This monthly blog highlights and discuss emerging trends and challenges related to healthcare data and its ever changing life cycle.
By Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, FAHIMA
Harry Nilsson said it best when he penned these lyrics for Three Dog Night’s 1969 hit song “One”:
“One is the loneliest number that you’ll ever do”
Healthcare organizations and providers continue to face increased challenges to reduce costs and improve outcomes. In order to drive sound decision making for maximum impact the industry is turning to analytics. One is a lonely number, however, and one point of data means nothing if it can’t be compared to a benchmark. Below are some lists of important health statistics and facts to remember as you begin planning for 2017.
Fraud and Abuse
- During Fiscal Year (FY) 2015, the Federal Government won or negotiated over $1.9 billion in healthcare fraud judgments and settlements.1
- $487 billion dollars is estimated to be lost annually to fraud and abuse activities.2
- The Medicare Strike Force has a current conviction rate of 95 percent.3
- In FY 2015, the Department of Justice (DOJ) opened 983 new criminal healthcare fraud investigations.4
- In FY 2015, Office of Inspector General (OIG) investigations resulted in 800 criminal actions and 667 civil actions against individuals or entities related to crimes against Medicare and Medicaid.5
- In FY 2015, the return on investment for all fraud and abuse programs is $6.10 returned for every $1.00 expended.6
- Obesity (defined as BMI at or over 95th percentile) for US children is currently: nine percent for two- to five-year-olds, 18 percent for six- to 11-year-olds, and 21 percent for 12- to 19-year-olds.
- 10 percent of average US consumers have fair or poor health.8
- Between 2000 and 2014 the birth rate among teenagers reached a record low for the US, down to 24.2 live births per 1,000.9
- Adult ages 18 to 24 report an average of 4.0 mentally unhealthy days in the past 30 days, while adults age 75 and older reported only 2.0.10
- Heart disease, cancer, and stroke alone cause more than 50 percent of all deaths each year.11
- Honolulu, HI is ranked number one in overall performance by hospital region, according to the 2016 Commonwealth Fund Scorecard.
- Hattiesburg, MS is ranked 306 out of 306 in overall performance by hospital region, according to the 2016 Commonwealth Fund Scorecard.
- Infant mortality in part of Mississippi, South Carolina, and Georgia average 10 deaths per 1,000 live births (rates that are par with Serbia and China).12
- Adult obesity rates rose in 111 of 306 hospital regions between 2011 and 2014.13
- For 2015-2025, health spending is projected to grow at an average rate of 5.8 percent per year.14
- Health spending is projected to grow faster than the Gross Domestic Product, rising to 20.1 percent of the GDP by 2025.15
- From 2015-2020 as health spending increases, some large employers with low-wage employees are expected to discontinue offering health insurance to their workers and just pay the penalty mandated in the Affordable Care Act.16
- 50 percent of all bankruptcies are in part due to medical expenses.17
- Uninsured rates for working adults ranged from four percent in Massachusetts to nearly 50 percent in Harlingen and McAllen, Texas.18
- By 2020, Medicare is projected to remain consistent at 20 percent of national health spending.19
- By 2020, the total government healthcare expenditure is projected to be 49 percent of national health spending.21
- Medicare spending is projected to grow to 7.9 percent by 2020.22
- Medicaid spending is projected to average a 6.0 percent growth rate from 2016-2025.23
- Despite expanded insurance coverage, growth is expected in private health insurance spending on physician services by the continued expected growth of high-deductible health plans.24
- Medicare spent as much as $8.5 billion (2.7 percent of total spending) on services deemed to have little or no clinical value in 2009, according to a 2014 JAMA Internal Medicine
- Despite a small increase in 2013 the rate of uninsured consumers in the US decreased in every age group from 2000-2014.25
- Between 1999 and 2006, self-insurance rates increased from 44 to 55 percent among all employers, and from 62 to 89 percent among employers at firms with 5,000 or more employees.26
- Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.29
- The Office of Disease Prevention and Health Promotion estimates the annual cost of limited health literacy is $1.6 to $3.6 trillion.27
- Nine out of 10 adults may lack the skills needed to manage their health and prevent disease.28
- Persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots.30
- A person who has limited or low literacy skills is not illiterate.31
- Persons with limited health literacy are more likely to have chronic conditions and less able to manage them.32
- Department of Health and Human Services (HHS) and Department of Justice (DOJ). Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2015. https://oig.hhs.gov/publications/docs/hcfac/FY2015-hcfac.pdf.
- Coalition Against Insurance Fraud. “By the numbers: fraud statistics: Healthcare.” http://www.insurancefraud.org/statistics.htm#13.
- Centers for Medicare and Medicaid Services. The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-03-19.html.
- HHS and DOJ. Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2015.
- Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). Health, United States, 2015 (In Brief Edition). http://www.cdc.gov/nchs/hus.htm.
- Office of Disease Prevention and Health Promotion. General Health Status. Healthy People 2020. https://www.healthypeople.gov/2020/about/foundation-health-measures/General-Health-Status.
- The Commonwealth Fund. “Rising to the Challenge: The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition.” http://www.commonwealthfund.org/publications/fund-reports/2016/jul/rising-to-the-challenge.
- CMS. National Health Expenditure Projections 2015-2025. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2015.pdf.
- Keehan, Sean P. et al. “National Health Spending Projections Through 2020: Recovery and Reform Drive Faster Spending Growth.” Health Affairs July 2011. http://content.healthaffairs.org/content/early/2011/07/27/hlthaff.2011.0662.full.
- Himmelstein, David U., Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler. “Illness and Injury as Contributors to Bankruptcy.” Health Affairs Web Exclusive, W5-63. February 2, 2005.
- “Rising to the Challenge: The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition.”
- “National Health Spending Projections Through 2020: Recovery and Reform Drive Faster Spending Growth.”
- CMS. National Health Expenditure Projects 2015-2025.
- CDC NCHS. Health, United States, 2015 (In Brief Edition).
- Kaiser Family Foundation and Health Research and Educational Trust. “Employer Health Benefits 2006 Annual Survey.” https://kaiserfamilyfoundation.files.wordpress.com/2013/04/7527.pdf.
- Walters, Jonathan. “The Price of Medical Illiteracy.” Governing the States and Localities. August 31, 2011. http://www.governing.com/topics/health-human-services/price-medical-illiteracy.html.
- US National Library of Medicine. “Health Literacy.” https://medlineplus.gov/healthliteracy.html.
- Office of Disease Prevention and Health Promotion. Healthy People 2010 website (archived). http://www.healthypeople.gov/2010/.
- Scott, TL et al. “Health literacy and preventative health care use among Medicare enrollees in a managed care organization.” Medical Care 40(5): 395-404. May 2002.
- US National Library of Medicine. “Health Literacy.”
- Williams, MV et al. 1998. “Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes.” Archives of Internal Medicine 158(2): 166-172. January 26, 1998.
Lou Ann Wiedemann (email@example.com) is vice president, HIM practice excellence at AHIMA.