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For-profit hospital operators likely to experience weak patient admissions through 2018

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Major for-profit hospital operators were plagued by weak patient volumes in the quarter that ended June 30, and this trend is likely to continue through next year, according to Reuters.

Dallas-based Tenet Healthcare’s net loss ballooned from $44 million in the second quarter of 2016 to $56 million in the second quarter of this year. The company’s hospitals experienced softer patient volume in the second quarter of 2017, including fewer patients seeking elective procedures, according to Reuters.

Tenet’s rivals, such as Nashville, Tenn.-based HCA Healthcare and Franklin, Tenn.-based Community Health Systems also experienced weak patient volumes in the second quarter. HCA ended the second quarter of 2017 with net income of $657 million, which was down slightly from $658 million in the same period of 2016. CHS recorded a net loss of $137 million in the second quarter of this year, compared to a net loss of $1.43 billion in the same period of 2016.

Tenet, HCA, CHS and other for-profit hospital operators experienced a surge in admissions in 2014 and 2015 due to higher insured rates under the ACA. However, many insurers have pulled back from the ACA exchanges since last year, which has caused the for-profit hospital operators to see lower patient volumes, analysts told Reuters.

The companies are expected to see weak patient admissions next year, as the future of the ACA remains uncertain and patients with high-deductible health plans face soaring out-of-pocket costs.

Presence Health to join Ascension

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St. Louis-based Ascension, the nation’s largest nonprofit Catholic health system, signed a nonbinding letter of intent to acquire Chicago-based Presence Health, Illinois’ largest Catholic health system.

Under the deal, Presence’s medical centers, outpatient facilities and other care sites would be operated by Amita Health, a joint venture created by Ascension’s Arlington Heights-based Alexian Brothers Health System and Hinsdale, Ill.-based Adventist Midwest Health, part of Altamonte Springs, Fla.-based Adventist Health System. Ascension would own the facilities.

Presence Life Connections’ skilled nursing and assisted and independent living facilities would join Ascension Living, Ascension’s senior care subsidiary, the companies said in a news release.

“The mission, values and history of Presence Health clearly align well with those of Ascension, as both systems are dedicated to caring for all, with special attention to persons living in poverty and those most vulnerable,” Ascension President and CEO Anthony Tersigni, EdD, said in the release. “We believe this will strengthen Catholic healthcare not only in the region but throughout the country as we are all dedicated to delivering personalized, compassionate care.”

Mark Frey, president and CEO of Amita and senior vice president of St. Louis-based Ascension Healthcare, a division of Ascension, also expressed excitement about the proposed transaction.

“Since we brought together Alexian Brothers Health System and Adventist Midwest Health to form Amita Health two years ago, we’ve always looked for opportunities to add like-minded partners with similar values to our system,” he said. “Bringing Presence Health into Ascension and AMITA Health is a perfect fit and an exciting continuation of our commitment to increase access to quality healthcare in the many communities we serve.”

Presence President and CEO Michael Englehart echoed these sentiments, saying his system “look[s] forward to working together to engage in this joint effort to expand, and continue to deliver, quality care for our patients and residents, as well as provide additional clinical opportunities and patient care resources to all our physicians and associates.”

The systems said a definitive agreement is expected in the future “pending detailed legal and financial due diligence, along with regulatory and canonical approval.” The deal, if completed, would add 10 Presence hospitals to Ascension and Amita, increasing Ascension’s hospitals to 151. Peoria, Ill.-based OSF HealthCare earlier this month announced plans to own the other two Presence hospitals — Presence Covenant Medical Center in Urbana, Ill., and Presence United Samaritans Medical Center in Danville, Ill.

Terms of the proposed deal were not disclosed.

 

Appeals court overturns ruling requiring HHS to clear Medicare appeals backlog by 2021

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The U.S. Appeals Court for the District of Columbia on Friday overturned an order requiring HHS to clear its backlog of Medicare reimbursement appeals by the end of 2020.

On Dec. 5, 2016, U.S. District Judge James Boasberg granted a motion for summary judgment filed by the American Hospital Association in AHA v. Burwell — a lawsuit that centers on the Recovery Audit Contractor Program.

He ordered HHS to incrementally reduce the backlog of 657,955 appeals pending before the agency’s Office of Medicare Hearings and Appeals over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020.

HHS filed a motion Dec. 15, 2016, asking the judge to reconsider his decision. HHS argued it would be impossible to reduce the appeals backlog on the schedule provided by the court without improperly paying claims, regardless of merit. In January, Judge Boasberg denied HHS’ motion for reconsideration.

In late January, HHS filed an appeal in the case, seeking to avoid the district court’s order enforcing the plan to clear the appeals backlog by the end of 2020.

On Friday, the appellate court sided with HHS.

Since HHS said it was impossible to lawfully comply with the district court’s order, the appellate court ruled it was “an error of law” and “an abuse of discretion” for the district court judge to order HHS to abide by the schedule to clear the Medicare appeals backlog.

“In sum, it was an abuse of discretion to tailor the mandamus relief without tackling the Secretary’s claims that lawful compliance would be impossible,” states the appellate court’s opinion.

The appellate court held that on remand the lower court should determine if compliance with the timetable to reduce the Medicare appeals backlog is impossible.

Physician who claimed to have 11k patients sentenced to 35 years in prison

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A 60-year-old Texas physician was sentenced Aug. 9 to 35 years in prison for orchestrating a $375 million healthcare fraud scheme, according to the Department of Justice.

Federal prosecutors said Jacques Roy, MD, and his cohorts used promises of cash, groceries and food stamps to recruit patients, including some of Dallas’ homeless, as part of the fraud scheme.

From January 2006 to November 2011, Dr. Roy’s office, Medistat Group Associates in DeSoto, Texas, handled more home healthcare visits than any physician’s office in the country. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 home healthcare agencies for home health services during that time, according to the DOJ.

“A doctor cannot care for 11,000 patients at once,” Assistant U.S. Attorney P.J. Meitl said during the trial, according to The Dallas Morning News

In April 2016, Dr. Roy, who has lost his medical license, was found guilty on eight counts of healthcare fraud, two counts of making a false statement relating to healthcare matters, one count of obstruction of justice and one count of conspiracy to commit healthcare fraud. Three owners of home healthcare agencies were also convicted on various felony offenses.

In addition to his 35-year prison term, Dr. Roy was ordered to pay $268.15 million in restitution.

BCBS of Michigan faces more than 30 lawsuits alleging hidden health plan fees

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More than 30 lawsuits filed against Detroit-based Blue Cross Blue Shield of Michigan in the past week claim the insurer charged employers unauthorized and hidden fees for their health plans, Bloomberg BNA reports.

Filed between Aug. 9 and Aug. 11 in Michigan’s federal court, the lawsuits allege BCBSM issued hidden markups to employers’ health plan assets to shore up its finances, the report states. The allegations stem from a 2014 appeals court decision finding the payer responsible for the unauthorized fees under the Employee Retirement Income Security Act. The decision also upheld a $6 million judgment against BCBSM.

More than 200 ERISA lawsuits alleging hidden health plan fees were filed against the payer since the 2014 decision, the report states. A college, an auto parts maker, a plastics manufacturer and a car dealer are among the employers suing BCBSM.

BCBSM did not respond to Bloomberg BNA‘s request for comment.

Operators of nearly 300 cancer treatment centers accused of illegally dividing up Florida market

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A 50-page federal whistle-blower complaint accuses Florida Cancer Specialists & Research Institute and 21st Century Oncology of illegally dividing services in southwest Florida to maintain their individual oncology care monopolies, according to the News-Press.

The lawsuit, which was filed under seal last year and recently made public, alleges the two Fort Myers, Fla.-based cancer care companies had an illegal “gentleman’s agreement” under which they provided exclusive patient referrals to each other.

The lawsuit further alleges Florida Cancer Specialists allowed unqualified medical assistants to service patients’ surgically implanted catheters.

The federal government declined to intervene in the case; therefore, the whistle-blowers will continue in the litigation.

The lawsuit was filed by Sharon Dill, who served as Florida Cancer Specialists’ vice president for human resources and chief human resources officer between 2012 and 2015, and Christina Sievert, Florida Cancer Specialists’ vice president of clinical financial services between 2013 and 2015.

Ms. Dill alleges she was fired after disclosing an unspecified disability. Ms. Sievert alleges Florida Cancer Specialists retaliated against her for waging a gender discrimination claim, according to the report.

Florida Cancer Specialists said it takes the allegations in the complaint seriously and is looking into the matter. 21st Century Oncology, which filed for Chapter 11 bankruptcy in May, told the News-Press it does not comment on pending litigation.

21st Century Oncology operates 179 cancer treatment centers across the U.S. and Latin America, and Florida Cancer Specialists has nearly 100 treatment locations.