The initiative hopes that improving access to affordable, nutritious food in underserved areas, particularly for diet-related, chronic conditions, will reduce avoidable ED visits and hospital admissions.
Chicago and Dallas residents living in "food deserts" will have easier access to nutritious, affordable food, thanks to a new initiative between Health Care Service Corp. and the Blue Cross Blue Shield Institute.
FoodQ is a delivery service open to anyone living in ZIP codes associated with the six-month pilot project, regardless of whether or not they have health insurance.
"We know a ZIP code is just as important as a genetic code in determining a person's health – impacting medical needs and access to care," said Trent Haywood, MD, president, BCBS Institute.
"As a physician, I know I can easily write a prescription, but what I don't know is how am I going to make sure patients have access to healthy meals they can afford and want to eat," Haywood said.
The hope is that the easy access to affordable, nutritious food will improve population health, particularly for diet-related, chronic conditions, while reducing avoidable ED visits and hospital admissions.
"With the alarming rates of obesity and diabetes in our country, we need a different approach to supporting healthy living, and this pilot program can help remove the barriers that keep people from accessing healthy, affordable and nutritious foods," Haywood said.
The consumers can access a mobile-optimized foodQ website and review the ready-to-heat lunch and dinner meal options. They enter their ZIP code in the foodQ site, which determines if they are eligible for the service.
When eligibility is verified, participants enter their payment information, select their meal choice, then choose a date and time for meal delivery.
Users select from five meal categories including beef, chicken, fish, pork and vegetarian options. Participants will receive a text message confirming the order, as well as notifications when the order is on its way and has been delivered.
Participants are encouraged to subscribe to foodQ for $10 per month, which includes free delivery and a buy-one-get-one option for every meal purchased. People who do not subscribe can buy individual meals for $10 with a $6 delivery fee.
Meal deliveries began in Chicago last week and start in Dallas in April.
HCSC supported the BCBS Institute's development of foodQ through an initiative to address the root causes of an expensive healthcare system, with investments in social determinants of health as one of the initial focus areas.
The BCBS Institute will pilot foodQ in 25 Chicago ZIP codes and 15 Dallas ZIP codes where HCSC operates health plans.
"Food deserts are one of the key social determinants of health impacting millions of Americans," said Manika Turnbull, vice president and community health and economic impact officer, HCSC, the nation's largest customer-owned health insurance company.
"With this program we are meeting people where they live to provide access, affordable pricing and education that can influence healthy behaviors, reduce health disparities and improve their quality of life," she said.
The pilot will work with Kitchfix in Chicago and Front Porch Pantry in Dallas to prepare and deliver meals.
The BCBS Institute tailored foodQ to the community's needs using its detailed data by ZIP code on the social and environmental factors influencing health.
Throughout the pilot, participants will be surveyed to measure the demand for foodQ service and assess any correlation between the pilot and reductions in avoidable hospital and ED visits.
A Growing Movement
Improving access to good food, particularly for economically disadvantaged areas, and addressing other social determinants of health is not a new idea, but the movement has been accelerating of late.
Last month, the Centers for Medicare & Medicaid Services announced that Medicare Advantage plans in 2020 would have the option of providing meals and supplemental benefits to beneficiaries with chronic illnesses.
"How can someone manage diabetes if they are constantly worrying about how they’re going to afford their meals each week?" Health and Human Services Secretary Alex Azar said in prepared remarks at the Hatch Foundation for Civility and Solutions last November.
Houston Methodist is running apopulation health initiative that includes a grant-supported program called Homeplate, which provides food and daily meals for inpatients after discharge.
"Food is one of the primary social determinants affecting health," says Janice Finder, MSN, BSN, director of population health and performance improvement at the health system.
"We have found that many patients who come out of the hospital do not normally require Meals on Wheels or similar programs, but they may need help with meals and a daily check for the first 14–30 days postop," she says.
Loel S. Solomon, PhD, KP's vice president for community health, says providers can no longer improve population health without looking beyond their own walls.
"Good clinical prevention is necessary, but insufficient to help our members eat better, which is critical to addressing obesity and diabetes and all sorts of chronic diseases," Solomon says.
The legislation's supporters say the bill scrubs only minor disciplinary scrapes that result in reprimands or probation.
The Federation of State Medical Boards has offered "strong opposition" to a provision in a Maryland Senate bill that expunges physicians' disciplinary records after three years.
"Maryland Senate Bill 372 proposes putting a three-year time limit on what patients in Maryland are allowed to know about the disciplinary history of their physician," FSMB President and CEO, Humayun Chaudhry, DO, said in a media release.
Chaudhry said the legislation would decrease transparency in the licensing process, potentially endangering patients, and would create a dangerous precedent that will have a national impact on patient safety.
"Instituting a mandatory time-limit to expunge a physician's disciplinary history is unprecedented," he said. "If passed, Maryland will become the first state in the nation to allow physicians to wipe their disciplinary records clean after a certain period of time, regardless of the severity of the offense or the danger to the public."
The bill would "severely limit" for state medical boards the availability of records detailing physician disciplinary actions, Chaudhry said, and it would deny patients' right to know the disciplinary history of their physicians.
While noting that physicians have a right to due process with their medical boards, Chaudhry said SB 372 "tips that power to the detriment of public safety."
"Not only would this bill hide this information from the residents of Maryland, but it would make it easier for previously disciplined doctors to leave the state and begin practicing in another jurisdiction undetected," he said.
"The bill only refers to minor written reprimands and probation," Ransom says. "If you actually read the language and Bill we're not talking about major offenses. We're not talking about consent orders we're not talking about people have been disciplined. We're talking about these minor things that end up creating all kinds of problems for physicians."
Ransom says the legislation provides "reasonable changes to try to improve the process."
"When a doctor gets punished by the board, even something as minor as a written reprimand because they failed to complete all their continuing medical education or they made a mistake filling out their paperwork or they had a procedural problem, it goes into the national practitioner data bank and it becomes for some of them a major problem for the rest of their career," he says.
"The question is that once you're punished, are you punished forever, or is there an opportunity if you only got probation or if you only got a written reprimand to have that come off your record," he says.
Ransom says MedChi open to suggestions for improving the process.
"If the Federation of State Medical Boards has a suggestion on how expungement should be done, we'll listen. We think expungement is a tool that should be used so people aren't stuck forever with these problems."
The state's Commonwealth Court is being asked to modify the consent decrees governing the relationship between UPMC and Highmark Inc., the largest healthcare provider and insurer in western Pennsylvania.
Pennsylvania Attorney General Josh Shapiro has filed a petition asking a state court to ensure that nonprofit UPMC meets its charitable obligations.
"Our petition today has a simple goal: to restore fairness to the healthcare system in western Pennsylvania and promote the public interest by ensuring patient access to affordable care and facilities which they have funded through their tax dollars," Shapiro said at a news conference in Pittsburgh on Thursday.
"As the Chief Law Enforcement officer for the Commonwealth of Pennsylvania, it is my constitutional mandate to ensure that charitable organizations like UPMC comply with our laws governing their conduct," Shapiro said. "We have concluded that UPMC is not fulfilling its obligation as a public charity."
Specifically, Shapiro asked the Commonwealth Court to modify the consent decrees governing the relationship between UPMC and Highmark Inc., the largest healthcare provider and insurer in western Pennsylvania.
Shapiro's petition asks the Commonwealth Court to:
Enable open and affordable access to UPMC through negotiated contracts with any health plan;
Require last, best-offer arbitration when contract negotiations between insurers and providers fail;
Protect against UPMC's unjust enrichment by prohibiting excessive and unreasonable billing practices inconsistent with its status as a non-profit health system.
In 2014, Pennsylvania intervened in an ongoing contract dispute between UPMC and Highmark that ended with a five-year consent decree mandating how the stakeholders would interact. That consent decree expires on June 30, 2019.
In late 2018, Hallmark agreed to proposed modifications to the consent decree that would have brought both stakeholders into compliance with their charitable obligations. UPMC did not agree to the modifications, which prompted Shapiro to file his petition on Thursday.
"Given the effect this dispute between UPMC and Highmark is having on Pennsylvanians, and the imminent expiration of the existing consent decree, we are asking the court to take action," Shapiro said.
"These changes are absolutely necessary to prevent UPMC from inflicting further harm on the public by forsaking its charitable obligations in pursuit of commercial success."
An AG's review of UPMC found that, even within the existing consent decree, UPMC violates its charitable obligations by:
Withholding access to doctors for patients in Williamsport, whose employers have contracts with a competing health plan; and
Refusing to negotiate reasonable payment terms with self-insured employers, "resulting in UPMC's unjust enrichment through excess reimbursements for the value of its services."
"As a public charity, especially one enjoying perpetual tax-exempt status, UPMC must behave in a manner consistent with its charitable mission in all facets of its operation," Shapiro said. "By law, it is a give-and-take relationship between UPMC and Pennsylvanians, and UPMC is taking more than its fair share from taxpayers."
UPMC Responds
Paul Wood, UPMC's chief communications officer, said the consent decree no longer needs to be renewed because the five-year consent decree created sufficient competition among insurers in western Pennsylvania.
"During that period, the region's insurance marketplace transformed from one of the nation's most highly concentrated and least competitive to one of the most competitive and pro-consumer markets in the nation with some of the lowest cost health plans available anywhere," he said.
That competition, Wood said, allows businesses to "offer alternative, affordable plans so their employees can choose insurance products that allow them full, unfettered in-network access to the UPMC hospitals and physicians they desire."
Highmark Chimes In
Highmark President and CEO David Holmberg said Shapiro's petition "is in the best interest of the communities we serve."
"We fully agree with the principle of preserving health care choice for all consumers; the sustainability of tiered, high-performance network health plans to meet consumer demand for quality, affordable care; and ensuring healthcare competition," Holmberg said in a media release.
"We've always believed that a level playing field should exist among health insurance companies and healthcare providers. We believe that all health plans and health systems should compete based on their value to the consumer," he said.
Alan Murray, a senior vice president with Moody's Investors Service, said requiring UPMC to continue to provide open access to its providers and hospitals would be a credit positive for Highmark.
"The petition – if ultimately successful – would enable Highmark to compete more effectively for customers, and to provide its insureds with expanded access to healthcare providers and facilities following the expected expiration of a consent decree on June 30,” Murray said.
Prosecutors allege that Greenway Health lied about the meaningful use certification of its Prime Suite electronic health records software.
Greenway Health LLC will pay $57.2 million to resolve False Claims Act allegations involving deceptive claims about the vendor's Prime Suite electronic health records software, the Department of Justice announced Wednesday.
In its complaint, federal prosecutors said Greenway falsely obtained 2014 Edition certification for Prime Suite, even as the vendor concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification.
Among its shortcomings, prosecutors allege that Prime Suite did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions.
According to DOJ, "Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary."
As a result of the alleged deception, DOJ said Greenway's Prime Suite users unknowingly submitted false claims to Medicare and other government healthcare programs using software that misrepresented their meaningful use capabilities.
Assistant U.S. Attorney General Jody Hunt of the Department of Justice's Civil Division said the resolution "demonstrates our continued commitment to pursue EHR vendors who misrepresent the capabilities of their products, and our determination to promote public health while holding accountable those who seek to abuse the government’s trust."
Federal prosecutors also alleged that Greenway was aware that a 2011 edition of its Prime Suite software did not correctly calculate the percentage of office visits for which its users distributed clinical summaries. As a result, some Prime Suite users unknowingly but incorrectly claimed that they were eligible for EHR incentive payments.
Lastly, prosecutors alleged that that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers.
U.S. Attorney for the District of Vermont Christina E. Nolan, a co-prosecutor in the Greenway settlement, noted that her office has prosecuted two cases against EHR vendors and recovered more than $212 million.
"These cases are important, not only to prevent theft of taxpayer dollars, but to ensure that the promise of health technology is realized in the form of improved patient safety and efficient healthcare information flow," Nolan said.
In a media release, Greenway Health CEO Richard Atkin said the settlement "is not an admission of wrongdoing by Greenway, and all our products remain ONC-certified."
"This agreement allows us to focus on innovation while collaborating with our customers to improve the delivery of healthcare and the health of our communities," Atkin said.
Greenway also entered into a five-year Corporate Integrity Agreement with the HHS Office of Inspector General that will require Greenway to retain an independent auditor to assess Greenway's software quality control and compliance, and to review Greenway's arrangements with providers to ensure compliance with the Anti-Kickback Statute.
The CIA also requires Greenway to give Prime Suite customers: An updated versions of Prime Suite for free; or the opportunity to switch to other Greenway software, also for free; or the option to transfer their data to another EHR vendor with no fees beyond money owed for goods or services already provided.
For every 100 steps taken the day after surgery, up to 1,000 steps, Cedars-Sinai researchers found that patients decreased their probability of a prolonged length of stay by nearly 4%.
Post-operative patients who walked more on the day after surgery had shorter hospital stays, researchers at Cedars-Sinai Medical Center in Los Angeles report.
The researchers gave Fitbit watches to 100 patients and found that every 100 steps taken the day after surgery, up to 1,000 steps, was correlated with a 3.7% reduction in the probability that the patient would have a prolonged length of stay related to the operation.
"We measure everything about our patients—whether it's heart rate, blood pressure, etc.—but nowhere do we measure steps, even though we know steps are so important for a patient's wellbeing," said senior author, Brennan Spiegel, MD, director of the Center for Outcomes Research and Education. "Now we have the ability to do so."
Timothy Daskivich, MD, director of Health Services Research for the Cedars-Sinai Department of Surgery, said the study provides a strong rationale for using devices such as Fitbits in the postoperative clinical setting.
He said it gives healthcare workers a precise way to monitor patient step counts and quickly know if a patient is recovering well. Daskivich hopes to see if Fitbits can increase step counts and reduce length of stay in a randomized controlled trial at Cedars-Sinai.
"We’re operationalizing this pop culture tech device for a real clinical purpose in the hospital, and using rigorous science to guide the process. We think it's exciting and patients are responding to it,” says Daskivich.
To encourage walks, the patients were given an app offering tours of Cedars-Sinai's art collection, with shorter and longer walks that include the exact step count for each tour.
In an accompanying invited commentary, Thomas M. Krummel, MD, said research like the Cedars-Sinai report "opens up an entirely new world of real-time data acquisition, monitoring, and intervention, and I believe the report by Daskivich et al is only the beginning."
"The general principle of ubiquitous wearable computers bodes well for our future ability to measure, track, and understand patient physiological data and behavior both in the hospital and at home," said Krummel, a thoracic surgeon and co-director of the Stanford Byers Center for Biodesign.
"The ability to capture that data, apply machine learning to evolving trends, and alert patients, nurses, and physicians instantaneously is powerful," Krummel said.
OnYourRxSide campaign targets critics who say safe harbors allow PBMs to flourish as self-serving middleman leveraging an arcane regulatory framework to rake in billions in profits at the expense of consumer.
Pharmacy benefits managers are hitting back against the Trump Administration's call for the elimination of the "middleman" rebates they receive from drug makers.
The Pharmaceutical Care Management Association this week launched a public relations campaigned dubbed OnYourRxSide,which PCMA says "is designed to increase awareness of the value that pharmacy benefit managers bring to patients and the employers and public programs providing prescription drug coverage."
"PBMs have an established and successful track record of implementing consumer-friendly, market-based tools, such as negotiating with drug manufacturers, to reduce costs for consumers," PCMA President and CEO JC Scott said in a media release.
"This campaign is designed to break through the noise in the drug pricing debate and clearly demonstrate how PBMs are the advocates for consumers in the fight to lower prescription drug costs," Scott said.
OnYourRxSide targets the claims of critics who say the safe harbors allow PBMs to flourish as self-serving middleman who leverage an arcane and opaque regulatory system to rake in billions in profits at the expense of consumer.
Instead, the PBMs say their "core mission is to be the primary advocate for consumers and health plans in the fight to keep prescription drugs accessible and affordable."
"PBMs negotiate on behalf of consumers, and are able to keep a lid on overall costs for prescription drugs with market-based tools that encourage competition among drug makers and drugstores, and incentivize consumers to take the most cost-effective and clinically appropriate medication," OnYourRxSide said.
The counteroffensive comes and more pressure is being place on the federal government to address spiraling drug costs. The issue has gained a lot of attention in the past year, was a key issue in the 2018 mid-term elections, and is expected to be a key issue in the 2020 presidential elections.
Reducing the prices consumers pay for prescription drugs is also seen as one of the few issues that a sharply divided and partisan Congress can forge a compromise.
Rebates drug makers pay to PBMs are legal under the safe-harbor provisions of the Anti-Kickback Statute.
The Trump Administration's proposal would eliminate the safe harbor for prescription drug rebates paid by manufacturers to PBMs, Medicare Part D plans, and Medicaid managed care organizations. It would implement a fixed-fee model between PBMs and manufacturers and add a safe harbor for discounts offered directly to consumers.
Health and Human Services Secretary Alex Azar says the proposal would pass savings along to patients by increasing transparency, encouraging discounts given directly to consumers rather than middlemen, and prohibiting a compensation system that incentivizes annual price hikes.
"This proposal has the potential to be the most significant change in how Americans' drugs are priced at the pharmacy counter, ever, and finally ease the burden of the sticker shock that millions of Americans experience every month for the drugs they need," Azar said in a statement.
President Donald Trump referenced addressing high drug costs as "the next major priority for me, and for all of us" in his State of the Union address Tuesday night, but he provided few details beyond his ongoing calls to require disclosure of the real prices of pharmaceuticals, which he said would foster competition among stakeholders.
"It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, unfair, and together we can stop it," Trump said, earning applause from both sides of the aisle.
The newly merged, $29 billion system will have a footprint in 21 states, with more than 700 care sites and 142 hospitals, and an extensive social services and population health network.
Dignity Health and Catholic Health Initiatives on Friday finalized the megamerger of the two Catholic health systems that will now be known as CommonSpirit Health.
The newly merged, $29 billion system will have a footprint in 21 states, with more than 700 care sites and 142 hospitals, along with research programs, virtual care services, home health programs, and population health initiatives to tackle the root causes of poor health.
CHI CEO Kevin E. Lofton and Dignity Health President and CEO Lloyd H. Dean are "each a CEO in the Office of the CEO" for the new health system, which will be based in Chicago.
"We didn't combine our ministries to get bigger, we came together to provide better care for more people," Dean said in a media release.
"We created CommonSpirit Health because in order to solve national health challenges, we need the breadth, scope, and resources to make a nationwide impact," Dean said.
Lofton said CommonSpirit Health "will bring the expertise of a national health system to neighborhoods across the country."
"Whether it's a neurological institute in Arizona, a 25-bed critical access facility in North Dakota, a mobile lung cancer screening program in Tennessee, or a 'hospital at home' in Nebraska, CommonSpirit Health will expand the best approaches from across our new organization," Lofton said. "Our whole will be much greater than the sum of our parts."
The new health system has 150,000 employees and 25,000 physicians and advanced practice clinicians.
Dean noted that 27 million Americans remain uninsured, and life expectancy continues to fall, despite some progress made under the Affordable Care Act. He said CommonSpirit will focus on underserved populations and the social causes of poor health.
"Too many people still can't access quality healthcare in their communities," Dean says. "America's healthcare system need big changes, and we have a big goal of improving the health of millions of people in this country."
Lofton said CommonSpirit "will focus on treating the whole person, particularly the social causes of poor health that lead to needless suffering, unnecessary hospital visits, and premature deaths."
"Our goal is to be the leader in every type of care, whether you need brain surgery, urgent care for the flu, or help managing your diabetes," he said.
CHI and Dignity Health previously announced that the new ministry will retain the names of local facilities and services in the communities where they are located.
'Gaining Economies of Scale'
Brad Haller, director in West Monroe Partners' Mergers & Acquisitions practice, notes that "so far, the new entity has shown very little change to how they will actually deliver care."
"While the organization has a name for the merged entity, CommonSpirit, both systems indicated they are going to continue operating under both the CHI and Dignity names in their local markets," he says.
"The merger wasn't about branding or changing the nature of its business, but rather gaining economies of scale and geographic footprint, which makes sense for the like-mindedness in the way they deliver care and manage operations," he says.
Concerns had been raised during the merger talks that women's healthcare services would be ill-affected under the consolidated health system. Haller says those concerns appear to have been addressed when California approved the merger with a stipulation that CommonSpirit must maintain emergency services and women’s healthcare services for 10 years after the deal closes.
"(California) also required CommonSpirit to create a Homeless Health Initiative to support hospitalized homeless patients," Haller says. "I would suspect that the newly merged organization will find more synergies in care delivery as time goes on, as most merged organizations find during the post-integration phase, but in the spirit of efficiency or expansion."
"The merger wasn't about branding or changing the nature of its business, but rather gaining economies of scale and geographic footprint, which makes sense for the like-mindedness in the way they deliver care and manage operations."
—Brad Haller
Allan Baumgarten, a veteran observer of the hospital sector in Midwestern states, says several Dignity hospitals are considered "non-Catholic" and not subject to the Vatican guidelines, such as not performing tubal ligations.
"Those hospitals will be kept somewhat separate so they can continue to offer those services," he says.
Baumgarten notes the odd choice of Chicago as a headquarters for CommonSpirit, "even though neither system has a presence there."
"CHI has three small hospitals in Minnesota (Park Rapids, Breckenridge, LIttle Falls) and some nursing homes, but otherwise the combined system has only a small presence in the Midwest," he says.
"Not sure what to say about the impact on care delivery," Baumgarten says. "In theory, if one system has certain strengths, like better care management and discharge planning, thereby reducing the number of readmissions, it could share those strengths and practices with the other hospitals."
"To gain efficiencies, you might see them agreeing on a single vendor for certain medical devices or commodity suppliers that all hospitals will have to use in the future," he says. "In any of these mergers, health economists will tell you that most of the benefits could be achieved by contracts and strategic partnerships."
CHI and Dignity announced their plans to merge in December 2017. The deal was expected to close at the end of 2018, but it was delayed for one month. No specific reason was given for the delay.
The name CommonSpirit Health was chosen in November from among more than 1,200 possible names. The health systems said they settled on that name because it represents a shared sense of missional service and because it resonates with the diverse populations being served, the organizations said.
Mission Health will become a for-profit health system, but continue to manage its seven hospitals in western North Carolina, while HCA runs operations, capital access, predictive modeling and analytics.
HCA Healthcare has completed its previously announced $1.5 billion acquisition of nonprofit Mission Health, a seven-hospital system in Asheville and western North Carolina.
"We're looking forward to investing in western North Carolina and helping ensure Mission Health's 133-year tradition of caring for communities throughout the region continues for many years," HCA CEO Sam Hazen said in a media release.
Based in Asheville, Mission Health is the sixth-largest health system in North Carolina. Mission Health's tax status changes to for-profit with the acquisition.
Nashville-based HCA said it will spend $430 million over five years for the completion of the Mission Hospital for Advanced Medicine, building a replacement hospital for Angel Medical Center and building a new behavioral health hospital.
The proceeds from the sale will be combined with Mission Health's remaining cash and investments and will be used to fund the newly formed Dogwood Health Trust, a population health initiative serving western North Carolina.
Mission Health President and CEO Ronald A. Paulus, MD, called the deal "a tremendous win for the people and communities that we serve."
"We've not only provided for the long-term sustainability of high-quality healthcare and secured special protections for our rural communities, we've also created the largest per capita foundation in the nation to address the social determinants of health," Paulus health.
Under the deal, "nearly all" Mission facilities will become part of HCA while continuing to operate under the Mission brand. Mission will continue to be managed locally while HCA runs operations, capital access, clinical trials, research, predictive modeling, and analytics.
The HCA-acquired hospitals are: 763-bed Mission Hospital in Asheville; 80-bed CarePartners Rehabilitation Hospital in Asheville; 49-bed Mission Hospital McDowell in Marion; 25-bed Angel Medical Center in Franklin; 25-bed Transylvania Regional Hospital in Brevard; 25-bed Blue Ridge Regional Hospital in Spruce Pine; and 24-bed Highlands-Cashiers Hospital in Highlands.
HCA is one of the nation's largest for-profit hospital chains and, with the Mission acquisition, now includes 185 hospitals and 1,800 care venues in 21 states and the United Kingdom.
HCA and Mission Health entered exclusive talks last March and signed a definitive agreement in August. North Carolina regulators approved the deal in January.
The Mission acquisition comes as HCA continues to demonstrate strong financial performance. The company reported this week that same hospital admissions increased by 2% in Q4, accompanied by rising revenues, accruing at nearly $12.3 billion, and adjusted EBITDA topping $2.5 billion, a 6.2% year-over-year increase.
Miraca Life Sciences allegedly subsidized physicians' EHR costs, and provided free or discounted consulting services in exchange for patient referrals.
A Texas-based pathology lab will pay $63.5 million to settle whistleblower allegations that it violated the False Claims Act and Anti-Kickback laws, the Department of Justice announced.
Prosecutors had alleged that Miraca Life Sciences Inc. illegally providing physicians with funding for electronic health records systems, and free or discounted technology consulting services, in exchange for patient referrals.
The company, now known as Inform Diagnostics, is headquartered in Irving, Texas. The company changed owners in 2017.
The Department of Health and Human Services in 2006 adopted provisions that allowed laboratories to provide EHR donations to physicians under certain conditions, but federal prosecutors said Inform Diagnostics violated those conditions. HHS withdrew those exemptions for laboratories in 2013.
"Patients deserve the unfettered, independent judgment of their healthcare professionals. Offering financial incentives to physicians and medical practices in exchange for referrals undermines citizens' trust in our healthcare system," U.S. Attorney Maria Chapa Lopez of the Middle District of Florida said in prepared remarks.
"With this settlement, our Civil Division confirms its commitment to our nation's critical struggle against practices that put public health programs at risk," she said.
The allegations stem from three lawsuits that were filed under the whistleblower provisions of the False Claims Act. The whistleblowers' share of the settlement announced today has not yet been determined.
Inform Diagnostics issued a statement saying it was "pleased to put this matter behind us and to move forward with renewed commitment to our clients and each other."
"We have admitted no wrongdoing as part of the agreement with the DOJ, but resolving this issue will allow us to focus on what's most important—providing best-in-class anatomic pathology services to our clients and building a business that is successful and sustainable," the company said.
The settlement of $63.5 million will be paid by Miraca Holdings, and Inform Diagnostics will not be subject to a Corporate Integrity Agreement, the company said.
Since the change of ownership in November 2017, Inform Diagnostics said it is led by a new group of senior executives and board members that has "put compliance at the center of everything we do."
The nation's largest publicly operated health plan has begun its $31 million initiative to recruit primary care physicians for safety net providers serving Los Angeles County.
L.A. Care Health Plan has given 29 community health clinics in Los Angeles County $125,000 each to recruit and retain primary care physicians, in the first phase of a $31 million drive to bolster the region's safety net.
L.A. Care CEO John Baackes says the publicly operated health plan's Elevating the Safety Net program, which started in mid-2018, should ultimately bring about 400 primary care physicians into the county over the next five years, through recruiting and compensation incentives, scholarships, and medical school debt relief.
"Part of our mission at L.A. Care is to support the safety net, and with estimates that California will face a shortage of nearly 9,000 primary care physicians by 2030, we were compelled to act," Baackes says.
Baackes calls L.A. Care's recruiting initiative "a good start" in a daunting challenge.
"We're making a dent, but to my knowledge, we're making the biggest dent that anyone is making," he says.
"It's well known that Kaiser (Permanente) pays more, and they suck up a lot of the new talent. The academic medical centers pay more too, and they get some of the talent," he says. "So this is trying to provide the safety nets with a level playing field for the recruitment of these primary care doctors."
The clinics can use their $125,000 award to either pay for a physician recruiter, or use it in an incentive package for prospective hires. "However they see fit," Baackes says.
The clinics must hire a physician from outside of L.A. County and bring them into the L.A. Care Medi-Cal network no later than June 30. to receive the money.
Once hired, the new physicians will be eligible for loan repayments of up to $5,000 per month for up to 36 months, topping out at $185,000, as long as they work within the safety net.
"Almost all of the awardees are federally qualified health centers, meaning that they have been in the safety net for 30 or 40 years, and they take care of about 300,000 of our lives," Baackes says.
"They're run by local community boards, and they provide generally a health center, a facility where the doctors work, and many of those facilities have ancillary services in there. When you go and visit, you can get a lot of services done in one place," he says.
The third part of the initiative is a scholarship program that awards eight full medical school each year. Four of the scholarships are for students attending the David Geffen School of Medicine at UCLA, and four are for those attending the Charles R. Drew University of Medicine and Science.
The first scholarships were awarded last July, and eight more will be awarded later this year.
L.A. Care Health Plan has more than 2.2 million members in Los Angeles County, making it the largest publicly-operated health plan in the country.
