In response to the New York Times story, officials at the Nashville-based HCA said that experts often disagree on when a patient should get a stent. They also noted that their hospitals are performing fewer of the procedures than in years past. But insurance billing records indicate the procedures continue to be popular with Florida's for-profit hospitals and particularly HCA. State data show that for-profit hospitals as a group do nearly 50 percent more catheterizations and one-third more angioplasties than nonprofit hospitals on a per-bed basis. HCA, which accounts for about half the state's for-profit hospitals reporting invasive cardiac procedures, performed them at even higher rates than their peers.
The state Department of Health and Human Services is not backing down from its recommendation to test additional Exeter Hospital employees for hepatitis C, despite the hospital's initial refusal to comply. On Friday, state health officials expressed hope the issue can be resolved amicably, but stressed they would do whatever is needed to fulfill their obligation to conduct a complete investigation. N.H. Associate Attorney General Anne Edwards said legal action is always an option, but she wouldn't say if it's currently being considered.
The fraud squads that look for scams in the federal Medicare and Medicaid programs have some new weapons: tools and funding provided by the Affordable Care Act. The federal health law and other legislation directed the federal government to start using sophisticated anti-fraud computer systems. Peter Budetti, who oversees anti-fraud efforts at the Centers for Medicare and Medicaid Services, said the systems, which are being used first with Medicare, are similar to those used by credit card companies to detect suspicious purchases. The computer program crawls around the heaps of Medicare claims—some 4 million a day—to look for outliers. And for the first time, doctors and others who want to bill Medicare are being assessed based on their risk to commit fraud. Those who seem crooked are kept out.
Accountable care organizations are a major component of health reform, but only 13 percent of hospitals are participating in one or plan to do so in the next year, according to a new report. In Greater Cincinnati, only Mercy Health has formed an ACO. The region's other major hospital systems are taking a wait-and-see approach, fearful that the arrangement won't be financially viable. The new data comes from a survey of 1,700 hospitals by the New York-based Commonwealth Fund.
Hospitals throughout Florida are challenging a state rule that limits payments to treat undocumented immigrants. The hospitals say the Agency for Health Care Administration made the rule without following the proper procedures and unfairly wants them to reimburse the state for some of the Medicaid payments used to treat immigrants who are in the United States illegally. At issue is a technical dispute over how much Medicaid pays for emergency services and when an emergency patient turns into a "stable" patient still in need of care. AHCA's position is that Medicaid covers emergency care for undocumented patients, but not the ongoing treatment needed to keep the patient stable.
Steward Health Care System LLC, which has amassed a chain of 10 community hospitals in Massachusetts, signed a letter of intent to buy financially struggling Mercy Health System of Maine from a Catholic hospital group. The letter, which does not spell out financial terms, gives Boston-based Steward exclusive rights to negotiate with Mercy’s owner, Catholic Hospital East, a Pennsylvania-based network of 35 hospitals and other healthcare facilities operating in 11 states from Maine to Florida. If the talks succeed, the parties would reach an asset purchase agreement converting 140-bed Mercy from a nonprofit to investor-owned. The deal would be subject to approval by Maine regulators as well as Vatican officials.