The panel directed CHS to give about $2.1 million back to Quorum, but it also rejected the basis for Quorum's withholding of about $1.5 million in payments to CHS.
Quorum Health Corporation said this week that arbitration over a multimillion dispute stemming from its 2016 spin-off from Community Health Systems has concluded with a final ruling.
While the ruling doesn't require Quorum to pay about $9.3 million in contested payments being withheld from CHS, it does require Quorum to pay about $1.5 million, according to a statement released Monday by Quorum.
Meanwhile, CHS will be required to return about $2.1 million in disputed payments to Quorum, according to the statement.
The long-running feud centers on two transition agreements signed when CHS spun off 38 hospitals to form Quorum as a separate company. The agreements outlined services CHS would provide to Quorum for five years, including information technology, payroll, billing, collections, and more.
One item to keep an eye on is how the acting director approaches anything related to Medicaid expansion.
There's a new boss overseeing Medicaid at the federal level.
Chris Traylor, who joined the Centers for Medicare & Medicaid Services last July as deputy administrator for strategic initiatives, was named acting director this week of the Center for Medicaid & CHIP Services.
Traylor retired in 2016 from his post as executive commissioner of the Texas Health and Human Services Commission. He previously served more than three years as the state's Medicaid director and accumulated more than 26 years in public-sector work, according to a CMS announcement.
One item to watch is how Traylor approaches anything related to Medicaid expansion, since Texas is among the 14 states that have not adopted expansion under the Affordable Care Act.
Traylor takes over for Mary Mayhew, who resigned Friday after less than three months on the job. As Maine's Medicaid director, Mayhew had garnered a reputation as an opponent of Medicaid expansion.
Mayhew left to take a job with Governor-elect Ron DeSantis in Florida, another state without Medicaid expansion. (Newly elected Maine Gov. Janet Mills ordered the state tomove forward with Medicaid expansion last week after her predecessor, Paul LePage, had blocked the initiative.)
CMS Administrator Seema Verma said in a statement that the agency will miss Mayhew.
"I appreciate her efforts at CMS and I look forward to continuing to work with her as she uses her many talents to help the state of Florida create a healthcare system that serves the needs of its citizens," Verma said.
In the CMS statement, Mayhew said the Trump administration's "vision for state flexibility" is the reason she's excited to return to state-level work.
Police are investigating after the executive reportedly sent organization funds to someone posing as a representative of a construction company doing work for the health system.
While healthcare executives have been fretting for years over the emerging threats posed by increasingly sophisticated computer hackers, a simpler security risk has persisted: classic social engineering.
That's reportedly how a swindler posing as the chief financial officer of a construction company working for Hamilton Health Care System in Dalton, Georgia, persuaded the system's finance director to wire $1.2 million into the fraudster's account.
Steven Bridenstine, director of finance and treasury services, sent two payments about two weeks apart after hospital management received an email in late November claiming the construction company wished to be paid via electronic fund transfers, rather than checks, as the Times Free Press reported, citing an incident report by Dalton police.
Bridenstine called the construction company a week after sending the second payment. That's when a company representative told him the company had neither received his payment nor requested the electronic transfers.
Bridenstine, who reported the incident to Dalton police on December 28, declined the local paper's request for comment.
Hamilton Health Care System President and CEO Jeff Myers told WRCBtv's Anna Huffstutlerthat the matter is the subject of an active investigation.
"This is a matter we take with the utmost seriousness," Myers said. "Hamilton is aggressively pursuing all available legal recourse and is fully cooperating with the FBI and local law enforcement. As this is a current open federal investigation, we are unable to comment any further at this time."
The alliance, which was formed last year by seven health systems and three philanthropic organizations, aims to tamp down drug costs by collaborating on generics.
A nonprofit alliance of health systems seeking to rein in drug costs and alleviate shortages has grown significantly in the four months since its launch.
Civica Rx announced Monday that 12 additional health systems, representing about 250 hospitals, have joined the venture as founding members, bringing the total number of participating U.S. hospitals to about 750.
The organization described its growth as momentum, with future growth expected, as policymakers and health system executives nationwide look for ways to wrangle escalating drug costs.
Three philanthropic organizations and seven major health systems—including Trinity Health, Catholic Health Initiatives, HCA Healthcare, Intermountain Healthcare, Mayo Clinic, Providence St. Joseph Health, and SSM Health—founded Civica Rx last September, with a plan to produce generic drugs to stabilize supply and challenge manufacturers that have hiked prices sharply.
With its launch, the organization identified 14 hospital-administered generics as its initial focus. The plan is for members to drive the selection of additional drugs.
The 12 new founding members announced Monday are as follows:
Advocate Aurora Health
Allegheny Health Network
Baptist Health South Florida
Franciscan Alliance
Memorial Hermann Health System
NYU Langone Health
Ochsner Health System
Sanford Health
Spectrum Health
St. Luke's University Health Network
Steward Health Care
UnityPoint Health
In a statement, Civica Rx CEO Martin VanTrieste expressed excitement and gratitude for the additions.
"Drug shortages have become a national crisis where patient treatments and surgeries are canceled, delayed or suboptimal," VanTrieste. "We thank these organizations for joining us to make essential generic medicines accessible and affordable in hospitals across the country."
The three philanthropic organizations that helped found Civica Rx are the Gary and Mary West Foundation, Laura & John Arnold Foundation, and the Peterson Center on Healthcare. The organization is collaborating also with the American Hospital Association's Center for Health Innovation.
Colorado joins California-led coalition to defend the law after Trump's DOJ abandons key provisions on preexisting conditions.
A growing coalition of Democratic state attorneys general that stepped in to defend the Affordable Care Act against a lawsuit filed an appealThursday, beginning the next chapter of a legal saga that could progress to the Supreme Court and carry major implications for U.S. healthcare.
The federal judge who declared the entire ACA invalid last month formally placed his ruling and further District Court proceedings on hold on New Year's Eve, giving a green light for the appellate process to begin.
Although the ACA remains active law, the judge's ruling could bring dire consequences if ultimately allowed to take effect, several members of the Democratic coalition led by California Attorney General Xavier Becerra said during a press call Thursday, framing the case as a matter of life and death.
Colorado Attorney General–elect Phil Weiser, who is set to be sworn in next week, said joining the California-led coalition to defend the ACA will be his first official act.
"We will fight to protect the law, protect the rule of law, and protect people who depend on this protection," Weiser said, adding that Medicaid expansion under the ACA has been a critical lifeline to rural hospitals in the state.
A Growing Coalition
Colorado is the 17th state to join the California-led coalition, which also includes the District of Columbia and which could grow even more in the near future.
Weiser's win in Colorado was one of four state attorney general races Democrats picked up in the 2018 midterm elections, giving the California-led coalition a potential boost over the Texas-led coalition of Republican state attorneys general who sued to overturn the ACA. The other three were Nevada, Michigan, and Wisconsin.
Nevada Attorney General–elect Aaron Ford is expected to join the California-led coalition with backing from the incoming Democratic governor, as The Nevada Independent reported.
In Michigan, the GOP-controlled legislature sought in 2018's final days to limit the power of incoming Attorney General Dana Nessel, who was sworn in this week, but Republican Gov. Rick Snyder vetoed the measureshortly before leaving office, as The New York Timesreported. Nessel has said she will join the coalition to defend the ACA this month.
Wisconsin Attorney General–elect Josh Kaul, who will be sworn in Monday, will have a tougher time formalizing his support for the California-led coalition. The state's GOP-controlled legislature passed power-limiting measures that, unlike in Michigan, were signed by the outgoing Republican governor, Scott Walker, giving state lawmakers authority over Wisconsin's involvement in the ACA suit, as the Milwaukee Journal Sentinelreported.
Wisconsin was among 20 states with Republican leaders who filed as plaintiffs in the Texas-led lawsuit. That number included Maine, where the attorney general's office said outgoing Gov. Paul LePage signed onto the suit in his individual capacity, not on the state's behalf. That means a sizable majority of the 50 states are involved in the case on one side or the other, with each coalition about equal in number.
Congressional Involvement?
Midterm voters also put Democrats in control of the U.S. House of Representatives, which is slated to vote next week on whether to intervene in the ACA lawsuit, as The Hillreported.
Democrats are using the vote to press their Republican counterparts, telling them either to agree to defend the ACA or to face the political consequences of declining to support the ACA's popular provisions, including protections for people with preexisting conditions.
Editor's note: This story has been updated to include additional information about Democratic state attorneys general in Michigan and Wisconsin.
The lowest-paid worker at one health system in the Philadelphia area will make $15.15 per hour, effective New Year's Day 2019.
As the year draws to a close, hospitals and health systems around the U.S. have announced in spurts that they will raise minimum wages for their workers early next year to as much as $15.15 per hour.
Some have touted the raises as investments not only in their employees but also in the economies of their local communities, but they have also been clear that these moves are part of an effort to stay competitive in a tight labor market.
That could help to explain why many of the 10 recently announced wage hikes below appear to be cropping up in geographic clusters.
North Carolina
Wake Forest Baptist Medical Center, based in Winston-Salem, said November 9 it raised its minimum wage to $12.50 per hour, benefiting 1,460 employees, or about 9% of its workforce, as the Winston-Salem Journal reported.
Hugh Chatham Hospital, based in Elkin, said November 29 it will increase its minimum wage to $12 per hour, effective January 6, benefitting an undisclosed number of its 800 employees, as the Winston-Salem Journal reported.
UNC Health Care, based in Chapel Hill, said December 11 that it will raise its minimum wage to $14 per hour, effective January 13, then to $15 per hour in July 2019. Other hourly workers will see their wages rise as well, the system said, resulting in bigger paychecks for about 9,000 workers.
(This cluster of activity comes after Novant Health, based in Winston-Salem, said in August that it will raise its minimum wage to $12.50 per hour, from $11 per hour, benefitting about 5,000 workers. It comes also after Greensboro-based Cone Health raised its minimum wage in 2017 to $12 per hour, from $10.15, as part of its efforts to compete for workers, as the Triad Business Journal reported.)
Philadelphia Area
Cooper University Health Care, based in Camden, New Jersey, said November 13 it will increase its minimum wage to $15 per hour, effective January 1, benefitting about 10% of the system's 7,500 employees.
Jefferson Health, based in Philadelphia, Pennsylvania, said November 29 it will increase its minimum wage to $15 per hour in January across all 14 of its hospitals, benefiting more than 1,800 current employees. Compensation for employees who earn less than $18 per hour will be adjusted as well, the system said.
Virtua Health, based in Marlton, New Jersey, said December 5 it will raise its minimum wage to $15.15 per hour, effective January 1, raising wages for 900-1,000 of the system's 9,000 workers. "We want to send a clear signal to our employees that we care about them," Virtua President and CEO Dennis W. Pullin, FACHE, said in a statement.
(St. Joseph's Health and Inspira Health Network indicated in November that they are in the process of working toward a $15-per-hour minimum wage, as ROI-NJ.com reported. RWJBarnabas Health CEO Barry Ostrowsky indicated in December that his organization, too, is considering a possible $15-per-hour minimum wage, but Ostrowsky noted such a hike would come with "unintended consequences," such as higher wages causing some workers to lose their eligibility for public assistance programs, as ROI-NJ.com reported.)
Christiana Care Health System, based in Wilmington, Delaware—which is about 30 miles southwest of Philadelphia—said December 10 it will increase its minimum wage to $15 per hour, effective February 1, benefitting 500 of the system's nearly 12,000 workers. "This is the right thing to do for our employees, and we also believe that it will have a positive economic impact on our community," President and CEO Janice E. Nevin, MD, MPH, said in a statement.
Other Noteworthy Names
In addition to the clusters above, some big-name health systems in other areas have similarly announced minimum-wage increases recently:
Ochsner Health System, based in New Orleans, Louisiana, said December 6 that it will raise its minimum wage to $12 per hour, from $8.10, effective January 20, benefitting more than 1,200 employees systemwide. "Although Ochsner was already well above the current Louisiana minimum wage, we wanted to do more," Ochsner President and CEO Warner Thomas said in a statement.
Advocate Aurora Health, headquartered in Chicago and Milwaukee, said November 29 it will increase its minimum wage to $15 per hour by early 2021, with incremental raises planned for $13 per hour in mid-2019 and $14 per hour in early 2020. "We know that if our team members feel this is the best place to work, our patients will feel this is the best place to entrust their health and wellness," Chief Human Resources Officer Kevin Brady said in a memo to staff.
Cleveland Clinic President and CEO Tom Mihaljevic, MD, said December 11 in a guest column in The Plain Dealer that "the overwhelming majority of our Northeast Ohio workforce will make no less than $15 per hour" by 2020.
More than 8.5 million people signed up for 2019 coverage during the nationwide open-enrollment period. That's about 367,000 sign-ups behind last year.
Despite a newly toothless individual mandate, a federal judge declaring the entire Affordable Care Act invalid, and other potential headwinds, the number of people who signed up for 2019 coverage through the federally facilitated ACA exchange during open enrollment finished higher than some had feared.
Six weeks into the seven-week period, sign-ups were trailing by more than half a million compared to a similar time frame last year. But by the time open enrollment ended Saturday, that gap narrowed to about 367,000 sign-ups behind last year's open enrollment, according to preliminaryfigures published Wednesday by the Centers for Medicare & Medicaid Services.
More than 4.3 million plans were selected during the seventh week, bringing the cumulative total to nearly 8.5 million, down about 4% from the 8.8 million sign-ups last year.
Citing the numbers, CMS Administrator Seema Verma declared vindication from claims that she and the rest of the Trump administration have sought repeatedly to undermine the ACA's success.
"This Administration has taken strong steps to promote a more competitive, stable health insurance market and these steady enrollment numbers are yet another sign that the Administration's efforts are working," Verma said in a statement, adding that at least some of the enrollment drop for exchange plans could potentially be explained by an increase in employment.
In a series of tweets, Verma rebuffed notions that the Trump administration's reductions to the ACA advertising budget and promotion of short-term limited-duration plans would necessarily diminish enrollment.
"Big HC.gov ad budget does not drive enrollment," she wrote. "Enrollment dropped in 2017 after boosting ad spending by $47 mil and then increased in 2018 after ad funding reduced by $91 mil. Enrollment steady into 2019 with lower ad spending, more focused outreach."
As evidence that promoting short-term plans wouldn't undermine demand for ACA-compliant plans, Verma noted that New Jersey saw an 8% drop in enrollment despite instituting its own individual mandate and banning short-term limited-duration options in the state.
Aside from rising employment and the Trump administration's actions, there's another noteworthy reason why ACA enrollment might dip, as Business Insider's Bob Bryan and Zachary Tracer reported: Virginia expanded Medicaid, extending eligibility to about 100,000 people who would otherwise buy ACA exchange plans.
As demand surged ahead of Saturday's deadline, an unspecified number of people seeking coverage were asked to leave their contact information for follow-up calls, CMS said. The process of enrolling those consumers in 2019 plans has begun, so the final number of sign-ups is expected to rise.
Editor's note: A previous version of this story stated, based on rounded numbers, that open enrollment sign-ups are down about 300,000, or 3.4%, from 8.8 million for 2018 to 8.5 million for 2019. The change is more accurately described as a drop of about 367,000, or 4%, from 8,822,329 sign-ups for 2018 to 8,454,882 sign-ups for 2019.
The $71 billion deal, which joins a major insurer with a PBM, is expected to close Thursday.
A massive merger between health insurance giant Cigna and pharmacy benefit management firm Express Scripts has secured final regulatory approval.
Following conditional approvals last week from California and New York, regulators in New Jersey gave their go-ahead Tuesday, Cigna said in a filing Wednesday to the Securities and Exchange Commission.
The deal is expected to close on Thursday.
Stock prices for Cignaand Express Scriptsrose in mid-morning trading Wednesday on the news.
The deal calls for Cigna to pay $58 billion for Express Scripts and take on $13 billion in the PBM's debt, resulting in a total transaction value of about $71 billion, according to New York regulators.
The regulatory approval comes as a similar tie-up between CVS Health and Aetna, valued at about $70 billion, faces scrutiny in a federal courtroomafter earning sign-offs from federal and state regulators and closing the deal last month.
While consolidation across the healthcare payer/provider landscape has been common for years, these two mergers are part of a push to better coordinate care in an environment that's increasingly consumer-driven and decreasingly hospital-centric.
How well CVS-Aetna and Cigna–Express Scripts translate data into actionable insights is likely to be a major factor determining how successful each couple ultimately becomes.
"With Express Scripts, we'll be better equipped to understand, support, and inform physicians based on the breadth of data the combined company will be able to generate from the billions of customer touchpoints we'll have," Cigna CEO David Cordani told analysts on an earnings call last May.
As is the case industrywide, the end goal is to figure out how to rein in costs while providing high-quality care.
The group of 17 state attorneys general who stepped in to defend the legislation are pushing Judge Reed O'Connor to clear up any ambiguity and give them a legal basis to file an appeal.
A coalition of Democratic state attorneys general have asked U.S. District Court Judge Reed O'Connor in Fort Worth, Texas, to clarify the sweeping declaratory judgment he issued late Friday calling the entire Affordable Care Act invalid.
The coalition, led by California Attorney General Xavier Becerra, filed a motion Monday to request that O'Connor issue either a stay pending appeal or an order specifying that his ruling didn’t relieve anyone of their duties to uphold the ACA. This clarification would avoid the "extraordinary disruption" that would ensue if the ruling were to take effect suddenly, the coalition argued.
"We're asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it," Becerra said in a statement.
The filing acknowledged that the Trump administration has said it will continue enforcing the ACA as the appeals process progresses.
The coalition—which intervened in the lawsuit to defend the ACA after the Trump administration abandoned its defense of key provisions in the law, including those that require insurers to cover people with preexisting conditions—requested also that O'Connor enter partial final judgment or certify his decision. That would enable the intervening defendants to appeal.
Without an immediate legal basis for the defendants to appeal, the judicial review process could result in a prolonged period of uncertainty for healthcare industry players and policymakers alike, even if the ACA is ultimately upheld again in part or whole, whether by the Fifth Circuit or Supreme Court.
O'Connor issued a follow-up procedural order Sunday, directing the parties to propose a schedule for further proceedings at the District Court level. The coalition of 17 state attorneys general asked him to set that plan aside, and they asked that he do so this week.
O'Connor should act on the motion this week to clarify his ruling ahead of New Year's Day, when (according to O'Connor's ruling) the ACA's individual mandate will become unconstitutional in light of Congress zeroing out the tax penalty tied to the mandate, the coalition argued.
The need for action this week is further supported by the prospect of another government shutdown this Friday night, the Democrats said.
There could be much more said at the District Court level, where the judge has asked the parties to propose a schedule to resolve their remaining concerns.
The legal wrangling over a federal judge's late-Friday ruling invalidating the entire Affordable Care Act has just begun. While an appeal is certain, it may not come immediately.
Even though the Trump administration has indicated it will continue to treat the ACA as active law, a slow-moving judicial review could inflict prolonged political and business uncertainty, as conservative and liberal policymakers alike renew their debates over potential ACA replacements and industry stakeholders await final word on which portions of the sprawling legislation, if any, endure.
"Texas just really messed with us," said Jefferies health-strategist Jared Holz in a note, as Bloomberg reported. "The market skittishness could cause exaggerated moves in health-care stocks."
Judge Reed O'Connor followed up his controversial decisionwith a procedural order Sunday, giving the parties until this Friday to confer with each other and come up with a proposed schedule for further proceedings at the District Court level.
O'Connor granted partial summary judgment on just the first of five counts raised in the amended complaintfiled last spring by 18 state attorneys general and two governors. The proposed schedule, which the parties must submit jointly to O'Connor by January 4, is supposed to address how the remaining claims might be resolved.
The remaining claims question the legality of ACA-authorized agency rulemaking and raise the prospect of an injunction to bar federal officials from implementing the law. (O'Connor's ruling Friday was a declaratory judgment, without an injunction.)
California Attorney General Xavier Becerra, who's leading Democratic attorneys general from 16 states who intervened in the ACA challenge to defend the Obama-era law, released a statement Friday denouncing the decision. A spokesperson for Becerra's office could not be reached Monday morning to answer whether the intervenors plan to pursue an immediate appeal or to wait for more District Court proceedings.
Some legal scholars on both ends of the political spectrum have rejected O'Connor's conclusion that the ACA's individual mandate is inseverable from the rest of the law, leading many to expect his ruling to be overturned.
"There's no reason why the individual mandate provision can't be struck down and keep all the good provisionsof the Affordable Care Act," Sen. Susan Collins, R-Maine, told CNN's Jake Tapper on Sunday.
Don't Forget About Maryland
While a majority of the states and the federal government continue their dispute in a Fort Worth courtroom, Maryland will be arguing this week in a separate ACA suit.
Maryland filed its suit last September (shortly after a hearing in which O'Connor reportedly seemed sympathetic to the argument raised by Republican state attorneys general), seeking an injunction to require the federal government to continue enforcing the law.
A spokesperson for the Maryland Office of the Attorney General tells HealthLeaders that the parties will be in court Wednesday to argue the government's motion to dismiss and the state's motion challenging the inclusion of Acting Attorney General Matthew Whitaker's name on the case.
Wednesday may also be the day the Centers for Medicare & Medicaid Services announces how many people signed up for ACA plans through HealthCare.gov, wrapping up an open-enrollment period that had been lagging behind last year's sign-ups even before Friday's ruling.
Correction: An earlier version of this story incorrectly identified California Attorney General Xavier Becerra as Javier Becerra.