Top Disruptors within Our Healthcare Systems Part 2

There are those who still say that these ‘disruptors’ were brought on by the COVID pandemic and will now fade away (“just give it time”)?

Certainly the pandemic has played a role in the disruption and destabilizing of our healthcare systems – and future pandemic preparedness must now factor in these long-term effects to our society, healthcare delivery, economic, supply chain, and other critical systems.[7]

However, the issues racking our healthcare systems were present and accelerating long before the COVID crisis – and have continued to worsen throughout and since the pandemic.

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9. Impossible-to-Complete Healthcare Workloads

Healthcare workers are facing impossible-to-complete work overloads. One study [70] documents that it takes primary care physicians 26.7 hours each day to adequately (per standards) complete all their daily clinical tasks – to meet all minimum guideline-directed care. Workloads for nurses and other ‘hands-on’ workers are equivalent or worse.  These loads are made even more overwhelming [71] by increasing shortages of these workers – as many leave healthcare for other professions.

10. ‘Prior Authorizations’ Dilemma – Worsening Workloads & Denials of Timely Patient Access

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An evolving crisis with insurance companies denying [72] or delaying more and more patient services, procedures, medications, [73] and other physician requests. These denials [74] lead to increased toxic work overloads, burnout, and further departures of physicians from the healthcare workplace [28] – as well as increasing healthcare costs to the system and consumers. [75] Denials and the subsequent appeals process result in significant delays [76] in patients receiving necessary [77] and sometimes critical care – and contributes to worsening patient outcomes, [78] increased litigation [79] expenses and higher system costs. [80] Companies increasingly are utilizing questionable benchmarking formulas, computer algorithms or people with little relevant experience to issue denials, sometimes bundles at a time – without the final reviewer ever seeing the patient’s medical chart. [72]

11. Hospital Bed Availability/ Overcrowding Crisis/Reductions in Services

The lack of workers has accelerated this already worsening crisis. [81] More and more ‘admitted’ patients with critical needs are now being kept on stretchers in hospital hallways or in already overcrowded emergency departments nation-wide [83] – for days – while waiting for in-patient beds to become available.  These same shortages cause delays in the safe and efficient discharge of hospitalized patients [84] – further contributing to the overcrowding and backup. Increasing numbers of hospitals – facing a growing financial crisis and accelerating lack of doctors, nurses, and other healthcare workers – are outright closing their facilities, closing departments, or ending inpatient or other services. [85]

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12. Accelerating Hospital Closures

Major hospital systems across the U.S. reported billions in losses last year, with some studies showing almost 50% of U.S. hospitals [86] ending 2022 with negative margins. Financial losses have led to increasing closures. [82] Closures have led to further decreased patient access, delay and/or denial of critical healthcare needs and increased stress and pressures on other, already overburdened hospital systems. The ‘overburden’ can and will lead to further destabilizations and ‘domino effect’ further closures! [87]

Many of these hospitals report that, due to healthcare worker shortages, they are not able to find/employ adequate numbers of doctors, mid-levels, and nurses to keep critical service lines open – thus failing to maintain critical revenue generation – thus leading to further closures.

Meanwhile, hospitals are facing a growing wave of mistrust and criticisms from all sectors – including patients. [88]

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13. Increasing Delays in Patient Access to Clinic and Ambulatory Healthcare

The same worker shortage also affects timely access [89] to clinic and ambulatory healthcare with patients now sometimes waiting weeks-to-months for appointments and referrals. This staffing shortage effect [90] further contributes to delays in essential care leading to worsening patient outcomes.

14. Industry-wide Employment Compensation Inequity

Healthcare ‘management’ has become a ‘booming industry’ with an ever-increasing number of healthcare corporate leaders, ‘C-suite’ personnel and other similar managers now receiving 7-figure salaries [91], even while the systems they ‘supervise’ are failing or doing less well.

Numbers of U.S. healthcare administrators increased 3,200% [42] between 1975 – 2010, while numbers of doctors and nurses have not kept up with the growth in population. This while full-time ‘hands-on’ healthcare workers – especially physicians and mid-levels have seen their salaries remain static or in fact decrease [92] in many instances. with CMS now enacting compensation cuts for most US physicians. [93. 94] These conditions have led many nurses and physicians to become ‘traveling’ nurses or ‘locums’ physicians – being episodically contracted out to hospitals facing critical worker shortages that now are having to pay many times that of full-time workers to fill essential positions. However, most doctors and nurses do not have the flexibility to uproot and become ‘transient’ episodic workers.

15. Replacing Healthcare Workers with Artificial Intelligence (AI)?

We find ourselves in an era of volatility within the healthcare workplace with ongoing mass healthcare worker exoduses from what they describe as ‘toxic’ abusive, overworked, understaffed workplaces, with movements towards unionization by those who remain, while hospitals face growing financial hardships made worse by the worker shortage crisis.

Hospitals and healthcare leaderships are already attempting to address physician, nursing and other worker shortages through increased use of ‘virtual;’ systems. Some senior corporate leaders have been heard to state that doctors and nurses are one of the biggest obstructions to ‘profitable’ healthcare. [37] Therefore, rather than facing the efforts and costs of improving the healthcare workplace, some feel that it would be more ‘profitable’ to simply replace healthcare workers with ‘AI.’ [96]

With multiple studies showing that AI can perform medical tasks such as better interpretation of imaging studies, producing improved differential diagnoses, and now results from several trials of AI driven interactive responses to patient questions versus those of the doctors themselves, where the patients felt the A.I. interactions were more empathetic and of higher quality [96] – there is growing interest in some sectors for ‘solving’ the healthcare workplace dilemma with ‘AI.’ [97]

Companies are already marketing AI-driven patient call-in question-answer services. [98]

If physician, nursing, and other healthcare worker shortages continue to worsen, we may be forced to go to AI solutions – in order to provide any healthcare options – especially in rural or other underserved areas!

16. Most ‘Top Hospital’ Decision Makers now have no healthcare background

Recent studies show that large, increasingly corporate healthcare systems are being governed by those with no healthcare backgrounds [99] and are increasingly isolated and without input from clinical professionals.

It is postulated that these ‘business leaders’ – recruited from other non-medical industries in attempts to stave off accelerating financial crises – are increasingly responsive to profit [37] as their singular guiding goal.

Meanwhile, though multiple studies [100] have shown that hospitals managed directly [101] by doctors provide better patient services at lower prices [102] – multiple laws including Stark Laws, anti-kickback statutes, and more recently elements of the Affordable Care Act [103. 104] have severely restricted the formation of physician-owned/managed hospitals. Yet data shows that these same laws allow for Kickback and profiteering activities [103] by non-physician-owned hospital systems at a rate much greater than was ever seen previously.

17. Increasing Public Distrust in the Whole Healthcare System

“Confidence in the medical system as a whole fell from 51 percent in 2020 to a record low of 38 percent in 2022.” [88] The vast majority of Americans (82%) now distrust the Healthcare System – believing the “Focus is on Profits Over People.” [105]

18. Meanwhile, Record Profits for Some

In fact, profits are being seen in most healthcare industry sectors, [106] healthcare administrations, Health Insurers, [107] ‘big pharma’, [108] medical device manufacturing, private equity, – with pervasive greed being frequently touted as the driving, destructive force.

Notably, the only major failing segment is the ‘pillar’ upon which all these profit-making systems rest – the healthcare workplace!

Can Our Health System be Fixed – Potential Solutions?

Each of these issues have available or potential solutions but will require a concerted effort from all of us – Government, healthcare leaders, economic and business leaders, society in general – in order to stabilize and realign our healthcare economies and systems.  As these issues are interrelated and feed upon each other, one great difficulty is addressing multiple disruptive issues in unison.

Action is further hampered by the lack of collaboration [110] among all the different healthcare stakeholders. [111, 112] In fact, incentives of these different groups frequently are misaligned, [113. 114] and sometimes completely oppositional [115] to one another – Administrators vs physicians, vs mid-levels, vs nurses, insurers, vs pharmacies, vs pharmaceuticals, vs regulators, vs government, vs public health, vs hospitals, vs primary care, vs specialists, vs corporations, vs private equity, etc. American medicine has been labeled as a “conglomerate of monopolies” [115] with the stakeholders (as noted above), “each working to maximize its own revenue and profit. All are unwilling to innovate in ways that benefit patients – when doing so comes at the sacrifice of financial performance.”

Thus, little is being done to address these critical issues. [116

In the end this is a problem for each and every one of us – as sooner or later – we will, unfortunately, each face critical healthcare issues and want, expect, and deserve to have a healthcare system that is available and can rapidly and effectively respond to those needs.

Disclaimer: Opinions expressed are Dr. Severance’s alone and should not be construed as representing any opinions or positions of his employers or affiliates.

References:

1. Jakob Emerson & Erica Carbajal, ‘Patients are going to die’: Hospital access meltdown in Central California leaves officials in search of solutions. Becker’s Hospital Review, Jan 19, 2023. ‘Patients are going to die’: Hospital access meltdown in Central California leaves officials in search of solutions (beckershospitalreview.com)
2. Marcus Robertson, 631 hospitals at risk of closure, state by state. Becker’s Hospital CFO Report. Jan 3, 2023. https://www.beckershospitalreview.com/finance/631-hospitals-at-risk-of-closure-state-by-state.html
3. Harry W Severance, “631 hospitals at risk of closure, state by state”. LinkedIn, Jan 6, 2023. https://www.linkedin.com/feed/update/urn:li:activity:7017219042918756352/
4. Rita Numerof, A Dire Forecast Lies Ahead for U.S. Healthcare Delivery in Distress, And Change Isn’t Waiting For A Sinking Ship To Right Itself. Forbes, Jan 17, 2023.  A Dire Forecast Lies Ahead For U.S. Healthcare Delivery In Distress, And Change Isn’t Waiting For A Sinking Ship To Right Itself (forbes.com)
5. ROBERT GLATTER, PETER PAPADAKOS, AND YASH SHAH, The Coming Collapse of the U.S. Health Care System. Time, Jan 10, 2023. The Coming Collapse of the U.S. Health Care System | Time
6. Michael DePeau-Wilson, “Hospitals Close While Execs Made Millions; Prestigious Group Took Sackler Money”. MedPage-today, April 26, 2023.  Hospitals Close While Execs Made Millions; Prestigious Group Took Sackler Money | MedPage Today
7. Harry W Severance, “COVID-19 can offer some silver linings”. Emergency Physicians Monthly , Feb 2, 2021. COVID-19 can offer some silver linings (epmonthly.com)
8. Lydia Saad, “Americans Sour on U.S. Healthcare Quality.” Gallup, Jan 19, 2023. Americans Sour on U.S. Healthcare Quality (gallup.com)
9. Megan Brenan, “Record High in U.S. Put Off Medical Care Due to Cost in 2022”. Gallup, Jan 17, 2023. Record High in U.S. Put Off Medical Care Due to Cost in 2022 (gallup.com)
10. Jakob Emerson and Molly Gamble, “Healthcare’s affordability problem is about to get worse.” Becker’s Hospital CFO Report. June 16, 2023. Healthcare’s affordability problem is about to get worse (beckershospitalreview.com)
11. The Commonwealth fund, New Study: “S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly”. Sept 23, 2011. New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly | Commonwealth Fund
12. The Commonwealth fund, “S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes ”. Jan 31, 2023. U.S. Health Care from a Global Perspective, 2022 | Commonwealth Fund
13. Robert Langreth, “Why Prescription Drug Prices in the US Are So High”. Bloomberg, July 19, 2022. Why Prescription Drug Prices in the US Are So High – Bloomberg
14. Emily Hutto, “How Patent Thickets Keep Cheaper Drugs Off the Market”. MedPaage-Today, Feb 3, 2023. How Patent Thickets Keep Cheaper Drugs Off the Market | MedPage Today
15. Britney Heimuli, ‘This is the worst I’ve ever seen’ — Chemotherapy drug record shortage puts patients at risk. Yahoo News, June 7, 2023. ‘This is the worst I’ve ever seen’ — Chemotherapy drug record shortage puts patients at risk (yahoo.com)
16. Erik Swain, Michael Ganio, Patricia Nale, “Shortages affect availability of some drugs used in emergent cardiac care”. Cardiology Today, July 13, 2023. Shortages affect availability of some drugs used in emergent cardiac care (healio.com)
17. KAITLIN VOGEL, These 22 Medications Are in Short Supply—Is Yours on the List? Parade, Jan 27, 2023. 22 Medication Shortages: List of Drugs – Parade: Entertainment, Recipes, Health, Life, Holidays
18. Deidre McPhillips, Nearly all hospital pharmacists say drug shortages are negatively impacting care; a third say impacts are ‘critical’. CNN Health, Aug 10, 2023. Drug shortages: Nearly all hospital pharmacists say shortages are negatively impacting care; a third say impacts are ‘critical’ | CNN
19. Jen Christensen, New drug shortages in the US increased nearly 30% in 2022, Senate report finds. CNN Health, March 22, 2023. New drug shortages in the US increased nearly 30% in 2022, Senate report finds | CNN
20. Harry Severance, “Isn’t It a Seller’s Market for Healthcare Professionals? – Competition for a scarce resource (providers) could improve the workplace.” MedPage-Today, Oct 12, 2022. Isn’t It a Seller’s Market for Healthcare Professionals? | MedPage Today
21. Deb Gordon, , Amid the Great Resignation… Forbes Magazine , May 17, 2022. Amid Healthcare’s Great Resignation, Burned Out Workers Are Pursuing Flexibility And Passion (forbes.com)
22. Harry Severance, MD, “Should You Stay or Should You Go?” EP Monthly, June21, 2022. Should You Stay or Should You Go? | Emergency Physicians Monthly (epmonthly.com)
23. JESSICA STILLMAN, A Toxic Workplace Triples Your Risk of Depression, a New Study Finds. INC, July 28, 2021. A Toxic Workplace Triples Your Risk of Depression, a New Study Finds | Inc.com
24. Harry W Severance, MD, ‘Burnout’ and the Healthcare Workplace. EP Monthly, Aug 5, 2022. ‘Burnout’ and the Healthcare Workplace (epmonthly.com)
25. Eric Reinhart, Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System. The NY Times, Feb 5, 2023, Opinion | Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System. – The New York Times (nytimes.com)
26. Lazarus A. Traumatized by practice: PTSD in physicians. J Med Pract Manage. 2014 Sep-Oct;30(2):131-4. PMID: 25807606. Traumatized by practice: PTSD in physicians – PubMed (nih.gov)
27. Devon McPhee, Primary care doctors would need more than 24 hours in a day to provide recommended care. U Chicago News, April 11, 2022, Primary care doctors would need more than 24 hours in a day to provide recommended care | University of Chicago News (uchicago.edu)
28. Harry Severance, MD. Yet Another Issue Is Disrupting the Healthcare Workplace. MedPage-Today. Jan 10, 2023. Yet Another Issue Is Disrupting the Healthcare Workplace | MedPage Today
29. Harry Severance, The financial hit to healthcare has sparked a period of transition. Here’s what experts think will happen next. LinkedIn, March 2023, https://www.linkedin.com/feed/update/urn:li:activity:7073108319468486656/
30. Giancarlo Toledanes, The Other Epidemic: Violence Against Healthcare Workers. Medscape, Aug 30, 2021. The Other Epidemic: Violence Against Healthcare Workers (medscape.com)
31. Annie Burky, Healthcare ranked lowest for employee satisfaction, Qualtrics survey finds. Fierce Healthcare, Jan 19, 2023. Healthcare ranked lowest for employee satisfaction, survey finds (fiercehealthcare.com)
32. Molly Gamble, Healthcare workers keep calling it quits. Becker’s Hospital Review. July 6, 2023. Healthcare workers keep calling it quits (beckershospitalreview.com)
33. Mari Devereaux, Why so many doctors are quitting. Advisory Board, July 18, 2023. Why so many doctors are quitting (advisory.com)
34. Federation of State Medical Baords (FSMB), FSMB Census of Licensed Physicians in the United States, 2020. JOURNAL of MEDICAL REGULATION VOL 107, N O 2 |, 2021. 2020-physician-census.pdf (fsmb.org)
35. Tanya Albert Henry, Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years. AMA News, Jan 18, 2022. Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years | American Medical Association (ama-assn.org)
36. Harry Severance, MD. A Manager’s Perspective on Healthcare Unionization — Her response was not at all what I expected. MedPage-Today, June 11, 2023. A Manager’s Perspective on Healthcare Unionization | MedPage Today
37. Harry Severance, MD. Suits vs Scrubs: The Evolving Healthcare Workplace — The patient pays the ultimate price. MedPage-Today, April 19, 2023. Suits vs Scrubs: The Evolving Healthcare Workplace | MedPage Today
38. Simon G. Talbot and Wendy Dean, Physicians aren’t ‘burning out.’ They’re suffering from moral injur STAT, July 26, 2018. Physicians aren’t ‘burning out.’ They’re suffering from moral injury – STAT (statnews.com)
39. Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics. 2021 Aug;28(5):590-602. doi: 10.1177/0969733020966776. Epub 2021 Jan 11. PMID: 33427020; PMCID: PMC8366182. Moral injury in healthcare professionals: A scoping review and discussion – PubMed (nih.gov)
40. TOMI MITCHELL, I will not sell my soul to modern medicine: Curing physician moral injury. com, Sept 23, 2022. I will not sell my soul to modern medicine: Curing physician moral injury (kevinmd.com)
41. BEN KORNITZER, MD, Physician burnout is a threat, no different from the spread of a virus—here’s how to fix it. com, July 15, 2023. Ben Kornitzer, MD | KevinMD.com
42. Joe Cantlupe, Expert Forum: The rise (and rise) of the healthcare administrator. Athena Health, Nov 7, 2017. Number of healthcare administrators explodes since 1970 | athenahealth
43. Kimberly Ruppel and Christopher Rya, PHYSICIAN NON-COMPETE AGREEMENTS: WHAT YOU SHOULD KNOW. Health Law Blog, Feb 24, 2022. Physician Non-Compete Agreements: What You Should Know – DW Health Law Blog (dickinson-wright.com)
44. Harry Severance, MD. Yet Another Issue Is Disrupting the Healthcare Workplace. MedPage-Today, Jan 10, 2023. Yet Another Issue Is Disrupting the Healthcare Workplace | MedPage Today
45. Yash B. Shah, Violence in the Workplace: The Hidden Dangers of a Medical Career. Medscape, Feb 25, 2022. The Hidden Dangers of a Medical Career (medscape.com)
46. Wallace Stephens, Violence Against Healthcare Workers: A Rising Epidemic.  AJMC. May 12, 2019. Violence Against Healthcare Workers: A Rising Epidemic (ajmc.com)
47. Harry Severance, MD. The escalating violence in health care workplaces: a critical problem facing the nation’s health care system. com, June 2, 2023. The escalating violence in health care workplaces: a critical problem facing the nation’s health care system (kevinmd.com)
48. CAROL DAVIS, 5,217 NURSES WERE ASSAULTED ON THE JOB JUST IN Q2 2022. Health leaders media, SEPTEMBER 12, 2022. 5,217 Nurses Were Assaulted on the Job Just in Q2 2022 | HealthLeaders Media
49. Claire Wallace, Police officers warn physicians to be prepared among growing patient attacks. Becker’s Physician Leadership. July 18th, 2023. Police officers warn physicians to be prepared among growing patient attacks (beckersphysicianleadership.com)
50. Christine Lehmann, Hospital Shootings Have Doctors Worried About Their Personal Safety. Medscape, June 12, 2023. Hospital Shootings Have Doctors Worried About Their Safety (medscape.com)
51. Erica Carbajal, Nurse stabbed at Massachusetts hospital: Police. Becker’s Hospital Review. June 13th, 2023. Nurse stabbed at Massachusetts hospital: Police (beckershospitalreview.com)
52. Shari Berg, A Comprehensive Guide of State-by-State Nursing Unions. Incredible Health, Feb 14 2022. A Comprehensive Guide of State-by-State Nursing Unions | Incredible Health
53. David M Sack, Doctors Are Reluctant to Unionize. Why? com, June 26, 2023. Doximity
54. Maura Mastrony, Claire Pariano, Jason Stanevich, Following the Doctor’s Orders: NLRB Decision Prescribes Union Election for Physicians. JDSupra, April 12, 2022. Following the Doctor’s Orders: NLRB Decision Prescribes Union Election for Physicians | Littler – JDSupra
55. Kelly Gooch, Unionization gaining traction among physicians. Becker’s Hospital Review, August 4th, 2023. Unionization gaining traction among physicians (beckershospitalreview.com)
56. The Natioonal Law Review, Doctors, Unions, and Protected Activity. August 28, 2023, Volume XIII, Number 240. Doctors, Unions, and Protected Activity | The National Law Review (natlawreview.com)
57. Andis Robeznieks, Doctor shortages are here—and they’ll get worse if we don’t act fast. AMA News, APR 13, 2022. Doctor shortages are here—and they’ll get worse if we don’t act fast | American Medical Association (ama-assn.org)
58. Dropstat, The Nursing Shortage: Causes, Consequences, and Cures. The Nursing Shortage: Causes, Effects & Cures | DropStat
59. Michael Nedelman, Why doesn’t the US train more doctors? CNN Health, March 14, 2017. Why doesn’t the US train more doctors? | CNN
60. Jacob Kupietzky, It’s Not Just A Shortage Of Nurses But Of Training And Understanding. Forbes, Nov 29, 2021. It’s Not Just A Shortage Of Nurses But Of Training And Understanding (forbes.com)
61. Derek Thompson, Why America Has So Few Doctors. The Atlantic, FEBRUARY 14, 2022. Why America Has So Few Doctors – The Atlantic
62. Harry W Severance, MD. The Great Healthcare Exodus – Physician Shortage – Critical Changes are Needed!. LinkedIn, August 2022, https://www.linkedin.com/feed/update/urn:li:activity:6923692910936829952/
63. Lorna Collier, 7 Reasons Doctors Are Leaving Medicin Healthgrades, July 28, 2023. 7 Reasons Doctors Are Leaving Medicine | Healthgrades for Professionals
64. Ed Yong, WHY HEALTH-CARE WORKERS ARE QUITTING IN DROVES. The Atlantic, NOVEMBER 16, 2021. Why Health-Care Workers Are Quitting in Droves – The Atlantic
65. Joyce Frieden, Are There Too Many Foreign-Born Docs in the U.S.? Maybe, Maybe Not. MedPage-Today. February 16, 2022. Are There Too Many Foreign-Born Docs in the U.S.? Maybe, Maybe Not | MedPage Today
66. Mariah Taylor, 47% of physicians are 55 or older: 8 things to know about the physician workforce. Becker’s Hospital Review. January 17th, 2023. 47% of physicians are 55 or older: 8 things to know about the physician workforce (beckershospitalreview.com)
67. Linda Beattie, Physician Shortages in Medical Specialties in 2021: An Inside Look. AMN Healthcare, March 16, 2021. Physician Shortages in Medical Specialties in 2021 | Merritt Hawkins
68. ELAINE K. HOWLEY, The U.S. Physician Shortage Is Only Going to Get Worse. Here Are Potential Solutions. Time, July 25, 2022, There’s a Physician Shortage In the U.S. Here’s Why | Time
69. Joyce Frieden, What Should Be Done About the Health Workforce Shortage? MedPage-Today, February 16, 2023. What Should Be Done About the Health Workforce Shortage? | MedPage Today
70. Heather Landi, Primary care docs need 27 hours a day to provide guideline-based care, study finds. Fierce Healthcare, Aug 23, 2022. Doctors need 27 hours a day to provide recommended care: study (fiercehealthcare.com)
71. Lauren Dixon, Challenges of the Health Care Worker Shortage. Medium – Talent Economy, Nov 29, 2017. Challenges of the Health Care Worker Shortage | by Lauren Dixon | Medium
72. Eliabeth Rosenthal, Denials of health insurance claims are rising. Times-Tribune, August 28, 2023. Denials of health insurance claims are rising | News | thetimestribune.com
73. Brian Barnett, Who’s choosing Americans’ medications — doctors or insurers? The bane of prior authorization. STAT News, Jan. 1, 2021. Under prior authorization, who is choosing Americans’ medicines? – STAT (statnews.com)
74. Susan Morse, Current prior authorization practices are adding to burnout, surgeon general says. Healthcare Finance, Jan 18, 2023. Current prior authorization practices are adding to burnout, surgeon general says | Healthcare Finance News
75. Rich Daly, Prior-authorization cost and time burdens increase for providers, report finds. HFMA, January 22, 2020. Prior-authorization cost and time burdens increase for providers, report finds (hfma.org)
76. Thomas Beaton, Prior Authorization Issues Contribute to 92% of Care Delays. HealthPayer Intelligence, March 19, 2018. Prior Authorization Issues Contribute to 92% of Care Delays (healthpayerintelligence.com)
77. Andis Robeznieks, How insurance companies’ red tape can delay patient care. AMA News, MAR 30, 2018, How insurance companies’ red tape can delay patient care | American Medical Association (ama-assn.org)
78. American Hospital Association, [Special Edition] How Prior Authorizations Can Harm Patient Car (Podcast), 09/23-2022, [Special Edition] How Prior Authorizations Can Harm Patient Care | AHA
79. Thomas Law Offices, When Prior Authorization Leads to Harm Caused by Delayed Care. May 26, 2023. When Prior Authorization Leads to Harm Caused by Delayed Care | Thomas Law Offices
80. American Hospital Association, Survey: Commercial Health Insurance Practices that Delay Care, Increase Costs 11-1-22, Survey: Commercial Health Insurance Practices that Delay Care, Increase Costs Infographic | AHA
81. Carey Goldberg, S. Hospitals Cope With Fatal Overcrowding. Bloomberg , January 26, 2022. U.S. Hospitals Cope With Fatal Overcrowding – Bloomberg
82. Alan Condon, Hospital closures, bankruptcies could see uptick in 2023. Becker’s CFO Report, November 7th, 2022. Hospital closures, bankruptcies could see uptick in 2023 (beckershospitalreview.com)
83. Savioli G, Ceresa IF, Gri N, Bavestrello Piccini G, Longhitano Y, Zanza C, Piccioni A, Esposito C, Ricevuti G, Bressan MA. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J Pers Med. 2022 Feb 14;12(2):279. doi: 10.3390/jpm12020279. PMID: 35207769; PMCID: PMC8877301. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions – PubMed (nih.gov)
84. American Hospital Association, Workforce Shortages Delay Patient Discharges and Exacerbate Providers’ Severe Financial Challenges. December 2022, Workforce Shortages Delay Patient Discharges and Exacerbate Providers’ Severe Financial Challenges | AHA
85. Andrew Cass, 42 hospitals closing departments or ending services. Becker’s CFO Report, June 30th, 2023. 42 hospitals closing departments or ending services (beckershospitalreview.com)
86. Molly Gamble, Hospitals suffer worst financial year since the pandemic. Becker’s CFO Report, January 30th, 2023. Hospitals suffer worst financial year since the pandemic (beckershospitalreview.com)
87. Alan Condon, 6 latest healthcare bankruptcies. Becker’s CFO Report, June 16th, 2023. 6 latest healthcare bankruptcies (beckershospitalreview.com)
88. Jakob Emerson, ‘Hospital purgatory’: Confidence in healthcare plunges as criticism grows louder and large Becker’s Hospital Review, February 6th, 2023. ‘Hospital purgatory’: Confidence in healthcare plunges as criticism grows louder and larger (beckershospitalreview.com)
89. Sara Heath, Top Challenges Impacting Patient Access to Healthcare. Patient Engagement, February 22, 2022. Top Challenges Impacting Patient Access to Healthcare (patientengagementhit.com)
90. Steven Ross Johnson, Staff Shortages Choking U.S. Health Care System – A growing shortage of health care workers is being called the nation’s top patient safety concern. US News & World Report, July 28, 2022. Staff Shortages Choking U.S. Health Care System | Healthiest Communities Health News | U.S. News (usnews.com)
91. Rebecca Pifer, ‘An ever-spiraling upward cycle’: nonprofit hospital CEOs paid 8 times more than average worker. Healthcare Dive, Feb. 11, 2022. ‘An ever-spiraling upward cycle’: nonprofit hospital CEOs paid 8 times more than average worker | Healthcare Dive
92. Alan Condon, CMS physician pay down 22% from 2001-2022; providers urge Congress to fix ‘broken’ system. Becker’s Hospital Review, February 10th, 2023. CMS physician pay down 22% from 2001-2022; providers urge Congress to fix ‘broken’ system (beckershospitalreview.com)
93. Medical Economics, Medicare’s 2023 fee schedule: cuts in reimbursement, expanded payments for behavioral health. Nov 2, 2022. Medicare’s 2023 fee schedule: cuts in reimbursement, expanded payments for behavioral health (medicaleconomics.com)
94. Riz Hatton, ‘Will the last to leave please turn out the lights?’: The consequences of declining physician pay – Interview with Dr. Harry Severance, Becker’s ASC Review, July 21st, 2023. ‘Will the last to leave please turn out the lights?’: The consequences of declining physician pay (beckersasc.com)
95. Bill Siwicki, How virtual nursing can help solve many workforce shortage woe HIMSS, March 14, 2023. How virtual nursing can help solve many workforce shortage woes | Healthcare IT News
96. Harry W Severance, MD. AI-driven solutions for burnout, patient empathy, and worker shortage. com, JUNE 9, 2023. AI-driven solutions for burnout, patient empathy, and worker shortage (kevinmd.com)
97. Harry W Severance, MD, Can AI solve the physician shortage crisis?. com, MARCH 19, 2023. Can AI solve the physician shortage crisis? (kevinmd.com)
98. SIMBOAI, SIMBO.AI – Reducing Physician Burnout. LinkedIn, (1) SIMBO.AI – Reducing Physician Burnout: Overview | LinkedIn
99. Gondi, S., Kishore, S. & McWilliams, J.M. Professional Backgrounds of Board Members at Top-Ranked US Hospitals. J GEN INTERN MED38, 2428–2430 (2023). https://doi.org/10.1007/s11606-023-08056-z Professional Backgrounds of Board Members at Top-Ranked US Hospitals – PubMed (nih.gov)
100. James k. Stoller, Amanda Goodall, and Agnes Baker, Why The Best Hospitals Are Managed by Doctors. Harvard Business Review. December 27, 2016. Why The Best Hospitals Are Managed by Doctors (hbr.org)
101. Jesse M. Ehrenfeld, End restrictions on physician-owned hospitals to expand quality care. AMA News, AUG 10, 2023, End restrictions on physician-owned hospitals to expand quality care | American Medical Association (ama-assn.org)
102. Wang Y, Plummer E, Wang Y, Cram P, Bai G. Comparison of Commercial Negotiated Price and Cash Price Between Physician-Owned Hospitals and Other Hospitals in the Same Hospital Referral Region. JAMA Netw Open.2023;6(6):e2319980. doi:10.1001/jamanetworkopen.2023.19980 Comparison of Commercial Negotiated Price and Cash Price Between Physician-Owned Hospitals and Other Hospitals in the Same Hospital Referral Region | Health Policy | JAMA Network Open | JAMA Network
103. Elizabeth Plummer, Peter Cram, Ge Bai, Who’s Afraid of Physician-Owned Hospitals? — It’s high time to lift the restrictions. MedPage-Today, July 6, 2023. Who’s Afraid of Physician-Owned Hospitals? | MedPage Today
104. Michael W. Peregrine and David Jarrard, New study of hospital board members is highly flawed, but still noteworthy. Becker’s Hospital Review. February 22nd, 2023. New study of hospital board members is highly flawed, but still noteworthy (beckershospitalreview.com)
105. Community Healthcare of Texas, The Vast Majority of Americans Distrust the Healthcare System Believing the Focus is on Profits Over People. November 21, 2022. The Vast Majority of Americans Distrust the Healthcare System Believing the Focus is on Profits Over People – Community Healthcare of Texas (chot.org)
106. Berwick DM. Salve Lucrum: The Existential Threat of Greed in US Health Care. JAMA. 2023;329(8):629–630. doi:10.1001/jama.2023.0846 Salve Lucrum: The Existential Threat of Greed in US Health Care | Health Care Economics, Insurance, Payment | JAMA | JAMA Network
107. CNN, Health insurance companies make record profits as costs soar in US. Feb. 3, 2022. Health insurance companies make record profits as costs soar in US (nbc29.com)
108. Ledley FD, McCoy SS, Vaughan G, Cleary EG. Profitability of Large Pharmaceutical Companies Compared With Other Large Public Companies. 2020 Mar 3;323(9):834-843. doi: 10.1001/jama.2020.0442. PMID: 32125401; PMCID: PMC7054843. Profitability of Large Pharmaceutical Companies Compared With Other Large Public Companies – PMC (nih.gov)
109. JARED DASHEVSKY, PRIVATE EQUITY IN HEALTHCARE: THE GOOD, THE BAD, AND THE UGL Workweek, April 15, 2023, Private Equity in Healthcare: the Good, the Bad, and the Ugly – (workweek.com)
110. Ryan Howard, Thomas Leyden, Michael Englesbe, How Collaboration Can Drastically Improve U.S. Health Care. Harvard Business Review, March 16, 2022. How Collaboration Can Drastically Improve U.S. Health Care (hbr.org)
111. The Future of Health.care, Stakeholders in Healthcare. May 20, 2020, Stakeholders in Healthcare – The Future of Health.care
112. Public Health, Nigeria, Who are the Stakeholders in The Healthcare System?, Who Are the Stakeholders in The Healthcare System? – Public Health
113. Larry R. Hearld, PhD, Jeffrey A. Alexander, PhD, Barriers and Strategies to Align Stakeholders in Healthcare Alliances. Am J Manag Care. 2012;18:S148-S155. Barriers and Strategies to Align Stakeholders in Healthcare Alliances (ajmc.com)
114. David E. Bloom & Daniel M. Cadarette & Jonty Roland & Jessica Sullivan, “Misaligned Stakeholders and Health System Underperformance, Industry Agenda Council on the Future of the Health Sector ” World Economic Forum, December 2016, pdf (weforum.org)
115. Robert Pearl, Value-based care battle: Kaiser-Geisinger vs. Amazon, CVS, Walmart. LinkedIn, July 17, 2023. (5) Value-based care battle: Kaiser-Geisinger vs. Amazon, CVS, Walmart | LinkedIn
116. Harry W Severance, US Healthcare System is a House of Cards; Could it Collapse? Duke University Opinion and Analysis – Duke Medium, August 2, 2022. US Healthcare System is a House of Cards; Could it Collapse? | by Duke University Opinion and Analysis | Medium