Will development of AI systems more powerful than GPT-4 be suspended in response to the appeal? How is your organization preparing for the next wave of AI?

Key Takeaways from Discussion:

  • ‘Generative AI will not take the place of clinician judgement anytime soon. The processes of diagnosing and treating patients, especially complex conditions, will not be displaced. However, in primary and preventive health where standardization is more attainable, it will have profound impact perhaps sooner than in other areas.’
  • ‘GPT-4 et al will have profound impact on the delivery of healthcare and hospital operations, but there are many unknowns and risks associated with its use beyond routine tasks that can be standardized based on pattern recognition. ‘
  • ‘Continued development of platform solutions using GPT-4 and others in healthcare and other industries will accelerate. The moratorium will not happen. There’s too much at stake for investors and users.’
  • ‘Non-profit hospitals and health systems are struggling financially as a result of the supply and labor cost increases, declining reimbursement from payers and negative returns on investing activities (non-operating income). Caution is key, so AI-related investing will be conservative in the near-term. An exception would be AI solutions that mitigate workforce shortages or reduce administrative costs for documentation.’

Topic Two: Value-based Care

Context: Value-based care is widely accepted as key to the health system’s transformation. Changing provider incentives from volume to value and engaging provider organizations in risk-sharing models with payers (including Medicare) are means to that end. But implementation vis a vis value-based models has produced mixed results thus far and current financial pressures facing providers (esp. hospitals) have stymied momentum in pursuit of value in healthcare. Last week, CMS indicated it intends to continue its value-based insurance design (VBID) model which targets insurers, and last month announced continued commitment to its bundled payment and ACO models. But they’re considered ‘works in process’ that, to date, have attracted early adopters with mixed results.

Questions: What’s ahead for the value agenda in healthcare? Is it here to stay or will something replace it? How is your organization adapting?

Key takeaways from Discussion:

  • ‘Not-for-profit hospitals and health systems are fighting to survive: near-term investments in value-based models are unlikely unless they’re associated with meaningful near-term savings that hospitals and physicians realize. Unlike investor-owned systems and private-equity backed providers, NFP systems face unique regulatory constraints, increasingly limited access to capital hostile treatment in media coverage and heavy-handed treatment by health insurers.’
  • ‘Demonstrating value in healthcare remains its most important issue but implementing policies that advance a system-wide definition of value and business models that create a fair return on investment for risk-taking organizations are lacking. The value agenda must be adopted by commercial payers, employers and Medicaid and not limited to/driven by Medicare-alone.’
  • ‘The ACO REACH model is promising but hospitals are hesitant to invest in its implementation unless compelled by direct competitive threats and/or market share leakage. It involves a high level of financial risk and relationship stress with physicians if not implemented effectively.’
  • ‘Health insurers are advantaged over provider organizations in implementing value-strategies: they have data, control of provider networks and premium dollars.’
  • ‘Any and all value models must directly benefit physicians: burnout and frustration are palpable, and concern about income erosion is widespread.’
  • ‘Value in healthcare is a long-term aspirational goal: getting there will be tough.’

My take:

Hospitals, health systems, medical groups and other traditional providers are limited in their abilities to respond to opportunities in AI and value-based models by near-term operating margin pressures and uncertainty about their finances longer-term. Risk avoidance is reality in most settings, so investments in AI-solutions and value-based models must produce near-term ROI: that’s reality. Outsiders that operate in less-regulated environments with unlimited access to capital are advantaged in accessing and deploying AI and value-based model pursuits. Thus, partnerships with these may be necessary for most traditional providers.

AI is tricky for providers: integration of AI capabilities in hospitals and medical practices will produce added regulator and media scrutiny about data security and added concern for operational transparency. It will also prompt added tension in the workforce as new operational protocols are implemented and budgets adapted.  And cooperation with EHR platforms—EPIC, Meditech, Cerner et al—will be essential to implementation. But many think that unlikely without ‘forced’ compliance.

Value-based models: Participation in value-based models is a strategic imperative: in the near term, it adds competencies necessary to network design and performance monitoring, care coordination, risk and data management. Longer-term, it enables contracting directly with commercial payers and employers—Medicare alone will not drive the value-imperative in US healthcare successfully. Self-insured employers, private health insurers, and consumers will intensify pressure on providers for appropriate utilization, lower costs, transparent pricing, guaranteed outcome and satisfying user experiences. They’ll force consumerism and value into the system and reward those that respond effectively.

The immediate implications for all traditional provider organizations, especially not-for-profit health systems like the 11 who participated in Chicago last week, are 4:

  • Education: Boards, managers and affiliated clinicians need ongoing insight about generative AI and value-based models as they gain traction in the industry.
  • Strategy Development: Strategic planning models must assess the impacts of AI and value-based models in future-state scenario plans.
  • Capital: Whether through strategic partnerships with solution providers or capital reserves, investing in both of these is necessary in the near-term. A wait-and-see strategy is a recipe for long-term irrelevance.
  • Stakeholder Communication: Community leaders, regulators, trading partners, health system employees and media will require better messaging that’s supported by verifiable facts (data). Playing victim is not a sustainable communications strategy.

Generative AI and value-based models are the two most compelling changes in U.S. healthcare’s future. They’re not a matter of IF, but how and how soon.


PS The dueling U.S. District Court medication abortion decisions last Friday from the Northern District of TX banning the use of mifepristone (Miefprex) and, 2 hours later, the Eastern District of WA ruling that granted a preliminary injunction protecting its availability guarantee two unintended results: 1-the court-system will play a bigger role in conflicts between science and socio-political ideology and 2-the dispute about mifepristone will likely to find its way from District, to Circuit SCOTUS eventually. Then late Friday, the DOJ appealed the decision to the United States Court of Appeals for the Fifth Circuit. Attorney General Merrick Garland said the Department of Justice strongly disagreed with the decision. The judicial system’s role in healthcare going forward cannot be overlooked!

PPS: Next week’s Report (April 17) will be a special edition devoted to Executive Compensation in Healthcare: Facts, Trends, and Implications. It provides context to the heightened attention hospital CEO compensation is getting i.e. legislative proposals in CO and WA, recent media mentions of hospital CEO comp in NFP organizations, et al.

1-Elon Musk, Steve Wozniak, Andrew Yang et al “Pause Giant AI Experiments: An Open Letter”  Future of Life Institute


Re: VIVE Technology Conference Recap in Nashville last week: “Key generative AI applications in healthcare include care search and care coordination. True AI-driven care may take longer to reach critical mass as clinicians generally don’t want to be told want to do,   instead they prefer tools that bring information together. “Incentives” was the word of the week attendees debated how value-based care models can tilt the scale toward more efficient incentive structures…”

Recapping the 2023 ViVE Healthcare Technology Conference Pitchbook April 4, 2023

Re: the future for hospitals: “What do we want the end game to be for hospitals, with rising expenses and low political sympathy/appetite for support? I’m not a policy expert, but some fodder for discussion:

If you think hospitals should exist in the current status quo, then you should join the calls for increased government funding, higher payor reimbursement and support for hospital based care. On the other hand, if you think other care delivery models deserve to be supported amidst the secular shift to Medicare and outpatient care, then you should be asking hospitals to lean up, cut down on admin bloat, reign in executive pay, and focus on retaining & support of clinicians.”

Blake Madden Hospitals will have to want to evolve, though. And that evolution will be painful. Blake Madden “Key Takeaways: Why the answer on hospital losses is somewhere in the middle” WorkWeek April 6, 2023

 Re: workforce: “Young workers may not possess the experience or wisdom of their older colleagues. But they’ve always had one advantage in the workplace: their enthusiasm. Unattached and kid-free, they’re willing to burn the midnight oil. They have yet to grow bored or disgruntled. They’re full of hopes and dreams — and the naivete to drink the company Kool-Aid. That’s why they’ve traditionally been more involved in and excited about their jobs than their graying counterparts.

But since the pandemic hit, there’s been a startling shift. From 2019 to 2022, according to Gallup surveys, the share of people under 35 who reported being engaged with their jobs dropped from 37% to 33% — the lowest level since 2011. At the same time, the share who reported being “actively disengaged” rose to 17% from 12%. This rise in workplace disenchantment has been so powerful that it has virtually eliminated the old-young engagement gap. Gen Zers and young millennials, in other words, have soured on work just as much as everyone else.”

Aki Ito “Gen Z is sick and tired of their jobs: Young workers are now as disengaged as burned-out boomers” Business Insider April 3, 2023

Re: a plateau for health spending “Traditional expenditure analyses, like CMS’s, miss the dynamism that is changing healthcare’s underlying supply-demand relationships. This dynamism explains, for example, the push into healthcare by big retailers like Amazon. The market is reorganizing to offer higher-value, customer-friendly products and services. This is the real threat to status-quo provider and payer business models dependent upon fee-for-service (FFS)/administrative-services-only (ASO) contracting.

Expect healthcare’s share of the national economy to flatline or decline through the balance of the decade. This is good news for the U.S. economy and the American people. As a nation, we need less healthcare and more health…It’s time for the healthcare industry to clean up its act and address its dysfunction. Financial sustainability for hospitals and health systems must come from overhauling their bloated and ineffective business models. Health systems have a choice. In value there is salvation.”

David W. Johnson “A ‘Tough Love’ Message Healthcare Needs to Hear” 4Sight Health HFM Magazine April 2023

Re: artificial intelligence: “We firmly believe that the introduction of AI and machine learning in medicine has helped health professionals improve the quality of care that they can deliver and has the promise to improve it even more in the near future and beyond. Just as computer acquisition of radiographic images did away with the x-ray file room and lost images, AI and machine learning can transform medicine… AI and machine learning will not put health professionals out of business; rather, they will make it possible for health professionals to do their jobs better and leave time for the human–human interactions that make medicine the rewarding profession we all value.”

Haug, Drazen “Artificial Intelligence and Machine Learning in Clinical Medicine, 2023” March 30, 2023 N Engl J Med 2023; 388:1201-1208 DOI: 10.1056/NEJMra2302038

Re: longevity: “Imagine a world where age was truly but a number. Where centenarians are not just commonplace but nimble and healthy, maybe even still working…Such a world may not be so far away. Armed with increasingly powerful AI tools and a growing ability to analyze and manipulate genetics, more and more tech companies are taking a crack at selling longevity. Dreams of immortality aside, the prize for founders focused on providing services to live longer, healthier lives could be big — age-defying consumers would likely be a lucrative source of recurring revenue.”

CB Insights

Re: weight loss drugs: “People who are overweight are flocking to a drug called Ozempic to slim down, but looming is an even more powerful weight-loss treatment called Mounjaro… The Eli Lilly diabetes drug helped a typical person with obesity who weighed 230 pounds lose up to 50 pounds during a test period of nearly 17 months. No anti-obesity drug has ever safely made such a difference. In the coming months, it is widely expected to get the go-ahead from U.S. health regulators to be prescribed for losing weight and keeping it off, Mounjaro could be one of the highest-selling drugs of all time with annual sales exceeding $25 billion. One diabetes doctor called it a “King Kong” of diet drugs.”

Peter Loftus “The ‘King Kong’ of Weight-Loss Drugs Is Coming” Wall Street Journal April 3, 2023


Study: Hospital price transparency: Researchers analyzed prices reported by 2,379 hospitals as of September 9, 2022. Findings:

  • “On average, cash prices and commercial negotiated rates were 64% and 58% of the corresponding chargemaster prices for the same procedures at the same hospital and in the same service setting, respectively.
  • Cash prices were lower than the median commercial negotiated rates in 47% of instances, and most likely so at hospitals with government or nonprofit ownership, located outside of metropolitan areas, or located in counties with relatively high uninsurance rates or low median household incomes.
  • Hospitals with stronger market power were most likely to offer cash prices below their median negotiated rates, whereas hospitals in areas where insurers had stronger market power were less likely to do so.”

Wang et al “The Relationships Among Cash Prices, Negotiated Rates, And Chargemaster Prices For Shoppable Hospital Services” Health Affairs April 2023

Study: transactions: involving nonprofit rural hospitals: Researchers assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010–18, focusing on hospitals that were unprofitable at baseline. Findings:

  • 7% closed. 17% merged, most commonly with organizations from outside of their local geographic market. 77% continued to operate through 2018 without closure or merger. with half returning to profitability.
  • At the market level, 22% of markets served by unprofitable hospitals lost a competitor to closure or within-market merger. Out-of-market mergers affected 33% of markets with an unprofitable hospital.

Carroll et al “Hospital Survival In Rural Markets: Closures, Mergers, And Profitability”  Health Affairs April 2023

Fitch: 2023 a “make-or-break year” for hospitals: Based on its analysis of 80 nonprofit hospitals’ creditworthiness for the first half of 2021 versus the first half of 2022:

  • For the six months ended June 30, labor costs as a percentage of total revenue increased to about 56% 2022 from 53% in the first six months of 2021.
  • Revenue growth for the six months ended June 30 was 6.2% but costs increased by 10.5%.

John Holloran Fitch Ratings April 5, 2023

Study: Hospital data security lacking: UPenn researchers analyzed data transfers to third parties on a census of US nonfederal acute care hospital websites. Findings:

“We found that third-party tracking is present on 98.6% of hospital websites, including transfers to large technology companies, social media companies, advertising firms, and data brokers. Hospitals in health systems, hospitals with a medical school affiliation, and hospitals serving more urban patient populations all exposed visitors to higher levels of tracking in adjusted analyses.

By including third-party tracking code on their websites, hospitals are facilitating the profiling of their patients by third parties. These practices can lead to dignitary harms, which occur when third parties gain access to sensitive health information that a person would not wish to share. These practices may also lead to increased health-related advertising that targets patients, as well as to legal liability for hospitals.”

Friedman et al Widespread Third-Party Tracking On Hospital Websites Poses Privacy Risks For Patients And Legal Liability For Hospitals Health Affairs April 2023

Study: Hospital performance ratings when MA enrollees included: Researchers analyzed the impact of including MA beneficiaries in readmission and mortality measures reclassifies hospital performance rankings compared with current measures. Findings:

“Of the hospitals in the top-performing quintile for readmissions and mortality based on FFS beneficiaries, between 21.6% and 30.2% were reclassified to a lower-performing quintile with the inclusion of MA beneficiaries. Similar proportions of hospitals were reclassified from the bottom performance quintile to a higher one across all measures and conditions. Hospitals with a higher proportion of MA beneficiaries were more likely to improve in performance rankings.”

Oseran et al “Effect of Medicare Advantage on Hospital Readmission and Mortality Rankings” Annals of Internal Medicine April 4, 2023

Joint Commission: Hospital sentinel events up: The Joint Commission found that of all reported sentinel events in 2022, 44 % resulted in severe temporary harm and 20% resulted in a patient death. There were 1,441 reports of sentinel events in 2022, up 19% from 2021– above pre-pandemic levels. The top category of sentinel events was falls (42%).

Joint Commission” The Joint Commission releases sentinel event data on serious adverse events at U.S. healthcare organizations” April 4, 2023

Study: Nonprofit hospitals that pay board members provide less charity care: Hopkins researchers analyzed the correlation between non-profit hospital trustee compensation and charity care. Findings:

  • Among all nonprofit hospitals, more than 37% compensated their board members in 2019.
  • From 2011 to 2019, nonprofit hospitals that paid board members increased compensation by 57 %, rising from $31,964 to $50,156.
  • The average amount of charity care provided by nonprofit hospitals was $6.6 million in 2019.
  • On average, a $10,000 increase in average board member compensation was linked with a nearly $70,000 decrease in annual provided charity care.
  • From 2011 to 2019, average charity care-to-expense ratio for nonprofit hospitals that paid board members decreased from 2.5% to 1.6%. For non-paying hospitals, the ratio fell from 2.5%t to 2.2 %on average during the same period.

Bai et al Trustee Compensation and Charity Care Provision In US Nonprofit Hospitals Health Affairs April 3, 2023

Health Insurance

Study: Impact of MA enrollment growth on quality and utilization: Researchers compared quality and utilization measures in Medicare Advantage and traditional Medicare comparing i2010 and 2017. Findings:

  • Clinical quality performance was higher in MA health maintenance organizations (HMOs) and preferred provider organizations (PPOs) than in traditional Medicare for almost all measures in both years.
  • MA HMOs outperformed traditional Medicare on all 7 measures in 2017. MA PPOs performed the same as or better than traditional Medicare on all but one patient-reported quality measure in 2010 and 2017.
  • The number of emergency department visits was 30% lower, the number of elective hip and knee replacements was approximately 10% lower, and the number of back surgeries was almost 30% lower in MA HMOs than in traditional Medicare in 2017. Utilization trends were similar in MA PPOs, but differences from traditional Medicare were narrower.

“Despite increased enrollment, overall utilization remains lower in Medicare Advantage than in traditional Medicare, whereas quality performance is the same or higher.”

Landon et al “Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017 Health Affairs April 2023

Commonwealth uninsured breakdown for U.S. adults ages 19–64 in 2021: The proportion of uninsured populations in Medicaid expansion states is double that of rates in expansion states:

  • All adults: Expansion states (9.1%) vs. non-expansion (18.0%)
  • All Black adults: Expansion states 9.4% vs. non-expansion 18.2%
  • All Hispanic adults: Expansion: 19.2% vs. Non-expansion 33.9%
  • All White adults: Expansion states: 6.2% vs. non-expansion 12.5%

Commonwealth Fund, Inequities in Health Insurance Coverage and Access for Black and Hispanic Adults, March 2023

RWJ: Health exchange premiums up:  Monthly health insurance premiums for ACA benchmark plans increased by an average of 3.4% in 2023 vs. average benchmark premiums that decreased by an average of 2.2% annually from 2019-2022. Premiums were an average of $128 higher in regions where only one payer offered ACA plans than in those where five or more insurers offered plans. States that expanded Medicaid eligibility requirements saw smaller premium increases

“Changes in Marketplace Premiums and Insurer Participation, 2022-2023” RWJF April 3, 2023

Prescription Drugs

SSR Study: Drug prices down after adjusting for inflation:

  • Wholesale drug prices up by 5% in 4Q 2022 last year, up from 4.3% a year earlier and 4.9% in the previous quarter but adjusted for inflation, down by 3%.
  • Net prices health plans paid for medicines — after subtracting rebates, discounts, and fees — dropped by 0.4% but adjusted for inflation were down 8.5%. considering inflation, net prices actually fell 8.5%, compared with 8.2% in the third quarter of 2022.

SSR Health


Gallup: loneliness down from pandemic: 17% of surveyed Americans experienced loneliness “a lot of the day yesterday,”– down from a high of 25% amid COVID lockdowns.

“Loneliness in U.S. Subsides from Pandemic” High Gallup April 4, 2023

Morning Consult: Majority disagree with Tx Judge ruling on ACA preventive health: A decision from District Court Judge Reed O’Connor in Texas last week to strike down an Affordable Care Act requirement for health plans to cover certain preventive services at no cost is unpopular with voters. Per Morning Consult’s poll of 2200 U.S. adults conducted March 31-April 2:

  • 50% said they either “strongly” or “somewhat” disapprove of O’Connor’s ruling, 28% said they approve of the decision and 22% said they do not know or have no opinion.
  • A majority of Democrats (55%) and independents (51%) disapprove of the ruling, as do a plurality of Republicans (40%). Notably, an equal share of Democrats and Republicans (33%) said they approve of O’Connor’s decision. Among independents, 1 in 6 said they approve of the decision and nearly 1 in 3 said they do not have an opinion.
  • Among all adults, 37% said they “definitely” or “probably” expect to delay or avoid health care due to potential costs following the ruling, while 41% said they do not expect to skip care and 22% said they do not know.
  • Among all adults, 42% said federal judges in general have too much power, 27% said they have the right amount of power and just 4% said they don’t have enough power

“A Federal Judge’s Ruling to Block ACA Requirement for No-Cost Preventive Care Is Unpopular” Morning Consult  April 5, 2023

The Economy

Federal Spending on Health Programs and Services (fiscal year 2022): Per the Kaiser Family Foundation:

  • Federal spending on health programs and services accounted for 30% of net federal spending in fiscal year 2022 – or $1.7 trillion out of a total of $5.9 trillion.
  • Major programs: Medicare: $760.9B (13%), Medicaid and CHIP*: $578.5B (10%), Other Health (non-Medicare): $290.0B (5%), Veterans’ Hospital and Medical Care: $103.5B (2%), & Global Health: $8.1B (0.1%)

KFF, As Debate Heats Up in Washington Over Possible Entitlement Cuts, A New KFF Analysis Details the 30% of Federal Spending That Goes to Health Care Programs, March 1, 2023


Signals: Economy stabilizing: Reports from the Departments of Labor, Commerce and Morning Consult last week indicate the economy may be stabilizing:

  • The Labor Department reported there were a seasonally adjusted 9.9 million job openings in February–down from January’s downwardly revised 10.6 million. And below the record 12 million reached in March 2022.
  • The Commerce Department reported that new orders for manufactured goods fell a seasonally adjusted 0.7% in February from the previous month. Tuesday’s manufacturing figures came a day after a March survey of purchasing managers by the Institute for Supply Management pointed to the fifth straight month of contraction in the U.S. manufacturing sector, partly due to the effect of higher interest rates.
  • And Morning Consult reported “The share of U.S adults reporting lost pay or income fell from 9.7% in February to 9.5% in March, reflecting the resilience of the U.S. labor market. The incidence of income losses was relatively low across industries tracked by Morning Consult Economic Intelligence…As of March 25, 20.2% of all employed adults and 22.0% of prime-age employed adults were actively applying for new positions…. While these companies continue to increase headcounts for now, the pace is slowing and hiring plans are considerably less ambitious than they were in Q3 2022.”

US Department of Labor

US Department of Commerce

Despite Economic Uncertainty, the Labor Market Shows Few Signs of Weakness (Report Preview) Morning Consult April 5, 2023

Direct Care Workforce stats: in the United States: Direct care workers assist older adults and
people with disabilities with essential daily tasks and activities across a range of long-term care settings. Current stats:

  • Home Care Workers –2.6 million
  • Residential Care Aides–647,500
  • Nursing Assistants in Nursing Homes–471,000

“Over the past decade, the direct care workforce added nearly 1.5 million new jobs, growing from 3.2 million workers in 2011 to 4.7 million in 2021.2 This trend is expected to continue, with the direct care workforce projected to add approximately 1.2 million new jobs from 2020 to 2030—more new jobs than any other single occupation in the country…Wages remain low—the median hourly wage for direct care workers was just $14.27 in 2021.”


Challenger & Gray: Healthcare job cuts in 1Q 2023: All U.S.-based employers announced a combined 270,416 cuts in the first quarter of 2023, up 396% from the 55,696 cuts announced in the same period one year prior and the highest first-quarter total recorded since 2020. The healthcare industry announced the third-most job cuts out of 30 industries and sectors measured in the first quarter of 2023. Healthcare, which includes hospitals and healthcare products manufacturers, announced 22,950 cuts in 1Q 2023– a 65% increase from the 13,923 cuts announced in the first quarter of 2022.

Job Cuts Rise 15% in March, up 319% from Same Month Last Year, Highest Q1 Since 2020” CHALLENGER REPORT March 2023

Population Health

Study: moderate alcohol consumption not associated with increased all-cause mortality risk: The Canadian research team conducted a systematic review and meta-analysis of 107 cohort studies published between 1980 and 2021 involving more than 4.8 million participants to determine the association between moderate alcohol consumption and all-cause mortality. Findings:

Conclusions and Relevance:  In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk, while increased risk was evident at higher consumption levels, starting at lower levels for women than men.”

Zhao “Association Between Daily Alcohol Intake and Risk of All-Cause Mortality A Systematic Review and Meta-analyses” JAMA Network Open March 31, 2023;6(3):e236185. doi:10.1001/jamanetworkopen.2023.6185


Physician comp trends: Per Medscape’s “Physician Compensation Report 2022”:

  • Primary care physicians earned an average of $260,000 in 2022, with specialists earning an average of $368,000.
  • Physician pay decreased for four specialties from 2021 to 2022 — interventional cardiology, hematology, radiology and pediatrics — and increased for eight specialties — OB-GYN, anesthesiology, non-invasive cardiology, neurology, gastroenterology, orthopedic surgery, urology and internal medicine.
  • The average salary of a chief medical officer in the U.S. is $447,344 per year: The bottom 10% of CMOs make $341,090 annually. vs. top 10% at $587,024.

Medscape’s “Physician Compensation Report 2022”:


Bill to link physician fee schedule to Medicare rate changes: On Monday, Rep. Raul Ruiz (D-Calif.) introduced the “Strengthening Medicare for Patients and Providers Act,”  which links the Medicare Physician Fee Schedule to the Medicare Economic Index — a measure of inflation physicians are subjected to that relates to practice costs and wage levels. In the bill, physician payment updates in the Medicare Physician Fee Schedule would be based on a single conversion tied to the HHS Secretary’s estimated % increase in the Medicare Economic Index beginning in 2024.

H.R.2474 – To amend title XVIII of the Social Security Act to provide for an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index

CMS Issues Final Rule on Prior Authorizations: Last Wednesday, CMS issued a final rule that limits Medicare Advantage prior authorizations that providers say restrict their access to care. The rule:

  • limits the use of coordinated care MA plans’ prior authorization policies to confirming the presence of diagnoses or other medical criteria and/or ensuring that an item or service is medically necessary,
  • prohibits coordinated care MA plans from requiring prior authorizations for an active course of treatment for at least 90 days when a patient switches MA plans,
  • requires all MA plans to establish utilization management committees to ensure consistency with Traditional Medicare’s national and local coverage decisions and guidelines, and
  • requires that prior authorization approvals remain valid “for as long as medically reasonable and necessary to avoid disruptions in care in accordance with applicable coverage criteria, the patient’s medical history, and the treating provider’s recommendation.”

CMS April 5, 2023