Focusing on providers is key because healthcare expenses are so concentrated: High-cost cases account for the vast majority of the total. In those cases, the care provided is, as it should be, mainly the services and tests recommended by the provider. So if you do not influence provider recommendations in those cases, you cannot do all that much to improve the system. The evidence suggests, furthermore, that shifting away from paying for quantity and toward paying for quality affects what providers do in those high-cost cases. Although other quality- improvement measures can also influence provider behavior, the payment system is arguably the single most important determinant.
Even as many states gear up for tougher insurance regulations under the federal health law, Maine lawmakers last year bucked the trend, loosening rules they blamed for some of the highest premiums in the nation. Proponents promised lower rates for all Maine residents, with increased competition among insurers. But six months after the state's rules took effect, no new insurers have entered the state—and premiums have gone up for the vast majority of small businesses. The results have been mixed for individuals: Everyone under 40 saw rate cuts, while most people over 55 received increases, some as high as 18 percent, according to an analysis of state data released Tuesday by advocacy group Consumers for Affordable Health Care, which opposed the law changes.
Baptist Healthcare System Inc. has acquired a hospital in Richmond, Ky., and has rebranded its statewide health system as Baptist Health. The Louisville-based company announced Wednesday that it has added Pattie A. Clay Regional Medical Center in Richmond to its holdings. The company also owns and operates five other hospitals: Baptist Hospital East in Louisville, Baptist Hospital Northeast in La Grange, Central Baptist Hospital in Lexington, Baptist Regional Medical Center in Corbin and Western Baptist Hospital in Paducah. Together, the hospitals have more than 1,500 licensed beds.
New York Downtown Hospital will pony up $13.4 million to the feds and the state to settle a lawsuit alleging fraudulent Medicare and Medicaid programs. A joint investigation by the Brooklyn U.S. attorney's office and office of state Attorney General Eric Schneiderman found that New York Downtown conspired with an out-of-state vendor to operate a detox program at the hospital in lower Manhattan, and filed false reimbursement claims to Medicare and Medicaid for services. The vendor was not licensed to operate a detox program in New York. The hospital also paid the vendor a monthly fee for referrals to the program, which is illegal under a state anti-kickback law. The hospital will pay the feds $5.84 million and the state $7.56 million.
Nine months after scooping up 150 doctors from Beth Israel Deaconess Medical Center's physician group, fast-growing Steward Health Care System has lured away more than 110 other healthcare providers affiliated with the giant Partners HealthCare System. Hawthorn Medical Associates, the largest multi-specialty practice in the New Bedford area, disclosed Wednesday that it has signed a 10-year affiliation deal with Steward, a Boston-based chain of 11 hospitals and other medical care facilities across Eastern Massachusetts. The agreement takes effect Jan 1. At the end of this year, Hawthorn will let its 14-year affiliation with Partners Community Healthcare, the chain's physician network, expire.
Three hospital groups plan to form an alliance to be called Hudson Health Partners LLC, bringing six facilities in three Hudson Valley counties together to pursue collaborations. A formal announcement has been scheduled for Wednesday by the partners, which are Saint Francis Hospital and Health Centers in the Town of Poughkeepsie, St. Luke's Cornwall Hospital in Newburgh, and Bon Secours Charity Health System, based in Suffern, Rockland County.