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Healthcare Industry 2021 PLUSThe Pandemic Is the Healthcare Story of the YearThe current data from The COVID Tracking Project is tragic and sobering. As of 12/24/20, there were 18.44 million cases in the US, 202,579 new cases (an 8.4% increase from 7 days previously) and a total of 320,451 deaths.The Project also reported 120,151 hospitalized with COVID-19 and 22,607 in ICUs. According to the US Department of Health and Human Services, approximately 12.5% of US hospitals, or almost 600, were at or exceeded ICU capacity for the week of 11/27/20.During November 2020, the US government announced patients with acute conditions, such as pneumonia and asthma, can remain at home with proper evaluation and monitoring to alleviate the strain on hospitals.5 States with the Most and Least Percentage Increases in COVID-19 Cases for the Week Ending 12/24/20, December 2020States with MostPercentStates with LeastPercent#1: Maine18.6%#1: North Dakota1.2%#2: California16.2%#2: Iowa3.3%#3: New Hampshire13.5%#3: South Dakota3.6%#4: West Virginia12.8%#4: Minnesota3.9%#5: Pennsylvania11.5%#5: Michigan4.3%The COVID Tracking Project, December 2020More Americans Ready To Be VaccinatedVarious polls indicate more Americans are willing to be vaccinated against the COVID-19 virus. A University of Michigan poll found 58% of adults 50 to 80 were somewhat or very likely to be vaccinated; however, 46% said they would wait so others could be protected.In another poll conducted by USA Today/Suffolk University during December, 46% of respondents wanted to be vaccinated as soon as they are allowed, compared to 26% from a late October poll, with 32% willing to wait for more vulnerable people to receive it first.Unsurprisingly, the distribution and administration of vaccines have been confusing, considering the enormous scope of the task and states and counties are responsible for deciding who receives a vaccine first, and they’re exhausting funds for the process. Factors Influencing Older Adults’ Decision To Receive a COVID-19 Vaccine, October 2020Access TypePercentHow well it works80%Their research56%A physician’s recommendation52%Public health officials’ recommendations42%Family or friends’ recommendations13%University of Michigan, November 2020Medicare During the PandemicFor the period 1/1–9/12/20, there were 1.19 million COVID-19 cases with Medicare claims, or 1,843/100K population. The largest age group was adults 85+ at 3,459/100K, with African Americans 3,210/100K and Latinx Americans 3,100/100K the largest by ethnicity.During the same period, there were 332,672 Medicare/COVID-19 hospitalizations, or 517/100K population, and were significantly more in urban areas 567/100K, compared to 334/100K in rural areas.Almost half (49%) of the hospitalized COVID-19 Medicare patients stayed at a hospital for 1–7 days, with another 16% 8–10 days and 15% 11–15 days. Almost one-third (32%) were discharged to their homes, 22% to a skilled nursing facility and 5% to a hospice.Total Medicare COVID-19 Cases and Hospitalizations, April–September 2020DatesCasesHospitalizationsApril 18th53,34622,198May 16th46,33412,823June 13th37,9317,665July 18th65,37716,175August 15th45,94014,038September 12th26,9097,405Centers for Medicare & Medicaid Services, October 2020Americans’ Perspectives on US HealthcareUnsurprisingly, a November 2020 Gallup poll found 69% of respondents said COVID-19 was the country’s most urgent health problem, the largest percentage of similar polling since 1987 when 62% of Americans said AIDS was the most urgent health problem.Despite the pandemic, another November 2020 Gallop poll revealed slightly fewer Americans said the US healthcare system has major problems, or 61%, compared to 63% during 2019 and 70% during 2018.A majority (56%) of survey respondents said the federal government should ensure Americans have health insurance, a 2-point increase from 2019, while those who don’t think that is a responsibility of the government decreased 3 points from 2019 (45%) to 42%.Americans Who Think the US Healthcare System Has Major Problems, by Political Party Affiliation, 2016–2020YearDemocratsRepublicansIndependents201658%80%74%201772%72%72%201884%60%65%201983%46%60%202078%43%62%Gallup, December 2020Paying Medical BillsAn early-April 2020 survey from AccessOne, a provider of patient financing solutions, found 51% of participants were concerned about losing their health insurance and 68% thought they might be unable to pay their general medical expenses during 2020.Of the people who responded to a November 2020 VisitPay survey, 35% were still concerned about paying their medical bills and might delay treatments to minimize payments. Other than credit cards, medical bills caused more stress for 60%.The VisitPay survey also revealed 37% of respondents were paying their medical bills with credit cards and 75% were forced to pay their credit card balance during several months; however, making those payments was last after mortgages, rents and utilities.Likelihood of Higher-Income Consumers Delaying Various Medical Care, April 2020Delay of Medical Care$100K or More$50K–$100KLess than $50KNon-emergency, but necessary surgery (e.g., knee replacement)63%59%56%Non-emergency, but necessary surgery by as much as 6 months46%26%31%A diagnostic procedure (e.g., colonoscopy)59%59%54%A diagnostic procedure by as much as 6 months43%29%29%AccessOne, May 20202019 Healthcare SpendingTotal US healthcare spending increased during 2019 to $3.8 trillion, but the increase of 4.6% was slightly less than 2018’s increase of 4.7%. Total health care spending’s share of the GDP was slightly more than 2018, or 17.7% and 17.6%, respectively.Despite increases in hospital care, physician and clinical services and retail purchases of prescription drugs, total spending declined because the health insurance providers’ tax was suspended during 2019, decreasing the net cost of health insurance by 3.8%.Health care spending per American was $11,582, compared to $11,172 for 2018. Private health insurance was the major source of health care dollars, with a 31% share; followed by Medicare 21%, Medicaid 16% and out-of-pocket (11%).Healthcare Expenditures by Category, 2019CategoryAmountChangeShareCategoryAmountChangeShareHospital care$1.2 T+6.2%31%Home health care$113.5 B+7.7%3%Physician and clinical services$772.1 B+4.6%20%Other professional services$110.6 B+6.5%3%Retail prescription drugs$369.7 B+5.7%10%Other non-durable medical products$82.1 B+5.6%2%Other health care$193.6 B+1.2%5%Durable medical equipment$57.6 B+5.0%2%Nursing care facilities$172.7 B+3.3%5%Total$3.8 T+4.6%100%Dental services$143.2 B+4.2%4%Centers for Medicare & Medicaid Services, December 2020 red=more than 2018; green=less than 2019; no color=no changeFuture Healthcare Spending TrendsAccording to the Centers for Medicare & Medicaid Services (CMS) projections, 2020 healthcare spending will increase 5.2%, with a faster increase for the cost of personal health care as the primary driver.CMS also forecasts an increase in total healthcare spending during the 2021–2023 period, but only two-tenths of a percentage point more than 2020, or 5.4% and 5.2%, respectively. More spending for hospital services will increase the average Medicare growth to 5.7%.During the 2024–2028 period, total US healthcare spending will increase by another modest two-tenths of one percent, to 5.6%. Medicare spending will increase by one-tenth of one percent to 5.8% as more Baby Boomers exchange private health insurance for Medicare.Projections of Payer Sources for US Health Expenditures, December 2020Payer Sources2018201920202021–2023*2024–2028*Medicare+6.4%+6.7%+7.2%+7.8%+7.7%Medicaid+3.0%+3.9%+4.5%+5.7%+5.8%Private health insurance+5.8%+3.8%+5.2%+4.6%+5.0%Out-of-pocket+2.8%+3.7%+4.0%+4.1%+4.3%Centers for Medicare & Medicaid Services, December 2020*average/yearAffordable Care Act Remains PopularAccording to December 2020 data from CMS, 8.23 million Americans selected a 2021 health insurance plan from the Affordable Care Act (ACA) exchanges available in their states. This was a 6.6% increase from the 2020 selection period. Although more people (8.3%) enrolled for 2020, the percentage of enrollees increased for 2021, because New Jersey and Pennsylvania launched state-based exchange platforms for 2021 and Nevada had for 2020, reducing the number of states with exchanges to 36.November 2020 analysis from the Kaiser Family Foundation indicated 30 new insurers joined ACA exchanges in 20 states and 61% offered more service options where they were already operating. For 2021, 78% of enrollees could choose from more plans than 10 States with Cumulative ACA Individual Selections for the 2021 Enrollment Period*, December 2020StateTotalStateTotal#1: Florida2,115,424#6: Michigan266,893#2: Texas1,284,524#7: Virginia261,906#3: North Carolina536,270#8: South Carolina230,033#4: Georgia514,641#9: Missouri215,188#5: Illinois291,159#10: Tennessee211,474Centers for Medicare & Medicaid Services, December 2020*11/1–12/15/20Use of Telehealth to Continue After PandemicA July 2020 survey from Harmony Healthcare IT found 67% of respondents said they had used telehealth since the start of the pandemic, compared to 46% prior to the pandemic, and respondents averaged 2.9 visits during the pandemic period. During May 2020, Frost & Sullivan, an information and growth consulting company, indicated telehealth demand would increase 64.3% YOY for 2020, and increase at a CAGR (compound annual growth rate) of 38.2% for the five years through 2025.Of the participants in the Harmony Healthcare IT survey, 60% said they would continue to use telehealth after the pandemic, with just 12% saying they would not. Increased security/privacy (41%) is the #1 reason patients said they would use telehealth more often. Positive Factors for Patients’ Use of Telehealth, July 2020FactorPercentFactorPercentConvenience63%Comfort (being at home)24%Safety (avoid virus exposure)59%Easier to schedule follow-up18%Flexibility46%Better communication16%Less wait time35%Other2%Harmony Healthcare IT, July 2020Physicians’ Perspectives on TelehealthA July/August 2020 survey of physicians from the COVID-19 Healthcare Coalition found those practicing in urban (60.2%) and rural (59.5%) areas had been using telehealth for 4 to 6 months almost equally to suburban (67.7%) areas.Approximately 80% of physicians were conducting telehealth visits from their clinic: rural 87.2%, suburban 82.1% and urban 79.7%, with large percentages also conducting visits from their homes: rural 48.0%, suburban 68.3% and urban 69.2%.An average of 76.9% of physicians in these three areas said low or no reimbursement was the #1 challenge to being able to maintain telehealth services after the pandemic while an average of 73.8% cited patients’ biggest challenge as access to technology. The Types of Telehealth Visits Physicians Would Like To Continue To Offer Patients After the Pandemic, July/August 2020TypePercent*TypePercent*Chronic disease management76.9%Mental/Behavioral health47.1%Medical management68.5%Specialty care45.0%Care coordination64.0%Acute care43.2%Preventative care56.1%Other11.2%Hospital or ED follow-up50.6%The COVID-19 Healthcare Coalition, August 2020*average of physicians in rural, urban and suburban areasNew Technologies Will Revolutionize HealthcareAlthough most physicians and patients will be most familiar with telehealth technologies after their pandemic-era experiences, artificial intelligence and machine learning are expected to address medical administration challenges during 2021.Big players, such as Walmart, Amazon and Alphabet, will continue to penetrate and disrupt the healthcare industry, from Amazon’s online prescription service to Walmart combining a health plan with provider services specifically for rural Medicaid recipients. Virtual reality (VR) and augmented reality (AR) will increasingly enhance telehealth as well as have more applications to help stroke victims, for example, with the added convenience of stimulated environments instead of physical therapy. Remote-Sensor Technologies Physicians Say They Are Using to Improve Patient Care Via Telehealth, July/August 2020TechnologyPercent*TechnologyPercent*Smartphone cameras (photos)40.8%Continuous glucose monitor8.3%Blood pressure cuffs27.9%Activity monitors6.0%Body weight scale22.3%Other 3.9%Pulse oximeter21.5%Portable EKG3.5%Thermometer 19.7% Home spirometer2.4%Smartphone microphone (audio)17.1%Not currently using, but would like to start20.5%Heart rate monitor11.9%None25.4%The COVID-19 Healthcare Coalition, August 2020*average of physicians in rural, urban and suburban areasA New Administration’s Healthcare ChallengesClearly, the top healthcare priority for the Biden administration is to create robust initiatives to control the pandemic and end its threat quickly. President-elect Biden has already indicated more science-backed advice and protocols from credible health officials. The new administration has also prioritized completing the work of the Trump administration to lower drug prices and provide patients with direct discounts and eliminate “surprise” medical bills, especially when patients use out-of-network providers.President-elect Biden continues to support the ACA and considers it imperative to protect and expand the program with a public option, although the healthcare industry is likely to push back as an expanded ACA could decrease revenues.More Valuable InsightsIn a November 2020 poll of physicians from Doximity, the largest community of healthcare professionals in the US, 82% of physicians said they would recommend their patients receive one of the COVID-19 vaccines. The remaining 18% wanted more information and advice from the Food & Drug Administration (FDA). Physicians in nephrology, infectious disease, pulmonology, obstetrics & gynecology and rheumatology were the top 5 specialty physicians who would recommend a vaccine. Physicians in Tennessee, New Jersey, Michigan, Virginia and Ohio were the top 5 by state. According to the Kaufman Hall November 2020 National Hospital Flash Report, hospitals’ financial situation, despite increasing COVID-19 hospitalizations, were all in negative numbers for October 2020.Median YOY Change in US Hospitals’ Financial Situation, by Categories, January–October 2020Financial CategoriesChangeMargin: operating margin without CARES Act-6.0%Margin: operating margin with CARES Act-1.7%Volume: adjusted discharges-11%Volume: OR (operating room) minutes-12%Volume: ED (emergency department) visits-16%Revenue: gross IP (in-patient)-2%Revenue: gross IP (out-patient)-7%Expenses: total expenses per adjusted discharge+14%Kaufman Hall, November 2020Despite these red numbers, Moody’s Investor Services revised its forecast for for-profit hospitals from negative to stable during early December 2020. By the end of 2020, volumes will be 10% to 15% less than the pre-pandemic volumes, and then increase, and also profits, during the next 12 to 18 months. For-profit hospitals are also expected to receive another $50 billion of the $175 billion allocated in federal relief funds. Sources: The COVID Tracking Project Website, 12/20; USA Today Website, 12/20; HealthLeaders Website, 12/20; University of Michigan Health Website, 12/20; Centers for Medicare & Medicaid Services Website, 12/20; Gallup Website, 12/20; AccessOne Website, 12/20; Healthcare Dive Website, 12/20; Frost & Sullivan Website, 12/20; Harmony Healthcare IT Website, 12/20; The COVID-19 Healthcare Coalition Website, 12/20; MobiDev Website, 12/20; Fierce Healthcare Website, 12/20; Buchanan Ingersoll Rooney Website, 12/20; Doximity Website, 12/20; Kaufman Hall Website, 12/20.Updated: December 2020? 2020 Media Group Online, Inc. All rights reserved.Local Market and Station Information ................
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