Aug 29, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Best wishes to Sen. Johnny Isakson, who announced yesterday that he's retiring at the end of the year because of health reasons.

  • Isakson has always been kind and generous with his time, including when I brought my kid mentee to Capitol Hill. She still talks about how a U.S. senator shook her hand!

Situational awareness: Juul is pushing a new age-verifying checkout system in retail stores to prevent teens from buying e-cigarettes, WSJ reports.

Today's word count is 903 words, or ~3 minutes.

1 big thing: The financial power of a Colorado hospital system
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Data: UCHealth documents and Moody's Investors Service; Chart: Axios Visuals

Market power, state laws, location and population wealth often dictate how well hospitals do. That's why local politics matter just as much, if not more, to the industry than what's going on at the federal level, Axios' Bob Herman reports.

How it works: Look to Colorado, where the University of Colorado Health holds one of the highest profit margins in the country and controls large shares of inpatient and outpatient services throughout the state.

By the numbers: UCHealth had a 13.3% operating margin in its 2019 fiscal year.

  • UCHealth's margin has consistently been above 10%, which is far above the hospital industry average of 2–3%, according to data from Moody's Investors Service.
  • Because UCHealth is a tax-exempt, not-for-profit system, it is supposed to reinvest all surplus money into the community. But those funds are often directed elsewhere.

The big picture: "Hospital systems have consolidated and merged to a point where they really have the leverage over the (insurance) networks. They are the ones dictating the prices," said Merrit Quarum, CEO of medical billing audit firm WellRithms.

  • UCHealth expanded into the suburbs when its academic medical center merged with a dominant system in 2012. It now controls more than 50% of the market in 2 of its regions and extracts some of the highest prices from insurers in the country.

Colorado is also a particularly lucrative market. The state's median income is higher than the U.S. average, and UCHealth's suburban facilities are located in affluent areas with high rates of commercial insurance.

  • Colorado expanded Medicaid under the Affordable Care Act, which has boosted hospitals' bottom lines.
  • It also administers a program for low-income patients that involves collecting fees from hospitals to get higher federal Medicaid payouts.

UCHealth declined several interview requests but said in a statement that it offers "competitive prices."

2. Seniors are increasingly going hungry

Nearly 8% of Americans 60 and older were "food insecure" in 2017, according to a study by Feeding America. This translates to 5.5 million seniors — a number that has more than doubled since 2001, Time reports with Kaiser Health News.

The number of hungry seniors has risen along with our awareness of the social determinants of health.

  • While keeping people fed is important, it's also cheaper than caring for them down the line when they're sick — which is often what happens to people who don't have the food they need to live a healthy life.

Details: Hunger among seniors is the worst in the South and the Southwest, Time and KHN report. It's also worse among black and Latino seniors than among whites.

  • And while children's hunger can be addressed in schools, "the plight of hungry older Americans is shrouded by isolation and a generation’s pride," KHN's Laura Ungar and Trudy Lieberman write.

The outlook: As America gets grayer, the number of seniors receiving home-delivered meals through a federal program has dropped.

  • The program needs to be reauthorized by Congress this fall, but it's unclear whether its funding will get a substantial boost.

The bottom line: "Even if it rarely kills directly, hunger can complicate illness and kill slowly," Ungar and Lieberman write.

Worthy of your time.

3. Why doctors over-treat low back pain

Photo: Media for Medical/Universal Images Group via Getty Images

Low back pain is one of the most common reasons why people visit their doctor, and it also frequently leads to over-treatment, Undark reports.

Why it matters: Unnecessary care can be expensive and wasteful, but in this case, it can also have adverse health impacts on patients.

Unless patients present with symptoms of a serious problem, it's recommended that doctors wait 6 weeks before ordering imaging. In the meantime, patients should wait for the pain to go away by itself.

  • Although research shows that routine imaging for low back pain isn't beneficial, scans increased by 50% between 1995 and 2015, one study found. Another analysis found that as many as 35% of them were inappropriate.
  • Scans often pick up too much information, leading to even more unnecessary procedures.

Between the lines: Financial incentives partially explain why over-treatment happens so often.

  • But there's also the fact that many patients don't want to hear that they're going to have to live with their pain, so doctors don't tell them.

Go deeper: The U.S. has the worst patients in the world

4. Pinterest’s next move on vaccines

Pinterest said yesterday that it will start showing only information from health organizations when people search for vaccine information, AP reports.

  • These organizations include the World Health Organization, the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the WHO-established Vaccine Safety Net.

Vaccine misinformation has spread via social media, and experts worry that it's dissuading parents from vaccinating their children.

  • The implications are clear: The measles outbreak recently broke a 27-year record.
5. Rising concern about antidepressants

The number of people taking antidepressants for long periods of time is going up, and experts are concerned about whether the risks of long-term use negate the rewards, the Wall Street Journal reports.

Recent studies have suggested that antidepressant use leads to higher risk of heart attacks, strokes and death. But even the longest studies looking at the drugs' effects have only followed patients for a couple of years.

Yes, but: While some patients may be receiving prescriptions for drugs that they'd be better off without, other people with depression and anxiety who should be receiving treatment aren't.

  • "We have big problems of undertreatment and people who may be on these medications longer than they need to be," Mark Olfson, a professor at Columbia University Irving Medical Center, told the Journal.
Caitlin Owens