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Trinity Health slide deck

Top executives at Trinity Health heralded to investors this week that hospitalizations at their $16 billion national Catholic hospital system are on the rise, according to a slide deck obtained by Axios. Trinity CEO Dr. Richard Gilfillan and others were presenting at the annual Citi not-for-profit health care conference. An arrow along the slide's Y axis proclaims that when it comes to hospital admissions, "higher is better."

Why this matters: Hospital leaders publicly extol the concept of "value-based care," which includes keeping patients out of the hospital and focusing more on outpatient and preventive care. Experts agree it's better and safer for people to receive care in other settings when appropriate, and fewer inpatient services saves money.

Trinity's slide reveals a "weird disconnect," according to health economist Austin Frakt, but also reveals some truth-telling at a bank conference: Hospitals still want to fill beds with patients as often as they can.

Trinity's presentation: Before the slide that shows Trinity's hospitalizations over the past two years, a separate slide details how patient admissions in the system's Medicare accountable care organization are declining, and "lower is better" for that population. ACOs, or networks of health care providers, are paid based on the quality of care, not on the quantity of services.

Gilfillan told me late Wednesday that the "higher is better" arrow for overall hospital stays is about making sure patients choose Trinity's facilities: "We are actively managing our population so that they have fewer hospital admissions. We also recognize that we're in a very competitive, patient-driven marketplace, and we want to do everything we can to provide great care so people choose us when they do require inpatient or outpatient or any services."

What experts are saying: This is an inconsistent message about reducing the amount of hospital admissions.

  • Dr. Ashish Jha of the Harvard T.H. Chan School of Public Health looked at Trinity's slide and said hospitals still remind him of the airline industry: "Every extra passenger they can squeeze in is profit."
  • Dr. J. Michael McWilliams of Harvard Medical School said Trinity's framing underscores a contradictory strategy and marketing by big health systems as they try to move away from a system that pays for every service.
  • However, Jha notes that hospitals also are in "a real pickle." They are expensive to run, and they need certain volumes to keep the lights on and pay employees. Hospital executives are trying to straddle a line where they are trying to avoid hospitalizations for some people while still attracting as many admissions as possible to keep revenue up. "I'm not at all convinced that strategy is going to work for them," Jha said.

Go deeper

Updated 54 mins ago - Politics & Policy

Senate action on stimulus bill continues as Dems reach deal on jobless aid

Photo: Alex Wong/Getty Images

Democratic leaders struck an agreement with Sen. Joe Manchin (D-W.V.) on emergency unemployment insurance late Friday, clearing the way for Senate action on President Biden's $1.9 trillion stimulus package to resume after an hours-long delay.

The state of play: The Senate will now work through votes on a series of amendments that are expected to last overnight into early Saturday morning.

Capitol review panel recommends more police, mobile fencing

Photo: Olivier Douliery/AFP via Getty Images

A panel appointed by Congress to review security measures at the Capitol is recommending several changes, including mobile fencing and a bigger Capitol police force, to safeguard the area after a riotous mob breached the building on Jan. 6.

Why it matters: Law enforcement officials have warned there could be new plots to attack the area and target lawmakers, including during a speech President Biden is expected to give to a joint session of Congress.

Financial fallout from the Texas deep freeze

Illustration: Annelise Capossela/Axios

Texas has thawed out after an Arctic freeze last month threw the state into a power crisis. But the financial turmoil from power grid shock is just starting to take shape.

Why it matters: In total, electricity companies are billions of dollars short on the post-storm payments they now owe to the state's grid operator. There's no clear path for how they will pay — something being watched closely across the country as extreme weather events become more common.

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