Mission Health will become a for-profit health system, but continue to manage its seven hospitals in western North Carolina, while HCA runs operations, capital access, predictive modeling and analytics.
HCA Healthcare has completed its previously announced $1.5 billion acquisition of nonprofit Mission Health, a seven-hospital system in Asheville and western North Carolina.
"We're looking forward to investing in western North Carolina and helping ensure Mission Health's 133-year tradition of caring for communities throughout the region continues for many years," HCA CEO Sam Hazen said in a media release.
Based in Asheville, Mission Health is the sixth-largest health system in North Carolina. Mission Health's tax status changes to for-profit with the acquisition.
Nashville-based HCA said it will spend $430 million over five years for the completion of the Mission Hospital for Advanced Medicine, building a replacement hospital for Angel Medical Center and building a new behavioral health hospital.
The proceeds from the sale will be combined with Mission Health's remaining cash and investments and will be used to fund the newly formed Dogwood Health Trust, a population health initiative serving western North Carolina.
Mission Health President and CEO Ronald A. Paulus, MD, called the deal "a tremendous win for the people and communities that we serve."
"We've not only provided for the long-term sustainability of high-quality healthcare and secured special protections for our rural communities, we've also created the largest per capita foundation in the nation to address the social determinants of health," Paulus health.
Under the deal, "nearly all" Mission facilities will become part of HCA while continuing to operate under the Mission brand. Mission will continue to be managed locally while HCA runs operations, capital access, clinical trials, research, predictive modeling, and analytics.
The HCA-acquired hospitals are: 763-bed Mission Hospital in Asheville; 80-bed CarePartners Rehabilitation Hospital in Asheville; 49-bed Mission Hospital McDowell in Marion; 25-bed Angel Medical Center in Franklin; 25-bed Transylvania Regional Hospital in Brevard; 25-bed Blue Ridge Regional Hospital in Spruce Pine; and 24-bed Highlands-Cashiers Hospital in Highlands.
HCA is one of the nation's largest for-profit hospital chains and, with the Mission acquisition, now includes 185 hospitals and 1,800 care venues in 21 states and the United Kingdom.
HCA and Mission Health entered exclusive talks last March and signed a definitive agreement in August. North Carolina regulators approved the deal in January.
The Mission acquisition comes as HCA continues to demonstrate strong financial performance. The company reported this week that same hospital admissions increased by 2% in Q4, accompanied by rising revenues, accruing at nearly $12.3 billion, and adjusted EBITDA topping $2.5 billion, a 6.2% year-over-year increase.
Miraca Life Sciences allegedly subsidized physicians' EHR costs, and provided free or discounted consulting services in exchange for patient referrals.
A Texas-based pathology lab will pay $63.5 million to settle whistleblower allegations that it violated the False Claims Act and Anti-Kickback laws, the Department of Justice announced.
Prosecutors had alleged that Miraca Life Sciences Inc. illegally providing physicians with funding for electronic health records systems, and free or discounted technology consulting services, in exchange for patient referrals.
The company, now known as Inform Diagnostics, is headquartered in Irving, Texas. The company changed owners in 2017.
The Department of Health and Human Services in 2006 adopted provisions that allowed laboratories to provide EHR donations to physicians under certain conditions, but federal prosecutors said Inform Diagnostics violated those conditions. HHS withdrew those exemptions for laboratories in 2013.
"Patients deserve the unfettered, independent judgment of their healthcare professionals. Offering financial incentives to physicians and medical practices in exchange for referrals undermines citizens' trust in our healthcare system," U.S. Attorney Maria Chapa Lopez of the Middle District of Florida said in prepared remarks.
"With this settlement, our Civil Division confirms its commitment to our nation's critical struggle against practices that put public health programs at risk," she said.
The allegations stem from three lawsuits that were filed under the whistleblower provisions of the False Claims Act. The whistleblowers' share of the settlement announced today has not yet been determined.
Inform Diagnostics issued a statement saying it was "pleased to put this matter behind us and to move forward with renewed commitment to our clients and each other."
"We have admitted no wrongdoing as part of the agreement with the DOJ, but resolving this issue will allow us to focus on what's most important—providing best-in-class anatomic pathology services to our clients and building a business that is successful and sustainable," the company said.
The settlement of $63.5 million will be paid by Miraca Holdings, and Inform Diagnostics will not be subject to a Corporate Integrity Agreement, the company said.
Since the change of ownership in November 2017, Inform Diagnostics said it is led by a new group of senior executives and board members that has "put compliance at the center of everything we do."
The nation's largest publicly operated health plan has begun its $31 million initiative to recruit primary care physicians for safety net providers serving Los Angeles County.
L.A. Care Health Plan has given 29 community health clinics in Los Angeles County $125,000 each to recruit and retain primary care physicians, in the first phase of a $31 million drive to bolster the region's safety net.
L.A. Care CEO John Baackes says the publicly operated health plan's Elevating the Safety Net program, which started in mid-2018, should ultimately bring about 400 primary care physicians into the county over the next five years, through recruiting and compensation incentives, scholarships, and medical school debt relief.
"Part of our mission at L.A. Care is to support the safety net, and with estimates that California will face a shortage of nearly 9,000 primary care physicians by 2030, we were compelled to act," Baackes says.
Baackes calls L.A. Care's recruiting initiative "a good start" in a daunting challenge.
"We're making a dent, but to my knowledge, we're making the biggest dent that anyone is making," he says.
"It's well known that Kaiser (Permanente) pays more, and they suck up a lot of the new talent. The academic medical centers pay more too, and they get some of the talent," he says. "So this is trying to provide the safety nets with a level playing field for the recruitment of these primary care doctors."
The clinics can use their $125,000 award to either pay for a physician recruiter, or use it in an incentive package for prospective hires. "However they see fit," Baackes says.
The clinics must hire a physician from outside of L.A. County and bring them into the L.A. Care Medi-Cal network no later than June 30. to receive the money.
Once hired, the new physicians will be eligible for loan repayments of up to $5,000 per month for up to 36 months, topping out at $185,000, as long as they work within the safety net.
"Almost all of the awardees are federally qualified health centers, meaning that they have been in the safety net for 30 or 40 years, and they take care of about 300,000 of our lives," Baackes says.
"They're run by local community boards, and they provide generally a health center, a facility where the doctors work, and many of those facilities have ancillary services in there. When you go and visit, you can get a lot of services done in one place," he says.
The third part of the initiative is a scholarship program that awards eight full medical school each year. Four of the scholarships are for students attending the David Geffen School of Medicine at UCLA, and four are for those attending the Charles R. Drew University of Medicine and Science.
The first scholarships were awarded last July, and eight more will be awarded later this year.
L.A. Care Health Plan has more than 2.2 million members in Los Angeles County, making it the largest publicly-operated health plan in the country.
The divestitures leave Tenet, one of the nation's largest for-profit hospital chains, with no hospitals in Illinois, although it continues to operate four surgery centers in the Chicago area.
Tenet Healthcare Corp. this week finalized its previously announced sale of its three acute-care hospitals in Chicagoland.
Dallas-based Tenet, which lost $9 million and saw revenues drop 2.7% in the third quarter of 2018,said in July that it would sell its Chicago-area acute care hospitals to Pipeline Health LLC, a hospital management company based in Los Angeles.
The three hospitals included in the sale are: 236-bed Louis A. Weiss Memorial Hospital on Chicago's Northside; 230-bed Westlake Hospital in Melrose Park; and 234-bed West Suburban Medical Center in Oak Park. Financial terms were not disclosed.
The divestitures leave Tenet, one of the nation's largest for-profit hospital chains, with no hospitals in Illinois, although it continues to operate four outpatient surgery centers in the Chicago area.
Ambulatory care remains one of Tenet's strong suits, generating about $502 million in net operating revenues.
The deal marks Pipeline Health's first foray into the Chicago Market.
"Pipeline Health has a proven model for saving and sustaining smaller hospitals that are cornerstones of the communities we serve," Pipeline Health CEO Jim Edwards said in amedia release.
The divestiture comes as Tenet attempts a turnaround after reporting $9 million in losses in Q3. That loss was down from the $24 million in net income during Q2 but still an improvement compared to the $366 million net loss in Q3 2017.
The Q3 performance prompted Tenet CEO Ronald Rittenmeyer to complain that "our hospitals did not meet our expectations and we are focusing on specific areas to address those gaps."
Tenet's fourth-quarter results are expected to be released by the end of February.
A new federal analysis shows that 910,000 fewer HACs were reported from 2014 through 2017, which helped prevent 20,500 hospital deaths and saved $7.7 billion.
Hospital-acquired conditions dropped 13% from 2014 to 2017; from 99 per 1,000 acute care discharges to 86 per 1,000, according to newly released federal data.
That reduction translates into 910,000 fewer HACs, including adverse drug events and healthcare-associated infections, which helped prevent 20,500 hospital deaths and saved $7.7 billion over the three-year span, according to a new analysis from the Agency for Healthcare Research and Quality.
AHRQ's review quantifies trends for several HACs, including adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, Clostridioides difficile infections, pressure ulcers, and surgical site infections.
The report showed marked declines in several categories, such as adverse drug events, which dropped 28%, and C. diff. infections, which fell 37% from 2014 to 2017.
"The updated estimates are a testament to the successes we've seen in continuing to reduce hospital-acquired conditions," AHRQ Director Gopal Khanna said.
It was not all good news, however. HACs involving pressure ulcers increased by 6%, and the number of surgical site infections didn't budge over the three years.
"There's no question that challenges still remain in addressing the problem of hospital-acquired conditions, such as pressure ulcers," Khanna said. "But the gains highlighted today were made thanks to the persistent work of many stakeholders' ongoing efforts to improve care for all patients.
The Centers for Medicare & Medicaid Services wants to reduce HACs by 20% between 2014 and 2019, which would result in 1.8 million fewer HACs over the five-year period, potentially saving 53,000 lives and saving $19.1 billion in hospital costs.
CMS Administrator Seema Verma said Tuesday that the work around reducing HACs is ongoing, as her agency develops new patient-centered measures that place outcomes over processes.
"While I am so proud of this accomplishment, we are working to get to a smaller set of dynamic measures that patients can use to identify high-value providers," Verma told theCMS Quality Conference.
Federal auditors examined the claims costs of payers participating in exchanges, and the factors driving exchange participation, premiums, and plan design.
Claims costs, pricing strategies, competition, state policies, and federal funding fluctuations were key factors health insurers considered when determining whether to expand or withdraw from the Affordable Care Act's Marketplace, a federal study shows.
The Government Accountability Office sought to determine the claims costs of payers participating in exchanges through the early years of the rollout, and the factors driving the payers' changes in exchange participation, premiums, and plan design.
To do so, GAO auditors reviewed previous studies on marketplace plans, payer data on claims costs, patient mix, and premiums, and interviewed nine marketplace payers and other stakeholders operating in California, Florida, Massachusetts, Minnesota, and Mississippi.
The study found that:
Claims costs for individual plans were higher than expected in the early years of the ACA. From 2014 to 2015, the growth in per member per month claims costs averaged 13% nationally. However, some payers saw cost claims swings ranging from a 67% decrease to a 26% increase that year.
These cost swings were attributed to enrollees being sicker than expected, higher costs for services, and federal policies that included special enrollment periods that payer feared would be abused.
Claims costs grew from 2014 to 2017. Payers blamed the volatility on large changes in the number and health of enrollees each year.
Specifically, the payers interviewed by GAO all had a greater than 50% increase or decrease in enrollment in at least one year between 2014 and 2017. Six payers had enrollment increases of more than 100% in at least one of these years.
Average monthly claims costs varied significantly across payers in the same state. Often claims costs varied by more than $100 per enrollee, a significant variance given that median per member per month claims costs were about $300.
Several factors were weighed when payers decided whether or not to expand or reduce participation in the marketplace plans, including:
Claims costs. Payers said claims costs drove decisions on participation, premiums, and plan design. They noted that increasing claims costs drove premium increases.
Federal funding changes. Payers blamed reduced participation and higher premiums on the phase-out of federal programs that helped issuers mitigate risk, including payments and adjustments for issuers with higher cost enrollees, and the ending of federal cost-sharing for some enrollees.
State requirements and funding. Payers noted that some state policies reduced participation and increased premiums, while other state policies minimized premium increases or variations in benefit design.
Most payers told GAO that their improved financial performance in the marketplace was due more to premium hikes than to decreases in claims costs.
The longer payers participated in the exchanges, the more claims data they were able to access, which allowed for more accurate projections on costs and premiums.
"Specifically, two selected issuers said 2017 was the first year that multiple years of claims data associated with the new market conditions were available to set premiums for the next year," GAO said.
The 'What's Covered' app for mobile devices lets Medicare enrollees, caregivers and others see whether Medicare covers a specific medical item or service.
The Centers for Medicare & Medicaid Services has launched a new "What's Covered" app that allows Original Medicare enrollees and caregivers using mobile devices to determine coverage for specific medical items or services.
"eMedicare is one of several initiatives focused on modernizing Medicare and empowering patients with information they need to get the best value from their Medicare coverage," CMS Administrator Seema Verma said in a media release.
"This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information," she said.
In addition, CMS is using Blue Button 2.0 to enable enrollees to connect their claims data to applications and tools developed by private-sector companies to help them understand, use, and share their health data, Verma said.
Verma said the new techology is responding to increased demands on Medicare. The Medicare population is projected to increase almost 50% by 2030—from 54 million in 2015 to more than 80 million in 2030. In 2016, two-thirds of Medicare beneficiaries said they use the Internet daily or almost daily.
Medicare.gov gets about 15 million page views each year for coverage related content, and 1-800 MEDICARE gets more than 3 million coverage-related calls each year.
CMS launched eMedicare in 2018 to allow enrollees to more-easily access cost and quality information.
Other tools in the eMedicare suite include:
Enhanced interactive online decision support to help people better understand and evaluate coverage options and costs between Medicare and Medicare Advantage.
An online service that lets people quickly see how different coverage choices will affect their estimated out-of-pocket costs.
Price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center.
A webchat option in the Medicare Plan Finder.
Easy-to-use surveys across Medicare.gov so consumers can continue to tell us what they want.
Robust job growth in healthcare reflects the vibrancy and importance of the sector, but it also poses problems with recruiting, retention and the pressures of wage growth for hospitals and other care venues.
Healthcare job growth was robust in 2018, and there's nothing to suggest that there won't be more of the same in 2019.
"The conditions that cause the job growth in 2018 will persist to 2019," says Ralph Henderson, president of Professional Services and Staffing at AMN Healthcare Services, Inc.
"You have retirements of Baby Boomers, an aging healthcare workforce, continuing shortages in your overall job growth, a strong economy and all of those things should produce similar results at 2019 for these various professions."
Travis Singleton, a vice president at physician recruiters Merritt Hawkins, agrees.
"I don't see any way it couldn't be," he says. "Just starting with supply, the most-recent projection is a shortage of up to 121,000 physicians by 2030."
In 2018, healthcare created 346,000 new jobs, up from 284,000 jobs in 2017, according to the Bureau of Labor Statistics. The 2018 figures include 219,000 jobs in ambulatory services and 107,000 hospital jobs.
While the robust job growth in healthcare reflects the vibrancy and importance of the sector, it also poses problems with recruiting, retention and the pressures of wage growth for hospitals and other clinical venues.
Singleton says the demand for jobs will be felt across the healthcare space.
"There's a lot of talk with primary care and everything that goes with primary care; the physician extenders, the team-based health, nursing and all those things," he says. "There's going to be huge need for that. But what most people don't realize is that 72,000 of that physician shortage is specialists."
"This idea of preventative care and medical homes is good, but you can't manage your way out of the fact that 10,000 Baby Boomers are turning 65 every day," Singleton says. "That demographic is 14% of the population, but it's still generating about 34% and 37% of our diagnostics and procedurals, respectively."
The growing numbers of employed physicians and other clinicians presents good and bad news for health systems.
"The good thing about that is it allows health systems to be very nimble and aggressive to recruit providers and they have been," Singleton says. "You don’t see a lot of independent contractors. You don’t see a lot of partnerships. They're almost all on an employed basis."
"The bad news is it's very tough on retention," he says. "If you think five, six years ago, the physicians had their team and they own the practice, they own the equipment, they have the patient panels, they dealt with your family. In other words, you couldn't just have a bad day and walk away."
"Now we're starting to see—especially on the facility level—that retention is really starting to struggle. You're starting to see people change flags. They don't even relocate. They just go to a different system because they don't like the way they're treated."
"It was already ultra-competitive, and we already had a supply problem, and now it's about recruiting, retention, and engagement. If you're not good at all three of them, I don't know how you survive in the next two, three years," Singleton says.
Henderson says that health systems that he works with are budgeting for wage growth of up to 2.5% in 2019, although that growth could be higher in more-competitive regions on the East and West Coasts and in major hubs.
"We've seen big investments in the last three years on recruiting to help capture more of this shrinking supply, and we're seeing them put in place incentives for employees to stay longer and not retire," he says.
What should health systems do to improve recruiting and retention?
"I wish there was one magic bullet. We would just tell everyone exactly what that is," Henderson says. "Most are spending time defining their employee value proposition, making sure people understand their culture better, becoming more flexible in who they would consider for positions sometimes the standards get ratcheted up, and that can be detrimental to hitting your hiring goals."
"Others are investing in new options to make their existing labor more effective, like scheduling tools, technologies that make the job easier for people, and they start to market those things to prospective candidates," he says. "So, it's not just the job and what it pays, it's what our environment is, how we support you on the job. Those healthcare systems have a leg up in competing for new talent."
Singleton urges health systems to "figure out where you're vulnerable."
"We see so many of these beautiful plans that are drawn up in these strategic boardroom sessions about what they want their health system to be," he says. "That's great, but who's going to do it? Who's actually going to carry it out? We find a lot of health systems where, unbelievably, that's still a flaw in the strategy."
Dartmouth-Hitchcock Health is anchored by the 396-bed Dartmouth-Hitchcock Medical Center in Lebanon, the largest hospital in the state. GraniteOne Health includes flagship Catholic Medical Center, a 330-bed hospital in Manchester.
Two of New Hampshire's largest hospitals have signed a nonbinding letter of intent to combine their two organizations.
In ajoint media release, Dartmouth-Hitchcock Health and GraniteOne Health said the merger "will build on years of successful community engagement and clinical collaboration in order to meet the growing demand for seamlessly integrated primary, specialty, ambulatory and inpatient care, offering patients a high-quality, lower-cost, New Hampshire-based alternative choice to out-of-state providers."
The health systems described the letter of intent is first step in what they expect will be a lengthy process of at least 18 months that will include due diligence, public input, and clearance from state and federal regulators.
"As the healthcare landscape continues to evolve, it is important for healthcare systems to evaluate how we can best serve our patients and communities, and prepare for the future so we can continue to provide the high level of care that people expect," said Dartmouth-Hitchcock CEO Joanne M. Conroy.
"By combining these two top healthcare organizations, we would create a patient-focused, unique and unparalleled option for New Hampshire that is responsive to community needs and patients' desire for cost-effective, high-quality care," she said.
Dartmouth-Hitchcock Health serves New Hampshire and eastern Vermont, anchored by the 396-bed Dartmouth-Hitchcock Medical Center in Lebanon, the largest hospital in the state, and New Hampshire's only academic medical center. The health system includes the Norris Cotton Cancer Center, and the Children's Hospital at Dartmouth-Hitchcock, the state's only children’s hospital.
GraniteOne Health includes flagship Catholic Medical Center, a 330-bed hospital in Manchester, along with the New England Heart & Vascular Institute, Huggins Hospital in Wolfeboro, and Monadnock Community Hospital in Peterborough.
The merger would expand Dartmouth-Hitchcock's footprint in the Manchester service area.
Catholic Medical Center will continue to adhere to its Catholic care model while Dartmouth-Hitchcock will continue to serve its patients in all its existing healthcare venues. All care venues in the combined system will keep their current names, identities, and local leadership.
"I am impressed with the deliberate discussions that have taken place thus far and I believe that this combined system would strengthen Catholic Medical Center's ability to care for the suffering and sick in our community, while at the same time maintaining the integrity of its Catholic identity," said the Most Reverend Peter Libasci, Bishop of Manchester.
Conroy said Dartmouth-Hitchcock respects the historical role that Catholic Medical Center has played in the Manchester area. At the same time, she told Vermont Digger that Dartmouth-Hitchcock would continue to provide contraception, fertility treatment and sterilization services.
"Healthcare is a deeply personal experience and it is important to assure all our patients that they will continue to receive the healthcare services they want and need, at the place and time they want them," she said.
News of the proposed merger comes less than one year after the New Hampshire Attorney General's office gave the go-ahead to the merger of Elliot Hospital in Manchester and Southern New Hampshire Health in Nashua.
The approval was granted, even though state regulators said the information about the merger provided by the two hospitals "lacks the specificity needed to confirm that it is in the best interest of the communities the organizations serve."
Among the concerns raised in the report is that the merger could reduce competition among health providers in Southern New Hampshire, possibly leading to increased costs for consumers. But state reviewers determined that the merger can proceed as proposed by the hospitals.
Dartmouth-Hitchcock had attempted unsuccessfully to affiliate with Elliot before it merged with Southern New Hampshire Health.
Payers admit they may have 'overreacted' the political uncertainty created in Washington in 2018 during the fight over the future of the Affordable Care Act.
The Affordable Care Act's Marketplaces in 2019 had more insurers participating, saw modest premium hikes, and in some cases premium decreases, when compared with 2018, a new analysis shows.
Researchers at the Urban Institute interviewed marketplace insurers in 10 states (California, Florida, Georgia, Indiana, Maryland, Minnesota, Ohio, Virginia, Washington, and West Virginia) and found that they were more willing to enter new markets in 2019.
The findings are a sharp contrast to 2018, when a number of insurers fled the marketplaces as the Trump Administration and a Republican-controlled Congress attempted to abolish or hobble the ACA.
"The ACA marketplaces have rebounded from a period of political and policy uncertainty, which caused premiums to spike last year and issuers to think twice about participating,” said Anne F. Weiss, managing director at the Robert Wood Johnson Foundation, which funded the study.
"Political stability, along with support for people with modest incomes, are key ingredients for lower premiums and more marketplace choices," Weiss said.
John Holahan, a fellow at the Urban Institute, says executives he spoke with in many of the Marketplace plans admitted that they "overreacted" to the political uncertainty in 2018.
"They were very fearful of what was going on with the Trump Administration and the threat to the individual mandate and less money for outreach and enrollment, and the shorter enrollment period, and all those things that it would cause complete chaos," Holahan said.
"But, it kind of didn't, and that allowed them to go into 2019 feeling more comfortable that their pricing was adequate, if not more than adequate," he said. "We're seeing smaller premium increases in 2019, because they're where they need to be, and insurers did enter new markets in 2019 and they're actively looking to in 2020 to do more or less do the same thing."
The payers also figured out how to make the Marketplaces work for them. The study noted shifts between 2018 and 2019 that show more plans offering narrow provider networks to contain costs and limit networks to high-performing providers.
"What's left unsaid," Holahan said, is the lack of participation in the Marketplace plans from the "big players."
"You don't see United, Aetna, Humana, or Anthem coming back into a lot of these markets. Those big guys are still staying out so the market's not that great," he said, adding that BlueCross plans have been active, but use HMOs with tighter networks than their commercial plans.
What would it take to lure big payers back into the Marketplaces?
"We'd have to agree that the ACA is here to stay, and it's stable, and there's more money coming in to make the subsidies more generous so you get bigger enrollment," Holahan said. "For a lot of these guys there aren't enough covered lives to make it worth coming in, compared to Medicare Advantage or the commercial markets they participate in. It's still small."
