As I reported a couple of weeks ago, a recent NBC News investigation revealed that regulatory filings and internal documents show that an estimated “40-plus percent” of the country’s hospital emergency departments are now overseen by for-profit health care staffing companies owned by private equity firms. It is a developing trend that is raising questions and causing concern among medical professionals.
“Putting the profit motive in between the patient and the physician can lead to untoward consequences in terms of care,” a worried Dr. Robert McNamara, chairman of emergency medicine at Temple University’s Lewis Katz School of Medicine and chief medical officer of the American Academy of Emergency Medicine Physician Group, tells NBC. Now add private equity ownership of nursing homes and long-term care facilities as an additional area of unease.
Kaiser Health News reported that the Government Accountability Office is currently investigating the ownership of nursing homes, including by private equity firms. A report on their findings is expected in the fall. This is a sector well-known for being racked with nursing shortages, money problems, facility shutdowns and high COVID death rates. According to KHN’s Victoria Knight, the House Ways and Means Oversight Subcommittee is now in the process of trying to better understand the consequences of private equity’s involvement in health care and “the far-reaching impact” of bankruptcies or closures following private equity buyouts.
A February 2021 study from the National Bureau of Economic Research found that “going to a facility owned by a private equity firm increased the chance that a resident would die by 10%, compared with living in another type of facility,” says Knight. The American Investment Council, an advocacy group for the private equity industry, has countered with studies that dispute such findings.
What’s undisputed, says Robert Tyler Braun, an assistant professor of population health sciences at Cornell University, is “that private equity firms are buying nursing homes because they’re likely to be profitable.” Braun is the author of a November 2021 study that found that “residents of private equity-owned nursing homes were more likely to have emergency room visits or be hospitalized than residents of other for-profit homes,” KHN reports. Both the Cornell study and the study from the National Bureau of Economic Research found that “Medicare’s costs per resident were higher, meaning more taxpayer dollars were being spent in private equity facilities.”
What’s clear is this represents yet another sign that management of our health care system is a mess. And, as if we needed more proof, here comes a March report by Ricardo Alonso-Zaldivar of the Associated Press, warning that “when the end of the COVID-19 pandemic comes, it could create major disruptions” for our “cumbersome U.S. health care system.”
Winding down, possibly as early as summer, will be a raft of temporary emergency measures tied to the coronavirus public health emergency first declared more than two years ago. Says the AP report, it “could force an estimated 15 million Medicaid recipients to find new sources of coverage, require congressional action to preserve broad telehealth access for Medicare enrollees, and scramble special COVID-19 rules and payment policies for hospitals, doctors and insurers.” It does not “bode well for the complex U.S. health care system,” says Alonso-Zaldivar.
“The nonpartisan Urban Institute think tank estimates that about 15 million people could lose Medicaid when the public health emergency ends, at a rate of at least 1 million per month,” he writes. More people could wind up uninsured. Hospitals could take a major financial hit.
“This is an unprecedented situation … The uncertainty is real,” says Matthew Buettgens, lead researcher on the Urban Institute study.
This is all playing out at a time when our need for health care, and especially mental health services, may have never been greater – especially for a most vulnerable population: young people.
As reported by NBC News in March, according to a new Centers for Disease Control and Prevention survey, “more than half of high school students said they were victims of verbal outbursts during lockdown.” The report goes on to say that “a majority of teenagers say they endured insults, put-downs and other forms of emotional abuse from a parent or other adult at home during the height of the pandemic.”
Those participating in the survey were asked to complete the Adolescent Behaviors and Experiences Survey in the first half of 2021, reflecting on experiences from the previous year (2020). “More than half of the high school students — 55 percent — said they were on the receiving end of cursing or other verbal insults from an adult in the home during pandemic lockdown,” reports NBC. “More than 1 in 10, or 11.3 percent, said they suffered physical abuse, such as hitting, beating or kicking.” Researchers admit it remains unclear how significant a role lockdown played in such reports.
As mental health problems among kids continues to show signs of escalating, an influential panel of experts is now calling for all kids ages 8-18 to be screened regularly for anxiety.
The recommendation was made by the U.S. Preventive Services Task Force, which is comprised of volunteer experts appointed by a federal government agency. Their role is to make recommendations to health care providers on clinical preventive care. The draft guidelines are expected to be finalized later this year.
Dr. Martha Kubik is a member of the task force and a professor in the School of Nursing at George Mason University. “It’s critical to be able to intervene before a life is disrupted,” she explains to the New York Times.
Screening more children for anxiety is “really important,” adds Stephen P.H. Whiteside, a child psychologist and director of the Pediatric Anxiety Disorders Clinic at the Mayo Clinic. “Most kids in need of mental health care don’t get it.”
“Pediatricians have long recognized the need for screening,” Dr. Sandy Chung, president-elect of the American Academy of Pediatrics, explains to NPR.
“We are truly in a crisis situation with mental health,” she adds.