As attacks mounted over proposed rate increases by Anthem Blue Cross, Connecticut regulators said they will cut increases that would have raised premiums as much as 32% on individual policies. The Connecticut Insurance Department said that Commissioner Thomas R. Sullivan agreed the rate request is too high and expects to approve something less on certain policies.
David Popen, a senior vice president and chief development officer for Gallatin, TN-based Sumner Regional Health Systems, will resign. The hospital system won't fill his job, spokeswoman Angela Alexander said. Popen's departure comes less than a month after former hospital system CEO Bill Sugg's June 12 resignation.
California regulators have shut down a labor union health insurance scheme that put hundreds of consumers at risk of losing coverage. The Department of Managed Health Care said that it had obtained an order from an administrative judge barring Raymond and Jean Palombo of Riverside from selling health maintenance organization and preferred provider organization policies in California. The department contended that the Palombos conspired with a union to collect premiums from members but then failed to pay the premiums in full to Kaiser Permanente, the contracted health plan. That put nearly 500 people in jeopardy of losing their health coverage.
The Journal of the American Medical Association backed off a policy ordering public silence from anyone filing a complaint about study authors' possible undisclosed financial conflicts until a probe is complete. In March, the editors of JAMA published an online editorial in which they said anyone filing a complaint about unreported conflicts of interest would "be specifically informed that he/she should not reveal this information to third parties or the media while the investigation is underway."
After nearly 19 months of controversy, the New York City Landmarks Preservation Commission voted to approve a luxury condominium tower that is the financial linchpin of a two-tower, $1.63 billion reconstruction proposal by St. Vincent's Hospital Manhattan. Originally, the hospital, in conjunction with the Rudin Management Company, proposed a 266-foot-tall condominium, but after repeated objections from the commissioners over its size and architectural features, the tower was whittled to 233 feet last year and to 218 feet in June, and is now an additional 15 feet shorter. The hospital had said it needed some $300 million from the Rudin company to help pay for its own hospital tower.
The fundamental problem with our medical system is the combination of soaring costs and mediocre results, says David Leonhardt in this article for the New York Times. Leonhardt proposes a way to find the best treatment for illnesses at the lowest cost, using prostate cancer treatment as an example.
If you had to begin implementing computerized physician order entry (CPOE) today, how many years do you think it would take for you to reach 100% adoption? This was one of several questions that the College of Healthcare Information Management Executives posed to 335 of its CIO members in a June CPOE survey.
Of the 316 respondents who answered the question, only 8.5% of the respondents said full adoption could be achieved in a year. More than a third (34.5%) of respondents estimated a three-year timeframe.
These survey results hint at the challenges that many hospitals hoping to take full advantage of the EHR incentives outlined in ARRA are facing. Providers must implement CPOE for "all order types, including medication [inpatient and outpatient]" by 2011, according to the proposed meaningful use matrix that the Health Information Technology Policy Committee released last month. The specific measure that hospitals must report is the percentage of orders entered directly by physicians through CPOE.
And it all goes back to the very first goal outlined in the matrix: improve quality, safety, and efficiency of healthcare as well as reduce health disparities. The idea is that CPOE will help to get the ball rolling toward many of these important patient care goals.
A CPOE implementation is one that providers definitely don't want to rush, says Allison Viola, MBA, RHIA, director of federal relations for the American Health Information Management Association (AHIMA) in Washington DC. "It's going to take a very dedicated and careful approach because it is a very high-risk implementation," she adds.
On June 26, AHIMA issued comments regarding the proposed definition of meaningful use, specifically citing "considerable concerns about CPOE systems versus the components of a CPOE that would accommodate the desired functions to achieve meaningful use."
"It's not just an IT implementation. It's a workflow change," Viola says. "You cannot expect to implement the system and walk away. You need to understand how it modifies your current clinical and business practices."
The association urged HHS and ONC to reference Certification Commission for Healthcare Information Technology (CCHIT) criteria that the commission has already created when establishing more concrete requirements regarding CPOE. CPOE is fully supported in 2008 CCHIT-certified products, according to comments that the commission submitted regarding the proposed matrix.
Regarding the 2011 objective to implement drug-drug, drug-allergy, and drug-formulary checks on the inpatient and outpatient sides, CCHIT-certified 08 ambulatory outpatient EHRs include all three requirements either within the system or via the ePrescribing network. CCHIT-certified 08 inpatient EHRs include drug-drug and drug-allergy checks; drug-formulary checks were added as a 2009 requirement.
Providers who have yet to implement CPOE should start by looking at the CCHIT criteria for more information about functionality and applications, Viola says. Though CCHIT has yet to be formally named as the certifying body, its criteria at least provides a starting point for providers wishing to get up to speed with the technology.
Ask providers what functionality they currently offer and how they may be refining that functionality in response to the proposed meaningful use matrix, she adds.
The Tennessee Medical Association and two Nashville physicians have filed a potentially precedent-setting lawsuit against a fee audit recovery contractor that the physicians' organization says made false assertions of overpayment on out-dated claims and subjected physicians and their staff to "strong-arm" letters and high-pressure telephone collection efforts.
The contractor, Franklin, TN-based Health Research Insights, Inc., was hired by the Metropolitan (Nashville) Board of Public Education to recover alleged overpayments that were made in 2006 and 2007 on behalf of the board through Blue Cross Blue Shield of Tennessee, the third-party administrator for MBPE's health benefits plan. MBPE and BCBST are also named in the suit, which was filed in Davidson County Chancery Court.
The TMA and the two physicians--a pediatrician and an ophthalmologist--allege that HRI sent letters to scores of physicians, accusing them of overbilling and demanding the physicians send money or confidential medical records to justify the treatment provided.
"This is about protecting our patients' private health information and fair treatment for physicians," says Richard J. DePersio, MD, president of the 7,800-member TMA. "Our members complained to us about the HRI 'strong-arm' letters. We had to act because we cannot tolerate business practices that ignore state law and contracts, threaten patient privacy, and make false accusations of physician fraud. The threats and intimidation tactics used by HRI were a catalyst for our actions."
Theodore Perry, HRI's president/CEO declined to comment when contacted this week by HealthLeaders Media.
BCBST has denied any connection with HRI and has not claimed that the physicians were overpaid.
The lawsuit, filed last month, asserts that HRI caused MBPE to breach its contract with BCBST; violated the State Consumer Protection Act by engaging in unfair or deceptive business practices toward the physicians; and sought to obtain private patient information through misrepresentation.
The suit alleges MBPE contracted with HRI to recover overpayments even though MBPE had previously assigned matters relating to overpayment recovery to BCBST. In addition, TMA officials say HRI was going after payments that were more than 18 months old, a violation of state collection laws, and that physicians who did not respond to the letters were subjected to high-pressure telephone collection efforts by HRI employees.
HRI contends that its actions are not subject to contract terms and state laws prohibiting such late allegations of overpayment, or made directly by MBPE rather than BCBST. The TMA disagrees.
"HRI's actions were an attempt to circumvent state law and contracts involving BCBST, MBPE, and the physicians, which set forth how and when any questions regarding overpayment to network physicians are to be handled," DePersio says.
The lawsuit says that if BCBST did not have the authority to contract on behalf of MBPE, and MBPE can circumvent the terms of the BCBST/physician agreement, then discounts given to MBPE under that agreement should be refunded to physicians.
The lawsuit seeks an injunction and a declaratory judgment to stop the HRI tactics, and monetary damages for defamation and for expenses incurred by physicians accused of overbilling.
HRI operates in Tennessee, Kentucky, Georgia, and Texas, but TMA officials say they don't know if other state medical societies are taking similar actions against the contractor. While Tennessee state law limits retrospective overpayment recovery collections to 18 months, it is not clear if those statutes can apply to self-insured health plans, which usually fall under ERISA law.
Vice President Joe Biden—standing in for President Obama, who is travelling overseas—met with hospital leaders on Wednesday at the White House to announce the agreement that hospitals will give up about $155 billion in Medicare and Medicaid spending over the next decade. That money could then be used to help for the nation's 47 million uninsured.
"As more people are insured, hospitals will bear less of the financial burden of caring for the uninsured and the underinsured, and we'll reduce payments to cover those costs, in tandem with that reduction," Biden said.
Joining Biden were Rich Umbdenstock, president and CEO of the American Hospital Association; Richard Bracken, president and CEO, Hospital Corporation of America (and representing the Federation of American Hospitals); Wayne Smith, president and CEO, Community Health Systems; and Sister Carol Keehan, president and CEO, Catholic Health Association of the United States. Health and Human Services Secretary Kathleen Sebelius also attended.
The agreement is the latest in behind-the-scenes health reform negotiating instituted by Senate Finance Committee Chairman Max Baucus (D-MT) in an attempt to reduce the cost of retooling the nation's healthcare system and to pull in many of those organizations that had historically opposed such reforms. Baucus was not able to attend the meeting.
Of that $155 billion of projected savings, an estimated $40 billion to $50 billion would come from decreasing federal payments hospitals receive for providing care to uninsured and low income patients. The Medicaid cuts would be apportioned state by state, using a 10% annual reductions starting in 2015.
Roughly $100 billion more would come from reductions in planned annual Medicare payments to hospitals. In addition, hospitals are reaffirming to support initiatives such as value-based purchasing, testing ways to better integrate care, and reducing unnecessary hospital readmissions.
Hospitals, though, are looking to get something from the deal. In particular, they are eying current measures that include a public insurance option: Hospital groups want a plan that they say would reimburse them above the rates Medicare and Medicaid would pay if the option is approved by Congress.
Hundreds of women over the age of 40 are traveling to fertility clinics in Europe to try to get pregnant because the UK's National Health Service clinics will not take them, according to a study. The most popular destinations for UK women are the Czech Republic and Spain, the top locations for obtaining donated eggs, the study found.
