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NBC News highlighted a recent study showing that "After hospitals were acquired by private equity firms, patient death rates in the emergency departments rose by 13% compared with similar hospitals." The research analyzed 7 million emergency department visits over a ten-year period at 49 private equity-owned hospitals and 293 hospitals that had not been acquired by private equity. The article reports that "After hospitals were acquired by private equity, the number of full-time employees fell by an average 11.6% compared with non-private equity facilities, the research found, and salary expenditures in the emergency departments and intensive care units declined by 18% and 16%, respectively."

One co-author commented that "Most hospital care in the country remains a face-to-face, human, labor-intensive endeavor, especially in emergency departments and ICUs, ... When human labor is cut to this extent in staffing sensitive areas of the hospital, patient harm can plausibly ensue, including mortality." It seems plausible that someone will be able to figure out a more efficient staffing model at some point, but in the meantime, the hospitals that cut expenses and experience worse patient outcomes should not be rewarded. At the very least, publishing quality metrics might allow some patients to make more informed choices.

The medical community has highlighted the potentially devastating effects that the funding cuts to Medicaid and insurance subsidies mandated by the most recent federal budget are expected to have. KFF Health News published an article highlighting the anticipated impact on a specific community in Texas. Already, the health care system in Starr County seems stretched thin: it "has one of the highest uninsured rates in the nation" and "a third of the population falls below the poverty line." Additionally, primary care doctors in the county serve nearly three times the number of patients as the U.S. average. Since so many people lack insurance, they frequently delay seeking medical care until their conditions are more acute, and are therefore more expensive to treat. The number of uninsured is expected to rise, given the anticipated dramatic rise in out-of-pocket premiums. In conjunction with the funding cuts to Medicaid, it seems that the local health care system will be asked to do more with less.

Supporters of the new budget seem less concerned, citing "a temporary $50 billion fund to support rural doctors and hospitals, that's a little over a third of estimated Medicaid funding losses in rural areas" and a general belief that the new budget "won't cause 'the sky to fall.'" These dramatic changes, however, seem at the very least disruptive, and it is difficult to imagine how a temporary fund will be enough to offset funding cuts in the affected area that are nearly three times the temporary fund.

KFF Health News published a scary article about a gunshot victim almost losing his life to organ harvesting. Fortunately, the patient's neurosurgeon intervened in time, and the patient was able to recover. The article reports that an investigation reports that this was not an isolated case, but that over a four-year period, "providers had planned to harvest the organs of 73 patients despite signs of neurological activity."

Clearly, something went wrong in this case, although the organization responsible for organ procurement in that region appears to deny any wrongdoing. At the very least, it seems that some provider misjudged the patient's health. This particular case was caught, but it raises the larger question about how frequently providers err in their medical judgments, not just in organ transplantation, but in overall treatment.

Insurers are keen to control their costs and in theory, cost savings that insurers achieve are passed on to their customers. Understandably, however, such cost savings could interfere with quality of care and KFF Health News published an article explaining one example of such tension. In the case of the popular weight loss drugs known as GLP-1, the medications have proven effective at causing temporary, but not permanent, weight loss. As a result, patients need to continue the medication regimen, or likely regain weight. Unfortunately, GLP-1 is expensive ("list prices of roughly $1,000 a month") and insurers are considering ways of "deprescribing" the class of drugs. Many insurers seem to be limiting the duration that patients can take such drugs if the purpose is only for weight loss. There are vendors who sell programs to help maintain the weight loss, but it is unclear how popular those programs are among insurers.

This class of drugs poses an interesting policy question because they have proven so effective for temporary effects for a popular condition and are also so expensive. Previously, obesity has been thought of primarily as a behavioral issue, making it easier for society to blame overweight patients. Sentiment about obesity seems to have more recently shifted towards thinking of it as having deeper roots that warrant treatment. However, if those deeper roots cannot be effectively treated with the current state of medicine, should GLP-1 coverage continue indefinitely for patients who want it, raising the premiums for everybody?

KFF Health News published an article chronicling the struggles that one family experienced in getting medical care. Unable to find an in-network pediatric ophthalmologist, the family asked their insurer for a "network gap exception, under which the insurer would cover the recommended doctor's services as in-network." The family received a letter indicating that the procedures would be covered. However, after the surgery, the insurer only covered the services as out-of-network rather than at the much cheaper in-network rates.

While the episode was eventually resolved in the family's favor, it should not have required the involvement of a state senator. Wording from the insurer's letter stated that "These services will be covered at the network level because currently there isn't a doctor, health care professional, or facility in your area to provide these services." However, the insurer apparently denied ever sending that letter, telling the family "there was no record of its approval to cover the surgery as in-network." The insurer also claims that while they agreed to cover the procedures, they did not specify that they would cover it as in-network. However, that line of reasoning essentially nullifies their response to a request for a network gap exception: the family should be able to presume that procedures performed out-of-network would have been covered under the out-of-network rates.

To review, the insurance company does not offer what one might consider adequate provider coverage in an area where they sell insurance plans. To compensate for cases like these, the industry has developed a practice, which requires additional effort from the patient. The insurer issues an approval, and then reneges. It seems likely that a lower-level employee mixed something up, but even still, the family should not have to spend enormous amounts of time to correct the insurer's mistake.