The buildup will include hospitals in Dallas Fort-Worth, Houston, San Antonio, and two hospitals in the Austin area.
HCA Healthcare, Inc., the nation's largest for-profit health system, announced Wednesday that it was building five full-service hospitals in four Texas cities.
"Communities across Texas are undergoing a rapid increase in population, and the addition of these new hospitals will help our existing network meet the increasing need for healthcare services," HCA CEO Sam Hazen said in a media release. "We are thrilled to expand our presence in Texas, and we believe it will enhance our care and better serve our patients."
The buildup will include hospitals in the Dallas Fort-Worth, Houston, San Antonio, in partnership with Methodist Healthcare Ministries, and two hospitals in the Austin area in partnership with St. David's Foundation and Georgetown Health Foundation.
Nashville, Tenn.-based HCA now operates 45 hospitals and 632 care venues with 60,000 "colleagues" in Texas cities, including Austin, El Paso, the Dallas-Fort Worth metroplex, San Antonio, Houston, Corpus Christi and the Rio Grande Valley.
The publicly traded health system said the new hospitals will complement its presence in rapidly-growing communities across Texas, where it said it has invested more than $6.6 billion in the past five years.
A veteran healthcare executive, Gunasekaran's resume includes more than 20 years in healthcare administration and IT.
University of Iowa Hospitals & Clinics CEO Suresh Gunasekaran, MBA, has been named president and CEO at UC San Francisco Health, effective March 1.
"We have a truly unique opportunity to change the way care is delivered in the Bay Area and beyond by delivering the latest advances and supporting our people in delivering high-quality care," Gunasekaran said in a media release.
"We will achieve this by working with our partners to deliver a system of care that meets patients where they are in a compassionate way. At the heart of this system will be an unwavering commitment to overcome systemic barriers to health equity."
A veteran healthcare executive, Gunasekaran's resume includes more than 20 years in healthcare administration and IT. At UI Hospitals & Clinics, Gunasekaran oversees the state's only comprehensive academic medical center, with 11,000 employees and generating more than $2 billion in revenues.
"Suresh brings an impressive track record of healthcare leadership marked by strategic vision and strong financial performance, in service of his commitment to putting patients first," UCSF Chancellor Sam Hawgood, said in a media release.
"His longstanding dedication to health equity and compassion for the most vulnerable families in our communities, alongside his expertise in transforming health care operations, will guide UCSF Health well in the next stage of its growth," Hawgood said.
Gunasekaran succeeds Mark R. Laret, who retired Dec. 31 after 21 years at the helm.
Opponents of the CalCare single payer bill say it "would create a new and exorbitantly expensive government bureaucracy…ultimately resulting in significant job loss to California."
A broad coalition of 122 business and professional associations is urging the California Assembly to scuttle AB 1400 -- the proposed CalCare single payer bill -- saying it "would create a new and exorbitantly expensive government bureaucracy…ultimately resulting in significant job loss to California."
In a letter to lawmakers, the coalition – led by the California Chamber of Commerce, and including Anthem, Inc., and Blue Shield of California – said previous estimates of similar bills put the cost of the single-payer initiative at more than $400 billion a year, roughly four times the size of Medi-Cal.
"Successfully standing up a new function that would be twice the size of the existing state budget is highly doubtful, given the state’s recent experience with benefit delays and massive fraud in the unemployment system," the letter said.
"The kinds of tax increases needed to finance AB 1400 would detrimentally impact California businesses and certainly discourage companies from growing or relocating here," the letter said. "It would likely lead to significant layoffs or relocations as existing business and employers would be forced to cut costs to sustain the added new tax burden."
In addition, the coalition argued that single payer is not needed because 94% of Californians have healthcare coverage now.
"A majority of the uninsured population is comprised of undocumented individuals," the letter said. "Gov. Newsom's 2022-2023 Budget addresses this very issue and would make California the first state to offer healthcare coverage for all income-eligible residents regardless of immigration status."
White patients were majority users of video telehealth during the first months of the pandemic, but Black patients were 50% more likely to have virtual visits by mid-2020.
More patients are tapping into telemedicine during the COVID-19 pandemic, but while remote visits are growing among Black patients, they still face barriers that limit access, a new study shows.
The study, published online this week in Journal of the American College of Surgeons, found that in-person visits increased among Black and White patients as the pandemic dragged on in mid-2020. And while White patients continued to be majority users of video telehealth, Black patients were 50% more likely to have virtual visits than white patients.
The JACS study looked at 4,908 patients of general and gastrointestinal surgery at a Massachusetts academic medical center between March 24 and June 23, 2020, (Phase I) and from June 24 through December 31, 2020, (Phase II). The dates of the study were selected based on Massachusetts state policies that limited non-emergency surgical services, including outpatient consultations.
"During Phase I, 347 in-person and 638 virtual visits were completed. There were no significant differences in virtual compared to in-person visit use across demographic or insurance groups," the study reported. "Among patients utilizing virtual visits, Latinx and Hispanic patients were less likely to have video compared with audio-only visits than white patients."
Phase II saw 2,922 in-person and 1,001 virtual visits. No significant differences were observed across insurance types. "However, Black patients were more likely to have virtual visits than white patients. Among patients utilizing virtual visits, race or ethnicity and insurance type were not significant predictors of video use."
The study authors at Brigham and Women's Hospital in Boston believe that their findings provide evidence that virtual consultation can increase access to surgical care for underserved populations during the pandemic and beyond. The study called for hospitals to create policies to remote access for underserved populations.
"It's really interesting to sit here in January 2022 and analyze data on virtual care where about two years ago, we hardly ever used virtual care," said study coauthor Ali Tavakkoli, MD.
"The first wave of COVID pushed us to implement this path and format of care where we thought it would not be possible," Tavakkoli said. "Now the data, including this study, show that it can be done, and it can be done safely."
However, the study noted that technological barriers hamstring efforts to connect underserved populations to remote care. The study cited Federal Communications Commission findings that more than 21 million Americans still lack broadband access, and that internet capable device ownership remains disproportionately lower among low-income and older Americans.
"The surge in telemedicine has focused attention on the digital divide and highlighted the limited ability of vulnerable populations to access and use telemedicine," said study lead author Gezzer Ortega, MD, MPH, of Brigham and Women's Hospital in Boston.
DOJ had alleged that from December 2015 to October 2019, UC San Diego Health submitted claims to Medicare for the unneeded tests.
UC San Diego Health has paid $2.98 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary genetic testing reimbursed by Medicare, the U.S. Department of Justice said.
DOJ had alleged that from December 2015 to October 2019, UC San Diego Health submitted claims to Medicare for the unneeded tests, which were processed by the now-shuttered CQuentia Arkansas Labs, CQuentia NGS and Total Diagnostic II.
"Ordering unnecessary genetic tests creates a drain on vital government-funded health care programs like Medicare," said U.S. Attorney Randy Grossman for the Southern District of California.
Tennessee-based CQuentia, now closed, was itself the subject of a federal False Claims Act lawsuit in 2017 alleging that the company made bogus claims to consumers that its genomic tests could protect them from adverse drug reactions.
UCSD Health issued a statement acknowledging the settlement but admitted no liability.
"When UC San Diego Health learned that the Department of Justice had concerns about one of our technology providers, we fully cooperated and promptly resolved the matter," the health system said in prepared remarks.
"The DOJ's settlement announcement alleges that our doctors ordered tests from a company that then allegedly made false claims about those orders. This settlement does not assign any liability to UC San Diego Health and provides a prompt resolution that allows us to continue our focus on providing outstanding care for patients."
The suit alleges that Aliera falsely represented Sharity/Trinity as a legitimate HCSM that satisfied the ACA's standards for exemption.
California Attorney General Rob Bonta has filed a lawsuit against The Aliera Companies and the Moses family, founders of Sharity Ministries, Inc., alleging that the payer bilked consumers out of premiums.
According to the suit, Atlanta-based Aliera, a for-profit company, created and ran Sharity (formerly called Trinity Healthshare, Inc.), as a nonprofit corporation that purported to be a healthcare sharing ministry.
However, the suite notes that Aliera has never fit the legal definition of an HCSM, which requires that they be an IRS 501(c)(3) nonprofit in existence since December 31, 1999.
The suit alleges that Aliera falsely represented Sharity/Trinity as a legitimate HCSM that satisfied the ACA's standards for exemption.
The nonprofit payer allegedly collected hundreds of millions of dollars from beneficiaries across the nation, but declined claims and kept nearly 84% of premiums, enriching the owners but leaving many beneficiaries with crushing medical debts, the AG said.
"Aliera preyed on consumers who, in many cases, thought their monthly payments were being used to help others who shared their faith and religious beliefs," Bonta said in a media release. "Instead, Aliera and the Moses family funneled its members’ payments into their own pockets.”
"When members suffered medical emergencies, their problems were compounded by Aliera claiming it had no obligation to pay medical costs, he said. "Aliera's sham business is unlawful and our lawsuit seeks to ensure they are held to account to pay the price for the Californians they lured in and cheated."
Aliera did not repsond to HealthLeaders' request for comment.
Before the Affordable Care Act, HCSMs allowed people to pool their money with others who shared their religious beliefs to assist one another during times of medical crisis.
Some companies also began to capitalize on the exemption of HCSMs from many of the coverage mandates in the ACA by marketing their plans as a less-expensive alternative to ACA-compliant health insurance.
However, HCSMs do not guarantee payment for covered services or coverage for essential health benefits, like birth control, prescriptions, preexisting conditions, and mental health care.
Peter V. Lee, executive director of Covered California, said the allegations "provide a chilling reminder of the dark days of health insurance, when some companies took advantage of people by offering Swiss-cheese coverage that was full of holes, when benefits were routinely rejected and people were left with enormous medical bills."
In April 2021 Bonta's office issued a consumer alert after fielding consumer complaints alleging that their HCSM plans refused to cover treatments and pay their medical bills.
Carmela Coyle, president and CEO of the California Hospital Association, called the additional COVID funding "essential to helping hospitals and other providers respond to the record number of patients."
The California Hospital Association is backing Gov. Gavin Newsom's call to expand Medi-Cal to all eligible Californians, including an estimated 764,000 undocumented immigrants.
Carmela Coyle, president and CEO of the California Hospital Association, called the proposal "the final step needed to ensure that California becomes the first state in the nation to achieve universal health care coverage."
The proposed expansion of Medi-Cal was one of several healthcare initiatives unveiled in Newsom's budget, which also includes nearly $3 billion over five years to support behavioral health services, a $2.7 billion COVID emergency response package, and $1.7 billion for improvements to the state's public health infrastructure and to support frontline healthcare workers.
"Doubling down on our actions to reduce costs for middle-class families and expand access to important services, this proposal is a transformative step towards strengthening the healthcare system for all Californians," Newsom said. "Everyone is healthier when everyone has access to quality, affordable care."
Coyle called the additional COVID funding "essential to helping hospitals and other providers respond to the record number of patients."
"This funding will help ensure that providers have the supplies and staffing necessary to care for all those affected by COVID-19," she said.
Coyle also praised the governor's workforce expansion initiative, "especially those focused on workers providing care, included in the governor’s budget proposal," Coyle said.
"The healthcare field is facing a severe shortage of nurses, doctors, and other critical health care workers that will span years, if not decades," she said. "We urge state leaders to invest resources to help rebuild our depleted health care workforce."
The Alzheimer's Association called the CMS draft "a shocking discrimination against everyone with Alzheimer’s disease."
Medicare would pay for a limited class of pricey and controversial anti-amyloid drugs used to treat Alzheimer's disease, but only for seniors already enrolled in qualified clinical trials, under a proposed National Coverage Determination decision memorandum issued Tuesday by the Centers for Medicare and Medicaid Services.
The proposed NCD would cover only Food and Drug Administration-approved monoclonal antibodies -- such as Biogen's Aduhelm -- that target amyloid protein aggregates in early stage Alzheimer's patients with mild cognitive impairment.
Adulelm costs about $28,000-a-year per patient, and results so far have been mixed. While CMS and FDA do not take a drug's price into consideration when determining coverage, federal officials in November said the high cost of the drug was partially to blame for the $21-a-month increase in Medicare Part B premiums. However, Health and Human Services Secretary Xavier Becerra this week ordered Medicare to reassess the increase. CMS officials stressed that the proposal had no bearing on Becerra's comments.
CMS Administrator Chiquita Brooks-LaSure said the proposed NCD will give the public "a clear, trusted, evidence-based decision that is made only after a thorough analysis of public feedback on the benefits and risks of coverage for Medicare patients."
"CMS has proposed an evidence-based coverage policy after experts reviewed all relevant publicly available evidence and feedback received from stakeholders," she said.
Public comments on the NCD will be accepted over the next 30 days, and a final decision is expected by April 11.
The pharmaceutical lobby and Alzheimer's patient advocates let their disapproval be known within minutes of CMS's announcement late Tuesday afternoon.
Biogen said the draft "denies nearly all Medicare beneficiaries" from accessing its product and future amyloid-targeting therapies.
"It is imperative to change this draft decision to be aligned with reimbursement for other therapies for progressive diseases, where patients have immediate and equal access to medicines approved by the FDA," Biogen said in a media release.
PhRMA spokesperson Nicole S. Longo called the draft "another setback for patients suffering from Alzheimer's disease and their caregivers."
"With this proposal, CMS is writing off an entire class of medicines before multiple products have even been reviewed by FDA, positioning itself and not FDA as the key arbiter of clinical evidence," she said
The Alzheimer's Association called the CMS draft "a shocking discrimination against everyone with Alzheimer’s disease, especially those who are already disproportionately impacted by this fatal disease, including women, Blacks and Hispanics."
"With this approach, access to treatment would now only be available to a privileged few, those with access to research institutions, exacerbating and creating further health inequities," the association said.
"Critically, this draft decision is not about one treatment but about this class of potential future treatments targeting amyloid for the treatment of Alzheimer's disease. This draft decision appears focused on an individual treatment rather than a class, which is not what CMS set out to do."
George Vradenburg, chairman and co-founder of UsAgainstAlzheimer's, called the proposal "absolutely unacceptable" and noted that CMS's limiting Medicare coverage for an FDA-approved drug shows that "HHS is clearly at war with itself."
"If this decision stands, for the first time in history, millions of Americans will be denied coverage not just to a drug, but to a whole class of drugs—not by the agency that regulates drugs but by the federal insurance bureaucracy," Vradenburg said.
"Why are treatments for Alzheimer's patients being held to a different standard than those treating cancer, HIV, and other illnesses," he said. "Is it because there are so many of us? Is it because we’re old? CMS should be ashamed of the way it is discriminating against this one group of patients."
At a media teleconference Monday afternoon, CMS CMO Lee Fleisher, MD, director of the Center for Clinical Standards, said the NCD is limited in scope because "our obligation is to ensure that we look at approved treatments that are shown that benefits and those benefits outweigh the harms."
"We are making sure that the patients in this clinical trial will reflect the population of patients who have Alzheimer's in the Medicare population."
The average size of the smaller hospital partner by annual revenue increased to $619 million from $388 million in 2020.
There were fewer hospital mergers and acquisitions in 2021, but the deals that went through involved bigger health systems generating almost twice as much revenue when compared with M&As in 2020, Kaufman Hall reports in a new analysis.
Of the 49 consolidations identified in the KH analysis in 2021, eight (16.3%) were classified as "mega mergers," with the smaller partner's average annual revenues surpassing $1 billion. This was nearly double the percentage from 2020 (8.9%) and the highest in six years, KH said.
Overall, the average size of the smaller hospital by annual revenue increased to $619 million in 2021 from $388 million in 2020, KH reports.
The analysis identified several factors limiting smaller mergers in 2021, including the fact that there are simply fewer smaller, independent, unaffiliated community hospitals looking for a partner, and that acquiring hospitals are getting choosier.
"Organizations are focused on partnerships with a strong strategic rationale and have become increasingly selective in identifying potential partners," KH said. "They seek partnerships that will have a transformative impact through the addition of new capabilities, enhanced intellectual capital, and access to new markets or services."
The analysis also noted that:
Smaller M&A partners with a credit rating of A- or better comprised more than 10% of transactions, which is consistent with 2020 transactions.
Since 2011, average smaller partner size by annual revenue has increased at a compound annual growth rate (CAGR) of approximately 8%.
Not-for-profit health systems' roles as both buyer and seller grew as a percentage of total transactions in 2021, representing 87% of announced transactions, compared with 81% in 2020.
Rural or urban/rural sellers grew to 31% of announced transactions from 24% in 2020. The number of financially distressed sellers remained flat at 16% of announced transactions from 2020 to 2021.
Other notable trends identified in the analysis include hospitals’ greater focus on core markets and assets, strengthening intellectual capital resources, and addressing societal issues and underserved populations.
KH says these trends are expected to continue into 2022.
Established in 1998, the SDP can be used by providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties to voluntarily disclose self-discovered evidence of potential fraud.
Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a government-directed investigation and civil or administrative litigation. The revision unveiled this week incorporates legal changes made since the last revision to the SDP in 2013.
What's changed?
Increased the minimum amounts required to settle under the SDP to match new statutory minimum penalty amounts.
Required SDP submissions to be made through the HHS-OIG website.
Added references to OIG's 2019 Grant and Contract SDPs.
Clarified that CIA Reportable Events can be disclosed under the SDP.
Clarified that DOJ sometimes settles SDP cases.
Clarified that disclosures must include damages to each affected federal healthcare program and the sum of all damages.
Made technical changes to statistics, terminology and background facts.
What hasn't changed?
Timelines and content requirements.
Methods for calculation of damages.
Timely settlement with a lower multiplier and an exclusion release.
