January 23, 2023
Reporter, Health Care Inc. Writer

So you really decided to open this email, huh? Appreciate you. There’s a lot to cram into your brain today, but let’s start with this: Did you know researchers estimate “10% of large publicly traded firms are committing securities fraud every year”? Sure seems like that would include some health care companies. You know what to do: bob.herman@statnews.com.


The RACs that hospitals actually love
Covid hospital nurse

Brandon Bell / Getty Images

The acronym “RAC” is very triggering in health care. Hospitals and doctors loathe RACs, or “recovery audit contractors,” which are private entities authorized by Medicare to claw back overpayments from providers. 

But there’s another type of RAC — called a “regional advisory council” — that has been a boon to hospitals. Those RACs have provided many hospitals with traveling nurses and other temporary staff on the taxpayers’ dime.

One prominent example: Christus Health, the large not-for-profit hospital system with facilities in Texas, New Mexico, and Louisiana, received $95.4 million worth of travel nurses and other medical staff at no cost to Christus through those quasi-governmental regional advisory councils.

This free staffing highlights another instance during the pandemic in which hospitals have been propped up financially — largely through public subsidies — and contradicts industry messaging that all hospitals are on the brink of collapse. Read more about these RACs.


‘Take this job and shove it’

Roughly 2.9% of health care workers quit their jobs in November, equating to about 600,000 resignations, according to new data from the Bureau of Labor Statistics. That’s the second-highest quit rate in recent health care history, only behind the 3.1% rate in November 2021. (h/t Paul Hughes-Cromwick, a health care researcher, for pointing out the trend.)

Burnout from caring for Covid-19 patients, rigorous work schedules, and stagnant or low wages continues to push many hospital nurses, technicians, nursing home staff, and others to switch to other health care settings — or leave the profession completely. But health care employers are still desperate for people to care for patients, which is giving employees leverage to demand higher paychecks.

The average hospital employee made $40 per hour this past November, up from $34 per hour before the pandemic in November 2019, according to BLS. But people who work in physician offices continue to make more: over $46 per hour as of November. Those working in outpatient centers are making about $36 per hour, up from about $31 before the pandemic. People who work in nursing homes and residential care facilities are still making only $23.65 per hour, up from a little over $19 per hour in November 2019.


For hips and knees, practice, please

Good news for those who subscribe to Malcolm Gladwell’s “10,000-hour rule”: A new study underscores the importance of repetition in joint replacement surgeries, my colleague Tara Bannow reports

Using claims data from people who get their health insurance from their jobs, the research arm of analytics company Clarify Health waded through 180,000 hip and knee replacements. The results reinforce how surgeons who do a lot of these procedures have better quality scores and lower readmission rates — and they even have lower costs.

“It’s just human nature: We need practice,” The Leapfrog Group CEO Leah Binder, who was not involved in the study, told Tara.

Read Tara’s story for more details about Clarify Health’s study and how Zeke Emanuel thinks this data should be used. One thing the study doesn’t answer: determining how many of those joint replacements were needed in the first place.


Included Health not running toward an IPO, yet

Included Health, the startup that combines telehealth and care navigation for workers in employer health plans, met with investors at this month’s J.P. Morgan Healthcare Conference. So does it plan to go public this year?

“Not anytime soon, is the short answer,” Included Health CEO Owen Tripp told me in San Francisco. “Our company sees itself as a large, independent, and likely public company someday. The point of the business really was never to be a public company. The point of the business was to take care of as many members as we could and raise the standard of health care for everyone. I do think being public gives you access to capital and flexibility to do those things.”

Included Health is the mash-up of Grand Rounds and Doctor on Demand and now has more than 300 clients (that includes both large employers and health insurers). Tripp expects that base to grow even more as employers look for one-stop-shop vendors that can provide a wider range of benefits and ancillary services.

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Industry odds and ends

  • Moody’s Investors Service downgraded the credit rating of Walgreens, saying the drugstore chain’s primary care investments have created a problematic amount of debt.
  • Three top executives within Tenet Healthcare are retiring (the CFO, the head of its ambulatory surgery division, and the head of its billing and collections unit). Perhaps it’s no surprise Tenet tried to paper over this mass exodus by talking about preliminary “strong results” in the fourth quarter.
  • Sanofi has created a warranty program for hospitals if its drug for a rare, life-threatening autoimmune blood disorder doesn’t work on patients, my colleague Ed Silverman reports.
  • The rumors of CVS Health buying Oak Street Health are unfounded, Axios reports.
  • The folks over at Georgetown University’s Center on Health Insurance Reforms are publishing a blog series about the ways to improve employer-based health insurance and whether it can even be saved. Here’s the latest installment.
  • Aledade, the company that helps physician practices start accountable care organizations and take on more financial risk, is turning into a “public benefit corporation” instead of hitting the stock markets. Blake Madden at Workweek explains more.

The Meme Ward

Health Care Inc. Meme - Issue 27

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