In recent months, compensation for hospital CEOs has received heightened attention among regulators, policymakers, academic researchers and in media:
- On August 25, 2022, the SEC adopted final rules requiring public companies to disclose the relationship between the executive compensation actually paid to the company’s named executive officers (NEOs) and the company’s financial performance. (Pay for Performance)
- Glass Lewis published its “2023 Policy Guidelines for the United States” in November 2022, which included the following compensation updates in effect for the 2023 proxy season including a limit on severance packages exceeding 2.99X the executive’s base salary + bonus. For the 2023 proxy season, ISS issued similar guidance to publicly traded companies also calling for greater transparency about details of executive pay packages for shareholders.
- In Washington, State Sen. Randall introduced SB 5767 to tax hospital executive compensation when an individual is paid more than 10 times the average annual salary. In CA, a ballot measure backed by SEIU-United Healthcare Workers West would cap pay for hospital executives at the compensation of the U.S. president, or $450,000 per year. The California Hospital Association is challenging the measure arguing the President makes more.
- In North Carolina, State Treasurer Dale Folwell (R) called out CEO compensation in the state’s 9 not-for-profit health systems declaring “This is the biggest transfer of wealth in our generation, and it’s being financed disproportionately on the backs of sick, low- and fixed-income people. These nonprofit hospital executives have lost their mission. They are supposed to make people better, not make themselves richer.”
- The NY Times profiled business practices in prominent NFP health systems including CEO pay in a January 2023 article “How Non-Profit Hospitals Put Profits over People” in which system CEO comp is referenced.
- A February 2023 Health Affairs article called-out the pay-disparity between hourly workers and CEO’s in NFP systems.
- Per Siemier Brossy’s latest report, 97.2% of shareholder “say on pay” referenda passed among Russell 3000 companies last year with the majority getting more than 70% of votes cast
- And so on.
Why the sudden attention on hospital CEO pay? The impetus is multi-faceted:
- Growing public contempt for “Big Business” accompanied by declining trust in the medical system (Gallup)
- Increased shareholder demand for ‘Say on Pay’ for executive compensation plans (Institutional Shareholder Services)
- Increased regulatory scrutiny of not-for-profit hospital tax exemptions and executive compensation (NC)
- Growing public concern about healthcare affordability as lingering inflation takes its toll on working Americans (Kaiser Family Foundation Tracking Poll)
- Intensifying disputes between health insurers and hospitals wherein hospital Exec Comp is called out for excessiveness. (AHIP).
- Labor union campaigns that contrast hospital workforce median pay to CEO pay. (SEIU)
- Physician organizations that compare CEO compensation to physician income (Physician median is $433K vs. $1M or more for CEOs in hospitals with more than $1 billion revenues).
- Privately funded activist organizations that campaign against hospitals with particular disdain for Exec Comp along with pervasive waste in hospital operations. (Lowe Institute, Arnold Ventures)
- And more.
The Facts are these: In preparing this report, I sought out data in the public domain to determine objectively the status of current hospital CEO compensation. It’s not easy to find, and even harder to compare to other industries. As reflected in my resources (below), my conclusions are based on publicly accessible reports as well as proprietary data obtained through Sullivan Cotter. Here’s what I conclude:
1-Verifiable data about hospital CEO pay is hard to come by. The examples below illustrate discrepancies in reports of hospital CEO median base salary:
- Glassdoor: $119,939 (9/22/2022)
- com $187,012 (Range $132,208- $257,258) (3/28/2023)
- Modern Healthcare/Sullivan Cotter: $409.5K ($330.1K to $1,703.4M depending on size) (2022)
- Bureau of Labor Statistics: $179,520 (May 2021)
Complicating matters, ranges vary significantly, benefits i.e. auto allowances, club dues et al are not included and the timeliness of source data is inconsistent. For non-profit hospitals, form 990 filings are frequently 2-years old and sometimes incomplete. For-profit systems’ proxy statements are helpful for system-level CEO comp packages but FP hospitals owned by private equity do not disclose Exec Comp data. Except for the biggest hospital systems–not-for-profit, government and for-profits—CEO comp disclosures are hard to find. –
2-Hospital CEOs earn more than peers in most-other healthcare and business settings. As an industry, healthcare pays well per BLS. Of the 3.4 million CEOs in the U.S. economy, 3% are in healthcare health delivery and 7,000 run hospitals.
- Per the Bureau of Labor Statistics, median CEO hospital base compensation is 30% higher than Chief Executives officers in other industries.
- Per Modern Healthcare, median hospital CEO compensation correlates directly with the organization’s size (no. of hospitals) ranging from $551K for a one-hospital organization to $1.9M for an 11-hospital organization.
- Non-profit hospital CEOs are paid considerably more than their counter-parts in other comparably-sized non-hospital, non-profit organization (like foundations, trade associations, government agencies et al).
- For-profit hospital CEOs earn considerably more in long-term compensation due to equity awards (stock) and less in short-term base compensation compared to not-for-profit CEOs.
3-Not-for-profit health system CEOs that lead the largest organizations earn less than CEOs in comparably sized publicly traded organizations and less compared to for-profit hospital system CEOs. The differences are significant:
- Per Sullivan Cotter’s proprietary analysis which compared the 10 biggest NFP system CEO pay packages to 12 non-hospital private sector companies of similar size: NFP Total Comp $5.9M ($2.5M base+ $3.4M long-term) vs General Industry Median Total Compensation $15.5 million (Base $1.4 Million + $14.1 Short Term, Long Term and Equity). Ratio Difference: 1 to 2.6
- Comparing the same 10 NFP hospital systems to the 4 largest Investor-owned hospital systems (HCA, UHS, Tenet, CHS): NFP Total Comp $5.9M ($2.5M base+ $3.5M long-term) vs. total comp $18.2 million ($3.8 short term cash + bonus plus long-term $14.4 million including equity). Ratio Difference: 1 to 3.1
- Note: Neither comparison includes benefits i.e., Supplemental Retirement Benefits and other perks.
- Only one of the 10 highest paid CEOs in healthcare is a health system CEO: Sam Hazen, HCA. The rest are insurers and drug company CEOs.
Interest in CEO pay generally, and in hospital CEO pay specifically, is understandable. Per the Economic Policy Institute, the ratio of CEO pay to average worker pay across all industries reached 399 to 1 in 2020—up from 61 to 1 in 1990. It’s increased 1460% since 1978 while the stock market has grown 1063%. That disparity is drawing attention to CEO pay in every industry.
The public believes it has a right to know, but boards of directors have been responsive to the minimal extent of regulatory compliance rather than the broader obligation of transparency. Hospitals are no exception. The myriad of stakeholder groups with whom hospitals engage–physicians and hospital employees, insurers, employers, drug and device manufacturers, suppliers, lenders and regulators—expect to know. The bigger the organization—not-for-profit or for-profit—the higher the expectation.
The burden falls on Boards to bolster messaging to address transparency concerns, misinformation and disinformation on a broad range of issues including CEO pay. It falls on the Board compensation committees to justify adjustments to compensation that address the long-term sustainability of the organization, incorporating measures in addition to financial performance in evaluating the CEO’s performance. And increasingly, the relationship between the CEO’s pay to the short and long-term performance of the organization and to the “average worker’s pay” will be closely scrutinized.
In not-for-profit hospital and health systems, the burden is even higher. CEO pay is one of four indicators on which NFP critics base allegations that the pursuit of profit and corporatization has displaced their mission and purpose. It is certain to be mentioned as Provider Relief Payments and overall hospital finances are debated in forthcoming House Oversight Committee hearings.
As reflected in media coverage and in regulatory activity, NFPs are scrutinized for: 1-Patient debt collection policies, 2- the relationship between tax exemptions and community benefits, 3- the appropriateness of their investments in “non-core” businesses to generate non-operating income, and 4-CEO comp.—the Big Four. Being “not-for-profit” suggests to some that these hospitals operate differently and profit is subordinate to mission and purpose. But critics argue CEO pay-packages reflect otherwise.
The facts above show hospital CEOs are well paid, especially those who work in investor-owned systems where equity awards drive short and long-term comp. No one discounts the unique complexities of the hospital setting nor the economic, regulatory and social constraints under which they operate. The CEO job is tough: the questions being raised are about ‘how much is too much. and ‘does not-for-profit status’ mean anything beyond tax status.
It is unlikely the spotlight on hospitals will dim nor will interest in the compensation for their CEOs wane. It is for Boards and their Comp Committees to reflect, assess and act: everyone else is watching.
Semler Brossy’s report “2022 Say on Pay & Proxy Results”
Glass Lewis’ “2023 Policy Guidelines — United States” (November 18, 2022) and “2023 Policy Guidelines — ESG Initiatives” (November 18, 2022).
Willis Towers Watson’s report “U.S. Executive Pay Votes — 2022 Proxy Season Review
CEO pay has skyrocketed 1,460% in 1978 Economic Policy Institute October 4, 2022 ww.epi.org/publication/ceo-pay-in-2021
“How Nonprofit Hospitals Put Profits Over Patients” New York Times January 25, 2023 https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonprofit-hospitals
Why Are Nonprofit Hospitals So Highly Profitable? NY Times February 20, 2020 www.nytimes.com /2020/02/20/opinion/nonprofit-hospitals.html
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Top Executives,
at https://www.bls.gov/ooh/management/top-executives.htm (visited March 16, 2023)
Not-For-Profit Health Care and General Industry Public Company Compensation Comparisons Sullivan Cotter April 11, 2023 www.sullivanc February 20otter.com
Compensation of CEOs at nonprofit hospitals Cause IQ www.causeiq.com/insights/compensation-of-ceos-at-nonprofit-hospitals
Treasurer Folwell Hosts Press Conference Exposing N.C. Nonprofit Hospitals’ Extravagant Executive Pay State of NC Treasurer’s Office February 15, 2023
The Highest Paid Nonprofit CEOs Cause IQ www.causeiq.com/insights/highest-paid-nonprofit-ceos
Nonprofit Hospital CEO Compensation: How Much Is Enough? Health Affairs February 10, 2022 www.healthaffairs.org/do/10.1377/forefront.20220208.925255
Quotable from Last Week
Re: the hospital operating environment:” Most of us have operated our hospitals in a peacetime environment but today we face a wartime environment”
Joe impicciche, CEO Ascension speaking at the Scottsdale Institute Wednesday, April 12, 2023
Re: hospital strategy: “It is simply mind-boggling how delivery organizations, including some of the most renowned academic medical centers in the country, have failed to come to grips with the sobering reality that holding on tight to a FFS model – that has failed them and the patients they serve at every level – is no longer a sustainable course. Now, if they don’t course correct on their own, change will be thrust upon them, whether they like it or not. The winds of change have been building for years.”
‘Houston, We Have a Problem’: Abandoning Their Mission, Nonprofit Hospitals Have Veered Far Off Course Forbes April 14, 2023/www.forbes.com/sites/ritanumerof/2023/04/14/houston-we-have-a-problem-abandoning-their-mission-nonprofit-hospitals-have-veered-far-off-course
Re: consumer health product marketing penalty notice: “As set forth in more detail in the Endorsement Notice, such unlawful acts and practices include: falsely claiming an endorsement by a third party; misrepresenting that an endorsement represents the experience or opinions of product users; misrepresenting that an endorser is an actual, current, or recent user of a product or service; continuing to use an endorsement without good reason to believe that the endorser continues to hold the views presented; using an endorsement to make deceptive performance claims; failing to disclose an unexpected material connection with an endorser; and misrepresenting that the experience of endorsers are typical or ordinary. Note that positive consumer reviews are a type of endorsement, so such reviews can be unlawful if they are fake or if a material connection is not adequately disclosed.” L
Letter from FTC to 670 companies that produce OTC remedies April 13, 2023 www.ftc.gov/system/files/ftc_gov/pdf/Sample-cover-letter-substantiaton
Re: Value-based purchasing:” … research shows that physician interest in VBC is high, but risk appetite is still a work in progress. It’s true that the performance of participants in value-based models has varied. The number of accountable care organizations (ACOs) plateaued at around 1,000 in recent years, while 15 of the 53 entities participating in CMS’s direct contracting program in 2021 experienced net savings losses.”
Welcome Letter: Healthcare Private Equity Is Down but Not Out Bain April 10, 2023 www.bain.com/insights/welcome-letter-global-healthcare-private-equity-and-ma-report-2023/
Re: academic medicine: “I think that you’ll see continued and increased pressure on academic health systems to behave as if they’re non-academic health systems. Words that academic health systems don’t really understand—diabetes care, digital front door—we’re going to have to become increasingly familiar with to stay competitive and have patients come to us. I talk a lot about the indigent patients and these complex coronary patients, but the majority of the patients we take care of are in between. If we don’t have [the in-between] patients to take care of, then we’re not going to be ultimately successful.”
Craig Kent, MD, CEO of UVA Health and EVP Health Affairs University of Virginia. Modern Healthcare April 12, 2023 www.modernhealthcare.com/mergers-acquisitions/uva-health-looks-grow-and-diversify-revenue
Re: bundled payments program savings: “This study found that reconciliation payments paid to hospitals and physician groups in the BPCI-A program were large and would require substantial clinical spending reductions for CMS to break even. Such reductions in clinical spending—ranging from 3.7% to 8.2%—are much higher than the 0.53% reductions observed in the first 2 performance periods of the BPCI-A1 and are generally higher than the 3.8% reductions observed in evaluations of bundled payments for joint replacement.2–4 Reconciliation payments were too high because target prices were mis-calibrated and too easily achieved.1 Reconciliation payments may have been relatively higher in performance period 3 due to decreases in utilization of post-acute care during the COVID-19 pandemic.”
Ryan et al “Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses” JAMA April 11, 2023 2023;329(14):1221-1223. doi:10.1001/jama.2023.1435
Avelere Survey: Payers’ Use of Outcomes-based Contracts: Avalere Health conducted it online from February 14 to February 20 and receiving responses from 46 health plans. Highlights:
- About 58% of health plans had at least one outcomes-based contract for prescription drugs in 2022, an Avalere Health survey found. More than 35% had more than 10 outcomes-based contracts in 2022.
- About 58% of payers had at least one outcomes-based contract with a pharmacy benefit manager for prescription drugs in 2022, according to a survey published last week.
- Of the payers that had at least one outcomes-based contract, more than 35% had more than 10 outcomes-based contracts in 2022. Another 10% of payers had five to 10 contracts, and a little over 10% had two to five contracts. About 15% had no contracts, but were in negotiations for one or more. Less than 10% had no contracts and were not planning on taking any on.
Survey Finds 58% of Payers Use Outcomes-Based Contracts | Avalere Health April 5, 2023
UnitedHealth reports strong financial results: Highlights from Friday’s earning call:
- UnitedHealth Group reported a $5.6 billion first quarter profit and revenues up 15% to $92 million in the quarter thanks to “diversified double-digit growth at both Optum and UnitedHealthcare.”
- The UnitedHealthcare insurer’s net income rose 14% to $4.3 billion, driven by increased membership and slow recovery of non-urgent procedures. Revenue grew 13% to $70.5 billion. The insurer counted 52.8 million members this year, up 3.7% from 50.9 million.
- Optum’s net income increased 19% to $3.7 billion on revenue growth of 25% to $54.1 billion, primarily due to more patients visiting OptumHealth clinics and growth in OptumRx pharmacy scripts processed.
- Optum expects to add 10,000 physicians this year having recently announced acquisitions of Crystal Run Healthcare-NY (400 providers) — significantly more than St. Louis-based Ascension (49,000), Nashville, Tenn.-based HCA (47,000) and Oakland, Calif.-based Kaiser Permanente (24,000).
UnitedHealth First-Quarter Earnings, Revenue Up as Company Added Members WSJ April 14, 2023 ww.wsj.com/articles/unitedhealth-unh-q1-earnings-report-2023
Healthcare in the Courts
Update: Medication abortion pill judicial challenges:
- On Friday, April 7, Texas federal judge Matthew Kacsmaryk orderedthe Food and Drug Administration (FDA) to rescind its approval of mifepristone, a drug widely used in medication abortions. Later that day, Washington state federal judge Thomas Rice issued a conflicting ruling that forbade the FDA from rescinding approval in the 17 states and the District of Columbia where Democratic lawmakers have sued to protect access to the drug.
- On Wednesday, April 12, the Fifth Circuit Court of Appeals ruled that mifepristone could remain partially available while the Texas case proceeds through the courts—but rolled back more recent decisions issued by the FDA which have made the drug easier to obtain and use, including mail-order access. On Thursday, April 13, the Justice Department announced on Thursday that it was seeking emergency Supreme Court intervention, and Judge Rice issued a ruling on Thursday compelling the FDA to preserve full access to mifepristone in the plaintiff states.
- On Friday, April 14, 2023 the Supreme Court stayed the lower court’s ruling, restoring full access to mifepristone temporarily, to give the justices until Wednesday to resolve the matter. U.S. Supreme Court Justice Samuel Alito on Friday temporarily halted lower court rulings that set limits on access to the abortion pill mifepristone, giving the nation’s top judicial body time to weigh a bid by President Joe Biden’s administration to defend the drug amid a challenge by anti-abortion groups.
What the Supreme Court’s decision in the legal fight over abortion pills means for access to mifepristone NBC News April 14, 2023 www.nbcnews.com/health/womens-health/abortion-pill-lawsuit-mifepristone-questions-future-access
House Oversight Committee seeks accountability for hospital provide relief funding: In 2021, $178 billion was approved for the Provider Relief Fund to assist low-income hospitals struggling through the pandemic. A December article from The Wall Street Journal prompted Congress to look into where that money went, and why.
“We are concerned about HHS’s decisions to provide PRF funds to highly profitable hospitals in wealthy areas while rural hospitals risked going bankrupt as they tried to provide care to Americans in need,” the committee wrote in an April 11 letter to Xavier Becerra, HHS’ secretary.
According to the letter, 1,257 hospitals that collectively reported $53.6 billion in profits received $16.7 billion from the PRF. Meanwhile, 1,644 hospitals that reported a collective $129.1 billion loss received $35 billion during the same time period.
Comer & Langworthy Launch Investigation into HHS’s Failure to Provide COVID Relief Funds to Low-income Hospitals April 11, 2023 https://oversight.house.gov/release/comer-langworthy-launch-investigation-into-hhss-failure-to-provide-covid-relief-funds-to-low-income-hospitals
Study: third party tracking significant risk to hospital data: “We determined the presence of potentially privacy-compromising data transfers to third parties on a census of US nonfederal acute care hospital websites…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
And Legal Liability For Hospitals Health Affairs April 2023 No Access https://doi.org/10.1377/hlthaff.2022.01205
Kaufman Hall’s National Hospital Flash Report: “The median US hospital has now maintained a negative operating margin for a full year. Some good news may be on the horizon, as the picture is slightly less gloomy than a year ago, with year-over-year revenues increasing seven points more than total expenses. However, the external conditions suppressing operating margins aren’t expected to abate, and many large health systems are still struggling. Among large national non-profits Ascension, CommonSpirit Health, Providence, and Trinity Health, operating income in FY 2022 decreased 180% on average, and investment returns fell by 150 %on average, compared to the year prior. While health systems’ drop in investment returns mirrors the overall stock market downturn, and is largely comprised of unrealized returns, systems may not be able to rely on investment income to make up for ongoing operating losses. “
“Overall, 42% of hospitals reported observing some behavior they perceived to be information blocking. 36% of responding hospitals perceived that healthcare providers either sometimes or often engaged in practices that may constitute information blocking, while 17% and 19% perceived that health IT developers (such as EHR developers) and State, regional and/or local health information exchanges did the same, respectively. Prevalence varied by health IT developer market share, hospital for-profit status, and health system market share.”
Iverson et al “Experiences with information blocking in the United States: a national survey of hospitals” Journal of the American Medical Informatics Association, April 8, 2023 ocad060, https://doi.org/10.1093/jamia/ocad060
Report: nurse turnover: The 2023 NSI National Health Care Retention & RN Staffing Report based on data from 273 hospitals in 35 states on registered nurse turnover, retention, vacancy rates, recruitment metrics and staffing strategies. Highlights:
average cost of turnover for one staff RN increased 13.5% from 2021 to 2022, to $52,350.
- In 2021, the turnover rate for staff RNs decreased by 6% resulting in a national average of 22.5 %.
- The average cost of turnover for a staff RN is $52,350, (range $40,200 to $64,500)–up from $46,100 in 2021.
- Each percent change in RN turnover will cost or save the average hospital $380,600 per year.
- Over the past five years, RNs in step down, emergency services, behavioral health and telemetry were most mobile with a cumulative turnover rate between 7% and 115.2%.
2023 NSI National Health Care Retention & RN Staffing Report
Nursing Shortage worsening: Per results of a National Council of State Boards of Nursing and National Forum of State Nursing Workforce Centers study released April 13. Highlights:
- About 800,000 nurses say they intend to leave the workforce by 2027.
- A total of 610,388 RNs reported an “intent to leave” the nursing workforce by 2027, citing stress and burnout as the main drivers. This number also includes retirement-related attrition.
- These same challenges were most cited by another 188,962 RNs younger than 40 who also said they intended to leave the profession by 2027. In fact, there already has been a 3.3 percent decline in this age group of nurses in the past two years.
- More than 33,800 licensed practical/vocational nurses have already left the profession due to pandemic burn out.
Study projects nursing shortage crisis will continue without concerted action April 13, 2023 /www.aha.org/news/headline/2023-04-13-study-projects-nursing-shortage-crisis-will-continue-without-concerted-action
Fitch: workforce shortage pressure easing: “Hospital and ambulatory healthcare services payrolls have risen for 14 and 26 consecutive months, respectively, as of last month. Hospital and ambulatory healthcare services monthly job additions are also up an average of 15,150 and 24,300 per month, respectively, between March 2022 to February 2023. These statistics point to the potential of alleviating labor market pressure.” Highlights of report:
- The past year’s average job gains are a turnaround from the -2,010 and 20,350 average monthly job change for hospitals and ambulatory care reported from April 2021 to March 2022
- Compared to June’s 8.4% high, hospital employees’ year-over-year average hourly earnings growth has dipped to 4.7% as of February. Ambulatory care services employees’ average wages dropped from their 6.3% year-over-year increase in January 2022 to a 3.8% year-over-year increase in February 2023, per the report.
- Job opening rates within the healthcare and social assistance sector have also somewhat improved for employers. Fitch highlighted a decline from 9.3% in March 2022 to 7.4% in February 2023, though the group acknowledged that “the latest job openings rate remains very high compared to the 4.2% average job openings rate from 2010 to 2019.”
- The flip side of the numbers is that many healthcare and social assistance workers are still leaving their roles for greener pastures. Quit rates within the sector have inched up to 2.7% as of February, well above the 1.6% average of the 2010s, Fitch wrote. The sector is coming off 6.4 million total quits across 2022, which was also above 5 million in 2021 and 4.9 million in both 2020 and 2019.
Labor Picture Continues to Brighten for U.S. NFP Hospitals Fitch Ratings April 11, 2023 /www.fitchratings.com/research/us-public-finance/labor-picture-continues-to-brighten-for-us-nfp-hospitals
CDC: suicide rate up in 2021: Per the CDC: After a two-year decline, the U.S. suicide rate increased 4% in 2021 to 14.1 deaths/100,00, making it the 11th leading cause of death, although rates were lowest for females ages 10 to 14, that group experienced the largest percentage increase over the past two decades, from 0.6 deaths per 100,000 people in 2001 to 2.3 in 2021. Experts have expressed growing concern over the mental health of teens, particularly adolescent girls. Among young males, the most significant increase in suicide rates occurred from 2020 to 2021 for those ages 15–24, from 22.4 per 100,000 people to 23.8.
CDC April 11, 2023 www.cdc.gov
Study: homelessness and substance abuse: Context: At least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness. Researchers used a simulation modeling of 23 US cities: Finding:
Models estimated between 974 and 2175 additional overdose deaths per 10 000 people experiencing homelessness at 10 years in scenarios in which people experiencing homelessness who inject drugs were continually involuntarily displaced compared with no displacement. Between 611 and 1360 additional people experiencing homelessness who inject drugs per 10 000 people were estimated to be hospitalized with continual involuntary displacement, and there will be an estimated 3140 to 8812 fewer initiations of medications for opioid use disorder per 10 000 people. Continual involuntary displacement may contribute to between 15.6% and 24.4% of additional deaths among unsheltered people experiencing homelessness who inject drugs over a 10-year period.
Barocas et al “Population-Level Health Effects of Involuntary Displacement of People Experiencing Unsheltered Homelessness Who Inject Drugs in US Cities” JAMA. April 10, 2023. doi:10.1001/jama.2023.4800
AAMC Report: AAMC researchers analyzed residency application data for 2022-2023 by separating states into three cohorts: those with abortion bans, those with gestational limits, and those without gestational limits or abortion bans Findings:
- the number of U.S. medical school graduates who applied to programs in all states declined by 2% in 2022-2023 compared with the previous application cycle, it declined by 3%, or about 400 physicians, in states with abortion bans, including Alabama, Arkansas, Idaho, Kentucky,. Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin
- Applicants for ob/gyn residency slots were down 5.2% nationally compared with 4.6% the prior year, before the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization in June 2022, and applicants fell by a whopping 10.5% in the 13 states that ban abortions.
- The AAMC report also showed the largest drop in applicants for emergency medicine residency training programs — 21.4% — which followed the 2021-2022 drop from the prior year of 18.8%
Training Location Preferences of U.S. Medical School Graduates Post DOBBS V. JACKSON WOMEN’S HEALTH ORGANIZATION Decision AAMC April 13, 2023 /www.aamc.org/advocacy-policy/aamc-research-and-action-institute/training-location-preferences
BLS: CPI increased 0.1% in March, health services show decreases: The Consumer Price Index for All Urban Consumers (CPI-U) rose 0.1 %in March on a seasonally adjusted basis, after increasing 0.4% in February. Over the last 12 months, the all-items index increased 5.0% before seasonal adjustment: food +8.5%, energy -6.4%, medical care commodities +3.5%, medical care +1.0%.
Note: “The medical care index fell 0.3% in March, after falling 0.5% in February. The index for hospital services fell 0.4% over the month, after being unchanged in February. The index for physicians’ services continued to decline, falling 0.2% after declining 0.5% in February. The prescription drugs index increased 0.1%in March.”
US Bureau of Labor Statistics www.bls.gov