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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

Updated 3 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Eniola Odetunde/Axios

  1. Health: Most vulnerable Americans aren't getting enough vaccine information — Fauci says Trump administration's lack of facts on COVID "very likely" cost lives.
  2. Education: Schools face an uphill battle to reopen during the pandemic.
  3. Vaccine: Florida requiring proof of residency to get vaccine — CDC extends interval between vaccine doses for exceptional cases.
  4. World: Hong Kong puts tens of thousands on lockdown as cases surge — Pfizer to supply 40 million vaccine doses to lower-income countries — Brazil begins distributing AstraZeneca vaccine.
  5. Sports: 2021 Tokyo Olympics hang in the balance.
  6. 🎧 Podcast: Carbon Health's CEO on unsticking the vaccine bottleneck.

DOJ: Capitol rioter threatened to "assassinate" Alexandria Ocasio-Cortez

Supporters of former President Trump storm the U.S. Captiol on Jan. 6. Photo: Kent Nishimura / Los Angeles Times via Getty Images

A Texas man who has been charged with storming the U.S. Capitol in the deadly Jan. 6 siege posted death threats against Rep. Alexandria Ocasio-Cortez (D-N.Y.), the Department of Justice said.

The big picture: Garret Miller faces five charges in connection to the riot by supporters of former President Trump, including violent entry and disorderly conduct on Capitol grounds and making threats. According to court documents, Miller posted violent threats online the day of the siege, including tweeting “Assassinate AOC.”

Schumer calls for IG probe into alleged plan by Trump, DOJ lawyer to oust acting AG

Jeffrey Clark speaks next to Deputy US Attorney General Jeffrey Rosen at a news conference in October. Photo: Yuri Gripas/AFP via Getty Images.

Senate Majority Leader Chuck Schumer (D-N.Y.) on Saturday called for the Justice Department inspector general to investigate an alleged plan by former President Trump and a DOJ lawyer to remove the acting attorney general and replace him with someone more willing to investigate unfounded claims of election fraud.

Driving the news: The New York Times first reported Friday that the lawyer, Jeffrey Clark, allegedly devised "ways to cast doubt on the election results and to bolster Mr. Trump’s continuing legal battles and the pressure on Georgia politicians. Because Mr. [Jeffrey] Rosen had refused the president’s entreaties to carry out those plans, Mr. Trump was about to decide whether to fire Mr. Rosen and replace him with Mr. Clark."

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