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The Keckley Report

Is the Tax Exemption for Not-for-Profit Hospitals at Risk?

By February 5, 2024No Comments

Last Thursday, Seattle-based Providence Health System announced it is refunding nearly $21 million in medical bills paid by low-income residents of Washington and erasing $137 million more in outstanding debt for others. Other systems are likely to follow as pressure con mounts on large, not-for-profit systems to modify their business practices in sensitive areas like patient debt collection, price transparency, executive compensation, investment activities and others.

Not-for profit systems control the majority of the 2,987 nongovernment not-for-profit community hospitals in the U.S. Some lawmakers think it’s time to revisit to revisit the tax exemption. It has the attention of the American Hospital Association which lists “protecting not-for-profit hospitals’ the tax-exempt status” among its 15 Advocacy Priorities in 2024 (it was not on their list in 2023).

Background:  Per a recent monograph in Health Affairs: “The Internal Revenue Service (IRS) uses the Community Benefit Standard (CBS), a set of 10 holistically analyzed metrics, to assess whether nonprofit hospitals benefit community health sufficiently to justify their tax-exempt status. Nonprofit hospitals risk losing their tax exemption if assessed as underinvesting in improving community health. This exemption from federal, state, and local property taxes amounts to roughly $25 billion annually. However, accumulating evidence shows that many nonprofit hospitals’ investments in community health meet the letter, but not the spirit, of the CBS. Indeed, a 2021 study showed that for every $100 in total expenses nonprofit hospitals spend just $2.30 on charity care (a key component of community benefit)—substantially less than the $3.80 of every $100 spent by for-profit hospitals. A 2022 study looked at the cost of caring for Medicaid patients that goes unreimbursed and is therefore borne by the hospital (another key component of community benefit); the researchers found that nonprofit hospitals spend no more than for-profit hospitals ($2.50 of every $100 of total expense).”

In its most recent study, the AHA found the value of CBS well-in-excess of the tax exemption by a factor of 9:1. But antagonism toward the big NFP systems has continued to mount and feelings are intense…

  • Insurers think NFP systems exist to gain leverage in markets & states over insurers in contract negotiations and network design. They’ll garner support from sympathetic employers and lawmakers, federal anti-consolidation and price transparency rulings and in the court of public opinion where frustration with the system is high.
  • State officials see the mega- NFP systems as monopolies that don’t deserve their tax exemptions while the state’s public health, mental health and social services programs struggle.
  • Some federal lawmakers think the NFP systems are out of control requiring closer scrutiny and less latitude. They think the tax exemption qualifiers should be re-defined, scrutinized more aggressively and restricted.
  • Well-publicized investments by NFP systems in private equity backed ventures has lent to criticism among labor unions and special interests that allege systems have abandoned community health for Wall Street shareholders.
  • Investor-owned multi-hospital operators believe the tax exemption is an unfair advantage to NFPs while touting studies showing their own charity care equivalent or higher.
  • Other key NFP and public sector hospital cohorts cry foul: Independent hospitals, academic medical centers, safety-net (aka ‘essential’) hospitals, rural health clinics & hospitals, children’s hospitals, rural health providers, public health providers et al think they get less because the big NFPs get more.
  • And the physicians, nurses and workforces employed by Big NFP systems are increasingly concerned by systemization that limits their wages, cuts their clinical autonomy and compromises their patients’ health.

My take:

The big picture is this: the growth and prominence of multi-hospital systems mirrors the corporatization in most sectors of the economy: retail, technology, banking, transportation and even public utilities. The trifecta of community stability—schools, churches and hospitals—held out against corporatization, standardization and franchising that overtook the rest. But modernization required capital, the public’s expectations changed as social media uprooted news coverage and regulators left doors open for “new and better” that ceded local control to distant corporate boards. Along the way, investor-owned hospitals became alternatives to not-for-profits, and loose networks of hospitals that shared purchasing and perhaps religious values gave way to bigger. multi-state ownership and obligated groups.

The attention given large NFP hospital systems like Providence and others is not surprising. These brands are ubiquitous. Their deals with private equity and Big Tech are widely chronicled in industry journalism and passed along in unfiltered social media. And their collective financial position seems strong:  Moody’s, Fitch, Kaufman Hall and others say utilization has recovered, pandemic recovery is near-complete and, despite lingering concerns about workforce issues, growth in their core businesses plus diversification in new businesses are their foci. (See Hospital Section below).

I believe not-for-profit hospital systems are engines for modernizing health delivery in communities and a lightening rod for critics who think their efforts more self-serving than for the public good. Most consumers (55%) think they earn their tax exemption but 34% have mixed feelings and 10% disagree. (Keckley Poll November 20, 2023). That’s less than a convincing defense.

That’s why the threat to the tax exemption risk is real, and why every organization must be prepared. Equally important, it’s why AHA, its state associations and allies should advance fresh thinking about ways re-define CBS and hardwire the distinction between organizations that exist for the primary purpose of benefiting their shareholders and those that benefit health and wellbeing in their communities.


PS: Must reading for industry watchers is a new report from by Health Management Associates (HMA) and Leavitt Partners, an HMA company, with support from Arnold Ventures. The 70-page report provides a framework for comparing the increasingly crowned field of 120 entities categorized in 3 groups: Hybrids (6.9 million), Delivery (5.8 million) and Enablers 17.5 million

“At the start of the movement, value-based arrangements primarily involved traditional providers and payers engaging in relatively straight-forward and limited contractual arrangements. In recent years, the industry has expanded organically to include a broader ecosystem of risk-bearing care delivery organizations and provider enablement entities with capabilities and business models aligned with the functions and aims of accountable care…Inclusion criteria for the 120 VBD entities included in this analysis were:

  • 1-Serve traditional Medicare, MA, and/or Medicaid populations. Entities that are focused solely on commercial populations were excluded
  • 2-Operate in population-based, total cost of care APMs—not only bundled payment models.
  • 3- Focus on primary care and/or select specialties that are relevant to total cost of care models (i.e., nephrology, oncology, behavioral health, cardiology, palliative care). Those exclusively focused on specialty areas geared toward episodic models (e.g., MSK) were excluded. –
  • 4-Share accountability for cost and quality outcomes. Business models must be aligned with provider performance in total cost of care arrangements. Vendors that support VBP but do not share accountability for outcomes were excluded.

HMA_VBP-Entity-Landscape-Report_1.31.2024-updated.pdf ( February 2024



After State Lawsuit, Health System Erases or Refunds $158M in Medical Bills | MedPage Today February 2, 2024

Revise The IRS’s Nonprofit Hospital Community Benefit Reporting Standard | Health Affairs April 15, 2022

AHA fast-facts-on-us-hospitals-2024-20240112.pdf (


Sections in today’s Keckley Report:

  • Quotables
  • Capital
  • Care Management
  • Economy
  • Hospitals
  • Physicians
  • Polling
  • Regulators


Re: social media: “…On January 31st Mark Zuckerberg, the social network’s founder, was harangued by American senators over the spread of harmful material. The next day he announced another set of glittering results for Meta, Facebook’s parent company, which is now valued at $1.2trn. Yet even as social media reliably draw vast amounts of attention from addicts and critics alike, they are undergoing a profound but little-noticed transformation.

The weird magic of online social networks was to combine personal interactions with mass communication. Now this amalgam is splitting in two again. Status updates from friends have given way to videos from strangers that resemble a hyperactive tv. Public posting is increasingly migrating to closed groups, rather like email. What Mr. Zuckerberg calls the digital “town square” is being rebuilt—and posing problems.

This matters, because social media are how people experience the internet. Facebook itself counts more than 3bn users. Social apps take up nearly half of mobile screen time, which in turn consumes more than a quarter of waking hours. They gobble up 40% more time than they did in 2020, as the world has gone online. As well as being fun, social media are the crucible of online debate and a catapult for political campaigns. In a year when half the world heads to the polls, politicians from Donald Trump to Narendra Modi will be busy online.

The striking feature of the new social media is that they are no longer very social. Inspired by TikTok, apps like Facebook increasingly serve a diet of clips selected by artificial intelligence according to a user’s viewing behavior, not their social connections. Meanwhile, people are posting less. The share of Americans who say they enjoy documenting their life online has fallen from 40% to 28% since 2020. Debate is moving to closed platforms, such as WhatsApp and Telegram.

The end of the social network ( February 1, 2024


Re: site neutral payments: “Legislative language to restrict hospital billing rates in outpatient clinics continues to divide lawmakers as they try to coalesce around a broader health care package, with concerns about rural hospitals stalling progress in the Senate.

The language is aimed at preventing hospitals from buying up independent physician practices and then billing for the same services at a higher rate. Critics allege the practice unnecessarily increases costs, while hospitals argue their own costs are higher.

Some so-called “site-neutral” policies are included in every major piece of health care legislation moving through the committees of jurisdiction, with the exception of legislation from the Senate Finance Committee. Finance Chair Ron Wyden, D-Ore., said he’s still working to understand how the policy would impact rural hospitals.”

‘Site-neutral’ hospital policy muddles health package progress – Roll Call January 31, 2024


Re: women’s health:  “…women spend 25% more of their lives in debilitating health. Addressing the gaps and shortcomings in women’s health could reduce the time women spend in poor health by almost two-thirds. This has the potential to help 3.9 billion women live healthier, higher-quality lives by adding an average of seven days of healthy living for each woman annually, adding up to potentially more than 500 days over a woman’s lifetime…. Research shows that SRH and maternal, newborn and child health (MNCH) account for approximately 5% of women’s health burden, although this is probably an underestimate. An additional estimated 56% of the burden is due to health conditions that are more prevalent and/or manifest differently in women. The remaining 43% are from conditions that do not affect women disproportionately or differently.” in 2023 (2.7% of overall funding), down from $840M (5.5%) in 2022 and $2.1B (7.1%) in 2021.”

WEF_Closing_the_Women’s_Health_Gap_2024.pdf ( January 2024


Re: education system: “The purpose of a holistic, four-year education was to nurture successive generations of leaders with the myriad disciplines they need to advance society. But for most people a sufficient background in math for artist and civics and history for an IT technician should come from high school. Instead, the quality of primary and secondary education has degraded so far that this social responsibility has been shunted to colleges.

Rather than cultivating a rigorous academic environment, modern universities focus on “student life.” Prohibitive expense and wasted energy may finally help the country realize the burden professionals place on young people and parents by demanding they get an impractical degree simply because it was what the previous generation did.”

Opinion Mark McDermott Higher Education Must Rediscover Its Purpose – WSJ January 30, 2024


Re: Bidenomics: “Bidenomics amounts to little short of an economic revolution for America. It would be a revolution shaped by faith in government and a mistrust of markets.

Five elements stand out. The first is a desire to boost workers, mostly through unions. The second is more social spending, especially on early-childhood education. Third is tougher competition policy to restrain big business. Fourth, a wave of investment intended to make America both greener and more productive. Last, Mr. Biden wants to tax large firms and the wealthy to pay for much of this.”

What four more years of Joe Biden would mean for America’s economy ( January 30, 2024


Care Management

ACOs: Per Axios analysis: The number of ACOs has hovered below 500 since 2019 and assigned patients at slightly less than 11 million. “About 13.7 million Medicare patients this year are cared for by accountable care organizations, a 3% increase from last year. Nearly 817,000 providers are participating, compared with 700,000 in 2023…

The Biden administration wants to bring all Medicare beneficiaries into value-based care models by 2030, and ACOs are key to achieving that goal. The Affordable Care Act created ACOs as a way to improve efficiencies and control costs by letting the providers retain more money if they hold down expenses. But the savings still are a small fraction of what Medicare spends annually. This year, 480 groups will care for 10.8 million patients through Medicare’s flagship ACO initiative, the Shared Savings Program. CMS overhauled the program in 2022 amid plateauing interest from providers. Changes include up-front payments to providers in rural and underserved areas to help them get started.”

Accountable care participation grows in 2024 ( January 30, 2024


Study: Comparative effectiveness of behavioral activation psychotherapy (BA) or antidepressant medication management (MEDS) in patients with heart failure experiencing depression. Results:

In this comparative effectiveness randomized clinical trial that included 416 adults, BA recipients as well as MEDS recipients experienced nearly 50% reduction of depressive symptoms at 3, 6, and 12 months, with no statistically significant differences between treatments. BA recipients experienced improvement in physical health-related quality of life, fewer ED visits, and fewer days hospitalized compared with MEDS recipients.

“These findings suggest that patients with heart failure could be given the choice between BA or MEDS to ameliorate depression.”

Note: Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression.

Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial | Cardiology | JAMA Network Open | JAMA Network January 17, 2024


Study: Housing insecurity: Housing First is an approach to ending homelessness that recognizes permanent housing as a platform for stability and engagement in health services. Researchers analyzed the intervention’s impact on health care use, Medicaid enrollment, and mortality among people experiencing chronic homelessness who had frequent arrests and jail stays. Findings: Two years after assignment to the Housing First intervention, participants had an average of eight more office-based visits for psychiatric diagnoses, three more prescription medications, and six fewer emergency department visits than the control group. Although enrollment in Medicaid increased over the course of the study for both the intervention group and the control group, the intervention group was 5 percentage points less likely to be enrolled in Medicaid. Supportive housing had no significant impact on mortality.

‘Housing First’ Increased Psychiatric Care Office Visits and Prescriptions While Reducing Emergency Visits | Health Affairs January 24, 2024


Study: Seniors spend three weeks/year’s getting care: Researchers analyzed the composition of, variation and patterns in, and factors associated with contact days (Days spent obtaining health care outside the home) among older adults using 2019 data. Findings:.

  • Older adults had means of 17.3 ambulatory contact days and 20.7 total contact days in the year; 11.1% had 50 or more total contact days.
  • Older adults spent most contact days on ambulatory care, including primary care visits 3.5, specialty care visits (5.7), imaging (2.6), procedures (2.5) and treatments (5.7).
  • Half of the test and imaging days were not on the same days as office visits (48.6% and 50.1%, respectively). Factors associated with more ambulatory contact days included younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors.

Health Care Contact Days Among Older Adults in Traditional Medicare: A Cross-Sectional Study: Annals of Internal Medicine: Vol 0, No 0 ( January 23, 2024


Brain implant: Last Monday, Elon Musk announced that said that the first human has received a Neuralink brain implant—a brain-computer interface that could help those suffering from debilitating conditions such as paralysis to interact with their surroundings.

Elon Musk Says Neuralink Has Implanted Brain Chip in Human – WSJ January 29, 2024


Studies: weight loss drug efficacy for depression: “If further research yields positive results, it could drive even more demand for the highly popular GLP-1 treatments, which have increasingly been shown to help with problems across the body, such as heart and kidney complications. And especially if the cognitive benefits are proven out, the GLP-1 drugs would plug a critical gap in current treatments for depression, since most depression drugs help with mood, but close to none address cognitive symptoms that affect memory and attention…

This class of drugs targets receptors of the GLP-1 hormone, a hormone that was initially discovered to work in the gut to increase insulin production. But over time, scientists have found that the medications, which have more potent and long-lasting effects than the naturally occurring GLP-1 hormone, also trigger reactions in the brain to suppress food cravings and alter circuits that drive desire.”

Wegovy leads to weight loss. Can it treat depression, too? ( January 30, 2024


Study: impact of substance uses on teen mental health:  Teenagers who use cannabis, alcohol and nicotine are more likely to have underlying psychiatric symptoms, and worse symptoms, than their peers who are not regularly using substances. such substances are linked to an array of symptoms and conditions, including anxiety, depression, hyperactivity and suicidal ideation. “These findings suggest that asking adolescents about substance use may provide a powerful screening tool when looking for underlying mental health issues. With increasing rates of adolescent mental health–related problems, particularly suicide, clarification on these issues is needed to inform screening, prevention and intervention, and policy.”

Substance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students | Substance Use and Addiction Medicine | JAMA Pediatrics | JAMA Network January 29, 2024


Study: food security and mortality: Researchers analyzed the associations of the entire range of food security with all-cause premature mortality and life expectancy across racial and ethnic and sex groups in US adults from 2018-2019: Findings:

In this cohort study, although the association of food security and life expectancy varied across sex and racial and ethnic groups, overall, lower levels of food security were associated with a higher risk of premature mortality and a shorter life expectancy. The findings of this study highlight the potential importance of improving food security in promoting population health and health equity.

Food Insecurity and Premature Mortality and Life Expectancy in the US | Nutrition | JAMA Internal Medicine | JAMA Network January 29, 2024


Weight loss drug efficacy for depression: “Although it’s early days, there’s growing hope that the GLP-1 drugs for weight loss will also lead to a host of new ways to treat and even understand mental health disorders.

Early data and anecdotes suggest that drugs like Wegovy and Ozempic could help patients feel less depressed and anxious. The treatment may also fight the decline in cognitive and executive function that many people with mental health disorders experience, like worsening memory and losing the ability to focus and plan.

And if the cognitive benefits are proven out, the GLP-1 drugs would plug a critical gap in current treatments for depression, since most depression drugs help with mood, but close to none address cognitive symptoms that affect memory and attention.”

Can Wegovy treat depression as well as obesity? New research looks to GLP-1 drugs for mental illnesses



Bain: PE vs. strategic investors: Highlights:

  • In 2023, deal volume declined across sectors, but deal value rose because of notable megadeals in pharma and medtech.
  • Revenue growth is more important than margin growth in healthcare, making M&A an attractive path—and the industry has a lot of cash.
  • 80% of healthcare executives surveyed expect to do the same amount or more deals in 2024.
  • As the margin for error shrinks, dealmakers must double down on fundamentals to improve their M&A strategy and capability.
  • Pharma subsector has $171 billion in 2023 cash reserves

“M&A deal activity in payer, provider, and healthcare services continued to stay relatively low. The sector’s most notable deals were led by large payer/healthcare service companies buying providers, such as CVS Health’s purchase of Oak Street Health and the acquisition of Amedisys by United Health’s Optum division. The focus on scope deals continued, accounting for 89% of the health and life sciences deals during the first three quarters of 2023. It’s a trend that will continue as companies look for assets that can provide them access to disruptive technologies or product category innovation. As part of their M&A strategy, healthcare companies are looking to divest noncore or underperforming assets.”

Global M&A Report 2024 | Bain & Company



BLS (January 31, 2024):

  • 4Q 2023: Compensation costs for civilian workers increased 0.9%, seasonally adjusted, for the 3-month period ending in December 2023.and benefit costs increased 0.7% from September 2023.
  • 2023: Compensation costs for civilian workers increased 4.2% for the 12-month period ending in December 2023; wages and salaries increased 4.3% for the 12-month period ending in December 2023 and benefit costs increased 3.8% over the year vs. 4.9& for 2022.
  • Within the private industry, compensation costs increased 4.5% for union workers and 4.0% for non-union workers for the 12-month period ending in December 2023. Wages and salaries increased 5.4% for union workers and 4.2% for non-union workers for the 12-month period ending in December 2023. Benefit costs increased 3.4% for union workers and 3.6% for nonunion workers for the period ending in December 2023.

Employment Cost Index Summary – 2023 Q04 Results (


Altarum: January 2024 Health Sector Economic Indicators: Highlights:

Health care spending grew (as of November 2023) by 5.9% year over year (these are in nominal, not inflation-adjusted, dollars) –nine-tenths of a percentage point higher than the entire economy. Health care spending as a share of the total economy was unchanged and stood at 17.4%, no different than where it was in 2014.

More than half of that increased spending came from higher utilization, not rising prices, which grew by just 2.9% in December. That was below the growth in the consumer price index of 3.4%. Physician and clinical prices showed nearly zero growth year over year, which means in inflation-adjusted terms, they fell. Other findings:

Health spending has remained below 17.5% of GDP for nearly 2 years

  • Personal health care spending growth in November was 7.3%, year over year, and continues to be dominated by growth in utilization rather than increases in prices.
  • Year-over-year spending on home health care grew fastest in November at 12.9%, followed by prescription drug spending (12.2%), while spending on dental services and hospital care increased the least, at 5.8% and 5.9%, respectively, among major categories.

“Slow health care employment growth in December capped off a historic year of job creation in 2023”

  • Although health care employment growth slowed in December, the year 2023 saw historic growth in the sector, with 654,000 jobs added, accounting for almost a quarter of all jobs economywide.
  • Health care wage growth in November 2023 was 2.9% year over year, compared to 4.0% for the total private sector.
  • Wage growth in health care settings was highest in nursing and residential care, at 4.0% year over year, followed by hospitals at 3.3% and ambulatory care settings at 2.4%.

Health care price growth remained steady in December

  • The overall Health Care Price Index (HCPI) increased by 2.9% year over year in December, falling slightly from the revised growth rate of 3.0% a month prior.
  • Economywide inflation stabilized in December, with year-over-year growth in the Consumer Price Index (CPI) moving to 3.4% and growth in the Producer Price Index (PPI) increasing slightly to 1.0%.
  • Among the major health care categories, prices for dental care (5.0%), home health care (4.2%), and nursing home care (4.0%) grew the fastest, while physician and clinical services (0.3%) price growth was the slowest.
  • Our implicit measure of health care utilization growth fell slightly to 4.4% year over year in November, mostly due to a slight decline in overall spending growth during the second half of 2023.
  • The fastest utilization growth among health care categories occurred in home health care (8.6%), prescription drugs (8.5%) and physician services (7.8%), while dental services (1.4%) and hospital care (2.9%) utilization growth were the slowest.

January 2024 Health Sector Economic Indicators Briefs | Altarum


SPACs:  The number of SPACs to IPO since 2021 has slumped to 118 after more than 860 were listed in 2020 and 2021 combined, data from SPAC Research show. Even so, the majority of the hundreds of companies that used SPAC mergers to arrange back-door entries onto major US exchanges are struggling.

One-time SPAC darlings have spiraled as investors shun money-losing firms amid the Federal Reserve’s interest-rate hiking campaign. Nearly 200 of the roughly 440 former US-listed SPACs trade below $2 per share, data compiled by Bloomberg show, with 171 expected to need more money to make it through the next year.

SEC’s SPAC Rules to Limit Rosy Projections That Fueled Mania – Bloomberg January 31, 2024



Beckers: “10 health systems with strong finances” which include 4 academic medical centers (CO, OR, Duke & Mass General Brigham) and 6 other NFPs across 10 states.

10 health systems with strong finances | Becker’s ( February 2, 2024

Kaufman Hall: “Hospital profitability was up nationally last year as operating margins increased 16% year over year. But not every region experienced the same success…The average profitability change from 2022 to 2023 varied widely based on the region of the country and size of the hospital.

The size of the hospital also affected average operating margin growth or decline. Smaller hospitals with 25 or fewer beds reported average operating margins increased 17.3% from 2022 to 2023 while hospitals with 200-299 beds reported just a 3.9% average operating margin growth.

Hospitals with more than 500 beds had the greatest operating margin leap at 80.5% year over year.” Notably, Kaufman Hall reported Midwest Hospitals had negative margins vs. other positive operating and EBITDA margins in other regions.:

National Hospital Flash Report: January 2024 | Kaufman Hall January 30, 2024


Fierce Healthcare: NFP 2022 profitability: “Dicey operations and widespread bottom-line losses also extended to the country’s 10 largest nonprofit health systems. Case in point: The average 2.5% year-over-year operating revenue increase recorded across this year’s largest nonprofits (minus the newly formed Advocate Health) paled in comparison to the 9.4% average increase across last year’s list.

Expense increases due to labor and other sources were prevalent across the full cohort of major nonprofit health systems and drove more than a few of the organizations into negative operating margins. Additionally, bottom lines were dragged deeper into the red due to investment portfolios that lost millions to billions across a tumultuous year for the market.”

The top 10 nonprofit health systems by 2022 operating revenue ( June 24, 2023


Study: public health data reporting inadequacy: Using data from the 2020 and 2022 American Hospital Association information technology supplement surveys, this study examined US hospitals’ experiences in public health reporting, accessing clinical data from external providers for COVID-19 patient care, and their success in reporting vaccine-related adverse events to relevant state and federal agencies. Results: “Although many hospitals leaned toward automated data transmission, a substantial portion continued to depend on manual processes…The study underscores the necessity for standardized reporting protocols, explicit directives, and a pivot from manual to automated processes. Tackling these challenges is pivotal for ensuring prompt and reliable data, bolstering future public health responses, and rejuvenating public trust in health institutions.”

Challenges and dynamics of public health reporting and data exchange during COVID-19: insights from US hospitals | Health Affairs Scholar | Oxford Academic ( January 9, 2024


Optum Care: Optum has inked at least nine health system partnerships, most recently with Minneapolis-based Allina Health. Part of that deal includes Optum hiring 2,000 Allina employees… Other systems that have outsourced administrative functions and employees to Optum include  Brewer, Maine-based Northern Light Health (1,400 employees hired by Optum); Waukesha, Wis.-based ProHealth Care (800 employees hired); Owensboro (Ky.) Health (575 employees hired); Walnut Creek, Calif.-based John Muir Health (540 employees hired); Cooperstown, N.Y.-based Bassett Healthcare Network (500 employees hired); Boulder (Colo.) Community Health (275 employees hired); and Greenbrae, Calif.-based MarinHealth (an unknown number of employees hired). Optum also revealed in November it now employs or is affiliated with nearly 90,000 physicians and another 40,000 advanced practice clinicians serving tens of millions of people every year. Optum Care employed or worked with 38,000 physicians in 2018…Optum also owns naviHealth, a post-acute management organization, and it purchased home health provider LHC Group in 2023 for $5.4 billion. It also intends to purchase home and hospice care provider Amedisys for $3.3 billion.

Optum didn’t build hospitals — it hired their employees | Becker’s ( February 4, 2024


Steward target of Warren criticism: Last Monday, US Senator Elizabeth Warren (D-MA) said that Steward Health Care’s explanations for its financial distress “do not add up,” blaming the hospital operator’s problems on the economic motivations of its for-profit business model. In a statement, Warren said she was concerned about Steward’s stability, and that she was appalled by allegations that the company’s financial problems are affecting patient care. Steward has said it is in such a dire position that it may not be able to continue providing services at its nine Massachusetts hospitals.

Steward Health Care issues tied to profit motives, Warren says (



CMS cuts 2025 Benchmark rate: Last Wednesday, the Center for Medicare & Medicaid Services (CMS) Director Dr. Meena Seshamani said the agency is “unconcerned” about Medicare Advantage after a strong open enrollment period for calendar 2024. In their bids to participate in Medicare Advantage this year, health insurance companies reported they expect Medicare Advantage enrollment to grow more than 7% this year, and Dual Eligible Special Needs Plan sign-ups to increase 13%. Monthly premiums rose less than $1 on average this year, more plans are available and supplemental benefits increased.. Last week, CMS announced a MA proposed 0.16% payment reduction for 2025 along with other administrative changes drawing widespread pushback from insurers.

CMS proposes Medicare Advantage pay cut in 2025 | Modern Healthcare



Study: vacation days taken and working while on vacation associated with physician burnout:

In this cross-sectional study of 3024 US physicians, 59.6% took 3 weeks of vacation or less per year, and 70.4% worked while on vacation on a typical vacation day; both findings were associated with higher rates of burnout. Full electronic health record inbox coverage was associated with lower rates of working while on vacation and with lower burnout.

“These findings suggest that support for taking vacation and efforts to reduce physicians’ obligations to perform patient care–related tasks while on vacation, such as providing full electronic health record inbox coverage, should be considered to prevent physician burnout.”

Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians | Health Policy | JAMA Network Open | JAMA Network January 12, 2024



Polling: Price sensitivity: Last Wednesday, Gallup released results from its the Bentley-Gallup Business in Society Report survey based on responses collected May 8-15, 2023, from 5,458 U.S. adults via the Gallup Panel. Highlights:

  • In your experience, do you know how much your healthcare products or services will cost before you receive them? 17% Yes, 79% No, and 3% Don’t Know
  • Should healthcare organizations be required to tell you how much a product or service will cost before you receive it? Yes 95%, No 2% and Don’t Know 3%
  • Does the cost of healthcare products and services you receive reflect the quality of the products and services? 29% Yes 29%, No 56% and Don’t Know 16%

Few Americans Know How Much Their Healthcare Costs ( January 31, 2024

Medical Exchange Marketplace announced: Entreprenuers and private investors now have a futures exchange to leverage bets against uncertainty in the industry through the new the Chicago-based Intelligent Medicine Exchange (IMX) designated a contract market by the Commodity Futures Trading Commission (CFTC), It’s the first of its kind.

Health care gets first futures exchange | Crain’s Chicago Business January 26, 2024

Fitch: Not for profit hospitals:

  • Nonprofit hospitals’ operating margins have reset below traditional levels following the pandemic, according to a new report from credit agency Fitch Ratings.
  • Operating margins are now in the 1% to 2% range, representing a “pain point” for the sector amid higher costs, including salary and wage expenses… Typically, hospitals need margins of at least 3% to be able to meet their obligations.
  • Fitch does not predict it will downgrade nonprofits en masse. However, the agency maintained a negative outlook for the sector this year and said ratings downgrades will outpace upgrades

.Low operating margins will be new normal for some nonprofit hospitals: Fitch | Healthcare Dive


CMS: ACO Participation update:  Last week, CMS released its latest data on ACO participation. Highlights:

  • 19 newly formed accountable care organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program) are participating in a new, permanent payment option beginning in 2024 that is enabling these ACOs to receive more than $20 million in advance investment payments (AIPs) for caring for underserved populations. An additional 50 ACOs are new to the program in 2024, and 71 ACOs renewed their participation, bringing the total to 480 ACOs now participating in the Shared Savings Program, the largest ACO program in the country.
  • 245 organizations are continuing their participation in two CMS Innovation Center models — ACO Realizing Equity, Access, and Community Health (ACO REACH) and the Kidney Care Choices (KCC) models.” That figure of 480 ACOs in the MSSP is up from 456 participating as of a year ago, in January 2023, representing a 5.13-percentage increase in participation over one year ago.
  • “Overall, in 2024 there are about 13.7 million people with Traditional Medicare aligned to an ACO. ACOs are now serving nearly half of the people with Traditional Medicare, a 3% increase since 2023. This growth in ACOs is important since ACOs have been shown to have superior quality performance compared to similar physician groups not participating in an ACO, and ACOs have generated year-over-year savings for the Medicare Trust Fund.”

Participation Continues to Grow in CMS’ Accountable Care Organization Initiatives in 2024 | CMS January 29, 2024

CDC: Re: vaccine efficacy:  Data from the Increasing Community Access to Testing SARS-CoV-2 pharmacy testing program were analyzed to estimate updated COVID-19 vaccine effectiveness (VE) (i.e., receipt versus no receipt of updated vaccination) against symptomatic SARS-CoV-2 infection, including by SGTF result. Among 9,222 total eligible tests, overall, VE among adults aged ≥18 years was 54% (95% CI = 46%–60%) at a median of 52 days after vaccination. Among 2,199 tests performed at a laboratory with SGTF testing, VE 60–119 days after vaccination was 49% (95% CI = 19%–68%) among tests exhibiting SGTF and 60% (95% CI = 35%–75%) among tests without SGTF. Updated COVID-19 vaccines provide protection against symptomatic infection, including against currently circulating lineages. CDC will continue monitoring VE, including for expected waning and against severe disease. All persons aged ≥6 months should receive an updated COVID-19 vaccine dose

Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024 | MMWR ( February 1, 2024