Bob Herman May 25
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Trinity Health says more hospital admissions are better

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.
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Trump: Transgender people "disqualified" from the military

SecDef Jim Mattis and Gen. Joseph Dunford.
Secretary of Defense Jim Mattis and Gen. Joseph Dunford. Photo: Andrew Harrer-Pool / Getty Images

President Trump late Friday issued an order disqualifying most transgender people from serving in the military.

"[T]ransgender persons with a history or diagnosis of gender dysphoria -- individuals who the policies state may require substantial medical treatment, including medications and surgery -- are disqualified from military service except under certain limited circumstances."

Why it matters: Anything short of an inclusive policy for transgender troops will be viewed as a continuation of the ban Trump announced on Twitter in August.

Haley Britzky 3 hours ago
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Both Bush and Obama also requested line item veto power

Donald Trump.
Photo: Mark Wilson / Getty Images

President Trump tweeted on Friday evening that to avoid having "this omnibus situation from ever happening again," he wants Congress to re-instate "a line-item veto."

Why it matters: This would allow him to veto specific parts of a bill without getting rid of the entire thing. Trump was deeply unhappy with the $1.3 trillion spending bill approved by Congress early Friday morning, but signed it anyway on Friday afternoon.