BETH ISRAEL, LAHEY HEALTH MERGER GETS FTC, MASSACHUSETTS AG’S APPROVAL

https://www.healthleadersmedia.com/beth-israel-lahey-health-merger-gets-ftc-massachusetts-ags-approval?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_181130_LDR_BRIEFING%20(1)&spMailingID=14711589&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1522364043&spReportId=MTUyMjM2NDA0MwS2

he condition-laden approval stipulates a seven-year price cap that guarantees that the merged health system’s price increases will be kept below the state’s healthcare cost growth benchmarks.


KEY TAKEAWAYS

The Federal Trade Commission calls the merger ‘a close call’ but defers to state regulators.

The merged health system will provide $71 million for care in underserved areas.

The merged, 13-hospital health system will be one of the largest in the Bay State.

The proposed merger of Beth Israel Deaconess Medical Center and Lahey Health System cleared a huge hurdle today when Massachusetts Attorney General Maura Healey announced her conditional support.

The approval comes with what Healey called an “unprecedented” seven-year price cap that guarantees that the merged health system’s price increases will be kept below the state’s Health Care Cost Growth benchmark.

“Through this settlement, Beth Israel Lahey Health will cap its prices, strengthen safety net providers across the region, and invest in needed behavioral health services,” Healey said in a media release.

“These enforceable conditions, combined with rigorous monitoring and public reporting, create the right incentives to keep care in community settings and ensure all our residents can access the high-quality health care they deserve,” she said.

The deal also cleared a key federal hurdle when the Federal Trade Commission voted to close its investigation in light of Healey’s agreement.

“The assessment of whether to take enforcement action was a close call. However, based on Commission staff’s work and in light of the settlement obtained by the Massachusetts AG, we have decided to close this investigation,” the FTC said in a media release.

Kevin Tabb, MD, CEO of Beth Israel Deaconess Medical Center, who will serve as CEO of Beth Israel Lahey Health, called the state and federal approvals “an important step forward in making our vision a reality.”

“We appreciate the enormous effort that the Attorney General, her staff and the Federal Trade Commission have devoted to our proposal.  We share their commitment to health care innovation in Massachusetts, and we are eager to build on the strengths of our legacy organizations and deliver on our promise to our patients, their families and our communities,” Tabb said.

Massachusetts’ Health Care Cost Growth benchmark controls the annual growth of total medical spending in the state and is now set at 3.1%. Over the seven-year term, the cap will avoid more than $1 billion of the potential cost increases projected by the state’s Health Policy Commission.

When finalized, the merged, 13-hospital health system will be will one of the largest in the Bay State.

The merger push began in 2017, with Beth Israel and Lahey justifying the consolidation as a market-based attempt to address rising costs, price disparities, and healthcare access issues.

However, the deal has faced headwinds since its inception.

Even as late as this September, the Massachusetts Health Policy Commission noted that the merger would create a health system roughly the same size as Partner’s HealthCare System, the state’s largest health system, which would “increase substantially” market concentration in eastern Massachusetts.

“BILH’s enhanced bargaining leverage would enable it to substantially increase commercial prices that could increase total healthcare spending by an estimated $128.4 million to $170.8 million annually for inpatient, outpatient, and adult primary care services,” MHPC said.

In addition, the commission said spending on specialty physician services could increase by as much as $60 million annually if the merged health system obtains similar prices increases for those services.

“These would be in addition to the price increases the parties would have otherwise received,” the commission wrote. “These figures are likely to be conservative. The parties could obtain these projected price increases, significantly increasing healthcare spending, while remaining lower-priced than Partners.”

Those concerns appeared to have been alleviated on Thursday, when MHPC Commissioner Martin Cohen said “the investments required by the settlement will have a real impact on access to treatment for mental health and substance use disorders for patients across Eastern Massachusetts.”

Healey’s assurance of discontinuance also includes requirements that the merged Beth Israel Lahey Health pledge $71.6 million to support healthcare services for underserved areas.

The deal also requires BILH to strengthen its commitment to MassHealth; engage in business planning with its safety net hospital affiliates; enhance access to mental health and substance use disorder treatment; and retain a third-party monitor to ensure compliance with the terms.

The deal exempts affiliated safety net hospitals from the price-cap constraints. Lawrence General Hospital CEO Dianne J. Anderson said the exemption for her safety net will “ensure a commitment to joint, long-term planning for distribution of health care resources across the region.”

The $71.6 million that BILH will spend over eight years for underserved areas will include:

  • $41 million to fund affiliated community health centers and safety net hospitals, which guarantees support at the systems’ historic levels.
  • At least $8.8 million in additional financial support for affiliated community health centers and safety net hospitals.
  • At least $5 million in strategic investment to expand access to healthcare for low-income communities through community health centers.
  • At least $16.9 million to develop and expand behavioral health services across the BILH system.

“THROUGH THIS SETTLEMENT, BETH ISRAEL LAHEY HEALTH WILL CAP ITS PRICES, STRENGTHEN SAFETY NET PROVIDERS ACROSS THE REGION, AND INVEST IN NEEDED BEHAVIORAL HEALTH SERVICES.”

 

Rising Uninsured Rate Expected to Stress Margins of Nonprofit Providers

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More than 4 million people have lost coverage in the past two years, including many lower-income adults. That could prove problematic for safety net hospitals in the near future.

The ongoing efforts to destabilize the Affordable Care Act will adversely affect the operating margins of not-for-profit healthcare providers, according to a new analysis from S&P Global.

S&P analyst Allison Bretz said that over time, “a growing uninsured population could be a credit negative for not-for-profit hospitals and health systems, as these facilities would likely see an uptick in self-pay patients, charity care and bad debt.”

Two years into the Trump administration’s efforts to roll back the ACA, the uninsured population has risen from about 12.7% in 2016 to 15.5% in 2018.

A study by The Commonwealth Fund estimates that 4 million people have lost health insurance since 2016, and that the uninsured rate among lower-income adults rose from 21% in 2016 to 25.7% this spring.


“This will be most acute at safety-net providers and other providers with a high concentration of Medicaid patients, as that population is most vulnerable to many of these changes,” Bretz said in remarks accompanying the report.

Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, said the report “underscores concerns we’ve had since last year’s attempts to repeal the ACA and, now, with piecemeal changes that have weakened the law.”

“Many of the people who lose coverage seek care at our hospitals, which adds to uncompensated costs and puts more pressure on our members’ already low operating margins,” Feldpush said. “Because essential hospitals, by their mission, turn no one away, this could prove financially unsustainable for some.

Although active efforts to repeal the ACA in Congress have slowed in the past year, it is facing one of its greatest threats, as a federal judge in Texas hears a lawsuit brought by 20 states that challenges the constitutionality of the sweeping healthcare law.

For-profit, Payer Outlook Stable

While the rising uninsured rate could prove challenging for not-for-profit providers, S&P analyst David Peknay said it should have little effect on for-profit providers.

“The for-profit companies we rate have been reporting some increase in uninsured patients, consistent with national trends, but the impact on ratings is also currently immaterial,” he said.

The losses in covered lives for health insurance companies is offset by other factors, said S&P analyst Joseph Marinucci.

“A key contributing factor is the sustained migration of the government-sponsored insurance segments toward coordinated care (Medicare Advantage and managed Medicaid), which is expanding the market opportunity for health insurers,” Marinucci said.

“We expect ratings in the insurance sector to remain relatively stable in the near term despite the growth in the number of working-age uninsured individuals,” he said.

 

 

 

 

 

Harvey pounded the nation’s chemical epicenter. What’s in the foul-smelling floodwater left behind?

http://www.latimes.com/nation/nationnow/la-na-houston-chemical-plant-20170831-story.html

Image result for Harvey pounded the nation's chemical epicenter. What's in the foul-smelling floodwater left behind?

The pounding rains of Hurricane Harvey washed over the conduits, cooling towers, ethylene crackers and other esoteric equipment of the nation’s largest complex of chemical plants and petroleum refineries, leaving behind small lakes of brown, foul-smelling water whose contents are a mystery.

Broken tanks, factory fires and ruptured pipes are thought to have released a cocktail of toxic chemicals into the waters. Explosions that released thick black smoke were reported at the Arkema Inc. chemical plant, where floods knocked out the electricity, leaving the facility outside Houston without refrigeration needed to protect volatile chemicals.

Meanwhile, emissions into the air have soared as the petrochemical industry shut down and then started up chemical operations, a cycle that causes an uptick in releases.

The potential health problems were magnified by overflowing sewers, inoperative treatment plants and the residues of animal waste, including carcasses.

Nobody is sure how much long-term health impact, if any, will result from the tidal wave of toxins and bacteria that swept through the nation’s fourth largest city.

Exhaustive investigations by the Environmental Protection Agency and the National Academy of Engineering after Hurricane Katrina, in which floodwaters languished in New Orleans for about six weeks, showed that toxic concentrations and the resulting exposures were too low to cause significant long-term health problems.

That festering flood caused a stench for weeks that left soldiers gagging for air as they flew helicopters 2,000 feet over the city. The Army Corps of Engineers had to pump the water out of New Orleans, much of which lies below sea level.

A report by the National Academy of Engineering in March 2006 said the floodwaters contained elevated levels of contaminants. The inorganic compounds were below drinking-water standards, while arsenic levels, attributed in part to lawn fertilizer, were above those standards.

The EPA took 1,800 samples of residue and soil from across the New Orleans area after Hurricanes Katrina and Rita and found that generally “the sediments left behind by the flooding from the hurricanes are not expected to cause adverse health impacts to individuals returning to New Orleans.”

The situation is far different in Houston, where the floodwaters are receding much faster.

But because Houston is far more industrialized, Harvey could have a much larger potential for leaving a toxic trail.

Without question, air emissions rose significantly during and after the storm, said Elena Craft, a toxicologist and senior scientist at the Texas branch of the Environmental Defense Fund.

The industry shutdown and startup cycle released 2 million pounds of pollutants, equal to 40% of all the emissions from 2016, Craft said, based on reports the industry made to the Texas Commission on Environmental Quality.

“In a few days, we have had months of exposure,” Craft said.

Marathon Oil, for example, reported to the state that heavy rain had pounded the roof of a storage tank so hard that it tilted, exposing gasoline to the air.

The emissions reports also included such carcinogens and suspected carcinogens as benzene and butadiene.

Craft said that sewage treatment plants in Beaumont went off line. A pipe carrying anhydrous hydrogen chloride was compromised in La Porte. Harris County’s 26 federal Superfund toxic waste sites may have been affected, including one that contains dioxins from a former paper mill along the San Jacinto River.

The fire at the Arkema chemical plant in Crosby released organic hydrogen peroxide, which officials said is an irritant but not toxic.

Tommy Newsom, who lives about 7 miles from the plant, said he felt fine but wondered what other chemicals might be involved. “Who knows how much of what they’re telling us is true?” he said.

“I think the wind’s in my favor,” said Newsom, a 60-year-old port worker, pointing to Texas state and U.S. flags at the entrance to his housing development.

Jennifer Sass, a senior scientist with the Natural Resources Defense Council’s health program, said the situation in Houston is a perfect breeding ground for hepatitis and tetanus.

“The flood is so large and slow-moving and the area is packed with dirty industries that are poorly regulated. Because the oil and gas industries down here are not as safe, we are concerned those toxins and chemicals are leaking,” she said.

Texas regulators urged caution. “Floodwaters may contain many hazards, including infectious organisms, intestinal bacteria, and other disease agents,” the Texas Commission on Environmental Quality said in a statement. “Precautions should be taken by anyone involved in cleanup activities or any others who may be exposed to floodwaters.”

The American Chemistry Council said its members are in constant communication with state and federal regulators about the status of their operations.

“Hurricane Harvey has presented extreme and unique challenges for the city of Houston and the surrounding areas in southeast Texas and Louisiana, warranting an unprecedented response effort, including that by local industry,” the trade group said in a statement.

Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs

Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs

Image result for hurricane relief

Hurricane Harvey and its torrential aftermath disrupted everything on the Texas and Louisiana coasts — including health care. Patients can expect months of chaos, as their providers scramble just to get back to work and sort out medical records. In addition, the storm may end up killing, injuring and sickening many more people, as toxins such as mold and chemical explosions take their toll.

Even so, Harvey could have been worse, says a panel of experienced health care journalists on the latest Kaiser Health News “What the Health?” podcast. That’s because the medical infrastructure, unlike in many previous national disasters, held up relatively well. Hospitals planned for flooding, to the point that underground tunnels connecting one to another could be sealed off with “submarine doors” to keep the water from invading every facility.

Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times also discuss what impact the relief effort in Washington could have on an already jampacked September agenda. The pressing need for money to rebuild in Texas and Louisiana could complicate and delay other important congressional decisions, including deliberations on stabilizing or changing the Affordable Care Act.

Also this week: an interview with KHN Editor-in-Chief Elisabeth Rosenthal, author of “An American Sickness,” about why medical care costs so much.

Houston hospitals may not be back to normal for a month

https://www.statnews.com/2017/08/30/houston-area-hospitals-evacuations/

Amid the evacuation of approximately 1,500 patients from Houston-area hospitals, officials are commending the emergency response by health providers — while also cautioning that it may be weeks before the facilities are back to business as usual.

The SouthEast Texas Regional Advisory Council — which has overseen catastrophic medical operations since Hurricane Harvey as part of Houston’s emergency command center — estimates that nearly two dozen hospitals have evacuated patients by ambulance and airplane over the course of the past week.

“The storm was so huge it was uncertain what hospitals might be in harm’s way,” said Darrell Pile, chief executive officer of SETRAC. Had they known Harvey would grow into a Category 4 storm, Pile said, they would have staged evacuations three days in advance. But Harvey was unpredictable from the start — and grew stronger without much warning.

Evacuations have been slow not only because of the perils involved in moving patients but also because it has taken time to find other hospitals to accept them. “Some patients may have had gone to Dallas, San Antonio, Austin, or even Waco,” Pile said. “You’ve got to find the hospital to handle the unique needs of the patients you want to transfer.”

Evacuation numbers continued to climb on Tuesday. But Pile said numerous hospitals also scaled back or suspended plans for evacuations. One such facility was Ben Taub, one of Houston’s major safety-net hospitals, which only evacuated three patients after originally seeking to move all 350 patients after flooding occurred inside the hospital basement.

“In the case of Ben Taub, as the waters went down, and additional staff were able to arrive, they whittled down their list,” Pile said, speaking Wednesday. “They may even open back up to full service later today.”

Bryan McLeod, director of external and online communications at Harris Health System, said in a statement Tuesday afternoon that Ben Taub, the system’s largest hospital, is now seeking to “offload some of the patients that we currently have” in anticipation of a “surge of patients” expected as roads clear.

“I can only imagine the burden is going to increase,” said Vivian Ho, a health care economist with Rice University. “It’s going to get tough on them.”

Coordinated response

Pile praised the coordination of hospitals, first responders, and civic leaders. In other major storms elsewhere, he said, some hospitals have failed to communicate effectively; ambulances would bring patients to their doors even though the facilities might be unable to meet their needs.

By contrast, Pile said, roughly 25 hospitals affected by Harvey declared an “internal disaster” — a status that reflects a hospital facing problems in carrying out normal daily operations — that allowed SETRAC to pass along timely information along to first responders who could, in turn, divert patients toward care at hospitals capable of treating them.

“The majority of our hospitals stayed open,” Pile said. “The teamwork of hospitals and EMS agencies through our coalition kept it from becoming an even a bigger disaster.”

Pile hasn’t heard of any hospitals in the Houston area devastated to the point of shuttering — something that’s also occurred in other storm-ravaged cities. It’s because of that he believes nearly all Houston-area hospitals will be fully up and running by the end of September.

“This storm was paralyzing,” Pile said. “Within a month, [I expect] 90 to 95 percent of hospitals will be back in full service. That’s a first.”

 

Medicaid Expansion: Driving Innovation In Behavioral Health Integration

Medicaid Expansion: Driving Innovation In Behavioral Health Integration

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Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care. We found that safety-net providers in states that expand Medicaid are delivering more services and better-coordinated care than what is available in states rejecting the expansion.

Of particular interest is the effect of Medicaid expansion on attempts to integrate behavioral health services with primary health care — long a thorny issue for safety-net providers. Research has shown that the Affordable Care Act (ACA) has increased access to behavioral health services. We present case studies from two provider systems that illustrate some of the innovative approaches that are improving the quality of behavioral health care at safety-net institutions.

Gardens Regional Hospital, which treated the poor and homeless, files for bankruptcy

http://www.healthcarefinancenews.com/news/gardens-regional-hospital-which-treated-poor-and-homeless-files-bankruptcy

The California hospital was cited last year for ‘patient dumping’ a homeless woman at Los Angeles area of Skid Row.