From a Florida hospital settling a whistle-blower lawsuit for $12 million to six pharmaceutical executives being charged in an alleged fentanyl racketeering scheme, here are the latest healthcare industry lawsuits and settlements making headlines.
Monthly Archives: December 2016
10 hospital bankruptcies in 2016
http://www.beckershospitalreview.com/finance/10-hospital-bankruptcies-in-2016-decmeber13.html
From increased competition to reimbursement landscape challenges, many factors led hospitals and health systems to file for bankruptcy in 2016.
Here are 10 hospitals and health systems that have filed for bankruptcy protection since Jan. 1, beginning with the most recent.
20 Quotes To Inspire Leaders in the New Year (Part 1)
In the New Year, we will deal with leadership challenges we cannot predict now. To be ready, we need to set our leadership and learning on the path to success.
This series includes 20 quotes (linked to posts with leadership guidance) that will help you leverage your leadership planning. Here are the first 10:
Ethical Leadership is a “Fear-Free” Zone
Fear is insidious. It changes how we see the world and how we treat others. Here are 5 important reasons why fear has no place in our workplaces, our families or our communities:
5 Reasons Fear Has No Place in Leadership
- Fear creates a dampening field that blocks positive interpersonal behavior including respect and care
- Fear-inducing relationships are damaging to human health
- When they are fearful, people spend time trying to protect themselves rather than reaching for their potential, and that reduces job satisfaction and productivity
- The damaged job satisfaction and productivity that are common in fear-based relationships translate into damaged organizational results
- Fear leads to unethical choices about people who are not like us
Gov. John Kasich vetoes Heartbeat Bill, signs 20-week abortion ban
http://www.dispatch.com/content/stories/local/2016/12/13/John-Kasich-acts-on-abortion-bills.html#
While describing himself as a champion for the sanctity of life, Gov. John Kasich vetoed a bill Tuesday that would have forbidden abortions once a fetal heartbeat could be detected.
The second-term Republican, however, did sign into law a second bill, a GOP-backed lame-duck measure banning abortions after 20 weeks of pregnancy — providing an exception for saving the mother’s life but none for rape or incest.
The Heartbeat Bill’s foremost champion, Janet Porter of Faith2Action, immediately denounced Kasich’s “betrayal of life” and promised a campaign to find the necessary votes in the House to override the governor’s veto. The Senate’s vote was veto-proof on what would have been the nation’s most stringent abortion law.
In his veto message, Kasich said the Heartbeat Bill, which would have forbid abortions at about six weeks into pregnancy, was clearly unconstitutional under U.S. Supreme Court rulings and would have resulted in an expensive — and losing — court battle.
Trend to watch: Payer-provider joint ventures
Joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care.
Anthem and Aurora Health, Anthem’s Vivity, Aetna’s Inova, Presbyterian Health Services in New Mexico, and now Aetna and Texas Health Resources—all of these organizations and partnerships combine the strongest skills of a payer and a provider.
These partnerships allow providers to lean on the analytical and actuarial power of the payers, while focusing on improving health outcomes.
CopelandAbout 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.
Bill Copeland, vice chairman of Deloitte and leader of the company’s U.S. Life Sciences & Health Care industry group, says payers aren’t usually as effective as providers at working with patients, and providers don’t have the necessary capital to fully invest in high-value care. Joint ventures that marry the strengths of both parties have mutual benefit and should result in lower overall costs with better patient outcomes.
Three reimbursement changes to watch in 2017
By far, the biggest change Health Partners’ Donna Zimmerman sees in terms of reimbursement in 2017 is the increased momentum behind bundled payments for orthopedic care.
Zimmerman“Hospitals need to be prepared for more of this,” says Zimmerman, who is senior vice president of government and community relations at the Bloomington, Minnesota-based nonprofit healthcare provider and payer. That’s because employers are increasingly interested in bundled payments for orthopedic and other types of procedures, and they’re often offering incentives related to bundled episodes of care in benefit plans, she says.
Offering a bundled payment option for a joint replacement, in particular, is getting more common. Even with physical therapy that lasts a few months, these are “fairly discrete episodes of care,” says Zimmerman, who adds that bundled payments are particularly attractive to employers and payers since they allow them to manage the total cost of care.
As a result, provider organizations will need to continue to focus on improving their quality scores, since this is one of the primary ways to distinguish their facilities from competing hospitals. In addition to the total cost of care, Zimmerman highlights that payers will be keeping tabs on providers’ complication rates and will adjust the prices they’re willing to pay providers for bundles of care as a result.
Here’s more on how bundled payments will evolve in 2017, and two other reimbursement changes to watch.
GOP’S ‘OBAMACARE’ REPEAL PATH WORRIES HEALTH CARE INDUSTRY
One by one, key health care industry groups are telling the incoming Republican administration and Congress that it’s not a good idea to repeal the 2010 health care law without clear plans to address the consequences.
Hospitals, insurers and actuaries – bean-counters who make long-range economic estimates – have weighed in, and more interest groups are expected to make their views known soon. Representing patients, the American Cancer Society Cancer Action Network reminded lawmakers that lives are at stake.
The concerns go beyond the obvious potential hardship for the 20 million people covered by subsidized private insurance and expanded Medicaid under President Barack Obama’s signature law.
Hospitals say a stand-alone repeal would cost them billions, compromising their ability to serve local communities. Insurers say Congress must be careful not to create even more uncertainty and instability. Actuaries worry the mere promise of an eventual replacement won’t be enough to sustain the individual health insurance market.
For Obamacare, ‘Repeal & Delay’ Isn’t Just Republicans’ Best Choice — It’s Their Only Choice
WASHINGTON, DC – DECEMBER 06: Senate Majority Leader Mitch McConnell (R-KY, (C), speaks to the media after attending a weekly luncheon with Senate Republicans at the Capitol, December 6, 2016 in Washington, DC. Senate Republicans gathered at the weekly luncheon to discuss their upcoming agenda. (Photo by Mark Wilson/Getty Images)
Republican leaders in Congress have announced their intention to repeal key parts of Obamacare in early 2017, but delay the implementation of that repeal until 2019 or 2020. Some conservatives are complaining about this delay, arguing that the GOP should replace Obamacare immediately. But GOP leadership is right—and here’s why.
The fundamental problem is that in order to fully replace Obamacare, Republicans need to come up with a bipartisan plan that can attract the 60 votes necessary to overcome a Democratic filibuster.
Given that Republicans don’t even agree among themselves as to how to replace Obamacare, it’s going to take them some time—at least a year or two—to figure out how to do that.
Based on dozens of conversations I’ve had with Democrats on this subject, it seems clear that Republicans’ best and only chance to get 60 votes is to develop a plan that can cover approximately the same number of people as Obamacare—and ideally more.
Think about it the other way around. If Republicans try to pass legislation that covers 10 million fewer people than Obamacare, most Democrats won’t support it. And then when Obamacare’s funding streams expire, Dems will blame Republicans for the resultant turmoil. On the other hand, if Republicans draft legislation that credibly covers a comparable number of people to the ACA, then it’s Democrats who would look stubborn if they refuse to play ball.
Building A System That Works: The Future Of Health Care
Nearly a century after Theodore Roosevelt’s Bull Moose Party first called for health insurance reform, the United States has made major advances in access, quality, and affordability.
In the six years since President Obama signed the Affordable Care Act (ACA) into law, 20 million more people have health insurance, and, for the first time in our history, more than nine out of every 10 Americans are insured. Growth in both premiums for employer coverage and overall Medicare spending has also slowed. The Centers for Medicare and Medicaid Services’ Actuaries now project that we are on track to spend $2.6 trillion less over the ACA’s first decade than was projected without the ACA back in 2010.
Even with this slow down, any increase in costs can be challenging for businesses monitoring expenses or families working through their budgets. That’s why stakeholders nationwide have been coming together to reshape the future of health care. Using new advancements in data, medicine, and the tools and resources provided by the Affordable Care Act, institutions across the country are building a health care system that works better for all Americans.
This work has gone on steadily for years — through political turmoil and challenges in the courts. Yet through each challenge, these reforms have endured.
They must continue to endure. The 20 million Americans who gained coverage cannot lose it again. The more than 129 million people with pre-existing conditions do not want to go back to a time when insurers could discriminate against them, or block them from coverage. Eleven million Medicare Part D beneficiaries cannot afford to lose the $2,000 they have each saved, on average, from the law’s work to begin closing the “donut hole.” The American people do not want to turn back our nation’s progress. Improvements need to be made, but they need to build on progress and not take us backwards in terms of access (the number of insured), affordability (costs to individuals, businesses, and taxpayers), and quality (the benefits that are being provided).
As the Obama Administration comes to a close, this piece lays out my vision for the future of health care. I share the steps we have taken to change how we pay for health care, incentivize coordination, and unlock health care data. This is the path forward—a system where innovative actors are putting the patient at the center—and, despite differences in health care, I firmly believe it is a vision on which we can all agree.
HENRY KOTULA 