Chartis Top Reads – Week of July 18 - July 24, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.


Week of July 18 - July 24, 2021

Published July 23, 2021


The State of COVID-19

The Buzz This Week

A fourth wave of COVID-19 cases, the overwhelming majority of which are the Delta variant, is sweeping the United States, predominantly affecting areas of the country with low vaccination rates. The new case seven-day average is more than double the rate from 10 days ago, and hospitalizations are up over 35 percent week over week. While cases surge, vaccination rates continue to stall. Falling from a height of more than 3 million doses per day in the spring, new vaccine rates last week were around 270,000 per day. With much of the elderly population vaccinated and the rapid and severe nature of the Delta variant, new patients hospitalized with COVID are much younger and sicker than previously.

U.S.-approved vaccines so far have shown to be very effective against the variant. The vast majority of new cases and hospitalizations are among the unvaccinated population. HCA shared that according to its data, less than 1 percent of its COVID patients were fully vaccinated. AdventHealth released similar numbers, stating COVID hospitalizations were about 97 percent unvaccinated. The current surge is also raising concerns about the sustainability of reopening, and it was likely the main contributor to a more than 700-point Dow drop on Monday, the biggest one-day fall since October.

Why It Matters

The vaccines have allowed for incredible progress in fighting the COVID pandemic, and many Americans were extremely eager to get their vaccination. According to an ongoing research project by Kaiser Family Foundation (KFF) tracking public attitudes toward COVID-19 vaccination, half of American adults live in fully vaccinated households. However, that same poll showed that one quarter of American adults lived in a fully unvaccinated household. When it comes to the vaccine, there are two Americas. Case increases are much more pronounced in communities with significant vaccine hesitancy, and as Centers for Disease Control and Prevention Director Rochelle Walensky said last week, “This is becoming a pandemic of the unvaccinated. Our biggest concern is that we are going to continue to see preventable cases, hospitalizations, and sadly deaths among the unvaccinated.”

It is clear that the only opportunity for ending the pandemic and preventing COVID from becoming endemic must heavily rely on mass vaccination. Following are four levers noted by the New Yorker that have potential to increase vaccination rates:

  • Education: Significant misinformation and hesitancy remains in a large swath of the United States. KFF research shows that the majority of Americans believe or are unsure about at least one vaccine myth. Providers remain a highly trusted source of information, so there may be a portion of the vaccine hesitant population that will choose to receive the vaccine with education.
  • Incentives: Everything from lotteries to free products has been offered. While this is unlikely to change the minds of those adamantly opposed, it may offer enough of a boost to push those on the fence to get vaccinated.
  • Full FDA approval: Currently all three approved vaccines have an Emergency Use Authorization. A significant portion of those who are vaccine hesitant have said full approval would make them more likely to get vaccinated.
  • Mandates: While public opinion is mixed, businesses with on-site employees and shared living environments can legally mandate vaccinations. Additionally, certain entertainment venues or travel to other countries may require vaccination for entry. People with specific jobs or living situations, or those who desire to travel or attend events, may be convinced to receive the vaccine.

This fourth wave so far is smaller, and potentially more manageable, because of the large percentage of Americans who have been vaccinated. But it is all the more devastating because it is largely preventable.

Health Ecosystem of the Future

The Buzz This Week

As was outlined in a previous issue of Chartis Top Reads, a federal rule took effect on January 1 of this year that requires hospitals to post prices on their websites for available services, including the hospital’s price list (gross charge), payor-specific negotiated rates, and rates offered to cash-paying patients. Many hospitals have complied (at least in part), though a large minority still has not.

Kaiser Health News conducted an analysis of sample posted data, which found the following:

  • Very few hospitals posted payor-negotiated rates. In a sampling of 102 hospitals in the District of Columbia, only 3 percent provided payor-specific negotiated rates, while 78 percent provided gross charges, and 56 percent provided a self-pay rate.
  • As expected, prices were found to vary widely between different states, cities, and hospitals. For those that did post payor-negotiated rates, prices were also found to vary widely within the same hospital, depending on the payor, or if the patient pays out of pocket. For those who understand hospital revenue dynamics, this is one of the complexities of U.S. healthcare and the hospital business. But for the general public, this wide variation in pricing within the same institution for an identical service might be surprising (and potentially confusing).
  • An apples-to-apples comparison is very difficult with the data available because some prices include the professional fee (for services provided by a physician) while others do not; not all prices indicate whether they are for inpatient or outpatient services; and many hospitals have caveats that the prices shown are just “estimates” and that a customer service representative is required to get to a more accurate, patient-specific price.

The result? True and comprehensive hospital price transparency, despite the new federal rule, doesn’t yet exist. Consumers are not yet able to easily compare prices and potentially base part of their healthcare decision-making process on those prices. A writer for Kaiser Health News, who has experience in healthcare and hospitals, attempted to do his own price comparison, as he described in a piece published earlier in July. As he described, “I have spent hours toggling among multiple spreadsheets, each containing thousands of numbers, in an effort to compare prices for 20 common outpatient procedures …. After three months of glazed eyes and headaches from banging my head against walls of numbers, I am throwing in the towel …. Don’t try this at home.”

Why It Matters

Despite the fanfare about the new federal rule, consumers do not yet have a good window into hospital pricing. In fact, a Kaiser Family Foundation Tracking Poll from May of this year found that nearly 70 percent of adults were “not sure” whether hospitals were even required to post pricing information. It is doubtful then that many are out seeking the information, and as mentioned above, even if they find that information, it is difficult to interpret and make accurate comparisons.

However, even if hospital price transparency was made perfect, some doubt it would have much of an impact on consumer choices and/or in lowering total healthcare expenditures. A recently published study in Health Affairs found that even when patients knew about hospital pricing and viewed the information, most continued to choose the higher-cost physicians as in the past, with very little change in the overall healthcare expenditures. Although price transparency is necessary for a free market to function, people don’t necessarily make healthcare choices (at last for complex care) the same way they choose a brand of orange juice (a commodity), for example. Incorporate the facts that many consumers aren’t directly paying for much of the cost of individual services (a third-party payor is) and that consumers often base choices on a physician referral or family advice, pricing transparency may not yet be as transformational to our healthcare system — and continued rising expenditures — as intended.


Contributors

Roger A. Ray. MD
Chief Physician Executive
[email protected]

Alexandra Schumm
Principal, Vice President of Research
[email protected]

Abigail Arnold
Senior Research Manager
[email protected]


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Past Top Reads

Chartis Top Reads – Week of July 18 - July 24,… - The Chartis Group