The Great American Healthcare Recession: FM 2499 in Flower Mound

Were for you.
Irrational
Exuberance
a warning that a market
might be over valued
2
The Dot Com Bubble

What would you
have predicted
would happen
next?
Source: Congressional Budget Office: The 2014 Long-Term Budget Outlook in 26 Slides, Slide 19
30,000
25,000
27,288
United States Debt

History and Forecast
21,605
20,000
$ Billion
17,792
15,000
13,359
10,000
4,592
3,734
5,000
Debt Held by Public

Gross Federal Debt
1,507
Source: Congressional Budget Office, The Budget and Economic Outlook: 2015 to 2025, Table 1-1 analysis (January 2015)
2025
2022
2019
2016
2013
2010
2007
2004
2001
1998
1995
1992
1989
1986
1983
1980
1977
1974
1971
1968
1965
16.0
14.0
Changing Nature of
Federal Govt Spending
11.2
12.0
Percentage of GDP
14.9
10.0
9.1
8.0
8.7
9.1
7.4
6.0
Mortality
4.0
Everything Else
2.0
Social Security, Major
Health, & Interest
Productivity
Major Budget Variables

Health Care
Interest
Cost
0.0
2005
2015
Source: Congressional Budget Office, The Budget and Economic Outlook: 2015 to 2025, Figure 1-2 analysis (January 2015)
2025
Year
The Medicare Miracle

Per Beneficiary Medicare Hospital Insurance Cost
$7,000
$6,734
$6,500
$6,000
$5,500
$4,992
$5,179
$5,000
$4,500
$4,000
2014 Report
$3,500
$3,000
2009 Report
$3,272
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table V.B1, Page 188
2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table V.D1, Page 221
11
Subsidized Exchange Enrollees

20
18
19 19
16
16
14
Million People
18 18 18 18
17 17 17
12
10
What does this mean

for employer-sponsored
health coverage?
Source: Congressional Budget Office Insurance Coverage Provisions of the Affordable Care Act - CBOs January 2015 Baseline, Table B-2 analysis
0
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
12
2025
Projected Medicare savings

fund the Medicaid expansion
and Exchange creation
Exchange subsidies are

projected to parallel growth
in the GDP
13
Whats Does It Really Cost?
14
What Can You Buy for $23,215?
15
16
17
U.S. Median Household Income Is

$53,046
Household
Income After
Health Cost
$29,831
56%
Avg Health Cost

Family of Four
$23,215
44%
18
Source: Whitehouse.gov
19
Public Perception About How Fast Healthcare Costs Are Rising

Going up
slower than
usual
3%
Going up
about the
same
35%
Going up
faster than
usual
52%
Don't
know
10%
kff.org
20
Source: Bureau of Labor Statistics
21
22
23
2499 Observations
2499 Observations
2499 Observations
A Deeper Focus
Medicare/Private Hospital Payment Ratio

190%
185%
180%
170%
160%
149%
150%
146%
140% 140%
143%
144%
147%
141%
140%
128%
130%
122%
120%
114%
115%
117%
118%
113%
110%
American Hospital Association, Trendwatch Chartbook 2014, Chart 4.6 analysis
100%
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Medicare v Private Payer Inflation Variance

300%
296%
250%
200%
191%
150%
140%
119%
100%
81%
69%
64%
60%
50%
33%
42%
49%
54%
41%
32%
7%
0%
94
-50%
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
11
12
-39%
-60%
-63%
-75%
-100%
47Source
Source: Avalere and American Hospital
Association
Hospital Retail Price Vs Actual Cost

350
Markup
300
Cost
Retail Price
250
200
157
104
114
125
167
178
181
185
193
207
218
139
150
100
50
100
100
100
100
100
100
100
100
100
100
100
100
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
Year
Source: MedPAC analysis of American Hospital Association Annual Survey of Hospitals
48
$8,000
49
LAKE GRANBURY MEDICAL CENTER
DALLAS REGIONAL MEDICAL CENTER
MEDICAL CENTER OF MCKINNEY
LAS COLINAS MEDICAL CENTER
SOUTH HAMPTON COMMUNITY HOSPITAL
DENTON REGIONAL MEDICAL CENTER
DOCTORS HOSPITAL
MEDICAL CENTER OF LEWISVILLE
ENNIS REGIONAL MEDICAL CENTER
MEDICAL CENTER OF PLANO
PLAZA MEDICAL CENTER OF FORT WORTH
CENTENNIAL MEDICAL CENTER
TEXOMA MEDICAL CENTER
EAST TEXAS MEDICAL CENTER ATHENS
TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL
MEDICAL CITY DALLAS HOSPITAL
NORTH HILLS HOSPITAL
METHODIST RICHARDSON MEDICAL CENTER
NOCONA GENERAL HOSPITAL
METHODIST DALLAS MEDICAL CENTER
METHODIST MANSFIELD MEDICAL CENTER
METHODIST CHARLTON MEDICAL CENTER
MEDICAL CENTER OF ARLINGTON
WEATHERFORD REGIONAL MEDICAL CENTER
DALLAS MEDICAL CENTER
HUNT REGIONAL MEDICAL CENTER
BAYLOR MEDICAL CENTER AT GARLAND
BAYLOR MEDICAL CENTER AT IRVING
NAVARRO REGIONAL HOSPITAL
BAYLOR ALL SAINTS MEDICAL CENTER AT FW
BAYLOR REGIONAL MEDICAL CENTER AT PLANO
BAYLOR HEART AND VASCULAR HOSPITAL
BAYLOR UNIVERSITY MEDICAL CENTER
BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
BAYLOR MEDICAL CENTER AT WAXAHACHIE
BAYLOR MEDICAL CENTER AT CARROLLTON
THE HEART HOSPITAL BAYLOR PLANO
DOCTORS HOSPITAL
TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS
LAKE POINTE MEDICAL CENTER
WISE REGIONAL HEALTH SYSTEM
TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON
TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN
TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN
NORTH TEXAS MEDICAL CENTER
TEXAS HEALTH HARRIS METHODIST FORT WORTH
TEXAS HEALTH PRESBYTERIAN HOSPITAL-WNJ
TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO
TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILL
TEXAS HEALTH HARRIS METHODIST HURST-EULESS-
TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE
TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE
TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL
TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST F
JPS HEALTH NETWORK
TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON
HUGULEY MEMORIAL MEDICAL CENTER
PARIS REGIONAL MEDICAL CENTER
GLEN ROSE MEDICAL CENTER
UT SOUTHWESTERN UNIVERSITY HOSPITAL
HOPKINS COUNTY MEMORIAL HOSPITAL
PALO PINTO GENERAL HOSPITAL
TEXAS REGIONAL MEDICAL CENTER AT SUNNYVALE
$-
50% Discount
$5,000
Average Submitted Charges

$6,000
North Texas Level II Echocardiogram

$7,000
Average Total Payments
Medicare +40%
$4,000
$3,000
$2,000
$1,000
Holmes Murphy analysis of http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html
$2,500
$2,000
North Texas
Level II Echocardiogram
$2,525
$1,500
$1,262
$1,000
$500
$377
$527
$-
Medicare
Paid
Medicare
+40%
50%
Discount
Weighted
Avg Billed
50
Holmes Murphy analysis http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html
Medicare vs
Private Payer
Texas Study
US States with Counties
Medicare vs BCBSTX Spending 2008-2012

30
25
27
24
23
BCBSTX
20
Medicare
15
10
-1
0
Total Spending
Inpatient Spending
Inpatient Price
-5
Medicare and Private Spending Trends From 2008 to 2012 Diverge in Texas, Franzini, et al
Setting the Stage for

Taxing Health Insurance
53
Finding Additional Funds to Fill the

PPACA Shortfall
54
Can a large
employer afford a
$1 million a year
minimum wage
employee?
55
56
57
Copyright Holmes Murphy
Copyright Holmes Murphy
58

The Great American Healthcare Recession: FM 2499 in Flower Mound

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The Great American Healthcare Recession: FM 2499 in Flower Mound

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Were for you.

The Dot Com Bubble

United States Debt

Debt Held by Public

Major Budget Variables

The Medicare Miracle

Subsidized Exchange Enrollees

What does this mean

Projected Medicare savings

Exchange subsidies are

Whats Does It Really Cost?

What Can You Buy for $23,215?

What Can You Buy for $23,215?

What Can You Buy for $23,215?

U.S. Median Household Income Is

Avg Health Cost

Public Perception About How Fast Healthcare Costs Are Rising

Source: Bureau of Labor Statistics

Source: Bureau of Labor Statistics

Source: Bureau of Labor Statistics

Medicare/Private Hospital Payment Ratio

American Hospital Association, Trendwatch Chartbook 2014, Chart 4.6 analysis

Medicare v Private Payer Inflation Variance

Hospital Retail Price Vs Actual Cost

Source: MedPAC analysis of American Hospital Association Annual Survey of Hospitals

Average Submitted Charges

North Texas Level II Echocardiogram

Average Total Payments

Holmes Murphy analysis of http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html

Holmes Murphy analysis http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html

US States with Counties

Medicare vs BCBSTX Spending 2008-2012

Setting the Stage for

Finding Additional Funds to Fill the

Copyright Holmes Murphy

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