An ex-NFL player became a hospital CEO. Feds questioned his qualifications

https://www.beckershospitalreview.com/hospital-management-administration/an-ex-nfl-player-became-a-hospital-ceo-feds-questioned-his-qualifications.html

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The CEO of North Tampa Behavioral Health did not meet the requirements to lead the Wesley Chapel, Fla.-based psychiatric hospital, according to a report cited by the Tampa Bay Times.

Bryon Coleman Jr., the former CEO of North Tampa Behavioral, is no longer leading the hospital. Instead, he is in another position within Acadia Healthcare, the Franklin, Tenn.-based parent company of North Tampa Behavioral.

In October, lawmakers called on federal officials to look into North Tampa Behavioral after the Tampa Bay Times published an investigative report that found Mr. Coleman had no healthcare experience. The report also raised quality concerns, claiming North Tampa Behavioral boosted revenues by using a loophole in Florida’s mental health law to hold some patients longer than a 72-hour limit. The hospital rejected the claims.

In November, federal inspectors discovered serious problems at the psychiatric hospital, according to the Tampa Bay Times. Inspectors said medical staff hadn’t been held accountable for poor care. Inspectors also found “no evidence” that Mr. Coleman “met the education or experience requirements defined in the position description” for the CEO role. Officials threatened to end the facility’s federal funding if the issues aren’t addressed by Feb. 19.

Mr. Coleman became CEO of Tampa Behavioral Health in 2018. Prior to that, he quarterbacked for the Green Bay Packers practice squad, managed sales for a trucking company and oversaw employee benefits at an insurance firm, according to the Tampa Bay Times.

In a statement to the Tampa Bay Times, a spokesperson from Acadia denied that federal officials threatened to cut public funding from the hospital and said officials didn’t find Mr. Coleman lacked requirements for his job.

Read the full article here.

 

 

 

Lehigh Valley Health Network’s net income more than triples to $115M

https://www.beckershospitalreview.com/finance/lehigh-valley-health-network-s-net-income-more-than-triples-to-115m.html

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Allentown, Pa.-based Lehigh Valley Health Network saw its net income more than triple from $35.1 million in fiscal year 2018 to $115.3 million in fiscal year 2019, according to financial documents released Dec. 4. 

The health system saw its revenue increase year over year to $2.96 billion in the 12 months ended June 30. In the same period in 2018, the system reported revenue of $2.73 billion.

In fiscal year 2019, Lehigh Valley Health reported expenses of $2.86 billion, up from $2.68 billion in 2018.

Expense growth resulted from several factors, including an increase in salaries and wages and supply costs.

Lehigh Valley Health System attributed the net income increase to cutting back on contract workers and overtime and reducing costs on readmissions and contracts, according to The Morning Call. 

 

UPMC to close hospital in 2020

https://www.beckershospitalreview.com/finance/upmc-to-close-hospital-in-2020.html

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Pittsburgh-based UPMC will close its hospital in Sunbury, Pa., on March 31, 2020, according to The Daily Item.

The health system cited dwindling patient volume as one of the reasons it is closing UPMC Susquehanna Sunbury.

“This decision was made with careful consideration and analysis of the use of hospital services in the region,”  UPMC Susquehanna President Steven Johnson said, according to The Daily Item. “According to market data, patients are utilizing facilities other than UPMC Susquehanna Sunbury for their care. UPMC must prudently examine opportunities to integrate and consolidate functions balanced against the needs of the community.”

The hospital, previously named Sunbury Community Hospital, has been open for nearly 125 years. Jody Ocker, Sunbury city administrator, said she’s concerned local residents won’t have access to care after the hospital closes.

“I’m very concerned about our residents’ access to care,” she told TV station WNEP. “We have people that are getting around on their electric scooters and their bicycles. They don’t have access to reliable transportation.”

About 150 people will lose their jobs when UPMC Susquehanna Sunbury closes, according to WNEP. UPMC said it will try to relocate employees to other hospitals in the area.

 

Hospitals vs. the world

https://www.axios.com/newsletters/axios-vitals-3635dfb2-f6b2-4986-b8f0-15acd9436ea4.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

A hospital sign with the 'H' replaced with a dollar sign

Hospitals sued the Trump administration yesterday over its requirement that they disclose their negotiated rates, the latest of the industry’s moves to protect itself from policy changes that could hurt its revenues.

Why it matters: Hospitals account for the largest portion of U.S. health costs — which patients are finding increasingly unaffordable.

The big picture: Hospitals are going to war against Trump’s price transparency push while simultaneously trying to kill Democrats’ effort to expand government-run health coverage.

  • The industry is one of the main forces behind the Partnership for America’s Health Care Future, the group that’s gone on offense against “Medicare for All” and every other proposal that would extend the government’s hand in the health system, as Politico recently reported.
  • It’s also emerging victorious from blue states’ health reforms so far, which all started as proposals much more threatening to hospitals than the watered-down versions that eventually replaced them.

Between the lines: The industry has a lot to lose; even non-for-profit systems are, as my colleague Bob Herman put it, “swimming in cash.”

  • The Trump administration’s transparency measure could lead to either more pricing competition or further regulation, if it exposes egregious pricing practices.
  • And Democrats’ proposals often feature government plans that pay much lower rates than private insurance does.

Hospitals argue that the transparency measure could end up raising prices if providers with lower negotiated rates see what their competitors are getting. They also warn that Democrats’ plans could put hospitals and doctors out of business and threaten patients’ access to care.

The bottom line: Politicians are reacting to patients’ complaints about their health care costs, but the industry has historically been excellent at getting its way.

Go deeper: Hospitals winning big state battles

 

 

 

UNION RESCHEDULES KAISER PERMANENTE STRIKE POSTPONED AFTER CEO’S DEATH

https://www.healthleadersmedia.com/strategy/union-reschedules-kaiser-permanente-strike-postponed-after-ceos-death?spMailingID=16676008&spUserID=MTg2ODM1MDE3NTU1S0&spJobID=1780330838&spReportId=MTc4MDMzMDgzOAS2

The health system’s senior vice president of national labor relations said the conflict is resolvable, ‘and there is no reason to strike.’

A five-day strike that was postponed last month after the sudden death of Kaiser Permanente Chairman and CEO Bernard J. Tyson is back on the calendar.

Thousands of psychologists, therapists, psychiatric nurses, and other healthcare professionals plan to strike December 16–20 at more than 100 Kaiser Permanente facilities across California, the National Union of Healthcare Workers (NUHW) said Wednesday.

“Mental health has been underserved and overlooked by the Kaiser system for too long,” said Ken Rogers, PsyD, MEd, a Kaiser Permanente clinical psychologist who serves as a vice president on the NUHW executive board, in a statement released by the union.

“We’re ready to work with Kaiser to create a new model for mental health care that doesn’t force patients to wait two months for appointments and leave clinicians with unsustainable caseloads,” Rogers said. “But Kaiser needs to show that it’s committed to fixing its system and treating patients and caregivers fairly.”

The union accuses Kaiser Permanente of refusing to negotiate unless mental health clinicians agree to “significantly poorer retirement and health benefits” than those received by its more than 120,000 other California employees.

Dennis Dabney, senior vice president of national labor relations and the Office of Labor Management Partnership at the Kaiser Foundation Health Plan and Hospitals, said the parties have been working together with an external mediator in pursuit of a collective bargaining agreement. The union rejected a compromise solution proposed last week by the mediator, Dabney said.

“The only issues actively in negotiation in Northern California are related to wage increases and the amount of administrative time that therapists have beyond patient time,” Dabney said. “We believe these issues are resolvable and there is no reason to strike.”

The mediator’s recommendation includes about 3% in annual wage increases for therapists in Northern California for four years, plus a $2,600 retroactive bonus, Dabney said

“In Southern California, the primary contract concern relates to wage increases and retirement benefits,” Dabney said.

The mediator’s recommendation includes about 3% in annual wage increases for therapists in Southern California for four years, plus a $2,600 retroactive bonus, even though the organization’s therapists in Southern California “are paid nearly 35% above market,” Dabney said.

“Rather than calling for a strike, NUHW’s leadership should continue to engage with the mediator and Kaiser Permanente to resolve these issues,” Dabney said.

 

 

 

HOSPITAL SPLITS THIS PAYROLL EXPENSE 50/50 WITH LOCAL PAYER TO CURB ER OVERUSE

https://www.healthleadersmedia.com/strategy/hospital-curbs-er-overuse-splitting-payroll-expense-5050-local-payer

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New Ulm Medical Center struck a deal with a local payer willing to share the cost of a simple intervention. The arrangement has been paying dividends for seven years.


KEY TAKEAWAYS

The intervention slashed PMPM billing by 61% in three years for a small cohort of plan members.

What makes this program atypical is the way the hospital took a broad problem-solving approach while minimizing its expenses.

Patients who use the emergency department at least three times within four months at Allina Health’s New Ulm Medical Center in New Ulm, Minnesota, have their names added to a high-utilization list.

The keeper of that list is Jennifer Eckstein, a licensed social worker who follows up with each patient directly, looking to solve underlying problems that may be driving their frequent ED use. Whether the patients need a primary care physician, a mental healthcare provider, supportive housing, or another solution, Eckstein does her best to address their social determinants of health and steer them away from the ED for non-emergent care.

The intervention is a straightforward concept. Many other hospitals have similarly hired social workers to help meet the needs of these ED frequent flyers. The program at New Ulm Medical Center, in fact, was inspired in part by an earlier and narrower intervention that focused exclusively on mental health needs of ED patients at Allina’s Owatonna Hospital in Owatonna, Minnesota.

But what makes this program a bit different from others is the way New Ulm Medical Center took a broad problem-solving approach while minimizing its expenses. Rather than shouldering the full cost of employing a full-time ED social worker, the hospital partnered with local insurer South Country Health Alliance. They struck a deal and signed a contract agreeing to split the personnel expense 50/50, beginning in 2012.

Allina’s four hospitals in the Twin Cities metro area have regularly staffed social workers in their EDs, too, but none of them fund those positions through cost-sharing arrangements with health plans, according to a spokesperson for the nonprofit health system.

South Country Health Alliance CEO Leota Lind, who has been with the organization since its founding in 2000, says her organization didn’t need much convincing to sign the contract with New Ulm Medical Center. While unmet mental health needs are often a major factor contributing to ED overuse, they are far from the only factor, so the broader approach taken at New Ulm offered a chance to solve a wider range of the challenges that were leading plan members to an ED when they should be seeing a more cost-effective primary care physician instead, Lind says.

“We really just were looking at ways to influence and reduce emergency department visits,” Lind tells HealthLeaders. “By taking that broader scope, it gave us the opportunity to identify what other issues were contributing to that high utilization of the emergency department.”

FEWER DOLLARS, MORE SENSE

South Country Health Alliance and New Ulm Medical Center each contribute about $40,000 per year to cover Eckstein’s salary and benefits—which, at about $80,000 per year, are in line with what other hospital social workers earn in total compensation in the Midwest, says Carisa Buegler, MHA, director of operations for the hospital.

Both the hospital and payer say their shared investment has been paying off.

Before the social worker was introduced, a small cohort of 28 South Country Health Alliance plan members who received care in New Ulm Medical Center’s ED generated $731 per member per month (PMPM) in hospital bills, according to Buegler. A year after Eckstein began her work, in 2012, those bills fell to $416 PMPM, then they kept falling. By the end of the third year, in 2014, the 28-patient cohort generated $286 PMPM in bills, Buegler says.

That 61% reduction means the hospital billed the payer nearly $150,000 less in 2014—just for those 28 patients—than it had before the social worker was introduced. By the end of the third year, the cohort’s overall ED utilization was cut in half, and its inpatient admissions fell 89%, Buegler says.

That’s only part of the impact Eckstein’s labor has produced, since she doesn’t work exclusively with South Country plan members. Eckstein, who was hired into the position when it was created, says she helps roughly 150–200 patients per year, regardless of who’s paying for their care. Some needs are easier to meet than others, so she’s built a sense of rapport with some returning patients over the years.

“The good thing is they utilize me now instead of the ER, so when they get into a pickle or if they’re having trouble with something, they call me,” she says.

Across all payers, the intervention has likely been saving $500,000 or more, Buegler says.

The intervention is about more than just money, of course. It aims also to improve clinical care and patients’ quality of life.

“I don’t think the driver was necessarily just cost but appropriate care at the right place, at the right time, with the right kind of provider,” says South Country Health Alliance Chief Medical Officer Brad Johnson, MD.

But the financial implications of this intervention are especially interesting considering the fact that New Ulm Medical Center is spending $40,000 per year on a program that delivers cost-savings to payers while reducing the hospital’s revenue. The immediate financial benefit goes to the payer, not the provider.

The hospital has seen a 20% reduction in its overall ED volumes in the past five years, and that’s likely the direction in which most hospitals’ EDs are headed, which is generally good news, Buegler says. The situation presents a challenge, though, since value-based payment arrangements haven’t matured and proliferated to a point where they can compensate adequately for the trend, she says.

Why, then, would the hospital keep investing in this intervention?

“It’s the right thing to do,” Buegler says. “It’s providing the best level of care to our patients who are coming in the emergency department seeking help and then providing another level of service to those individuals to help them improve their social conditions, that will then help them to improve their health. … It’s really looking at the patient as a whole person.”

There’s also a longer-term business case to be made for the hospital’s continued investment, Buegler says.

“From a financial perspective, we’re preparing for more value-based payment contracts,” she says.

Although risk-based contracts have been arriving more slowly than many industry stakeholders had expected, leaders remain confident that more value-based models are on the way, so it makes sense for hospitals like New Ulm Medical Center to invest in the future it anticipates, Buegler says.

PLUGGED INTO SUPPORT NETWORK

Eckstein is the sole social worker stationed in the ED, but she’s not running a one-woman show.

New Ulm Medical Center has a social worker assigned to its clinic, too, and South Country Health Alliance employs a physician as a community care connector in each of the 11 counties it serves—so Eckstein has multiple partners just outside the ED’s walls.

“By having that hospital social worker work in partnership with the community care connector at the county, they’re able to effectively make referrals and access some of those other types of community supports that have also helped address the issues that individuals may be experiencing as barriers to managing their healthcare,” Lind says.

This idea of bridging the gap between traditional medical care and broader social services has been central to South Country Health Alliance’s mission since it was founded, Lind says.

“We recognized way back then that those other aspects, those other social, environmental aspects of an individual’s life, impact their ability to manage and maintain their healthcare,” she adds. “That’s been a part of our program since the beginning.”

Johnson says this care coordination is a vital component of the local safety net.

“In rural Minnesota,” he says, “there’s lots of opportunities for people that are not savvy users of the healthcare system to fall through the cracks.”

“THE GOOD THING IS THEY UTILIZE ME NOW INSTEAD OF THE ER, SO WHEN THEY GET INTO A PICKLE OR IF THEY’RE HAVING TROUBLE WITH SOMETHING, THEY CALL ME.”

 

 

 

 

Dignity Health’s class-action settlement actually worth $700M, workers say

https://www.beckershospitalreview.com/finance/dignity-health-s-class-action-settlement-actually-worth-700m-workers-say.html

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A California federal judge refused to approve a deal in October requiring Dignity Health to pay more than $100 million to settle a class-action lawsuit accusing the San Francisco-based health system of using a religious Employee Income Retirement Security Act exemption it wasn’t entitled to. Current and former Dignity workers argue the deal is actually worth more than $700 million in court documents filed Nov. 25, according to Law360.

Dignity Health allegedly used the religious exemption to underfund its pension plan by $1.5 billion. On Oct. 29, a federal judge in the Northern District of California refused to sign off on a proposed settlement because it contained a “kicker” clause. The clause would allow Dignity to keep the difference between the amount of attorneys’ fees awarded by the court and the more than $6 million in fees authorized by the settlement.

“Although the fact is not explicitly stated in the Settlement, if the Court awards less than $6.15 million in fees, Defendants keep the amount of the difference and those funds are not distributed to the class,” Judge Jon S. Tigar said, according to Bloomberg Law. “The Court concludes that this arrangement, which potentially denies the class money that Defendants were willing to pay in settlement — with no apparent countervailing benefit to the class — renders the Settlement unreasonable.”

Though the judge refused to sign off on the deal, he gave the parties an opportunity to revise the agreement and resubmit it for approval. Workers tweaked the proposed deal in a renewed motion for settlement filed Nov. 25.

According to the motion, the parties have agreed to eliminate the kicker clause.

“As provided in the new settlement, class counsel will apply to the court for approval of a total award of $6.15 million, for attorney fees, expenses and incentive awards,” the motion states. “If the court awards less than the requested amount, Dignity Health has agreed to pay the balance into the plan’s trust.”

The workers also argue that the attorney fee award is reasonable given the value of the settlement.

Under the proposed settlement, Dignity would add $50 million in retirement plan funding in 2020 and 2021.The settlement also requires Dignity to fund the pension plan until 2024 and prohibits the health system from reducing accrued benefits because of a plan merger or amendment for 10 years. For 2022 through 2024, Dignity Health’s cash contributions to the plan will be at least the “minimum contribution recommendation,” an amount calculated each year by independent actuaries.

“Under this settlement, Dignity Health will make substantial contributions to the plan for five years, in an amount we estimate to exceed $700 million,” the motion states.

The court previously noted that plaintiffs did not identify any settlement provisions governing how Dignity Health’s actuaries calculate the minimum contribution recommendation. The plaintiff’s actuary provided more information on the calculation in a supplemental declaration submitted Nov. 25.

The workers are seeking preliminary approval of the new settlement.