The announcement comes less than a year after the two New Jersey health systems signed a Letter of Intent to explore a partnership.
Saint Peter's Healthcare System and RWJBarnabas Health announced Thursday that they have signed a definitive agreement to merge the two New Jersey healthcare systems.
Financial terms of the deal were not disclosed.
The announcement comes less than a year after New Brunswick-based Saint Peter's and West Orange-based RWJBH signed a letter of intent to explore a strategic partnership.
Under the merger, Saint Peter's – and flagship hospital, Saint Peter's University Hospital, a 478-bed acute-care teaching hospital and acute care children's hospital – would remain as a full-service provider of acute healthcare services, and would retain its identity as Catholic.
In addition, RWJBH will make capital improvements at Saint Peter's facilities.
Sandra Jarva Weiss, a disinterested observer, and chair of the Norris McLaughlin Health Care & Life Sciences Law Practice, told HealthLeaders the consolidations "are indicative of the trend for smaller/local hospitals to join larger health networks for the benefits these larger networks can bring."
"In particular, the health networks may be positioned to make the capital commitments to specific service lines or facility or technology enhancements for the local hospital," she said.
Leslie D. Hirsch, president and CEO of Saint Peter's, said the merger agreement "assures Saint Peter's continued mission and identity as a Catholic hospital."
"We are truly excited about the potential of this opportunity to integrate with RWJBarnabas Health to create a premier academic medical center of national distinction in which Saint Peter's will share responsibility for leadership and governance," Hirsch said.
The agreement must clear state and federal regulatory hurdles, and be approved by the Catholic Church.
Barry H. Ostrowsky, president and CEO of RWJBarnabas Health, said that when the merger is finalized, "we will have the necessary foundation for the creation of our state's first and only premier academic medical center."
The settlement does not mandate a standard, five-year monitoring agreement for the hospital, nor an admission of wrongdoing on the hospital's part.
Wheeling Hospital, Inc., will pay $50 million to settle whistleblower False Claims Act allegations that the West Virginia hospital violated the Anti-Kickback Statute and the Stark Law prohibiting physician self-referrals, the Department of Justice said.
Federal prosecutors had alleged that between 2007 and 2020 R&V Associates, Ltd., former managers of the 223-bed acute care hospital, "systematically violated the Stark Law and Anti-Kickback Statute by knowingly and willfully paying improper compensation to referring physicians that was based on the volume or value of the physicians’ referrals or was above fair market value," DOJ said in a media release.
The settlement began as whistleblower complaint filed in 2017 by Louis Longo, a former executive vice president of Wheeling Hospital, who will receive $10 million of the settlement. DOJ intervened in the suit in 2019.
The fraud scheme allegedly began in 2007 after Wheeling Hospital hired CEO Ronald Violi, and R&V Associates to engineer a financial turnaround.
R&V Associates then allegedly employed many physicians to snag referrals, boost revenues, and grow market share.
The federal complaint also alleged that Wheeling Hospital paid millions of dollars to doctors based on referrals, including some who were paid annual salaries in excess of $1 million, and closely tracked the revenues physicians were generating under the referral scheme.
"Intimidation is a scare tactic often used against whistleblowers," said Longo's attorney, Jeffrey W. Dickstein, with Phillips & Cohen LLP.
Wheeling Hospital Responds
Wheeling Hospital CEO Douglass Harrison said the settlement "was in the best interest of the long-term viability of the hospital and the community."
"Prolonging the lawsuit would have paralyzed the ability of the hospital to attract the best physicians and to make the necessary capital improvements to ensure that the highest quality healthcare continues to be provided in the Upper Ohio Valley," he said.
Since the suit was filed, the Wheeling Hospital dumped R&V Associates, signed a management agreement with WVU Health System, and named Harrison the new CEO.
"The settlement will not impede the hospital’s focus on patient care or its commitment to compliance, ethical conduct and integrity," Harrison said, adding that the settlement does not mandate a standard, five-year monitoring agreement, nor an admission of wrongdoing on the hospital's part.
The Stark Law prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law's statutory or regulatory exceptions.
The Anti‑Kickback Statute prohibits paying physicians to refer services covered by Medicare, Medicaid, and other federal healthcare programs.
How will the coronavirus affect the seasonal influenza, and vice-versa? What do we know about the combined effects of COVID-19 and the seasonal flu? These are big questions, and the answers are unknown.
With the Labor Day weekend in its wake, the United States now sails full steam ahead into the flu season. But with COVID-19 affecting broad swaths of the nation, healthcare providers are finding themselves in uncharted waters.
How will the coronavirus affect the seasonal influenza, and vice-versa? What do we know about the combined effects of COVID-19 and the seasonal flu? These are big questions, and right now the answers are unknown.
Brian Garibaldi, MD, medical director at the Johns Hopkins Biocontainment Unit and an associate professor of medicine at Johns Hopkins University School of Medicine, provides HealthLeaders with a primer on the seasonal flu, and speculates on what the unprecedented upcoming season may bring. The following interview has been edited for brevity and clarity.
HL: When is the flu season?
Garibaldi: It varies from year to year, but usually cases start to spike in October and peak in December, January, then starts to taper off by March. But the flu season can shift from year to year. Sometimes it can last as late as May and you might start some cases in September.
HL: When do you encourage people to get flu shots?
Garibaldi: September/October is usually when we start to tell people to get vaccinated. There is a theoretical risk that if you get vaccinated too early immunity from the vaccine may be waning if the flu season goes on longer.
This year, we're much more worried about people just getting the shot. We want to make sure that as best we can, people are vaccinated against flu to reduce the possibility that people could get both flu and COVID, but also to reduce the burden on the health system from flu
HL: What's the mortality of the flu?
Garibaldi: Flu is usually in the range. 0.1%.
Depending on what studies you're looking at right now – it's always hard in the middle of an epidemic to understand overall mortality rates – COVID is at least 10 times higher, but at some series is much, much higher than that. We're still kind of learning
HL: Do the same underlying health issues that harm COVID patients harm flu patients as well?
Garibaldi: Yes. Those types of risk factors are similar; age, comorbidities, particularly things like diabetes, hypertension, heart disease, underlying respiratory issues, are all risk factors. But even the things that we're seeing with COVID, where younger people are getting sick, particularly if they're obese, those are factors that are probably at play in influenza as well.
HR: How many Americans die of the flu each year?
Garibaldi: I don't know the exact numbers off the top of my head, but the average number of deaths per year is probably on the order of 60,000 to 80,000.
HL: What sort of a flu strain are you anticipating this season?
Garibaldi: That's hard to stay. If you look at what's going on in in the southern hemisphere, South Africa for example, had a relatively mild flu season relative to normal for them, and that is probably related to their stricter COVID-19 precautions that were in place during the time that they would traditionally have their flu season.
If we're working really hard together to try to curb the spread of COVID-19, those same measures – social distancing, wearing masks, and avoiding large gatherings – the hope would be that maybe that would also tamper down the severity of our flu season.
HL: How do you respond when people say "COVID is just a virulent strain of flu."?
Garibaldi: It certainly has similar features of the flu. They both predominantly have respiratory symptoms, fever, malaise, and fatigue as their main symptoms. But by and large, the risk of having a severe outcome from COVID and the risk of mortality is substantially higher than it is with influenza. When you compare it to the flu, there's this danger of downplaying the significance of COVID.
HL: What do we know about the combined effects of COVID and influenza?
Garibaldi: There have been reported co-infections of flu and COVID, but not enough of them to really understand what that response will look like.
In the U.S., COVID peaked at the point when flu was on its way down, so we did not really get a sneak peek of what it looks like for someone to have both. The concern is that having both of those viral infections at the same time could potentially put you at risk for complications directly from the viruses and from the immune response to try to combat those two viruses.
HL: Are hospitals prepared for this double-whammy?
Garibaldi: The health system is very strained to provide care for all the patients who get hospitalized with flu. Close to 800,000 people a year get hospitalized for influenza. If you add the normal influenza burden on hospital capacity while COVID is surging, there are very few health systems that would be able to effectively deal with both at the same time.
COVID patients and flu patients are going to be competing for the same resources, the same providers, the same ER beds, the same hospital beds, the same personal protective equipment. That's probably the most important message to get out there is that there's a lot of uncertainty about what COVID plus flu looks like for an individual, but also for our community and health system.
HL: Could the tactics used to reduce COVID transmission reduce flu transmission too?
Garibaldi: That's my hope. It's still a little bit early to know for sure what the specific effectiveness of those interventions are, cut flu and COVID are spread through very similar mechanisms. It stands to reason that if you're successful at decreasing COVID transmission, you're at the same time probably going to reduce flu transmission.
HL: Is the flu as contagious as COVID?
Garibaldi: That's a complex question for two reasons. The first is that COVID itself probably has a higher attack rate than the flu. Let's say a given person with COVID probably infects more people than a given person with flu. Flu itself tends to last a little bit shorter but spread a little bit faster. The average time of incubation is only two to three days. But people can spread flu while asymptomatic, just as they can look COVID. So it's hard to compare the two.
COVID is probably a little bit more contagious in terms of the ability of one person to infect more people, but the flu potentially can spread more rapidly because of its faster cycle time.
HL: Do you think that public awareness of COVID might prompt more people to get vaccinated for the flu? Or, could it have the opposite effect, owing to public skepticism about the efficacy of a COVID vaccine?
Garibaldi: That's an important question that I don't have the answer to. I hope that people's awareness of COVID as a severe respiratory infection and the publicity that the flu season and COVID have been getting makes people reconsider getting their flu shot if they haven't on a routine basis.
Obviously, there's a concern with how quickly things are being pushed forward with certain treatments for COVID, particularly with worries about vaccine safety. There are some people who are going to be skeptical about any vaccine this year. But I hope the number of people who have been awakened to the risk of flu plus COVID and are willing to look at the data on safety for the flu vaccine and will get vaccinated this year.
HL: Is it possible that the COVID "second wave" could hit just as flu season is peeking?
Garibaldi: We're worried about a potential spike related to Labor Day. We saw spikes after Memorial Day. We saw spikes after the Fourth of July. So, if there's going to be a post-Labor Day spike, it's going to happen probably right as the flu season kicking off.
We're also not yet sure what role children play in the spread of COVID. There's very clear evidence that children are one of the primary drivers of influenza season. We're going to have to pay careful attention to what's happening in schools with COVID. If schools get shut down because of COVID, I suspect that that will mean that influenza transmission will decrease because children.
HL: What advice would you give to hospital leadership heading into flu season?
Garibaldi: As they've already been doing for COVID, making sure that they're paying attention to supply chain issues that are going to be related to personal protective equipment for respiratory viruses, testing equipment, to be able to make sure that they can continue testing both for COVID and for flu. And making sure that, as almost all hospitals do, they have easy access and requirements for the flu vaccine for their employees and their staff, to try to minimize the number of healthcare workers and providers who might miss time off work for being sick, but also to minimize the spread of respiratory viruses within the hospital environment.
We also need to recognize that there's a lot of uncertainty about what's going on and so being prepared for the worst while hoping for the best is a good strategy.
Most of the jobs came in the ambulatory sector, which had been all but shuttered this spring because of the coronavirus pandemic.
Healthcare sector job growth continued to rebound in August as the nation slowly emerges from the coronavirus pandemic shutdown, but the pace is slowing, according tothe latest federal jobs report.
The August gains included 14,000 jobs in hospitals, 49,000 jobs in physician and dentist offices, and 12,000 jobs in home and health services. Those gains were offset by the loss of 14,000 jobs in the nursing and residential care sector, BLS said.
Healthcare employment is down 679,000 jobs in 2020, including 348,000 job losses in the ambulatory sector, and 104,000 jobs losses in hospitals.
August marks the fourth consecutive month of job growth for the healthcare sector, which suffered epic job losses in the spring owing to the coronavirus pandemic. In May, the sector saw 312,000 payroll additions, mostly in outpatient care venues.
The August job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.
In the overall economy, BLS reported that payroll employment grew by 1.4 million in August, down from 1.8 million in July, and the unemployment rate fell to 8.4%.
"These improvements in the labor market reflect the continued resumption of economic activity that had been curtailed due to the coronavirus (COVID-19) pandemic and efforts to contain it," BLS said.
Upgraded design eases patient access when shopping for healthcare services.
The Centers for Medicare & Medicaid Services on Thursday launched a "streamlined redesign" of eight existing healthcare compare tools on Medicare.gov.
The Care Compare provides a single user-friendly interface that allows patients easier access to data on cost, quality of care, volume of services, and other data.
"By aggregating all eight of CMS' quality tools into a single interface, patients can easily research different providers and facilities before they entrust themselves to their care," CMS Administrator Seema Verma said in a media release.
"Today's launch of Care Compare is the next step in fulfilling our eMedicare promise. Our Administration is committed to ensuring our tools are robust and beneficial to patients," she said.
Under the existing framework, a patient planning to have bypass surgery would need to visit Hospital Compare, Nursing Home Compare, and Home Health Compare to research providers for the different phases of their surgery and rehabilitation.
Under the new system, patients can search at Care Compare to find and compare providers that meet their healthcare needs. The page will include information about quality measures presented similarly and clearly across all provider types and care settings.
"With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools," CMS said.
The final rule also re-emphasizes CMS's push for "pricing strategies based on real world market forces" under the Medicare Fee For Service program.
Medicare spending on acute inpatient hospital services will increased by about $3.5 billion (2.7%) in fiscal 2021, the Centers for Medicare & Medicaid Services said.
Thenew final rule applies to about 3,200 acute care hospitals and approximately 360 long-term care hospitals across the nation.
The final rule also re-emphasizes CMS's push for "pricing strategies based on real world market forces" under the Medicare Fee For Service program.
"Medicare generally pays hospitals a rate that is weighted by the relative cost of providing certain services based on a patient's diagnosis," CMS said. "These weights are currently based in large part on the charges that hospitals report to the federal government, which often have little relevancy to the actual rates paid by insurance companies."
Hospitals already are required to report negotiated rates under a Trump administration price transparency mandate. CMS is now finalizing a mandate for hospitals to report the median rate negotiated with Medicare Advantage Organizations for inpatient services to use instead of the charge-based data, starting in 2021.
CMS said it will use the pricing data to calculate inpatient hospital payments beginning in 2024.
Ashely Thompson, senior vice president for public policy at the American Hospital Association, said hospitals are "deeply disappointed that CMS continues to require hospitals and health systems to disclose privately negotiated contract terms with payers."
"By continuing to focus on negotiated rates rather than expanding access to a patient’s out-of-pocket costs, the Administration fails to meet the goal it set for itself – assisting consumers in becoming more prudent purchasers of healthcare," she said.
"Additionally, this policy will require hospitals to divert critically needed resources during this historic pandemic to administrative tasks that will not benefit patients," she said. "We do not believe CMS has the authority to compel the disclosure of these terms and our legal challenge remains ongoing.
The final rule also creates a Medicare Severity Diagnostic Related Group (MS-DRG) that "provides a predictable payment to help adequately compensate hospitals for administering Chimeric Antigen Receptor (CAR) T-cell therapies," CMS said.
FDA-approved CAR-T-cell cancer therapies use patients' genetically modified immune cells to treat specific types of cancer.
Thompson said hospitals "appreciate the agency's focus in addressing cost issues for life-saving CAR T therapy," but suggested that the funding was inadequate.
"We remain concerned that the policy the agency has put forth in this final rule is not adequate to address the extraordinary level of resources necessary to provide CAR T therapy to patients," she said. "We continue to urge CMS to consider an alternative method of determining the cost of CAR T therapy, as well as to consider carving out these very costly new technologies from the MS-DRG and paying for them on a pass-through basis."
In reversing the district court last month, the appeals court ruled that the Trump administration's payment reductions were a reasonable exercise of statutory authority.
Hospital stakeholders this week asked the full U.S. Court of Appeals for the District of Columbia to rehear a three-judge panel's ruling last month that upheld the Trump administration's authority to impose site-neutral payments under the Outpatient Prospective Payment System final rule.
"The panel decision sustained a draconian Centers for Medicare & Medicaid Services rulemaking by granting the agency extraordinary deference that it neither sought nor earned," the American Hospital Association, the Association of American Medical Colleges and dozens of member hospitals said in an 83-page appeal filed on Monday.
The Trump administration has maintained that CMS has the authority to impose payment cuts under the Bipartisan Budget Act of 2015 to reduce unnecessary and costly increases in hospital procedures.
OPPS had reduced reimbursement rates for clinic visits at hospital-owned outpatient provider departments by 40%, to match the rates paid for clinic visits in physician offices. CMS estimates that the OPPS final rule could save the Medicare program about $760 million in 2020.
Hospitals have complained that the site-neutral cuts undercut the intent of Congress to protect hospital outpatient departments, which are held to a higher regulatory standard and often serve a sicker, older, poorer patient mix.
In AHA v. Azar, a three-judge panel in July ruled unanimously in favor of the Department of Health and Human Services, reversing a district judge's ruling last September that CMS acted in a way that was "manifestly inconsistent with the statutory scheme" when it finalized the site-neutral payment as part of the OPPS final rule for 2019.
In reversing the lower court, the appeals court ruled that the Trump administration's payment reductions were a reasonable exercise of statutory authority under the Chevron Deference.
In their appeal, the hospitals said the three-judge panel overturned the lower court based on a what the plaintiffs called a flawed interpretation that "gave the wrong answer to several important, recurring Chevron questions."
"This case is not just important in the Chevron abstract. It is critically important in the here-and-now," the plaintiffs wrote.
"It permits the Executive to unilaterally cut hundreds of millions of dollars from hospital outpatient clinics serving millions of patients across the country. Those deep cuts will be felt all the more now, as hospitals navigate the unprecedented challenges imposed by the pandemic."
Federal prosecutors claim that Viztek LLC, a former subsidiary of Konica Minolta, falsely claimed that its EHR software was HHS compliant.
Konica Minolta Healthcare Americas Inc. will pay $500,000 to settle whistleblower allegations that a one-time subsidiary misrepresented the compliance status of its electronic medical records, the Department of Justice said.
Federal prosecutors in Newark, New Jersey, alleged that Viztek LLC, a former subsidiary of KMHA, violated the False Claims Act when it fraudulently obtained certification for its "EXA EHR" software by falsely claiming that the product complied with Department of Health and Human Services certification requirements.
Because of the deception, eligible providers who used EXA EHR inadvertently submitted false claims for incentive payments to Medicare, prosecutors said.
KMHA acknowledged the settlement, but denied the allegations, which were raised in a whistleblower lawsuit.
KMHA Responds
Wayne, New Jersey-based KMHA said "the allegations emanated from a time prior to KMHA’s acquisition of Viztek."
"The company cooperated fully with the government's investigation and maintains that the allegations are unfounded," KMHA said. "Given the high costs and future time demands associated with the investigation, this resolution is in the best interest of the business."
"Without the ongoing management distraction, KMHA can assure its focus remains true to its core mission of contributing to life changing healthcare solutions."
Aetna says it is working to correct the problem and is cooperating with state insurance regulators.
California insurance regulators this week slapped a $500,000 fine on Aetna Health of California, Inc. for "repeatedly failing" to pay beneficiaries' claims under the state's broader emergency room coverage standards.
"The plan’s failure to follow California law for reimbursing emergency room claims is unacceptable," said Mary Watanabe, acting director of the California Department of Managed Health.
Walnut Creek-based Aetna Health of California was also ordered to stop using the plan's national standard to deny emergency room claims.
"This has resulted in Aetna wrongfully denying emergency room claims," Watanabe said. "Aetna must follow the state's healthcare laws to ensure enrollees have access to the care they need."
Aetna issued a statement saying it is working to correct the problem and is cooperating with CDMC.
California law requires a health plan to pay for emergency medical services unless it can show that either the services were never performed or the enrollee did not require them and should have known so.
Aetna of California has had previous run-ins with CDMH over emergency medical services payments in 2015 and 2016 and paid $135,000 in fines. Aetna also agreed to Corrective Action Plans requiring training for employees handling claims for emergency services and reimbursement for emergency services based on the California standard.
"Despite the enforcement actions taken against the plan to correct its deficiencies, the DMHC Help Center received four complaints in 2018 and 2019 showing that the plan had wrongfully denied emergency room claims based on the incorrect standard," DMHC said.
DMHC reviewed a sample of Aetna's denials of emergency medical services and in 2019 concluded that 93% of the sampled claims were wrongfully denied.
DMHC also reviewed Aetna's commercial emergency medical services denial template for HMOs and determined that the templates did not follow California law.
Aetna Responds
Aetna of California issued this statement in response to the settlement.
"We are committed to providing our members with appropriate access to emergency room services and to complying with all laws applicable to our business. For medical emergencies, our members should utilize the nearest emergency room facility.
"We have taken a number of steps to help ensure that we handle emergency room claims consistent with California’s standard for determining whether an emergency medical condition exists. We are cooperating with the California Department of Managed Health Care in this matter."
The $412 billion includes $312 billion through Congress, $100 billion through the Trump administration, and at least $331 million through the Federal Reserve.
The federal government has authorized, spent, or committed $412 billion in coronavirus pandemic emergency funding for the healthcare sector, with more than 70% going directly to hospitals and other healthcare providers, a new analysis shows.
TheCommittee for a Responsible Federal Budget study said the $412 billion includes $312 billion through Congress, $100 billion through the Trump administration, and at least $331 million through Federal Reserve actions.
"A large portion of the money allocated thus far has gone to the health industry," the report said. "So far, roughly $291 billion (71%) of financial support to the health industry has been disbursed or committed."
CRFB said the emergency spending should result in a net deficit of $312 billion after loans and advanced payments are repaid.
Through the Trump administration, the provider relief includes $100 billion of advanced payments to Medicare providers, which will have to be repaid with interest.
Additionally, loan programs account for $58 billion of funds authorized and disbursed to the healthcare sector.
The Federal Reserve has purchased at least $319 million of large health care company bonds through its Corporate Credit Facility. CRFB said the figure is likely higher because they could only track bond purchases greater than $4 million.
CRFB estimates that the healthcare sector has received as much as $20 billion or more in Economic Injury Disaster Loans—assuming proportionality to the PPP.
Other authorized funds include $32 billion to support COVID-19 preparedness, $9 billion in health-related tax breaks, and several billion of additional spending.
Congress has also committed $11.2 billion for vaccine research, development, and manufacturing, including $2.5 billion to Moderna, $2.1 billion to GlaxoSmithKline, $2 billion to Pfizer, $1.6 billion to Novavax, $1.5 billion to Johnson & Johnson, $1.2 billion to Astrazeneca, and $450 million to Regeneron Therapeutic.
