Lee Domanico has made a career pulling hospitals back from the brink of financial ruin.
Domanico's most recent venture took him just north of San Francisco, to Marin General Hospital in Greenbrae, California, which recently changed its name to MarinHealth Medical Center, where he says there's great promise for the independent hospital to thrive without being tethered to a larger health system.
That being said, achieving and sustaining success as an independent hospital won't work just anywhere, he says. There are three intrinsic traits that such institutions need to succeed.
1. Geographic Advantage
"You need to have the benefit of geography and location, meaning that hopefully your geography creates some barriers to entry," Domanico says. "Related to that, you need to be a relevant hospital in the marketplace. You have to be relevant, or you have to make yourself relevant to the payer community, for sure."
MarinHealth Medical Center has this geographic edge because there's the Golden Gate Bridge to its South, the bay to its East, the Pacific Ocean to its West, and Wine Country to the North, Domanico says.
2. Secondary Revenue Source
"You need an alternative source of revenue or capital," Domanico says. "In our case, it's the tax base because we are a district hospital."
The organization raised $400 million to begin building a new hospital. Another independent institution could root its alternative financial reserves in an endowment or another significant philanthropic opportunity, for example, Domanico says.
"I think the biggest struggle for independent hospitals is amassing enough capital and debt capacity, given the capital-intensive nature of hospitals, particularly in California with the seismic retrofit mandates," he adds.
3. Partnership Mindset
The idea of being independent might seem to suggest a hospital is going it alone, but Domanico says independence from a health system opens doors to collaborative opportunities with a greater diversity of potential partners.
"You absolutely have to have a partnership-oriented hospital and medical staff," he says. "You need a medical staff that doesn't split their patients and their referrals, and you need a medical staff that wants to partner with the hospital, particularly in the ambulatory care space, so you're collaborating on serving the market in a service area rather than competing."
The president and CEO says this new leadership structure will help the system innovate and become more efficient in the face of a shifting healthcare landscape.
Catholic Health, based in Buffalo, New York, has dramatically restructured its senior leadership team.
President and CEO Mark Sullivan announced what the organization described as a "major reorganization" this week, about a year and a half after he was named to the system's top executive job.
"Change is happening all around us in healthcare and rather than react to the pressures of our industry, we must lead change in the region to sustain our mission and meet the needs of the patients and communities we serve," Sullivan said in a statement. "This new leadership structure will build on the high quality care that already exists within our system and drive development, innovation and efficiencies that will have an even greater impact on the health of our community."
The team will spend the next several months transitioning into their new roles, Sullivan said.
"We are all excited about the opportunities before us to lead the transformation of healthcare in our community, but we also know how important smooth transitions are," he added, "not only for our physician partners and associates, but more importantly, for the patients and long term care residents we serve."
Here are seven significant changes outlined in Sullivan's announcement:
Joyce Markiewicz, who had served as president and CEO of Home and Community Based Care, has been named Chief Business Development Officer for Catholic Health. Sullivan called Markiewicz "the ideal person" for the job, citing her experience developing strategic partnerships and new business initiatives.
Tom Gleason, who has served as chief operating officer for Home and Community Based Care, has been promoted to senior vice president of Home and Community Based Care, in light of Markiewicz's expanded role. Gleason will oversee Catholic Health's skilled nursing facilities and home care agencies, according to the announcement.
Gary Trucker, president and CEO of Mount St. Mary's Hospital, will retire this fall.
Marty Boryszak, former president and CEO of Sisters of Charity Hospital, has been named senior vice president of acute care services at Catholic Health. In light of Tucker's retirement, Sullivan decided to restructure Catholic Health's hospital presidents, who will report to Boryszak.
CJ Urlaub, former president and CEO of Mercy Hospital of Buffalo, has been named senior vice president of strategic partnerships, integration, and care delivery in Niagara County for Catholic Health. As part of these responsibilties, he will assume the role as president of Mount St. Mary's Hospital when Tucker retires.
Eddie Bratko, who had been chief operating officer of Mercy Hospital of Buffalo, has been named president of Mercy Hospital.
John Sperrazza, who had been chief operating officer of Sisters of Charity Hospital, has been named president of the hospital and its St. Joseph campus.
Walt Ludwig, who was named president and CEO of Kenmore Mercy Hospital just last year, will keep his position, according to the announcement.
The overhaul comes after two recent high-level hires. William Pryor was named Catholic Health's new chief administrative officer, and Dr. Hans Cassagnol was named chief clinical officer and physician executive. And it comes as Catholic Health is currently conducting a national search for a chief operating officer and chief transformation & innovation officer, according to the announcement.
"How healthcare is delivered in the future will be different than it is today and our executive team must be reflective and responsive to these changes," Sullivan said. "With the new talent we are recruiting to the region and the experienced leaders we have assuming new roles within our system, I am confident we have the right team in place to fulfill our Mission and drive change where it is needed to better serve the community and build upon our success as the quality, safety and patient satisfaction leader in Western New York."
The organizations expect their combined strengths will enable them to improve affordability, increase access, improve quality, and streamline the customer experience.
Two major nonprofit health plan companies in New England are looking to join forces.
Harvard Pilgrim Health Care and Tufts Health Plan announced Wednesday that they intend to combine their two nonprofit organizations.
"Our communities and consumers today face four major hurdles in health care: affordability, access, quality of health and a fragmented health care experience across various stakeholders and health systems," said Tufts Health Plan President and CEO Tom Croswell in a statement. "Through our shared vision, we believe we can tackle these issues and bring more value to the communities we serve."
Croswell is expected to serve as CEO of the combined organization, while Harvard Pilgrim Health Care President and CEO Michael Carson serves as president, overseeing the combined business lines and subsidiary, according to the announcement.
Joyce Murphy, board chair for Harvard Pilgrim Health Care, is expected to chair the combined board of directors, which will have equal representation from each legacy organization.
"Through the combination of two strong organizations with a commitment to non-profit health care in New England, we will be able to provide even greater value to consumers, as well as improve access to care throughout the region," Murphy said in the statement.
The two organizations said they expect their combined strengths will enable them to improve affordability "through scale and administrative cost efficiencies," increase healthcare access, improve healthcare quality, and streamline the customer experience.
The combined organization, which has yet to be named, would serve nearly 2.4 million plan members in Maine, New Hampshire, Massachusetts, Connecticuit, and Rhode Island.
Both boards approved the agreement, but the organizations will remain separate pending regulatory approvals, according to the announcement.
The company, led by Michael Neidorff, has expressed confidence in its business strategy despite uncertainty over the ACA's future.
Centene Corp. said Tuesday that it aims to expand the health plans it offers on the Affordable Care Act exchanges in 10 states in 2020.
The move reflects the company's confidence in the future of the markets created by the Obama-era legislation, despite ongoing attempts by the Trump administration to have the law invalidated in its entirety.
Michael F. Neidorff, Centene's chairman, president, and CEO, said his company is proud of its status as the largest provider of ACA exchange health plans and will adapt to meet market demands.
"The need for affordable, high-quality healthcare has never been more urgent, and we will continue to demonstrate disciplined execution, agility and capacity to successfully navigate industry changes to the benefit of our members, customers and shareholders," Neidorff said in a statement Tuesday.
Centene said it served about 1.9 million exchange members across 20 states, as of June 30. The markets in which it plans to expand, pending regulatory approval, are Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas, and Washington.
The announcement comes after Centene posted second-quarter adjusted earnings per share of $1.34 this year, up 49% from a year prior. It comes also as Centene looks to finalize its planned acquisition of one of its major competitors, WellCare Health Plans, in a proposed deal that some industry stakeholders warn could undermine competition.
Reports released by CMS show that the number of people paying full-price for their individual health insurance market is declining.
Enrollment in the individual health insurance market continued to decline last year, especially among those who pay full price for their coverage, according to a report released Monday by the Centers for Medicare & Medicaid Services.
After average monthly enrollment in the individual market rose 7% from 2015 to 2016, it fell 10% in 2017 and another 7% in 2018, according to the CMS report. Unsubsidized beneficiaries accounted for 85% of the enrollment decline in 2017 and all of the enrollment decline in 2018, which was offset by a small increase in subsidized enrollment, the report states.
While some states saw unsubsidized enrollment drop by less than 1%, others saw more dramatic changes, including six states where unsubsidized enrollment declined by more than 70% between 2016 and 2018, according to the report. Nationwide, unsubsidized enrollment dropped by 40%, or 2.5 million people, during that period.
CMS Administrator Seema Verma said the numbers demonstrate what the Trump administration has been saying all along: that the Affordable Care Act has been an utter disaster.
"As President Trump predicted, people are fleeing the individual market," Verma said in a statement. "Obamacare is failing the American people, and the ongoing exodus of the unsubsidized population from the market proves that Obamacare's sky-high premiums are unaffordable."
The CMS statement notes that unsubsidized enrollment declines coincided with average monthly premium increases of 21% in 2017 and 26% in 2018.
Despite concerns over affordability, Cynthia Cox, a vice president at the Kaiser Family Foundation, reportedly said she isn't terribly concerned about the individual market's stability, as long as the current law remains in place.
"Even in the absence of the individual mandate penalty, the ACA subsidies have helped keep enrollment higher than it was before the ACA," Cox told Politico's Dan Diamond.
In addition to the report on trends in subsidized and unsubsidized enrollment through 2018, CMS released an early report Monday on effectuated enrollment for 2019. It shows that 10.6 million consumers had effectuated coverage through the ACA exchanges as of March 15, meaning they selected a plan, paid their first month's premium (if applicable), and had coverage in February. This year's number is less than a percent lower than the effectuated enrollment CMS reported last year.
The healthcare entities associated with Michigan State University will adopt policies requiring a healthcare professional to serve as a chaperone during sensitive medical exams, under a voluntary agreement reached with HHS OCR officials.
Healthcare providers affiliated with Michigan State University—including the medical practice MSU HealthTeam and the separate nonprofit MSU Health Care—will be required to make chaperones available for sensitive medical exams as part of a voluntary agreement with the Health and Human Services Officer for Civil Rights announced Monday.
The agreement comes after Larry Nassar, DO, who had been employed by MSU, used his position of trust to sexually abuse hundreds of young women and girls, including many Olympic gymnasts, over two decades. The agreement resolves a civil rights investigation that stemmed from the revelation of Nassar's long-running abuse.
"While Nassar and the dean who oversaw him have been rightly convicted of crimes, the institutional reforms that MSU has agreed to undertake will help ensure that no patient is ever victimized like this again," HHS OCR Director Roger Severino said in a statement.
The agreement stipulates that MSU HealthTeam's chaperone policy will direct staff to always honor a patient's request to have a support person, such as a parent, relative, or friend, present during sensitive exams or other treatment. In addition to allowing support persons, staff must provide an authorized healthcare team member to serve as a chaperone for all sensitive examinations of patients at least 10 years old, according to the agreement. The staff "shall accommodate, to the extent practicable, the Patient's request for a same-sex chaperone," the document states.
The resolution agreement also includes commitments that the MSU entities will do the following, according to the HHS OCR announcement:
Revise their nondiscrimination notices and sexual misconduct policies to clarify the sex discrimination prohibitions in Title IX and Section 1557 of the Affordable Care Act;
Improve processes for investigating and resolving sex discrimination complaints;
Designate a responsible official to coordinate acceptance, investigation, and resolution of such complaints; and
Conduct all-staff training, with biannual reports to HHS OCR, during the agreement's three-year term.
The announcement also comes a day before the deadline to comment on HHS OCR's controversial proposed rule reinterpreting the definition of sex discrimination in Section 1557 in a way that excludes gender identity from the list of protected categories, effectively reducing protections for transgender patients. The online commenting portal indicates that more than 115,300 comments had been received as of Sunday night. None of those comments have been published by HHS OCR.
The resulting hybrid network will include more than 68,000 healthcare providers, more than twice as many as had been in the state's plan alone.
More than 720,000 public school teachers and other state employees in North Carolina will have access to a broad network of healthcare providers in 2020 after Treasurer Dale Folwell agreed to compromise on his proposal to set reimbursement rates for the state's health plan at about double Medicare rates.
Only five health systems had signed onto the plan early last week, adding to concerns that beneficiaries might be stuck with a severely restricted network. But those concerns melted Thursday, when Folwell announced a change that would allow several other major providers to remain in-network, as The Charlotte Observer's Hannah Smoot reported.
In addition to the systems that had signed onto Folwell's proposal, the state will allow health systems to keep their existing agreements with Blue Cross Blue Shield of North Carolina. That means major systems that had resisted the proposal, including Atrium Health, Novant Health, Duke Health, and UNC Health, could continue to serve beneficiaries of the public health plan, as the Observer reported.
Whereas the state's plan alone would have included about 28,000 providers, the hybrid network will reportedly include more than 68,000 providers.
A health system spokesperson said the two departed for purely personal reasons.
Two senior leaders at Beaumont Health are resigning this month, as the Southfield, Michigan–based health system executes a workforce realignment initiative and a growth strategy across state lines.
Christine Stesney-Ridenour, MBA, FACHE, who has been with the organization for 35 years and has been president of the system's Taylor, Trenton, and Wayne acute care campuses since January, resigned effective August 14, a Beaumont Health spokesperson confirmed to HealthLeaders on Friday.
Chris Harrison, CPA, who was named senior vice president of financial operations and corporate finance in March 2018, was effective Friday, according to the spokesperson, who said both executives resigned for purely personal reasons.
Practice Fusion, which is now known as Veradigm, had been under investigation for nearly a year when Allscripts acquired it in March 2018.
Allscripts and the U.S. Department of Justice have reached an agreement in principle to end civil and criminal investigations involving subsidiary Practice Fusion, the company announced Thursday.
Allscripts said in a press release with its latest financial reports that it has accounted for a second-quarter charge of $145 million that it believes will be enough to cover all potential civil and criminal liability under the deal, which hasn't been finalized.
"We expect that a final settlement with the DOJ, if it were to be completed, would include other material non-financial terms and conditions, including a deferred prosecution agreement and a civil settlement agreement," Allscripts said in a filing with the Securities and Exchange Commission on Friday, adding that there are still multiple material issues to be hammered out during negotiations.
Practice Fusion, which now goes by the name Veradigm, is an electronic health records company that has been subject to investigations regarding its certification through the Health and Human Services Electronic Health Record Incentive Program and its compliance with the Anti-Kickback Statute and HIPAA, as Allscripts revealed in an SEC filing last May.
Below is a timeline of key dates in the investigation, as outlined in Allscripts' latest SEC filing:
March 2017: Practice Fusion received a request for documents and information from the U.S. Attorney's Office for the District of Vermont, pursuant to a civil investigative demand (CID).
February 2018: Allscripts acquired Practice Fusion.
April 2018 to June 2019: Practice Fusion received from the DOJ seven more requests for documents and information through four more CIDs and three HIPAA subpoenas.
March 2019: Practice Fusion received a grand jury subpoena related to a criminal investigation into its compliance with the Anti-Kickback Statute.
August 6, 2019: Allscripts reached an agreement to resolve all of the DOJ's outstanding civil and criminal investigations, including the one in Vermont.
If the settlement isn't finalized, the DOJ will likely bring one or more enforcement actions against the subsidiary, which could result in substantial fines and penalties or other sanctions, Allscripts said. There's also concern that other investigations or proceedings, including those brought by private parties, could follow this DOJ settlement, the company noted.
"We may also be subject to negative publicity related to these matters that could harm our reputation, reduce demand for our solutions and services, result in employee attrition and negatively impact our stock price," Allscripts said.
Providers with higher-level skills in their staffing mix aren't necessarily more productive than those that rely exclusively on medical assistants.
The optimal staffing model for a primary care clinic that remains focused on fee-for-service reimbursement differs from the optimal setup in a value-based context, according to a Premier white paper published Thursday.
That suggests clinics will have to reevaluate and tweak the composition of their clinical care teams as they explore the possibility of taking on more risk for the patient populations they serve—a balancing act that the industry's forward-thinking executives have already undertaken.
Twenty-two percent of family medicine clinics use a staffing model that relies exclusively on medical assistants (MA), according to the white paper, which studied 257 family medicine and primary care practices with more than 885 providers and 1,445 staff members. Fifty-four percent of the clinics were staffed with a combination of MAs and either registered nurses (RN) or licensed practical nurses (LPN), while another 24% were staffed with MAs, RNs, and LPNs, according to the Premier report.
Providers with a higher skill mix among their staff members didn't necessarily exhibit higher levels of productivity, as measured in work relative value units (wRVUs). The most productive clinics often had higher numbers of support staff per provider, according to the report.
"Higher skill mix models that are not using their staff to better coordinate and manage care may be contributing to a higher cost of care," Premier Vice President of Physician Enterprise Services Chris Smedley said in a statement. "As the industry moves toward value, participating in risk-based models will become a more viable option for many to ensure financial success. Providers will need to layer on staff with more specialized skill sets in order to more proactively address patient needs in value-based models."
"The key," Smedley added, "is to appropriately evolve staffing models as organizations shift to managing the health of their populations."
What this means is physician practices should invest intentionally in staffing models that will directly support the practice's shift from volume to value, according to Premier's report. A model that relies exclusively on MAs may make the most sense for fee-for-service providers. Those moving "further along the value chain," however, will likely need a higher skill mix.
"Value-based arrangements are more challenging and require very specific clinical, technical and administrative capabilities," the report states. "For example, pharmacist support, behavioral health providers, nutritionists and social workers are key to supporting community services. Moreover, patient education, care planning and coordination of care for the highly complex or vulnerable populations will further improve efficiency and effectiveness in a value-based payment model."
"The challenge," the report adds, "is determining the readiness for building the right value-based model that can successfully assume and manage greater levels of risk."