Health insurance plans that colleges, universities, and trade schools endorse or mandate for students cost too much for the coverage provided, and are running afoul of federal protections recently signed into law, according to a report released today by the New York Attorney General's Office.
"Many of the sponsored healthcare plans looked at during our investigation leave students at risk while providing massive profits for insurance companies," Attorney General Andrew M. Cuomo said in a media release. "It is important for students to have adequate healthcare coverage to protect themselves during times of illness or injury, but a bad health insurance plan can have catastrophic and long-lasting effects on a young person's life."
In a letter to more than 300 colleges, universities, professional schools, and trade schools, Cuomo urged schools to review their student health insurance plans and fix problems that add needless costs and put students at risk. The letter was sent to schools in New York and about 30 out-of-state schools nationwide that are attended by New York residents.
Cuomo's letter also noted that students who purchase insurance are a generally healthy population, so schools can bargain with health plans to provide sufficient, fairly-priced coverage.
"By being informed of the problematic practices that currently exist in the industry, schools can negotiate for better health plans, and students and their families can be better equipped to select the coverage that is best for them," Cuomo said.
The AGs report said that the school-sponsored student health insurance industry generates more than $1 billion in revenue each year, and provides coverage for about one million college students nationwide. The students pay annual premiums that can range from $100 to more than $2,500.
More than two-thirds of private colleges and universities and almost one-quarter of public colleges and universities require their students to either purchase the school-sponsored plan or have their own "comparable" health insurance.
The AG's report found that many school-sponsored student health plans have limits and exclusions that put students and their families at risk of facing catastrophic costs for medical care. Some plans have exclusions for pre-existing conditions, leaving many students with such conditions completely uncovered for any related treatments.
Some plans require students with pre-existing conditions that are not covered to purchase the plan at its full price. Many plans also have extremely low coverage limits. For example, some plans cap all coverage at less than $25,000, while others have per-illness caps of as low as $700. Additionally, many plans either fail to include prescription drug coverage or limit such coverage to an inadequate level.
In addition to providing limited coverage, the AG's investigation found that many school-sponsored plans are unnecessarily costly. In many cases, the amount of claims paid out by the insurance company is only a fraction of the premiums students pay, resulting in excessive profits for the insurance companies, according to the AG.
Cuomo's office issued subpoenas to some of the nation's largest insurers of students, including Aetna Inc.; UnitedHealthcare Insurance Co.; Gerber Life Insurance Co.; Markel Insurance Co.; Beech Street Corp.; United States Fire Insurance Co.; Combined Life Insurance Co. of New York; National Union Fire Insurance Co. of Pittsburgh, PA; Security Mutual Life Insurance Co. of NY; and Commercial Travelers Mutual Insurance Co..
In response, UnitedHealthcare said, "We continually strive to improve access to quality, effective health care for all Americans, including students. We have been actively working with the New York Attorney General on this issue and remain committed to providing colleges and universities with affordable coverage that gives students meaningful access to healthcare services."
Robert Zirkelbach, spokesman for America's Health Insurance Plans, says college health plans aren't like the regular commercial market.
"First of all, colleges and universities have a great deal of flexibility in determining the type of insurance they are going to offer students," he says. "These are highly customized to meet the unique and varying needs of colleges and are oftentimes designed to compliment existing health resources on campuses such as health clinics. The insurance is supplementing what is already being provided to students."
Zirkelbach says premiums for student coverage are "quite affordable," especially considering the cost structure associated with the coverage.
"There is a lot of turnover, they are highly customized, and they have higher structural costs than other insurance products," he says.
The AG also issued subpoenas to insurance brokers, agents, and consultants, including University Health Plans, Inc.; Niagara National Inc.; Haylor, Freyer & Coon, Inc.; The Bailey Agencies; and Mercer Health & Benefits LLC.
James C. Turner, MD, president of the American College Health Association, says he isn't surprised by the AG's findings, because his organization has been pointing out the shortcomings of many college health insurance plans for years.
Turner, an internist who is also the director of the Department of Student Health at the University of Virginia, said the AG's letter to college presidents borrows heavily from the ACHA's recommendations that were issued in 2008.
The Ambulatory Surgery Center Advocacy Committee, which represents ASC operators, state associations, and the ASC Association, said the report in the April issue of Health Affairs made "incorrect assumptions" about the industry.
"The study authors make inaccurate statements about the relationship between physician ownership of ASCs and higher surgical volume, inferring that physician owners are driven to refer patients to their facility by financial incentives," the ASCAC said in a media release. "While the study authors recognize limitations with their methodology, the ASCAC is particularly concerned with their sole reliance on surgical volume as a proxy for ASC ownership. Volume is not a valid method for identifying which physicians have ownership interests in ASCs. In fact, many non-owners practice at ASCs."
The University of Michigan Medical School study in Health Affairs looked at Florida patients who underwent one of five common outpatient procedures: carpal tunnel release, cataract excision, colonoscopy, knee arthroscopy, and myringotomy with tympanostomy tube placement in the ear.
The researchers determined which doctors were owners of a surgery center. They then compared surgery use among owners in two time periods—before and after they acquired ownership—with that of physicians who remained non-owners.
The study found that while caseloads increased overall between the earlier and later time periods for all physicians—regardless of whether or not they had a financial stake in the surgery center—the increases were more rapid and dramatic among owners.
"Our data suggest that physician behavior changes after investment in an outpatient facility," said study author John Hollingsworth, MD, a Robert Wood Johnson Clinical Scholar at U-M Medical School, in Ann Arbor.
"Through what some have labeled the 'triple dip,' physician owners of surgery centers not only collect a professional fee for the services provided, but also share in their facility's profits and the increased value of their investment," Hollingsworth said. "This creates a potential conflict of interest. To the extent that owners are motivated by profit, one potential explanation for our findings is that these physicians may be lowering their thresholds for treating patients with these common outpatient procedures."
Far from being a driver in rising healthcare costs, ASCAC said the U-M study failed to recognize the lower cost to patients and payers when identical procedures are performed in an ASC as opposed to the hospital outpatient setting. The trade group said Medicare patients save more than 50% on out-of-pocket cost and that ASCs save Medicare approximately 40% annually. By shifting just half of all eligible outpatient surgeries to the ASC setting, Medicare could save an additional $2.3 billion annually, the ASCAC claimed.
The U-M study showed that number of surgery centers has increased nearly 50% over the last decade, largely driven by the investment of physicians, who had a stake in 83% of these facilities. Investment gives doctors more control over their practice, from scheduling to purchasing equipment. For patients, these centers often have shorter wait times than hospitals, according to the report.
The ASCAC pointed to a 2009 study by KNG Health Consulting that showed that 70% of ASC volume growth between 2000 and 2007 was because of migration from hospitals to ASCs.
Five more states have joined the lawsuit challenging the constitutionality of the federal health reform law.
Indiana, North Dakota, Mississippi, Nevada, and Arizona announced this week that they will join 13 other states that filed suit just minutes after President Obama signed the law on March 23.
Florida Attorney General Bill McCollum, a Republican who is running for governor, filed the initial suit last month and said Wednesday he welcomes the additional support "as we continue fighting to protect the constitutional rights of American citizens and the sovereignty of our states."
Among its myriad complaints, the lawsuit, filed in U.S. District Court in Pensacola, FL, alleges that the law violates the constitution by mandating all citizens and legal residents have healthcare coverage or pay a penalty.
Nevada joined the suit without the support of Democratic Attorney General Catherine Cortez Masto.
When Masto refused to join the suit, the state's Republican Gov. Jim Gibbons signed an executive order that circumvented the Attorney General's office and assigned outside legal counsel to represent the state in the suit. Masto office is considering filing suit to block the order, her spokeswoman said.
North Dakota Republican Attorney General Wayne Stenehjem, a Republican, said the lawsuit "will test the most objectionable of those flaws, the so-called individual mandate."
"The individual mandate in the healthcare law is unprecedented—a direct federal requirement for an individual to purchase insurance from a private company," said Stenehjem.
He added that by 2016, an adult who does not have health insurance would be penalized $695 per year, and a family up to $2,085, or 2.5% of income, whichever is greater.
"Never before has Congress, under the commerce clause, required Americans to purchase any good or service, and it certainly has never claimed the commerce clause regulates citizens who decline to participate in the marketplace by refusing to purchase goods or services."
Joining McCollum in the initial suit filed last month were attorneys general from South Carolina, Nebraska, Texas, Utah, Alabama, Colorado, Michigan, Pennsylvania, Washington, Idaho, and South Dakota, all Republicans; and Louisiana's Buddy Caldwell, a Democrat.
A hearing is set for April 14 in Pensacola.
Critics of the suit have dismissed it as groundless, and a political stunt designed to take advantage of public angst over the issue during an election year.
Several attorneys general who joined the suit are also running for governor, including McCollum, Terry Goddard, the Democratic attorney general of Nevada, and Greg Zoeller, the Republican attorney general from Indiana.
Republican lawmakers in Georgia additionally have threatened to impeach Democratic Attorney General Thurbert Baker, because he refused Republican Gov. Sonny Purdue's request to join the suit.
After 160 years of continuous operations, financially-troubled St. Vincent's Hospital in Manhattan will close inpatient services, including all acute and behavioral healthcare, the hospital announced.
The vote Tuesday by the Saint Vincent Catholic Medical Center's board of directors to close its flagship hospital came after a six-month effort to save the last Catholic-affiliated hospital in New York City, which is $700 million in debt, and had defaulted on its Chapter 11 restructuring plan.
The closure affects only St. Vincent's Hospital Manhattan inpatient services. Other facilities and programs of Saint Vincent Catholic Medical Centers will continue as the organization seeks new sponsorship to operate them, the health system said in a media release.
"The decision to close St. Vincent's Hospital Manhattan inpatient services was made only after the board, management, and our advisors exhausted every possible alternative," said Alfred E. Smith IV, chairman of the board of Saint Vincent Catholic Medical Centers. "We are deeply saddened that we were unable to come up with a viable plan to save the inpatient services at the hospital that has proudly served Manhattan's West Side and Downtown for 160 years."
Smith said outpatient services, including the hospital's Cancer Center and the HIV/AIDS Center, will remain open, but the hospital will transfer those services to new sponsors.
The 400-bed hospital with 3,500 employees anticipates there will be changes to its outpatient health center clinics in the future, but they will continue to operate as usual. Elective surgeries will continue on a case-by-case basis, though it is anticipated that elective surgeries will cease April 14.
New York Gov. David Paterson, who created a task force to save St. Vincent's and gave the hospital $9 million in emergency loans to keep it running, said in a media release that he was "disappointed" that the hospital is closing.
"We should use this as an opportunity to ensure that the healthcare needs of this community are met by creating an urgent care center combined with other vital healthcare services the community needs," Paterson said. "To that end, I have directed the Department of Health to solicit proposals for this new model of care. Although this news will be difficult for employees, patients, and the hospital's many supporters, we will continue to work aggressively with the hospital and its board, lenders, unions, and elected officials in this next step."
Paterson said the state's Department of Health would work with St. Vincent's and other providers in the area to ensure continued access to critical inpatient services, and an orderly transition of St. Vincent patients to other hospitals.
The remaining parts of Saint Vincent Catholic Medical Centers, including its nursing homes, home health agency, St. Vincent's Hospital Westchester, and US Family Health Plan, will continue to operate without interruption as the organization finalizes their sale.
Four Sisters of Charity founded St. Vincent's in 1849 as a 30-bed hospital in a brick house on 13th Street, as one of the few charity hospitals in New York City, according to the hospital's Web site.
St. Vincent's, located in Greenwich Village, was the closest hospital to the World Trade Centers after the Sept. 11, 2001 terrorist attacks, and provided care for hundreds of people wounded after the towers fell.
A federal grand jury in Manhattan has indicted a former Mount Sinai Medical Center and School of Medicine purchasing agent for his alleged role in a bid-rigging and fraud conspiracy related to maintenance and insulation contracts at the hospital, the Department of Justice announced.
The three-count indictment charges Mario Perciavalle with conspiring to rig bids on the Mount Sinai contracts between June 2004 and September 2005. Perciavalle and unnamed co-conspirators allegedly made it appear that Mount Sinai was awarding competitive contracts, when they had actually submitted intentionally high, non-competitive bids, DOJ said.
Perciavalle and his co-conspirators also allegedly committed mail fraud between March 2003 and September 2005 when Perciavalle awarded work at Mount Sinai to a co-conspirator's company while Perciavalle was allegedly getting cash kickbacks. Perciavalle is also charged with mail fraud related to alleged payments mailed by Mount Sinai to Percivalle's co-conspirator for work done on the rigged contracts, DOJ said.
A bid-rigging conviction carries a maximum penalty of 10 years in prison and a $1 million fine. The fraud conspiracy conviction carries a maximum penalty of 20 years in prison and a $1 million fine. The maximum fine for both charges may be increased to twice the gain derived from the crime or twice the loss suffered by the victim of the crime, if either of those amounts is greater than the statutory maximum fine, DOJ said.
The indictment against Perciavalle is the latest chapter in an ongoing federal antitrust investigation of bid rigging, fraud, bribery, and tax-related offenses relating to construction, maintenance, and service contracts administered by the Engineering Department of Mount Sinai and the Facilities Operations Department and the Engineering Department at New York Presbyterian Hospital.
Last week, a federal grand jury indicted former re-insulation contractor David Porath and co-conspirator Andrzej Gosek for allegedly participating in a bid-rigging scheme at New York Presbyterian Hospital.
So far, eight people and three companies have pleaded guilty to charges arising from the investigation.
Doctors invested in outpatient surgery centers perform about twice as many surgeries as doctors with no such financial stake, according to a new study in the April issue of Health Affairs.
"Our data suggest that physician behavior changes after investment in an outpatient facility," said study author John Hollingsworth, MD, a Robert Wood Johnson Clinical Scholar at the University of Michigan Medical School, in Ann Arbor, in a media release.
"Through what some have labeled the 'triple dip,' physician owners of surgery centers not only collect a professional fee for the services provided, but also share in their facility's profits and the increased value of their investment," Hollingsworth said. "This creates a potential conflict of interest. To the extent that owners are motivated by profit, one potential explanation for our findings is that these physicians may be lowering their thresholds for treating patients with these common outpatient procedures."
The study looked at all patients in Florida who underwent one of five common outpatient procedures: carpal tunnel release, cataract excision, colonoscopy, knee arthroscopy, and myringotomy with tympanostomy tube placement in the ear.
The researchers determined which doctors were owners of a surgery center. They then compared surgery use among owners in two time periods—before and after they acquired ownership—with that of physicians who remained non-owners.
The study also found that while caseloads increased overall between the earlier and later time periods for all physicians—regardless of whether or not they had a financial stake in the surgery center—the increases were more rapid and dramatic among owners.
The number of surgery centers has increased nearly 50% over the last decade, largely driven by the investment of physicians, who had a stake in 83% of these facilities. Investment gives doctors more control over their practice, from scheduling to purchasing equipment. For patients, these centers often have shorter wait times than hospitals, according to the report.
"There are some definite advantages for surgeons, as well as patients, associated with care at surgery centers," Hollingsworth said. "However, we need to better understand the implications of these new findings, in particular their overall effect on healthcare expenditures. Insofar as our results are due to lowered treatment thresholds, policymakers should consider, at the very least, requiring all physicians to disclose their financial interests to their patients."
The American College of Surgeons Committee on Trauma this week verified Sanford USD Medical Center in Sioux Falls, SD, as a Level II Pediatric Trauma Center—the first and only one for the region, Sanford Health & MeritCare announced today.
The verification means access to pediatric surgeons, emergency physicians, a dedicated pediatric trauma flight team, and rapid access to operating rooms. Following treatment at the Trauma 5 ED, the pediatric patients will likely be transferred to the nearby146-bed Sanford Children's Hospital.
"This is a wonderful step forward for the care of the pediatric trauma patient in our region. To know that a pediatric specialist is involved in your child's care from the moment they arrive at Trauma 5 through their rehabilitation should be comforting," Pediatric Trauma Director and Pediatric Surgeon Adela Casas-Melley, MD, said in a media release.
With more than 500 beds, Sanford USD Medical Center is the largest tertiary care hospital in South Dakota. The hospital also received re-verification as a Level II Adult Trauma Center by the ACSCT, and has been verified as an adult trauma center for 16 years.
The report, released this week, also found that serious disciplinary actions against doctors across the nation rose slightly in 2009, but are still about 18% lower than they were at their peak five years ago.
Sidney Wolfe, MD, director of Public Citizen's Health Research Group, said that had the national rate of doctor discipline remained at that peak, there would have been 653 additional serious disciplinary actions against physicians in 2009.
"There is considerable evidence that most boards are under-disciplining physicians," Wolfe said. "Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner."
The weighted average rate of disciplinary action in the top five states—Alaska, North Dakota, Kentucky, Ohio, and Arizona—was 5.45 serious disciplinary actions per 1,000 physicians. The weighted average rate in the bottom five states—Minnesota, South Carolina, Wisconsin, New Hampshire, and Connecticut—was 1.5 actions.
In other words, problem physicians are more than 3.6 times as likely to be seriously disciplined by medical boards in the top five states as in the bottom five.
The rankings are calculated using three years of data from the Federation of State Medical Boards on serious disciplinary actions taken against doctors in 2007-2009.
Lisa Robin, senior vice president of advocacy and member services at Federation of State Medical Boards (FSMB), says she has "mixed thoughts" about the rankings. "Public Citizen provides a valuable public service by pointing out that medical boards need to have sufficient funding and staffing. We are on the same page on that because to be able to do their jobs they need to be adequately funded," Robin says.
"We don't believe the boards should be ranked because there is so much difference and variability between the states, not only to resources and staffing, but statutory authority and differences in the laws that can account for some variance," she adds. FSMB last week released its own report showing a 6% increase in the number of disciplinary actions taken by state medical boards. In that report, FSMB specifically urged the media not to rank states.
Robin says Public Citizen only uses serious disciplinary actions. "They count other actions as non-actions. What that misses is a lot of the good work that medical boards do," Robin says.
"They have a range of sanctions and actions they can take and that would be from some sort of retraining in a problematic area, or where the physician is not as competent as he should be. There are also interventions with a letter of public reprimand or a fine and that may be sufficient to get the physician back practicing at an acceptable level." Robin says many state medical boards also have confidential programs for physicians with substance abuse problems that wouldn't be reflected in the Public Citizen report.
However, Wolfe said dismissing state-by-state comparisons because some boards have better funding, tougher laws, and larger staffs doesn't make sense. He added that Arizona's state medical board, which for several years had been among the worst in the nation, improved dramatically when the state legislature increased the board's staff and budget, and hired new leadership.
"That is exactly why you need to compare them. That is something that needs to happen to get those states that aren't doing such a good job to do a better job," he says.
Wolfe says that FSMB is a trade association that wants to protect all its members.
"It's difficult because some boards are doing better than others," he says. "If you don't want to make some boards look better than others, the easy way, the cop out, is to say ‘you shouldn't rank them because it makes some boards look better than others.' That is ridiculous."
The Public Citizen report said boards are likely to do better jobs disciplining physicians if they have good leadership, are independent, proactive, adequately staffed, and adequately funded, with all money from license fees going to fund board activities instead of going into the state treasury for general purposes.
In addition, Public Citizen said effective medical boards need a "reasonable legal framework" for disciplining doctors, such as "preponderance of the evidence" rather than "beyond reasonable doubt" or "clear and convincing evidence."
Boston Scientific Corp. subsidiary Guidant LLC pleaded guilty on Monday to criminal misdemeanor charges for its failure to notify the government about short-circuiting problems in three of its implantable cardioverter defibrillators. The medical device maker will pay nearly $300 million in penalties, the Department of Justice announced.
Under the terms of the plea agreement, first announced on Nov. 6, Guidant pleaded guilty in U.S. District Court in St. Paul, MN, to withholding information from the Food and Drug Administration regarding catastrophic failures in some of its devices.
Specifically, Guidant admitted to: lying to the FDA about the status of the Ventak Prizm 2DR device; and failing to notify the FDA of a "correction" to the Contak Renewal devices, models H135 and H155, which the company made to reduce a health risk caused by the devices. The agreement calls for Guidant to pay a criminal penalty in excess of $296 million, according to DOJ.
The plea caps a four-year federal investigation and still must be approved by U.S. District Court Judge Donovan W. Frank. If approved, the plea would be the largest criminal penalty ever imposed on a device manufacturer for violating the Food Drug and Cosmetic Act.
"Guidant's guilty plea today is about accountability," said Assistant Attorney General Tony West, who heads the Justice Department's Civil Division. "This successful prosecution serves as an important wake-up call to all those who seek to withhold vital information about public health and safety. We will continue our efforts to prosecute those who jeopardize public health by evading their reporting obligations to the FDA."
Guidant was charged in federal court on Feb. 25. The guilty plea agreement was then filed with the court on March 11.
Boston Scientific first announced the settlement "in principle" on Nov. 6. The Natick, MA-based company said Guidant's failure to disclose the problems with the defibrillators occurred before Boston Scientific acquired it in 2006. Boston Scientific added it had already posted a third-quarter charge to cover the $294 million fine.
"We are pleased this investigation has been resolved," Ray Elliott, president/CEO of Boston Scientific, said in November. "Guidant and its employees acted in good faith and believed they complied with applicable laws and regulations. We elected to resolve this matter so we could put it behind us and devote our full energies and resources to developing our innovative technologies."
Monday's plea agreement marks the second time in four months that Boston Scientific has agreed to a sizeable fine for actions at Guidant. On Dec. 23, Boston Scientific entered an agreement with the Justice Department to pay $22 million to settle a civil complaint related to post-market surveys conducted by Guidant.
Amedisys, Inc., the Baton Rouge, LA-based home health and hospice company, announced Monday that it has acquired Bluewater Healthcare Inc., a private hospice agency in Killen, AL. Financial terms of the deal were not disclosed.
Bluewater, which generated $900,000 in revenues in 2009, covers seven counties in northwest Alabama, six which are new to Amedisys.
"We welcome the new employees from Bluewater into the Amedisys family and look forward to serving the hospice needs of the patients and families in northwest Alabama," William F. Borne, CEO of Amedisys, said in a media release. "We believe that this acquisition provides a good platform for the continued expansion of our hospice services as we strive to become the largest hospice provider in the U.S."
Amedisys operates 65 hospices in 22 states. Amedisys also has home health agencies in more than 500 locations in 42 states, the District of Columbia, and Puerto Rico.
