News gems: Hospital price caps, costly drinking water, child-unready hospitals, more

A U.S. state is enjoying $50 million in annual savings after imposing price caps on its hospitals. 

Well and good—but what good things got sacrificed? Did patients see care quality nosedive? Did hospitals take a hit to their operations, capabilities or bottom line? None of the above, according to a new analysis. 

• The state was Oregon, which went live with the program in 2019. Its core stratagem: limiting hospital payments to 200% of Medicare rates for care provided to state employees by in-network hospitals. Out-of-network hospitals had their payments for these patients capped at 185% of the Medicare rates. Two dozen hospitals, the state’s largest and best-resourced, were affected. 
   
• This year researchers from Brown University took a close look at the effects of Oregon’s creative pruning of overgrown healthcare costs. The journal Health Affairs published the team’s study last week. “We found small and nonsignificant changes in Oregon hospitals’ revenues, expenses and margins after implementation of the cap,” healthcare economist Roslyn Murray, PhD, and co-authors report. “Consistent with these findings, we observed limited changes in hospital operations and the patient experience of care. Overall, we found little evidence that Oregon’s payment cap disrupted hospital operations or care delivery.”
   
• Surprisingly, the researchers found patient experience actually improved—albeit only slightly—on several measures. These included clinicians’ communications and attentiveness. In covering the study, The Oregonian asked Murray what she made of these paradoxical rewards. “The improvements we observed were small but statistically significant,” Murray tells the newspaper. “One possibility is that hospitals responded to the payment cap by investing in quality, hoping to stay competitive and appeal to higher-paying commercial insurers.”
   
• OregonLive reporter Kristine de Leon notes the state’s experiment has inspired imitators. This year, she points out, legislators in at least six states have submitted bills aimed at capping hospital prices for certain services or patient populations. 

The ranks of U.S. hospitals with advanced pediatric services are thinning quickly. 

The falloff might not be so glaring if the inverse weren’t so worrisome: Hospitals providing only barebones pediatric services—like in the ER, and that’s it—rose 137% over the two-decade period ending in 2022. The best-staffed and -equipped, which provide numerous advanced pediatric service lines, fell 38%.

• Hospitals falling into one of two categories between those two extremes—more than the barest but less than the best—also saw big decreases in nationwide presence. The findings are from a study led by Kenneth Michelson, MD, MPH, of Lurie Children’s Hospital in Chicago and published Dec. 10 in Pediatrics.
   
• Concentration of pediatric hospital services in fewer hospitals is an example of regionalization, Michelson and co-authors comment. “Although regionalization may have benefits for certain pediatric subspecialties and outcomes,” they write, “declines in pediatric inpatient capacity can have negative ramifications for care delivery and access such as longer transfer times, reduced access, and burdens on families.” 
   
• What can be done to make sure good hospital care is there for American kids now and going forward? “Improving Medicaid reimbursement could help reduce the financial motivation for hospitals to cater preferentially to adult patients,” Michelson and colleagues offer. “Ensuring emergency departments are ready for children and providing certification to facilities for high readiness could ensure hospitals without pediatric inpatient capability can stabilize children before transfer.” 
   
• Sensible but largely untried approaches might be worth considering as well, the team suggests. Measures worth a shot might include “enacting a program for pediatric critical access hospitals, deepening investments in safety-net hospitals or expanding pediatric emergency or inpatient teleconsultation.”
   
  • The study is available in full for free.

U.S. health and social care could save at least $8 billion every year by mitigating the effects of ‘forever chemicals’ in drinking water. 

So conclude researchers at the University of Arizona who note the $8B would come from avoidance of PFAS-associated medical care, long-term health impacts and reduced lifetime earnings. 

• The team found that mothers receiving water from  PFAS-contaminated sources had higher first-year infant mortality, more preterm births and more births with infants weighing less than 5.5 pounds. These findings “build on earlier laboratory and public health research but offer new evidence from real-world exposure across a large population,” the school’s news operation points out. 
   
• Removing PFAS from drinking water not only results in drastically improved health outcomes but also produces a significant long-term economic benefit. The point is made by corresponding author Derek Lemoine, PhD. He and co-authors underscore that activated carbon filters—whether used by water utilities or installed in homes—can remove long-chain PFAS from drinking water. Talk about a big problem with a seemingly simple solution. What are we waiting for? 

Also worthwhile:

• Covid-19 vaccination substantially lowered risks for children last season, CDC report says (CNN) 
   
• Hundreds are quarantined in South Carolina as measles spreads in 2 US outbreaks (ABC News) 
   
• The economics of medical weight loss (KevinMD.com)