Weekend Longforms: Hospital mortality, autism clinic costs, Ebola and skinny health plans

May 29, 2026

I have published Weekend Longforms and an animal photo on Saturday in the past. This week, I’m sending this out on Friday in anticipation of the weekend opportunity to read (or listen to) longer articles. Hope when it comes your weekend is wonderful.

A. Are hospital mortality improvements real, or just a coding trick?

Massachusetts General Hospital and Brigham and Women’s Hospital, both consistently ranked among the nation’s top medical centers, have been touting improvements in observed vs. expected mortality. Their administration has been touting improvements in their observed-to-expected mortality ratio (a standard benchmark comparing actual patient deaths to statistically predicted ones). The Boston Globe’s Jessica Bartlett reported that physicians, speaking anonymously, attributed most of the apparent improvement to bookkeeping.

The article suggests that apparent improvements in mortality might be due to coding patients as sicker than before (which increases expected mortality) and making more referrals to hospice (since hospice patients are not included in calculations of mortality). Vizient, the analytics firm that supplies hospitals with quality benchmarking data, explicitly advises clients that more intensive diagnosis coding and increased hospice referrals can improve their observed-to-expected mortality ratios.

Hospice care can be enormously valuable to patients at the end of life and their families, but many terminally ill patients are referred to hospice too late. Increasing timely hospice referral can genuinely improve patient care regardless of impact on reported mortality.

Employers are increasingly looking at quality data to construct narrow networks or incentives to use high value providers. This report shows that quality data remains sensitive to provider billing practices.

B. How autism clinics squeeze dollars from Medicaid

Sarah Kliff and Margot Sanger-Katz of the New York Times report that autism clinics — many backed by private equity — are marketing themselves to families as providers of free child care while billing state Medicaid programs for intensive therapy sessions at rates that generate substantial profits.

Federal mental health parity law (MHPAEA) prohibits states from imposing stricter utilization controls on mental health treatment, such as prior authorization or visit limits, than they apply to physical health care. That constraint makes it legally difficult for Medicaid programs to limit how many therapy hours these clinics can bill.

Profit motives shape every aspect of how these clinics operate. Some employ their own psychologists to make the diagnoses that then generate referrals to their own therapy programs, a direct conflict of interest. Staff reportedly also restrict children’s naps to keep them awake and billable for more hours.

These clinics almost certainly bill commercial insurers as well, extending the same high-margin model beyond Medicaid. Employers should expect their medical carriers to carefully credential autism treatment centers and monitor utilization.

C. The world prepared for ebola. Just not this Ebola

Jason Gale of Bloomberg (gift link valid until Monday June 1) reports that efforts to develop vaccines and monoclonal antibodies for potential Ebola outbreaks focused on other strains that have caused large outbreaks. The current Ebola outbreak in Congo and Uganda is the bundibugyo virus, which in the past has only caused small clusters of disease.

D. Non-ACA plans have lower premiums, but limited coverage

Sara Kwon of KFF Health News reports on people who left plans that were compliant with the Affordable Care Act due to big premium increases. Some chose hospital indemnity plans, which pay $2,000 per hospitalization, while hospitalization costs averaged $30,000 in 2022. Others chose health sharing ministries, which are not insurance and are not obligated to pay for medical care. For more on this topic, see this February post, Health plans that are too good to be true.

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Views expressed in Employer Coverage are purely my own.

Animal photo:

Gallinule in Wakadohatchee Wetlands, Delray Beach, FL, December, 2024