Located in Los Angeles, Cedars-Sinai Medical Center is a nonprofit, academic health science center. U.S. News ranks it the 6th best hospital in the U.S. It's a leader in research for treating heart disease, cancer, and brain disorders. Innovations include using cardiac stem cells to repair damaged hearts, new cancer drugs, and less invasive surgical techniques.
The Cedars of Lebanon Hospital was founded in 1902 as a tuberculosis hospital by Kaspare Cohn. The first Los Angeles Mt. Sinai hospital opened on Bonnie Beach Place in 1926. In 1961, Mt. Sinai merged with Cedars of Lebanon. In 1972, the 1.6-million-sq-foot 1,120-bed Cedars-Sinai Medical Center began construction. In 1984 it was designated a Level 1 trauma center. Today U.S. News ranks it #2 nationwide for gastroenterology and #3 in cardiology, orthopedics, and lung surgery. It's ranked #9 for cancer care.
Cedars-Sinai offers graduate and continuing education, including a PhD in Biomedical Sciences, Master's degrees in Health Delivery Science and Magnetic Resonance. Numerous fellowships and residencies are offered for medical students, physicians, scientists and nurses. Cedars-Sinai is an affiliate hospital of the David Geffen School of Medicine at UCLA. They also offer simulation training.
Hollywood celebrities have funded many facilities and institutes at Cedars-Sinai including the Barbra Streisand Women's Heart Center, the Burns and Allen Research Institute, and the S. Mark Taper Foundation Imaging Center. Among the many celebrities who drew their last breath at the hospital are Frank Sinatra, Lucille Ball, Elizabeth Taylor, Charles Bronson, Bobby Darin, Henry Fonda, Eva Gabor, Merv Griffin, Stan Lee, Groucho Marx, Gilda Radner, Debbie Reynolds, and Danny Thomas. Celebrity births include Liza Minelli, Frances Bean Cobain, Michael Jackson, Jr., the Kardashian/West children: North, Saint, Chicago, and Psalm, as well as the twins Rumi and Sir Carter.
Thanks to typically lower costs and more perks, Medicare Advantage (MA) plans often offer great value in comparison to Original Medicare. Despite featuring managed care protocols and more limited provider choices, MA plans have been steadily drawing Medicare eligible seniors away from Original Medicare. As of December 2021, over 27.3 million Americans were enrolled in Medicare Advantage plans, an increase of more than 55% from December 2016 levels. By comparison, during this same five-year time period the total Medicare eligible population only grew by about 11%.
The popularity of Medicare Advantage plans nationally is mirrored in the four-state Southwestern region of the country. In the last five years MA plan enrollment in the Southwest grew at an average rate in excess of 10% per year, more than 3.5 times faster than the growth rate of the Medicare eligible population in the Southwest during this period. Here is a deeper look at the Southwest's Medicare Advantage enrollment growth by state from December 2016 to December 2021:
The Southwest's Medicare Advantage Enrollment Growth by State
Medicare Eligible *
MA Enrollment *
Annual % Growth
State
Dec-21
Dec-16
Dec-21
Dec-16
Eligible
MedAdv
AZ
1,402.3
1,200.5
640.2
453.3
3.2%
7.2%
NM
442.1
390.3
190.1
125.5
2.5%
8.7%
OK
764.9
704.5
238.9
119.0
1.7%
15.0%
TX
4,407.9
3,819.2
2,037.8
1,194.8
2.9%
11.3%
Region
7,017.2
6,114.5
3,106.9
1,892.5
2.8%
10.4%
U.S.**
63,710.0
57,388.1
27,294.4
17,562.2
2.1%
9.2%
* Medicare Eligible and MA Enrollment numbers in thousands, as of December 2021 and December 2016 ** U.S. totals include territories Numbers may not total due to rounding
With normally lower costs and more benefits, Medicare Advantage plans are a great value compared to Original Medicare. Despite often having managed care protocols and fewer provider choices, MA plans are drawing more and more Medicare eligible seniors away from Original Medicare. As of December 2021, about 27.3 million Americans were enrolled in MA plans, an increase of more than 55% from December 2016 levels. In contrast, during this same five-year time span the total Medicare eligible population only grew by about 11%.
The popularity of Medicare Advantage plans nationally is mirrored in the Mid-East region of the country, where MA plan enrollment grew at an average rate of 8% per year over the past five years, more than four times faster than rate of growth of the region's Medicare eligible population during this period. Here is a closer look at the U.S. Mid-East's Medicare Advantage enrollment growth by state over the last five years:
The U.S. Mid-East's Medicare Advantage Enrollment Growth by State
Medicare Eligible *
MA Enrollment *
Annual % Growth
State
12/21
12/16
12/21
12/16
Eligible
MedAdv
DC
94.9
91.0
24.6
7.3
0.8%
27.5%
DE
223.9
188.7
52.3
17.1
3.5%
25.1%
MD
1,080.9
973.2
177.4
53.6
2.1%
27.1%
NJ
1,667.4
1,542.5
588.8
257.7
1.6%
18.0%
NY
3,731.1
3,454.9
1,734.2
1,283.1
1.6%
6.2%
PA
2,818.9
2,616.7
1,314.9
1,029.6
1.5%
5.0%
Region
9,617.0
8,867.0
3,892.1
2,648.5
1.6%
8.0%
U.S.**
63,710.0
57,388.1
27,294.4
17,562.2
2.1%
9.2%
* Medicare Eligible and MA Enrollment numbers in thousands, as of December 2021 and December 2016 ** U.S. totals include territories Numbers may not total due to rounding
Nearly 148,500 speech language pathologists (SLPs) were employed in the United States as of May 2020 according to the latest occupational employment data available from the U.S. Bureau of Labor Statistics (BLS). More than 22,300 employed SLPs were living in the five-state Great Lakes region at that time. BLS data revealed the region to be a subpar one for speech language pathologist pay, as no Great Lakes state recorded a SLP annual mean wage level that topped the national average for the profession. A further examination of May 2020 BLS data reveals the following state-level details about speech language pathologist pay in the Great Lakes region:
Speech Language Pathologist Pay in the Great Lakes Region
State
# Employed
Annual Mean Wages
Wage Rank*
IL
7,370
$80,420
22nd
IN
2,580
$76,220
31st
MI
3,880
$79,310
25th
OH
6,230
$79,010
26th
WI
2,250
$75,220
37th
U.S.
148,450
$83,240
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
The U.S. Bureau of Labor Statistics' (BLS) most recent occupational employment data put the number of recreational therapists employed in the United States at more than 20,000 as of May 2020. At that time, just under 1,900 recreational therapists were employed in the seven-state Great Plains region according to BLS figures. Although Iowa ranked as a top ten state for recreational therapist annual mean wages according to BLS data, the Great Plains region was a rather weak one for recreational therapist pay. Other states in the region registered recreational therapist annual mean wage levels that were below the national average for the profession, with Kansas ranked amongst the ten worst states in the nation for that pay metric. A closer look at May 2020 BLS data provides the following details about recreational therapist pay in the Great Plains region:
Recreational Therapist Pay in the Great Plains Region
State
# Employed
Annual Mean Wages
Wage Rank*
IA
180
$53,970
9th
KS
390
$38,710
45th
MN
720
$49,630
17th
MO
440
$50,720
14th
NE
100
$46,980
32nd
ND
40
$49,390
19th
SD
-------
-------
NR
U.S.
20,080
$51,260
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
The latest occupational employment data from the U.S. Bureau of Labor Statistics (BLS) put May 2020 employment numbers for massage therapists (MTs) at more than 85,000. Just under 19,700 massage therapy jobs were in the six-state Far Western region of the country. A review of BLS data reveals wide disparity for massage therapist pay in the Far West. Although home to four of the top 5 states in the nation for massage therapist annual mean wages, 65% of the region's MTs lived in California or Nevada, two states where the massage therapist annual mean wage level was below the national average for the profession. A closer look at BLS data from May 2020 shows us the following about massage therapist pay in the Far Western U.S.:
Massage Therapist Pay in the Far Western U.S.
State
# Employed
Annual Mean Wages
Wage Rank*
AK
510
$78,790
1st
CA
11,450
$44,730
30th
HI
780
$56,940
5th
NV
1,350
$39,270
42nd
OR
1,490
$61,820
4th
WA
4,110
$64,950
3rd
U.S.
85,040
$47,350
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
More than 590 hospitals were evaluated for their proficiency at delivering adult cardiac care in the most recent (21-22) U.S. News & World Report rankings of American hospitals. In this analysis, hospitals were measured on multiple metrics related to the outcomes of their adult cardiac care patients, the scope of their adult cardiac care programs, and the degree of professional recognition they've received from the wider cardiac care community. Among the top 50 ranked U.S. hospitals for adult cardiac care in 21-22, two were based in the six-state New England region:
For a closer look at the metrics used to grade adult cardiac care and heart surgery hospitals in the 21-22 U.S. News survey, or to find the cardiac care rating of other New England hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery.
The most recent occupational employment data available from the U.S. Bureau of Labor Statistics (BLS) reported nearly 93,000 physical therapy (PT) assistants at work in the United States as of May 2020. About 13,300 physical therapy assistants worked in the Mid-Eastern U.S., a region that includes the District of Columbia and five states. BLS data shows the region to be a generally weak one for physical therapy assistant pay. Although New Jersey ranked among the top five states in the nation for physical therapy assistant annual mean wages, other states in the region recorded annual mean wages levels for the profession that were below the national average. A deeper look into BLS data from May 2020 reveals the following details about physical therapy assistant pay in the Mid-Eastern U.S.:
Physical Therapy Assistant Pay in the Mid-Eastern U.S.
State
# Employed
Annual Mean Wages
Wage Rank*
DC
160
$43,540
49th
DE
250
-------
NR
MD
1,760
$54,490
36th
NJ
1,290
$69,310
4th
NY
5,200
$55,220
33rd
PA
4,600
$56,820
28th
U.S.
92,740
$59,440
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
Over 326,000 clinical laboratory technicians and technologists were working in the U.S. as of May 2020 according to the most current occupational employment data from the U.S. Bureau of Labor Statistics (BLS). At that time, just over 88,000 of the nation's clinical lab techs were working in the twelve-state Southeastern region of the country. For clinical lab techs, the Southeast was one of the weakest pay regions in the nation. The average annual mean wage for clinical lab techs in every state in the region was below than the national average for the profession. Moreover, seven states in the region ranked among the bottom third of all states in the country for clinical lab tech annual mean wages. Further examination of May 2020 BLS data reveals the following state-level details about clinical lab tech pay in the Southeastern U.S.:
Clinical Lab Tech Pay in the Southeastern U.S
State
# Employed
Annual Mean Wages
Wage Rank*
AL
5,480
$46,120
49th
AR
2,600
$45,320
51st
FL
21,420
$52,970
30th
GA
11,790
$50,440
40th
KY
3,950
$55,120
24th
LA
4,290
$50,530
39th
MS
3,360
$45,970
50th
NC
12,200
$52,420
34th
SC
4,150
$50,660
37th
TN
8,860
$54,660
25th
VA
8,270
$55,160
23rd
WV
1,690
$50,570
38th
U.S.
326,220
$55,990
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
In the most recent (21-22) U.S. News & World Report survey of American hospitals, close to 600 hospitals were scored on their effectiveness at providing adult cardiac care, including heart surgery. In this analysis, hospitals were examined on various metrics pertaining to their experience and outcomes with adult cardiac patients, the breadth of their adult cardiology programs, and the degree of distinction a hospital has earned within the adult cardiology care community. Among the top 50 rated U.S. hospitals for adult cardiac care in 21-22, six were based in the seven-state Great Plains region. This included the Mayo Clinic, the 2nd highest rated cardiac care hospital in the country. Here's a quick rundown of the six Great Plains region medical institutions that made the top 50 and where they ranked nationally for adult cardiac care in the 21-22 survey:
The Best Cardiac Care Hospitals in the Great Plains Region
For a further look at the metrics used to score adult cardiac care and heart surgery hospitals in the 21-22 U.S. News survey, or to find the cardiac care rating of other Great Plains region hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery.
Over 590 hospitals were rated for their effectiveness and proficiency at delivering adult cardiac care in the most recent (21-22) U.S. News & World Report rankings of American hospitals. This analysis graded subject hospitals on multiple metrics related to the outcomes experienced by their adult cardiac care patients, the scale of their adult cardiac care programs, and the amount of professional recognition a hospital earned from the wider cardiac care community. Among the top 50 ranked U.S. hospitals for adult cardiac care in the 21-22 survey, fourteen were based in Mid-Eastern U.S., a region that includes the District of Columbia and five states. In the 21-22 survey, no other region of the country had as many top-quality cardiac care hospitals as did the Mid-East. Here are the Mid-Eastern region hospitals that earned high accolades for adult cardiac care in the 21-22 survey:
The Best Cardiac Care Hospitals in the Mid-Eastern U.S.
For insight into the metrics used to grade adult cardiology and heart surgery hospitals in the 21-22 U.S. News survey, or to find the cardiac care rating of other Mid-Eastern U.S. hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery
Per the most recent occupational employment data from the U.S. Bureau of Labor Statistics (BLS), the number of family medicine physicians employed in the United States came in at more than 98,000 as of May 2020. Just over 5,100 family medicine physicians were employed at that time in the five-state Rocky Mountain region. BLS data reveals the region to be a mixed picture in terms of family physician pay. Montana ranked among the top ten states nationally for family medicine physician annual mean wages, and three other states in the region recorded family physician annual mean wage levels near or above the national average. However, 59% of Rocky Mountain region family medicine physicians lived in Colorado, which ranked among the ten worst states nationally for family physician annual mean wages. A closer examination of BLS May 2020 data provides the following details about family medicine physician pay in the Rocky Mountain region:
Family Medicine Physician Pay in the Rocky Mountain Region
State
# Employed
Annual Mean Wages
Wage Rank*
CO
3,020
$199,190
43rd
ID
610
$214,140
29th
MT
410
$237,990
8th
UT
880
$214,700
28th
WY
200
$231,050
11th
U.S.
98,590
$214,370
-------
(*) annual mean wage ranking among the 50 states and the District of Columbia
Nearly 96,000 general dentists were employed in the U.S. as of May 2020 according to the most current occupational data available from the U.S. Bureau of Labor Statistics (BLS). Per BLS data, just under 23,600 of those employed general dentists worked in the twelve-state Southeastern region of the country. The region was a mostly subpar one in terms of general dentist pay, as ten of the twelve states in the region registered an annual mean wage level for general dentists that was below the national average. Moreover, four Southeastern states ranked among the ten worst states in the nation for general dentist annual mean wages. Further examination of May 2020 BLS data details the following about general dentist pay in the Southeastern U.S.:
In the 21-22 U.S. News & World Report survey of American hospitals, more than 590 hospitals were examined for their proficiency and effectiveness at providing cardiac care to adult patients. Hospitals in the survey were scored on various metrics related to their cardiac patient outcomes, the scale of their cardiac care programs, and the level of professional recognition earned by these hospitals from other members the cardiac care community. Among the top 50 rated U.S. hospitals for adult cardiac care in the 21-22 survey, ten are based in the five-state Great Lakes region. The region's top cardiac care hospital, Cleveland Clinic, was also rated as the best cardiac care hospital in the nation. Here's a summary look at these ten Great Lakes region hospitals and where they ranked nationally for adult cardiac care in the 21-22 survey:
The Best Cardiac Care Hospitals in the Great Lakes Region
For more insight into the metrics used to score adult cardiology and heart surgery hospitals in the 21-22 U.S. News survey, or to learn more about the cardiac care rating of other Great Lakes region hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery.
Seeking to Shift Costs to Medicare, More Employers Move Retirees to Advantage Plans
Susan Jaffe
As a parting gesture to a pandemic-ravaged city, former New York Mayor Bill de Blasio hoped to provide the city with a gift that would keep on giving: new health insurance for 250,000 city retirees partly funded by the federal government. Although he promised better benefits and no change in health care providers, he said the city would save $600 million a year.
Over the past decade, an increasing number of employers have taken a similar deal, using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. Employers and insurers negotiate behind closed doors to design a private Medicare Advantage plan available only to retirees from that employer. Then, just as it does for private individuals choosing a Medicare Advantage plan, the federal government pays the insurer a set amount for each person in the plan.
Experts say this arrangement often saves the employer money because the federal payment reduces the employer’s share of the cost of coverage. But retirees’ health care may be disrupted if the plan no longer includes their doctors and hospitals or the insurer has new requirements or charges new fees to access benefits.
Scores of private and public employers offer Medicare Advantage plans to their retirees. Yet the details — and the costs to taxpayers — are largely hidden. Because the federal Centers for Medicare & Medicaid Services is not a party to the negotiations among insurers and employers, the agency said it does not have details about how many or which employers are using this strategy or the cost to the government for each retiree group.
Employer-sponsored plans receive billions of dollars in federal payments, but they also get something other Medicare Advantage insurers don’t: automatic exemptions to some requirements that apply to the policies available to individual beneficiaries. Plans can set their own enrollment deadlines, send members information without prior CMS approval for accuracy, and follow weaker requirements for provider networks, among other things.
“There are as many plans as there are stars in the sky because employers and insurers can design their health benefits any way they want to,” said Tatiana Fassieux, a training specialist for California Health Advocates, a consumer group. She switched her health coverage to try a new employer-sponsored Medicare Advantage plan AT&T introduced this year for retirees to see whether it would save her money for better benefits. She qualifies for it because her late husband was an employee of the company.
These group retiree plans are similar to the public Medicare Advantage plans that insurance companies advertise on TV and in the mail. Run by private insurance companies, they must offer the benefits of the government’s traditional Medicare and often add extras like dental and vision coverage. However, they can restrict members to a network of medical providers.
In traditional Medicare, the government pays doctors, hospitals, and other health care providers directly for beneficiaries’ care. But Medicare Advantage is different. The government pays the insurance companies that sell Medicare Advantage policies a fixed amount every month for each member they sign up.
In most of the employer-sponsored retiree plans, the federal government is paying the “overwhelming majority” of medical costs, said Barry Carleton, senior director for health and benefits at Willis Towers Watson, which advises dozens of large companies and state retirement systems. “And in some cases, it pays the entirety of the cost.” Under a separate arrangement for employer-sponsored Part D drug coverage, the federal contribution and manufacturer discounts “can account for a majority of the cost of the pharmacy plan,” he said.
“Employers find Medicare Advantage [plans] appealing because they can drive significant savings,” said Chris Maikels, a senior principal and the U.S. marketplace growth leader for retiree solutions at Mercer Marketplace, another benefits consulting firm. His clients have saved up to 50% by moving retirees into employer-sponsored Medicare Advantage and drug plans. Under some plans, retirees can go to any Medicare provider, he said, so “there is typically little retiree disruption.”
CareFirst BlueCross BlueShield — an insurer that serves Maryland, Washington, D.C., and Northern Virginia — began offering Medicare Advantage plans to four new retiree groups this year, said Dave Corkum, executive vice president and chief growth officer. “Most employer groups could achieve double-digit percent savings on annual retiree health costs,” he said.
The number of beneficiaries in employer-sponsored Medicare Advantage plans has soared from about 1.6 million in 2008 to more than 5 million last year, according to CMS. UnitedHealthcare, the nation’s largest health insurance company, has “seen tremendous growth” in the employer-sponsored plans during the past decade, said national vice president Joe Altman. “We’ve had new groups coming on to our group Medicare Advantage [plans] every year,” Altman said. He would not divulge their names.
In a typical employer retiree plan, beneficiaries are often covered by traditional Medicare, which picks up part of their medical costs, and the employer and retiree are responsible for the rest. The government’s payments to Medicare Advantage plans are supposed to be equal to what it would cost if beneficiaries stayed in the government-run Medicare. But it doesn’t always work out that way.
With each Advantage member, the government spends 4% more than it does for someone in the traditional fee-for-service program, according to the Medicare Payment Advisory Commission, which advises Congress. In 2019, CMS paid the plans $7 billion more than the cost of caring for those beneficiaries in traditional Medicare, a study by KFF found. Much of that difference comes when the insurers’ reimbursements are increased by Medicare to account for services for sicker patients that are either not provided or not necessary. A recent investigation by the inspector general for the U.S. Department of Health and Human Services found that the practice resulted in overpayments of $6.7 billion in 2017.
The exemptions to Medicare Advantage rules granted to these retiree plans are intended to make it easy for employers to make the switch. A provision of federal law allows Medicare officials to “waive or modify requirements that hinder” employer-sponsored Advantage plans.
For example, provider network requirements are watered down for the employer plans, which means finding a doctor who participates in the plan may be more difficult for members, explained David Lipschutz, associate director of the Center for Medicare Advocacy.
Details about plan benefits and costs don’t have to be approved by Medicare for accuracy or posted on the insurer’s website, as they do for Medicare Advantage plans sold to the public. Medicare’s plan finder website also omits this information, since employer-sponsored plans are only for retirees from the same company. So retirees must rely on their former employer, their union, or the health insurer for assistance, instead of impartial sources such as the State Health Insurance Assistance Program.
“We know that these employer Medicare Advantage plans receive a great deal of federal subsidies, with the cost paid by CMS and the taxpayers,” Lipschutz said. “But what are the strings attached to this money? And what kind of oversight do these plans get?”
In New York City, some retirees sued to stop the new plan. They claimed they didn’t have essential details, including which doctors and hospitals would accept it. About 47,000 retirees have opted out of the new plan, according to a spokesperson for Mayor Eric Adams.
“We were told that everything that this plan is doing has been approved by Medicare and that they have to follow all the Medicare rules,” said Marianne Pizzitola, a Fire Department retiree and president of the New York City Organization of Public Service Retirees, which filed the lawsuit.
State Supreme Court Justice Lyle Frank has twice delayed implementation of the plan and has ordered city officials to correct mistakes in the enrollment guide, contact medical providers about accepting the new coverage, and take other steps to address retirees’ concerns. City officials have assured the judge they will follow his instructions but declined to provide KHN with details, including how much the federal government is paying for the plan.
If Frank is satisfied, the change can take effect April 1. A decision in the lawsuit is expected this week.
Some New York officials are still skeptical. “I sure hope this plan is better for cheaper,” Eric Dinowitz, a city council member from the Bronx, said during a hearing on the plan. “It sounds like magic,” he quipped sarcastically.
