St. Joseph’s Community Health Services in Hillsboro has joined Gundersen Lutheran Heath Services with the formal affiliation expected to be finalized this month, the two WI healthcare providers have announced.
The combined system – to be known as St. Joseph’s Health Services – Gundersen Lutheran – will serve Hillsboro, Wonewoc, Elroy, and surrounding communities in the Hill Country area of west central Wisconsin. In November 2010, St. Joseph’s signed a management agreement with La Crosse, WI-based Gundersen Lutheran.
“We are pleased to be able to take our relationship with Gundersen Lutheran to the next level,” said Deb Smith, CEO of St. Joseph’s Health Services, in a media release announcing the affiliation. “As St. Joseph’s sought a partner to help create a more efficient healthcare delivery system for our patients, one of the first that came to mind is Gundersen Lutheran.”
In the coming months, the Gundersen Lutheran – Hillsboro Clinic and St. Joseph’s Hillsboro Clinic will consolidate at St. Joseph’s Hospital. Plans are underway to merge Gundersen Lutheran and St. Joseph’s in Wonewoc.
Sigurd B. Gundersen III, MD, medical vice president, Gundersen Lutheran Health System, said the affiliation will allow Hill Country residents to continue to receive quality care close to home. “In fact, enhancing the care in all of the communities we serve and creating a more efficient delivery system are part of our mission and our ongoing plans for the future,” Gundersen said in a media release.
During and after the transition, St. Joseph’s will accept insurances they now accept. After the transition, all patients’ billing statements will come from the consolidated clinic operation, St. Joseph’s Health Services -- Gundersen Lutheran.
There are no plans to cut overall employment with the affiliation. Staff and facility transitions will occur over the coming months, the health systems said.
Four members of the St. Joseph’s Community Board will serve on the board of St. Joseph’s Health Services – Gundersen Lutheran Board, along with five representatives from Gundersen Lutheran.
St. Joseph’s is the third regional hospital that is affiliated with Gundersen Lutheran. The others are Tri-County Memorial in Whitehall, WI, and Palmer Lutheran in West Union, IA.
Online job ads for healthcare practitioners, technical workers, and support staff tapered in February, undercutting some of the surging job demand gains for the healthcare sector in January, according to the new The Conference Board Help Wanted Onlinereport.
Labor demand for healthcare practitioners and technicaloccupations dropped 4,300 in February to 600,100 owing largely to decreases in advertised vacancies for registered nurses and occupational and physical therapists. Healthcare support positions posted a similar decrease of 4,200 to 139,000 in February, The Conference Board reports.
The board's Help Wanted Online Data Series tracks more than 1,000 online job boards across the United States.
In January, The Conference Board reported 78,500 new listings for practitioners and technicians, and 16,600 new ads for healthcare support jobs also grew by 16,600 listings, as healthcare jobs led a strong first month of 2011.
Even with February’s slight drop, there were still more than three job listings for every healthcare technician and practitioner job seeker, with the average salary of $33.51 an hour. There were two healthcare support workers for every online job listing, with pay averaging $12.84 an hour, The Conference Board reports.
Hospitals created 50,100 jobs in 2010, nearly double the rate of job creation from 2009, and the entire healthcare sector - everything from allergists to X-ray technicians -- created 265,800 jobs for the year, Bureau of Labor Statistics preliminary data shows.
Overall, the healthcare sector employed 13.9 million people at the end of 2010, including 4.7 million jobs at hospitals, 6 million jobs in outpatient ambulatory services, and 2.3 million jobs in physicians' offices, BLS data show.
The tapering off of February on-line job listings in healthcare mirrored a slight drop in job listings in the overall economy, which saw online advertised vacancies dipped by 27,400 in February to 4,245,600, The Conference Board reports.
“Total labor demand (new ads and ads that are reposted from the previous month) paused in February, but the number of new, first-time advertised vacancies continued to rise and is an indication that employers are continuing to look for workers,” said June Shelp, vice president at The Conference Board. “Nationally, new ads were up 86,100 in February, and that is a positive sign in contrast to the last few years when advertised vacancies either dropped or remained unchanged from January to February.”
Nationally, there were 9.6 million more unemployed workers than advertised vacancies in January -- the latest month for which unemployment data are available.
Labor demand in the overall economy has added 1.41 million online postings since the series’ low point in April, 2009. This increase offsets approximately 80% of the 1.76 million drop in ad volume during the two-year downturn period from April 2007 through April 2009.
The nation's largest hospital associations have banded together to ask the Obama administration to resist efforts by governors to reduce maintenance-of-effort funding for Medicaid in their cash-strapped states.
"We want to reiterate our strong support for the Medicaid MOE requirement that was part of the Affordable Care Act, and urge you to continue to resist efforts to erode the important coverage protections that this provision is intended to ensure," the associations said in a joint letter Tuesday to Health and Human Services Secretary Kathleen Sebelius. "The nation's hospitals and health systems recognize the significant fiscal pressures facing many states and stand ready to work with them, as you do, to find effective solutions without compromising coverage."
The letter was sent as Republican governors urged the Obama Administration to change Medicaid from its reliance on state and federal matching funds, and into a block grant program. The GOP governors said block grants would provide them with the flexibility to manage the budget-busting program and cover gaping state revenue shortfalls. Several media outlets reported Tuesday that the Obama administration has rejected the idea.
Medicaid covers more than 50 million people, and the rolls have increased in recent years owing to the recession and sputtering recover. The hospital associations in the letter to Sebelius acknowledged the pressure that Medicaid is putting on state budgets, but they urged the federal government to resist any requests for MOE waivers, which are otherwise prohibited before Jan. 14, 2014, when the ACA's coverage expansion goes into effect.
"A relaxation of the MOE provisions will push many low-income Americans off Medicaid rolls, thereby increasing the number of uninsured – moving us backwards rather than forward towards the ACA's goal of expanded health coverage," the associations said. "Removing people from Medicaid does not keep them from getting sick and will deter them from seeking the care that they need. Further, it shifts the burden of their care from states and the federal government largely onto the nation's hospitals. Hospitals currently provide some $40 billion in uncompensated care and the loss of the Medicaid MOE will only increase this burden on providers."
The letter was signed by representatives from the American Hospital Association, Catholic Health Association of the United States, Federation of American Hospitals, National Association of Children's Hospitals, National Association of Public Hospitals and Health Systems, the Association of American Medical Colleges, and VHA Inc.
Healthcare quality continues to progress, albeit slowly—about 2.3% a year. Disparities based on race, ethnicity, socioeconomic status and other factors, however, remain unacceptably high, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued this week by the Department of Health & Human Services' Agency for Healthcare Research and Quality.
The reports, mandated by Congress, are based on more than 200 healthcare measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.
"All Americans should have access to high-quality, appropriate and safe healthcare that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal," said AHRQ Director Carolyn M. Clancy, MD. "We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement."
Healthcare quality gains were seen in several areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42% in 2005 to 81% in 2008. Very modest gains were seen in rates of screening for preventive services and child and adult immunization.
Measures of lifestyle modifications such as reducing obesity, smoking cessation and substance abuse saw no improvement.
The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40% of core measures. Asians received worse care than whites for about 20% of core measures. Hispanics received worse care than whites for about 60% of core measures. Poor people received worse care than high-income people for about 80% of core measures.
Of the 22 measures of access to healthcare services tracked in the reports, about 60% did not show improvement, and 40% worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3% of people saying they were unable to get or had to delay getting prescription medications to 60% of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.
Ventas, Inc. will acquire Nationwide Health Properties, Inc. in an all-stock transaction valued at $7.4 billion that – when completed – will create the nation's largest publicly traded real estate investment trust, the two REITs announced jointly Monday.
The board of directors at both REITs unanimously approved the definitive agreement, under which Chicago-based Ventas will acquire all of the outstanding shares of NHP in a stock-for-stock transaction that would be the equivalent to $44.99 of Ventas stock for each NHP share, which represents a premium of about 15% over NHP's closing price on Friday.
The combined company will have more than 1,300 assets in 47 states, the District of Columbia, and two Canadian provinces, which represents approximately $17 billion in equity value, and an enterprise value of approximately $23 billion, the two REITs said.
Ventas shareholders are expected to own approximately 65% of the combined company, and NHP shareholders are expected to own approximately 35%. The transaction is expected to be immediately accretive to Ventas's normalized funds from operations and funds available for distribution after the closing, which is expected to occur in the third quarter of 2011, the REITs said.
Ventas Chairman/CEO Debra A. Cafaro will be chairman/CEO of the combined company. Douglas M. Pasquale, NHP's chairman/president/ CEO, will serve as a senior advisor during the transition. When the deal is finalized, the Ventas board will be expanded to include three directors from NHP, including Pasquale, bringing the total to 13 members. The REIT will continue to be headquartered in Chicago.
"The combination of Ventas and NHP increases the scale and diversification of the combined company, the strength and flexibility of the company's balance sheet and the quality and geography of the assets," Cafaro said. "With Ventas's successful track record of value-creating transactions and NHP's longstanding history of regional, asset-level acquisitions, taken together with one of the strongest balance sheets in the REIT industry, the combined company will have a unique opportunity for continued external growth."
Pasquale called Ventas "the right partner" for Newport Beach, CA-based NHP. "Our shareholders, property operators and tenants will all benefit from our expanded strength, diversification and capabilities," he said. "We're pleased that this all-stock transaction offers NHP shareholders a premium and also the opportunity to participate in the combined company's future prospects for dividends and growth."
Among its $5.1 Billion in healthcare real estate assets, NHP owns 667 properties in 42 states including
United Regional Health Care System has agreed to a demand from federal prosecutors that it no longer block health plans from contracting with other hospitals in the Wichita Falls, TX area, the Department of Justice has announced.
Federal prosecutors said URHCS illegally used contracts to maintain its monopoly for hospital services in violation of the Sherman Act, which meant that consumers paid more for healthcare. This is the first case brought by DOJ since 1999 that challenges a monopoly with in traditional anticompetitive unilateral conduct.
"Unfettered competition among hospitals is vital to ensuring that patients receive high-quality, low-cost healthcare," said Christine Varney, assistant Attorney General in charge of the Department of Justice's Antitrust Division. "Today's settlement prevents a dominant hospital from using its market power to harm consumers by undermining its competitors' ability to compete in the marketplace."
Phyllis Cowling, president/CEO of URHCS, said the private, nonprofit health system "was pleased with the resolution" of the investigation.
"While we disagree with the Department's interpretation of the facts and would have welcomed the opportunity to address this matter in a court of law, we believe it is in the best interest of United Regional and our patients to instead move forward with our total attention and resources focused on our passion of providing excellence in healthcare for the communities we serve," Cowling said in a statement posted on the URHCS Web site.
URHCS is the largest hospital in Wichita Falls, controlling about 90% of general acute-care inpatient hospital services, and 65% of outpatient surgical services. It is the region's only provider of cardiac surgery, obstetrics and high-level trauma care. URHCS's average per-day rate for inpatient hospital services sold to commercial health insurers is about 70% higher than its closest competitor for the services that are offered by both hospitals.
DOJ said URHCS systematically demanded most commercial health insurers to sign contracts that required the insurers to pay significantly higher prices if they contracted with a nearby competing healthcare facility. Since URHCS is a must-have hospital for any insurer that wants to sell health insurance in the Wichita Falls area, and because the penalty for contracting with the health system's rivals was significant, almost all insurers offering health insurance in Wichita Falls entered into exclusionary contracts with URHCS.
The proposed settlement -- now under consideration by a U.S. District Judge in North Texas -- would be in effect for seven years. It would ban URHCS from using agreements with commercial health insurers that improperly inhibit insurers from contracting with competitors. In particular, URHCS would be banned from conditioning the prices or discounts that it offers to commercial health insurers based on exclusivity. URHCS also would be banned from taking retaliatory actions against an insurer that contracts with a rival provider.
There is something inherently commonsensical about wellness programs.
If employers entice and incentivize employees to take better care of themselves, by losing weight, quitting smoking, exercising, etc., then the healthier life style will result in lower medical costs, which will be reflected in lower health insurance premiums, and other costs associated with employer-based health plans.
It's a remarkably simple theory. Until recently, however, it's been just that: theory. It's been difficult to consistently demonstrate savings generated by wellness programs. As the wellness movement matures, however, more studies prove they are a worthy return on investment.
Highmark Inc., the Pittsburgh-based health insurers, have published the findings of a four-year study which found that healthcare costs rose at a 15% slower rate among wellness participants who were offered a consistent and comprehensive wellness program over several years, when compared with employees in a control group who did not participate in wellness programs.
The study of select Highmark employer group wellness programs showed that the savings per participant was $332 a year, when compared with the control group of nonparticipants. Actually, the savings could be considerably higher, says Jennifer Grana, a director at Highmark, because the study does not factor in the cost of lost productivity and absenteeism due to health issues.
The study was published in the March/April edition of the American Journal of Health Promotion.
Grana says the measuring ROI on wellness programs has been difficult because it often takes years to see the results. "When you start to talk about a return on investment you will want to evaluate and measure your wellness program knowing it takes time to change behavior," she says. "You have to allow for the fact that it usually takes three to five years of good participation to even begin to move the needle and demonstrate a return on investment."
"It is all about changing behavior, and that takes time," Grana says. "It could take several attempts for people to quit smoking or lose weight. It is not something you will necessarily see overnight. But if you keep at it you will be able to see that you are moving the needle, and that can equate to some dollars saved."
Highmark evaluated the impact of wellness programs on healthcare costs and utilization over time by matching approximately 10,000 wellness program participants at 47 Highmark employer groups with a risk-matched comparison group. The employers offered Web-based wellness programs from Highmark to their employees consistently for at least three or more years.
The study found that wellness program participants used services such as preventive physicals, mammograms and cancer screenings more than their comparison group counterparts, possibly as a result of self-care knowledge obtained from their worksite wellness programs. While these preventive care measures often cost employers more in the short term, they can help save on longer-term healthcare costs.
Grana says that Highmark data show that successful wellness programs almost always start with a health risk assessment that could be combined with biometric screenings. "It's important to follow up with the 'what's next?' with the data," she says. "Whether it's a digital coaching program that a worker can access that deals with topics like binge eating or weight management or insomnia, or it could be telephonic coaching, or employer-sponsored worksite programs. (Making) them aware of the resources that are readily available for them is crucial."
While worksite health promotion and wellness programs have been around for 30 years, Grana says that in the past five years employers have more readily embraced wellness as part of their organizational mission. "Some have tied incentives for participation in wellness programs to their benefit design. Those types of movements have allowed great progress in terms of getting more participation so there is more data, so we can implement more meaningful programs or interventions that address the data," she says.Grana says she is finding C-suites are becoming more receptive toward wellness programs as they demonstrate their value, and as healthcare costs continue to pile up. "It's not just in terms of healthcare dollars. It's also in terms of productivity," she says. "We know people who manage their stress or depression who are healthier are more productive employees. They miss less work and when they are at work they are functioning at a higher level."
Accepting the validity of the wellness movement, and building a wellness movement for your organization are not the same thing, however. "Wellness is not easy," Grana says. "You have to have a trusting culture, you have to motivate employees, and you have the have the administrative and communications support to make these things successful to get the biggest bang for the buck. When you balance it all out employers know it's the right thing to do."
Wellness programs may be the right thing to do for employees, and they may give the folks in HR a higher sense of purpose as they help colleagues enjoy the higher quality of life that comes with better health. But wellness programs will only prosper and proliferate if they're shown to be cost effective. Fortunately, the data is telling us that it's true.
Medical student and resident education has to include instruction on how healthcare systems function -- especially with the advent of complicated national healthcare reforms, University of Michigan physicians said.
Two U-M physicians and a U-M Medical School graduate called for a national curriculum in health policy for medical students and residents, in an article in the New England Journal of Medicine. “Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox,” said co-author Matthew M. Davis, MD, associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy.
Davis said his previous research has found that fewer than half of graduating medical students in the U.S. said they received adequate training in understanding healthcare systems and the economics of practicing medicine.
“As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” said Mitesh S. Patel, MD, a 2009 U-M Medical School graduate and lead author of the article. “These issues have a major impact on the delivery and cost of healthcare. However, they are rarely discussed in educational lectures or during teaching rounds.”
Physicians who don't understand the healthcare system or health insurance policies disserve their patients, said Monica Lypson, MD, assistant dean of Graduate Medical Education at U-M and a co-author on the article. “The healthcare system is complicated, but it’s no more complicated than the other things we expect medical students and residents to learn,” Lypson said. “Regardless of partisan persuasion or political beliefs, physician trainees and medical doctors in general should have the knowledge needed to engage in meaningful discussions regarding health policy.”
The U-M Medical School has added an elective course in healthcare policy, which Davis teaches. “It is enrolled to the maximum,” he said. “The students were hungry to learn more. We have to find the best ways to teach medical students to be the best navigators of the healthcare system for their patients.”
The three authors want a common national curriculum -- with content tailored regionally and locally. They recommend pilot projects as a precursor to a standardized national curriculum and propose a focus on four concentrations: healthcare systems, healthcare quality, value and equity, and health politics and law.
The new curriculum should not jeopardize other topics, but that policy discussions should be integrated with clinical instruction and permeate the educational training. The authors want a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.
Lypson said patients expect physicians to be knowledgeable about healthcare reforms, health insurance, health policy, and the impact of these forces on their care. “We don't expect them to learn to practice medicine simply by saying, “Go take care of patients now,’” she said. “That doesn't work for clinical knowledge, and it doesn't work for policy knowledge, either.”
North Country Health Services in Bemidji, MN, and Dakotas-based Sanford Health have signed an affiliation agreement that will create Sanford Health of Northern Minnesota on March 1. As part of the affiliation, Sanford will invest $70 million in resources over the next ten years and will immediately make a $5 million gift to the NCHS Foundation, the two healthcare systems said Friday in a joint announcement.
NCHS and Sanford Bemidji Clinic said the affiliation is the "first step" in the integration of the two Bemidji-based organizations to provide coordinated care for patients close to home. Plans are underway to expand service lines for heart, cancer, orthopedics & sports medicine, women's health, and research and education. The affiliation is also expected to help with clinician recruiting.
"A yearlong evaluation process revealed many ways for us to better serve the region together as an integrated provider," said Kelby Krabbenhoft, CEO of Sanford Health. "We will combine the resources of a strong regional healthcare institution and a multi-specialty physician clinic, together with the Sanford Health System, to offer more primary and specialty care services and new programs in research and education. Our goals were the same -- to make Bemidji a regional referral center in northern Minnesota and this merger will enable us to do so."
Sanford Bemidji will consist of Sanford Bemidji Medical Center and Sanford Bemidji Clinic and will operate under the legal name of Sanford Health of Northern Minnesota, based in Bemidji. Sanford Bemidji will serve as the regional hub for Sanford Health in northern Minnesota.
The existing board at NCHS will comprise the new Sanford Bemidji Board of Directors, using the same corporate structure as other Sanford hospitals such as Sanford USD Medical Center, and Sanford Fargo Medical Center.
"Both NCHS and Sanford Bemidji Clinic have deep roots in this region as well as a legacy of community service," said Paul Hanson, president/CEO of NCHS. "At a time of great change in healthcare, we see this affiliation as an opportunity to grow and provide quality healthcare to the people of this region now and for years to come."
NCHS has more than 900 employees with 25,000 emergency visits, 5,500 acute admissions and 1,000 births per year. NCHS opened in 1898 and is an acute care hospital serving a region of approximately 100,000 people in northern Minnesota. It has 80 acute hospital beds, 16 acute rehabilitation beds, 12 acute geriatric psychiatric beds and 78 skilled nursing home beds; 120 assisted living apartments including a distinct dementia unit; a durable medical equipment company; a Class A licensed homecare agency and Medicare certified hospice program.
Sanford Bemidji Clinic has 75 physicians, 15 mid-level providers and 550 employees.Sanford Health is an integrated health system headquartered in Fargo, ND and Sioux Falls, SD and consists of two long-standing organizations that merged in 2009. Sanford is now the largest, rural, not-for-profit healthcare system in the nation with a presence in 111 communities in eight states.
Sanford Health includes 31 hospitals, 111 clinic locations and more than 800 physicians in 70 specialty areas of medicine. With more than 19,000 employees, Sanford Health is the largest employer in North and South Dakota.
Both health organizations said the affiliation would create more healthcare-related jobs, rather than layoffs, as the full integration of the systems continues over many months.
Will Sanford Health Plan be offered in Bemidji?
The Sanford Health Plan is currently the second largest commercial health insurer in South Dakota, covering more than 65,000 lives. Recently it was introduced in North Dakota and it is currently available in southwest Minnesota. Work is being done so we can offer both group and individual policies in northern Minnesota in the future. This is subject to regulatory approvals. In the meantime, Sanford Health Plan is available to all Sanford Health employees.
How will Mr. Sanford's gift be used in this new health system?
Mr. Sanford's gift of $400 million is being used for clearly defined Sanford Health Initiatives: The Sanford Project – a quest to cure Type 1 diabetes, Sanford Children's Clinic development around the world and a multitude of other research development projects. His most recent gift of $100 million will be used for advancement of breast cancer research and treatment. These initiatives will be part of the new integrated health system (including NCHS).
BlueCross BlueShield of Illinois will pay the federal government and the state of Illinois $25 million to settle False Claims Act allegations, the Justice Department has announced.
The settlement resolves claims that BCBS IL illegally terminated coverage for private duty skilled nursing care for medically fragile, technologically dependent children, which shifted the cost of the care onto Medicaid, DOJ said in a statement.
Under the alleged scheme, children whose specialized care should have been covered by BlueCross BlueShield of Illinois were shifted to the government-funded Home and Community Based Services Medicaid program, operated by the Illinois Division of Specialized Care for Children.
The settlement also resolves claims that BCBSI denied patient claims based on internal, undisclosed guidelines that were more restrictive than the language provided to beneficiaries in plan policy materials. Additionally, the DOJ claimed that BCBSI improperly told policy holders that children were not covered for private duty nursing during the claims review process sought after denials.
Under the agreement, BlueCross BlueShield of Illinois will pay $14.25 million to Illinois and $9.5 million to the federal government. The insurer, a division of Health Care Service Corp., will also pay $1.25 million to Illinois under the state consumer fraud statute.
"It is appalling for a major insurance company to terminate medical services coverage for sick children in need just to boost their bottom line at taxpayers' expense, as we've alleged here," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "When private insurance companies improperly force patients to turn to Medicaid for medical coverage those companies should be providing, we will hold them accountable."
BCBS IL issued the following statement: "Our agreement with the state attorney general and the federal government resolves a long-standing dispute concerning certain claims involving private duty nursing benefits. While we disagree with the allegations and deny any inappropriate conduct at any time, we are pleased to put this matter behind us and focus on serving the needs of our policyholders. This dispute began many years ago when we reviewed certain claims and determined that the benefits sought were not covered by the applicable insurance plans and policies. These plans and polices determine which benefits are covered and which are not. Several years ago, in cooperation with the state attorney general, we expanded our explanation of benefits to ensure that our members understood what nursing benefits are covered under their plans. That action, coupled with today's agreement, are in the best interests of our members."
DOJ has used the False Claims Act to recover more than $5.5 billion since January 2009 in cases involving fraud against federal healthcare programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 are nearly $7 billion.
