Hospitals this year are seeing more red than black as growing financial challenges, like spiked labor costs and inflation on medical supplies, puts them on pace to have the worst financial performance into the pandemic thus far.

More than half of hospitals (53% of more than 900 sampled) are projected to have negative margins by the end of the year, compared to 39% in 2019, according to a September report from management consulting firm Kaufman Hall, on behalf of the trade group American Hospital Association (AHA).

The firm put the median operating margin for hospitals at about -1%, which could mean service cuts, and for more vulnerable hospitals, including rural ones, closing their doors. But why is the financial outlook so bleak for hospitals? A few factors are conspiring:

Labor costs: The top reasons hospitals are struggling financially in 2022 are “labor, labor, and labor,” said Kevin Holloran, senior director at Fitch Ratings. The healthcare labor shortage doesn’t just extend to nurses, but across the board.

Rising supply prices: Blame inflation. AHA reported that the “costs for energy, resins, cotton, and most metals surged in excess of 30%” between fall 2020 and early 2022.

Sicker patients, longer stays: Intensive care units across the country were overwhelmed with Covid-19 patients at the outset of the pandemic, but more recently hospitals have been caring for sicker non-Covid patients, said Aaron Wesolowski, AHA’s vice president for policy research and analytics. Keep reading here.—MS

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Doctors that spread Covid-19-related misinformation (think: reckless and factually wrong) and disinformation (i.e., intentionally misleading) are facing increased scrutiny. Specifically, the question being raised is whether these doctors should be disciplined. Although nine out of 10 Americans polled think they should be, states have been all over the map with their responses.

• California became the first state to pass a bill that could lead to doctors having their license suspended or revoked for “spreading false or misleading medical information.”
• Georgia also adopted the Federation of State Medical Boards’ stance that physicians who spread Covid-19 misinformation or disinformation risk having their license suspended or revoked.

But more than 30 states, from Alaska to New Hampshire, have introduced bills that would shield practitioners who advise or prescribe “off-label” treatment for Covid-19 from disciplinary measures, according to the Federation of State Medical Boards.

The divide seems to reflect the long-established inconsistency in the way state medical boards discipline doctors for “serious” actions across the US, as documented by watchdog group Public Citizen.

Robert Oshel, adviser to Public Citizen’s Health Research Group, said rules for boards and their makeup—like how doctor-heavy boards are versus having more consumer representation—influence discipline for issues as serious as potential malpractice. Formerly with the National Practitioner Data Bank, which tracks such disciplinary actions, Oshel said doctors are less inclined to be sympathetic when the issue is behavioral—say, for spreading medical misinformation.

That doesn’t mean medical boards will be uniform in punishing physicians for this. However, especially in states where legislators are invoking free-speech protections, that could shield doctors from discipline.

“In all cases, the law says their primary duty is to protect the public,” Oshel said. “But how that’s actually done varies from state to state.”—MS

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Today’s top healthcare reads.

Stat: The median age of people who give birth reached 30 in 2019, up from 27 in 1990. (the New York Times)

Quote: “Parents are trying to take care of their own health while also taking care of the health of their family members. That, along with work and their own personal relationships, can make it even more difficult for parents to cope.”—Jeffrey Eisen, chief medical officer for behavioral health at Washington-based MultiCare, on the mental health burdens of parents in the pandemic (Crosscut)

Read: It is dangerous for teenagers to give birth, an outcome that is becoming more common in states that ban abortion and offer limited access to birth control; while they can get pregnant, their bodies are not yet developed for childbirth at that age. (Kaiser Health News)