Ownership and leadership change as a result of this deal being finalized, but the name and headquarters will remain the same.
LifePoint Health, based in Brentwood, Tennessee, officially completed its merger Friday with RCCH HealthCare Partners and left the NASDAQ as part of a privatization plan.
The completion comes after shareholders expressed their approval of the deal and their disapproval of more than $120 million in so-called golden parachutes for four exiting executives in >a nonbinding vote. The terms of the compensation package will be paid out as planned, a company spokesperson told HealthLeaders.
"We are officially one organization dedicated to providing high quality, community-based healthcare, and I am energized by the opportunities we have ahead of us to serve non-urban communities across the country," said LifePoint CEO David Dill in a statement Friday.
Dill's appointment to the CEO position was effective Friday, upon the merger's completion. The company's announcement noted five additional executives:
John Bumpus, executive vice president for administration;
Michael Coggin, executive vice president and Chief Financial Officer;
Victor Giovanetti, FACHE, executive vice president for hospital operations;
Rob Jay, executive vice president for integrated operations; and
Jennifer Peters, executive vice president and general counsel.
LifePoint's former Chairman and CEO William F. Carpenter III, who announced in September thathe plans to retire, and RCCH's former CEO Marty Rash will be members of the privatized LifePoint board of directors.
Related: LifePoint Agrees to Merger with RCCH, Votes Down Golden Parachutes
"I'm thrilled that our organizations have come together as one and am incredibly confident in the future of the newly-expanded LifePoint Health under David Dill's leadership," Carpenter said in the statement. "Ultimately, it is the care and services that our hospitals and health systems are providing that are most important, and I know the combined team will continue our legacy of supporting our employees and caregivers so that we are Making Communities Healthier for decades to come."
RCCH is owned by funds managed by Apollo Global Management affiliates. Despite the change in ownership, the organization will continue to operate under the LifePoint Health name and continue to be headquartered in Brentwood, Tennessee.
The name represents the union of two Catholic-affiliated nonprofits with a shared mission and service to diverse populations, the organizations announced.
The post-merger entity being formed by Catholic Health Initiatives (CHI) and Dignity Health will be called CommonSpirit Health, the two nonprofits announced Thursday.
The name—which was chosen from among more than 1,200 possible names—was picked because it represents a shared sense of missional service and because it resonates with the diverse populations being served, the organizations said.
"It was important that our name could provide a connection between all people: our employees, physicians, patients, families, and neighbors alike. CommonSpirit does just that," Dignity Health President and CEO Lloyd H. Dean said in a statement.
The name was also vetted with an eye on legal implications and symbolic connections to faith-based healthcare.
"We appreciate how the manifestation of the Spirit is woven into so many messages—God's gift of compassion, the calling to heal others, and serving the common good. Each comes together and is reflected in just one powerful word, CommonSpirit," CHI CEO Kevin E. Lofton said in the statement.
There were many reasons why CHI, based in Englewood, Colorado, and Dignity Health, based in San Francisco, California, settled on the name. In addition to their shared mission, backed by Catholic social teaching, they chose the name with a sense of history, as "an expression of gratitude for the courage of the women religious who established their health ministries in the face of significant obstacles to meet the most pressing health needs of people and communities."
The two nonprofits said they will develop a shared visual identity that follows their previously announced "house of brands" strategy, which will keep the names of local facilities intact.
The deal, which was announced last Decemberand will create one of the largest systems in the nation, is expected to close by the end of the year.
Medicaid-funded housing could be on the horizon, as the Trump administration looks to push toward value-based care. 'I want you to stay tuned,' the HHS secretary said.
As the healthcare delivery system moves toward a value-based model that rewards quality over quantity, the federal government has ambitions to lead the charge with innovative strategies to improve social determinants of health.
During a speech on Wednesday, Health and Human Services Secretary Alex Azar said the department he oversees is logically positioned to think of healthcare as broad and interconnected with other needs.
"Social determinants would be important to HHS even if all we did was healthcare services, but at HHS, we cover health and human services, all under one roof," he said in his prepared remarks. "In our very name and structure, we are set up to think about all the needs of vulnerable Americans, not just their healthcare needs."
Here are five big takeaways from the speech, which was delivered to the Hatch Foundation for Civility and Solutions in Washington, D.C.:
1. Housing Costs Could Be Covered
Azar went so far as to strongly hint that forthcoming models from the Center for Medicare & Medicaid Innovation (CMMI) could include public reimbursement for housing costs.
"What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs?" he said. "What if we gave organizations more flexibility so they could pay a beneficiary's rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food?
"If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to."
(In a separate speech Wednesday evening, Azar put a finer point on this hint: "We are actively exploring how we could experiment with actually paying for non-health services, like housing and nutrition—an integrated, individually driven approach to health and human services on a scale that has never before been tried in the United States," he said.)
2. Feds Won't Abdicate Leading Role
Azar was clear that his ambitions around social determinants are about better aligning federal spending, not handing the reins off to another entity entirely.
"There are a variety of reasons why the federal government takes the lead on financing healthcare, and that is not about to change," he said. "But we believe we could spend less money on healthcare—and, most important, help Americans live healthier lives—if we did a better job of aligning federal health investments with our investments in non-healthcare needs."
3. Local Needs Should Drive Solutions
Azar said it should come as no surprise that the Trump administration is thinking about healthcare improvement in a way that appreciates the nation's decentralized system and traditional involvement of the private sector and civil society. That framework extends, he said, to devising value-based solutions.
"One approach to social determinants of health would be, for instance, to say that we should identify a couple of the most common needs—like nutrition or housing—and really focus on investing in those," he said. "But that's not going to be of great use to someone in, say, a rural area, where food and housing may be affordable but finding a ride to their healthcare provider is the real challenge.
"That's why we don't believe in a rifle-shot approach to human services: You can't focus on one or two needs to the exclusion of others," he said.
4. Expect More From Medicare Advantage
Azar expressed an eagerness to tackle social determinants of health through the Medicare program and said Medicare Advantage (MA) represents "one of the best ways" the government can do that.
"Because MA plans hold the risk for their patients and they compete for their patients' business, they have an incentive to offer benefits that are both appealing to their members and that will bring down health costs—whether those benefits are traditionally thought of as health services or not," he said.
"The key is just that we need to give them the flexibility to do this, which we generally haven't done."
Azar noted that MA plans will be permitted next year to begin paying for a wider range of health-related benefits, including home health visits and transportation. That leeway will expand further in 2020, he said, when MA plans will be able to cover home modifications, meal deliveries, and more.
5. Building on Mental Health Initiatives
Azar mentioned that HHS and its agencies are building on a foundation that has already begun to address some major drivers of healthcare utilization, including the need for mental health and substance use treatment.
"For decades now, Americans with serious mental illness have been poorly served by our health system—first, by an inhumane system of institutionalization, and now, by a system that fails to provide them with what they need to live healthy lives in the community," he said. "With these waivers and other work across the administration, we believe that can begin to change—and we can enter an era where serious mental illness is treated as effectively as any other health condition.
Editor's note: This story has been updated to include a quote from Azar's related speech on Wednesday evening.
The researchers' central finding was that hospital accreditation hasn't boosted patient outcomes. But the study drew invalid comparisons between two 'radically different' groups of hospitals, biasing the results against accredited hospitals, The Joint Commission said.
A study that found independent hospital accreditation carries no real benefit for patient outcomeshas garnered a formal rebuttal from The Joint Commission, which argues the researchers reached faulty conclusions due to a number of methodological flaws.
Authors of the original report, published last month in the BMJ, said their findings show that hospitals accredited by private organizations were no better than those reviewed by a state survey agency, and at least one researcher involved in the project cited it as evidence that the status quo should be upended.
"We need to rethink what private accreditation buys us. Its a huge industry," Ashish K. Jha, MD, MPH, a professor of global health and health policy at the Harvard T. H. Chan School of Public Health and a practicing internist at the Veterans Affairs Boston Healthcare System, wrote last month in a tweet linking to the report. "We find little evidence that its doing patients good."
"The findings are clear: accredited hospitals do not seem to be providing better care," he wrote.
"We need to reexamine the standards required for accreditation to ensure that they are promoting what’s actually important: the health, safety, and optimal experience of patients," Jha added.
The Joint Commission, however, contends that the study drew invalid conclusions by trying to compare "two radically different groups of hospitals" resulting in a bias against accredited hospitals. The organization, which is the predominant independent hospital accrediting organization in the U.S., submitted a formal response that the BMJ published last week, followed by a separate statement.
One of the big complaints raised by The Joint Commission was the difference in size of hospitals in the group accredited by independent organizations versus the group reviewed by state survey agencies. While two-thirds of the hospitals in the former group have more than 100 beds, an overwhelming majority, 93%, of hospitals in the latter group have fewer than 100 beds, the organization said.
Larger hospitals and teaching hospitals, especially, tend to care for more-seriously ill patients, too, but the researchers made their comparisons worse by failing to adjust for differences in patients' severity of illness, according to The Joint Commission's healthcare quality evaluation division Executive Vice President David W. Baker, MD, MPH, FACP, and President and CEO Mark R. Chassin, MD, FACP, MPP, MPH, who drafted the organization's formal response.
What's more, the study reviewed mortality for six categories of surgical procedures, but a majority of the hospitals in the group reviewed by state survey agencies didn't perform some of the procedures being studied (because some procedures are uncommon at smaller hospitals), Baker and Chassin wrote.
"[D]espite the small numbers of cases, the authors combined the outcomes of the six types of surgery into a single multivariate model," they wrote, arguing that this is problematic because more than 80% of all surgical cases for hospitals reviewed by state survey agencies were for hip replacements, while hospitals with independent accreditation covered all six categories.
"For three of the five other surgical procedures, the results favored [accrediting organization] hospitals," they wrote.
Baker and Chassin complained that the authors minimized the importance of lower readmission rates for independently accredited hospitals.
"Based on the 3 million medical admissions at Joint Commission-accredited hospitals, which represent 88% of all medical admissions to [accrediting organization] hospitals, the findings indicate that patients treated in Joint Commission-accredited hospitals experienced 12,000 fewer deaths and 24,000 fewer readmissions," they wrote. "These differences matter to patients."
Jha, who is listed as the point of contact for the authors of the original report, did not respond to HealthLeaders' request for a response to The Joint Commission's concerns.
North Memorial Health Care rescinded a conditional offer of employment to a nurse who said she couldn't work Friday nights, given her religious beliefs as a Seventh-day Adventist.
The Equal Employment Opportunity Commission failed to prove that a hospital in Minnesota violated the law by rescinding a registered nurse's conditional employment offer after she requested a modified schedule to accommodate her religious beliefs, according to the Eighth Circuit Court of Appeals.
A three-judge panel ruled 2-1 on Tuesday to affirm the lower court's summary judgment decision in favor of North Memorial Health Care, based in Robbinsdale, Minnesota.
"There is no duty to accommodate an applicant or employee by hiring or transferring her into a position when she is unwilling or unable to perform one of its essential job functions," Circuit Judge James B. Loken wrote in the decision.
The dispute began five years ago, when Emily Sure-Ondara, RN, received a conditional offer of employment with North Memorial's Collaborative Acute Care for the Elderly (CACE) Unit in November 2013. The position required each nurse to work an eight-hour shift every other weekend, as established by the hospital's collective bargaining agreement with the Minnesota Nurses Association, according to court records.
Sure-Ondara accepted the conditional offer then later requested an accommodation for her religious beliefs as a Seventh-day Adventist, which preclude her from working on Friday nights to allow time for Sabbath rest.
The hospital's human resources team considered Sure-Ondara's request but determined that it would be unable to accommodate the schedule modification for a newly trained nurse in this particular program. The hospital rescinded the employment offer but encouraged her to apply for other positions.
Sure-Ondara did apply for other North Memorial jobs but did not secure one. She was hired in February 2014 to a non-union position at a different hospital that accommodated her religious beliefs, according to court records.
In addition to the EEOC, Sure-Ondara has had backing from the American Civil Liberties Union, the General Conference of Seventh-day Adventists, and other religious groups. She also may have found a sympathetic ear in Circuit Judge L. Steven Grasz, who dissented.
"This case presents an important question: whether a request by a job applicant or employee for a religious accommodation can qualify as 'opposition' to an unlawful employment practice under Title VII, and thus form the basis of a retaliation claim under [the relevant statute]," Grasz wrote.
"In light of the Supreme Court's broad interpretation of this provision in Crawford v. Metropolitan Government of Nashville & Davidson County, Tennessee, … and the near-universal consensus of circuit courts of appeals interpreting almost identical statutory language in the Americans with Disabilities Act (ADA), I would answer this question in the affirmative."
Grasz said he would reverse the district court's summary judgment decision on the basis that the EEOC established "a genuine dispute of material fact on each element of its claim."
The added flexibility allows states to request Medicaid waivers to cover treatment in an institution for mental disease for certain adults and children.
States have long been prohibited from using Medicaid funding to cover treatment at inpatient institutions for mental disease (IMD), but that so-called "IMD exclusion" may be loosening further, thanks to a new waiver opportunity announced Tuesday by the Trump administration.
In a letter to state Medicaid directors, the Centers for Medicare & Medicaid Services outlined how states can secure authority to cover short-term residential treatment services at IMDs for adults with serious mental illness and children with serious emotional disturbances.
The agency said it won't approve waiver requests unless they are for short-term stays only and budget-neutral for the federal government.
Health and Human Services Secretary Alex Azar announced the policy during a speech Tuesday morning before the National Association of Medicaid Directors. The original intent of the IMD exclusion was appropriate, he said. The federal government was trying to discourage states from shoving patients in need of mental healthcare patients off onto the federal program.
"But today, we have the worst of both worlds: limited access to inpatient treatment and limited access to other options," Azar said in his prepared remarks. "Given the history, it is the responsibility of state and federal governments together, alongside communities and families, to right this wrong."
Azar noted that the Obama administration began granting Medicaid demonstration waivers in 2015 to make exceptions to the IMD exclusion regarding substance use disorders (SUD), in particular, adding that the Trump administration unveiled a new approach to these waivers a year ago, approving 13 waivers with more pending. There have been 17 approvals thus far.
"Where we have been able to assess results, they have already been impressive," he said.
In Virginia, for example, which secured a waiver in 2016 under the Obama administration, the state saw a 39% decrease in opioid-related emergency department visits and a 31% decrease in ED visits related to substance use, according to the Trump administration.
Azar said the new expanded waiver opportunity covering mental health needs more broadly should be taken in a broad context with multiple types of treatment to meet varying needs.
"As with the SUD waivers, we will strongly emphasize that inpatient treatment is just one part of what needs to be a complete continuum of care, and participating states will be expected to take action to improve community-based mental health care," he said.
"There are effective methods for treating the seriously mentally ill in the outpatient setting, which have a strong track record of success and which this administration supports. We can support both inpatient and outpatient investments at the same time," he added. "Both tools are necessary and both are too hard to access today."
"There are so many stories of Americans with serious mental illness, and their families, that end in tragic outcomes because treatment options are not available or not paid for," Azar said.
"I urge everyone involved in state Medicaid programs here today to consider applying for the kind of waiver I've just outlined," he added. "These waivers will help complement the good work so many of you are already doing to fight substance abuse, and [they] will help build a system where Americans with serious mental illness and their families can finally find the treatment and support they need."
The goal is to reduce the time and cost associated with verifying professional credentials by facilitating the secure exchange of verified information among members.
Anyone in the healthcare industry who provides patient care or pays for it knows that credentialing for healthcare professionals can be a pain, often taking up to six months. That's the problem a blockchain-based pilot project said it aims to solve in partnership with major health plans and providers.
WellCare Health Plans, which serves about 5.5 million members, and Spectrum Health, a 12-hospital nonprofit system in western Michigan, are among the five organizations participating in the distributed-ledger program, the companies announced last week.
Known as the Professional Credentials Exchange, the project is being developed by ProCredEx, a company with backing from Hashed Health. The goal is to reduce the time and cost associated with verifying professional credentials by facilitating the secure exchange of verified information among members.
"A fundamental component of developing the exchange lays in building a network of members that bring significant verified credential datasets to the marketplace," said ProCredEx cofounder and CEO Anthony Begando in a statement.
"Over the coming months, we intend to grow the Partner Program in a manner that diversifies our member base and grows the volume of verified credentials data available within the exchange," Begando added.
Matthew Denenberg, MD, vice president of medical affairs for Spectrum Health, said this pilot could enable the health system to accelerate into the domains to which healthcare is shifting.
"We are excited to be participating in this network and look forward to addressing the long-standing challenges credentialing presents to our business and our expansion into growth areas such as telemedicine and outpatient care," Denenberg said in the statement.
Executives taking part in the HealthLeaders CEO Exchange offered their insights on the biggest challenges and opportunities facing healthcare today.
About 40 executives from healthcare organizations across the country convened in Santa Barbara, California, this week for the annual HealthLeaders CEO Exchange, where they have discussed what they and their peers can do to surmount the industry's most vexing challenges.
Their wide-ranging conversations, which began Thursday and will continue Friday, have unpacked the new and developing definitions of "market share," mulled the perils and opportunities presented by potential partnerships, compared notes on driving clinical efficiency, and more.
Here are just a few of their insights from Day 1:
1. Your window for proactivity is closing.
Gone are the days when a health system could afford to evolve gradually over the course of several decades before emerging surefooted as a leader in providing high-quality care at a reasonable cost, said Mark L. Wagar, president of Heritage Medical Systems in Palm Springs, California. The imperative to innovate has grown far more urgent, he said.
"We all have to do this in the next five to 10 years, quickly," Wagar said during a roundtable discussion Thursday with fellow healthcare executives, noting that outside competitors and the federal government alike have made no secret of their plans to make healthcare more cost-effective one way or another.
"In the absence of provider-driven solutions, they'll implement their own," Wagar said.
This threat of disruption is precisely why leaders must take the initiative to upend their own status quo, said Terri Kline, MPH, president and CEO of Health Alliance Plan in Detroit.
"It's so hard to disrupt yourself, but that's what we need to do in order to stay viable," Kline said.
2. You must contemplate cost as a threat.
Efforts to make healthcare more affordable aren't just part of the industry's perpetual push for self-improvement. They have become central to an organization's survival, Kline said.
"I think the cost of care is actually the biggest threat to an enterprise. It's often not thought of that way," she said, "but patients can't afford the cost of care."
Russell M. Howerton, MD, FACS, senior vice president of Wake Forest Health Network and system chief medical officer, framed the cost-of-care conundrum as an existential question: "If the majority of your customers can't afford your services, are you really a business?"
Regardless of which cost-limiting tactics your organization pursues, it's vital that leaders thoroughly engage with physicians on the topic, said John Phillips, FACHE, president of Methodist Dallas Medical Center.
"The misalignment between the medical staff and the hospital is both a problem and an opportunity," Phillips added.
3. Match your services to market needs.
Several members taking part in the CEO Exchange outlined how they have sought to achieve their mission of serving a given population by developing targeted service lines and jettisoning those that are either not profitable or not a center of excellence.
"In the competitive Chicago market, how do we differentiate ourselves? What are trends? What's happening with payers? What are the population needs here?" said James Robinson, president of Presence St. Joseph Hospital. "And then we look at our service lines to determine where we should specialize versus areas in which we're becoming irrelevant and taking a hard look at ourselves. If we are not the leader, then where should we be investing our resources more effectively?"
Kurt A. Barwis, FACHE, president and CEO of Bristol Hospital and Health Care Group in Bristol, Connecticut, said once his organization completes its community-needs and supply-and-demand assessments to settle on a course of action, the team invests aggressively.
"It takes a trusting and engaged culture to achieve this," Barwis said. "We need to create a culture that's very entrepreneurial and looking for the next thing, and that takes working with your team and giving feedback to everyone in your organization."
Editor's note: Julie Auton and Amanda Czepiel contributed to this report.
Thirteen of the states suing to overturn the ACA have active elections involving their state attorneys general, and several have races for governor.
It's been more than two months since Republican attorneys general for 20 states asked a federal judge to impose a preliminary injunction blocking further enforcement of the Affordable Care Act, including its coverage protections for people with preexisting conditions. Some see the judge as likely to rule in favor of these plaintiffs, though an appeal of that decision is certain.
Amid the waiting game for the judge's ruling, healthcare policymaking—especially as it pertains to preexisting conditions—rose to the top of voter consciousness in the midterms. That explains why some plaintiffs in the ACA challenge have claimed to support preexisting condition protections, despite pushing to overturn them.
The lawsuit and its implications mean healthcare leaders should be watching races in the 20 plaintiff states in the Texas v. Azar lawsuit: Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Maine Gov. Paul LePage, Mississippi Gov. Phil Bryant, Missouri, Nebraska, North Dakota, South Dakota, South Carolina, Tennessee, Texas, Utah, West Virginia, and Wisconsin.
Thirteen of those plaintiff states have active elections involving their state attorneys general, and several have races for governor in which the ACA challenge has been an issue, including these noteworthy states:
Texas: Attorney General Ken Paxton, a Republican representing the lead plaintiff in the lawsuit, is facing a challenge from Justin Nelson, a Democrat, and the race seemed to be competitive, as The Texas Tribune reported. Gov. Greg Abbott was expected to win against Democratic challenger Lupe Valdez.
Florida: Attorney General Pam Bondi, a Republican, is term-limited, so she's not running for reelection. Ashley Moody, a Republican, and Sean Shaw, a Democrat, are facing off for Bondi's position. Moody expressed support for Florida's participation in the ACA challenge, while Shaw said he would pull the state out, calling the case a "partisan stunt," as the Tampa Bay Times reported. Bondi has campaigned, meanwhile, for Republican gubernatorial candidate Ron DeSantis, who's facing off with Democrat Andrew Gillum. Gillum said he would back a state law to protect people with preexisting conditions, while DeSantis said he would step in if federal action removed the ACA's preexisting condition protections, as the Miami Herald reported. Gillum and DeSantis are vying to succeed term-limited Gov. Rick Scott, a Republican who's running for U.S. Senate.
Wisconson: Attorney General Brad Schimel, a Republican, is facing a challenge from Josh Kaul, a Democrat who has slammed Schimel's participation in the ACA challenge, as The Capital Times reported. Gov. Scott Walker, a Republican, said he supports preexisting condition protections, despite authorizing his state's participation in the lawsuit. Democratic challenger Tony Evers accused Walker of "talking out of both sides of his mouth," as the Milwaukee Journal Sentinel reported.
Massachusetts, California, Nevada, and Oklahoma each have ballot initiatives that could significantly impact the business of healthcare in their respective jurisdictions.
Massachusetts mulls nurse staffing ratios. Question 1 would implement nurse-to-patient staffing ratiosin hospitals and other healthcare settings, as Jennifer Thew, RN, wrote for HealthLeaders. The initiative has backing from the Massachusetts Nurses Association.
California could float bonds for children's hospitals. Proposition 4 would authorize $1.5 billion in bonds to fund capital improvement projects at California's 13 children's hospitals, as Ana B. Ibarra reported for Kaiser Health News. With interest, the measure would cost taxpayers $80 million per year for 35 years, a total of $2.9 billion, according to the state's Legislative Analyst's Office.
Proponents say children's hospitals would be unable to afford needed upgrades without public assistance; opponents say the measure represents a fiscally unsound pattern. (California voters approved a $750 million bond in 2004 and a $980 million bond in 2008.)
Nevada nixing sales tax for medical equipment? Question 4would amend the Nevada Constitution to require the state legislature to exempt certain durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax. The proposal, which passed a first time in 2016, would become law if it passes again.
Bennett Medical Services President Doug Bennett has been a key proponent of the measure, arguing that it would bring Nevada in line with other states, but opponents contend the measure is vaguely worded, as the Reno Gazette Journal reported.
Oklahoma weighs Walmart-backed optometry pitch. Question 793 would add a section to the Oklahoma Constitution giving optometrists and opticians the right to practice in retail mercantile establishments.
Walmart gave nearly $1 million in the third quarter alone to back a committee pushing for the measure. Those opposing the measure consist primarily of individual optometrists, as NewsOK.com reported.