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Johns Hopkins surgeons operate on a patient. Photo: Brendan Smialowski / AFP via Getty Images

States' broad flexibility over health policy can produce some awkward effects for health care providers that operate across state lines — as Johns Hopkins Health System can show you.

The bottom line: Johns Hopkins mostly operates in Maryland, which caps hospital revenue. But it also owns a facility outside of the state that is not bound to those restrictions. And you can tell the difference by looking at their bottom lines.

The details: Maryland uses all-payer rate setting, a payment system that limits how much money hospitals in the state can get from Maryland patients. Inpatient and outpatient spending in the state can't grow faster than 3.58% per year (the rate of growth for Maryland's economy).

Johns Hopkins, an academic powerhouse based in Baltimore that owns six hospitals, reported its finances yesterday for the last six months of 2017.

  • Revenue grew a little above the all-payer rate. Operating profit fell 8.6% year over year to $82 million, due to losses in the system's Medicaid health plan.
  • But profits increased heavily at Sibley Memorial Hospital, a 288-bed hospital in Washington, D.C., that is not bound by Maryland's rules. Johns Hopkins said Sibley's profits were "driven by higher inpatient and outpatient volumes across several areas, including oncology and surgical cases."
  • Sibley was the most profitable hospital in the Johns Hopkins system in the last three months of 2017, just ahead of a children's hospital in Florida.

Why it matters: Hospitals in the rest of the country are regulated like Sibley, which means they have incentives to get more admissions and perform more procedures in the absence of large-scale reform like all-payer rate setting.

Go deeper: A former Johns Hopkins employee filed a lawsuit last year claiming that the system favors out-of-state patients to boost revenue; the system said that suit was baseless.

Go deeper

Dan Primack, author of Pro Rata
8 mins ago - Economy & Business

Filings show Sweetgreen isn't profitable, despite claims

Illustration: Sarah Grillo/Axios

Restaurant chain Sweetgreen on Monday filed to go public, and revealed that it lost money in each year since 2014.

Why it matters: The company lied when it repeatedly told reporters it was profitable.

U.S. border cities again see low violent crime rates

Expand chart
Data: FBI, Kansas Bureau of Investigation, U.S. Census Bureau; Chart: Jared Whalen/Axios

Reported violent crime in the United States rose in 2020 for the first time in four years, but violent crime rates in 11 of the largest communities along the U.S.-Mexico border stayed below the national average, an Axios analysis found. 

Why it matters: Year after year, data showing low violent crime rates in majority-Mexican American and Mexican immigrant border communities dispels myths of the U.S.-Mexico border as a region filled with crime and chaos.

Biden to Dems: This is my make-or-break moment

President Biden walks with House Speaker Nancy Pelosi after addressing the House Democratic caucus on Thursday. Photo: Jim Watson/AFP via Getty Images

President Biden told the House Democratic caucus Thursday "my presidency will be determined" by the votes he wants in the next week on his $1.75 trillion social safety net expansion and $1.2 trillion infrastructure package.

Driving the news: Biden made the comment, according to a source in the room, as he tried to rally support for the $1.75 trillion package. House Speaker Nancy Pelosi acted immediately, calling for a vote on the $1.2 trillion bipartisan infrastructure bill later in the day.

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