Author Archives: henrykotula

Policy Basics: Top Ten Facts about Social Security

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https://www.cbpp.org/research/social-security/policy-basics-top-ten-facts-about-social-security

 

Happy Birthday, Social Security!

President Franklin D. Roosevelt signed the Social Security Act into law on August 14, 1935, 83 years ago today. Here are some key facts about the program:

  • About 62 million people received Social Security checks in June of this year.
  • The average monthly check was $1,343.
  • Social Security lifts about 15 million elderly Americans out of poverty.
  • Benefits for the average worker are only about half those in other developed countries.
  • About 1 in 5 seniors rely on Social Security for more than 90 percent of their income.
  • Administrative costs for the program are just 0.7 percent of annual benefits.
  • Social Security’s trust funds will be exhausted by 2034. If policymakers do not act by then, payments could be reduced by about 25 percent.

 

Cigna prevails in Texas hospital’s suit over $50M in unpaid claims

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https://www.bna.com/cigna-prevails-texas-n73014481565/

Image result for hospital out of network fee forgiving

Cigna Healthcare defeated a lawsuit by a Houston hospital accusing it of underpaying hundreds of medical benefit claims.

Cigna didn’t abuse its discretion when it reduced benefit payments to North Cypress Medical Center Operating Co. Ltd after it learned that the hospital engaged in fee-forgiving—a practice where out-of-network providers charge patients less than what they owe under their health insurance plans, a federal judge in Texas held Aug. 7.

Multiple lawsuits challenging the billing and payment practices between out-of-network providers and health insurers have been filed in the past decade, when insurers started reducing or withholding payments to providers that engaged in fee-forgiving. Insurers such as Cigna, Aetna, and UnitedHealthcare allege this practice is fraudulent.

The ruling, which came after an eight-day bench trial, is a significant victory for Cigna in a long-running lawsuit by North Cypress, which sought to hold the insurer liable for at least $50 million in unpaid claims.

In 2016, Judge Keith P. Ellison held that Cigna violated federal benefits law by denying full payment of benefit claims.

Since then, the U.S. Court of Appeals for the Fifth Circuit issued a number of opinions in favor of insurers, including one where it reversed a $16.4 million judgment against Cigna in a case in which another small Texas-based hospital accused it of underpaying medical claims. Last week, the Fifth Circuit affirmed a ruling against the hospital in its lawsuit accusing Aetna Life Insurance Co. of underpaying medical claims in violation of the Employee Retirement Income Security Act and Texas law.

After the parties Cigna and North Cypress engaged in full discovery, the claims at issue were limited to the 575 benefit claims for which the hospital exhausted its administrative remedies. Cigna argued at trial that in these 575 claims, it didn’t apply its fee-forgiving protocol to reduce payments to 395 of them because they were for nonemergency services.

Cigna’s interpretation of its plans to require an out-of-network provider to collect the full portion of coinsurance from a patient was reasonable, Ellison said.

Ellison, who sits in the U.S. District Court for the Southern District of Texas, pointed out that Cigna had substantial evidence to support its determination that North Cypress engaged in fee-forgiving. Cigna had sent surveys to patients who had received treatment at North Cypress and it discovered that the hospital was discounting or forgiving out-of-network coinsurance, Ellison said.

 

 

6 Ways Leaders Bully People Without Realizing It

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6 Ways Leaders Bully People Without Realizing It

Bullying at Work

In the latest edition of Leaders Behaving Badly, the University of Maryland has placed multiple members of the men’s football team staff on administrative leave, including head coach DJ Durkin, while the school investigates their role in creating a toxic culture that contributed to the death of offensive lineman Jordan McNair in June after a football workout.

The ESPN report cited these examples:

  • There is a coaching environment based on fear and intimidation. In one example, a player holding a meal while in a meeting had the meal slapped out of his hands in front of the team. At other times, small weights and other objects were thrown in the direction of players when Strength and Conditioning coach, Rick Court, was angry.
  • The belittling, humiliation and embarrassment of players is common. In one example, a player whom coaches wanted to lose weight was forced to eat candy bars as he was made to watch teammates working out.
  • Extreme verbal abuse of players occurs often. Players are routinely the targets of obscenity-laced epithets meant to mock their masculinity when they are unable to complete a workout or weight lift, for example. One player was belittled verbally after passing out during a drill.
  • Coaches have endorsed unhealthy eating habits and used food punitively; for example, a player said he was forced to overeat or eat to the point of vomiting.

There is absolutely no room for that kind of behavior in sports, school, or the workplace. Leaders have to be held to a higher standard.

Bullying is not just verbal or physical intimidation of someone. Especially in the workplace, bullying can manifest itself in many subtle ways. Any behavior you use to intimidate, dominate, embarrass, harass, or purposely make someone feel inferior could be considered bullying.

Here are six subtle ways you may be acting like a workplace bully without even realizing it:

1. You are condescending—When you act in a condescending manner, whether it’s patronizing someone, being dismissive of a person’s contributions, or minimizing someone’s accomplishments in order to highlight yours, you are sending a message that you believe you are superior to the other person.

2. Wounding with sarcasm—I like sarcastic humor as much as the next guy, but there is a huge difference between sarcasm that highlights the irony of a situation and is self-deprecating, versus sarcasm that is intended to belittle and injure another person. Next time you’re ready to drop that witty, sarcastic joke, pause and consider if it will build up the other person or tear her down.

3. Being cliquish—Cliques aren’t only for high school. Unfortunately, many adults carry that same behavior into the workplace. Purposely excluding people from activities is a bullying behavior intended to send the message that “you’re not one of us” and “we’re better than you are.” Trusted leaders look for opportunities to include people so they feel valued and appreciated.

4. Thinking you know it all—Have you ever worked with a person who thinks she knows it all? How annoying is that?! Much like behaving in a condescending manner, acting like you are the all-knowing expert is a way to intimidate others to go along with your ideas or wishes. Just stop it! No one really believes you anyway.

5. Being passive-aggressive—Perhaps one of the most subtle forms of bullying and manipulation, passive-aggressive behavior poisons teams, departments, and organizations. A common trait of bullies is expressing aggression in order to intimidate another person. Passive-aggressive people are bullies who express aggression in indirect ways such as disguising hostility in jokes, stubbornness, procrastination, resentment, or giving just the minimum effort required. I perceive passive-aggressive people as double-agent bullies disguised as victims. Watch out for them!

6. Gossiping—Have you ever considered gossiping as a form of bullying? Probably not, but it easily could be considered bullying, and some experts even consider it a form of workplace violence because it’s intended to harm another individual or group. Why do people gossip? It’s to make themselves feel powerful. The gossiper believes she knows something that other people don’t and she uses that information as leverage to elevate herself above others.

Leaders are charged with bringing out the best in their people and I don’t understand how some leaders, particularly sports coaches, believe that bullying is an acceptable form of motivation. It’s not. It’s belittling, destructive, demeaning, dehumanizing, and does nothing but feed the power-hungry ego of the bullying leader.

If you’re a leader in the workplace, whether it’s in an office, factory, warehouse, construction site, or any other place, make sure you’re not being a bully without even realizing it. You’re better than that and your people deserve your best.

 

 

 

 

NOT-FOR-PROFIT OPERATING MARGINS CONTINUE TO DECLINE

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https://www.healthleadersmedia.com/finance/not-profit-operating-margins-continue-decline?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_180801_LDR_BREAKING_DeKalb_Emory%20(1)&spMailingID=14040768&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1460932625&spReportId=MTQ2MDkzMjYyNQS2

Operating margins for systems and hospitals continued to decline due to increasing expense pressures as well as slowing net patient revenue growth across all rating levels.

KEY TAKEAWAYS

Strong balance sheets and capable leadership continue to lead the way for stable success.

M&A activity has bolstered the financial standing and credit ratings of not-for-profit health systems.

Not-for-profit systems are outnumbering stand-alone hospitals through increased M&A activity.

Stand-alone hospitals experienced their second consecutive year of negative outlooks.

Not-for-profit health systems and stand-alone hospitals have maintained generally favorable bond ratings due in large part to strong balance sheets, despite the continual decline in operating margins and cash flows.

S&P Global Ratings released research this week on the financial status of not-for-profit health systems and stand-alone hospitals in 2017.

The sector remained consistent in several year-to-year, such as improving days’ cash-on-hand levels and marginal reduction in debt levels, though the study found that the underlying pressures on not-for-profits are beginning to take their toll. The operating margin for the sector declined from 2.4% in 2016 to 1.8% in 2017.

S&P also noted that not-for-profit health systems continue to outnumber stand-alone hospitals and received stronger overall ratings from the agency.

RATINGS ACTIONS FOR THE SECTOR THROUGH JUNE 22:

  • 152 total affirmations
  • 16 total upgrades, though six upgrades were driven by systems merging together.
  • 15 total downgrades

S&P said a major factor that allowed health systems and hospitals to weather financial challenges last year was the combination of strong balance sheets and leadership. 

CREDIT STRENGTHS OF NOT-FOR-PROFIT SYSTEMS:

  • Robust M&A activity has improved the financial profile for systems.
  • Despite the same challenges with maintaining an overall patient base, systems have experienced a growth in outpatient services.
  • Sizable investments in information technology have resulted in strong credit ratings.

S&P analysts said that stand-alone hospitals featured stronger medians than systems but found they are weakening. This is due to softer patient volumes, a weakening payor mix combined with increased pressure from commercial payors, and labor expenses. 

HOW STAND-ALONE HOSPITALS PERFORMED:

  • While the amount of stand-alone hospitals are shrinking, they produced stable balance sheets that were noted as a “principal strength of financial profile.“
  • Debt levels fell due to declining unrestricted net assets.
  • However, negative operating margins appeared in BBB rating levels.