The systems announced Wednedsay morning that they signed a letter of intent to bring their operations together.
Two healthcare providers serving the Philadelphia area announced plans Wednesday morning to merge.
Einstein Healthcare Network and Jefferson Health, which were part of the same organization before they split a decade ago, hosted a press conference and ceremonial signing of a non-binding letter of intent to unite once again.
Stephen K. Klasko, MD, MBA, president and CEO of Thomas Jefferson University and Jefferson Health, spoke alongside Barry R. Freedman, president and CEO of Einstein Healthcare Network, according to a notice released by both organizations.
"As two academic medical centers that have embraced a no-limits approach to a very different future, we are a perfect match," Klasko said in a statement.
Freedman said the proposed merger would enable Einstein to continue carrying out its mission while also pursuing growth opportunities.
“Both Jefferson and Einstein are aligned in our belief that together we can redefine how patient care is delivered, how health professionals are educated, how research discoveries are brought to patients, and how the health of our communities can be improved," Freedman said in the statement.
If, after a period of due diligence, both organizations opt to move forward with the proposed merger, they will sign a definitive agreement subject to regulatory approval.
The deal would mark Jefferson's sixth acquisition since Klasko was hired as CEO in 2013, as The Inquirer's Harold Brubaker reported.
Tuesday is the deadline to comment on the proposed rule, which aims to enhance existing protections for healthcare workers who object to certain medical procedures.
The Department of Health and Human Services (HHS) has received an average of 1,181 comments per day on its proposed rule to bolster protections for the conscientious objections of healthcare workers.
The department had received 69,688 submissions in the 59 days since the comment period opened, as of Monday, according to the online rulemaking portal. The deadline to add a comment to the pile is Tuesday night.
Although the proposal points to more than two dozen existing statutes as the bases for enhanced enforcement by the newly created Conscience and Religious Freedom Division within the HHS Office for Civil Rights (OCR), the matter has proven controversial, with critics warning the policy could impede healthcare access for women and LGBT patients.
Proponents contend, however, that the proposal is sorely needed after eight years of the Obama administration failing to prioritize the rights of healthcare workers to decline participation in certain medical procedures, such as abortion, sterilization, and assisted suicide.
In a comment submitted on Monday, the American Hospital Association (AHA) acknowledged the tension between a healthcare worker’s rights of conscience and the healthcare access needs of various patient populations.
The AHA said it both supports policies to accommodate employees’ convictions and opposes discrimination against patients on the basis of race, religion, national origin, sexual orientation, or gender identity.
“The intersection of these equally important obligationscan present unique challenges,” AHA Executive Vice President Thomas P. Nickels wrote. “Neither obligation can or should be addressed in a vacuum.”
Accordingly, the way OCR approaches its planned enforcement must take both obligations into account, Nickels added, outlining three main recommendations:
The way HHS OCR enforces these protections should be modeled after the policies, practices, and court precedent governing other civil rights protections. That means OCR should avoid novel policies and practices “that add unnecessary complexity and burden or prefer conscience protections over other civil rights.”
The regulations should be written with explicit protections for due process. The proposed regulations say nothing about procedural protections for organizations who could be penalized as a result of an OCR investigation, so the final version should be updated to include notice and hearing rights, among other protections.
The regulatory burden should be minimized. The breadth of the proposed rule is “problematic,” the AHA wrote, citing specific examples of particularly burdensome provisions. Therefore, the proposal to require hospitals to report reviews, investigations, and complaints to HHS should be scrapped, the organization argued.
The full AHA comment is available on the organization’s website, but the government had not released any of the comments publicly as of Tuesday morning.
An HHS OCR contractor tasked with handling media inquiries about the proposed rule told HealthLeaders Media in early February that the comments would be made public before the end of the comment period. Earlier this month, however, the contractor said plans had changed and the comments would likely not be published until after the comment window closed.
Late last year, HHS drew heavy criticism for withholding more than 10,000 public comments on a separate request for information pertaining to abortion and healthcare for transgender patients, as Politico reported. At first, only 80 comments were released publicly, most of them supporting the Trump administration’s position.
During an interview earlier this month with Catholic radio show Doctor, Doctor, HHS OCR outreach adviser Arina Grossu assured stakeholders that their feedback would be handled properly.
“All the comments will be read and taken into account,” Grossu said. “And this is a proposed regulation, which means that once we review the comments that we receive, we will incorporate information into the final rule.”
When asked about concerns that enhancing protections for healthcare workers could lead to more discrimination against LGBT patients, Grossu said anyone is welcome to file complaints with HHS OCR if they believe their rights of conscience, civil rights, or health information privacy rights have been violated.
“These federal laws were put in place to prohibit discrimination and are not themselves discriminatory,” she said. “They actually protect people from being discriminated against.”
The healthcare giant agreed to reimburse Glenview Capital Management up to $500,000 in fees and expenses incurred in order to reach the deal.
Tenet Healthcare Corporation and Glenview Capital Management announced Monday that they reached a deal to end their months-long feud over how the hospital operator should be governed.
The companies disclosed their agreement to the Securities and Exchange Commission (SEC), noting that Tenet will reimburse Glenview up to $500,000 within 10 business days, in cash, for the fees and expenses the investment firm incurred in the run-up to the deal.
Glenview—which currently owns more than 17.9 million of Tenet’s 101.2 million outstanding shares, or 17.74%, according to SEC filings—had called last month for governance changes, including the ability for shareholders to vote by proxy without a meeting, citing Tenet’s worse-than-anticipated financial performance.
This came after two Glenview representatives left the Tenet board last August, citing “irreconcilable differences.” Tenet’s CEO announced his resignation shortly thereafter.
For the fourth quarter of 2017, Tenet posted a $230 million loss and continued down a steep path of planned divestitures.
“With this agreement in place, we can continue our work on the initiatives we have underway to position us as a stronger leader in healthcare delivery and create additional shareholder value,” Tenet Executive Chairman and CEO Ronald A. Rittenmeyer said in a joint statementMonday with Glenview founder and CEO Larry Robbins.
“As a long-term shareholder of Tenet and as its largest investor, we firmly believe in the Company’s value creation opportunities and we appreciate steps taken in recent months to enhance Tenet's focus on patient satisfaction, operating efficiency, incentive alignment and corporate governance,” Robbins said.
“We are pleased that these bylaw amendments will benefit all shareholders by providing greater shareholder safeguards and an improved framework for a continuing constructive dialogue between the Board, senior management and owners.”
Tenet agreed on Friday to amend its bylaws in three key ways:
Special meeting: It will revise its special meeting bylaw so that it can be amended only by a majority vote of Tenet shareholders.
Annual meeting: It will require that an annual meeting be held at least every 13 months under a bylaw that can be amended only by a majority vote of Tenet shareholders.
Shareholder rights: It will adopt a bylaw that requires 75% of board members to approve the adoption of any future shareholder rights plan, with a maximum plan length of one year and a 90-day window to seek shareholder approval for an extension.
Glenview agreed, under the terms of the deal, to take three actions of its own:
Proposal withdrawn: It will withdraw its notice that it intended to make a proposal at the 2018 Annual Stockholders’ Meeting.
Limit ownership: It will agree to keep its ownership stake in Tenet at or below 20% for at least one year. (Its current stake is greater than 17% of Tenet’s outstanding shares, according to SEC filings.)
Support nominees: It will vote in favor of all directors the board nominates at the annual meeting, as listed in a document filed March 19 with the SEC.
The head of Medicare testified that addressing restrictions designed to prevent fraud and abuse among physicians is ‘an important piece’ of the push for value-based healthcare delivery.
It remains unclear how high Stark Law reform ranks on the Trump administration’s list of healthcare policy priorities, but high-level officials keep mentioning it.
Demetrios Kousoukas, principal deputy administrator for the Centers for Medicare and Medicaid Services (CMS) and director of the Center for Medicare, said policymakers need to consider such reforms as they push toward a value-based healthcare system.
Kousoukas made the comments Wednesday in response to a question from Rep. Kenny Marchant, R-Texas, during a hearing on the implementation of physician payment policies under the Medicare Access and CHIP Reauthorization Act (MACRA).
“I have visited with some of the doctors in my district just recently and have heard from several of their physician organizations. Their big complaint is they say that the Stark laws are creating real barriers to their coordination,” Marchant said, before asking Kousoukas to help advance a bill that has the backing of a bipartisan group of nine representatives.
Kousoukas responded by saying, generally, that the Trump administration is interested in solving the problem identified by the bill Marchant backs.
“It has a really big impact on how relationships are structured in the healthcare space,” Kousoukas said of the Stark laws, which prohibit physicians from referring a Medicare or Medicaid patient to a provider with which the physicians have financial ties.
“You have to look at all of the arrangements that are arrayed behind the physician that’s facing the patient and the complex web of financial and other relationships that come about partly as a result of the evolution of the healthcare system to have so many fractured silos to have so many rules and regulations that govern every part of the healthcare system,” Kousoukas said.
“We acknowledge that MACRA is just a piece of this, that we’ve got to look at the other parts,” he added, “and Stark is an important piece of that.”
Kousoukas pointed to the president’s budget proposal for fiscal year 2019, which includes a line item calling for the “physician self-referral law” to be reformed “to better support and align with alternative payment models [APM] and to address overutilization.”
The document does not include an estimate of how much such reforms would cost.
In making his comments, Kousoukas echoed CMS Administrator Seema Verma, who said during an American Hospital Association (AHA) webinar in January that “an inter-agency group” would conduct a Stark Law review.
The AHA has made its position on the matter clear. In a statement submitted to the health subcommittee of the House Ways and Means Committee for Wednesday’s hearing, the AHA referred to Stark and anti-kickback laws as “outdated.”
“These statutes and their complex regulatory framework are designed to keep hospitals and physicians apart—the antithesis of the new value-based delivery system models,” the AHA wrote, recommending that Congress create a “safe harbor” to promote collaboration in healthcare.
Some senators encouraged the president to follow through on the threat after their colleagues sent the bill to the White House on Friday morning.
Update: The president held a news conference Friday afternoon during which he said he would sign a spending bill into law, citing the need to do so as a matter of national security.
"While we're very disappointed in the $1.3 trillion ... we had no choice but to fund our military because we have to have, by far, the strongest military in the world," he said.
"I will never sign another bill like this again," he added, citing the quick pace with which Congress finalized the measure.
[The full story HealthLeaders Media published Friday morning is included below:]
President Donald Trump threatened to veto a $1.3 trillion spending bill passed early Friday morning by the Senate, suggesting he might singlehandedly shut down the federal government.
The bill includes a $10 billion boost for the Department of Health and Human Services (HHS) and additional funding for programs to combat the opioid epidemic, but it excludes proposals that had aimed to stabilize the Affordable Care Act (ACA) insurance markets.
If the president follows through on his threat, it would likely prompt HHS to furlough half of its workforce, nearly 41,000 staff members.
The timing is particularly inconvenient for members of Congress, many of whom have already returned to their home districts for a two-week recess after the Senate voted 65-32 early Friday morning in favor of the spending package, as Politico reported.
Lawmakers had fully expected Trump to sign their bill without incident after White House officials indicated his support for the measure. Asked if Trump would sign the bill, Office of Management and Budget Director Mick Mulvaney said, “Yes,” on Thursday, as CNBC reported. "Why? Because it funds his priorities."
In a tweet shortly before 9 a.m. Friday, however, the president cited two priorities unrelated to healthcare as the basis for his “considering” a veto: Deferred Action for Childhood Arrivals (DACA) and funding for a wall along the southern U.S. border.
The so-called Dreamerswho benefit from DACA “have been totally abandoned by the Democrats,” and the border wall “is desperately needed for our National Defense,” Trump wrote.
Democratic Sen. Tim Kaine of Virginia shot back with a snarky tweet of his own, accusing the president of snoozing through the negotiations.
“Seriously though, Rip Van Winkle, did you just awake from a long slumber?” Kaine wrote. “We gave you a deal last month that offered all the border funding you wanted AND a path to citizenship for Dreamers. YOU (or your minions) tanked it and turned us down. Art of the Deal-Wrecker!”
But other senators welcomed the president’s veto.
Republican Sen. Rand Paul of Kentucky—who made a stunt of tweeting his way through the 2,200-page bill—agreed that “this sad excuse for legislation” should be blocked “because it’s $1.3 trillion in spending that (almost) no one read.”
Republican Sen. Bob Corker of Tennessee similarly encouraged Trump to make good on the threat.
“I am just down the street and will bring you a pen,” Corker wrote. “The spending levels without any offsets are grotesque, throwing all of our children under the bus. Totally irresponsible.”
Trump's threat comes after the House Freedom Caucus sent him a letter this week urging him to "reject" the bill. The letter included a bulleted list of four complaints the caucus has with the bill, including its funding for grants to Planned Parenthood and the absence of ACA reforms.
"We must continue to reduce burdensome regulations in the healthcare marketplace, return to free market principles, and empower consumers," the caucus wrote. "This bill fails on all three fronts."
Republican Rep. Mark Meadows of North Carolina said the caucus "would fully support" Trump's veto, preferring to pass another short-term continuing resolution instead so negotiations can continue.
This story has been updated to include additional comments from lawmakers.
The organization does not plan to release any additional information about the reasons for his departure.
The board of directors for 340B Health announced Thursday that Ted Slafsky would step down Thursday from his role as CEO of the association, leaving the organization without a CEO for the rest of March.
Maureen Testoni, former senior vice president and general counsel of 340B Health, will step in as interim president and CEO on April 1, the organization said in a brief statement.
In the meantime, Rob Miller, senior vice president of business development, strategic planning, and operations, will be the group’s highest-ranking leader, a spokesperson tells HealthLeaders Media.
Slafsky, who worked more than two decades with the organization, made the decision jointly with the board, a spokesperson said, declining to characterize the reasons for the sudden departure.
The spokesperson said 340B Health does not anticipate releasing any additional information about the situation.
Testoni, who will serve in an interim capacity while a search is conducted for a permanent replacement, previously worked seven years with 340B Health.
“Maureen is well known and respected in the 340B community and we are confident that she will successfully lead the organization during this transition,” the organization said in its statement.
The organization describes itself as an association of more than 1,300 hospitals that advocates for hospitals that participate in the 340B Drug Pricing Program.
Slafsky—who has been vocal in the ongoing fight against planned cuts to 340B federal funding—released a statement via email Thursday to HealthLeaders Media calling 340B Health "a great organization that I was fortunate to lead."
"I am confident it will continue to do an excellent job in representing the interests of the 340B hospital community," Slafsky wrote. "I have nothing but great memories and wish the organization, our members and staff my very best.”
Despite a bipartisan push, efforts to restore cost-sharing reductions were not included, as Congress looks for compromises to keep the government open.
The U.S. House of Representatives released a 2,200-page spending bill Wednesday night as lawmakers finalize their negotiations ahead of their Friday deadline to avert another government shutdown.
One notable item missing from the $1.3 trillion bill: any part of the Senate’s proposal to stabilize insurance markets under the Affordable Care Act.
A few Democrats and Republicans had come together to push for policies that would restore reinsurance and cost-sharing reduction (CSR) subsidies that President Donald Trump halted last fall. Their parties reached an impasse, however, when abortion-restricting language was added to the mix.
The bipartisan proposal would have increased the budget deficit by more than $19 billion over the next decade and reduced nongroup insurance premiums by about 10% next year, according to estimates released Monday by the Congressional Budget Office.
“It’s deeply disappointing that lawmakers did not include critical market stabilization measures in the omnibus budget bill that would have made coverage more affordable for individuals and families, especially those who are not eligible for assistance in purchasing coverage,” Justine Handelman, senior vice president for Blue Cross Blue Shield Association, said Wednesday after the bill was released, as Forbes reported.
What made the cut?
Although the ACA stabilization proposal was spurned, a number of other healthcare-related provisions survived, according to House Appropriations Committee Chair Rodney Frelinghuysen, R-N.J.:
The Department of Health and Human Services (HHS) gets a funding increase of $10 billion under the bill, compared to fiscal year 2017.
That HHS boost includes a $3 billion increase for the National Institutes of Health (NIH) and a $1.1 billion increase for the Centers for Disease Control and Prevention (CDC).
Funding for the Centers for Medicare and Medicaid Services (CMS) remains flat at $4 billion for administrative expenses.
The Agency for Healthcare Research and Quality (AHRQ)—which has repeatedly found itself on the chopping block—escaped with $334 million, an increase of $10 million, in the bill.
The measure also includes funds earmarked to fight the opioid crisis.
Additionally, observers may disagree as to whether this bill is a win for healthcare IT, as Politico’s Darius Tahir reported. Funding for the Office of the National Coordinator (ONC) remains flat, while other tech items received funding boosts.
Citing the office of House Majority Whip Steve Scalise, CNBC reported that the House expects to vote early Thursday afternoon. If approved, the measure would then go to the Senate.
The judiciary has no authority to second-guess the OPPS rates HHS sets each year, according to the latest court filings in a suit that aims to halt planned cuts to the 340B Drug Pricing Program.
The federal government argued in a court filing this week that an appellate judge should dismiss a lawsuit brought by a long list of hospital organizations challenging a reduction in payments under the 340B Drug Pricing Program.
The plaintiffs—which include the American Hospital Association, the Association of American Medical Colleges, America’s Essential Hospitals, and others—argue that the program is needed to improve patient care. But the government argues the judiciary has no authority to review the Outpatient Prospective Payment System (OPPS) rates set each year by Health and Human Services (HHS).
That’s because Congress, in drafting the relevant statutes, intended “to confer unreviewable discretion on the [HHS] Secretary to make adjustments to the OPPS payment rates, including those for 340B drugs,” the Department of Justice argued on behalf of HHS.
The hospitals brought this appeal after a district court dismissed their complaint late last year.
Any adjustments to OPPS rates must be budget neutral, the government argued, so if a judge orders HHS to forgo planned cuts to 340B, the ruling would require offsets elsewhere as well.
“If a court were to invalidate the adjustment at issue here, it would affect not only payment rates for 340B drugs, but also payment rates for services across the classification system,” the DOJ’s filing states.
The document—which says resetting 2018 OPPS rates would be like “unscrambling the egg”—is included here:
With state approval, the nonprofit system can close the most significant deal it has pending in the northern part of the state.
Rideout Regional Medical Center, a 219-bed acute care hospital in Marysville, California, will soon become part of Adventist Health, a nonprofit system that serves patients in three states.
The California Attorney General’s Office approved the transition of the medical center and a number of other Rideout Health assets throughout Yuba and Sutter counties, which are north of Sacramento, Adventist announced Tuesday.
“We are confident that the partnership will have a positive impact on patients and the broader Yuba-Sutter community,” Adventist CEO Scott Reiner said in a statement.
The arrangement, which the organizations announced last October with the signing of an affiliation agreement, is expected to close officially on April 1. In addition to the medical center, other Rideout Health assets will be transferred to Adventist, including a heart center, cancer center, outpatient clinics, and other ancillary services.
Adventist CFO Joe Reppert, CPA, MBA, who was promoted into his current position last month, told HealthLeaders Media in January that the Rideout acquisition was the most significant deal Adventist, which is based in Roseville, California, had pending in the northern part of the state.
“The addition of Rideout Health will enablemore effective coordination of certain services and specialty careamong our hospitals in that geography,” Reppert said. “That circles right back to better care for our patients. As a result of this new affiliation, other partnerships are developing for further expansion of services, locations, and covered lives.”
Janice Nall, chair of Rideout’s board of directors, said her organization is pleased to have the attorney general’s approval and that the deal will ultimately benefit Rideout patients.
“Adventist Health’s philosophy of health and wellness will bring important prevention programs to our region," Nall said in the statement.
Both organizations have agreed to a number of legally binding conditions. For example, the hospital must continue to operate as a licensed general acute care hospital with 24-hour emergency and trauma medical services for 10 years.
Additionally, the hospital must provide cardiac, neonatal, obstetric, women’s health, and certain other services for five years. And it must provide at least $2,826,391 annually in charity care—which the attorney general’s conditions define as the actual cost of care, not the price.
More than 2,100 people are employed by Rideout, including about 300 physicians on staff. As previously reported, none of them are expected to be displaced.
Arbitration proceedings between the two companies are pending after multiple disputes erupted over transition agreements signed to coincide with Quorum’s creation.
Community Health Systems (CHS) is seeking early termination of two transition agreements it signed with Quorum Health Corporation in 2016, when CHS spun off 38 hospitals to form Quorum as a separate company.
In a form filed Tuesday with the Securities and Exchange Commission (SEC), Quorum acknowledged the move by CHS, marking the latest episode in a years-long dispute over how financial projections and plans were calculated and arranged in the run-up to the spin-off.
The news comes as Mike Culotta, who has been Quorum’s CFO since the company was formed, prepares to pass the baton to Alfred Lumsdaineat the end of the month.
On the same day that CHS announced the Quorum spin-off had been finalized, the organizations entered into five-year transition services agreements, which outlined services CHS would provide to Quorum. These services included information technology, payroll, billing, collections, and others, according to the SEC filing.
Within four months, however, Quorum released second-quarter finances that severely underperformed CHS projections, and its stock price tanked, riling investors. From their debut at $16.50 apiece, Quorum shares fell more than 50% by the end of 2016, and they continued to slide in 2017.
Investors complained that CHS used proceeds from the deal to pay down its own debt, while Quorum began paying millions of dollars more than anticipated back to its former headquarters. Irked by what they deemed disturbing and perhaps even unlawful behavior, the investors called for an independent investigation into each organization’s leadership team.
“We believe that either Quorum’s management team is complicit in this cover up or they are guilty of gross mismanagement for their inability to analyze the costs of their own business for months after the spin-off,” R2 Investments LDC—which owned $50 million of bonds and 1.3 million shares of Quorum stock in mid-2016—wrote to the Quorum board on October 12, 2016.
Five months later, the Quorum board replied to R2 Investments with a letter saying an independent investigation “did not produce conclusive evidence of intentional misconduct or fraud by CHS” but did unearth facts that “suggest (at a minimum) several bases for questioning CHS’s operational competence in connection with the planning and execution of the spin-off, and the formulation of financial projections.”
Dispute pending in arbitration
Quorum received a demand for arbitration from CHS on August 4, 2017, pertaining to the two transition services agreements the organizations signed in 2016, according to Quorum’s latest SEC filing.
While CHS claims Quorum owes it $9 million, Quorum contends that CHS issued the bills improperly.
“We intend to vigorously contest the charges as not payable to CHS under the transition services agreements and have made a counterclaim for termination of the agreements as well as substantial damages we believe we have suffered as a result of the transition services agreements and other actions taken by CHS in connection with the spin-off,” Quorum said in the filing.
The dispute is pending before the American Arbitration Association, with proceedings scheduled for June and a decision expected in August.
If CHS gets its way, the agreements will be terminated effective September 30 or sooner, if both parties agree to an earlier date.
Quorum, CHS, and R2 Investments did not respond Tuesday to requests for comment.
