Saum Sutaria, MD, has been named COO with direct oversight of hospital operations. Long-serving President of Hospital Operations Eric Evans is out and taking his title with him.
Tenet Healthcare Corp. on Wednesday announced an executive shakeup a few weeks after the Dallas-based for-profit hospital chain reported sluggish third-quarter performance.
Saumya "Saum" Sutaria, MD, a longtime senior partner at McKinsey & Company, was named COO for Tenet, effective Jan. 6.
Gone is Eric Evans, president of hospital operations, who after 14 years at Tenet will leave at the end of this month.
Sutaria will directly oversee Tenet's hospital operations business, including acute care hospitals, hospital-affiliated outpatient centers and employed physicians, in what the company called "a newly created enterprise role."
He will report to CEO and Executive Chairman Ron Rittenmeyer, with a focus on operational improvements, integration and other initiatives for Tenet businesses, including USPI and Conifer Health Solutions.
"We are continuing to add top talent to drive improvements in performance and maximize opportunities for our business," Rittenmeyer said in a media release. "Saum's knowledge of healthcare dynamics and his relationships in the space are unmatched."
Sutaria's hiring and the portfolio of his new position made Evans and his title redundant.
"With the addition of Saum, it is clear the role of President of Hospital Operations is a layer which Eric and I, in consultation with our board, mutually decided to eliminate," Rittenmeyer said. "This is consistent with our philosophy of a flatter organization."
The shakeup comes three weeks after Tenet posted a $9 million loss in Q3 and saw revenues down 2.7% year-over-year though adjusted EBITDA rose $70 million.
"Our hospitals did not meet our expectations and we are focusing on specific areas to address those gaps," Rittenmeyer said on Nov. 5.
Tenet on Wednesday reiterated its Nov. 5 outlook for 2018 and said that it continues to expect Adjusted EBITDA growth of 3% to 5% in 2019.
AccuDoc Solutions was 'the victim of a cyber incident' this fall involving Atrium patient billing information. The data was accessed by unauthorized users but not downloaded.
A third-party vendor providing billing services for Atrium Health was hacked and gave unauthorized users access to about 2.65 million records, Atrium Health announced Tuesday.
Atrium said the hackers broke into to the databases of billing services contractor AccuDoc Solutionsin late September. AccuDoc told Atrium on Oct. 1. A subsequent investigation determined that the information was not removed from AccuDoc's systems.
"The exact number is hard to pinpoint, but based on our investigation it looks like the unauthorized user gained access to databases that had about 2.65 million records. Of the 2.65 million, it appears around 700,000 included Social Security numbers," Atrium spokesman Chris Berger said.
"It is very important to understand that the data was accessed but not downloaded in this incident," Berger said.
Atrium said patients whose Social Security numbers may have been exposed are being offered free credit monitoring and identity protection services.
In addition, Berger said Atrium Health's core systems and those of its managed locations are separate from AccuDoc's and were not involved in the hack.
Personal clinical and medical records were not involved, nor was financial account information, such as bank account numbers or credit card or debit card information.
Information that may have been accessed includes personal information about patients' first and last name, home address, date of birth, insurance policy information, medical record number, invoice number, account balance, dates of service and Social Security numbers.
The databases accessed by the unauthorized third party contained information provided in connection with payment for healthcare services at an Atrium Health location, and at locations managed by Atrium Health, including Blue Ridge HealthCare System, Columbus Regional Health Network, New Hanover Regional Medical Center Physician Group, Scotland Physicians Network and St. Luke's Physician Network.
Procedure Price Lookup provides Medicare patients with price differences for some surgical procedures in hospital outpatient and ambulatory surgery center care venues.
The Centers for Medicare & Medicaid Services on Tuesday launched an online tool that allows consumers to compare Medicare payments for surgical procedures in hospital outpatient departments and ambulatory surgical centers.
The Procedure Price Lookup tool displays national averages for what Medicare pays the provider, and the national average copayment fpr a Medicare beneficiary with no supplemental insurance.
"Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs," CMS Administrator Seema Verma said in a media release.
The Procedure Price Lookup tool was mandated by Congress in the 21st Century Cures Act.
Medicare statutes require that CMS maintain separate payment systems for different types of healthcare providers, meaning both CMS and patients may pay different amounts for the same service, depending on the care venue.
"The different payment rates are a prime example of Medicare's misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another," Verma said in a blog post.
"Unfortunately, it would take an act of Congress to change the payment systems within Medicare that charge patients different prices for the same services based on the care setting, but in the meantime patients have the right to at least know what they will be charged," she said.
Procedure Price Lookup is the latest online tool created under CMS's eMedicare initiative, whose other patient-oriented transparency tools include an overhauled version of the agency's drug pricing and spending dashboards that lists the drug makers who were responsible for price hikes.
A Hartford physician allegedly ignored the advice of a colleague and spoke to a TV reporter in a dispute with a patient over the use of a service animal at the allergy practice.
A Connecticut physicians group will pay the federal government $125,000 to settle alleged violations of confidentiality laws after disclosing a patient's identity to the news media.
The Office for Civil Rights at the Department of Health and Human Services alleged that one of three physicians at Allergy Associates of Hartford, PC, disclosed a patient's health information in 2015 while responding to a television reporter's inquiry.
The patient had contacted the television station to complain about an Allergy Associates physician who allegedly turned away the woman from the practice because she used a service animal, the OCR complaint said.
When a reporter at the television station contacted the physician to hear that side of the story, "the doctor impermissibly disclosed the patient's protected health information to the reporter," OCR said.
The alleged violations of the Health Insurance Portability and Accountability Act came after the doctor was told by Allergy Associates' privacy officer to not respond to the media.
Not surprisingly, Allergy Associates did not respond to HealthLeaders' request for a statement.
OCR said the doctor—whose name was not disclosed—"demonstrated a reckless disregard for the patient's privacy rights," and that Allergy Associates failed to discipline the doctor or take any corrective action following the illegal disclosure.
"When a patient complains about a medical practice, doctors cannot respond by disclosing private patient information to the media," OCR Director Roger Severino said in a media release.
"Because egregious disclosures can lead to substantial penalties, covered entities need to pay close attention to HIPAA’s privacy rules, especially when responding to press inquiries," he said.
In addition to the $125,000 payout, Allergy Associates agreed to a corrective action plan that includes two years of monitoring their compliance with the HIPAA Rules.
The agreement states that it is not an admission of liability by Allergy Associates, nor is it a concession from HHS that HIPAA laws were not violated.
The approval from New York comes with a boatload of conditions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance enrollment.
The megamerger of CVS Health Corp. and Aetna Inc. got the go-ahead Monday from New York state officials, clearing its last hurdle in a $69 billion deal that is expected to be finalized on Wednesday.
The approval of New York's Department of Financial Services comes with a boatload of conditions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance education and enrollment and other consumer health protections, DFS said in a media release.
"DFS listened to the concerns of the public and has obtained significant commitments from CVS and Aetna to address those concerns, ensuring that the companies hold to their promises of reduced costs and improved health care for New Yorkers, not pass on the costs of this acquisition to New Yorkers, enhance data privacy, and not act in an anti-competitive manner going forward," Financial Services Superintendent Maria T. Vullo said.
"DFS will use its full regulatory authority to ensure that the companies adhere to these robust commitments and that both CVS and Aetna are held accountable for promises made to New Yorkers," she said.
The approval comes two weeks after the deal cleared another stipulation-laden approval from California. The federal government approved the deal last month.
In a filing today with the Securities and Exchange Commission, CVS said the deal will be finalized "on or about Nov. 28, 2018," The Street reported.
The New York state approval comes with conditions that:
No funds from Aetna covering New Yorkers can be used to pay for CVS's acquisition.
Acquisition costs, including executive comp, cannot be passed on to any Aetna New York insurer.
Increased health insurance rates cannot be sought in New York to pay for the deal, and premiums and cost-sharing owed by policyholders cannot increase.
Dividends cannot be paid by Aetna without the prior approval of DFS for three years.
The merged company must provide DFS with annual reports for three years documenting its progress toward achieving promised synergies.
Aetna New York insurance products must be maintained for three years.
One or more new products must be made available by Aetna to the small and large group markets within two years through a New York-domiciled insurer.
New healthcare measures must include underserved communities.
$40 million will be given to support health insurance education and enrollment and strengthen the state's healthcare transformation activities.
An independent third-party audit assesses whether Aetna employees have improperly accessed confidential information.
Adherence to DFS' s cybersecurity regulations is maintained.
There is no preferential pricing to Aetna-affiliated health insurers in New York, including MCOs.
Participating provider networks include non-chain New York pharmacies for three years.
Caitlin Beck Stella talks about her new role as the leader of one of the most prestigious pediatric hospitals in the nation, and the challenges and responsibilities that come with the job.
It's been about five months since Caitlin Beck Stella was named CEO at Joe DiMaggio Children's Hospital in Hollywood, Florida.
It's Stella's first job as a CEO, after serving as chief administrative officer at UCLA Mattel Children’s Hospital and Women’s Health. She spoke with HealthLeaders about her new role as the leader of one of the most prestigious pediatric hospitals in the nation, and the challenges and responsibilities that come with the job.
The following Q&A has been edited for length and clarity.
HLM: You've been CEO at Joe D. since July. How's it going?
Stella: It's been wonderful. It's been such a warm welcome from the entire community and the hospital is amazing. We have a wonderful team, so I couldn't be happier.
HLM: There was a nationwide search to fill this job. Why do you think you were picked to lead Joe D.?
Stella: I definitely think it's my energy. I'm a kid at heart and when you come to Joe DiMaggio Children's Hospital you feel that we all have a similar heart. I was recruited because I share the love of being with kids and serving families and children. I've been doing it since I was volunteering in high school at a children's hospital. It's just part of what I love to do.
The team here saw in me what they see in themselves. I see it and I feel it every day and my job is to make sure it's protected and that we continue to grow.
HLM: What's been your primary focus in these first few months?
Stella: First and foremost, it's really been understanding the market here, having come from California and a very different environment in a variety of different ways. Also, connecting with my peers and other leaders and other organizations to get to know everyone.
More importantly, it's continuing to build on the amazing legacy with Joe DiMaggio that's been here for over 25 years. We're expanding into Wellington, so we're in growth mode. It's a combination of keeping things growing and then also just getting to know the market.
HLM: What are some of the differences between Florida and California with respect to pediatric healthcare?
Stella: Just the way children's healthcare is managed, paid for etc., such as differences in Medicaid reimbursement. I find a lot of benefits here. We have a pretty good system in Florida from what I know of it so far.
And then, the systems themselves. I've done healthcare consulting, so I've learned that states do things differently and provide care for children that varies slightly in terms of how things are managed for kids who have chronic or complex needs. It's nuances around system, infrastructure, how things get done, how things are handled.
I would say that in Florida, in general, I've found it to be a very pleasant state. California was a little bit of the beast in terms of efficiency and bureaucracy.
HLM: This is your first CEO job. How is it different?
Stella: My focus as a chief administrative officer was more about business and operational oversight. Now I view my role as being the leader of the pack, if you will, in terms of keeping the priorities on track and making sure that the family-centered environment continues to grow and is supported and it's part of how we train, and part of how we onboard.
I'm very conscious of maintaining the culture here because it's the thing we're most known for and it's the thing that families love really. I had a little kid the other day crying in the valet area as I was walking in and I stopped to ask "why are you crying?" and his mom said he doesn't want to leave. We're doing something right when he doesn’t want to leave the hospital.
HLM: What will be your focus going forward?
Stella: I've described this organization like someone just handed me the keys to a Ferrari. It's already high-performing, well-run, well-oiled. All I have to do is figure out where we want to go with it. I've spent a lot of time studying the market, but I'm still in learning mode.
Growth is definitely part of our plan. Not only are we growing up—we're adding four stories to our hospital as our services continue to grow—but also bringing care closer to home. Having everything in Hollywood located at the main hospital doesn't work for all families, so we have to make sure that our services are available. We'll definitely be expanding our footprint.
Also, looking at programs and services that the community and children here need. We're looking to see if there are there gaps in care or ways to partner with other institutions to serve families better.
HLM: What are some of the unique challenges that pediatric health systems face?
Stella: Nationally, the big differentiator between a children's health system and an adult health system is payer oriented. Medicare is the primary payer in adult hospitals, and Medicaid is the primary payer in children's hospital. Medicaid does not reimburse for care in the same way as Medicare does, so most children's hospitals can't survive without philanthropy.
We're all in the same boat. Every year there are cuts to Medicaid either at the federal or state level. No matter where the cuts are coming from, we feel it. More and more we need to look for philanthropic support to continue to grow.
My husband grew up here and so I've known this about people in South Florida: They're wonderful people. They're generous, kind, want to be involved. I've had people reaching out to me, asking "how can I help?" Anyone I've met, once they know that I'm working at Joe DiMaggio, they're like, "I want to get involved. What can I do?" The fact that the reaction has been so supportive tells me that, as we have increasing needs, our community will be there to help.
What other challenges do you foresee?
Stella: I look at them as opportunities. Some of them have to do with training future generations of physicians, nurses, pharmacists, respiratory therapists, etc.
In this market there is a predicted shortage of healthcare professionals. Making sure that we have training programs in place is important. We have a graduate medical education program. We have residents. We have a new teaching program, we have a nursing residency program, and we have other training programs coming online to be able to meet those workforce needs.
Pediatrics in general, tends to have shortages. Pediatrics is already a specialty and then to sub-specialize with pediatric nurses, neurosurgeons or cardiologists, etc., that takes even more time and training. We have to plan to be able to sustain the pipeline, whether that means fellowships or other things. We want to be a destination for teaching as that will continue to grow our workforce.
What metrics will you use to determine success?
Stella: Patient experience is what we're known for here. It differentiates us from children's hospitals here and beyond nationally. We have outstanding patient experience and patient satisfaction scores. I want to make sure we maintain that. Beyond that, looking at things that every CEO is looking at; market share, being top of mind when families need us. We'll definitely be watching all kinds of things.
Another priority is to make sure that, as we grow our services, we're making our care experience easy and seamless for parents, especially for the new generation of parents who are looking for easy access to information, appointments, using technology.
A lack of competition among payers and providers in rural areas means consumers who live there have fewer, more-costly coverage options.
Premiums for silver plans under the Affordable Care Act can be 40% higher or more in rural areas than in urban areas, an analysis of federal data shows.
Urban Institute researchers found premiums were cheaper in 2016 and 2017 for urban silver plans, which cover about 70% of healthcare costs.
The study found that states with the largest premium differences between rural and urban areas in 2017 were Tennessee ($415 urban vs. $601 for rural) and Nebraska ($368 urban vs. $555 rural). In 2016, the greatest gap occurred in Colorado ($282 urban vs. $402 rural) and Nevada ($272 urban vs. $398 rural).
The researchers speculate that the price differential is a function of competition. Even though urban healthcare systems are more expensive, they have larger populations that invite competition and spread the risk, thus lowering premiums.
Rural areas generally have a lower cost of living, but the lack of population density is a disincentive for payers and providers.
"Although many factors go into the cost of coverage, competition among providers seems to be the critical factor driving premiums lower in America's urban centers," said Anne F. Weiss, managing director at the Robert Wood Johnson Foundation, which sponsored the study.
"Less competition among providers in rural areas means consumers are paying more. Therefore, policy solutions should recognize the unique needs of rural communities," Weiss said.
Maggie Elehwany, vice president of government affairs and policy at the National Rural Health Association, says rural Americans often have only one coverage option.
"Since rural patients have no plan choice and are often forced into a plan they can't afford—most purchase a bronze plan with high deductible," Elehwany says. "When they get sick, they can't afford the bill and the provider has to subsidize the cost."
The researchers also found that areas with narrow network Medicaid-managed care plans—which now offer private coverage to low-income residents—or provider-sponsored plans, which are offered directly by a health system or group of doctors instead of a traditional insurance company were associated with significantly lower premiums in 2016 and 2017.
In contrast, areas with Blue Cross Blue Shield health plans featuring wider networks of doctors and hospitals generally had higher premiums in 2016. By 2017, most BCBS plans implemented narrower networks similar to those used by provider-sponsored plans, ultimately decreasing their premiums.
Radiation oncologists are leery of mandatory alternative payment models put forward by HHS, but they'll withhold criticism until they see the proposed model.
Radiation oncologists have been champions of alternative payment models, but not necessarily when they are mandatory.
So, there were mixed reactions when Health and Human Services Secretary Alex Azar strongly suggested that radiation oncologists would soon be placed in a mandatory APM.
"We have some reservations about moving forward in a mandatory fashion and really need to learn more about what the secretary has in mind," says Dave Adler, vice president for advocacy at the American Society for Radiation Oncology.
"Our biggest concern would be going 'full mandatory,' where every radiation oncologist is required to participate in this model on Day One," Adler says. "That may be too much and too fast. But it'd be premature to say we object to mandatory model without having those details."
In a speech earlier this month, Azar signaled a shift in HHS policy when he said his department has "reexamined" last year's decision to pull back on episode payment models before they were launched.
"We intend to revisit some of the episodic cardiac models that we pulled back, and are actively exploring new and improved episode-based models in other areas, including radiation oncology," Azar said. "We're not going to stop there: We will use all avenues available to us—including mandatory and voluntary episode-based payment models."
Adler says Azar's comments were not particularly surprising because he's been talking about mandatory APMs since his confirmation hearings in the Senate last January.
In April 2017, ASTRO submitted a model APM to the Center for Medicare & Medicaid Innovation. Adler says the big question now is how much of that proposal HHS will incorporate into any mandatory APM it rolls out.
"It's probably not lost on them that the radiation oncology community has rallied around this model," Adler says. "We think it's a strong opportunity to improve quality and reduce costs in a way that's meaningful for radiation oncology practices and their patients."
First and foremost, Adler says ASTRO's APM proposal calls for physician autonomy.
"When it comes to the payment incentives, when it comes to quality measures, it's got to be things that are in control of the radiation oncologist," he says. "We don't want them to be held accountable for things outside of their control."
Whatever APM is put forward, Adler says there will be little ramp up time for implementation, which is expected to begin on Jan. 1, 2020.
"A lot of the path that got us here has been driven by Congress through legislation that has frozen key radiation therapy payments for the last couple of years to allow CMS time to work with the community to come up with an APM," Adler says.
"That legislation was extended earlier this spring to go through the end of 2019. A lot of stakeholders, ASTRO included, hope we could have this model up and running before no later than the expiration of that legislative deadline," he says.
Adler says ASTRO has gotten good feedback for its APM model from CMMI.
"We have had every indication that they've looked closely at our model, asked a lot of good questions to understand the model and how radiation oncology practices work, so we've really been impressed with commitment at CMMI to learn about the specialty and our model," he says.
"We want to hear the administration out. We want to see what they had in mind, not only on mandatory but for all aspects of the model," he says. "We know what we've proposed, but we don't know exactly what CMS has in mind so we want to ensure that we have ample opportunity to review all aspects of the model and then to consider the pros and cons and look at mandatory in the context of all aspects."
The for-profit hospital chain says it will sell its four remaining hospitals in the Palmetto State as part of its ongoing strategy to consolidate operations and reduce debt.
Debt-laden Community Health Systems, Inc. announced Monday that it will sell its four remaining South Carolina hospitals to the Medical University Hospital Authority in Charleston, S.C.
Financial terms were not disclosed for the deal, which includes clinical and outpatient services, and is expected to be finalized in the first quarter of 2019.
The acquisition will virtually double the number of hospital beds to more than 1,400 for MUSC.
"This transaction is the first time MUSC has acquired other hospitals," said MUSC board Chairman Charles W. Schulze in a media release.
"The additions will increase the size and scale of the MUSC Health network, and in today's environment, larger, more efficient health care systems can deliver greater value to patients and have a positive impact on population health," Schulze said.
In October, CHS announced that it would sell its two-hospital Mary Black Health System to Spartanburg Regional Healthcare System in South Carolina in a deal that is expected to be finalized by year's end.
Franklin, Tennessee-based CHS has sold or announced the pending sale of 16 hospitals so far in 2018. The company has been struggling since its ill-advised $7.6 billion acquisition of Health Management Associates in 2013.
The four hospitals to be sold to MUSC are:
82-bed Chester Regional Medical Center.
225-bed Springs Memorial Hospital in Lancaster.
396-bed Carolinas Hospital System in Florence.
124-bed Carolinas Hospital System—Marion in Mullins.
The four hospitals were among the planned divestitures discussed during CHS's third quarter 2018 earnings call.
The four hospitals in 2017 combined delivered care through more than 129,000 emergency department visits, 159,000 outpatient visits, 18,800 hospital admissions, and 339,000 clinic visits with physicians, MUSC said in a media release.
In 2017, CHS sold 30 hospitals that CHS executives said were low performing. However, a recent report by Axios challenges that assertion.
Even with the divestitures, CHS remains one of the largest publicly traded hospital companies in the nation and owns, leases or operates more than 100 affiliated hospitals in 19 states.
MUSC includes a 700-bed medical center, a pediatric hospital, a cancer center, and a medical school. When the CHS deal is finalized, MUSC will employ more than 16,400 people across South Carolina.
Roughly 60% of MUSC Health patient care revenues are generated outside of the tri-county area of Charleston, Berkeley, and Dorchester counties.
Facing regulatory headwinds and tensions over expansion plans, Harvard Pilgrim and Partners have suspended merger talks that many skeptics believe would have been difficult to finalize.
Harvard Pilgrim Healthcare and Partners HealthCare have suspended merger talks amid reports that the deal was raising concerns by Massachusetts state officials.
"Now isn't the right time to try to push something like that ahead," Partners CEO David Torchiana told the Boston Globe. "I don’t think either organization is sure that it's something that’s actually possible to achieve . . . in this environment right now where there’s such intense scrutiny of every move."
Michael Carson, president and CEO of Harvard Pilgrim Health Care, said in a statement to HealthLeaders Media that: "Our discussions with Partners HealthCare have always been focused on exploring ways we can improve and enhance the patient experience while helping to control costs."
"We continue to evaluate opportunities for collaboration with Partners on this important mission," Carson said.
The talks, which were first reported on sometime last spring, were done largely out of the limelight, but it quickly brought the attention of state officials who raised concerns about increased costs of care to patients post-merger.
WBUR, which first reported that the talks were off, cited unnamed sources who said Partners suspended talks to focus on internal matters.According to WBUR, tensions were forming within Partners' leadership over two sets of expansion plans that include the acquisition of Care New England in Rhode Island. A proposed partnership with Lifespan is off.
The second expansion plan, involving a collaboration with Harvard Pilgrim, raised questions about the complexity of having doctors and insurers manage care and costs together, WBUR reported.
Throughout the negotiating process, observers had said the deal would have to clear some high hurdles.
Kristina Minnick, professor of finance at Bentley University, told the Boston Herald that the federal government is not receptive to large, horizontal mergers in the healthcare sector.
"I think it’s going to be really difficult for the deal to go through," Minnick told the Herald. "Unless they’re able to show that they can offer better service at a lower price — which will be difficult — I doubt at the state level Massachusetts and the attorney general will let it pass."
Even Massachusetts Gov. Charlie Baker, the former CEO at Harvard Pilgrim, had expressed skepticism about the success of the deal.
"There are three really big questions. The first one is what’s the strategic rationale behind it and is it legitimate and justified," Baker told the Herald. "The second is what's it going to do to people's ability to access healthcare here in the commonwealth and the third question is what's it going to do with respect to the cost of health care."
