Mayo 'shocked and deeply saddened by the wholly inaccurate and incomplete reporting' of alleged medical kidnapping. CNN stands by its coverage.
It's been an eventful week for the Mayo Clinic.
On Tuesday, the renowned Rochester, Minnesota–based health system was named the nation's best hospital for the third straight year in the widely read annual rankings from U.S. News & World Report, which includes metrics such as patient experience.
On Wednesday, however, Mayo was the subject of a less-favorable patient experience story in a scathing investigative journalism piece on CNN.
The cable news channel reported that Mayo attempted to "medically kidnap" 18-year-old Alyssa Gilderhus, a high school senior who'd spent two months at the hospital after suffering a ruptured brain aneurism.
The reporting highlights raw video of Mayo staffers grabbing Gilderhus by the arm while she was in a wheelchair and allegedly trying to stop her from leaving the hospital with her family.
"She was truly being held captive," her grandmother, Aimee Olson told CNN. "I would never believe a hospital could do that—never in my wildest dreams."
On Thursday, Mayo went public and called the CNN piece "inaccurate, incomplete and irresponsible reporting."
"A team of Mayo Clinic leaders met with CNN for more than four hours to give them context and share insights to inform their reporting and help them see that there were highly complex and sensitive family dynamics involved in caring for this patient," Chris Gade, chair, Mayo Clinic Department of Public Affairs, said in a media release.
"While we knew the reporter was focused on a pre-determined narrative, the information we provided should have helped them see that their premise was inaccurate. Instead they chose to ignore that information," Gade said. "We were shocked and deeply saddened by the wholly inaccurate and incomplete reporting that was published."
In a letter to Rick Davis, CNN's executive vice president for standards and practices, Gade called Gilderhus's experience "a complex situation involving a vulnerable adult in a suspected abusive family environment."
Gade ticked off a 12-point critique of the reporting that included allegations that CNN contacted patient care staff "with veiled threats and ask(ed) them to breach confidentiality in order to corroborate information."
The magazine's renowned ranking system, now in its 29th year, is ostensibly designed to help patients choose care venues, but much of its importance lives in the eyes of industry insiders.
The U.S. News & World Reportannual hospital rankings continue to be an industry-wide must-read for the hospital sector.
But what do the rankings really mean? Do they matter? That depends on who you are.
While the rankings are purportedly designed to help consumers pick care venues, one researcher says the annual list is far more important to hospital executives than potential patients.
Riba spoke with HealthLeaders Media about the U.S. News rankings, and how to place it in a proper perspective. The following is a lightly edited transcript.
HLM: Why do these rankings continue to be so popular?
Riba: The short answer is the brand. They're known for their rankings, and that U.S. News & World Report seal. It's identifiable and people associate it with rankings, and not just in healthcare but in education, colleges. They've done a brilliant job positioning and branding themselves.
HLM: The rankings target consumers, but seem to get more attention from within the hospital industry.
Riba: The biggest "wows" actually come from within the industry. I work at the University of Michigan. We are ranked No. 5 on the list and U of M was very proud of it, and immediately circulated the news in our internal newsletters. It was up on the website within milliseconds of being released. It's a point of pride. It's a marketing tool for the industry.
HLM: So then, who is served with these rankings?
Riba: This is absolutely meant to be consumer-facing, but what we've learned from the research is that consumers don't really use these rankings to decide where they're going to get care.
Where does their doctor recommend they go because they have that trusted relationship? Family and friends have recommendations too. But overwhelmingly it's geography. People rarely have the ability to go to another part of the state or the country to get this care. U.S. News acknowledges that. It is not realistic to think consumers are going to go to U of M if you're living in Iowa.
HLM: What is the value of these rankings?
Riba: By and large, it is a marker of quality. U.S. News has a rigorous, systematic way that they develop these rankings. As we've also found, with all the different rankings out there, there are a hundred hospitals who can say "We're No. 1" in some area, and that can be confusing. Questions need to be raised about what they're measuring and indicating as "best," and those vary.
HLM: It sounds like you're saying that the rankings' biggest value is as a marketing tool.
Riba: I don’t want to sound cynical, but yes and no. There is some method that indicates a level of quality but it is based on that particular ranking system and how they are defining quality, and that is where it gets confusing for consumers.
Most people don't get into metrics. Most people just want to know "Am I going to go in, and am I going to come out, and am I going to feel OK. Are they not going to kill me?"
In general, all of these rankings are an indicator of some kind of quality, but that varies depending upon who's doing the ranking. And it can give consumers some modicum of comfort knowing they're going to a great hospital. But, there are other things that weigh into the decisions of where to go, and there are lots of things that go into making high-quality care.
HLM: Do hospitals game the rankings?
Riba: I don’t know that I'd call it gamesmanship, but sometimes it is a little like teaching to the test. That's across the board. Anytime you get to performance and quality metrics that say "this is what you're going to be graded on," some organizations are going to put their resources toward achieving that.
Hospitals that teach to the test might put more resources and effort into the patient experience, for example. That's great! We want patients to be happy and have the great experience, but some would argue that's not the best indicator of quality.
HLM: Is there much of a difference between No. 1 and No. 50 hospitals?
Riba: It depends on what's being measured. For example, U of M ranks No. 5 on the U.S. News Honor Roll. IBM Watson also does a ranking. They have different goals and they use publicly available claims data so they are very hard data oriented. U of M doesn't appear in their Top 100. Different criteria, different outcomes.
Saying you're No. 1 is great. It makes people feel good. It provides a marker and indicator of quality. But the quality is based on that specific methodology that the ranking organization has set up. It's really like oranges to apples when you're trying to compare.
HLM: What caveats do you apply when looking at this ranking?
Riba: For a consumer, it's one of many pieces of information you want to consider. The fact that a hospital is ranked in these specialties maybe is a good starting point. But you also want to see what your doctor recommends, and talk to friends and family about their outcomes. Maybe not just rely on one ranking, but use multiple sources to see where you want to go for care.
For hospitals that didn't make it in, it helps them understand where they can improve and it is incumbent on them to determine where they want to put their resources to improve.
For hospitals that win, celebrate a win for your organization. But also it’s not the end all, be all.
The Catholic health system says the decision to sell comes after a yearlong 'thoughtful and deliberate process' to determine the long-term sustainability of the three hospitals.
SSM Health is negotiating with the University of Missouri Health Care and Mosaic Life Care "to explore transferring ownership" of three SSM hospitals in Jefferson City, Maryville, and Mexico, Missouri.
The St. Louis-based, Catholic, not-for-profit health system this week entered exclusive discussions with MU Health to sell its Mid-Missouri hospitals, which include SSM Health St. Mary's Hospital—Jefferson City and SSM Health St. Mary's Hospital—Audrain, with affiliated outpatient, home care, hospice and medical group venues in the region.
SSM Health is also in exclusive discussions with St. Joseph-based Mosaic Life Care to sell SSM Health St. Francis Hospital—Maryville and ancillary services in the northwestern Missouri.
The three health systems have begun a due diligence process that is expected to take several months and the terms of the deals are still being finalized.
SSM said the decision to sell the hospitals came after a yearlong "thoughtful and deliberate process" by the board of trustees, which weighed options to ensure the long-term sustainability of the three hospitals.
"The healthcare industry has shifted dramatically over the past several years," SSM President/CEO Laura S. Kaiser said in amedia release.
"In order to provide safe, high-quality healthcare services that are convenient and affordable, health systems must integrate all points of service across the entire continuum of care."
"Given the close proximity of MU Health Care and Mosaic Life Care’s existing services, we feel this transition of ownership will best serve the people of Jefferson City, Mexico, Maryville and surrounding communities," she said.
MU Health CEO Jonathan Curtright said the two hospital acquisitions in mid-state will create new opportunities to train physicians and other clinicians, while providing care access for patients in underserved rural areas.
"As an academic health system, we will be able to offer these communities improved access to our comprehensive integrated health care services that include the latest treatments and leading-edge research available," he said.
Mosaic Life Care, a member of the Mayo Clinic Care Network, includes three hospitals and more than 60 outpatient locations, urgent care clinics and doctors' offices in Northwest Missouri.
Mosaic CEO Mark Laney, MD, said the health system has pledged to "further expand access to important services needed throughout rural communities in Northwest Missouri–while helping our patients become the healthiest versions of themselves."
The post-acute care provider admitted no wrongdoing, and claimed that 'many' of the allegations 'commenced long before Post Acute acquired the facilities.'
Pennsylvania-based Post Acute Medical, LLC will pay the federal government, Texas and Louisiana $13.1 million to resolve whistleblower allegations that it knowingly paid physicians and other providers illegal kickbacks for referrals, the Department of Justice said.
DOJ alleged that Post Acute had been running the kickback scheme that involved numerous physician-services contracts with its hospitals that started when the post-acute care provider was founded in 2006.
"Although the purpose of these contracts was ostensibly to retain physicians as medical directors or in other administrative or medical roles, the United States alleged that in reality the company’s payments under these contracts were intended to induce the physicians to refer patients to PAM's facilities," DOJ said.
Prosecutors alleged that Post Acute violated the Anti-Kickback Statute and the Stark Law banning self-referrals by using what it called "reciprocal referral relationships” with unaffiliated healthcare providers such as home health companies, billing Medicare and Medicaid for the services.
"In the course of those arrangements, PAM allegedly referred patients to those other providers with the understanding that those providers would refer other patients to PAM’s facilities," DOJ said.
Post Acute posted a statement on its website noting that the payment resolves allegations that first surfaced in 2012, "raising certain issues related to physician relationships in some of the facilities it had previously acquired."
"Although Post Acute disputes that there were any substantive defects with respect to those relationships from a compliance and documentation perspective, many of which commenced long before Post Acute acquired the facilities, in the interest of moving forward and avoiding continued expense, Post Acute agreed to an amicable resolution with the government which it did not acknowledge any violations of applicable rules," Post Acute said.
Prosecutors offered a different perspective.
C.J. Porter, agent in charge for the U.S. Department of Health and Human Services Office of Inspector General, said the "alleged kickbacks and improper physician relationships threatened the impartiality of medical decision-making and the financial integrity of Medicare and Medicaid."
Under the settlement, Post Acute will pay $13,031,502 to the federal government, $114,016 to Texas, and $22,482 to Louisiana. Douglas Johnson, the whistleblower who initiated the federal complaint, will collect $2.3 million as his share of the federal government's recovery.
The health system has also entered into a five-year corporate integrity agreement with the federal government, which Post Acute called "a positive step in continuing its commitment to all regulatory and compliance obligations."
In 2005, CEOs at major nonprofit health systems made three times as much as orthopedic surgeons. In 2015, they made five times as much. The disparity grew even wider for pediatricians and registered nurses.
The wage gap between senior executives and the physicians and nurses they employ at 22 major nonprofit health systems across the nation widened considerably over a decade, with clinicians on the lagging end.
The inflation-adjusted average compensation for CEOs at these medical centers increased from $1.6 million in 2005 to $3.1 million in 2015, a 93% increase, according to a new studyin Clinical Orthopaedics and Related Research.
Over the same decade, compensation rose by 26% for orthopedic surgeons, 15% for pediatricians, and 3% for registered nurses, the study showed.
"There is a fast-rising wage gap between the top executives of major nonprofit centers and physicians that reflects the substantial, and growing, cost-burden of management and nonclinical worker wages on the U.S. healthcare system," lead author Randall E. Marcus, MD, of University Hospitals Cleveland Medical Center/Case Western Reserve University, said in remarks accompanying the study.
In 2005, hospital CEOs made three times as much as orthopedic surgeons. In 2015, they made five times as much. There were larger increases in the wage gap between CEOs and pediatricians, from 7:1 to 12:1; and CEOs and registered nurses, from 23:1 to 44:1, the study found.
The researchers also looked at the rising numbers and costs of managers and other nonclinical workers. In 2015, there were 10 nonclinical workers for every one physician.
Nationwide, healthcare wages grew from $663 billion in 2005 to $865 billion in 2015. Nonclinicans accounted for 27% of this growth, managers for 7%, and physicians for 18%, the study said.
National healthcare expenditures increased from $2.5 trillion in 2005 to $3.2 trillion in 2015, with wages accounting for more than one-fourth of the growth that took place despite relatively stable use of healthcare services over the decade, the study said.
The study suggested the growing numbers of nonclinicians and their compensation increases "appear to outpace plausible growth in value."
"It appears unlikely to us that the near-doubling of mean compensation to hospital executives is justified by the value added by their work," the study said.
"The value of each nonclinical healthcare worker, including executives, should be of concern to all of us and scrutinized closely by the boards of directors of these nonprofit medical centers."
With the new name, the faith-based health system says it 'will move to being one consumer-centric, connected and identifiable national system of care for every stage of life and health.'
Adventist Health System is changing its name to AdventHealth.
The Altamonte Springs, Florida-based health system said its nearly 50 hospitals and hundreds of care venues in 10 states will adopt the AdventHealth name and logo beginning Jan. 2, 2019.
"We are transforming to be a more consumer-focused healthcare system to better meet the needs of those we care for and the communities we serve," Adventist CEO Terry Shaw said in a media release.
"Becoming AdventHealth allows us to be a fully integrated and distinguishable health system across all aspects of the care continuum, while also speaking to our Christian healing ministry, message of wholeness and our rich Seventh-day Adventist roots," Shaw said.
Adventist will launch a "transition campaign" next month that will include TV and print ads in markets across the country. New signage and optics at hospitals and other care venues will be installed when the name change takes effect Jan. 2. Joint venture facilities will not change names.
Adventist did not say how much the rebranding will cost, but stressed that the health system is not changing owners, business structures, or its faith-based mission.
"We want our hospitals and care sites to be places where people can experience hope as well as healing," Adventist Board Chair Gary Thurber said.
"The AdventHealth name so appropriately expresses that sense of expectation and optimism while also connecting with our promise of wholeness and our rich faith-based heritage,” he said.
S&P Global Ratings lowers the credit rating after noting the significant debt burden ProMedica assumed to finance the acquisition that essentially doubled its size.
ProMedica Healthcare has taken a hit on its credit rating for the $3.3 billion acquisition of HCR ManorCare.
S&P Global Ratings on Tuesday lowered the health system's debt obligations to "BBB" from "A+" with a stable outlook.
ProMedica on July 26 acquired bankrupt HCR ManorCare in a deal that made the 13-hospital, Toledo-based health system the 15th largest in the nation by revenue, with 70,000 employees in 30 states.
The joint venture with real estate investment trust WellTower was hailed as a "first-of-its-kind partnership" that gives not-for-profit ProMedica immediate scale in the fast-growing home health and post-acute care markets.
A WellTower subsidiary acquired HCR ManorCare's real estate and assets, and ProMedica bought 20% of the subsidiary, with which it also entered into long-term lease.
S&P Analyst Anne Cosgrove said "the multi-notch downgrade reflects the significant debt issuance of $1.15 billion and cash usage of $524 million to fund ProMedica's full acquisition of HCR ManorCare's operations but not most of the hard assets, as well as the 20% investment in the real estate joint venture with WellTower."
While the new debt load and lease "significantly pressures" ProMedica's projected debt burden, S&P notes that cash flow could be stronger with the acquisition, "and there are strategic opportunities for ProMedica to diversify revenues and grow outside of the immediate northwest Ohio Market."
However, there remains uncertainty around the post-acute care industry, which S&P notes "has experienced significant operating pressures, particularly about reimbursement and occupancy in recent years."
"The stable outlook reflects our expectation that management will execute on its integration plan of HCR ManorCare into ProMedica effectively such that the organization maintains healthy cash flow that generates adequate coverage levels and unrestricted reserve metrics as projected," S&P said.
The bond rating agency left open the possibility of lowering the rating again over the two-year outlook period "if operating performance and cash flow fail to meet operating targets or materially deviate from expectations provided in management's combined projections."
S&P said a ratings upgrade was unlikely given the significant debt, the "sizeable" operating lease, and the use of cash to finance the deal.
"However, we could do so if ProMedica generates significantly increased operating cash flow and rebuilds overall unrestricted reserves to levels commensurate with a higher rating," S&P said.
"Integration success, achieving the acquisition's key strategic goals, and the ability to operate in the long-term care space will also be important factors in future upward rating potential," S&P said.
In the face of glowing recommendations by independent analysts, the billionaire hedge fund manager has dropped his opposition to the proposal that last week he called 'a $60 billion folly.'
Carl Icahn has dropped his opposition to Cigna's proposed $54 billion purchase of pharmacy benefits manager Express Scripts, after the deal was vetted and recommended by two independent analysts.
"In light of the ISS and Glass Lewis recommendations in favor of the Cigna/Express Scripts transaction and the significant stockholder overlap between the two companies, we have informed the SEC that we no longer intend to solicit proxies to vote against the transaction," Icahn said in a media release.
Icahn's terse reversal, coming one week after he called the proposal "a $60 billion folly" and urged shareholders to reject the deal, should put an end to a very public spat the billionaire hedge fund manager waged with Cigna leadership.
Cigna CEO David M. Cordani issued alengthy statement detailing "the favorable recommendations from both Glass Lewis and ISS as momentum continues to build in support of our merger with Express Scripts."
"Their recommendations underscore the significant shareholder value that this transformative merger will deliver in a highly dynamic market environment," Cordani said.
Icahn, who owns a sliver of Cigna's outstanding stock, had argued that Express Scripts is too big and risky of a bet
However, his critique provided a sharp contrast to the Glass Lewis analysis, which positively gushed over the proposal, and said it "represents an attractive opportunity to create a more diverse and integrated business model in the evolving healthcare services industry which will be better positioned to serve consumers, adapt to competitive and structural challenges, respond to regulatory changes, capitalize on growth opportunities and potentially realize significant incremental cost savings and operational efficiencies."
U.S. News & World Report's rankings, now in their 29th year, compare more than 4,500 hospitals nationwide in 25 specialties, procedures and conditions.
For the third consecutive year, Mayo Clinic sits atop the Honor Roll of the nation's top hospitals, as rankedby U.S. News & World Report.
"We are humbled and honored by our ranking with U.S. News & World Report," said Gianrico Farrugia, MD, the CEO of Mayo Clinic in Florida. Farrugia was named CEO-electof the prestigious Rochester, Minnesota-based health system last week.
"We have continuously refined our system of care for more than 150 years. We are always working to deliver accurate answers as quickly as possible and ensure the best outcomes for our patients," Farrugia said.
Honor Roll designation is awarded to 20 hospitals that U.S. News said demonstrate high-level care in multiple areas. After Mayo, the other prestigious hospitals and medical centers on this year's Honor Roll either stood pat or shuffled a few spots up and down from the rankings of previous years.
Here’s the 2018-19 Best Hospitals Honor Roll. The numbers in parentheses are the 2017-18 rankings.
Mayo Clinic, Rochester, MN (1)
Cleveland Clinic (2)
Johns Hopkins Hospital (3)
Massachusetts General Hospital (4)
University of Michigan Hospitals-Michigan Medicine (6)
In addition, nearly 160 hospitals were nationally ranked in at least one specialty from among the more than 4,500 hospitals that were evaluated.
U.S. News says its methodology for determining the nation's Best Hospitals is "based largely or entirely on objective measures such as risk, adjusted survival and readmission rates, volume, patient experience, patient safety and the quality of nursing."
New this year, the magazine said the rankings include more emphasis on patient experience and outcomes measures. For the first time, the procedures and conditions ratings used ICD-10 to achieve comparability in patient populations and outcomes.
The health system wants the food it serves to align with its missions to care for and educate patients with heart disease, diabetes, and obesity-related chronic illnesses.
In the coming months, the University of Pennsylvania Health System will take the healthy foods initiative a step further and phase out the sale of sugary drinks on its campuses, noting the direct link between the sweet beverages and the increased risk of obesity and Type 2 diabetes.
The list of banned added-sugar beverages takes effect over the next several months and will include regular soda, fruit-flavored drinks, sports drinks, and sweetened milk, tea and coffee drinks. Diet and unsweetened beverages, 100% fruit juice, milk and flavored-waters will still be available, Penn Health said.
"As a health system, we aspire to create a model environment for the health and wellness of our patients, their families, and our employees, an effort which extends to the food and drinks we serve in our cafeterias, snack bars, coffee stands, and vending machines," Penn Medicine CEO Ralph Muller said in a media release.
"Our work to prevent and care for patients with chronic conditions impacted by their diets includes educating them on healthy food and beverage choices—lessons which we believe should be mirrored by what we serve in our facilities," he said.
Penn Health said patients, visitors and staff will still be able to bring their own sugary drinks on campus, and third-party vendors within hospitals—such as Starbucks—will continue to serve sweetened drinks, such as the sugar-infused Gingerbread Frappuccinos, which can contain up to 70 grams of sugar.
