Michigan's Henry Ford Health System seemed like the perfect candidate for the most ambitious Obama administration effort to change the way Medicare pays hospitals. So it puzzled observers when it withdrew its application last month from a program that puts it on the fast track to becoming a Medicare accountable care organization, which would reward hospitals for delivering high-quality care at lower cost. The reasons Henry Ford dropped out from the administration's Pioneer program reflect the challenges facing hospitals that are choosing between multiplying payment reform initiatives. In short, it had better options -- or, at least, more predictable ones -- than the ACO program. It's widely agreed that the fee-for-service model that Medicare has long used to pay providers is not sustainable because it drives up health spending. But two things are making it hard for hospitals to move forward: the uncertainty about which new payment experiments are going to pan out and the unpredictable rollout of federal initiatives.
Major health insurance companies seeking steep premium increases in New York have submitted memos to state officials to justify the higher rates. Now they are fighting to keep the memos from the public, saying they include trade secrets that competitors could use against them. "How these companies are setting these rates is vital for the public to know, and should not be treated like a state secret," Benjamin M. Lawsky, the state superintendent of financial services, said on Tuesday. "Transparency will promote healthy competition and enable the public to rigorously comment on proposed rates, two goals that all of us should favor." Lawsky, whose new agency oversees the state insurance division, has ordered that the memos be made public. His decision, which will go into effect by the end of November unless the companies obtain a court injunction, ends a longstanding policy that exempted the insurance companies from public access under a "trade secret" exception.
Sen. Charles E. Grassley (R-IA) has asked Mary K. Wakefield, PhD, RN, administrator of the Health Research and Services Administration to schedule an in-depth briefing on the issues surrounding the decision to shut down public access to the National Practitioner Data Bank's Public Use File. In a letter dated Oct. 7, Grassley sent a letter about the matter stating that the NPDB PUF serves as the backbone for providing transparency for "bad acting healthcare practitioners." However, in light of one Kansas City Star reporter shining on their abilities to identify a physician's databank record by comparing de-identified information with state court records, HRSA wrote the reporter Aug. 26, "threatening monetary penalities for 'republication of information obtained from the NPDB.'" Wrote Grassley: "It seems disturbing and bizarre that HRSA would attempt to chill a reporter's First Amendment activity with threats of fines for merely 'republishing' public information from one source and connecting it with public information from another..."
Blue Cross Blue Shield of Massachusetts has decided to remain a nonprofit public charity after examining whether it should seek a different legal status given its extensive business operations as the state's largest health insurer. The inquiry was spurred by outrage over Blue Cross's $11 million payout to its former chief executive, Cleve L. Killingsworth, and the five-figure annual fees paid to members of its board of directors. The controversy raised the question of whether an organization that rivals some of the state's biggest companies in revenues should be considered a public charity.Blue Cross chief executive Andrew Dreyfus and other executives consulted with about 50 community leaders between May and June about the Blue Cross "identity crisis.'' They ultimately concluded that they would not pursue a change. Before the consultations began, the Blue Cross board indefinitely suspended compensation for directors, and there are no plans to reinstate the pay.
Adult & Pediatric Dermatology, a firm that offers surgical and cosmetic skin care from offices in Marlborough, Westford, Concord and Wolfeboro, N.H., lost more than 2,000 patient records last month when a computer flash drive was stolen from an employee's car. The data stolen included digital photographs of surgical skin cancer procedures, operation reports and copies of consultation letters to referring doctors. The flash drive did not include Social Security numbers, credit card numbers, health insurance numbers, home phone numbers or home addresses. "We are all committed to delivering the highest quality care to our patients and we deeply regret what has happened," COO Glenn Smith wrote. "Our employee was a victim of a crime and this is the very unfortunate outcome of that crime." Company spokeswoman Ashley McCown said the information was contained in a flash drive that was stolen from an employee's locked car outside his or her home in Lowell. Through McCown, Smith declined to say whether the flash drive had been encrypted to prevent access to the data.
A Baltimore law firm lost a portable hard drive containing information about its cases, including medical records for 161 stent patients suing cardiologist Dr. Mark G. Midei, a firm client, for alleged malpractice at St. Joseph Medical Center in Towson. The drive was lost Aug. 4 by an employee of Baxter, Baker, Sidle, Conn & Jones who was traveling on the Baltimore light rail, according to a letter obtained by The Baltimore Sun that was sent to one of the stent patients last week -- two months after the drive went missing. The storage device held a complete back-up copy of the firm's data, including medical records related to the stent malpractice claims, along with patient names, addresses, dates of birth, social security numbers and insurance information. It was taken home nightly as a security precaution in case of fire or flood, a firm spokesman said, though the portable information was not encrypted -- among the most stringent security precautions that is standard practice for health professionals dealing with medical records.