Healthcare Finance

Given the growing trend toward high-deductible, consumer-driven health--and larger co-pay requirements--patients are paying closer attention to their medical bills. And when they're hit with an unexpectedly large bill from a medical clinic deemed "hospital based," some are hitting the roof. Hospital administrators say that they need to charge facility fees to cover their overall operational costs. But industry attorneys say that this practice is likely to face significant challenges in …

In the year 2000, American taxpayers paid $1.1 billion in healthcare costs for illegal immigrants between the ages of 18 and 64, according to new, hotly-contested research by the Rand Corporation. That's about $11 per U.S. household. The study found that almost 22 percent of illegals have health insurance, which covered about $362 million in costs, and that the immigrants themselves paid another $321 million in out-of-pocket expenses. It's worth noting that Rand's study only included …

This is the story of one more healthcare system's struggle to provide humane, cost-efficient care to an underserved population, in this case illegal immigrants. Like other uninsured patients, Delaware's illegal immigrants often have little access to primary care. When they're sick, they end up in the emergency rooms of Delaware's hospitals, crowding out insured patients while generating bills they can't pay. The hospitals get some federal funding to compensate for the cost of caring for …

Drug store chain CVS has agreed to acquire pharmacy benefit management firm Caremark Rx for about $21 billion in stock, merging Caremark with PharmaCare, CVS's existing PBM. The deal creates an "integrated pharmacy services provider" with annual revenues of about $75 billion, and should generate about $400 million in operating efficiencies for the two. The …

More than half of commercial HMOs in the U.S. have now implemented some form of pay for performance program, according to a new study conducted by researchers at the Harvard School of Public Health. The study, which surveyed 242 commercial HMOs, concluded that 52.1 percent of the plans were using some type of pay for performance scheme. These plans collectively manage for 81.3 percent of all U.S. commercial HMO enrollees, …

San Pablo, CA-based Doctors Medical Center should soon be receiving a $20 million cash infusion from county authorities. The bankrupt hospital, which is run by the West Contra Costa Health Care District, had been losing $1 million per month, and was turning away ambulances from its emergency department. Under the terms of a new proposal, the hospital will receive the $20 million in three installments this year. The hospital had previously said that it needed at least $18 million to stay …

A coalition of patient advocacy groups has come together to demand that Medicare drop its current prostate cancer treatment policy, charging that the policy emphasizes cost containment over patient well-being. Right now, Medicare policy requires that patients receive the "least cost alternative" (LCA) treatment for prostate cancer, if in CMS's view, multiple treatments appear to offer the same benefits. If patients choose the more expensive treatment, they must cover the difference …

A new report released by the state of Connecticut suggests that the state's hospitals are in a uniquely difficult financial position. The report, issued by the state's Legislative Program Review and Investigations Committee, concluded that Connecticut hospitals "appear not as healthy financially as hospitals in the rest of the country." This is music to the ears of the Connecticut Hospital Association, which has been making this point for more than a decade, according a piece in the …

A new report by the American Hospital Association says that uncompensated care at community hospitals held steady in 2005 at 5.6 percent of expenses, rather than continuing to climb as it had in past year. The total cost of uncompensated care, including free or discounted services and bad debt, climbed 7.1 percent to $28.8 billion last year. This was boosted by growing Medicare and Medicaid shortfalls, which jumped 14.5 percent to $25.3 billion.

The hospitals had previously posted …

One way or the other, you're going to end up treating the uninsured. So why not cut your losses, and along the way, salvage your bottom line? That seems to be the thinking behind an emerging practice in which some forward-thinking hospitals are providing free preventative care to uninsured working poor patients who don't qualify for public medical funding. One proponent of this approach is the Seton Family of Hospitals, an Austin, TX-based Roman Catholic hospital network. Through its …