Arizona Gov. Jan Brewer has built a political career in standing up to the federal government over everything from immigration to health care. So she surprised almost everyone when she announced last week that she not only plans to push for an expansion of the state's Medicaid program under the federal health care law—she plans to fund it by raising taxes.
The state Attorney General's Office is asking dozens of questions about the proposed sale of St. Mary's Hospital in Passaic to a California-based for-profit hospital company as part of the review required when charitable institutions are converted to for-profit status. State authorities want to know how Prime Healthcare Services, which operates 21 hospitals and wants to expand into the Northeast, came to bid on St. Mary's, and how the proposals submitted by Prime and other bidders were evaluated. "Why are the trustees willing to accept a commitment from [Prime Healthcare] to maintain the hospital as an acute-care facility for only five years?" asks one of the 50 questions.
A proposed settlement between ratepayers and Highmark, which would have set the stage for further litigation against UPMC, appeared to be in critical condition Friday as the plaintiffs motioned to cancel it, claiming they were misled. Attorneys for Royal Mile Co., Cole's Wexford Hotel and Pamela Lang—who in 2010 sued the region's biggest hospital system and biggest insurer, alleging price gouging—had been poised to settle with Highmark. The insurer had pledged $4.5 million to cover the plaintiffs' legal costs, a trove of documents they could use against UPMC, and two measures portrayed as spurs to competition. Those measures: Highmark would not give some medical providers higher reimbursements than others through 2014; and Highmark would guarantee to continue to offer its low-cost Community Blue product.
Remember how Obamacare was going to "Bend the cost curve" for health care spending? That was OMB director Peter Orszag, back when Obamacare was being debated. There were a number of theories about how it would accomplish this. There were electronic medical records, which would cut down paperwork and medical errors. And ACOs, which would finally bring America to the promised land of "bundled payments", which was supposed to radically change treatment incentives. Medicare pilot projects were going to open up new, more efficient ways to do things. If all those failed, the legislation contained an Independent Payment Advisory Board which will recommend a panel of automatic cuts unless health care cost inflation stays below a fairly low target level.
When a big hospital chain buys an independent doctor's office, we often hear the move will "enhance care," "integrate care" or "improve health-care efficiency." Spare us the euphemisms. Patients are the losers in these deals. We pay higher costs. We get fewer choices because doctors are pressured to refer patients only to providers who also work for the hospital. And, because these acquisitions are so common today, an independent doctor's office is becoming as quaint as the house call.
Some emergency room doctors in the Denver area are restricting the types and amounts of addictive painkillers they administer, citing a nationwide increase in overdose deaths. Denver Health' emergency room will stop filling long-term prescriptions for such painkillers as Percocet, OxyContin and Vicodin, the Denver Post reported Saturday. The hospital will also try to limit prescriptions for acute-care painkillers to small amounts to last only until patients can contact their regular physicians. University of Colorado Health is writing policies that would end the practice of filling prescriptions that patients claim were lost or stolen.