Evercare's health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers, according to this account.
A proposal by Atlanta-based Grady Memorial Hospital to increase medical costs to some uninsured patients has alarmed advocates who say people will avoid care, become sicker, and perhaps even die. Grady officials have stressed that the proposal is still in the discussion phase, but acknowledged it could cut off some people from free care. Some of those people receiving free care have been abusing the system, and others have the finances to pay at least part of their bill, said Grady CEO Michael Young.
The Centers for Medicare & Medicaid Services has ordered Citrus Health Care Inc. to suspend enrollment of and marketing to Medicare beneficiaries. The suspensions were effective Jan. 1, according to a letter from CMS to Citrus, a health management organization headquartered in Tampa, FL. The sanctions were based on Citrus' failures in two audits conducted in September, the letter said.
The disease management-inspired Medicare Health Support project did not save money or improve patient behavior and self-management, according to CMS' second report on the program, which was released just before the new year. In its report to Congress, CMS' evaluator reviewed the first 18 months of the project, which ended last year because CMS was disappointed with the DM programs' results.
Linda Quick, the president of the South Florida Hospital and Healthcare Association, warns that groups she represents are not recession-proof, and that could be very bad for everyone.
A former nurse manager is locked in a high-profile legal battle with the Peoria, IL-based Proctor Hospital. A trial is set for this year after the 7th Circuit of the U.S. Court of Appeals in Chicago reversed a lower court's decision to dismiss the case. Phyliss Dewitt, whose employment record was spotless, claims the hospital fired her because of her husband's high medical expenses. Experts say more conflicts of this kind are likely as economically stressed employers confront escalating healthcare costs and the reality that a small number of sick employees or family members account for the vast majority of medical expenses.