testifies before Congress to discuss value that physician ownership brings
Representing the physician-owned hospital (POH), was Joe Minissale,
President of Methodist McKinney Hospital, a joint venture partnership
between area physicians, the non-for-profit Methodist Health System and
Nueterra. Methodist McKinney Hospital offers specialized care for
Cardiology, ENT, Gastroenterology, General Surgery, Gynecology, Internal
Medicine, Neurology, Neurosurgery, Orthopedics, Pain Management, Podiatry
and Primary Care, went before the House Ways and Means Subcommittee on
Health hearing titled "Improving Competition in Medicare: Removing Moratoria
and Expanding Access", Congress to discuss the value POHâ€™s bring to
Minissale has spent his career both in private and community healthcare
organizations turning around failing hospitals, successfully growing and
stabilizing struggling rural hospitals, and opening new hospitals. He will
share his experience as a higher quality, lower cost provider in his
community and the ban on growth that was enacted as part of the Affordable
The law continues to have a chilling effect on the POH industry by
prohibiting any new physician owned hospitals from treating Medicare and
Medicaid patients and also in effect prohibiting those POHs that were
grandfathered under the law from expanding. The inability of POHs to expand
their capacity meet community demand for healthcare services has negatively
impacted access to higher quality, lower cost healthcare, particularly
Medicare and Medicaid patients.
Physician-owned hospitals account for only approximately 5% of hospitals
nationwide, yet consistently outperform general non-profit and
corporate-owned hospitals. On April 16, 2015, the Centers for Medicare and
Medicaid Services (CMS) released summary star ratings based on patient
satisfaction and experience in its HCAHPS (Hospital Consumer Assessment of
Healthcare Providers and Systems) Survey for hospitals nationwide. 67% of
the participating POHs received a 4- or 5-star rating.
Under the new CMS Value-Based program that rewards or penalizes hospitals
based on the quality of care they provide, seven of the top 10 and 43 of the
top 100 hospitals in the country are physician owned in FY 2015.
Dr. Blake Curd, M.D, President of the Board for Physician Hospitals of
America, addressed the special treatment for major medical centers and large
hospital systems with the U.S tax system, stating, "Community hospitals
enjoy non-profit status and receive additional state and national funding
for serving medically underserved areas while POHs operate in the same
medically underserved areas, care for a similar percentage of Medicare and
Medicaid patients, yet receive no governmental assistance. Additionally,
Physician-owned hospitals pay millions of dollars in local, state, and
national taxes per year."
For more information visit
Testimony from the hearing is available on the
Ways and Means Committee web page.
Hospitals say no
to Scott's profit-sharing plan
Florida hospitals have a response to Gov. Rick Scottâ€™s proposal that lost
federal healthcare funding be offset by profit sharing: No way.
On May 8, the governor wrote in a letter that surpluses from profitable
hospitals could be used to help keep afloat those that donâ€™t break even as a
possible replacement for the federally funded Low-Income Pool, which ends
But the FHA says its hospitals already fund poor Floridiansâ€™ healthcare by
way of Medicaid. Pointing to a report commissioned by the state, FHA points
out that hospitals contribute roughly $1.3 billion to Medicaid.
â€śYou have suggested that a new tax on hospital operating surpluses might be
a way to sustain the existing LIP program,â€ť the letter, signed by the
association's board of trustees, says. â€śSuch an arrangement is not a
solution to the challenge we face.â€ť
The hospitals support a Medicaid expansion plan put forward by the Florida
Senate, which Scott and the House are unwilling to agree to.
FHA likens Scottâ€™s profit-sharing idea to an additional tax on hospitals.
The governor likes to compare it to something else.
The healthcare funding question will likely come to a head during a June
1-20 special session of the Legislature, when lawmakers are expected to
approve a budget and will consider the Senateâ€™s Medicaid plan.
Visit Tampa Bay Times for the story.
Americans benefiting from Obamacare than realize it?
One reason the Affordable Care Act gets mixed reviews is the persistent and
sharp partisan divide in public opinion on the law. But a less appreciated
reason for this is simply that many more people benefit from the ACA than
may realize it.
More than half of Americans say the health reform law has had no impact on
them or their family, Kaiser Family Foundation Health Tracking Polls have
found. As the chart above shows, thatâ€™s true of Democrats (60%),
independents (54%), and Republicans (55%).
But the ACA benefits more people than say it has affected them and far more
than the approximately 23 million more people who have signed up for a
marketplace plan or Medicaid as a result of the law.
For example, 49% of Americans say they or a family member have a
pre-existing medical condition such as heart disease, diabetes, asthma, or
cancer; and a quarter say someone in their family had been denied coverage
or had their premium raised because of it. The ACA solves this problem for
all these people by eliminating underwriting for pre-existing conditions,
giving them peace of mind that they can get coverage if they lose
employer-based insurance or the ability to buy health coverage if they are
in the non-group market.
The Obama administration released a report last week estimating that 137
million people are eligible for these no-cost prevention and screening
services, which are guaranteed for everyone with private insurance except
those in grandfathered plans that people had before the law passed in 2010.
The law also eliminated lifetime caps on insurance coverage, something the
government estimates affected 105 million people who faced the possibility
of using up their insurance if they had a serious illness.
Such ACA-related insurance reforms affect many Americans, and these
provisions are popular with the public. But as the Kaiser poll findings
show, Americans donâ€™t always connect the benefits with the law. Itâ€™s likely
that many people just donâ€™t know that the law is responsible for their free
flu shot, or contraceptive coverage, or their ability to get coverage if
they have a pre-existing condition. These new benefits are provided by
insurers or employers without a promotional label reading â€śbrought to you by
To be sure, there are some unpopular features of the ACA that many Americans
are not fully aware of, such as the â€śCadillac taxâ€ť on higher-cost health
plans set to take effect in 2018 (and that could lead to some employers
scaling back coverage). People are, however, very aware of the lawâ€™s most
unpopular feature: the individual mandate.
The ACA may never be as popular as Medicare or Social Security, programs in
which people enroll and from which they receive common benefitsâ€“something
that makes these programs almost sacrosanct. But gradually, more people may
become aware of the popular benefits the ACA provides beyond expanding
coverage for the uninsured.
Visit Wall Street Journal for the article.
'Underinsured' population has doubled to 31 million
One-quarter of people with healthcare coverage are paying so much for
deductibles and out-of-pocket expenses that they are considered
underinsured, according to a new study.â€¨An
estimated 31 million insured people are not adequately protected against
high medical costs, a figure that has doubled since 2003, according to the
2014 national health insurance survey by the Commonwealth Fund.â€¨â€¨
Rising deductibles â€” even under ObamaCare â€” are the biggest problem for most
people who are considered underinsured, according to the 22-page report.
â€śThe steady growth in the proliferation and size of deductibles threatens to
increase underinsurance in the years ahead,â€ť the report warns.
The data is an early warning sign for the Obama administration, which has
promised that the millions of people who gained healthcare under the
presidentâ€™s law would have affordable access to healthcare.
The survey found that millions of people are paying into healthcare but are
largely unable to reap the benefits. People who purchase the lowest-quality
health insurance are also less likely to see a doctor when they are ill or
injured because they fear their high out-of-pocket costs.
When people do see a doctor, the costs accumulate quickly. Half of
underinsured adults and 41 percent of privately insured adults with
deductibles of $1,000 or higher were paying off accumulated medical bills of
$4,000 or more, the report found.
The increase in deductibles comes even as the nationâ€™s healthcare costs have
flatlined overall, which the Obama administration has taken partial credit
The underinsured rate has flattened over the last several years, with the
biggest increases in the underinsured population occurring between 2003 and
Visit The Hill for the report.
CareFirst exposes data on 1.1 million customers
CareFirst BlueCross BlueShield was the victim of a cyberattack that
compromised information on about 1.1 million current and former customers,
the health insurer that covers residents of DC, Maryland and Virginia
The CareFirst attack occurred in June 2014, according to a Web site set up
by the insurer. The company said its cyber-security team thought it had
fended off the attack at the time, but a recent review discovered that the
attackers had gained access to the usernames that customers created on its
Web site as well as their real names, birth dates, e-mail addresses and
subscriber identification numbers.
The database the hackers accessed did not contain members' Social Security
numbers, medical claims, employment, credit card or financial information,
the company said.
"We deeply regret the concern this attack may cause," CareFirst President
and CEO Chet Burrell said in a statement. "We are making sure those affected
understand the extent of the attack â€“ and what information was and was not
The company said it first learned that data on customers was accessed nearly
a month ago, on April 21, during the course of a review of its systems by
cybersecurity firm Mandiant. CareFirst said it did not disclose the
discovery until now so it could complete its investigation of the incident.
CareFirst is offering affected customers two years of free credit monitoring
and identity-theft protection services. The FBI said it is investigating the
The bureau "is working with the victim company in order to determine the
nature and scope of this incident," an FBI spokesperson said in an e-mailed
Dave Kennedy, the founder of cybersecurity firm TrustedSEC, said consumers
can expect more healthcare industry breaches to be disclosed. "There are
probably a whole lot of other places that are just now discovering they were
breached," he said.
Visit the Washington Post for the story.
Analysis of 4,600
hospitals nationwide helps patients find hospitals for routine procedures
and medical conditions
U.S. News & World Report unveiled the broadest expansion of its analysis of
hospital quality since it began ranking medical centers 25 years ago. The
Hospitals for Common Care ratings cover nearly every hospital in the
country and evaluate each one in five common surgical procedures and medical
conditions that account for millions of hospitalizations a year.
U.S. News developed the new ratings to help patients easily identify
hospitals in their communities that excel in treating common conditions.
Patients can look up any U.S. hospital at no cost at usnews.com to see how
it rates in three common operations â€“ heart bypass, hip replacement and knee
replacement â€“ and two widespread chronic conditions â€“ congestive heart
failure and chronic obstructive pulmonary disease, or COPD. A hospital may
be rated as "High Performing," "Average" or "Below Average."
Approximately 90 percent of the hospitals rated in each condition or
procedure were High Performing or Average. Hospitals were not rated in a
procedure or condition if they treated too few patients of that type for
U.S. News to conduct a rigorous statistical analysis.
"The choice of hospital can be life-changing even for relatively routine
surgery. Hospitals can differ greatly in quality, and excelling in one area
doesn't guarantee that a hospital excels in other areas," said Ben Harder,
chief of health analysis for U.S. News. "The good news for patients is that
the majority of hospitals performed average or better."
U.S. News' analysis of the data also found:
Approximately 10 percent of the hospitals rated in each condition or
procedure were High Performing, meaning their quality measures were
statistically better than the national average. Another 10 percent were
statistically below average.
More than 700 hospitals were rated High Performing in at least one procedure
More than 700 hospitals were rated Below Average in one or more procedures
or conditions. In each surgical procedure, a Below Average rating was
associated with a mortality rate approximately twice the national average.
Thirty-four hospitals earned High Performing ratings in all five procedures
and conditions. Another six hospitals that do not offer heart bypass surgery
earned High Performing ratings in all of the other four categories.
More than 1,700 hospitals treated too few patients to be rated in certain
procedures or conditions. Patients treated in these very-low-volume
hospitals fared worse than similar patients treated elsewhere. For example,
mortality among hip patients undergoing surgery at unrated hospitals was
more than 60 percent higher than among patients at all rated hospitals.
To generate the ratings, U.S. News evaluated hospitals across more than 25
quality measures â€“ including mortality, readmissions, infections and patient
satisfaction scores â€“ and analyzed more than 5 million patient records,
taking into account each patient's health conditions, age, sex,
socioeconomic status and other factors affecting risk.
Visit PR Newswire for the release.
Identifying illness correctly is key to drugs'
effectiveness, researcher says
Incorrect antibiotic use can cause patient harm, reduce the effectiveness of
antibiotics and increase healthcare costs, the researchers noted.
"Antibiotic therapies are used for approximately 56 percent of inpatients in
U.S. hospitals, but are found to be inappropriate in nearly half of these
cases, and many of these failures are connected with inaccurate diagnoses,"
study author Dr. Greg Filice said in a news release from the Society for
Healthcare Epidemiology of America.
Filice, an internist with the Minneapolis Veterans Affairs Health Care
System, and his colleagues analyzed 500 inpatient cases at the Minneapolis
VA Medical Center. They found that inappropriate use of antibiotics occurred
with 95 percent of patients who received an incorrect or indeterminate
diagnosis, or those with an identified symptom but no diagnosis.
By comparison, incorrect use of antibiotics occurred in 38 percent of
patients who received a correct diagnosis.
Overall, only 58 percent of patients received a correct diagnosis,
researchers found. The most common misdiagnoses were pneumonia, cystitis,
urinary tract infections, kidney infections and urosepsis (when an infection
starts in the urinary tract and spreads to the bloodstream).
The study was published online in Infection Control & Hospital
Epidemiology, the journal of the Society for Healthcare Epidemiology of
The findings suggest that programs overseeing antibiotic use in hospitals
would be more effective if designed to help providers make accurate initial
diagnoses and to know when antibiotics can be safely withheld, Filice said.
The researchers said relying on intuition rather than proper analysis
contributed to incorrect diagnoses and inappropriate use of antibiotics at
hospitals. Other contributing factors on the part of staff: fatigue, sleep
deprivation, mental overload, dealing with patients with a previous
diagnosis from another healthcare provider, lack of clinical experience, and
lack of experience with drug side effects.
"Diagnostic accuracy is integral to the safe use of antibiotics. In order to
improve the use of antibiotics in health care, we must consider this
challenge and look for tools and strategies that help clinicians decrease
unnecessary and potentially harmful antibiotic use" Filice said. (HealthDay)
Visit NIH for the study.
and CEO Karen Ignagni to lead EmblemHealth; AHIP EVP Dan Durham appointed
America's Health Insurance Plans' (AHIP) Board Chairman Mark B. Ganz, CEO
and President of Cambia Health Solutions, released the following statement:
â€śToday (May 21) the Board of Directors accepted the resignation of Karen
Ignagni as president and chief executive officer of AHIP. The board is
grateful for Karenâ€™s twenty-two years of service to the association and
industry. As the voice of our industry, she has worked tirelessly on our
behalf with acumen that is unmatched. As the Board Chair of AHIP, I have had
the honor and pleasure of working with Karen and witnessed her incredible
On behalf of the board, we not only want to thank Karen for her service but
offer our congratulations as she begins her next chapter. We are pleased to
continue our work with Karen as she joins an AHIP member company,
EmblemHealth, as President and CEO.
As the health insurance industryâ€™s top representative in Washington, Karen
has successfully navigated intense challenges from the Patientâ€™s Bill of
Rights to the Affordable Care Act. With tenacity, intellect and deep policy
knowledge, she ensured our industry has a seat at all tables. Perhaps her
greatest contributions have been highlighting the value and innovations of
The Board of Directors will immediately launch a national search for her
successor. While we conduct our search, the board has appointed Dan Durham,
Executive Vice President for Strategic Initiatives, as interim CEO.
Dan has over thirty years of leadership experience with major policy and
regulatory issues, primarily in the health care field. Prior to his current
role, Dan served as Executive Vice President for Policy and Regulatory
Affairs at AHIP and led healthcare reform implementation efforts and policy
activities. Before joining AHIP, he was Vice President for Policy at the
Pharmaceutical Research and Manufacturers of America where he played a
leadership role during healthcare reform and implementation of the Medicare
prescription drug program. Dan has also served in high-level policy
positions in the federal government at the U.S. Department of Health and
Human Services, the Social Security Administration, and the Office of
Management and Budget. He also held key policy positions at AARP and the
California Legislative Analystâ€™s Office.
Dan and the senior team of the association have the full confidence of the
board as they continue to drive the industryâ€™s priorities forward.â€ť
Visit AHIP for the announcement.
Day from our entire staff at HPN
Healthcare Purchasing News
wishes you and your families and friends a wonderful and healthy Memorial
Day weekend. The HPN Daily Update will be back on Tuesday, May 26.