Tersigni, who has led the St. Louis-based Catholic health system for 15 years, will depart at the end of the year. The search is underway for his successor.
Long-serving Ascension CEO Anthony R. Tersigniwill retire at the end of 2019, and the search is on for his replacement, the St. Louis-based Catholic health system announced Thursday.
"Tony has informed the Board that he intends to retire on December 31, 2019, after leading Ascension for more than 15 years," Ascension Board Chairman Stephen M. Dufilho said in a message posted on the health system's website.
"He will continue to serve Ascension as a member of the executive committee of Ascension's healthcare investment fund and will provide consultative services to Ascension on an ongoing basis. The Board has begun a formal process to evaluate and select a successor to Tony," Dufilho said.
Tersigni was named president and CEO of Ascension Health in 2004, after serving briefly as the interim leader of the health system, and before that as COO since 2001.
When Ascension was formed in 2012 as the parent organization of Ascension Health and its other subsidiaries, Tersigni became its first president and CEO.
"A vibrant servant leader, Tony has shepherded Ascension through a period of unprecedented change in the U.S. healthcare industry while remaining true to the vision and legacy of the founding religious congregations of Ascension," Dufilho said.
Tersigni was a driving force behind the health system's One Ascension initiative, which aligned and improved operational structures to improve consistency and efficiency, Dufilho said.
"As the healthcare landscape continued to rapidly change, Tony led the effort to review and update Ascension's Strategic Direction as a strategic framework to best position the health ministry for the future," Dufilho said.
"Tony championed the idea that we must pursue a Dual Transformation model, optimizing and transforming our core healthcare operations while creating transformational new models that extend our reach and provide the engine for growing our ministry and its impact," Dufilho said.
Tersigni is the fourth senior leader at Ascension to announce their departure this year.
Patricia A. Maryland announced in January that she would leave Ascension Healthcare after serving in various roles for 15 years, effective July 1.
Similarly, John D. Doyle, Ascension's executive vice president, and David B. Pryor, MD, Ascension's CCO, will retire on June 30, the end of the company's fiscal year.
Ascension is one of the largest Catholic health systems in the nation, with 151 hospitals, more than 50 senior care facilities, 2,600 care sites, 156,000 employees and 34,000 providers operating in 21 states and the District of Columbia.
A study found that 37% of patients who took warfarin also took aspirin. That could place patients at a significantly higher risk of adverse outcomes, including major bleeding events.
Physicians who've prescribed anticoagulants to their patients should double-check to make sure they're not using aspirin too, a new study out of Michigan Medicine suggests.
The study, published this month in JAMA Internal Medicine, found that 37.5% of the 6,539 patients reviewed were receiving the anticoagulant warfarin and aspirin without a clear indication, and that these patients were at a significant increase in adverse outcomes.
"Nearly 2,500 patients who were prescribed warfarin were taking aspirin without any clear reason, over a seven-year period," said senior author Geoffrey Barnes, MD, a vascular cardiologist and an assistant professor of internal medicine at U-M Medical School. "No doctors really own the prescribing of aspirin, so it's possible it got overlooked."
The study cohort included 6,539 patients who were enrolled at six anticoagulation clinics in Michigan between 2010 and 2017.
In this study, 5.7% of those using aspirin and warfarin experienced major bleeding events after one year, compared to 3.3% of those on warfarin only. The combination group that was using aspirin without a clear indication also visited the emergency department and/or were hospitalized for bleeding significantly more often.
There wasn't a difference in stroke or heart attack outcomes that are typical uses for aspirin, Barnes says. The mortality rates at one year were similar between both groups, and 2.3% of those on both medications had a thrombotic event at one year compared to 2.7% of those on warfarin alone.
Barnes spoke with HealthLeaders about the findings. The following is an edited transcript.
HLM: More than one-third of patients were taking both aspirin and warfarin. Why is that percentage so high?
Barnes: You're seeing here is a two factors. First is, unlike many randomized trials, we included all patients who were managed in our anticoagulation clinics. So we were not filtering out only the healthy patients are only those who did not have risk of bleeding. You get a broader perspective of what kind of risk patients are at when you follow them over the long term. This was a practice-based, real-world cohort as opposed to a randomized trial cohort.
Secondly, we've known from various is other studies that the more blood thinners you take, the higher your risk of bleeding. When these patients are taking both aspirin and warfarin together, that's going to increase their overall risk of bleeding.
HLM: If they didn't consult with a physician, what made these patients think it was a good idea to take both medications?
Barnes: We don't know exactly why they were taking aspirin. However, there are a couple potential scenarios. The first is that this is somebody who maybe was on aspirin for primary prevention and then developed Afib or DVT and so was started on warfarin, but nobody thought to stop aspirin.
Another scenario is they were on warfarin for Afib and they read or heard something that said, 'you should take aspirin to help prevent a heart attack.' That's out there in the in the media quite a bit. And so they said, 'Oh, well, it's just over the counter. It's got to be safe.' So they go ahead and take it.
The third is that maybe they had a good reason to be on aspirin. Maybe they had a coronary stent that was placed or something, and so they were on aspirin. As time went on, that coronary stent was no longer recent, no longer fresh, and so the indication for aspirin is not quite as strong and yet nobody bothered to think about stopping aspirin.
HLM: Is this something that should be addressed on the patient level, or is this a health systemwide issue that requires new protocols?
Barnes: It's actually both. The first thing we know is that aspirin is a really difficult drug to study and understand because it's not prescribed. Many clinicians do not know whether their patients are taking aspirin or not, because they're not routinely examining their medical record.
Secondly, we as healthcare providers don't always do a great job reconciling the medication list. Even though patients are coming into clinic are coming in for procedures, we don't do a great job making sure we know which drugs they are taking, or they're not taking. Right off the bat, there are some challenges to even knowing when the situation exists.
Systematically there are opportunities for us to build in a screen so you could run a report of all your patients who are on multiple antibiotics, and then cross reference that with sort of those who have indications like heart valve replacement, or recent stent placement or something, and those who don't.
In our situation, we have these big robust anticoagulation clinics. We've put in place a process where we will screen anyone who's on aspirin at the time to start warfarin and say 'is it really necessary?'
Of course, it always comes down to the individual patient level. You have to make a personalized decision. Some are going to be clear cut. Others may be more questionable.
What do you do if somebody had a coronary stent a year or two ago? Should they be an aspirin or not? These are questions that we have to ask other specialists then make the best decision for each individual patient.
A national study of more than 5,000 physicians indicates that most are generally happy and have high life satisfaction.
A new study commissioned by the American Academy of Family Physicians finds that most physicians are happy with their careers and personal lives.
Despite the spate of alarming headlines about physician burnout, a surveyof more than 5,000 physicians currently practicing found that 71% reported being happy in their professional lives, and 59% said they were satisfied with their lives in general.
"Practicing medicine is a profoundly rewarding profession," said Clif Knight, MD, senior vice president of education for AAFP.
"As with any job, it's important to find meaningful work-life integration," Knight said. "The AAFP has developed resources to help improve physician well-being while we are simultaneously fighting to reduce administrative burden, one of the key factors physicians cite as a barrier to happiness at work."
The survey, compiled with the healthcare staffing firm CompHealth, found that workplace happiness "is grounded in developing positive relationships with family members, friends, coworkers and patients."
"Physician burnout is a real issue that has dominated the industry for a lot of years. With this survey we wanted to take a deeper look at what drives workplace happiness, and why," said Lisa Grabl, president of CompHealth.
"We found that many physicians still take great joy in the practice of medicine and discovered areas where administrators and physicians alike can work together to further increase physician happiness," she said.
The survey found that:
Relationships matter. Physicians with a lot of friends at work reported high life satisfaction, while physicians with no friends at work only had 39% report they had high life satisfaction.
Lack of control and excess paperwork make physicians unhappy. Work issues such as lack of control (72%), clerical burdens (71%) and emotional exhaustion (69%) detracted from medical providers’ happiness. Specific tasks such as administrative duties (28%) also limited workplace happiness.
Lack of time with patients may be another contributing factor for physician unhappiness. Fifty-five percent of physicians reported time available for individual patients has declined since they started practice. However, 44% reported that quality of patient care had improved since they began practice.
CHI Franciscan has confirmed that the case has been settled, but few details have been made public.
Washington state has settled a price fixing suit involving CHI Franciscan Health and two physician practices in the Tacoma area, the Kitsap Sun reported.
Details of the settlement are scarce. Washington Attorney General Bob Ferguson's office did not return queries Wednesday, but the settlement was confirmed by a spokeswoman for CHI Franciscan.
The trial was scheduled to begin this week in U.S. District Court in Tacoma. The two sides were ordered to file dismissal paperwork by the end of April.
Cary Evans, vice president of communications & government affairs at CHI Franciscan, said that "along with the court's recent judgment to remove WestSound Orthopaedics from the lawsuit, the settlement ensures CHI Franciscan's joint affiliations with WestSound and The Doctors Clinic remain in place."
"This is good for patients and doctors on the Peninsula, keeps our highly skilled doctors in our community, and ensures everyone has access to great care close to home," Evans said.
Ferguson filed suit against CHI Franciscan, The Doctors Clinic and WestSound Orthopaedics in August 2017, to undo what he said were two unlawful agreements that raised prices and decreased competition for healthcare on the Kitsap Peninsula.
"These transactions were intentionally made to decrease competition, increase prices, and pad CHI Franciscan's bottom line at the expense of its patients," Ferguson said at the time, alleging that CHI Franciscan has netted well over $1 million in ill-gotten gains.
CHI Franciscan WestSound Orthopaedics, a practice of seven orthopedic physicians based in Silverdale in July 2016. Two months later, CHI Franciscan announced an affiliation with The Doctors Clinic, a multi-specialty practice with more than 50 physicians, which has seven locations in Kitsap County.
In the lawsuit, the state alleged that both transactions violated state and federal antitrust laws.
However, CHI Franciscan denied the allegations, and said the physicians' groups were financially distressed and acted independently when they proposed the affiliations, and that they had attempted unsuccessfully to work with Ferguson's office to find a solution.
"We are very concerned that the AG’s actions will drive away physicians from the community, inhibit our ability to recruit new physicians to the area, and will ultimately result in fewer choices and less quality healthcare available to the residents of the community," CHI Francisican said in prepared remarks.
Cigna claims that it's owed around $16 billion as the injured party in the deal, while Anthem says it's owed $20 billion after Cigna intentionally scuttled the deal.
Feuding Cigna Corp. and Anthem Inc. are waiting for a chancery court judge in Delaware to decide which of the two health insurance giants is owed billions of dollars in compensation after 2017's collapsed merger bid,CT Mirrorreports.
In a trial that began Feb. 25, Cignatold Delaware Chancery Judge Travis Laster that it's owed around $16 billion as the injured party in the deal, while Anthemsays it's owed $20 billion after Cigna intentionally scuttled the deal.
Although Cigna shareholders were expected to collect a 30% premium with the merger, Anthem alleged that Cigna CEO David Cordani sabotaged the deal because he would have had a reduced role as COO in the newly merged company, which would be led by Anthem CEO Joe Swedish, Bloomberg reported.
Anthem announced plans to acquire Cigna in 2015 for $49 billion in cash and stock, which if finalized would have created the largest health insurance company in the nation. However, the merger collapsed in 2017 after the Department of Justice successfully sued to block the deal after raising antitrust concerns.
The collapsed merger talks, suit, and countersuit exposed bitter fighting among top executives at both companies.
During the DOJ antitrust trial in late 2016, transcripts obtained by The Wall Street Journal revealed details about the continuing antagonism between Anthem and Cigna's top executives.
Cordani confirmed to the court that Cigna had stopped participating in some merger activities, saying he worried that Anthem's integration strategy could damage Cigna's network and value, the Journal reported.
Swedish testified that when Cigna stopped cooperating with the merger plan, Anthem created a confidential team to complete the task without Cigna's knowledge, according to the documents.
DOJ attorneys expressed concern that the rift could cause the merger to fall apart even if the court allowed the plans to proceed, and that such a failure could harm both companies' customers.
That prompted the U.S. District Judge Amy Berman to question the insurers' promises of a smooth consolidation. "How do you work on integration without talking to the person you're integrating with?" Jackson asked.
Work requirements could shrink Medicaid rolls and increase uncompensated care costs for hospitals in states that implement them.
Hospitals in 15 states could take a financial hit from shrinking Medicaid rolls if work requirements are mandated for beneficiaries, a new Commonwealth Fund study shows.
However, the design of states' work requirement programs will play a key role in how many beneficiaries lose coverage and the resulting financial hit for hospitals, the study found.
Under most work requirement mandates, Medicaid beneficiaries lose health insurance coverage if they cannot find work, are unable to document the required number of hours of work activity, or cannot document an exemption.
The Commonwealth Fund study estimates that Medicaid work requirements could contribute to an increase in uncompensated care costs for all hospitals across 15 states that have implemented the mandates, or hope to, totaling between $2.5 billion to $3.7 billion in 2019.
Those financial woes could trickle through the communities these hospitals serve in the form of staff reductions and the elimination of services.
"This analysis demonstrates that imposing Medicaid work requirements could have a detrimental effect not only for people who could lose their healthcare coverage, but on hospital finances," said Commonwealth Fund President David Blumenthal, MD.
"The way that states design these work requirements will play a big role in the severity of the loss," he said.
Because most people who lose Medicaid coverage are ineligible for premium subsidies in the health insurance marketplaces and would not have jobs that offer employer-sponsored insurance, many would become permanently or temporarily uninsured.
The study's findings extrapolate the early results of Medicaid coverage loss after Arkansas implemented work requirements in June 2018, targeting enrollees that became eligible through the ACA Medicaid expansion.
The state started work requirements for enrollees ages 30 to 49 and expanded to enrollees ages 19 to 29 in January 2019.
Nearly 8,500 people lost their Medicaid coverage within the first four months of the program. Between 23% and 29% of the targeted population either did not meet the work requirement or failed to report their work activities each month.
Assuming these rates continue, nearly 50,000 (29%) of the state's estimated 167,000 Medicaid enrollees may lose their coverage, the report projected.
Hospitals in Indiana and Kentucky could take the biggest hit because those states apply work requirements to both the traditional Medicaid and expansion populations up to age 59 and 64, respectively.
In Kentucky, for example, Medicaid generates $30.2 million on average for the state's 88 hospitals, but the projected disenrollment could lop up to 22% ($6.7 million) in Medicaid funding, the study said.
In contrast, Arizona, Arkansas, and Ohio will apply work requirements only to the expansion population up to age 49, and the study estimates that hospital Medicaid revenues in those states will decline by 10% to 14%.
Medicaid work requirements would further reduce operating margins for rural hospitals that are already operating at a loss on patient care. For example, Kentucky's stringent requirements could adversely affect hospital operating margins in that state between -1.7% to -3.1%.
Waiting until closer to the start of flu season offers greater immunity. However, there are risks with delay, especially if the flu comes early, or patients skip their flu shot.
Thousands of flu cases and hundreds of deaths could be avoided if older adults get their flu shots in October instead of August, new research suggests.
"There's controversy in the public health community over whether influenza vaccination should happen as soon as the vaccine becomes available in August, or if it's better to wait until later in the fall,” said study lead author Kenneth J. Smith, MD, professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine.
"What we've found is that it's a balancing act, but if a clinician believes a patient will return for vaccination in the fall, then our analysis shows that it is best if they advise that patient to wait," Smith said.
Smith pointed to a previous study which showed that flu vaccines are less potent as the flu season progresses and peaks in mid-winter.
Waiting until closer to the start of flu season ensures greater immunity.
However, if flu season arrives early or if delayed vaccination prompts more than one in 20 people who would otherwise be vaccinated to skip their flu shot, then the gains are negated, according to the Pitt study, published in the American Journal of Preventive Medicine.
Pitt researchers ran computer models to compare a "compressed" vaccination period that begins in October to the status quo, which typically begins in August, for people aged 65 or older.
The researchers focused on older adults because waning vaccine effectiveness is more of a threat to the elderly whose immune systems don't typically mount as strong of a defense to infections as younger people.
Older adults also have higher early vaccination rates than younger adults.
Using data from the 2013-2014 and 2014-2015 flu seasons, the researchers forecast the number of cases, hospitalizations and deaths for compressed and status quo vaccination scenarios if the flu season had peaked in December, February or April – early, normal or late, respectively. "Peak" refers to the period when the greatest number of people are sick that season.
In the projections for the normal and late flu seasons, compressed vaccination saved as many as 258 lives and prevented up to 22,062 cases of flu, compared to status quo vaccination timing.
But if flu season peaked early, as it does in about one of every four seasons, the model projected that dozens to hundreds of older adults would die because they wouldn't have been vaccinated in time.
In addition, the team found that if more than 5.5% of older adults who defer vaccination ultimately don't get the flu shot, then compressed vaccination will be a failure and will prevent fewer influenza cases than status quo vaccination.
Smith says these findings can help clinicians determine when to offer their patients flu immunizations – if the patients have multiple appointments each year and will be in the office in the fall or if they are in a senior community where flu immunization is offered through a scheduled clinic, then waiting is likely advisable.
However, if a patient comes in only for an annual check-up and is unlikely to seek out the flu vaccine in the fall, or if offering vaccinations during a compressed window will put overwhelming strain on the clinic, then getting vaccinated when convenient – even if that's in August – is best.
"In all scenarios, simply getting vaccinated is the best way to avoid the flu," said Smith. "If the choice is between getting the influenza immunization early or not getting it at all, getting it early is definitely better."
The former leader of Palo Pinto General Hospital and his coconspirators used the hospital's national provider ID to submit fraudulent claims for lab work.
The former CEO of a Texas community hospital has pleaded guilty to defrauding three health insurers in a pass-through billing scheme involving laboratory services, the Department of Justicesaid.
According to his plea papers, Palo Pinto General Hospital ex-CEO Harris Brooks and his co-conspirators, used the Mineral Wells, Texas hospital's in-network contracts with BlueCross BlueShield of Texas, CIGNA Texas, and United Healthcare to swindle the payers out of more than $9 million.
Using PPGH's national provider identification number, Brooks and his co-conspirators submitted claims to the insurance companies for allergy and genetic testing purportedly performed at PPGH.
In reality however, PPGH did not have the equipment on-site to perform the tests for which it submitted claims, and the patients for whom claims were submitted were receiving treatment at various spas and clinics throughout Texas and elsewhere, not PPGH, the plea agreement states.
The patients did not know about the pass-through charges using PPGH's insurance contracts.
Between September 2017 and June 2018, Brooks and his co-conspirators submitted claims totaling more than $55 million, the vast majority of which were fraudulent. As a result of these claims, the insurance companies paid PPGH more than $9 million.
Harris admitted that the purpose of the scheme was to receive higher reimbursements from the insurers.
According to his plea agreement, Brooks faces up to five years in prison and will be required to pay restitution to those he defrauded.
The 'strategic affiliation' will share management and administrative services with the aim of improving quality, lowering costs, and improving the consumer experience.
Cambia Health Solutions and Blue Cross and Blue Shield of North Carolina announced Tuesday that they will combine management and administrative services.
"We have to do something different to make health care better, simpler, and more affordable for the people we serve," Patrick Conway, president and CEO of Blue Cross NC, said in a media release.
"By sharing resources, innovations, and best-in-class services we can fundamentally transform the way individuals and families experience the health care system," Conway said.
Working under the Cambria Health Solutions name, the "strategic affiliation" will be governed by a board made up of 10 members from Blue Cross NC's board and nine members from Cambia's board.
Blue Cross NC will retain its own separate board and name, and the two companies will retain their separate, tax-paying, not-for-profit corporate structures.
"People and their families are hurting every day in the current health care system, longing for care focused on their needs,” said Mark Ganz, president and CEO of Cambia Health Solutions. "Together, we have the power to accelerate transformation, be a model for what is possible, and positively impact the lives of those we serve."
Under the affiliation, Ganz will be executive chair of Cambia's board, and Conway will be Cambia's new CEO. Conway also will remain CEO of Blue Cross NC, and the corporate headquarters will be in Durham, NC, and Portland, OR.
The strategic affiliation also will maintain the separate health plans in five states, all locally led and regulated.
The deal is subject to regulatory approval in North Carolina, Oregon, Washington, Idaho, and Utah.
While the two companies are calling the deal a "strategic affiliation," Nathan Ray, a senior principal in West Monroe’s healthcare & life sciences practice said "it appears to be like a merger."
"It will take the form of a long-term MSA with an agreement to share management, operations and administrative staffs, and the BCBSNC CEO becoming the CEO of Cambia," Ray said in an email exchange with HealthLeaders.
Ray said sharing management operations and administration makes sense because it provides cost synergies.
"They don't directly compete which probably allowed the executive teams to discuss such an opportunity," Ray said. "Geographic advantages including cheaper labor, or healthier membership may also be fringe benefits."
"In many cases consolidation of management, operations, administration of payers is an easy exercise to realize efficiencies and take advantage of unique opportunities sharing technology or strategy," he said.
Blue Cross NC and Cambia's health plans include Regence BlueCross BlueShield of Oregon, Regence BlueShield in Washington, Regence BlueShield of Idaho, and Regence BlueCross BlueShield of Utah.
The two companies said the affiliation builds on their existing Echo Health Ventures, a healthcare investment and development company launched in 2016.
Federal prosecutors said the illegal remuneration took the form of free or discounted medical practice and market development support for physicians.
Covidien LP will pay more than $17.4 million to settle whistleblower allegations that it provided illegal kickbacks to physicians to entice the use of its vein ablation products, the Department of Justice said.
The alleged kickbacks, violations of the False Claims Act and the Anti-Kickback Statute, took the form of free or discounted medical practice and market development support for physicians in California and Florida, DOJ said.
Assistant Attorney General Jody Hunt for DOJ's Civil Division said the settlement "serves as an important reminder to those in the healthcare community that unlawful kickbacks come in many forms and are not limited to monetary payments to providers."
"Providing free or discounted services to healthcare providers to induce the use of certain items or services can lead to excessive and unnecessary treatments, and drive up healthcare costs for everyone," Hunt said.
Federal prosecutors alleged that Covidien provided the illegal remuneration to physicians in California and Florida from Jan. 1, 2011, through Sept. 30, 2014, to induce them to buy Covidien's ClosureFAST radiofrequency ablation catheters that were billed to Medicare and to the California and Florida Medicaid programs.
The catheters are used to treat venous reflux disease, a disease often marked by the presence of varicose veins.
The illegal support allegedly provided by Covidien included customized marketing plans for specific vein practices; scheduling and conducting "lunch and learn" meetings and dinners with other physicians to drive referrals to specific vein practices; and providing assistance to specific vein practices in connection with planning, promoting, and conducting vein screening events to cultivate new patients for those practices.
"The government contended that Covidien provided discounted or free services to health providers – and so hoped to evade kickback charges," said Steven J. Ryan, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. "Companies seeking to buy clients through such arrangements can expect to pay a steep price."
Under the settlement agreement, Covidien will pay an additional $1.47 million to California and $1 million to Florida for claims settled by these state Medicaid programs.
The settlement resolves whistleblower lawsuits filed by two former sales managers for Covidien and a former employee of one of Covidien's customers. The whistleblowers will share more than $3.1 million of the settlement.
HealthLeaders' requests for comment from Covidien were not returned Tuesday morning.
