The 308-bed, tertiary care hospital will be renamed St. Elizabeth's Medical Center, A Boston University Teaching Hospital.
For-profit Steward Health Care's flagship St. Elizabeth's Medical Center will become a teaching hospital for Boston University School of Medicine, the stakeholders announced Monday.
The partnership "expands medical education programs at the hospital and gives additional resources to physicians, including teaching opportunities and broader research collaboration," according to a media release.
Michael Callum, MD, president of Steward Medical Group, Executive Vice President for Physician Services, and a BU School of Medicine Graduate called the partnership with Boston University School of Medicine is "the latest example of Steward investing in our local communities."
"St. Elizabeth's programs of excellence rival the quality of other academic medical centers – but at a better value to patients, payors and employers," Callum said.
The 308-bed, tertiary care hospital will be renamed St. Elizabeth's Medical Center, A Boston University Teaching Hospital.
Karen Antman, MD, BU Medical Campus provost and dean of the School of Medicine, said the agreement will expand the numbers of medical students, physician assistants, mental health and genetics counselors who will do clinical rotations at St. Elizabeth's.
"The education of future clinicians requires hands-on patient care experiences, small-group or even one-on-one teaching. Ideally each student is part of the team that cares for a number of patients, with increasing levels of responsibility under close supervision," Antman said. "This new arrangement with St. Elizabeth's will help us achieve that objective."
St. Elizabeth's Medical Center recently opened a 10-bed intensive care unit and a "hybrid operating room" and has committed to investing $100 million in capital improvements for the hospital, which opened in 1868.
Physician-owned Steward, based in Dallas, operates 34 hospitals in nine states, 11 of which are teaching hospitals, and in Colombia, and Malta.
C-section rates varied widely between hospitals in California before the initiative with no particular reason.
A four-year, Stanford-led initiative to reduce C-sections for low-risk, first-time mother in California is paying dividends, a new study finds.
The study, published in the Journal of the American Medical Association, found that the initiative slightly exceeded national goals and led California to become the first state in the nation to reach a sustained reduction in C-sections.
C-section rates varied widely between hospitals in California before the initiative with no particular reason, said study senior author Elliott Main, MD, clinical professor of obstetrics and gynecology at Stanford Medicine.
"We had pregnant women going to different hospitals in California and, through one door, the cesarean delivery rate was 15%, while through another it was 60%," Main said. "That wasn't right."
The study examined several coordinated initiatives in California to reduce C-sections between 2015 and 2019, including annual public reporting of hospital C-section rates, messaging to the state's 238 hospitals, as well as state agencies and payers, and quality improvement programs targeting hospitals with the highest C-section rates.
As a result of those efforts, the study found that the initiative reduced the percentage of first-time California mothers with low-risk pregnancies who underwent C-sections from 26% in 2014 -- a rate equal to the current national average – to 22.8% in 2019, putting the Golden State below the 23.9% target put forward by the Centers for Disease Control and Prevention in its Healthy People 202 initiative.
"It's a big change from the U.S. average, and our collective efforts have not only significantly lowered the average rate for the state but also narrowed the variation between hospitals in California," Main said. "This is great news for California women, especially because we have preserved and even improved on babies’ outcomes at the same time."
When appropriate, Main said, C-sections can be lifesavers for babies and their mothers, but they also carry risks. C-sections are considered major surgery and thus create potential complications, longer recovery periods, and endanger future pregnancies than vaginal births.
The study identified several factors that have nothing to do with the health or safety of the patients as factors driving C-section rates, including hospital policies, the culture of the labor delivery unit, and the attitudes of individual doctors and nurses.
"Getting healthcare providers to change their behaviors is difficult, but this was a concerted effort with many layers of support for our hospital teams," said the study lead author, Melissa Rosenstein, MD, associate director for implementation science at the California Maternal Quality Care Collaborative and an assistant professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
"After we shared multiple strategies and provided every hospital with an analysis of its own data, each hospital chose the approach, or approaches, it wanted to work on," Rosenstein said.
The sweeping proposed rule also calls for a 2.8% IPPS rate increase for FY22, and creates 1,000 new residency slots to bolster the healthcare workforce in rural and underserved areas.
The Centers for Medicare & Medicare Services on Tuesday unveiled a sweeping proposed rule that would nullify the mandated public disclosure of negotiated rates between payers and providers and increase by 2.8% Medicare's inpatient prospective payment in fiscal year 2022.
"The rule's provisions seek to sustain hospital readiness to respond to future public health threats, enhance the health care workforce in rural and underserved communities, and revise scoring, payment and public quality data reporting methods to lessen the adverse impacts of the pandemic and future unplanned events," CMS said in a media release, adding that the proposed repeal of "collection of market-based rate information on the Medicare cost report and the market-based MS-DRG relative weight methodology… will avoid imposing additional unnecessary burden on hospitals."
Not surprisingly, provider groups were elated.
"Based on our initial review, we are very pleased CMS is proposing to repeal the requirement that hospitals and health systems disclose privately negotiated contract terms with payers on the Medicare cost report," Tom Nickels, executive vice president of the American Hospital Association said in a media release.
"We have long said that privately negotiated rates take into account any number of unique circumstances between a private payer and a hospital and their disclosure will not further CMS's goal of paying market rates that reflect the cost of delivering care," he said. "We once again urge the agency to focus on transparency efforts that help patients access their specific financial information based on their coverage and care."
CMS said the IPPS 2.8% net rate increase would apply to hospitals "that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users."
"This reflects the projected hospital market basket update of 2.5% reduced by a 0.2 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by legislation," CMS said.
With the aim of bolstering the nation's badly understaffed healthcare workforce in rural and underserved areas, the proposed rule also would distribute 1,000 new physician residency slots over five years to hospitals in healthcare deserts, phasing in 200 slots per year over five years, at a Medicare-funded cost of about $300 million a year.
"Hospitals are often the backbone of rural communities – but the COVID-19 pandemic has hit rural hospitals hard, and too many are struggling to stay afloat," Health and Human Services Secretary Xavier Becerra said in a media release. "This rule will give hospitals more relief and additional tools to care for COVID-19 patients and it will also bolster the healthcare workforce in rural and underserved communities."
Nickels said the additional slots will "help ease current physician shortages and bolster the foundation of our healthcare system."
CMS said it also wants to hear suggestions from stakeholders about policy changes that could facilitate healthcare equity.
"This includes enhancing hospital-specific reports that stratify measure results by Medicare/Medicaid dual eligibility and other social risk factors, ways to improve demographic data collection, and the potential creation of a hospital equity score to synthesize results across multiple measures and social risk factors," CMS said.
The proposed rule also would: extend new COVID-19 treatments and add-on payments through the end of the fiscal year, when the public health emergency is supposed to end; "suppress" most hospital value-based purchasing metrics, resulting in neutral payment adjustments for hospitals; exclude 2020 pandemic-tainted data when measuring hospital-acquired conditions in fiscal years 2022 and 2023; discount pneumonia readmissions to FY 2023 hospital readmission penalties, and exclude COVID-19 patients from the other five readmissions measures.
CMS is accepting comments on the proposed rule through the end of June.
Molina said it will fund the purchase with cash on hand, and the deal is expected to be finalized by the end of 2021.
Molina Healthcare, Inc. will spend $60 million to buy Cigna Corp.'s Texas Medicaid and Medicare-Medicaid Plan, the two companies announced Thursday.
Cigna's Texas Medicaid and MMP health plan serves 48,000 Medicaid beneficiaries in the Hidalgo, Tarrant, and Northeast service areas, and 2,000 MMP members in the Hidalgo service area, with full year 2020 premium revenues of $1 billion.
Long Beach, California-based Molina said it will fund the purchase with cash on hand, and the deal is expected to be finalized by the end of the 2021, pending regulatory approval.
"Acquiring Cigna's Texas Medicaid business provides us with a stable base of membership and revenue that will deepen Molina’s service offerings in Texas, allowing us to meet the needs of thousands of additional Medicaid and MMP members," Molina said in a media release. "The transaction demonstrates continued execution and is nicely representative of our growth strategy."
Bloomfield, Connecticut-based Cigna said in a statement: "We are proud of the positive impact we have made on customer lives through our Texas Medicaid business, and are confident that Molina will build on our work to improve their health, well-being, and peace of mind. We remain fully committed to the state of Texas, and look forward to continuing to bring affordable, predictable, and simple health care solutions to the millions of Texans we serve through our Medicare, Commercial, and Health Services businesses."
Median net patient revenue for not-for-profit health systems was $1 billion in fiscal 2020, nearly double the $568 million in 2010.
Hospital partnerships, affiliations, and mergers and acquisitions "will continue at a robust pace in the healthcare sector in 2021," extending a decade-long consolidation trend in both the not-for-profit and for-profit sectors, Moody's Investors Service said in a new report.
"Larger health systems will pursue M&A to increase market share through geographic and service line diversification," Moody's said in its April Healthcare Quarterly report. "As COVID-19 takes a toll on financial performance, smaller providers will look to partner to gain access to clinical, strategic, and financial resources and reduce labor, supply and information technology expenses."
The report noted that median net patient revenue for not-for-profit health systems was $1 billion in fiscal 2020,1 nearly double the $568 million in 2010.
Moody's credited the steady increase of revenues for not-for-profit health systems over the past decade to provider consolidation, because bigger systems have greater leverage with payers. In addition, larger systems offer better access to pricey clinical resources for complex money-making procedures.
While Coronavirus Aid, Relief and Economic Security (CARES) Act money, Medicare accelerated payments and expense reductions have offset pandemic-related losses, Moody's said that relief "will be temporary as hospitals will need to repay Medicare for the payment advances while volumes will likely remain at lower-than-historical levels."
"Smaller systems may find it more difficult to repay the Medicare funds, given lower liquidity and less financial flexibility than larger health systems," Moody's said. "And partnerships provide an opportunity to lessen financial challenges, such as an increasingly more expensive workforce."
Moody's said M&A will allow larger health systems to diversify revenue streams, which will become more important with a weakening payer mix, particularly in areas where Medicare, Medicaid, and other government insurers are the dominant payers.
"An aging population will exacerbate the trend as an increasing number of older Americans shift to Medicare and, at least during the economic downturn, if people out of work move to Medicaid coverage," Moody's said. "Additionally, organic growth will be constrained by an increasing level of patient care moving to lower-cost, non-hospital settings, including those operated by nontraditional providers, which drives down potential reimbursement revenue."
Moody's also anticipates that independent physicians will affiliate with larger health systems offering financial incentives. "Physician burnout and the financial impact of the pandemic-related shutdown in elective services also stands to drive hospital/physician partnerships or acquisitions," Moody's said.
For-profits Flush with Cash
For-profit health systems are flush with cash thanks to CARES Act money and rapid cost reductions because of the pandemic, Moody's said, and that will push M&A activity in the for-profit sector for the next 12-to-18 months.
"Consolidation will be focused on enhancing services provided outside the hospital as consumers seek more access points and flexibility," Moody's said. "Flush with liquidity, for-profit hospitals will focus M&A efforts on building capabilities in non-hospital settings to meet consumer demand."
Some for-profit systems refused CARES Act funds or returned it, which Moody's said illustrates their continued financial health during the pandemic. "HCA Healthcare, Inc. (Ba1 stable), for example, returned its funds, but liquidity improved substantially in fiscal 2020," Moody's said.
U.S. Chamber of Commerce, Harvard Pilgrim, Ascension, and others back audio-only Medicare Advantage bill.
A group of 33 business leaders and healthcare stakeholders have signed on to a letter urging Congress to support legislation allowing the use of audio-only telehealth for Medicare Advantage risk adjustments.
The bipartisan Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021, sponsored by Senators Catherine Cortez Masto (D-NV) and Tim Scott (R-SC) and Representatives Terri Sewell (D-AL) and Gus Bilirakis (R-FL), would protect continuity of care for Medicare Advantage beneficiaries during the COVID-19 pandemic by allowing the use of audio-only telehealth for risk adjustment purposes.
The House bill would also allow audio-only telehealth visits for Programs of All-Inclusive Care for the Elderly (PACE) organizations.
"It is essential that the collection of diagnoses required for risk adjustment be as complete and as accurate as possible," the letter said. "Action by Congress now will … provide relief necessary for Medicare Advantage and PACE organizations, allowing them to continue to provide high quality, affordable care to millions of Medicare beneficiaries."
A study published last August in JAMA Internal Medicine found that 41% of Medicare beneficiaries lacked access to a computer with a highspeed internet connection in their home, and that 41% didn't have a smartphone with a wireless data plan. More than one in four (26.3%) of beneficiaries had neither form of digital access.
Those numbers worsened depending upon the beneficiaries' socioeconomic groups, with half (50.9%) of beneficiaries with an income of 100% below federal poverty level lacking digital access, compared with 11.5% of beneficiaries with income 400% or more above the federal poverty level.
Led by the Better Medicare Alliance, the letter's cosigners include the U.S. Chamber of Commerce, Ascension, Harvard Pilgrim Health Care, Northwell Health, SummaCare, UPMC Health Plan, the American Physical Therapy Association, LeadingAge, and the Visiting Nurse Associations of America.
Better Medicare Alliance President and CEO Allyson Y. Schwartz noted that "telehealth has been a lifeline for older Americans amid COVID-19, but challenges persist."
"Limited access to broadband internet, financial constraints, and functional limitations are real barriers for many vulnerable Medicare Advantage beneficiaries," she said. "Use of audio-only telehealth brings greater equity during the COVID-19 response, as it ensures all seniors have the opportunity to use virtual care options that meet their needs."
MDLIVE specializes in providing 24/7, on-demand, online telehealth services for patients, hospitals, physician groups, employers and payers.
Cigna health services subsidiary Evernorth has completed its previously announced acquisition of privately held MDLIVE Inc., a 24/7 telehealth delivery platform, the Bloomfield, Connecticut-based company announced this week.
Financial terms of the deal were not disclosed.
The transaction, first announced on February 26, "expands Evernorth's capabilities to lower the cost of care – while increasing access to healthcare providers – through virtual visits that can be accessed from the home or anywhere," the Bloomfield, Connecticut-based company said in a media release.
Miramar, Florida-based MDLIVE specializes in providing 24/7, on-demand, online telehealth services for patients, hospitals, physician groups, employers and payers. Evernorth executives say the acquisition comes as more Americans grow comfortable with virtual care.
"By bringing MDLIVE into Evernorth, we have a highly complementary platform that will rapidly expand our capabilities to deliver greater affordability, predictability and simplicity for our customers and clients," said Evernorth President and COO Eric Palmer. "Evernorth is uniquely positioned to bring new, differentiated and future-state care solutions that substantially lower medical costs and improve the overall healthcare experience."
MDLIVE will continue to serve its existing clients and customers and expand access to virtual care as a Evernorth health services subsidiary, which already includes Express Scripts, Accredo and eviCore.
"MDLIVE and Evernorth share a common vision and passion for changing healthcare for the better," said Charles Jones, chairman and CEO of MDLIVE. "Together, we can accelerate the delivery of new virtual care capabilities in a way that will optimize the care journey for our clients and customers."
ACA marketplace enrollment would increase 60% in 2022 by extending ARPA's temporary subsidies.
The numbers of uninsured people in the United States would fall by 4.2 million if the temporary health insurance subsidies in the American Rescue Plan Act were made permanent, according to a new study by the Urban Institute.
The study, commissioned by the Robert Wood Johnson Foundation, estimates that subsidized enrollment would increase by 5.1 million, and that 317,000 people with non-Affordable Care Act-compliant coverage would switch to a more comprehensive ACA-compliant plan if they were to become newly eligible.
When those estimates are combined, the report said, it could lead to a 60% increase in marketplace enrollment in 2022 if the ARPA were to become permanent.
"Making the enhanced ACA subsidies in the American Rescue Plan Act permanent would have a dramatic effect on both coverage and affordability," said Katherine Hempstead, a senior policy adviser at RWJF.
"Enhancing premium tax credits could positively impact the marketplace, leading to greater insurer participation and resulting in lower premiums. That’s good news for consumers and insurers," she said.
Under the ARPA, people with incomes over 400% of poverty are eligible for subsidies to buy health insurance on the ACA marketplace. The law also increases financial assistance for lower-income people who were eligible for ACA coverage. Both provisions took effect retroactively on Jan. 1, 2021 and will expire in two years.
President Biden is expected to sign the bill, which has already cleared the Senate.
A bipartisan U.S. House on Tuesday night voted 384-38 to delay until the end of 2021 Medicare's reviled 2% across-the-board sequestration cuts that were supposed to take effect on April 1.
The Senate passed the bill 90-2 last month and President Joseph R. Biden is expected to sign it in the coming days. To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts.
American Medical Association President Susan R. Bailey, MD, said the overwhelming support in Congress for delaying the cuts "acknowledges that cutting Medicare payments during a pandemic is ill-conceived policy."
"Physician practices are already distressed, and arbitrary 2% across-the-board Medicare cuts would have been devastating," she said.
Rick Pollack, president and CEO of the American Hospital Association, said the delay was needed while hospitals and clinicians contend with the coronavirus pandemic and ongoing vaccination efforts.
"Even though our country is making great progress by vaccinating millions of people a day, it is clear that this pandemic is far from over and that there is an urgent need to keep hospitals, health systems and our heroic caregivers strong," Pollack said.
Anders Gilberg, senior vice president, government affairs, at the Medical Group Management Association, said his association was "relieved that Congress heeded our call to protect medical groups from the arbitrary 2% Medicare sequester cuts through the end of 2021."
"MGMA has long opposed the sequester cuts, a tax that penalizes medical practices for Congress’ inability to meaningfully address the country’s budgetary affairs," Gilberg said. "To reinstate the Medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat."
With the extension in place, Gilberg urged Congress "to work in a bipartisan manner to expeditiously pass legislation that would prevent an additional 4% Medicare spending cut next year due to the budgetary effects of the American Rescue Plan."
The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021. Specifically, requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021.
The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.
The bill also includes both Medicare-enrolled RHCs located in a hospital with less than 50 beds and RHCs that have applied for Medicare enrollment as of this date.
Medicare also faces a separate 4% cut -- about $36 billion -- owing to the Pay-as-You-Go mandates that offset the cost of the American Rescue Plan Act. The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.
Pollack said the AHA will continue to press Congress and the Biden administration for more "support, resources and tools" for the nation's hospitals.
"This includes continuing to advocate for more overall funding for the Provider Relief Fund, relief for hospitals and health systems with Medicare accelerated payments, hospital and health system priorities to be included in the upcoming infrastructure legislative package and Congressional action by the end of the year on Medicare cuts due to the effects of PAYGO," he said.
AMA president applauds the initiatives announced this week but calls them 'just a first step.'
President Joseph R. Biden's proposals to require serial numbers and background checks for "ghost guns" and model legislation for "red flag" laws that identify potentially dangerous gun owners are getting healthy reviews from physicians.
Susan R. Bailey, MD, president of the American Medical Association, applauded the administration for its "bold action" on a "public health crisis" that claims more than 40,000 lives each year, but stressed that the proposals "are just a first step."
"People die every day—and almost every place—in our country from firearm-related injuries. Movie theaters, grocery stores, places of worship, and elementary school classrooms have all been scenes of violence," Bailey said in prepared remarks. "Most of these deaths are preventable, and now is the time for lawmakers, policy leaders and advocates on all sides to seek common ground and save lives."
The AMA in 2016 declared firearm-related violence a public health crisis and one of the leading causes of intentional and unintentional injuries and deaths in the United States.
Biden on Thursday rolled out the initiative, which comes in the wake or shootings in Georgia and Colorado that have claimed 18 lives. The president called the nation's gun violence epidemic "a national embarrassment,"
He also conceded that his options to address the problem through executive authority are limited and that more aggressive action to curb gun violence would require action from Congress.
"We’ve got a long way to go — it seems like we always have a long way to go,” Mr. Biden said during an appearance in the Rose Garden, The New York Times reported.
Jacqueline W. Fincher, MD, president of the American College of Physicians, said the initiatives put forward this week by Biden "are consistent with the types of recommendations that ACP put forward in our 2018 policy paper Reducing Firearm-Related Injuries and Deaths in the U.S."
"In the past year, even as the US has been fighting a global pandemic, injuries and deaths from firearms increased more than any other year in the past two decades," Fincher said. "Advocating for policies, like those announced today, to reduce the toll of these injuries and deaths is in the medical profession’s lane—this is our lane —as is any issue the causes harm to our patients and could be prevented by sound public policy."
Fincher called on Congress to step up and advance other gun control measures, including universal background checks on firearms sales and a ban on assault weapons.
"Deaths and injuries from firearms are avoidable and preventable," Fincher said. "Changing the laws that surround the purchase and use of guns, in ways that are fully consistent with the second amendment, is something that must be done in order to end this crisis that America is facing."
