From the start, Highmark Inc.'s plan to assemble an in-house provider network was viewed as audacious and financially risky. A successful integration of West Penn Allegheny Health System—the centerpiece of the under-construction provider network—would give insurers nationwide a new way forward as they dealt with health care costs that always seem to trend skyward. But if Highmark were to gamble and lose, a failed merger would be another reminder why these sorts of insurer-hospital shotgun marriages didn't work in the 1980s and 1990s, when big insurers began to disband managed-care networks, shed their physicians clinics and sell their hospital systems.
Kris Pyles-Sweet, a physician assistant at Battle Mountain General Hospital, guesses about one-in-five patients she sees receive help they might not otherwise have gotten thanks to Project ECHO, a University of Nevada School of Medicine program, which pairs rural care providers with specialists in Reno through video conferencing. It works like this: Rural care providers gather case reports on patients with similar problems. Then once every week or two, they go to a room at their hospital or clinic that has an online video connection that puts them in touch with other rural providers around the state having similar issues as well as a team of specialists in Reno. It allows treatment of maybe six to eight times more patients in the same amount of time as traditional telemedicine.
As health providers shift to more preventive measures to control costs, hospitals such as Abbott Northwestern in Minneapolis are focusing more of their patient marketing on their ability to use technology to see inside the body in greater detail than ever. But the push for more scans has only heightened the debate over whether they are necessary for many of the people who get them. At Abbott's Minneapolis Heart Institute, officials are quick to point to the early warning benefits for people considered at low to intermediate risk of heart disease, highlighting their service, called HeartScan, which measures calcium deposits in arteries around the heart. Still, the practice of selling scans to patients who could otherwise be healthy sparks plenty of criticism from some within the medical community.
Ninety-one people have been charged in seven cities in a series of arrests carried out by the Medicare Fraud Strike Force. The suspects are accused of participating in various fraud schemes involving more than $429 million in false billing. According to officials at the Department of Justice, the suspects allegedly billed Medicare for treatments that were improper or unnecessary. In some cases the government was billed for treatments that were not even provided. Doctors and nurses are among those arrested. Arrests were made in Houston, Dallas, Brooklyn, Baton Rouge, Chicago, Los Angeles and Miami. The largest crackdown occurred in South Florida where 33 people were rounded up and charged in connection with health care fraud cases totaling more than $230 million.
At least five people dead and 35 sickened with fungal meningitis that has been linked to steroid shots for back pain. These incidents involved medicines that had been custom-mixed at compounding pharmacies which supply hospitals, clinics and doctors. The risks from these products have long been known but are being amplified now by a national shortage of many drugs that has forced doctors to seek custom-made alternatives to the usual first-choice treatments. The steroid suspected in the current outbreak has been in short supply. "Because of the incredible number of drugs that are out of stock or back-ordered, compounding pharmacies are working with local hospitals, clinics and physicians to fill that gap," said David Miller, executive vice president of the International Academy of Compounding Pharmacists, a trade organization.
The parent corporation of two local hospitals is searching for a new financial partner after deciding it does not want to join forces with Tennessee-based Community Health Systems. On June 6, board members for Ohio Valley Health Services & Education Corporation—parent company of Ohio Valley Medical Center and East Ohio Regional Hospital—announced they were going through a "due diligence" process to determine whether to partner financially with CHS. The move would have resulted in the hospitals being partially or wholly owned by CHS. At the time, board members believed a final deal would be reached this fall, but said Thursday the negotiations had ceased.