When it comes to financial losses, hospitals largely control their own fortunes. On paper, uncompensated care is the hallmark of a hospital's charitable nature. It's the foundation of nonprofit hospitals' tax-exempt status and a badge of honor that hospitals, regardless of whether they belong to for-profit companies, tout as a measure of benevolence to the communities they serve. But charity can also be the gateway to tangible financial benefits for hospitals. Nationally, and in New Mexico, where analysis of hospital pricing data from the federal Centers for Medicare and Medicaid Services showed markups on health care sometimes exceeding 800 percent of the government-prescribed rates, pricing has a direct correlation to how charitable hospitals appear on paper.
A major architect of ObamaCare is coming under fire for a video where he seems to support the notion the law was worded to push states to create their own health exchanges. In a 2012 Youtube video that gained attention Friday, Jonathan Gruber, a Massachusetts Institute of Technology professor, is heard telling an audience the Federal government was refraining from helping states that have not built their own health exchanges to politically pressure them to do so. Gruber was a major architect of Massachusetts RomneyCare and advised the Obama administration in 2009 in developing the Affordable Care Act.
When Johns Hopkins Hospital agreed this week to a $190 million settlement with thousands of patients who were secretly photographed during gynecological exams, it put a number of prominent East Coast medical institutions on the hook. Hopkins joined with hospitals and schools affiliated with Yale, Cornell and Columbia universities and the University of Rochester years ago to create a pair of insurance companies to save money and pool risk, but they now face one of the largest claim settlements of its kind. Hopkins has said little about the settlement with patients of Dr. Nikita Levy, who worked in a Hopkins clinic in East Baltimore, and how it will be paid, aside from saying it would be covered by insurance and the hospital's quality of care wouldn't be affected.
Sanford Health paid the federal government $625,000 earlier this year to settle a whistle-blower lawsuit which claimed two Sioux Falls doctors engaged in a kickback scheme to encourage use of a spinal implant. The "Anterior Lumbar Interbody Fusion" was developed by Dr. Wilson Asfora. It was hailed by Sanford as a major development in the treatment of spinal conditions when it was approved for use by the FDA in 2009. The device also is known as the Asfora Bullet Cage. It's difficult to pinpoint just how many patients have been treated with the bullet cage, but Medicare data obtained and analyzed by Argus Leader Media shows that Asfora and Dr. Bryan Wellman are among the most aggressive in the state in performing spinal fusion surgeries.
Mercy Health has adopted a new compensation model for physicians, but some doctors are unwilling to sign the new contracts. Mercy executives report the new pay structure is an effort to standardize compensation for all 2,100 Mercy-employed physicians across the system's four-state operation, including Missouri. But the model also addresses the changes occurring in the health care industry, system officials report. "In this challenging environment we felt a need to look at the compensation model," Donn Sorensen, a regional president at Mercy, said. But some doctors are balking at the changes, saying the new contracts are too restrictive or that pay is based on the quantity of work performed.
Guy Goodness of Fort Edward keeps his diabetes in check with monitoring and coaching from Jessica Casey, a care manager he sees every two weeks. Patients scheduled to get hip replacements at Glens Falls Hospital must attend a pre-operation class, where they learn about the procedure, recovery and post-surgical therapy. At Moreau Family Health Center, doctors, nurse practitioners and care managers start the day huddled over data to share perspectives on patients who have appointments. These are scenes from the emerging American health system, where increasingly more time is spent on coordination, prevention and education, and less on expensive tests and hospital stays.