Mildred Beam joins Orlando Health as vice president, general counsel effective September 29. Beam will be responsible for the management of all legal affairs at Orlando Health including federal and state regulatory compliance, corporate business matters, transactional law, patient care, employment, real estate, liability and insurance, construction, and medical affairs.
Chicago's Resurrection Health Care has named Sandra Bruce CEO of the eight-hospital system, effective Nov. 3. She replaces Joseph Toomey, who is retiring after 16 years at the Catholic healthcare system. Bruce currently serves as president and CEO of St. Alphonsus Regional Medical Center in Boise, Idaho.
With the controversial Recovery Audit Contractor program going nationwide by 2010, many hospitals are concerned about the high number of overpayments collected from providers.
All is not right in the world of consumer-directed healthcare. It's just one story, but this piece in the Des Moines Register should be a wake-up call for those who think the future of healthcare cost containment lies with these vehicles.
People don't want them.
There, I said it. And it pains me to do so.
A more nuanced way to put it is that people don't want them if a company's clearly using them to offload risk and the plans are clearly inferior to what employees are already getting.
The very reason people are no longer opting for them in large numbers is that they're smart enough to recognize that in many cases, they're not getting enough of a return for the risk they're taking on. Back when these plans got their start, with hungry young companies like Lumenos, proponents were careful to sell them to employers not necessarily as a cost reduction tool only, but as a way to ultimately bring down the cost of healthcare over time. To that end, they encouraged employers to make sure to entice employees to make the shift by generously contributing the savings versus the traditional health plan to employees' accompanying health savings account.
On a macroeconomic basis, these plans have had an effect on the rising cost of healthcare. Healthcare cost increases have moderated in recent years. Consumer-directed healthcare is a part of that. But what we're seeing now masquerading as consumer-directed healthcare is anything but.
Transparency was to be the key. Employee perceptions—in other words, the perception that the company wasn't just passing off risk to the employee—was critical. Turns out that over time, many companies resisted or even refused to make contributions to the HSAs—opting instead to offer the much more restrictive health reimbursement account mechanism, or simply encouraging employees to contribute to HSAs on their own. That's not consumer-directed healthcare. It's simply offering a high-deductible health plan—also known as old-fashioned benefit cutting.
Gee, thanks for nothing.
Years later, those young, hungry companies have been acquired by the behemoths of the insurance industry. Anthem-Wellpoint bought Lumenos, for example. These plans have morphed from the goal of reducing the cost of healthcare to the notion of maximizing the profit of the insurers and the companies who buy their products. That's no crime, but at least shoot straight with us.
It's just one story in a small-population state, but it's illustrative of the problems employers are having with getting employee acceptance of these plans. And Iowa is a place where analysts expected CDHP to get strong acceptance—from companies with large bases of manufacturing employees who might be interested in taking on more of the management of their own healthcare. The Register story says Wellpoint blames the slow economy for employers deciding against switching to or offering the plans to their employees. Excuse me, but aren't the plans cheaper than traditional insurance? Shouldn't a slower economy increase interest in these plans?
The real reason, I suspect, is that employees are wise to these plans as they are in practice, not as they are in theory—and they don't want them.
Here's my suggestion: Give me the same tax break the companies get and let me choose whether to take what the company offers or go out and find my own insurance. Oh, and pay me the difference that the company currently spends on my health insurance premium. That would be too straightforward. And it won't happen.
So yet another silver bullet that would solve the problem of healthcare inflation now seems like a lead dud.
Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at pbetbeze@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media Finance, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
As insurers try to limit their payouts and new treatments become available, patients are finding more gaps in what their medical policies will cover. As he considers 10 bills passed by the Legislature that would expand what insurers are required to pay for, California Gov. Arnold Schwarzenegger must balance improved medical coverage with the risk of driving costs so high that people can't afford it.
Foundation Coal Holdings Inc. says it has found an unconventional way to cut health costs: Seek out the nation's best care and give workers incentives to use it. About two-thirds of operations have proven to be cheaper at better-rated hospitals out of state, and even when the price was higher, the company saved money by reducing misdiagnoses, complications, and repeat procedures. The experiment could now be a model for politicians and insurers seeking to curb the growth in U.S. healthcare spending.
The Centers for Medicare and Medicaid Services announced today the approval of DNV Healthcare, Inc. as a deeming authority for U.S. hospitals. DNV is the first new organization to receive deeming authority for hospitals in more than 30 years.
According to the pre-Federal Register announcement, DNV was recognized "as a national accreditation program for hospitals seeking to participate in the Medicare or Medicaid programs" effective September 26, 2008 through September 26, 2012.
"We're coming into this business not just as another option," says Yehuda Dror, president of DNV Healthcare. "We want to take a leadership position."
"I think a lot of people will explore the possibility," says Bud Pate, REHS, vice president for Content and Development for The Greeley Company (a division of HCPro, Inc.). "There are some hurdles that people will need to walk through--since DNV is new they're going to need to work through some residency issues, contract issues, that may exist and may mention The Joint Commission but none of these are insurmountable."
DNV has crafted a system intended to combine CMS Conditions of Participation with ISO 9001 quality management. This program, called the National Integrated Accreditation for Healthcare Organizations, or NIAHO(SM), was created to make the accreditation process more streamlined as well as identify means for improving current standards and promoting continual improvement.
"The ISO-9001 certification seems to be a logical progression to the focus on quality assurance and quality improvement that has occurred in healthcare, primarily in hospitals," says Larry Poniatowski, RN, BSN, CSHA, principal consultant for Accreditation Compliance Services with The University HealthSystem Consortium. "The issue here now will be to see how well it's embraced by hospitals."
Twenty seven U.S. hospitals in 22 states have been accredited by DNV Healthcare using the NIAHO(SM) program in addition to other accreditation services.
In mid-2007, DNV Healthcare acquired Cincinnati-based TUV Healthcare Specialists with the belief that the acquisition would help cement DNV's application to CMS. In 2006, TUV had unsuccessfully applied for deeming authority.
DNV Healthcare is a division of Houston-based DNV USA, a subsidiary of the Norwegian company Det Norske Veritas. DNV focuses on risk management and training in several industries, including healthcare.
New Brunswick, NJ-based St. Peter's University Hospital has reported that an eighth patient has tested positive for the bacteria that causes Legionnaires' disease. Hospital officials said in a statement that the latest patient was released from St. Peter's on Aug. 30. Hospital officials say a drop in the level of chlorine in the water system likely caused the outbreak. Eight patients have now tested positive, and two have died, in the Legionnaires' disease outbreak.
St. Charles Parish Hospital administrator Federico Martinez said during a recent meeting that the 59-bed hospital needs to find a partner because it simply isn't big enough to thrive in today's healthcare marketplace. The publicly owned St. Charles Parish Hospital is exploring a partnership with the Ochsner Health System, which will start out as an informal working relationship and could evolve into Ochsner's lease of the hospital. Under the current agreement, Ochsner physicians will be able to practice at the hospital.
