A blog covering the health/care ecosystem and people.

How financially vulnerable are people with medical debt in the U.S.? Significantly more, statistically speaking, we learn from the latest survey data revealed by the National Financial Capabilities Study (NFCS) from the FINRA Foundation. The Kaiser Family Foundation and Peterson Center on Healthcare analyzed the NFCS data through a consumer health care financial lens with a focus on medical debt.          Financial distress takes many forms, the first chart inventories. People with medical debt were most likely lack saving for a “rainy day” fund, feel they’re “just getting by” financially, feel their finances control their life, and

The peak of venture investment for digital health was in 2020 and 2021, precipitously declining later in 2022. And the outlook for 2023 is practical and Show-Me: that is, demonstrate clinical outcomes and return-on-investment before “I” (for investors) can take a leap of faith to spend a dollar, a Yen, a Euro, or British pound on a shiny new-new healthcare thing. If it’s January, then CES and JP Morgan convene their influential annual meetings which feature health technology for globally engaged health industry stakeholders — investors, surely, but also providers, innovators, analysts, and insurers.       In my January

Only 4% of health care payments in the U.S. are pure fee-for-service (FFS) these days. “The end of pure FFS is near,” according to The State and Science of Value-Based Care, a report-out of survey research from Innovaccer and Morning Consult.             Innovaccer, a health cloud/data analytics company, worked with Morning Consult to do deep-dive interviews with 75 senior health care executives; research was conducted in November and December 2021, so these perspectives represent those of health system leaders at the start of 2022. The full report is worth your read; my focus in this Health

“Social distancing is great. Medical distancing? Not so much,” I observe in Medical Distancing in America: A Lingering Pandemic Side Effect., my essay published this week in Medecision’s Liberate Health blog. Since we learned to spell “coronavirus,” we also learned the meaning and risk-managing importance of physical distance early in the COVID-19 pandemic. But medical distancing became a corollary life-flow of the physical version, and for our collective health and well-being, it hasn’t been good for our health in ways beyond keeping our exposure to the virus at bay. For health care providers — physicians, hospitals, ambulatory clinics, diagnostic centers —

Rising costs, generational shifts, digital transformation, and fast-growing investments in new health care models and technologies are forcing change in the legacy health care, noted in the State of Consumerism in Healthcare 2021: Regaining Momentum, from Kaufman, Hall & Associates. As the title of Kaufman Hall’s sixth annual report suggests, health care consumers are evolving — even if the traditional healthcare system hasn’t uniformly responded in lock step with more demanding patients. Kaufman Hall analyzed 100 health care organizations in this year’s consumerism survey to assess their readiness to embrace consumer-centric strategies, understand how the industry prioritizes these approaches, evaluate

U.S. hospitals’ operating margins went negative in January 2021 after turning north for the first time in December 2020 since the start of the coronavirus pandemic, according to the February 2021 Hospital Flash Report from Kaufman Hall, commissioned by AHA, the American Hospitals Association. The first chart illustrates the importance of CARES Act funding to keep hospitals financially afloat during the public health crisis through most of last year. The start of 2021 was difficult for hospitals and health systems, Kaufman Hall explains, with falling outpatient revenues and increasing expenses resulting in that below-the-line blue bar for January 2021’s operating

Physicians in the U.S. are experiencing “death by 1,000 cuts,” according to the 2021 Medscape Physician Burnout & Suicide Report. Medscape polled 12,339 physicians representing over 29 specialties between late August and early November 2020 to gauge their feelings about work and life in the midst of the coronavirus pandemic. Medscape researched its first Physician Lifestyle Report in 2012. That research focused on physician “happiness” and work-life satisfaction. In 2013, the issue of burnout was called out on the cover of the report, shown here with the question, “does burnout affect lifestyle?” In 2015, the Physician Lifestyle Report was titled,

The COVID-19 pandemic has accelerated health care providers’ and plans’ investment in digital technologies while reducing capital spending on new physical assets, we learn in Building resilience during the COVID-19 pandemic and beyond from the Deloitte Center for Health Solutions. What must be built (or truly re-built), health care leaders believe, is first and foremost trust, followed by financial viability to ensure long-term resilience and sustainability — for the workforce, the organization, the community, and leaders themselves. For this report, Deloitte interviewed 60 health care chief financial officers to gauge their perspectives during the pandemic looking at the future of

The coronavirus pandemic accelerated many trends and new workflows for patients and consumers, and health care providers, too. The convergence of basic needs like hygiene and safety, financial and health security, and living-working-learning-and-cooking-at-home has turbocharged a migration of more acute care delivered at home. I explore this growing concept in my latest essay on Medecision’s Liberation blog, How the Pandemic Is Accelerating the Hospital-At-Home Concept. The key points are that: Hospital-at-home services (H-a-H) combine home visits with virtual care and remote monitoring Think: advanced home care, enabled through virtual health technologies and wrap-around services both clinical and scaled social determinants

The core business of hospitals is patient care, often baked with teaching and research. But wait — there’s more, asserts the Lown Institute in their approach to ranking America’s Best Hospitals in 2020. The Institute’s methodology for assessing what’s “best” addresses ten pillars. Several of these are the “stick-to-the-knitting” components of the Webster Dictionary definition of hospital work: patient outcomes, clinical outcomes, avoiding overuse, patient safety, and a recent focus, patient satisfaction. Community benefit has been part of a hospital’s life, especially in the not-for-profit world where hospitals must demonstrate goodwill generated for and provided in the neighborhoods in which

Patients in the U.S. are self-rationing care in the era of COVID-19 by cutting spending on health care visits and prescription drugs. The coronavirus pandemic’s impact on health consumers’ spending varies depending on whether the household is generally a healthy family unit, healthy “enthusiasts,” dealing with a simple or more complex chronic conditions, or managing mental health issues. PwC explored how COVID-19 is influencing consumers’ health care behaviors in survey research conducted in early April by the Health Research Institute. The findings were published in a May 2020 report, detailing study findings among 2,533 U.S. adults polled in early April

The coronavirus pandemic is dramatically impacting and re-shaping our health and wealth, simultaneously. Today, I’ll be brainstorming this convergence in a “collaborative health conversation” hosted by Carium’s Health IRL series.  Here’s a link to the event. Jeanne founded ClearHealthCosts nearly ten years ago, having worked as a journalist with the New York Times and other media. She began to build a network of other journalists, each a node in a network to crowdsource readers’-patients’ medical bills in local markets. Jeanne started in the NYC metro and expanded, one node at a time and through many sources of funding from not-for-profits/foundations,

In the midst of growing inpatient admissions and test results for COVID-19, Congress is working as I write this post to finalize a round of legislation to help Americans with the costs-of-living and (hopefully) health care in a national, mandated, clarifying way. Right now in the real world, real patients are already being treated for COVID-19 in American hospitals. Patients are facing health care costs that may result in multi-thousand dollar bills at discharge (or death) that will decimate households’ financial health, particularly among people who don’t have health insurance coverage, covered by skinny or under-benefited plans, and/or lack banked

Outpatient revenue is crossing the curve of inpatient income. This is the new reality for U.S. hospitals and why I’ve titled this post, “outpatient is the new inpatient,” a future paradigm for U.S. hospitals This realization is informed by data in a new report from Deloitte, Where have the many hospital inpatient gone? The line chart illustrates Deloitte’s top and bottom line: “The shift toward outpatient is happening and will likely have a tremendous impact on operations, business models, staffing, and capital. Health systems should prepare for the future today and start thinking not only about how to manage their

There are 1,844 rural hospitals operating in the U.S. That number is down by 19 in the 2019 calendar year, the worst year of rural hospital closings seen in the past decade. That hockey-stick growth of closures is shown in the first chart, where 34 rural hospitals shut down in the past 2 years. Rural U.S. hospitals are in poor fiscal health. “The accelerated rate at which rural hospitals are closing continues to unsettle the rural healthcare community and demands a more nuanced investigation into rural hospital performance,” threatening the stability of the rural health safety net, according to the

Twenty Democratic Presidential candidates each have a handful of minutes to make their case for scoring the 2020 nomination, “debating” last night and tonight on major issues facing the United States. I watched every minute, iPad at the ready, taking detailed notes during the 120 minutes of political discourse conducted at breakneck speed. Lester Holt, Savannah Guthrie, and Jose Diaz-Balart asked the ten candidates questions covering guns, butter (the economy), immigration, climate change, and of course, health care — what I’m focusing on in this post, the first of two-debate-days-in-a-row. The first ten of twenty candidates in this debate were,

Patients in the U.S. assume the role of payor when they are enrolled in high-deductible health plans. People are also the payor when dealing with paying greater co-payments for prescription drugs, especially as new therapeutic innovations come out of pipelines into commercial markets bearing six-digit prices for oncology and other categories. For mainstream Americans, “the math doesn’t add up” for paying medical bills out of median household budgets, based on the calculations in the 2019 VisitPay Report.  Given a $60K median U.S. income and average monthly mortgage and auto payments, there’s not much consumer margin to cover food, utilities, petrol,

Beyond the physical and emotional pain that people experience when they become a patient, in the U.S. that person becomes a consumer bearing expenses and financial pain, as well. 98% of Americans rank paying their medical bills is an important pain point in their patient journey, according to Embracing consumerism: Driving customer engagement in the healthcare financial journey, from Experian Health. Experian is best known as the consumer credit reporting agency; Experian Health works with healthcare providers on revenue cycle management, patient identity, and care management, so the company has experience with patient finance and medical expense sticker shock. In the

When it comes to healthcare costs, lines that decline over time are generally seen as good news. That’s how media outlets will cover the top-line of PwC’s report Medical cost trend: Behind the numbers 2019. However, there are other forces underneath the stable-looking 6.0% medical trend growth projected for 2019 that will impact healthcare providers, insurers, and suppliers to the industry. There’s this macro-health economic story, and then there’s the micro-economics of healthcare for the household. Simply put: the impact of growing financial risk for healthcare costs will be felt by patients/consumers themselves. I’ve curated the four charts from the

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

At this moment, the healthcare job I’d least like to have is that of a non-profit hospital Chief Financial Officer (CFO). Five news stories, published in the past 24 hours, tell the tale: First, Moody’s forecast for non-profit hospitals and healthcare in 2018 is negative due to reimbursement and expense pressures. The investors report cited an expected contraction in cash flow, lower reimbursement rates, and rising expense pressures in the midst of rising bad debt. Second, three-quarters of Federally Qualified Health Centers plan to lay off staff given lack of budget allocations resulting from Congressional inaction. Furthermore, if the $3.6

Overtreatment is a major contributor to waste and patient risk in America. Most U.S. physicians say it’s a common fact of life in American healthcare, gleaned through physician survey detailed in Overtreatment in the United States, published in PLOS One on September 6, 2017. The overwhelming majority (8 in 10 physicians) identified malpractice as the reason for overtreatment, followed by patient pressure/request (59%). Other reasons cited for overtreatment included: Difficulty accessing prior medical records Borderline indications Inadequate time to spend with patients, and Lack of adequate information or previous medical history. Overall, physicians judged 20% of healthcare to fall into

Patient satisfaction should be baked into healthcare provider service goals, according to Prioritizing the Patient Experience from West Corporation, the communications company. West is in the business of improving communications systems, and has a vested interest in expanding comms in health. This research polled patients and providers to assess how each healthcare stakeholder perceives various patient satisfaction issues, which when done well are grounded in sound communications strategy and technologies. Patient satisfaction is directly linked to the bottom lines of healthcare organizations, West contends, due to two key drivers: Evolving payment models are increasingly tying patient satisfaction to reimbursements; and,

Spending on health care in the U.S. hit $3.2 trillion in 2015, increasing 5.8% from 2014. This works out to $9,990 per person in the U.S., and nearly 18% of the nation’s gross domestic product (GDP). Factors that drove such significant spending growth included increases in private health insurance coverage owing to the Affordable Care Act (ACA) coverage (7.2%), and spending on physician services (7.2%) and hospital care (5.6%). Prescription drug spending grew by 9% between 2014 and 2015 (a topic which I’ll cover in tomorrow’s Health Populi discussing IMS Institute’s latest report into global medicines spending). The topic of

Health care payment responsibility continues to shift from employers to employee-patients, More of those patients are morphing into financially burdened health consumers, according to TransUnion, the credit agency and financial risk information company, in the TransUnion Healthcare Report published in June 2016. Patients saw a 13% increase in their health insurance deductible and out-of-pocket (OOP) maximum costs between 2014 and 2015. At the same time, the average base salary in the U.S. grew 3% in 2015, SHRM estimated. Thus, deductibles and OOP costs grew for consumers more than 4 times faster than the average base salary from 2014 to 2015.  In

As HIMSS 2016, the annual conference of health information technology community, convenes in Vegas, an underlying market driver is fast-reshaping consumers’ needs that go beyond personal health records: that’s personal health-financial information and tools to help people manage their growing burden of healthcare financial management. There’s a financial risk-shift happening in American health care, from payers and health insurance plan sponsors (namely, employers and government agencies) to patients – pushing them further into their role as health care consumers. The burden of health care costs weighs heavier on younger U.S. health citizens, based on a survey from the Xerox Healthcare

By shifting primary care visits by 5 minutes, moving some administrative tasks and self-care duties to patients, the U.S. could conserve billions of dollars which could extend primary care to underserved people and regions, hire more PCPs, and drive quality and patient satisfaction. Accenture’s report, Virtual Health: The Untapped Opportunity to Get the Most out of Healthcare, highlights the $10 bn opportunity which translates into conserving thousands of primary care providers. PCPs are in short supply, so virtual care represents a way to conserve precious primary care resources and re-deploy them to their highest-and-best-use. The analysis looks at three scenarios

Startup Health, the health/care entrepreneur development company which has helped launch over 100 health/tech companies since “starting up” in 2011, announced a collaboration with Aurora Health Care today. This is one of the first ventures of its kind, linking up health/tech entrepreneurs with a health care provider organization as a living lab, or in the words of Unity Stoakes, Startup Health Co-Founder, a “collaboratory.” I spoke with Unity before the announcement went public, and learned that Startup Health sought a partner with shared values focused on getting innovations into patient care that could transform the healthcare delivery system. “Every single

Health care consumers face a fragmented and complicated payment landscape after receiving services from hospitals and doctors, and paying for insurance coverage. People want to “view their bills, make a few clicks, pay…and be done,” according to Jamie Kresberg, product manager at Citi Retail Services, a unit of Citibank. He’s quoted in Money Matters: Billing and payment for a New Health Economy from PwC’s Health Research Institute. The healthcare service segment most consumers are satisfied with when it comes to billing and payment is pharmacies, who score well on convenience, affordability, reliability, and seamless transactions – with only transparency being

This past weekend, 60 Minutes’ Leslie Stahl asked John Castellani, the president of PhRMA, the pharmaceutical industry’s advocacy (lobby) organization, why the cost of Gleevec, from Novartis, dramatically increased over the 13 years it’s been in the market, while other more expensive competitors have been launched in the period. (Here is the FDA’s announcement of the Gleevec approval from 2001). Mr. Castellani said he couldn’t respond to specific drug company’s pricing strategies, but in general, these products are “worth it.” Here is the entire transcript of the 60 Minutes’ piece. Today, Health Affairs, the policy journal, is hosting a discussion

During my conversation with a prominent pharma industry analyst yesterday, he observed, “As a consumer, you are self-insured until you get sick.” My brain then flashed back to a graph from the 2013 Employer Health Benefits Survey conducted annually by the Kaiser Family Foundation (KFF). The chart is shown here. It illustrates the upward line indicating that in 2013, 4 in 5 workers were enrolled in a health plan that included an annual deductible. That’s the “self-insurance” part of the observation my astute conversationalist noted. Simply put, when you are enrolled in a high-deductible health plan, You, The Consumer, are responsible for

Yesterday kicked off this week in Health Populi, focusing on the growing role of transparency in health care in America. Today’s post discusses the results from Change Healthcare’s latest Healthcare Transparency Index report, based on data from the fourth quarter of 2013, published in May 2014. Charges for health services — dental, medical and pharmacy – varied by more than 300% in Q42013 — even within a single health network. Change Healthcare found this, based on their national data on 7 million health-covered lives. The company analyzed over 180 million medical claims. The company built the Healthcare Transparency Index (HCTI)

Employers who sponsor health insurance in America are at a fork on a cloudy road: they know that they’re in the midst of changes happening in the U.S. health system. Except for one certainty: that health care costs too much. So employers’ plans for health benefits in 2014 strongly focus on getting a return-on-investment from health spending in an uncertain climate, according to Deloitte’s 2013 Survey of U.S. Employers. Key findings are that: Employers will grow their use of workers’ cost-sharing, continuing to shift more financial responsibility onto employees They will expand other tactics they believe will help address cost

  Money and health are two things most people don’t like to talk about. But if people and their doctors spoke more about health and finance, outcomes (both fiscal and physical) could improve. In late October 2013, Best Practices for Communicating with Patients on Financial Matters were published by the Healthcare Financial Management Association (HFMA). Michael Leavitt, former head of the Department of Health and Human Services, led the year-long development effort on behalf of HFMA, with input from patient advocates, the American Hospital Association, America’s Health Insurance Plans, the American Academy of Family Physicians and the National Patient Advocate Foundation, along

The current role of health insurance at work is that it’s the “benefits” part of “compensation and benefits.” Soon, benefits will simply be integrated into “compensation and compensation.” That is, employers will be transferring risk to employees for health care. This will translate into growing defined contribution and cost-shifting to employees. Health care sponsorship by employers is changing quite quickly, according to the 2013 Aon Hewitt Health Care Survey published in October 2013. Aon found that companies are shifting to individualized consumer-focused approaches that emphasize wellness and “health ownership” by workers to bolster behavior change and, ultimately, outcomes. The most

Return on innovation in medical technology is on the decline. Med tech needed a GPS for its role in the health ecosystem, and lost its way as it focused on a few wrong priorities. In a $349 billion market, there has been much to lose…and will be to gain. The new world for medical technology and how the industry can turn around is the subject of P2C’s report, Medtech companies prepare for an innovation makeover, published in October 2013 by the PwC Health Research Institute (HRI). The problem has been an addiction to incremental improvements on existing products: think about the analog in

U.S. health consumers faced greater out-of-pocket health care costs in 2012, especially for outpatient services (think: doctors’ visits) and generic drugs, as presented in The 2012 Health Care Cost and Utilization Report  from the Health Care Cost Institute (HCCI) published in September 2013. At the same time between 2011 and 2012, wages grew about 3%, remaining fairly flat over the past decade as health care costs continued to grow much faster. HCCI found that per capita (per person) out-of-pocket growth for outpatient visits amounted to an average of $118 between 2011 and 2012. But the biggest share of out-of-pocket costs for

Urgent care centers are growing across the United States in response to emergency rooms that are standing-room-only for many patients trying to access them. But can urgent care centers play a cost-effective, high quality part in stemming health care costs and inappropriate use of ERs for primary care. That’s a question asked and answered by The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? from the Center for Studying Health System Change by Tracy Yee  et. al. The Research Brief defines urgent care centers (UCCs) as sites that provide care on a walk-in basis, typically during regular

The number of retail health clinics will double between 2012 and 2015, according to a research brief from Accenture, Retail medical clinics: From Foe to Friend? published in June 2013. What are the driving market forces promoting the growth of retail clinics? Accenture points to a few key factors: Hospitals’ need to rationalize use of their emergency departments, which are often over-crowded and incorrectly utilized in cases of less-than-acute care. In addition, hospitals are now financially motivated under the Affordable Care Act (ACA, health reform) to reduce readmissions of patients into beds (particularly Medicare patients with acute myocardial infarction [heart attacks],

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The

Today’s Health Populi is devoted to Steven Brill and his colleagues at TIME magazine whose special report, Bitter Pill: Why Medical Bills Are Killing Us, is required reading for every health citizen in the United States. Among many lightbulb moments for readers, key findings from the piece are: Local hospitals are beloved charities to people who live in their market – Brill calls these institutions “Non-Profit Profitmakers). They’re the single most politically powerful player in most Congressional districts The poor and less affluent more often pay the high chargemaster (“retail list”) price for health products and services vs. the wealthy

Estimates on health spending in the U.S. are under-valued, according to The hidden costs of U.S. health care: Consumer discretionary health care spending, an analysis by Deloitte’s Center for Health Solutions. Health spending in the U.S. is aggregated in the National Health Expenditure Accounts (NHEA), assembled by the Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS). In 2010, the NHEA calculated that $2.6 trillion were spent on health care based on the categories they “count” for health spending. These line items include: Hospital care Professional services (doctors, ambulatory care, lab services) Dental services Residential

The saying goes, “you pays your money and you makes your choice.” In 2012, if you have a bolus of $20,700 to spend, you can choose between a health plan for a family of four, or a sedan for the same family. That’s the calculation from the actuaries at Milliman, whose annual Milliman Medical Index is the go-to analysis on health care costs for a family of four covered by a preferred provider organization plan (PPO). While the 6.9% annual average cost increase is lower than the 7.3% in 2011, it is nonetheless, a record $1,335 real dollar increase at

1 in 3 U.S. health citizens had some problem paying for medical care in the first half of 2011, according to a survey from the Centers for Disease Control. In 2010, about 1 in 5 people had trouble paying for medical care. 26% of people were paying medical bills over time; 20% of people had problems paying medical bills in the past year; and, 11% had medical bills they were unable to pay at all. Not surprisingly, among people under 65, those who were poor and near-poor were most likely to be in families with medical bill problems. If you were

Transparency and authenticity, constant and clear communication, and a drive toward value underpin the future health system — for those health leaders who can commit to these pillars of transformational change. Leading Through Transformation: Top Healthcare CEOs’ Perspectives on the Future of Healthcare summarizes the interaction among 17 health execs who convened at the second CEO Forum held by Huron Healthcare Group. The report was released in January 2012. Health leaders concur that regardless of the politics of the Affordable Care Act and its prospects for whole or partial survival beyond November 2012, market pressures in the health sector are driving

This morning during my still-dark-at-5:15 am walk, my iPod was motivating me to “get up offa that thing,” as James Brown was motivating me to “release the pressure.” Two minutes into the song, he urges, “Get into the sunshine, church is out.” This brought to mind a publication I’ve taken time to review from the General Accounting Office (GAO) report to the U.S. Congress, Health Care Price Transparency – Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care, published in September 2011. While employers and health plans want consumers to become more engaged in their health, a key barrier facing

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context, The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350 The car buyer could purchase a Mini-Cooper with $20,000 The investor could invest $20K to yield $265,353 at a 9% return-on-investment. The MMI increased 7.3% between 2010 and 2011, about the same

Mature users of electronic health records bear many scars and learnings, having been through the first several rungs of the health information technology (HIT) adoption ladder. A few of these lessons for HIT adoption success… Implementing EMRs is a strategic and not just an IT-department initiative. HIT adoption requires top-down commitment and engagement. It takes longer and costs more than the planners of systems expect. During transition to an EMR, hospitals see an 80% “spike” (increase) in IT operating expenses — directly impacting the hospital’s overall operating budget as much as 200 basis points or more. There is evidence that those spikes