Humana Inc. said Monday that its first-quarter profit fell 21 percent as the health insurer paid out more in claims and beefed up spending to handle expected growth in its lucrative Medicare Advantage membership. The company, based in Louisville, nudged up its earnings expectations for the full year to a range of $7.55 to $7.75 per share, up from its prior forecast of $7.50 to $7.70 per share. But the first-quarter results and the increased forecast were short of Wall Street expectations. In essence, Humana set aside more money in previous quarters than was needed to pay claims during a slowdown in the use of health care services by consumers who felt pinched during the recession.
Medical devices sustain and improve the quality of life for millions of Americans. But as the over $100 billion-a-year industry pushes thousands of devices to market every year, reports of faulty devices, repeat surgeries, and recalls have increased. The FDA and the industry maintain that a speedy approval process gives patients faster access to life-saving devices. But critics say that unlike drugs, a substantial number of risky devices are cleared without clinical testing, and receive almost no oversight once on the market. We've taken a closer look at four types of implantable medical devices that have drawn the most criticism.
After a patient died last year at a Veterans Affairs hospital in Manhattan, federal inspectors discovered nurses in his unit had a startling gap in their skills: They didn't understand how the monitors tracking vital signs worked. The incident followed two deaths in the cardiac monitoring unit at a VA hospital in Denver that raised similar questions about nurse competency. Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. Some nurses "did not demonstrate competency in one or more required skills," but there was no evidence of retraining, the report said.
The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows. Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops.
Banner Health hired Executive Health Resources to fight back against Medicare and UnitedHealthcare when they deny claims or pay bills for less than what Banner thinks it is owed. But Banner executives began to worry about EHR's independence when the firm was acquired in 2010 by UnitedHealth Group. As insurers eager to add revenue streams convert themselves into diversified health-services companies, they often buy traditional business adversaries, including physician groups and hospital consultants such as EHR. They're also buying technology companies and research firms that serve medical-care providers, raising questions not only about independence but about the privacy of patient information.
Baptist Health South Florida wants you to stay out of the hospital. It may seem illogical—a healthcare system actively working to keep patients from spending heavily for the hospital care. But that's exactly what Baptist's newest mission is all about, said longtime Baptist Health CEO Brian Keeley. The reason: Preventive medicine and primary care improve the public health of the community, cut healthcare costs and reduce hospital expenditures for nonpaying or uninsured patients. But with the aging baby boomer generation putting more pressure on healthcare, the shift to primary care and prevention is increasingly important for all healthcare systems, experts say.