Friday, September 15, 2017

Middle East - More than 70 new hospitals needed by 2022

Property consultant JLL estimates at least 70 new hospitals need to be built in five key Middle East cities by 2022.

The company’s newly released report on the regional healthcare sector concludes that the Middle East is lagging behind other developed economies in terms of per capita spending on healthcare and the provision of hospital beds.

Faced with a shortage of hospitals, clinics and other healthcare facilities, an ageing population and the rise of medical tourism, JLL estimates the cities of Cairo, Jeddah, Riyadh, Dubai and Abu Dhabi need to add a combined 10,500 hospital beds over the next five years, which equates to 70 new hospitals, just to maintain the current per capita bed provision.

JLL says the biggest requirement is in Cairo, which needs an additional 4,800 beds and 32 hospitals by 2022. Next is Riyadh, with 2,250 beds and 15 hospitals. The figures for Dubai are 1,050 beds and 7 hospitals, while Abu Dhabi has slightly higher requirements at 1,350 beds and 9 hospitals. The figures given for Jeddah are the same as for Dubai.

Even with this additional capacity, the per capita provision of hospital beds in the region will remain far behind the OECD average of 4.8 beds per 1,000 people, at 1.9 beds. To reach the OECD average, JLL says 470,000 additional beds would be required across the same five major cities by 2022, which equates to 3,130 new hospitals.

With such huge requirements, JLL says the healthcare market is highly attractive for real estate investors, offering a chance to diversify their portfolios in a sector not tied to the performance of the economy.


Monday, September 11, 2017

The ground has shifted on US health care reform: Opinion

— Congress's failed effort to undo Obamacare this year revealed an important political shift in the U.S.: Americans are no longer content to let people go without health insurance. As the Affordable Care Act has taken root, most have come to believe the federal government has a responsibility to make sure everyone is covered.

Republicans should take note: Another stab at destroying Obamacare is not what voters want. Instead, both parties should dedicate themselves to building on it — and, to that end, work is needed by the end of this month, when insurers are due to sign contracts to sell policies on the state exchanges next year.

To be sure, merely shoring up Obamacare won't bring universal coverage. The law has cut the number of uninsured by half, but 26 million people remain without coverage, and that number is expected to rise. To eliminate this gap, big new initiatives are needed: automatic enrollment of the uninsured into subsidized, no-frills plans, for example, or state programs that let people buy Medicaid policies.

For the moment, however, it's essential to keep the ACA functioning. President Donald Trump and Republicans in Congress have argued for dumping Obamacare and starting over, but the most sensible path toward universal coverage is to build on the progress already made toward that goal.

The immediate danger is that individual policies sold through state exchanges may be priced out of the market. This threat stems directly from the Trump administration's efforts to destabilize that market. Each month, the president holds out the possibility that he might refuse to reimburse insurers for lowering some policy holders' out-of-pocket costs, as the ACA provides. And this is driving insurers to either push up premiums or leave the market altogether.

Here are four things all advisors should know about the current state of single payer in California and beyond.

Congress could counteract the sabotage by expressly appropriating the subsidies, at least through 2018. It could also create a permanent federal reinsurance program to help insurers pay the biggest claims. Alaska and Minnesota have demonstrated how this strategy keeps premiums to a minimum.

Such steps will appeal more to Democrats than to Republicans — so in return Democrats should agree to allow states greater authority to determine the minimum requirements for insurance policies sold on the Obamacare exchanges. Some states, for example, would like to allow relatively cheap catastrophic-care policies combined with health savings accounts to be sold on their exchanges.

Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington are having a conversation of this kind. Their push for legislation is made more urgent by the White House's continuing efforts to sow division. Most recently, the Trump administration slashed the ACA's advertising budget by 90 percent. If that results in fewer healthy customers being attracted to open enrollment this fall, premiums could rise higher.

Recognizing that the country's attitude to health care has shifted should make bipartisan compromise on the issue — hitherto hard to imagine — possible for the first time. Congress needs to stop fighting over Obamacare, and begin discussing how best to get from here to granting all Americans access to health insurance.


Friday, September 8, 2017

Effort Launches to Expand Medicaid in Maine Through Ballot Initiative

Mainers for Health Care officially launched their campaign to expand Medicaid though a ballot initiative this November.

Dr. Elizabeth Rothe, a family medicine physician at Central Maine Medical Center, says expanding the insurance program will not only help an estimated 70,000 Mainers, it will also help hospitals.
"Caring for patients who cannot pay their bills puts hospital budgets in the red," Rothe says. "It jeopardizes jobs, departments, and even entire hospitals. Maine needs to expand Medicaid."
Under the Affordable Care Act, states that expand Medicaid receive extra federal dollars. Maine lawmakers have approved expansion five times, but Governor LePage has vetoed the legislation.

Thursday, July 20, 2017

Nigeria - Private doctors cry over poor patronage

          Doctors removing 40 knives from man
MEDICAL doctors under the aegis of Association of General and Private Medical Practitioners of Nigeria (AGPMPN) have cried out over low patronage from patients.

And this is not that the health of Nigerians have improved that they now need less medical attention from hospitals, but solely to the recessed state of the Nigerian economy which the doctors say has reduced capacity utilisation to as low as 20 per cent.

Dr Omo-Ehijele Frank Odafen, National President of the association, speaking in Port Harcourt, recently pointed out that hospitals had never had it as bad before in the history of the country.

He lamented the high abscondment rates of patients from hospitals saying the practice was increasing number of debtor-patients, because  the bulk of our patients are out-of-pocket payers”.

He noted the high poor adherence to treatment modules, which had led to drug resistance and high cost of healthcare services, as well as patronage of quacks, prayer houses and self-medication.

The national president said the association was battered with multiple taxation by the three tiers  government, whose interest was to increase their internally generated revenue (IGR) and appealed to government to address the ugly development to save the health sector.

The doctors also decried the upsurge in abduction of doctors, especially in Rivers State saying, it was disheartening that doctors now lived and carried out their duties with fear.

They condemned the frequent kidnap of medical doctors, noting that some of their members had lost their lives in the hands of suspected kidnappers.

Dr Odafen charged government and security agencies to ensure safety of doctors by providing armed security men for medical practitioners to enable them carry out their duties effectively without fear of being abducted or killed.

He said, “Doctors are struggling people. Doctors are committed people. We practise social service for the nation.  We are appealing to the society and kidnappers to leave doctors alone.

We don’t have money.  We are struggling people. “We are appealing to the government, especially Rivers State government.  We thank the government and security agencies too.

“But, we are appealing to the government, to please, provide armed security men for doctors at their residential homes and offices.  “In the middle of the night, when people are sleeping, doctors are out taking care of patients.

“We are everywhere.  So, how would it be, if our lives are in danger? Government should see it as a responsibility to see that doctors are protected, so that they can freely carry out their services to the society unhindered,” the national president appealed.


Tuesday, July 18, 2017

After hospital closes, hope for healthcare coming back to Crockett

CROCKETT, TX (KTRE) -The past 17 days have been difficult for Crockett area residents looking for healthcare.

The Crockett Clinic opened its doors for the first time this morning for the first time since Little River Healthcare close Timberlands Hospital at the end of June due to financial issues.

"We have been a clinic here for 50 years," Dr. Christopher Haeckler said. "We were only managed by Little River for three months. When they announced they were closing, we had to shut down and make sure we got all of our accounts back opened in our name, so we could operate."

The clinic does primary care and can see people of all ages. They are currently working on getting permits back to do X-rays as well. The shock still has not worn off.

"It's like running into a brick wall," Haeckler said. "One minute everything is okay, and then the next, you are being called over to the hospital and being told that you are getting shut down. We are very fortunate that we could go back to work, but the community is pulling together the best they can."

The clinic being opened was good news to George Gale, who brought his wife for an early afternoon appointment. The couple lives in a subdivision on Houston County Lake and just driving to Crockett takes 20 minutes. Gale is concerned that it will only get worse the longer the city goes without a hospital.

"We have to go to Palestine, Lufkin, or Nacogdoches," Gale said. "Elderly people are just not in shape to drive over there, and some can't drive it. They have to have a hospital here."

Inside the hospital, it is quiet. There is very little activity except for a dentist office and a foot doctor that operate as private practices. Crockett Dental Care has been inside the hospital building for 17 years. The closure came as a shock for them. Everyday, the staff still goes outside at noon to pray for a resolution. It is a practice that started the day after the closure was announced.

"We know we are going to have healthcare," said Office Manager Laura Holcomb. "We don't know what shape or form that is going to be, but we know we need it and that God will provide."

Inside the office, just like at business across the county, a coin jar is set up to collect change that will be donated to the Houston County Hospital Board with expenses they now have.

"We had a 25-year lease with Little River," Holcomb said. "We did not think about having to do fund-raising efforts. Now the board has expenses they did not think about like yard work and attorney fees."

As the days count on, someone has left a message on the sign that once said Timberlands. It is a message to help people remember the struggle facing the community. It is a sign that simply reads, "Keep Hope Alive." Holcomb smiled when she thought about the sign.

People can donate to the fundraising effort by dropping off funds at: The Grapeland Messenger, Twisted Sister, Lucky Cleaner, Knox Furniture, The Houston County Courier, The Moosehead Cafe, Davy Crockett Drug, Crockett Dental Care, The Houston County CO-OP, Mike's Corner Store, Lovelady State Bank, and Prosperity Bank.


Thursday, July 13, 2017

Provider-sponsored plans carry on, despite hefty losses

Northwell's CareConnect in New York City rides losses, boosts premiums to stay in market.

It seems simple enough: A provider wanting to move into value and looking to gain the population health prowess needed to get there decides to sponsor a health plan.

Sometimes it works, but recently there's been harsh examples showing how it hasn't.

Health systems backpedaling their decision by recently divesting of health plans that put them in the red include Catholic Health Initiatives of Englewood, Colorado and Tenet Healthcare in Dallas.

Other providers that have been resetting their business plans due to insurance losses include Texas Children's Hospital in Houston, Banner Health in Phoenix, and Partners HealthCare System in Boston.

The majority provider-sponsored plans have not even produced savings, according to independent consultant Paul Keckley.

"It's hard to get scale, to get enrollment, especially where you get dominant in the market," Keckley said. "They've run into challenges."

But when he talks to clients, Keckley finds that most didn't enter the insurance game to make money.

"They went in for the long-term population health management," Keckley said. "This is an excuse to get doctors to work together."

Systems that are making it work have said they were modest about expectations going in, he said.

One example is the Marshfield Clinic Health System and Security Health Plan in Wisconsin. Its two hospitals, 40 clinics and health plan are thriving if CFOs can base that definition on a margin of 1 to 2 percent.

Another success is Sentara Healthcare and its health plan Optima Health in Virginia.

"Running a hospital is very different from running a health plan," said Michael Dudley, president and CEO of Optima Health and senior vice president of Sentara Healthcare. "It takes a lot of patience and a lot of time. It takes time in terms of several years, for people to understand both sides of the equation. Hospital administers are designed and have the incentive to fill hospital beds. A health plan executive is designed to help people stay healthy and not need healthcare."

Providers taking on the disparate businesses of treating patients and then taking the responsibility for paying for that treatment seems like a crazy business model. But as Woody Allen said about accepting craziness from a guy who thought he was a chicken, "We need the eggs."

Providers need the information, the data and the population health. If there's one certainty providers agree on, it's that the move to value-based care will continue.

"I think from the standpoint of population health management, it gives you a perspective," said Richard Miller, deputy CFO, business strategy for Northwell Health and senior vice president, payer relations and contract development. "Without having a health plan, we wouldn't have that level of insight around care management and analytics."

Managing a plan is harder than you think, said Howard Gold, Northwell's executive vice president, chief managed care and business development officer. "It's not for the faint of heart. I think providers can do well on certain kinds of value-based contracts, bundled payment or shared savings. A lot of that rests on how providers organize and deliver care, not the funding mechanism. The issue is, is there enough money in value-based  programs, or does value-based take funding away from providers?"

Having a health plan gave Northwell more knowledge on how to handle shared savings and even risk contracts, Gold said.

New York-based Northwell Health, formerly the North Shore-LIJ Health System, suffered losses due to its health plan CareConnect. It originally set premium prices low because it was a narrow network, and also ran up against risk adjustment numbers that favored the larger Oxford Health Plan owned by UnitedHealthcare.

Northwell is in the number two spot for business, right behind Oxford, Miller and Gold said.

Northwell posted an operating loss of $36.2 million during the first quarter, with $22.7 million of that from losses in CareConnect's individual and small group plans.

The losses were due to federal risk adjuster methodology in the small group line of business, which represents about 80 percent of the business.

In the budget neutral risk adjustment system, CareConnect had to pay $130 million in 2016 because the government deemed its members were less sickly than the populations served by other plans in the New York City metropolitan area.

State regulators have since agreed to reduce the risk adjustment by 30 percent in 2018 and 40 percent in 2019, in a move signaling recognition of CareConnect's higher cost for member care.

Northwell has filed for a 30 percent premium increase in its individual line of business, and for a 20 percent hike in small group.

Both products are sold on or off the exchange.

"The relief from New York State partially helps us to move towards a breakeven or better financial result," Gold said. "The rate increase, both in the small group and individual line, we believe will move us in the right direction."

Even with the premium increase, CareConnect has a low-priced insurance product compared to the market, Gold said.

"It does move us closer to break even," Miller said. "We're pricing products to be sustainable."

Northwell and CareConnect have made a decision to stay in the commercial line of business. For individual and small group, "we're here to stay for now, and do what we have to do to fix it," Gold said. "We may get more relief depending on what's happening in Washington on risk-adjuster."

Northwell started the health plan in 2014 to take advantage of the newly insured under the Affordable Care Act and Medicaid expansions in 31 states and the District of Columbia, according to Miller and Gold, who serve on the board of the Northwell Health Plans Holding Company.

"The rationale was to enter with a narrow network product around our providers, but not (be) exclusive," Gold said. "By having our own insurance company, patients to the extent they needed healthcare, would use our healthcare and physicians. We thought that would give us a competitive edge. More would come into the health system and stay in network."

That has happened, he said.

"The more we're in it, the better results we'll have."

Alan Murray, CEO of CareConnect, said Northwell CEO Michael Dowling recruited him to work in the managed care environment to see how the system could move into risk. That's when CareConnect was founded three-and-a-half years ago.

"The reason Northwell started this was to be in the business of keeping people well, to be part of an integrated delivery system," Murray said.

If not for the risk-adjustment, by any other measure, CareConnect is successful, Murray said.
It has a medical loss ratio under 80 percent, an integrated arrangement with the health system and a large amount of value- based contracting. Administrative costs are running about 15 percent.

"Next year we'll probably break-even if get rate increases," Murray said. "The cultural impact of owning the medical risk of a population is not just your ability to manage a population, you have to retain them from a medical experience. We focus heavily customer experience."

Programs to improve care include Northwell Health Solutions that coordinates home visits and takes responsibility for patients for 30 days post discharge from the hospital or emergency room.

"If you're going to start an insurance company, you're starting a completely new business," Murray said. "Like any other business, you have lessons learned as you move forward. Very few businesses start up and start making a profit in three years."

Sentara Healthcare, which owns the health plan Optima Health, has been successful in the provider-sponsored business for a number of years.

Optima Health offers commercial products including employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

Sentara Healthcare, which has 12 hospitals, also contracts with non-Sentara providers.
Optima is about halfway down the continuum to value-based agreements, moving towards the total cost of care targets and taking risk, Dudley said.

It will stay in the exchange market, Dudley said, though it also had adverse selection and the risk adjusters did not fully make up for the losses sustained.

"For those providers who got into health plan business last five years, a start-up is tough," Dudley said. "If there isn't good experience and knowledge to anticipate risk, there might be losses."

To be successful, a provider-sponsored health plan must have everyone in the organization aligned on goals and have experienced leadership on the health plan side, he said.

Health plans need to have enough enrollees to be competitive on pricing. Many of the 140 provider-sponsored health plans in a recent Robert Wood Johnson Foundation report were only able to price competitively by paying their own providers below-market rates.

The report found that most provider forays into health insurance have failed financially. Of 37 provider-sponsored health plans that have formed since 2010, only four were profitable in 2015, according to the report released in June by Allan Baumgarten, an independent research analyst.

"This is risky business for providers to get into," Dudley said. "For those of us who have been it for a number of years, we've had made it work. We foresee we will see strong results going forward."


Friday, June 23, 2017

Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard

For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.

Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.

"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.

The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.

That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.

And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.

"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."

All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.

Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.

"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.

But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.

Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.

"So we're still providing care, but we're no longer being compensated," Noble says.

And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.

The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.

"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.

In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.

"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.

"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.

For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.

"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"

Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.