The name change brings together 30 brands under one banner, with an emphasis on patient-centered care and easy access to healthcare resources.
Adventist Health System on Wednesday changed its name to AdventHealth.
The Altamonte Springs, Florida-based health system announced the name change in August, and said its nearly 50 hospitals and more than 1,200 care venues in 10 states adopt the AdventHealth name and logo beginning Jan. 2.
The name change is part of a system-wide brand transformation to become what AdventHealth called "a more consumer-centric, connected and identifiable national system of care, enabling consumers to easily distinguish locations and services across its vast care network, which serves more than 5 million patients annually."
"This is a historic day for our organization, and I can't be more excited about the direction we are heading," Terry Shaw, president/CEO for AdventHealth, said in a media release.
"Our facilities and team members are galvanized around one name, brand and mission, and in doing this, we will deliver on our promise of wholeness and make the health journey easier for consumers," Shaw said.
In addition to the name change, AdventHealth launched aconsumer-centric website with a user-friendly interface for system searches, appointment scheduling, and self-service payment options.
"Historically, we have consisted of about 30 brands," Shaw said. "Now, united as AdventHealth under one brand promise, we are striving to provide preeminent whole-person care, focused on helping consumers seamlessly navigate from one care setting to the next and committed to never discharging anyone from our care."
The new AdventHealth signage is being put on hospitals and other facilities, and a national advertising campaign featuring the "feel whole" message is also underway.
The sales are part of CHS's strategy to consolidate operations and reduce debt. The Tennessee-based hospital chain is expected to sell its last four hospitals in South Carolina in the first quarter of 2019 and exit the state.
Financial terms were not disclosed for the deal, which wasannounced in October.
The sale includes the 207-bed Mary Black Health System—Spartanburg, and 125-bed Mary Black Health System—Gaffney, and their related physician clinic operations and outpatient service.
The four-hospital, nonprofit Spartanburg Regional, one of the largest health systems in South Carolina, includes three hospitals and serves an 11-county region.
With the divestiture, CHS now operates four hospitals in South Carolina. However, the Franklin, Tennessee-based for-profit hospital chain announced in November that it was selling those four hospitals to the Medical University Hospital Authority in Charleston, in a deal that is expected to close in the first quarter of 2019.
CHS has sold or announced the pending sale of 12 hospitals so far in 2018. The Franklin, Tennessee-based for-profit hospital chain has been struggling since its ill-advised $7.6 billion acquisition of Health Management Associates in 2013.
In 2017, CHS sold 30 hospitals that CHS executives said were low performing. However, a report published by Axios in October challenges that assertion.
CHS remains one of the largest for-profit hospital chains in the nation, and it now owns, operates or affiliates with 111 hospitals in 20 states.
Hospital stakeholders 'immeasurably pleased' with the court's 'carefully reasoned decision.' HHS says the ruling could harm funding for other vital healthcare programs.
A federal judge has ruled that Health and Human Services Secretary Alex Azar did not have the statutory authority to cut billions of dollars in 340B drug payments to hospitals.
In a ruling issued Thursday, U.S. District Judge Rudolph Contreras sided with the American Hospital Association and other hospital stakeholders who asked that he vacate the 22% cut in 340B payments that Azar had announced late last year.
"While in certain circumstances the Secretary could implement the rate reduction at issue here, he did not have statutory authority to do so under the circumstances presented," Contreras said in his 36-page ruling."
Contreras said that while the hospital plaintiffs were entitled to some relief, "the potentially drastic impact of this Court's decision on Medicare's complex administration gives the Court pause."
Instead, he ordered the two sides to file supplemental briefs to address "the question of a proper remedy."
The 340B program allows qualified hospitals to buy certain outpatient drugs at or below cost in an effort to extend scarce federal resources.
However, HHS complained that the 340B program has created a large profit margin between the price that hospitals pay for 340B drugs and the reimbursement paid by Medicare. As a result, HHS said hospitals would be incentivized to overprescribe the discounted drugs.
That concern was validated by a Government Accountability Office report in 2015 which showed that Medicare Part B drug spending was substantially higher at 340B hospitals.
HHS issued a statement saying it was disappointed with the ruling and is "evaluating next steps."
"As the court correctly recognized, its judgment has the potential to wreak havoc on the system," HHS said. "Importantly, it could have the effect of reducing payments for other important services and increasing beneficiary cost-sharing. We look forward to briefing the court on this important matter."
The hospital plaintiffs in the suit, which included the American Hospital Association, America's Essential Hospitals, and the Association of American Medical Colleges, issued a joint statement saying they were "immeasurably pleased" with "the court's carefully reasoned decision."
"For more than 25 years, the 340B program has helped hospitals stretch scarce federal resources to reach more patients and provide more comprehensive services—this was Congress' clear intent for the program," the plaintiffs said. "The court's ruling will help ensure 340B can continue supporting access to affordable health care for our most vulnerable communities."
Bruce Siegel, MD, president and CEO of America's Essential Hospitals, called the ruling "a victory for law and common sense."
"Congress was crystal clear when it created the 340B program to support the work of essential hospitals. Now our hospitals can continue their great work caring for the most vulnerable as good stewards of the program," Siegel said.
Not everyone in the hospital sector was happy with Contreras' decision. Federation of American Hospitals President and CEO Chip Kahn called the ruling "unfortunate because it undermines HHS efforts to cut drug costs and promote fairer payments."
"The current HHS policy will ultimately lower drug costs for patients. It also benefits the vast majority of hospitals, including some 80 percent of rural facilities. This ruling puts all those benefits at risk," Kahn said. "We look forward to an appeals process that will recognize HHS authority to advance these program improvements."
A handful of key issues that emerged or gained speed in 2018 have the potential to transform healthcare delivery in the United States. Here's a look at four of them.
There was no shortage of big stories in healthcare in 2018, but it's still too soon to separate the truly innovative and transformative developments from the mere hyped-up stories that generate a few headlines and disappear.
With that in mind, here are four stories that likely will have a long-lasting impact on U.S. healthcare.
1. Vertical Integration
Arguably no single issue will have a more profound effect on the way care is delivered than the vertical integration that is occurring among commercial health insurers and pharmacy benefits managers and their retail subsidiaries.
But the biggest reason why this trend is so transformative is because it will force traditional healthcare providers to rethink their business models, and hustle in areas where they've preferred to be laggards because they haven't had any competition; in particular, with pricing transparency and consumer convenience.
2. Horizontal Mergers
This is hardly a new trend in 2018, but there were several noteworthy health system consolidations in the past 12 months, including the megamerger between Advocate HealthCare and Aurora Health Care.
Hospital folks like to say there are a number of reasons why these consolidations are occurring, including the creation of synergies and economies of scale, and the reduction of redundant services, all of which they say will result in lower costs for consumers, a claim that is widely disputed by a number of studies.
Of course, the real reason why hospitals merge is because the larger system can maximize an advantage of size to extract better deals from commercial payers, and because hospitals need a larger footprint as the nation transitions to risk-based compensation.
As long as that transition continues, there is nothing to indicate that this trend is going to slow down anytime in the coming year.
3. Amazon
It's hard to gauge exactly how much Amazon changed healthcare delivery in 2018 but it sure generated a lot of talk. Perhaps, in looking back five years from now, we will see that Amazon used 2018 as a transition period on a number of key fronts.
In January, a loosely formed partnership between Amazon, JPMorgan Chase, and Berkshire Hathaway to form some sort of healthcare entity got a lot of media play, and it generated a lot of speculation. They named healthcare policy rock star Atul Gawandeas CEO. But, that's about it.
Other Amazon initiatives that garnered less media attention have the potential to be more impactful.
For example, Amazon this fall began selling software that mines patient medical records for information physicians and hospitals could use to improve care and cut costs.
In June, signaling its intent to enter the pharmacy benefits space, Amazon acquired PillPack, a relatively small company with only 40,000 customers that ships pills directly to consumers and also makes daily individual packets.
Amazon's core competencies inlogistics and distribution, and its existing B2B ecommerce platform, will allow it to easily expand into hospital and provider supply, disrupting the traditional group purchasing organization contract model.
Amazon is also attempting to integrate its Alexa voice assistant into the health and wellness space, targeting people with chronic diseases with initiatives as simple as reminding patients to take their daily medications.
While many believe that Amazon's ventures into healthcare have the potential to disrupt traditional markets, especially pharmacy, pharmacy benefits, and supply chain, the Byzantine nature of the nation's $3.3 trillion healthcare sector will also determine the pace of that disruption.
4. Government
If nothing else, the Department of Health and Human Services under President Donald Trump has been predictably unpredictable in 2018.
On the one hand, the Centers for Medicare & Medicaid Services pushes doctrinaire conservative healthcare policy initiatives such as work requirements for Medicaid recipients.
On the other hand, HHS Secretary Alex Azar, a fervent free-market champion, sounded more like a Democratic Socialist this fall when he called for tethering Medicare Part B rates to the prices paid by other developed nations.
To its credit, CMS has also pushed for greater pricing transparency to help consumers understand irrational hospital prices.
In August, CMS unveiled a final rule to improve patient access to hospital price information.
In November, CMS launched an online tool that allows consumers to compare Medicare payments for surgical procedures in hospital outpatient departments and ambulatory surgical centers.
On other fronts, the Trump administration wasn't able to muster enough support in Congress to repeal the Affordable Care Act, so they're attempting to kneecap the legislation using HHS's broad regulatory authority. This includes the creation of cheaper, short-term health plans that are light on coverage, and which will be attractive to healthier people, leaving sicker populations in the more expensive, more comprehensive ACA plans.
Nearly $2 billion in penalties have been imposed on hospitals since the Hospital Readmissions Reduction Program began in 2012, but a growing number of researchers believe the program is doing more harm than good.
Using financial penalties to reduce hospital readmissions has been linked to a significant rise in post-discharge mortality for patients with heart failure and pneumonia, a new, large-scale study shows.
In an article published this week in JAMA, researchers at Beth Israel Deaconess Medical Center examined the unintended consequences of the Hospital Readmissions Reduction Program, a component of the Affordable Care Act that began in 2012.
Under the HRRP, hospitals have faced financial penalties for higher-than-expected 30-day readmissions for heart failure, pneumonia, and heart attack. Nearly $2 billion in penalties have been imposed on hospitals by the HRRP since 2012.
"Policy makers had observed that hospital readmissions for these conditions were high and that many of these readmissions were potentially avoidable," study first author Rishi Wadhera, MD, said in comments accompanying the study.
To one extent, HRRP worked. Hospitals made changes to avoid readmissions rates among Medicare beneficiaries and readmissions rates for those three conditions fell. However, a growing chorus of researchers and physicians have raised concerns that the drop in readmissions has led to increased mortality.
"Some policy makers have declared the HRRP a success because they believe that reductions in readmissions solely reflect improvements in quality of care," Wadhera said. "But the financial penalties imposed by HRRP may have also inadvertently pushed some physicians to avoid readmitting patients who needed hospital care, or potentially diverted hospital resources and efforts away from other quality improvement initiatives."
The researchers examined more than 8 million Medicare fee-for-service hospitalizations from 2005 to 2015. They evaluated mortality among Medicare patients who were hospitalized for heart failure, a heart attack or pneumonia before the establishment of HRRP in 2012.
Then, they compared those trends to determine if there was a significant change in mortality after the HRRP was announced in 2010 and then after the policy was implemented in 2012.
"Even though 30-day post-discharge mortality was increasing among patients hospitalized for heart failure in the years before HRRP was established, we found that the rise accelerated after the policy was implemented," said co-corresponding author Changyu Shen, PhD, senior biostatistician in the Smith Center for Outcomes Research in Cardiology at BIDMC.
The team also found mortality rates among patients with pneumonia were stable prior to HRRP, but began increasing after the HRRP. "Whether the HRRP is responsible for this increase in mortality requires further research, but if it is, our data suggest that the policy may have resulted in an additional 10,000 deaths among patients with heart failure and pneumonia during the five-year period after the HRRP announcement," Shen said.
Readmissions has become a controversial topic among physicians and researchers, with some studies indicating that it leads to a rise in mortality, and other studies indicating that HRRP has improved care delivery.
The primary implication of the research is that health systems and hospitals have made broad improvements to quality of care rather than changes aimed only at Medicare beneficiaries treated for the conditions targeted by HRRP.
Interveners want U.S. District Judge Reed O'Connor to clarify his December 14 ruling that the Affordable Care Act was unconsitutional, and they want him to certify the ruling so they can appeal it immediately.
Attorneys general from 17 states who've intervened in defense of the Affordable Care Act are again asking a federal judge who ruled the law was unconstitutional to expedite an appeal by January 1.
Their motion is similar to a request filed on December 17, which also asked O'Connor to certify the opinion so that it can be appealed to the Fifth Circuit Court of Appeals immediately.
The suit challenging the constitutionality of the ACA was filed by Republican state leaders in 20 states, who had successfully argued that the entire law was rendered invalid by Congress zeroing out the penalty tied to its individual mandate.
The Democratic AGs want O'Connor to clarify before January 1 that the ACA remains the law of the land during the appeals process. Ending the ACA, the interveners say, would cause incalculable harm to the U.S. healthcare system, states that rely on Medicaid expansion funding, and millions of Americans.
"It's hard to imagine a world in which millions of Americans could lose healthcare, but these are the stakes right now in federal court," Becerra said in prepared remarks.
"Every American could be affected by this case's outcome: children, seniors, workers covered by employers or through the Marketplace, and the hundreds of millions of people with a pre-existing condition," Becerra said. "This shouldn't be a debate: the ACA is the law of the land, and we will continue to challenge this dangerous attempt to undermine Americans' health."
Here's the timeline on the various motions filed since the December 14 ruling:
On December 17, the 17 Democratic AGs first filed for an expedited motion to clarify the status quo of the ACA and ask O'Connor to grant an immediate stay on his ruling, or to certify it so that it could be appeal immediately.
On December 18, O'Connor issued an order, requesting the federal government and plaintiff states respond to the request filed by the Democratic AGs, and additionally weigh in on whether they believe the court needs to resolve any pending claims that were not addressed in the December 14 ruling. The plaintiffs and the federal government were ordered to reply by December 21. The Democratic AGs were to respond by December 26.
On December 21, The Trump Administration and Republican AGs agreed that O'Connor's December 14 decision does not change the status quo of the ACA. They also agreed that O'Connor should certify his decision for appeal and issue a stay of proceedings pending appeal.
However, because O'Connor's decision was not final, the Trump Administration said it would ask the judge to clarify his decision and confirm that it doesn't require immediate compliance. The Republican plaintiffs said they won't enforce O'Connor's decision while the case is on appeal.
On December 26, the Democratic AGs reiterated their call for clarity in an expedited and certified ruling.
However, critics note the survey of hospital executives does not necessarily show that savings generated by mergers are passed on to healthcare consumers.
As state and federal regulators take a harder look at hospital mergers, an American Hospital Association-sponsored study suggests that in-market consolidations decrease costs and expand patient services.
The report comes as the AHA levelled criticism against the Federal Trade Commission for a hospital merger review process that AHA said was "overbroad" and "does not properly credit the many pro-consumer benefits of hospital transactions, and ignores key realities of the marketplace."
The newly extended survey—conducted by Charles River Associates—found that mergers of hospitals within 30 miles of each other generated savings of more than $6.6 million in annual operating expenses at acquired hospitals.
"These findings are important because antitrust authorities and some researchers have suggested that mergers involving hospitals in closer proximity can raise particular competitive issues," the survey found.
"Data demonstrating that there are somewhat greater cost savings from such mergers, no increase in revenues and some evidence of quality improvements underscore the procompetitive potential of such mergers and their likely benefits for patients," the survey said.
Matt Schmitt, an assistant professor of strategy at UCLA, whose research was cited in the Charles River report, says the findings are true, to an extent.
"My own research and that of CRA suggests that the average hospital merger reduces costs. That said, there is likely substantial heterogeneity across mergers," Schmitt said in an email to HealthLeaders.
"Some mergers likely reduce costs by quite a bit, whereas others have no effect (or even increase costs). I believe that it is unwise to apply the results of these aggregate studies to individual mergers: in my view, case-by-case analysis is necessary," he said.
Schmitt says it's "much less apparent" if merger savings trickle down to consumers in the form of lower healthcare prices.
"There are two steps here. First, whether those savings trickle down to insurers in the form of lower negotiated rates," he said. "Second, whether those lower negotiated rates trickle down to consumers in the form of lower premiums and/or more generous benefits."
Schmitt said the CRA report's attempt to examine revenue per admission "is very rough."
"For example, it includes Medicare and Medicaid, when negotiated rates between hospitals and commercial insurers is what we really want to see," he said. "Unfortunately, given the proprietary nature of hospital/insurer negotiations, it is not easy to get access to good data on those rates."
Schmitt said one study published in May found higher post-merger prices when the merging hospitals are geographically close.
"Overall, the jury remains out with respect to whether hospital mergers benefit consumers, both financially and perhaps more importantly with respect to the quality of care," Schmitt said.
The federal government collected $2.8 billion in False Claims Act settlements across all sectors of the economy in 2018, but the bulk of it came from the healthcare sector.
Healthcare fraud accounted for $2.5 billion in fraud recoveries for the federal government in 2018, and it came from a variety of sources within the healthcare sector, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians, DOJ said.
It's the ninth straight year that DOJ's civil healthcare fraud settlements and judgments have exceeded $2 billion. The recoveries reflect only federal losses but additional millions of dollars for state Medicaid programs. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $59 billion, DOJ said.
"Every year, the submission of false claims to the government cheats the American taxpayer out of billions of dollars," Principal Deputy Associate Attorney General Jesse Panuccio said in media release.
"In some cases, unscrupulous actors undermine federal healthcare programs or circumvent safeguards meant to protect the public health. Such fraud will not be tolerated by the Department of Justice," Panuccio said. "The nearly three billion dollars recovered by the Civil Division represents the Department’s continued commitment to fighting fraudsters and cheats on behalf of the American taxpayer."
Here are five of the big settlements in 2018:
AmerisourceBergen Corp. and some subsidiaries paid $625 million to resolve civil claims that the drug wholesaler improperly repackaged cancer drugs into pre-filled syringes and sent them to physicians treating cancer patients. Federal prosecutors said the drug wholesaling giant profiteered by skimming drug "overfill" contained in the original FDA-approved sterile vials and creating pre-filled syringes through a subsidiary, the now-shuttered Medical Initiatives Inc., that ABC claimed was a pharmacy.
Actelion Pharmaceuticals US, Inc. paid $360 million to resolve claims that it illegally paid the copays of thousands of Medicare patients who used the drug maker's hypertension drugs. Prosecutors said the San Francisco-based Actelion usedCaring Voice Coalition Inc., a tax-exempt patient financial assistance charity as an illegal conduit to pay the copays for a number of expensive pulmonary arterial hypertension drugs, including Tracleer, Ventavis, Veletri, and Opsumit.
A DaVita Inc. subsidiary paid $270 million to resolve claims it provided inaccurate information about patients that caused Medicare Advantage plans to get inflated payments from the government.
Health Management Associates paid more than $260 million to settle fraud charges that included paying kickbacks to physicians and ripping off Medicare and other federal healthcare programs. Prosecutors said HMA, which was acquired by the for-profit hospital Community Health Systems in 2014, paid physicians in exchange for patient referrals and submitted inflated claims for emergency department fees to federal health insurance programs, prosecutors said.
Detroit-based William Beaumont Hospital paid $84.5 million to resolve kickback allegations levelled by four former employees in whistleblower lawsuits. Prosecutors alleged that, between 2004 and 2012, Beaumont hospitals in Royal Oak, Troy, and Grosse Pointe compensated eight physicians with free or substantially discounted office space and employees in exchange for patient referrals, violating the Anti-Kickback Statute and Stark Law.
Also-rans includemedical device maker Alere Inc. paid $33.2 million to settle False Claims Act allegations that it knowingly sold "materially unreliable point-of-care diagnostic testing devices" to hospitals. Federal prosecutors allege that, from 2006 through 2012, Alere sold hospitals its Triage devices, which are used in emergency departments for the diagnosis of acute coronary syndromes, heart failure, drug overdose, and other serious condition.
Pfizer paid approximately$23.85 million to resolve claims that it used a foundation as a conduit to pay the co-pays of Medicare patients taking Pfizer drugs. The government alleged that Pfizer raised the price of one of those drugs by 40% in just three months.
No specific reason was given for the delay, but CommonSpirit Health is expected to be operational on January 31, 2019.
Dignity Health and Catholic Health Initiatives bumped back the closing date for the creation of their merged CommonSpirit Health, from December 31, 2018 to January 31, 2019, Dignity Health said in a media release.
"We continue to finalize the last steps to bring our operations together and to combine our ministries, including the completion of licenses, certifications and other administrative items," Dignity said. "We are looking forward to completing our alignment, and we also want to make sure this is seamless for those we serve."
CommonSpirit Health will include hospitals, outpatient centers, home health agencies, assisted living and retirement communities, and community-based health programs.
The organization will be led by CEOs Kevin E. Lofton, currently CEO of CHI, and Lloyd H. Dean, currently President/CEO of Dignity Health. They will oversee a health system that will include more than 700 care sites and 139 hospitals, approximately 159,000 employees and more than 25,000 physicians and other advanced practice clinicians.
The name CommonSpirit Health was chosen in November from among more than 1,200 possible names. The health systems said they settled on that name because it represents a shared sense of missional service and because it resonates with the diverse populations being served, the organizations said.
The merger becomes official on January 1, 2019, and both health systems vow to invest heavily in healthcare services for underserved areas in southern Georgia.
Atrium Health and Navicent Health have signed the definitive agreement for their "strategic combination," the two health systems announced jointly.
The merger, which takes effect on Jan. 1, 2019, will make Macon, Georgia-based Navicent Health a hub for Atrium Health for central and southern Georgia.
"This important milestone demonstrates our continued commitment to creating a personalized care experience for each and every patient and community we serve," said Atrium CEO and President Eugene A. Woods.
"By the joining of two well-respected healthcare organizations, we will have the privilege to provide even greater access and care for existing and new communities throughout central and south Georgia, while we continue to live our mission to improve health, elevate hope, and advance healing – for all," Woods said.
Under the merger:
Navicent Health will be the central and south Georgia hub for the Atrium Health network, led by the Navicent Health President and CEO Ninfa M. Saunders.
Atrium Health and Navicent Health will invest $400 million for routine expenditures and strategic expenditures to be funded from Navicent Health, $250 million for additional strategic expenditures to be funded by Atrium Health; $175 million for discretionary expenditures to be funded by Atrium Health and $175 million to be funded by Navicent Health.
Navicent and Atrium will continue to invest in underserved communities in central Georgia.
Atrium will maintain and expand Navicent's core services, including its Level I trauma center, tertiary services and teaching hospital.
Navicent will have two members nominated to the system-wide Atrium Health Board of Commissioners or Board of Advisors.
Navicent will have a locally controlled board which will include two members from Atrium.
