A pair of senators are asking CMS to require Medicare Advantage plans to cover stays in long-term care facilities at the same rate as traditional Medicare.
Chris Murphy, a Connecticut Democrat, and Thom Tillis, a North Carolina Republican, wrote a letter to CMS Administrator Chiquita Brooks-LaSure Dec. 21, asking the agency to clarify MA plans cannot use different standards to approve long-term care than traditional Medicare.
In their letter the senators wrote they have heard concerns from long-term care hospitals in states that “regularly receive denial letters from Medicare Advantage plans.”
“Unfortunately, Medicare Advantage plan prior authorization practices are creating significant barriers to [long-term hospital] care for critically and chronically ill patients,” the senators wrote.
In a final rule issued in April, CMS said Medicare Advantage plans cannot implement prior authorization criteria that are more stringent than traditional Medicare. In their letter, the senators asked the agency to clarify this statute also applies to long-term care hospitals.
“We write to ask CMS to confirm this interpretation is correct and to request such information be publicly clarified to eliminate confusion for Medicare Advantage plans and ensure that [long-term care hospitals] are treated the same as any other post-acute care provider under the Medicare Advantage regulations,” the senators concluded.
‘Twas the night before Christmas, when all of the staff Sat on Zoom hoping a leader would come, on their behalf. Tired of the power model still in the air, They hoped a servant-leader, soon would be there.
There had been no focus on long-term success, And Short-term drivers too long caused distress. While some struggled for a solution, others had fled, We needed a change before going in the red.
Then amongst the board there arose such a clatter, “Ego-based leaders” they said, “no longer matter.” “We’ve ousted the selfish, greedy narcissists, Replaced them with servant leaders, here to assist.”
Ego’s torn, pride drowned, the power leaders signed out, Their golden parachutes and bonuses now in doubt. Then, what to my wondering eyes should appear, Not whom we expected, but one we all held dear.
One who was humble, his concerns were sincere, We knew right then, our servant-leader was here. His demeanor was calm, though his message strong: “We’ve got much that’s broken, so the road will be long.”
“Now finance, accounting and back-office teams, we’ll focus on the future, sustainability our theme. As for the front-office, say to our customers, we’re focused on success, for all our stake holders.”
He asked for concerns from the group all around, listening for hours, until no more fears were found. He sought out solutions, volunteers and experts, “I’ve not all the answers, and count on your efforts”
As the night wore on, we grew less tired, As the future looked brighter, we grew more inspired. We were no longer feeding egos, pride and greed, But building something far greater, indeed.
New leaders were appointed, for now at least, Many volunteered to fill gaps by those now released. But the message was clear for all to observe: If you want to lead here, you had first to serve.
“Leaders won’t focus on fame, or their name in lights they will have busy days, large loads, and long nights. “They’ll focus instead on all our stake holders, putting other names in lights and magazine covers.”
The message hit home clearly, as we all knew, By serving others, we’d increase revenue. Leaders would focus on staff, who’d impress our customers, And with happy customers, we’d please investors.
Serving to lead, the paradox for success, That Christmas Eve our servant-leader did impress. Inspired we left, with challenges ahead, A long road yes, but we’d be servant-led
My head spun with excitement, as I called my wife. She asked “What’d that boss do now, give you more strife?” I answered “We’ve a new boss and one we deserve. We finally got it – to lead means to serve.”
Seattle Children’s Hospital has filed a lawsuit against the Texas Office of the Attorney General after the agency requested documents related to gender transition policies and such care provided to Texas children, NBC affiliate KXAN reported Dec. 20.
In a lawsuit filed Dec. 7, Seattle Children’s argues that the Texas attorney general does not have the jurisdiction to demand patient records from the hospital. It also states that Washington’s Shield Law, signed by Gov. Jay Inslee on April 27, protects it from requests made by states that “restrict or criminalize reproductive and gender-affirming care,” according to the report.
The Shield Law creates a cause of action for interference with protected healthcare services, which protects against lawsuits filed in other states related to reproductive or gender-affirming care that is lawful in Washington. Those harmed by such out-of-state lawsuits can also file a countersuit in Washington for damages and recover their costs and attorneys’ fees.
The Texas attorney general said it is investigating misrepresentations involving gender transitioning and reassignment treatments and procedures that allegedly violated the Texas Deceptive Trade Practices-Consumer Protection Act.It has demanded that Seattle Children’s provide the following documents:
All medications prescribed by the hospital to Texas children
The number of Texas children treated by the hospital
Diagnosis for every medication provided by the hospital to Texas children
Texas labs that performed tests for the hospital before prescribing medications
Protocol/guidance for treating Texas children diagnosed with gender identity disorder, gender dysphoria or endocrine disorders
Protocol/guidance on how to “wean” a Texas child off gender transitioning care
Seattle Children’s maintains that it does not have property, accounts, nor employees who provide gender-affirming care or administrative services for that care in Texas, according to affidavits obtained by KXAN. Hospital leaders also said that Seattle Children’s has not marketed or advertised this type of care in Texas either.
Attorneys for the hospitals argue that the demands are an “improper attempt” to enforce Texas’ SB 14 bill — signed June 2 by Gov. Greg Abbott — and investigate healthcare services that did not occur in Texas.
“Seattle Children’s took legal action to protect private patient information related to gender-affirming care services at our organization sought by the Texas attorney general,” a spokesperson for the hospital told Becker’s. “Seattle Children’s complies with the law for all healthcare services provided. Due to active litigation, we cannot comment further at this time.”
The Texas attorney general’s office did not respond to Becker’s request for comment.
The post-pandemic labor force has 1.5 million fewer individuals with some post-secondary education short of a bachelor’s degree. This shortfall is hitting healthcare hardest, affecting wages and qualification levels among jobholders.
Job vacancies requiring a post-secondary certificate or associate degree, particularly in healthcare, remain high. The mismatch between the supply of workers with this education level and the ongoing demand for them is leading to increased wages and greater reliance on more educated workers, according to a December 2023 bulletin from the Federal Reserve Bank of Kansas City.
Five takeaways from the bank’s report:
1. Before the pandemic, job openings across educational groups moved together and subsequently peaked together in mid-2022. Since then, while vacancies for most groups have fallen, the number of job vacancies requiring some college education remains 60% above its pre-pandemic level.
2. Vacancies for jobs requiring some college education are concentrated in healthcare. As of August 2023, about 50% of all open jobs posted in 2023 that required an associate degree or non-degree certificate were in healthcare.
3. As a result of the high demand, healthcare employers are turning to more educated workers to fill positions with requirements for some college education. Healthcare employment among workers with some college education has dropped by about 400,000 since 2019; healthcare employment among workers with a bachelor’s degree or more has increased by 600,000.
4. Combined, these factors can place upward pressure on healthcare wages. The supply-demand mismatch can lead employers to offer higher wages to competitively attract qualified workers. Employers turning to workers with more education, who are generally more expensive, will increase the average wage in these occupations.
5. From 2019 to 2023, overall wages for healthcare workers rose by nearly 25%, an increase the bank partially attributes to both increased wages within educational groups and composition effects. The shift in employment toward higher-educated workers accounts for an additional 2.7 percentage points of the total wage increase, for instance.
Big, industry-shaking acquisitions including Oakland, Calif.-based Kaiser Permanente’s purchase of Danville, Pa.-based Geisinger, could redefine healthcare delivery with an eye toward value. Regional deals, such as Detroit-based Henry Ford Health’s planned joint venture with Ascension Michigan and St. Louis-based BJC HealthCare’s plan to acquire Saint Luke’s Health System to create a $10 billion organization, have also made waves.
There were 18 hospital and health system transactions announced in the third quarter, up from 10 transactions over the same time period in 2022, according to Kaufman Hall’s third quarter M&A report. Financial pressures with inflation catapulting staffing and supply costs, and reimbursement rates growing much more slowly, have forced some systems to look for a buyer while others aim to increase market share.
Academic health systems are also seeking community partners at a higher rate than in the past, according to the Kaufman Hall report.
But not all announced deals have gone according to plan.
The Federal Trade Commission is scrutinizing deals more closely than ever before to ensure costs don’t increase after an acquisition in some cases. In other cases, the two partners aren’t able to agree upon the details after announcing their plans. The dissolved merger between Sioux Falls, S.D.-based Sanford Health and Minneapolis-based Fairview Health Services fell apart amid contention in Minnesota, and West Des Moines, Iowa-based UnityPoint Health’s plans to merge with Presbyterian Healthcare Services in Albuquerque, N.M., was halted without a publicly stated reason.
Will there be more or fewer health system deals in the next three years?
Seth Ciabotti, CEO of MSU Health Care at Michigan State University in East Lansing, thinks so, at least when it comes to academic medical centers.
“There will be more consolidation to mitigate risk,” he told Becker’s. “I believe we are heading down a path of having only a dozen or so non-academic medical centers/health systems being left in the near future in the U.S.”
Mark Behl, president and CEO of NorthBay Health in Fairfield, Calif., has a similar outlook for the next three years.
“I suspect we will see more mergers and acquisitions with a continued desire to grow larger and remain relevant,” he told Becker’s. “Independent regional health systems will fight for relevance, and sometimes survival.”
And health systems won’t be the only buyers. Private equity, health insurers and non-traditional owners are on the hunt for health systems. General Catalyst has strengthened its healthcare presence recently and announced it plans to acquire a system in the near future.
“I believe that over the next three years, the landscape of acquisitions, divestitures and joint ventures will continue to reshape the healthcare industry,” said Dennis Sunderman, system director of HR M&A, non-employee and provider services at CommonSpirit Health, told Becker’s. “Current and proposed legislation, the continued evolution of ownership groups, nonprofit, for profit, and private equity, and the drive to hire and retain exceptionally talented teams, will lead to new innovations and an enhanced focus on the associates affected by the transaction.”
Health systems will need to optimize their operations to expand their value-based care efforts and digital transformation, including telehealth and remote patient monitoring services. Not all systems have the expertise and resources to fully make this transition, but with the right partners and strategic alignments, they can accelerate care transformation.
“There will likely be more collaborations and partnerships to expand services and increase access versus brick and mortar acquisitions,” said Cliff Megerian, MD, CEO of University Hospitals in Cleveland. “Innovative thinking is critical for success and quite frankly survival in our industry, so health systems should already be investing in growing in-house expertise dedicated to ideating new models of care, but in three years, these efforts should be producing tangible results.”
Michelle Fortune, BSN, CEO of Atrium St. Luke’s Hospital in Columbus, N.C., pointed to recent collaborations between Mercy, Microsoft and Mayo Clinic as examples of how health systems can partner on important initiatives such as improved data sharing, generative AI, digital transformation and more.
“I expect to see an increase in collaborations and connections between health systems to a degree that has never existed before as part of the focus on bringing the right care to people across the full continuum, when and where they need it,” she said.
Kaufman Hall sees more minority ownership deals ahead, which allows the smaller system to maintain near-autonomy while benefiting from the resources of a larger system.
“Health systems are also engaging in creative transaction structures that allow partners to maintain their independence while building strategic alliances that enhance access to care,” the report notes. “Announced transactions in Q3 included [Charlottesville, Va.-based] UVA Health’s acquisition of 5% ownership interest in [Newport News, Va.-based] Riverside Health System as part of a strategic alliance design ‘to expand patient access to innovative care for complex medical conditions, transplantation, and the latest clinical trials.'”
Affordable Care Act (ACA) enrollment appears poised to reach record levels once again as signups grew by more than a third of what they were this time last year, a fact the White House is using to continue to draw attention to former President Trump’s threats to try again to repeal the law.
More than 15 million people have signed up for plans in states that use HealthCare.gov, representing a 33 percent increase from last year. The Biden administration estimates 19 million will sign up for plans by the Jan. 16 deadline.
On Dec. 15, the deadline for coverage starting Jan. 1, more than 745,000 people selected a plan through HealthCare.gov — the most in a day in history, the Department of Health and Human Services said.
For 2023 plans, more than 16.3 million people signed up through HealthCare.gov last year, another record. Of those who enrolled for this year, 22 percent were new to the marketplace.
This year’s enrollment had some unusual factors that may have played a part in boosting enrollment. Those who were disenrolled from Medicaid this year during the “unwinding” period were allowed to sign up for ACA plans earlier than normal.
There was also stronger insurer participation in the program this year, providing significantly more options for customers to choose from.
“Thanks to policies I signed into law, millions of Americans are saving hundreds or thousands of dollars on health insurance premiums,” President Biden said on Wednesday.
“Extreme Republicans want to stop these efforts in their tracks,” he added. “At every turn, extreme Republicans continue to side with special interests to keep prescription drug prices high and to deny millions of people health coverage.”
HENRY KOTULA 