The demand for physicians is so frantic that 64% of the 391 residents who answered the survey said recruiters were harassing them.
By John Commins, May 14, 2019
Nearly half (45%) of physicians in their final year of residency received more than 100 recruiting offers, and two-thirds of them (66%) received more than 50 offers, a new survey shows.
"Physicians coming out of training are being recruited like blue chip athletes," Travis Singleton, executive vice president of Irving, Texas-based physicians recruiters Merritt Hawkins, said in a media release. "There are simply not enough new doctors to go around."
The search for physicians has gotten so frantic that 64% of the 391 residents who answered the survey complained that recruiters were virtually harassing them. Seven percent of residents said they were not contacted enough.
The search is rigorous for both primary care and specialty physicians.
Nearly 70% of both primary care and internal medicine subspecialist residents said they received more than 50 recruiting solicitations, as did 64% of surgical specialists.
Singleton says the physician shortage goes beyond the demand for primary care doctors and extends to virtually all subspecialties, too.
"We need more primary care physicians to implement emerging healthcare delivery models that are based on enhanced access, prevention and quality," Singleton said. "But we also need more specialists to care for America’s rapidly aging population."
The Association of American Medical Colleges projects a shortage of nearly 122,000 physicians by 2032, including up to 55,000 primary care physicians and nearly 66,000 too few specialists.
Singleton blamed the physician shortage partly on Congress's 1997 cap on spending for physician training.
RURAL AREAS SEE LITTLE INTEREST
The survey results are bad news for rural hospitals and providers, which have always been hobbled in their efforts to recruit physicians.
For towns of 10,000 people or fewer, only 1% of medical residents expressed an interest in establishing a practice there, while 2% of residents expressed a desire to practice in towns with 25,000 people or fewer.
The majority of new physicians—65%—said they prefer to practice in cities with 250,000 or more people. International medical graduates appeared to be more amenable to practicing in rural areas than U.S. medical school graduates.
The employed-physician model is also gaining ground. More than 90% of new physicians said they would rather be employed than on their own in an independent practice. Of those seeking employment, 43% said they'd prefer to work with a hospital. Two percent said they want to work as a solo practitioner.
"The days of new doctors hanging out a shingle in an independent solo practice are over," Singleton said. "Most new doctors prefer to be employed rather than deal with the financial uncertainty and time demands of private practice."
DEBT BURDENS MOUNT
Fortunately for these new physicians, there are plenty of job offers, because they're knee-deep it debt.
More than half (51%) of final-year medical residents said they owe $150,000 or more in student loans, and 48% say they owe more than $200,000. Only 25% of international medical graduates owe that much.
Only 22% of U.S. medical school graduates said they'd accumulated no debts for their education, while 58% of international medical school graduates said they have no student debt.
Regrets
Even with a plethora of job options, 19% of new doctors say they're unhappy about their choice of profession and would not choose medicine as a career if they could do it all over again.
More than one-in-five (21%) U.S. medical graduates regretted their career choice, compared with 13% of IMGs.
"With high levels of physician burnout and continued uncertainty about the direction of the healthcare system, many doctors are under duress today," Singleton said. "It is not surprising that some newly trained doctors regret their choice of a career."
The decline in screenings is believed to be the result of the cumulative burden of screening discussions earlier in the day, and doctors falling behind in their busy schedules.
Cancer screening rates drop significantly as the physician work day goes on, according to a new study published today in JAMA Network Open.
Researchers in the Perelman School of Medicine and the Wharton School both of the University of Pennsylvania say these rates of decline may be in part due to "decision fatigue," the result of the cumulative burden of screening discussions earlier in the day, and doctors falling behind in their busy schedules.
"Our findings suggest that future interventions targeting improvements in cancer screening might focus on time of day as an important factor in influencing behaviors," Esther Hsiang, the study lead author, a Wharton Business School student, and a researcher with Penn Medicine Nudge Unit, saidin remarks accompanying the study.
The study looked at data from 2014 through 2016 across 33 Pennsylvania and New Jersey primary care practices.
The researchers found that, among eligible patients, primary care doctors ordered breast cancer screening more often for patients seen in the 8 a.m. hour (64%) as compared to those with appointments at 5 p.m. (48%).
Similarly, for colon cancer screening, tests were also ordered more frequently for 8 a.m. patients (37%) compared to those coming in later in the day (23%).
Ordering rates had far-reaching effects. When looking at the entire population eligible for screenings at these practices (roughly 19,000 for breast cancer and 33,000 for colorectal cancer), the study tracked whether the patients were screened within a year of their appointment.
The data showed that the downward trend associated with the timing of the appointments carried over.
Breast cancer screening—including mammograms—stood at a 33% one-year completion rate for the entire eligible population who had their appointment in the 8 a.m. hour. But for those who had clinic visits at 5 p.m. or later, just 18% completed screenings.
For colorectal cancer, screenings such as colonoscopies, sigmoidoscopies, and fecal occult blood tests were completed by 28% of the patients with appointments in the 8 a.m. hour. That number dropped to 18% for patients who saw the doctor at 5 p.m. or later.
The study also found that there was a brief spike in screening orders for breast and colon cancers when patients saw their clinician around noon. For example, breast cancer screening orders dropped to 48.7% at 11 a.m. but increased to 56.2% around noon, before gradually falling off again. This trend held true for one-year completion rates, as well.
The study authors suggest that this may be due to lunch breaks that give clinicians and opportunity to catch up and start fresh.
A downward trend in outcomes by hour was noted in a study in 2018 examining the rates of flu vaccinations by the time of day when patients saw a clinician.
“Our new study adds to the growing evidence that time of day and decision fatigue impacts patient care,” said Mitesh Patel, MD, MBA, director of the Penn Medicine Nudge Unit and an assistant professor of Medicine.
"In past work, we've found that nudges in the electronic health record can be used to address these types of gaps in care, which we suspect will be the case here," Patel said. "Future research could evaluate how nudges may be implemented in order to improve cancer screening."
The 2015 data breach exposed the personal information of 78.8 million people. Anthem says no fraud was ever linked to the breach.
A federal grand jury has indicted a Chinese national for his kingpin role in a sophisticated China-based hacking group that targeted large businesses in the United States, including Anthem Inc.
The four-count indictment, unsealed and handed up Thursday in Indianapolis, alleges that Fujie Wang, 32, and his accomplices breached the computer systems of "four distinct industry sectors," including Anthem and three other U.S. businesses that federal prosecutors did not identify, the Department of Justice said.
The breaches exposed the personal information of 78.8 million people, and Anthem was forced to pay a $16 million fine to settle what DOJ called the largest health data breach in U.S. history.
"The allegations in the indictment unsealed today outline the activities of a brazen China-based computer hacking group that committed one of the worst data breaches in history," Assistant U.S. Attorney General Brian A. Benczkowski said in a media release.
The indictment alleges that beginning in February 2014, the defendants used sophisticated techniques to hack into the computer networks of the victim businesses.
Once inside, the hackers allegedly installed malware and tools on the compromised computer systems to further compromise the computer networks of the victim businesses, after which they identified data of interest on the compromised computers, including confidential personal and business information.
The indictment further alleges that the defendants then collected files and other information from the compromised computers and then stole this data.
The defendants identified and ultimately stole Anthem data on 78.8 million people from Anthem's computer network, including names, health identification numbers, dates of birth, Social Security numbers, addresses, telephone numbers, email addresses, employment information and income data, the indictment said.
Wang and a defendant identified as "John Doe" are charged with one count of conspiracy to commit fraud and related activity in relation to computers and identity theft, one count of conspiracy to commit wire fraud, and two substantive counts of intentional damage to a protected computer.
According to a Wanted by the FBI poster, Wang remains at large, and is believed to be living in Shenzhen, China.
How they did it, allegedly
The indictment said the defendants used extremely sophisticated techniques to hack into the computer networks of the victim businesses.
"These techniques included the sending of specially-tailored 'spearfishing' emails with embedded hyperlinks to employees of the victim businesses," DOJ said. "After a user accessed the hyperlink, a file was downloaded which, when executed, deployed malware that would compromise the user's computer system by installing a tool known as a backdoor that would provide remote access to that computer system through a server controlled by the defendants."
According to the indictment, the defendants waited months before taking further action, eventually engaging in reconnaissance by searching the network for data of interest.
The indictment alleges that the defendants broke into Anthem to reconnoiter Anthem's data warehouse on multiple occasions in October and November 2014.
Once interesting data had been identified, the hackers allegedly placed it into encrypted archive files and sent it through multiple computers to destinations in China. Several times in January 2015, the hackers accessed Anthem's database, and transferred encrypted files containing personal information to China.
To avoid detection, the hackers then deleted the encrypted archive files from the computer networks of the victim businesses.
Anthem Says No Fraud Detected
FBI Special Agent in Charge Grant Mendenhall said "Anthem's cooperation and openness in working with the FBI on the investigation of this sophisticated cyber-attack was imperative in allowing for the identification of these individuals."
In turn, Anthem issued a statement saying it was "grateful for the support and partnership of the FBI and extended law enforcement team in investigating the sophisticated cyber-attack that Anthem was a victim of in February 2015, and are pleased with the action taken today."
"There is no evidence that information obtained through the 2015 cyber-attack targeting Anthem has resulted in fraud," Anthem said.
Wheeling Hospital accuses a former executive of attempting to 'extort a settlement' and filing a False Claims Act suit as an act of revenge.
A West Virginia hospital has flipped the script and is countersuing a former-employee-turned-whistleblower who filed a false claims lawsuit against the hospital.
Wheeling Hospital Inc. has filed a lawsuit against Louis Longo, an accountant, former executive vice president at the health system, and a partner with Deloitte, claiming abuse of process and breach of fiduciary duty.
The hospital alleges that "at no time during his employment, or in his role as a partner at Deloitte, did Longo report any suspicions of fraud or violations of federal regulations to Wheeling Hospital's compliance officer."
"Longo owed Wheeling Hospital a fiduciary duty to refrain from threatening to bring false claims in an effort to extort a settlement," the hospital's suit reads.
Longo's whistleblower suit was taken up in March by the U.S. Department of Justice, which alleges that nonprofit Wheeling Hospital violated the Stark Law and Anti-Kickback Statute.
Those violations allegedly were caused by R & V Associates Ltd., Wheeling's contracted management consultant, and Wheeling CEO Ronald Violi, who the DOJ alleges had "dictatorial control" of the compensation agreements.
Wheeling Hospital has contested the allegations and vowed to fight the suit.
In its countersuit, filed in U.S. District Court for the Norther District of West Virginia, Wheeling Hospital described Longo as a bitter former executive looking to "extort a settlement" based on unwarranted claims that the health system paid kickbacks to physicians for referrals.
"The purpose of Longo's FCA Complaint is for Longo to obtain a pecuniary award and to inflict harm on Wheeling Hospital," the complaint read. "Indeed, based upon information and belief, Longo's FCA Complaint has been characterized by Longo and/or his associates as 'Lou's Revenge.'"
The hospital alleges that Longo approached Violi one month after Longo collected his last paycheck "and threatened that, according to his 'legal team,' he had some kind of case against Wheeling Hospital that could cost the hospital a lot of money unless Wheeling Hospital settled with him."
Wheeling Hospital said Longo's FCA complaint "falsely alleges that during Longo's employment at Wheeling Hospital, Wheeling Hospital 'defrauded...Medicare and Medicaid out of tens of millions of dollars of federal funds by paying certain physicians excessive compensation."
"The allegations in the Complaint are false and were made purposefully by Longo in an effort to receive a quick monetary settlement as a Relator," the suit alleges.
"In fact, in his capacity as a Relator, Longo failed to disclose key evidence to the government including, but not necessarily limited to, the results of a 2015 exempt organization audit conducted by the IRS in which physician compensation for the exact physicians named in his Complaint were reviewed."
Wheeling Hospital is seeking a judgement in excess of $75,000, along with punitive damages, attorneys' fees, court costs.
The final rule will require drug makers to post the list price if that price is equal to or greater than $35 for a month's supply.
The pharmaceutical industry will soon be required to post the costs of pricey prescription drugs in direct-to-consumer TV ads for drugs covered by Medicare and Medicaid under a final rule unveiled today by the federal government.
"We're telling drug companies today you've got to level with people what your drugs cost. Put it in the TV ads," Health and Human Services Secretary Alex Azar said at a media availability Wednesday morning.
"Patients have a right to know, and if you're ashamed of your drug prices, change your drug prices," he said. "It's that simple."
The final rule, which takes effect 60 days after its publication in the Federal Register, will require drug makers to post the list price – the Wholesale Acquisition Cost – if that price is equal to or greater than $35 for a month's supply or the usual course of therapy.
"Why did we pick $35 as the threshold? We picked that because it approximates insurance plans average copayment for a preferred-brand drug," Azar said. "The public is already accustomed to paying roughly this amount for drugs out of pocket. In the absence of new information, we might presume that patients will pay this amount for a drug."
The rule will only apply to TV ads, Azar said, because that's where the pharmaceutical industry concentrates its advertising spend.
"Of the $5 billion that the pharmaceutical industry spends per year in advertising, $4 billion is on television ads. It is currently the highest-impact area for their advertising activity," Azar said.
"We decided at this moment to focus there, where they believe they are getting the highest impact and spending the most money," he said. "The door is open to other platforms and other forms of advertising as we move forward and as we evaluate the impact of behavioral change caused by this requirement."
According to HHS, the 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month or usual course of therapy.
Nearly half (47%) of Americans have high-deductible health insurance plans, which means they often pay the list price of a drug until they have spent through their deductible.
PhRMA 'Concerned'
Pharmaceutical Research and Manufacturers of America President and CEO Stephen J. Ubl said the drug industry is "concerned that the administration's rule requiring list prices in direct-to-consumer (DTC) television advertising could be confusing for patients and may discourage them from seeking needed medical care."
"We support providing patients with more transparency about medicine costs, which is why our member companies voluntarily began directing patients to links to comprehensive cost information in their DTC television advertising," Ubl said. "After speaking with patients across the country, we learned that patients prefer this approach."
Azar, a former top executive at Eli Lilly & Co., said the pharmacuetical industry's call to provide a link in the TV ad to pricing information on a website "would not be compliant with the requirements of this rule."
"The PhRMA proposal that they simply do that is not acceptable," he said. "They put $4 billion a year in TV advertising, because that is where people are getting their information. The transparent pricing information should be in a place and location where they are also pitching the patient to talk to their doctor and incur expenses."
Drug makers will police themselves
Azar said HHS would rely on the drug companies to police themselves.
"Enforcement of this rule will be done the way enforcement is traditionally done in the television marketing space with drug ads, which is actually by competitors," he said. "If a drug company fails to include the required information in their ad, then a competitor may bring a Lanham Act action against them for a deceptive trade practice."
"There are very large legal practices built on pharma companies suing each other for violations of the Deceptive Trade Practices provisions of the Lanham Act, so this will be a quite effective mechanism of enforcement," he said.
Ubl also raised concerns about the "operational challenges" of final rule, "particularly the 60-day implementation timeframe," and he added that the final rule "raises First Amendment and statutory concerns."
Azar rejected suggestions that the pricing requirement would infringe on free speech rights.
"We don’t believe there is any problem with requiring people in their ads, where they are telling patients to go to the doctor's office, to ask a doctor about a drug, for patients to be informed of what the price of that very product is," he said.
"We think it is a fundamental right to know, whether the drug they're being pitched is a $50 drug or a $5,000 drug before they are asked to spend hundreds of dollars on a doctor's appointment to ask about that drug."
Azar said the pricing disclosure will "prompt a more knowledgeable discussion between the doctor and the patient." He noted the car manufacturers have been required to post sticker prices on cars for more than 50 years.
The price disclosure rule was first brought forward in May 2018 as part of President Donald Trump's American Patients First blueprint to reduce drug cost and lower patients' out-of-pocket expenses.
Azar said HHS received 147 comments about the proposed rule during the comment period, but that no big changes were made for the final rule.
ONC was asked to consider slowing down the two-year implementation window, but one committee member blasted a 'dysfunctional' healthcare system as technology laggards.
A Senate committee during a status update Tuesday on the proposed rules for electronic health records under the 21st Century Cures Act offered mixed messages to policymakers charged with implementing those provisions.
Sen. Lamar Alexander (R-Tenn.) chairman of the Senate Health, Education, Labor and Pensions Committee, repeatedly raised concerns about past mistakes with HIT adoption under the Meaningful Use initiatives and warned that the pace of implementation under the 21st Century Cures Act was too hasty. He urged policymakers to proceed with caution.
"My major concern is to give the administration the advice my piano teacher used to give me before a recital," Alexander told officials from the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology.
"She would say 'Lamar, play it a little slower than you can play it. You're less likely to make a mistake.' That's pretty good advice," he said. "We don’t need to set a record time to get there with an unrealistic time line."
The Centers for Medicare & Medicaid Services in February proposed that Medicaid, Medicare, and other government-funded healthcare programs provide enrollees with immediate electronic access to medical claims and other health information by 2020.
Alexander suggested that ONC slow down the two-year implementation window with "a more phased approach" that starts with U.S. core data for interoperability, "do that well within those first two years, and then take a second step."
"You had a common clinical data set that set in 2015 and many people still haven’t been able to comply with that. Now you're having an updated data set. You're not only asking for that information. You're asking for all of the other information within a two-year period," Alexander said.
Don Rucker, MD, ONC's national coordinator for HIT, told the committee "the difference between the U.S. core data of interoperability and the common data set is we are adding in clinical notes and what is called metadata."
"All the core technical provisions and the testing about the core data for interoperability, that is the part that is computable," Rucker said. "We have evidence that the vast majority or providers, both hospitals and physicians, have access to that software today."
Following up on Alexander's remarks, Committee Ranking Member Patty Murray (D-Wash.) asked Rucker about the consequences of delaying provisions of the Act that dealt with information blocking.
"The main risk, fundamentally, to the extent this delayed or prevented, the American public is not in charge of their healthcare," Rucker said. "They're paying more for their care. They're not getting as good care as they could get, and fundamentally they're not in control of their care."
Sen. Mike Braun (R-Ind.) used his five minutes to rail against a "dysfunctional" healthcare system that has to be goaded by the government to adopt technologies that other sectors of the economy have been using for decades.
"Most industries would not be having hearings because there is transparency and there is competition and there is embracing of the technology," Braun told the committee. "I hated to hear that within the medical sector it's the only place where we see neutral or maybe negative annual gains in the use of technology. It begs the question: What is wrong with the industry itself?"
Braun, who referred to himself as a "Main Street conservative," said the problem is not with the government, but with the private sector.
"I lay the burden not here in the Senate, but on the shoulders of the industry itself," he said. "If you are cloaking and making this so difficult to get simple things like interoperability, we're hearing about blocking information, that is so far out of the mainstream from all other industries."
"I want the industry to hear what I've been saying all along. Get with it or you are going to be changed radically with all kinds of approaches that are based on frustration," he said.
The milestone continues a long-term trend that has shifted the distribution of physicians away from ownership of private practices.
Employed physicians outnumber self-employed physicians for the first time in the United States, according to an updated studyon physician practices by the American Medical Association.
"Transformational change continues in the delivery of healthcare and physicians are responding by reevaluating their practice arrangements," AMA President Barbara L. McAneny, MD, said in amedia release.
Employed physicians were 47.4% of all patient care physicians in 2018, up 6% points since 2012.
Self-employed physicians were 45.9% of all patient care physicians in 2018, down 7% points since 2012.
Such a dramatic shift is not unprecendented. Older AMA surveys show the share of self-employed physicians fell 14% points during a six-year span between 1988 and 1994.
Given the rate of change in the early 1990s, it appeared a point was imminent when employed physicians would outnumber self-employed physicians, but the shift took much longer than anticipated.
The AMA's researchers said that history suggests that "caution should be taken in assuming current trends will continue indefinitely."
The majority of patient care physicians (54%) worked in physician-owned practices in 2018 either as an owner, employee, or contractor. Although this share fell from 60% in 2012, the trend away from physician-owned practice appears to be slowing since more than half of the shift occurred between 2012 and 2014, the study said.
At the same time, there was an increase in the share of physicians working directly for a hospital or in a practice at least partly owned by a hospital.
Physicians working directly for a hospital were 8% of all patient care physicians, an increase from 5.6% in 2012. Physicians in hospital-owned practices were 26.7% of all patient care physicians, an increase from 23.4% in 2012.
In the aggregate, 34.7% of physicians worked either for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29.0% in 2012.
Younger physicians and women physicians are more likely to be employed. Nearly 70% of physicians under age 40 were employees in 2018, compared to 38.2% of physicians age 55 and over.
Among female physicians, more were employees than practice owners (57.6% vs. 34.3%). The reverse is true for male physicians, more were practice owners than employees (52.1% vs. 41.9%).
As in past AMA studies, physicians’ employment status varied widely across medical specialties in 2018.
The surgical subspecialties had the highest share of owners (64.5%) followed by obstetrics/gynecology (53.8%) and internal medicine subspecialties (51.7%).
Emergency medicine had the lowest share of owners (26.2%) and the highest share of independent contractors (27.3%). Family practice was the specialty with the highest share of employed physicians (57.4%).
Most physicians still work in small practices, but this share has fallen slowly but steadily since 2012. In 2018, 56.5% of physicians worked in practices with 10 or fewer physicians compared to 61.4% in 2012.
The AMA report said the transition has been driven primarily by the shift away from very small practices, especially solo practices, in favor of very large practices of 50 or more physicians.
The new study is the latest addition to the AMA's Policy Research Perspective series that examines long term changes in practice arrangements and payment methodologies.
Complexity, competition, and inexperience are keeping MMCOs away from the ACA Marketplace.
Goading more Medicaid managed care organizations to participate in the Affordable Care Act's Marketplace could lower premiums for enrollees, according to a new study commissioned by the Robert Wood Johnson Foundation.
In 15 states where marketplace premiums are higher than the national average, Medicare MCOs offer little or no coverage, according to the report, which was compiled by the Urban Institute.
In the 10 states with the lowest average benchmark premiums, all have MMCOs broadly offering marketplace coverage, the report found.
The report suggests that some insurers see Medicaid as more attractive than the Affordable Care Act marketplaces because Medicaid offers plans more policy stability, clearer delineation of rules, and less burdensome regulation.
"As policymakers grapple with affordable ways to expand coverage, they may consider ways to incentivize Medicaid insurers to expand their offerings," said Mona Shah, senior program officer at the Robert Wood Johnson Foundation.
"If Medicaid managed care plans offer coverage to more people and in more places, it could help protect consumers from higher healthcare costs," Shah said.
Medicaid MMCOs expressed concern about the different marketing and pricing tasks that would be necessary for success in the marketplaces. In other words, the MMCOs said entering the ACA Marketplaces was too complex.
Among the obstacles:
Marketplace insurers must compete for enrollees, which some Medicaid insurers do not have experience with because they are assigned enrollees or exclusive territories by some state Medicaid programs.
Marketplace insurers face more financial risk, because marketplace rules and conditions have changed drastically from year to year, making it more difficult for insurers to predict how costly their enrollees will be, and leading some insurers to lose money on their marketplace business.
Marketplace insurers need more sophisticated actuaries to price plans, whereas states often set Medicaid insurers' capitated rates.
Marketplace insurers must be able to collect premiums from consumers, whereas most Medicaid plans are available without a premium.
Marketplace insurers must obtain special insurance licenses and maintain larger capital reserves to cover any unexpected financial losses.
The Urban Institute researchers identified policy changes that could make the ACA's marketplaces more attractive to MMCOs. For example, the MMCOs have shown interest in a recent Medicaid buy-in program that allows residents to pay premiums to "buy in" to Medicaid.
Under that plan, the coverage for consumers who enroll in Medicaid buy-in might be the same as someone who would otherwise sign up for marketplace coverage.
However, the organizational requirements that would apply to sellers of these two types of plans could end up being very different. If a Medicaid buy-in program used Medicaid's less stringent requirements, it could prompt organizations not currently offering marketplace plans to offer new coverage options to consumers.
LHN CEO Mark Medley will take over Poore's portfolio after he leaves at the end of this month.
Lutheran Health Network Regional President Mike Poore is stepping down at the end of May after less than two years at the Fort Wayne, Indiana-based health system.
In a letter to employees, published byInside Indiana Business, Poore said he has planned to stay longer, but after several weeks of contemplation, "I’ve decided that this is the right time for me to return home."
He called the move "the right decision for me and for my family at this time in our lives."
LHN CEO Mark Medley will take over Poore's portfolio after he leaves at the end of this month.
"Over the next few weeks, I’ll be transitioning my responsibilities to Mark Medley and I’ll be working with our hospital and network leadership teams to ensure a smooth transition," Poore said.
Poore has served as president and CEO of LHN since June 2017, when parent company Community Health Systems ousted CEO Brian Bauer. Poore relinquished the CEO title earlier this year to focus on long-term planning.
Poore had served as vice president of operations for Franklin, Tennessee-based Community Health Systems Professional Services Corp. and CEO of hospitals and health systems in Georgia, North Carolina and Texas.
Lutheran Health Network has had its share of drama in recent years. Amid financial hardship, CHS considered selling the network in 2016, and Bauer was fired in 2017. A group of physicians then tried unsuccessfully to acquire the network, the chief medical officer was fired, and two other prominent physicians resigned.
In 2018, St. Joseph Hospital CEO Karen Fordham resigned after working in the Lutheran Health Network just seven months, having been accused of saying Bauer "should be shot and killed for what he did."
Bauer was sued by CHS for allegedly using privileged information to seek new ownership and help competitor IU Health establish its presence in the city, as the News-Sentinelreported last August.
DOJ 'upon further consideration' explains why it abandoned it partial defense of the ACA.
The Trump Administration this week detailed its argument for a judicial repeal of the Affordable Care Act.
"The district court correctly ruled that, in the absence of any revenue-raising provision, the individual mandate can no longer properly be upheld as a tax and is therefore unconstitutional," Assistant U.S. Attorney Joseph H. Hunt wrote in the50-page brieffiled Wednesday with the 5th U.S. Circuit Court of Appeals.
Hunt argued that, absent the mandate, "Congress would not have intended to retain the guaranteed-issue and community-rating provisions, which Congress expressly found depended on the mandate, or the rest of the ACA, which involves numerous other interdependent provisions likewise designed to work together to expand health-insurance coverage and to shift healthcare costs."
"Moreover, once those core provisions are excised, the balance of the ACA cannot continue to operate as intended," Hunt wrote.
"The desired interactions between these provisions cannot be achieved once the individual mandate and the guaranteed-issue and community-rating provisions are excised. Instead of rewriting the statute by picking and choosing which provisions to invalidate, the proper course is to strike it down in its entirety," Hunt said.
District Judge Reed O'Connor's decision last December went much further than the DOJ had urged, declaring the entire ACA invalid, as the Texas-led coalition of plaintiff states had requested. Now that an appeal is pending at the Fifth Circuit, however, the DOJ has decided that it agrees with the plaintiffs' argument and O'Connor's decision after all.
The DOJ had argued in District Court proceedings last fall that most of the sprawling healthcare legislation should remain intact, even if the ACA's individual mandate were to be struck down in light of Congress zeroing out its tax penalty. Only the ACA's community-rating and guaranteed-issueprovisions—which protect consumers with preexisting conditions—should fall with the mandate, the DOJ had argued.
"In the district court, the Department of Justice took the position that the remainder of the ACA was severable," Hunt wrote, "but upon further consideration and review of the district court’s opinion, it is the position of the United States that the balance of the ACA also is inseverable and must be struck down."
Democrats Seethe
House Speaker Nancy Pelosi (D-Calif.) said the DOJ brief was the latest effort in the "continuing Republicans' monstrous campaign to destroy pre-existing condition protections and Americans' access to affordable healthcare."
"There is no viable legal argument and no moral defense for the devastation the Trump Administration is asking the court to inflict on Americans' healthcare," Pelosi said in prepared remarks.
Pelosi said the House Democrats next week would vote on the Protecting Americans with Pre-existing Conditions Act to strengthen and reinforce these life-saving protections.
In the meantime, Pelosi said, "the Trump Administration owes the American people answers for why it is seeking to rip away protections for pre-existing conditions and cause such vast suffering for families across America."
