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CEO, CFO of Missouri hospital resign over inappropriate reimbursements
The CEO and CFO of Ranken Jordan Pediatric Bridge Hospital in Maryland Heights, Mo., have resigned after the hospital board discovered the executives violated the hospital’s paid time off policy, according to the St. Louis Post-Dispatch.
The hospital board requested and accepted the resignations of president and CEO Lauri Tanner and vice president and CFO Jean Bardwell, effective May 2, according to the report.
In a statement to the St. Louis Post-Dispatch, the hospital said the two executives were allegedly paid for time off “to which they were not entitled.” The hospital said the board is demanding Ms. Tanner and Ms. Bardwell repay the hospital, but it did not disclose the amount of inappropriate reimbursement the executives allegedly received.
The board’s executive committee initially identified the potential irregularities, and the board subsequently launched an investigation, which allegedly revealed the two executives violated hospital policy, according to the report.
To help prevent a similar issue from occurring in the future, the hospital has put corrective measures in place.
Ranken Jordan Pediatric Bridge Hospital COO Brett Moorehouse has been named interim president and CEO, and a hospital board member will serve as interim CFO, according to the St. Louis Business Journal.
Evidence keeps mounting that Affordable Care Act’s individual mandate was a success
Former HHS Secretary Tom Price.
Former HHS Secretary Tom Price’s statements and new research from the Commonwealth Fund suggest the ACA brought more young people to insurance pool.
When the Affordable Care Act was initially passed, some thought that many people, high-income men in good health particularly, would be driven from the insurance market and that would indicate a failure on the part of the ACA’s individual mandate. Instead the opposite appears to be true.
What’s more, former Health and Human Services Secretary Tom Price, MD, said publicly this week that when President Trump’s tax bill, which ends the individual mandate in 2019, kicks in insurance prices are going to rise.
Price’s statement comes after the uninsured rate dropped substantially at least when it comes to one studied demographic during the law’s first few years. Among 26-34-year-old men who earned more than 400 percent of the federal poverty level, the uninsured rate dropped from 11.7 percent in 2013 to 7.2 percent in 2015, according to new research by the Commonwealth Fund.
That’s actually greater than the drop in the uninsured rate of older men. Those between 55-64 also saw a reduction, but only from 3.9 to 2.5 percent.
Before the Affordable Care Act was enacted, young and healthy individuals in many states could purchase limited benefit packages at low premiums. The ACA mandated coverage and charged higher premiums to those not covered by federal subsidies.
Young, healthy males shouldered higher costs due to regulations that shifted the brunt of the cost away from disadvantaged groups, such as the poor and the elderly.
At the time of passage, some states had imposed rating rules for insurance coverage that sought to qualify more people for health subsidies, but the researchers found that when the ACA was passed, the percent of uninsured men that didn’t qualify for subsidies dipped at about the same rate in all states, regardless of whether they had enacted those rules.
The positive impact on young, high-earning men was credited by authors to financial penalties and effective marketing, but the Trump administration has cut the ACA marketing budget by $90 million. Just $10 million is now earmarked for that purpose.
“There are many, and I’m one of them, who believe that [the tax bill] will harm the pool in the exchange market,” Price said at the World Health Care Congress on Tuesday. “Because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently, that drives up the cost for other folks.”
HHS Secretary Alex Azar to Supreme Court: Time to rule on Medicare case that affects $4 billion
HHS Secretary Alex Azar
Lower court’s decision about disproportionate share hospital payments undermines the ability HHS has to administer Medicare reimbursement, Azar says.
Health and Human Services Secretary Alex Azar asked the U.S. Supreme Court to review an appeals court case won by numerous hospitals over disproportionate share hospital payments.
Azar said the decision affects between $3 and $4 billion in Medicare funding and therefore, the Supreme Court’s review is warranted.
At issue is whether the Centers for Medicare and Medicaid Services needed to go through a notice and comment rulemaking to get stakeholder feedback before deciding on its own to include Medicare Advantage beneficiaries in its calculations for DSH payments.
Medicare pays hospitals for providing inpatient care and gives an additional payment known as disproportionate share hospital adjustment to hospitals that serve a significantly disproportionate number of low-income patients.
The payment is based on two percentages. The first is a Medicare fraction, which is calculated using the number of patient days for patients who are entitled to benefits under Medicare Part A and for supplemental Social Security income benefits.
The second percent includes patient days attributable to patients who are not entitled to benefits under Medicare Part A.
Medicare Advantage, or Medicare Part C, established in 1997, allows individuals to receive benefits under Parts A and B through enrollment in a private MA plan.
Prior to 2004, CMS did not count a hospital’s Medicare Part C patient days when calculating the Medicare fraction used to determine DSH payments. Starting in 2004, CMS made a decision on its own interpretation of a rule and determined Part C patients were entitled to benefits under Medicare Part A within the meaning of Medicare-fraction provisions.
Hospitals challenged CMS’ interpretation done without notice and comment rulemaking. A district court sided with the government, but in 2017 the U.S. Court of Appeals in the District of Columbia ruled with the hospitals.
The appeals court said HHS needed notice and comment rulemaking before providing Medicare Administrative Contractors the payment calculation that is passed on to hospitals.
The decision undermines its ability to administer the annual Medicare reimbursement process in a workable manner, HHS said.
“The D.C. Circuit’s contrary decision would significantly impair HHS’s ability to administer annual Medicare reimbursements through the MACs that act on its behalf,” the Supreme Court filing said. “It would also impose significant costs on the government. Just with respect to the Medicare-fraction issue in this case, the decision below affects between $3 and $4 billion in Medicare funding.”
Solicitor General Noel Francisco filed the petition in April on behalf of Azar, against health systems Allina Health Services, doing business as United Hospital, Unity Hospital and Abbott Northwestern Hospital; Florida Health Sciences Center dba Tampa General Hospital; Montefiore Medical Center; Mount Sinai Medical Center of Florida dba Mount Sinai Medical Center; New York Hospital Medical Center of Queens; New York Methodist Hospital; and New York Presbyterian Hospital and New York Presbyterian Hospital Weill Cornell Medical Center.
Despite shift to value-based care, hospitals still paying doctors with fee-for-service expectations, AMA says
A quick breakdown of the different approaches hospitals are taking to compensate physicians amid the massive shift from volume to value.
The shift from fee-for-service payment models to those based in value has been occurring steadily over the past few years. Increasingly, providers are determining physician pay through a number of different means. But what does that mean for the ways hospital pay doctors? And what approach are your competitors taking?
The options include straight salary, compensation based on personal productivity (as has been the case in a fee-for-service world), bonus structures and tieing pay to an organization’s overall financial performance.
Salary is the most common model at 52.5 percent, while productivity still accounted for 31.8 percent. Only 9 percent was based on the practice’s financial performance, meanwhile, and bonuses comprised 4.1 percent, according to an American Medical Association analysis.
Here’s where the plot thickens a bit. “Over half of physicians (54.4 percent) indicated that their compensation was based on more than one method, greater than what was observed in 2014 and 2012,” AMA said.
Productivity was a greater chunk of compensation for private practice owners, at 44.7 percent; that number dipped to 22.3 percent for employed physicians.
Partly that’s because employed physicians were more likely to have a salary, decreasing the need for productivity to factor into their overall compensation equation, the AMA said. The group said some physicians are likely feeling pressure to increase their productivity by doing things like increasing their patient volume, or hiring outside help to perform more menial tasks.
It’s worth noting that while the AMA just published the findings, they are based on surveys conducted during September of 2012, 2014 and 2016 with approximately 3,500 respondents each year — and a lot has happened in value-based care since then.
“We also find evidence that the use of multiple methods to determine physicians’ overall compensation has been on the upswing,” AMA said.
Trinity Health chooses Epic for integrated EHR, revenue cycle management
The Michigan health system, one of the largest in the U.S., says it wants to roll out a single, enterprise platform to deliver “people-centered care.
It’s a big week for Epic implementations in the Upper Midwest. The world-class Mayo Clinic is ready to go live with its newly-minted system on May 5, after more than three years of work. And today comes news that sprawling Trinity Health, based in Livonia, Michigan, has selected Epic to build out its own enterprise-wide electronic health record and revenue cycle management system.
It’s a process the Catholic health system expects will take four years to implement across its 94 hospitals and 109 continuing care locations. The expected cost of the deal was not disclosed.
Trinity officials said the integrated Epic platform will allow the health system to improve experiences for patients and clinicians across the board.
“People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record,” said Mike Slubowski, president and chief operating officer of Trinity Health.
“At the same time, physicians and clinicians need tools that make it easier to practice medicine,” he said. “We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care.”
It’s the same appetite for a seamless and enterprise-wide system, across all locations and functionalities, that Mayo Clinic CIO Christopher Ross said was a factor in its choice of Epic back in 2015. That health system had been “steadily working toward a convergence of its practice” for several years, he said at the time, and best-of-breed would no longer suffice for achieving those goals.
At Trinity Health, the plan is to leverage Epic as a fully-integrated system for a single, comprehensive health record for every patient.
Trinity tapped Epic on the strength of the different products offered on that single, unified platform, officials said – not just enterprise EHR and revenue cycle, which will eventually go live at all of its hospitals, ambulatory centers, physician offices and continuing care programs, used by some 100,000 employee – but also online scheduling, e-visits and online bill pay.
“We are confident a single platform will enable new levels of innovation, consumer focus, clinical and business integration and efficiency to help us build our people-centered health system,” said Slubowski. “It will also help align people, process and technology to create a culture in which people-centered care becomes the standard way we care for the communities we serve.”
HENRY KOTULA 