A group of Temple University doctors is notifying patients that it has reached an impasse in contract negotiations with Keystone Mercy Health Plan. The contract with Temple University Physicians expires Aug. 31, and "based on the expiration of these contracts, TUP can no longer provide primary care, specialty care or hospital outpatient testing at Temple University Health System facilities for patients covered by Keystone Mercy," the university said in a release. Temple University Physicians consists of faculty members from Temple's School of Medicine, and they provide most of the care at Temple University Health System hospitals.
A federal judge in New Jersey has approved a $255 million settlement to resolve a case that alleged Health Net Inc. has used an inadequate and unfair system of reimbursing claims of members who got care outside the insurer's network. In the settlement of three class-action lawsuits, Health Net will pay $215 million to patients who received low reimbursement for out-of-network claims. Plaintiffs in the class-action case received out-of-network care and then wound up paying more than they should have because Health Net used an "invalid" database provided by Ingenix to determine the reimbursement, said plaintiffs' attorney Barry Epstein.
Patients with autism, eating disorders, substance abuse problems, or post-traumatic stress disorder would have greater access to treatments under proposed legislation that passed in the Massachusetts Senate. The measure differs from a broader "mental health parity" bill that has passed in the House, which would require insurance plans to cover all mental health disorders the same as physical conditions and would allow any treatments medically needed.
Massachusetts has temporarily suspended the medical license of a plastic surgeon who allegedly performed two operations at Beth Israel Deaconess Medical Center while impaired and appeared to fall asleep during a patient's liposuction. The hospital fired Loren J. Borud, MD, after he was allowed to practice for six years while struggling with substance abuse problems. Borud had previously entered a monitoring agreement with Physician Health Services, a rehabilitation program run by the Massachusetts Medical Society. Kenneth Sands, MD, senior vice president of healthcare quality at Beth Israel, said Physician Health Services has a good reputation for helping doctors recover from addiction and closely monitors them after they return to work to make sure they do not drink or take drugs.
An investigative committee established by the joint boards of the Shriners of North America fraternal organization and the Shriners Hospitals for Children brings to light problems with the national organization, which runs a network of 22 hospitals that provide free orthopedic and burn care to needy children. The report found that the chairman of the Shriners Hospitals Board of Trustees Ralph Semb sought to dismiss a fund-raising executive who had refused to hire a direct-mail company Semb and another board member tried to steer him to. Semb was re-elected chairman of the board of the hospitals in June at the annual Shrine convention in St. Louis.
The House Energy and Commerce Committee has unanimously approved a health IT bill and sent it to the full House for action. The committee leaders who sponsored the Protecting Records, Optimizing Treatment and Easing Communication Through Healthcare Technology Act of 2008 made significant concessions to privacy advocates and to those who use health information. The PRO(TECH)T Act aims to promote e-health records for all Americans by 2014, as the Bush Administration called for in 2004. It also establishes in law the technology standards activities that the Bush administration developed and would provide $560 million in grants and loans for healthcare providers to acquire EHR systems.