Six independent pharmacies in Texas have filed a federal law suit against CVS Caremark charging the drug retail giant and pharmacy benefits manager with violations of the Racketeer Influenced and Corrupt Organizations Act and trade secret misappropriation.
The complaint also alleges that CVS Caremark contracts requiring patients to buy maintenance medications only from CVS Caremark violate Texas' "Any Willing Provider" law.
"CVS Caremark traps patients and non-CVS retail pharmacies in a scheme to deny patient choice of pharmacy and to smother business competition," said Amanda Gohlke Fields, general counsel for plaintiffs American Pharmacies, a for-profit, member-owned pharmacy wholesale buying group.
CVS Caremark corporate spokeswoman Christine K. Cramer said the company is reviewing the suit. "CVS Caremark is confident that its business practices and service offerings, which are designed to reduce healthcare costs and expand consumer choice, are being conducted in compliance with applicable antitrust, privacy and other laws," Cramer said.
The suit claims CVS Caremark violates the firewall between the retail pharmacy and the pharmacy benefits manager divisions as required when the Federal Trade Commission approved the CVS and Caremark 2007 merger. Instead, the combined company built an information technology platform that straddles all of CVS Caremark's business segments, capturing in-depth patient data for marketing and other purposes in violation of HIPAA patient privacy laws, the suit alleges.
Patient information gathered from non-CVS pharmacies includes names, addresses, birth dates, medical diagnoses, prescription histories, and prescribing physicians. CVS Caremark mines the accumulated patient- and pharmacy-specific data to identify individual patient buying practices, their physicians' prescribing practices, and individual pharmacy business volume, the suit alleges.
American Pharmacies says patients report being forced, via higher copayments and refusal to cover maintenance medications, to leave their pharmacy where the patient and pharmacist have a professional and personal relationship. Other patients report moving to a CVS Caremark network pharmacy out of fear of losing all health insurance coverage, the suit alleges.
Woonsocket, RI-based CVS Caremark contacts patients via direct mail and phone calls about their prescriptions, urging, and in some cases mandating, plaintiffs' patients to use CVS Caremark retail or mail order stores. The patients' physicians also are targeted to change prescribing practices to include drugs from CVS Caremark-favored drug makers, the suit alleges.
"The defendants have an ambitious plan to take over 200 independent pharmacies per year," Fields said. "Taking trade secrets from their competitors' business records and excluding plaintiffs from CVS Caremark's pharmacy networks plays right into their plan. Knowing just how vulnerable a non-CVS pharmacy may be puts that pharmacy squarely in CVS Caremark's crosshairs."
The American Pharmacies plaintiffs want triple damages for the RICO violations, and an injunction barring CVS Caremark's practices in the future. The trade secret misappropriation claim includes a request for exemplary damages.
Whether by choice, cost, or lack of alternatives, patients are increasingly turning to their primary care providers for mental health services, a study from the Center for American Progress shows.
More than half of treated patients now receive some form of primary care for their mental disorder, mostly from a primary care doctor, and primary care is now the sole form of healthcare used by more than one-third of patients with a mental disorder accessing the healthcare system, said the study Mental Health Care Services in Primary Care: Tackling the Issues in the Context of Health Care Reform.
The study's author, Lesley Russell, said improving the integration of mental health services needs to be addressed as healthcare reform centralize primary care in the delivery and coordination of healthcare.
Key issues to address include:
Mental health workforce shortages and distribution problems
The ability of the primary care workforce to diagnose and treat mental health disorders
The lack of financial incentives for primary care providers to deliver mental healthcare
Insurance and financial barriers for patients seeking treatment for mental health disorders
Patients’ perceptions and fears that are barriers to accessing appropriate treatments for mental health disorders
The quality of mental health services
Co-morbidities of mental health disorders with physical illness and substance abuse
The need for early diagnosis and intervention
Racial and ethnic disparities in mental health services
The structure of the healthcare system as an impediment to the integration of mental health services
Suburban Chicago's Delnor Health System and Central DuPage Health have announced plans to merge and create a single, integrated health system.
The two systems have signed a memorandum of understand, and will undergo due diligence over the next several months, with the hope of expanding and broadening healthcare services for Chicago's western suburbs. The final agreement is subject to government approval.
"This relationship holds such great potential for making healthcare even better for our patients, physicians and staff at a time of unprecedented change in the industry," said Thomas L. Wright, president/CEO of 159-bed Delnor Hospital, in Geneva, IL, in a joint media release. "The two hospitals have a deep respect for one another's teams of highly talented professionals, dedication to innovation and track records in providing high quality care. Further collaboration will strengthen our ability to provide exceptional levels of clinical care and become more responsive to the new requirements of healthcare reform, while also delivering an extraordinary patient experience."
Luke McGuinness, president and CEO of CDH, which includes the flagship 313-bed Central DuPage Hospital in Winfield, IL, said the merger would: "build on the momentum of our respective investments in primary care, specialty care and advancement of the destination service lines at both campuses. Together, Delnor and CDH will build a health system synonymous with efficient, high quality, advanced care in the communities we serve."
The memorandum of understanding names McGuinness CEO of the new health system, but he and Wright will continue to oversee their respective hospitals through the due diligence process. Wright will continue as both president of Delnor and as an executive leader of the new health system. The new health system would be governed by a board of directors with equal representation from Delnor's and CDH's current boards.
Some federal antitrust laws could be waived if they hinder the creation of effective accountable care organizations, senior federal officials told healthcare leaders on Tuesday.
"From an antitrust perspective, we want to explore whether we can develop safe harbors so doctors, hospitals, and other medical professionals know when they can collaborate and when they cannot," Federal Trade Commission Chairman Jon Leibowitz said, in opening remarks at Tuesday's FTC/Centers for Medicare & Medicaid Service Workshop on ACOs.
"We are also considering whether we can put in place an expedited review process for those ACOs that fall outside of the safe harbors," he said.
Health and Human Services Inspector General Daniel R. Levinson told the workshop that fraud and abuse rules enforced by his office should not stand in the way of improving quality and reducing costs through ACOs.
"As the Medicare and Medicaid programs incorporate and test new payment and delivery models, there is a need for fresh thinking about program integrity and the types of risks faced by our programs and beneficiaries," Levinson said.
He noted that the Affordable Care Act gives HHS Secretary Kathleen Sebelius the authority to waive fraud and abuse laws "as necessary" and that "we and our HHS colleagues are looking closely at how the secretary might exercise this authority most effectively."
CMS Administrator Don Berwick, MD, told the group that flexibility was needed because ACOs represent a fundamental shift in the way healthcare is delivered. "The ACO is not the status quo repackaged. It is a new and better way to organize care and it involves changes for almost every stakeholder. Further, there is no one-size-fits-all model. I suspect there will be many different (models) needed to match the enormous diversity of settings and communities and histories in this textured nation," he said.
Leibowitz conceded that the healthcare sector holds a level of distrust towards the federal government in general, and the FTC in particular. "Too often, I believe, the healthcare community sees our antitrust enforcement actions as impeding improved care. If there is any stereotype I would like to disabuse you of today—that's the one," he said.
MEDNAX, Inc. subsidiary American Anesthesiology has acquired Southeast Anesthesiology Consultants, PA, a 90-physician group practice that provides anesthesia and pain management services at nine hospitals, 12 ambulatory surgery centers, and 10 pain management centers in the Charlotte, NC, area.
Financial terms were not disclosed, but Deutsche Bank Equity Research North America estimated that American Anesthesiology paid between $150 million and $200 million in the cash deal.
Deutsche Bank research shows Southeast Anesthesiology Consultants generates about $100 million in annual revenues and between $25 million and $30 million in trailing EBITDA. SAC, which does anesthesia volume of about 111,000 cases annually, is the fifth and largest group practice acquisition for MEDNAX, in terms of volume and facilities served.
SAC services eight of the 32 hospitals within Carolinas HealthCare System, the nation's second-largest not-for-profit healthcare system, including the system's largest hospital, the 874-bed Carolinas Medical Center.
SAC also provides anesthesia services at 11 ambulatory surgery centers in the Charlotte area, which includes part of South Carolina, and one facility in Virginia Beach, VA. The group also provides services at 10 pain management centers in Charlotte with annual volume of approximately 50,000 patient visits.
The group employs eight physician assistants and six certified registered nurse anesthetists. The physicians practice under an anesthesia care team model that includeshospital-employed CRNAs. SAC also has 45 clinical and administrative employees.
American Anesthesiology includes more than 620 anesthesia providers, including more than 275 physicians and 345 CRNAs and anesthesia assistants practicing in the Carolinas, Virginia, and Georgia, with administrative offices in Raleigh, NC, and Sunrise, FL.
This time it was Omaha, NE. You can read the local news accounts here.
It sounds callous, but I really don't care what prompted the gunman's bout with irrationality. My sympathy and concern for him ended when he picked up a gun to solve his troubles. Two police officers suffered "minor" gunshot wounds in the shootout that fatally wounded the gunman. Fortunately, no patients, visitors, or healthcare providers suffered physical injuries.
I hate to sound like a One Note Johnny on the issue of hospital violence, because there are a lot of other topics I would prefer to write about. But this just won't go away. It's hard to ignore this very disturbing trend when we're getting weekly reports of gunplay and other violence in places of healing.
A timely Emergency Nurses Association nationwide survey has found that between 8% and 13% of ED nurses say they are victims of physical violence every week. More than half (54.8%) of the 3,211 nurses ENA surveyed at three-month intervals between May 2009 to February 2010 reported physical or verbal abuse at work in the week before taking the survey.
The ENA's Emergency Department Violence Surveillance Study also found that 15% of the nurses who reported physical violence—slapping, shoving, spitting, punching, kicking, etc.—said they were injured as a result.
To me, the most disturbing factoid in the survey was that no action was taken against the perpetrator in 45% of the cases. In other words, the attacker went unpunished.
Three in four nurses who were victims of physical violence reported that the hospital gave them no response regarding that violence.
"We are extremely alarmed that there are so many cases in which hospitals do not respond to violence in the emergency department," said Diane Gurney, RN, president of the 37,000-member ENA.
"These incidents are not only frightening and dangerous for nurses, but also for patients in the emergency department. Hospital administration has a responsibility to keep patients and the healthcare providers who care for them safe. Every hospital should be required to adopt and implement policies to keep their emergency departments safer."
Gurney is exactly right. Hospital leadership can no long cling to the excuse that hospital violence is a random event that is impossible to prepare for, nor can leadership provide any excuse for failing to respond to acts of violence against staff.
Measures can be taken.
For example, the ENA survey found that ED nurses at hospitals with policies regarding violence reported experiencing fewer incidents of physical or verbal violence. Hospitals with zero-tolerance reporting policies had an 8% physical violence rate; hospitals with a non-zero-tolerance policy had a 12% physical violence rate; and hospitals with no policy had an 18% physical violence rate. Raise your hand if you spot the trend.
"These data underscore what nurses know first-hand," Gurney said. "Hospitals that have policies in place to respond to violence and to prevent it are safer for the healthcare professionals that work in them and the patients who seek treatment in them."
The survey revealed that simply strategies such as a panic button or silent alarm lower physical violence, and enclosed nurses’ station, security signs, and well-lit areas lower verbal abuse.
The survey also found that:
Patients and their relatives perpetrated nearly all physical violence (97%) and verbal abuse (91%).
Most physical violence occurred in patients' rooms (81%). Nearly a quarter (23%) occurred in corridors, hallways, stairwells or elevators and 15% occurred at the nurses’ station. *
The most frequently reported activities that emergency nurses were involved in when they experienced physical violence were triaging a patient (38%), restraining or subduing a patient (34%) and performing an invasive procedure (31%). *
Male nurses reported higher physical violence rates than female nurses (15% versus 10%); and physical violence rates tended to decline with older nurses.
Physical violence rates were higher in large urban areas (13%) than in rural areas (8%). Nurses working in EDs with more beds and treatment space, and those with higher numbers of visits were more likely to experience physical and verbal abuse than nurse in lower-traffic departments.
The ENA survey doesn’t provide a vaccine for the epidemic of hospital violence. It does give us a good idea of where hospital violence occurs, who the victims are, who the perpetrators are, and some basic strategies to reduce violence. It's a good starting point. Look at the survey and see how your hospital's antiviolence policies compare. You owe it to your employees. What are you waiting for?
* (Math majors may notice that these responses add up to more than 100%. ENA explains that for several of the survey questions respondents were allowed to select more than one response. For example, a violent incident could start in a patient’s room and spill out into the hallway as the incident progresses.)
A federal grand jury in Maryland has indicted five Baltimore-area residents on fraud and aggravated identity theft charges in a scheme to use patient personal information stolen from Johns Hopkins Hospital to open credit card accounts and make more than $600,000 in “instant credit” buys at retail stores.
Indicted were: Michael Allen, age 34; Jasmine Amber Smith, 25; Tyrell Douglas McCormick, 22; Ayanna Devon Johnson, 38; and Gloria Canada, 54. The superseding indictment was returned on Sept. 15, 2010 and unsealed last week with the arrest of Canada, the final defendant.
Officials at Johns Hopkins Medicine said they do not comment on ongoing litigation and referred all inquires to the U.S. Attorneys Office in Baltimore.
According to the 39 count indictment, while employed by Johns Hopkins Hospital from August 2007 to March 2009, Smith allegedly improperly obtained the personal identity information of patients and the parents and guardians of minor patients, including names, social security numbers, dates of birth and addresses. Smith allegedly gave the stolen information to Johnson and Canada.
From May 2008 to June 2009, Allen and McCormick allegedly used the stolen information to apply for instant credit at stores make purchases on “instant credit” before the fraudulently obtained credit cards were received by the victims. The indictment alleges that the defendants fraudulently obtained more than $600,000 in credit from over 50 stores and individuals.
The defendants face a maximum sentence of 30 years in prison for conspiracy to commit bank fraud and two years in prison consecutive to any other sentence for aggravated identity theft. McCormick and Allen face a maximum sentence of 30 years in prison for bank fraud and 15 years in prison for access device fraud.
Health and Human Services has awarded nearly $49 million in planning grants to help 48 states and the District of Columbia install health insurance exchanges in 2014.
The state-based exchanges will provide consumers and businesses with "one-stop-shopping" to compare and buy health insurance. Americans will have the same healthcare choices as members of Congress—who will also purchase coverage through the exchanges. Individuals and families purchasing health insurance through exchanges may also qualify for tax credits and reduced cost-sharing depending on their income, HHS says.
The grants of up to $1 million each will help the states' determine how their exchanges will be operated and governed, including:
Assessing information technology systems and infrastructure and determining new requirements.
Developing partnerships with community organizations to gain public input into the exchange planning process.
Planning for consumer call centers.
Determining the statutory rules needed to build the exchanges.
Hiring staff.
Planning the coordination of eligibility and enrollment systems across Medicaid, the Children's Health Insurance Program, and the exchanges.
Developing performance metrics, milestones and ongoing evaluation.
The Institute of Medicine will conduct a one-year study to determine if health information technology will achieve its full potential for improving patient safety in healthcare. The study will be carried out under a $989,000 contract from the federal Office of the National Coordinator for Health Information Technology.
"Since 1999, when the IOM published its ground-breaking study To Err Is Human, the Institute has been a leader in the movement to improve patient safety," said David Blumenthal, MD, national coordinator for HIT. "This study will draw on IOM?s depth of knowledge in this area to help all of us ensure that HIT reaches the goals we are seeking for patient safety improvement."
The study will examine patient safety-related issues, including prevention of HIT-related errors and rapid reporting of any HIT-related patient safety issues. It will make recommendations concerning the potential effects of government policies and private sector actions in maximizing patient safety and avoiding medical errors through HIT. The study will:
Summarize existing knowledge of the effects of HIT on patient safety;
Identify approaches to promote the safety-enhancing features of HIT while protecting patients from safety problems associated with HIT;
Identify approaches for preventing HIT-related patient safety problems before they occur;
Identify surveillance and reporting strategies for rapid detection and correction of patient safety problems;
Address the roles of private sector accrediting and certification bodies, and patient safety organizations and professional and trade associations;
Discuss roles for key federal agencies, including the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Centers for Medicare & Medicaid Services.
Donald Berwick, MD, CMS administrator said improving patient safety in healthcare depends on thoroughness in planning and execution, to find problems systematically and correct them decisively. "We have high expectations for patient safety improvement through HIT, but achieving those goals will require the same careful and vigorous approach that is needed to improve safety in any enterprise. The IOM can help us identify a productive path to better patient safety with the help of HIT," Berwick said.
The Health Resources and Services Administration has issued $17 million in grants to bolster primary care training programs in communities across the nation.
“(The grants) target community-level health professions shortages, support workforce diversity, and provide for retooling our workforce to meet the demands of an aging population, the chronically ill, and disabled,” said HRSA Administrator Mary K. Wakefield, RN.
The 99 grants, funded under 2010 appropriations, will support 21 Area Health Education Centers, 68 Geriatric Academic Career awards, and 10 Nursing Assistant and Home Health Aide Program awards.
Awards fall under two AHEC programs that will receive a total of $10 million: Infrastructure development grants go to four universities to establish and advance state-wide or multi-county AHEC programs; and point of service maintenance and enhancement grants support 17 universities that have established partnerships with community-based AHECs.
AHECs are interdisciplinary, community-based training programs led by academic and community leaders who collaborate to improve the supply, distribution, diversity, and quality of healthcare personnel, with a special focus on primary care personnel in rural and other underserved communities.
Sixty-eight GACA grants will share $5 million to support career development for academic geriatric specialists to help address the fast-growing 65-plus population, which is expected to almost double by 2030. In recognition of the importance of comprehensive care, the Affordable Care Act modified this program to expand eligible entities to include schools of medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy or other allied health disciplines in an accredited health professions school that is approved by the HHS Secretary.
GACA grants focus on chronic disease management, geriatric ethics, palliative care, and health promotion. Award recipients also work with underserved and uninsured patients across many community settings including acute, ambulatory, and long-term care.
Ten NAHHA grants totaling $2.4 million will go to colleges or programs that provide community-based training to nursing assistants and home health aides who treat the elderly, chronically ill, and disabled. As nursing homes and home health agencies continue to have problems with recruitment and retention of qualified workers, there is growing concern over the current and projected shortages of these frontline direct care workers. Grantees project that these awards will enable them to train more than 4,000 nursing assistant and home health aide students over the 3-year project period.
