Hartford, CT-based Aetna plans to eliminate 1,000 positions, almost 3% of its work force. The company has warned that it isn't immune to the economic downturn, despite a preliminary forecast of 3%-5% growth in 2009. Employees were notified of the possible staff cuts last month.
Utah legislators are laying the groundwork for what they believe will be a 10-year healthcare reform effort. The major bill in the plan would allow health insurers to offer HMOs and PPOs without some state-mandated benefits. In turn, the insurers would need to offer the plans through an Internet portal that would allow residents to compare rates, coverage, and histories of honoring claims.
Plans to increase health coverage for kids will be among the spending cuts in Washington Gov. Chris Gregoire's budget, according to a senior state official speaking on the condition of anonymity. The state official said that Gregoire would suspend plans to increase child health coverage to 300% of the federal poverty level, which is about $64,000 a year for a family of four.
The New Jersey Department of Health and Senior Services has found in its third annual Patient Safety Act report that 72 people died in the state's hospitals last year as a result of preventable errors—30 more than in 2006. Health officials and patient advocates say, however, that the increase appears to be the result of better reporting of these types of incidents, rather than poor care.
A Miami doctor has been sentenced to 30 years in prison—one of the stiffest penalties given for Medicare fraud—for her role in an HIV infusion fraud scheme. Prosecutors said Ana Alvarez-Jacinto worked at Saint Jude Rehab Center, Inc., a bogus HIV clinic that paid about $150 apiece in kickbacks to patients in exchange for their Medicaid numbers. Alvarez-Jacinto ordered hundreds of medically unnecessary and expensive HIV infusion treatments for patients at St. Jude, which then billed Medicare for approximately $11 million for those services during a five-month period in 2003. Medicare paid St. Jude more than $8 million, according to the Department of Justice.
The Carle Clinic Association of Urbana, IL, reached an agreement with the state in an anti-trust lawsuit filed by the state's attorney general's office. The Carle Clinic as well as the Christie Clinic of Champaign, IL, are accused of denying primary care to Medicaid patients. The agreement requires Carle to increase its Medicaid patient load by as much as 11,850 over the next three years. Legal action against Christie is still pending.
A project at Pittsburgh-based St. Clair Hospital will increase the square footage of the emergency department from 13,000 to 31,000 and take the number of available treatment rooms from 20 to 46. Among the treatment rooms will be 31 for acute adult care; six for pediatric care; six "fast track" rooms for patients with minor illnesses and injuries, and three behavioral and mental health rooms. The increase in the number of treatment rooms and a revamping of the way the emergency department functions is expected to drastically reduce the amount of time that patients will wait for treatment, said hospital representatives.
An near-altercation last weekend between Robert Jaffe and 9 West founder Jerome Fisher dampened a society party at Donald Trump’s Mar-a-Lago Club in Palm Beach- FL. Jaffe had recruited investors for Bernard L. Madoff, the money manager who has admitted to a Ponzi scheme in which he lost $50 billion of his clients’ money—among them was Fisher. He was reportedly upset by Jaffe’s presence at the event. The situation highlights how the Madoff scandal has upended a crucial part of fund-raising for many of Boston's hospitals. For years, the hospitals have gone to Palm Beach seeking donations from rich donors. The hospitals hold lavish events at hotels and private parties at homes in an effort to attract donations, but now, with many donors out millions, that strategy is being reevaluated.
The nonprofit Commonwealth Fund has developed a new site, WhyNotTheBest.org, where side-by-side comparisons of 4,500 hospitals nationwide can be found. Hospital-ranking programs and rating systems have proliferated in recent years, but Commonwealth Fund representatives say the new site is meant to fill a gap because existing report cards don't offer hospitals an easy way to compare their performance to each other or offer resources to help them improve. The site offers tools and case studies of high performers, so users can network with people at the best hospitals.
The latest addition to the healthcare reform debate would pit a government plan against private insurers while maintaining the employer-based insurance system.
Supporters of a public insurance option say it would increase healthcare coverage, reduce costs, and improve quality and value. House Ways and Means Health Subcommittee Chairman Rep. Pete Stark (D-CA), U.C. Berkeley professor Jacob Hacker, PhD, and Institute for America's Future co-director Roger Hickey spoke today at a press conference about Hacker's report "The Case for Public Plan Choice in National Health Reform."
President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus have backed the idea, which would mirror conventional Medicare. The federal government would manage the program and pay private providers to deliver care. Proponents say the public plan is not a "Medicare for all" solution, but builds a subsidized government option to private insurers and ensures that Americans can receive proper health coverage.
"This is not an argument for a universal Medicare program, but what I call a hybrid approach that builds on the best elements of the present system while putting in place this new means with which those without access to secure workplace insurance can choose among health plans that provide strong guarantees of quality, affordable coverage," says Hacker.
The public plan would compete with private insurers as a way to provide a level playing field to protect Americans without health insurance. Hacker says a public insurance option is similar to the healthcare system in Germany, and he estimates the U.S. could save up to $46 billion annually if it created a public-private system.
Stark supports the idea of a public insurance option that is based on the Medicare program. "I think that everybody should be covered and everybody should pay according to their ability to pay," said Stark.
Surveys show that Americans support a public-private health insurance system. "The proposal that I am putting forth basically lets Americans have their cake and eat it too," says Hacker.
Hacker says the public plan is needed because public insurance, including Medicare and the Veterans Health Administration, has:
Reined in costs and preserved access better than private insurers
Created new payment and quality-improvement methods that are followed by private plans
Hacker says public choice is critical in sparking private plans to improve transparency and invest in quality.
Medicare has less overhead than private insurers and doesn't pass on costs to consumers while increasing profitability, he says. As an example, Hacker says Medicare's health spending per enrollee increased 4.6% between 1997 and 2006 while private insurer spending ballooned at 7.3% a year during that same period.
Hacker says competition with government plans would improve private insurance offerings and give an alternative to those who don't think the public option serves their needs.
"If, as many critics of public plan choice contend, the private sector can provide greater value than the public sector, then private plans should have nothing to fear from competing on a level playing field with a new public plan," wrote Hacker in his report. America's Health Insurance Plans recently presented its own healthcare reform plan. Rather than rely on greater government intervention, AHIP's plan builds on top of the current employer-based system and requires all Americans to have health insurance, which mirrors the Massachusetts healthcare reform. Robert Zirkelbach, director of strategic communications for AHIP, says the organization's proposal would cover all Americans, improve quality, and make healthcare coverage more affordable.
"Healthcare reform should build on what's working in the current healthcare system and allow patients to continue to benefit from the innovative care coordination and disease management tools that health plans have implemented," he says.
Stark says he doesn't expect Congress to pass a major healthcare reform package in Obama's first 100 days. There are deferred issues, such as Medicare payment cuts to doctors, health information technology, and the State Children's Health Insurance Program, that Congress will need to tackle first. Stark suggests healthcare reform will take a full year.
The Congressman says reforms plans will need widespread support in healthcare, but questions whether health insurers will back a program that expands public insurance.
"I think you have to give everybody a chance of a hearing. We're not going to pass these plans if we don't have the American Medical Association, American Hospital Association, and even Pharma. You're not going to get the insurance companies on board, I don't think, but they are the easiest to roll because nobody likes insurance companies," says Stark.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
