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Background: In response to the declining utilization and patient revenue due to the COVID-19 pandemic, the U.S. hospital industry furloughed at least 1.4 million health care workers to contain their clinical-related expenses. However, it remains unclear how hospitals responded by adjusting their administrative expenses, which account for more than a quarter of U.S. hospitals' spending, a proportion substantially higher than that of other industrialized countries. Examining changes in hospitals' administrative expenses during the COVID-19 pandemic is important for understanding hospitals' cost-containment behaviors under operational shocks during a pandemic., Objective: To assess changes in hospitals' administrative expenses and clinical expenses during the COVID-19 pandemic in 2020., Design: Time-series observational study., Participants: 1420 Medicare-certified general acute-care hospitals with fiscal years starting in January and continuously operating during 2016-2020., Main Measures: Hospitals' annual administrative expenses and clinical expenses., Key Results: Hospitals' median administrative and clinical expenses both increased consistently around 4% each year from 2016 to 2019. From 2019 to 2020, the median administrative expenses grew by 6.2% while the median clinical expenses grew by 0.6%. The interrupted time-series regression estimated an additional 6.4% (95% CI, 4.5 to 8.2%) increase in administrative expenses in 2020, relative to the pre-COVID annual increase of 3.9% (95% CI, 3.3 to 4.4%), while an additional increase in clinical expenses in 2020 (0.5%; 95% CI, -0.3 to 1.4%) did not differ from the pre-COVID annual increase of 3.7% (95% CI, 3.5 to 4%). Stratified analysis showed hospitals with larger utilization volume, located in states with lower COVID-19 burden, or situated in counties with higher median household income experienced larger increase in administrative expenses in 2020., Conclusions: In 2020, administrative expenses grew much faster than clinical expenses, resulting in a larger share of hospital financial resources allocated to administrative activities. Higher administrative expenses might reflect hospitals' operational effort in response to the pandemic or inefficient cost management., (© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Using bargaining agreement data from the Federal Mediation Conciliation Services, we found that the median national resident COVID-19 mortality percentage (as of April 24, 2022) of unionized nursing homes and that of nonunionized ones were not statically different (10.2% vs. 10.7%; P = 0.32). The median nursing home resident COVID-19 mortality percentage varied from 0% in Hawaii to above 16% in Rhode Island (16.6%). Unionized nursing homes had a statistically significant lower median mortality percentage than nonunionized nursing homes (P < 0.1) in Missouri, and had a higher median mortality percentage than nonunionized nursing homes (P < 0.05) in Alabama and Tennessee. Higher average resident age, lower percentage of Medicare residents, small size, for-profit ownership, and chain organization affiliation were associated with higher resident COVID-19 mortality percentage. Overall, no evidence was found that nursing home resident COVID-19 mortality percentage differed between unionized nursing homes and nonunionized nursing homes in the U.S., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Olson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The Hospital Price Transparency Final Rule, effective January 1, 2021, requires hospitals to post online a machine-readable file that includes payer-specific negotiated commercial prices for all services. The regulation aims to improve the affordability of hospital care by promoting price competition. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation. Understanding hospitals' compliance status to the regulation has important implications for its enforcement effort and effectiveness assessment., Objective: To analyze nationwide hospitals' compliance status to the Hospital Price Transparency Rule., Design: Cross-sectional observational study., Participants: A total of 3558 Medicare-certified general acute-care hospitals were examined., Main Measures: A binary compliance rating was generated by using data collected by Turquoise Health. "Noncompliance" means that no machine-readable file was posted or the posted file contains no commercial negotiated prices. "Compliance" means that a machine-readable file was posted with commercial negotiated prices for at least one insurance plan., Key Results: As of June 1, 2021, 55% of the 3558 Medicare-certified general acute-care hospitals we examined had not posted a machine-readable file containing commercial negotiated prices. Wide variations of compliance existed across states and hospital referral regions. A hospital's compliance status is strongly associated with the average compliance status of peer hospitals in the same market. Hospitals with greater IT preparedness, for-profit hospitals, system-affiliated hospitals, large hospitals, and non-urban hospitals had greater compliance. More concentrated hospital markets had greater average compliance., Conclusions: Hospitals take into consideration the behavior of their peers in the same market when making price disclosure decisions. Compliant hospitals are likely to have better IT preparedness, more financial resources and personnel expertise to mitigate the cost required for the implementation of the Price Transparency Rule. The compliance cost, therefore, might be a barrier for some hospitals., (© 2021. Society of General Internal Medicine.)

Hospitals acquire and maintain long-term operating assets such as land, buildings, and equipment. In this study, we analyzed hospitals' long-term assets acquisitions data extracted from the Medicare Cost Report, a mandatory annual filing for all Medicare-certified hospitals. The first objective of this study is to examine the time trend of land, buildings, and equipment acquisitions of all general acute care hospitals in the U.S. from 2005 to 2019 to understand the relative magnitude and temporal changes for the operating assets. The second objective is to examine the 15-year accumulated acquisitions of land, buildings, and equipment per capita in each state to understand the variations of potential access to hospital operating resources across states. To understand the longitudinal changes in acquisitions of operating assets for each year from 2005 to 2019, we calculated the total acquisition amounts across all hospitals for land, buildings, and equipment, respectively, and adjusted the amounts to 2019 dollars based on the consumer price index (CPI). For each state (including Washington D.C.) and the whole nation, the 15-year accumulated CPI-adjusted acquisition amounts per capita for land, buildings, and equipment were also calculated, respectively. The nationwide acquisitions of those operating assets grew rapidly from 2005 to 2008 followed by a negative overall growth from 2008 to 2014 and since 2015, started increasing steadily again. In 2019, U.S. general acute care hospitals acquired $3.0 billion of land, $44.6 billion of buildings, and $33.9 billion of equipment. Huge geographical variation in per capita cumulative total asset investment were also found with the first place North Dakota having a per capita investment that is almost four times higher than that in the lowest ranked state of Alabama., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Self-insured employers cover more people than Medicare, Medicaid, or direct purchasers of private insurance.This study examined the ability of self-insured employers to negotiate hospital prices and the relationship between hospital prices and employer market power in the United States., Study Design: Repeated cross-section analysis of commercial claims., Methods: We used the US Census Bureau County Business Patterns data to estimate employer market power at the metropolitan statistical area (MSA)-year level and used the Truven Health MarketScan commercial claims to estimate mean hospital prices and price ratios at the MSA-year level (2010-2016). We calculated descriptive statistics for employer market power, mean hospitalization prices, and a case mix-adjusted price ratio measure during the study period and analyzed the 10 most concentrated labor markets. We estimated MSA-year-level ordinary least squares regressions of hospitalization price and the price ratio measure on employer market power., Results: Large self-insured employers had concentrated market power in very few MSAs in 2016. The mean value of our employer market power measure was 62 for 2016, compared with the mean value of 5410 for hospital market power in the United States. Regression analyses find a slight relationship: A 1-point increase in employer market power was associated with a $6.61 decrease in the hospitalization price (mean = $20,813), but this result becomes statistically insignificant once the models control for hospital wages., Conclusions: Employer market power is low in most MSAs. Self-insured employers may consider building purchase alliances with state and local government employee groups to enhance their market power and lower negotiated prices for hospital services.

Medical service charges, which remain consistent across all payers, do not affect the statutorily determined reimbursements from public payers, such as Medicare and Medicaid fee-for-service programs.[1], [2] These charges, however, have important implications for the price paid by private payers, uninsured patients, and out-of-network patients.[1], [2] Prior research found that service charges relative to Medicare payment varied across medical specialties in 2014 and the trend of charges relative to the Medicare payment differed among a few major medical specialties from 2012 to 2018.[1], [3] The specific trend for each individual medical specialty, however, remains unknown. 2010 USD were converted to 2019 USD using the Personal Consumption Expenditures Price Index SP b sp 2010 charge to Medicare payment ratio is not associated with % change in weighted average charge, 2010-2019 (correlation coefficient: 0.16; I P i = 0.25), or with % change in weighted average Medicare payment, 2010-2019 (correlation coefficient: 0.18; I P i = 0.20) Across all 51 specialties, the 2010-2019 percent change in weighted average charge is highly positively associated with the percent change in weighted average Medicare payment (correlation coefficient: 0.87; I P i < 0.001). [Extracted from the article]