catholic healthcare west

WellPoint proceeds with $11.8M settlement with hospitals, despite dropouts

Anne Zieger — Mon, 08 Sep 2008 04:17:37 -0400

Though nearly 20 percent of the hospitals it approached have decided not to participate, WellPoint subsidiary Anthem Blue Cross of California is proceeding with its $11.8 million class action settlement with the California Hospital Association. The settlement pays hospitals for claims related to patients whose policies were retroactively canceled, establishing an $11.65 million fund to pay hospitals for services to members, and a $150,000 fund for patients who paid some or all of the bill after their policies were canceled. The hospitals, for their part, will agree not to make any further attempts to collect from the patients.

While the majority of California Hospital Association members went for the deal, three entities opted out. Sutter Health, Catholic Healthcare West and St. Joseph Health System decided not to participate. Sutter said that the deal was not in the best interest of its affiliate hospitals; St. Joseph said it wanted to resolve the issue without going to court; and CHW said that it plans to proceed with its own suit against Anthem to collect money owed to its facilities. Collectively, the three entities represent 74 hospitals, or less than one-quarter of the Association's membership.

To learn more about the settlement:
- read this Sacramento Business Journal article

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California HealthCare Foundation donates $10M for low-interest clinic loans

Anne Zieger — Thu, 07 Aug 2008 12:14:48 -0400

The California HealthCare Foundation has contributed $10 million to a low-interest loan pool that helps clinics for the poor and uninsured provide care during the state's budget impasse. This follows a similar move by several hospital groups, including Sutter Health and Catholic Healthcare West, which announced in late July that they had kicked in $11.8 million. The fund, administered by nonprofit lender NCB Capital Impact, now totals $24 million. NCB Capital Impact will handle underwriting, approval, documentation and servicing of the loans.

The funds are intended to help the California Primary Care Association's (CPCA) 700 member clinics, which are losing $1,500 each minute that the state fails to resolve its budget woes, the group says. According to the CPCA, 41 percent of clinics are able to cover operating expenses for 30 days without reimbursement from Medi-Cal, the state's Medicaid program. However, once they run out they might otherwise be forced to turn to traditional lines of credit, interest rates for which can run as high as 14.5 percent.

To date, only 26 clinics have applied for funding, a small fraction of the 700 health centers and clinics statewide, possibly because they're still functioning based on checks issued at the end of July, observers say. To qualify, clinics must be nonprofit primary care, family planning or tribal clinics in existence for three years prior to their application. The clinics will be eligible to receive a total of $500,000 or 90 days' operating expenses at a modest interest rate.

To learn more about the program:
- read this California HealthCare Foundation article

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Coalition protests healthcare cuts in CA

Fri, 27 Jun 2008 06:59:57 -0400

It's somewhat ironic that a Governor as well known for his commitment to physical fitness as he is for being an aging action adventure hero has proposed deep budget cuts that could leave more than one million Californians without access to healthcare. But if adopted, Arnold Schwarzenegger's budget proposals would cut Medicaid spending by more than $1.1 billion in the fiscal year that begins next Tuesday.

A coalition of providers, carriers, labor unions and consumer advocates have joined forces to protest the cuts. The coalition includes Catholic Healthcare West; the Service Employees International Union; AARP and Health Access California; Kaiser Permanente and Health Net. In January, the same group failed to convince legislators to support a bill that would have funded a $15 billion health care expansion. The proposed cuts are expected to be approved because California has a $17 billion deficit.

Providers are rallying where they can to come up with strategies for ensuring access. For example, Health Net of California said that it will provide up to $5 million in emergency loans to keep safety-net health clinics vulnerable to budget cuts open.

For more info:
- see The Los Angeles Times story

IL considering bill limiting charges to uninsured

Thu, 29 May 2008 06:59:56 -0400

The state of Illinois is considering a bill that would set limits on what hospitals would be allowed to charge and collect from eligible uninsured patients. Under the terms of the bill, which was passed by the state House and is expected to pass the Senate, hospitals could charge no more than 135 percent of the costs for medically necessary care for eligible patients. To meet the criteria, the patient would have to be a state resident and make no more than six times the federal poverty level, or half of that in rural or critical-access regions. For patients who met these conditions, the hospital would be prohibited from collecting more than 25 percent of a patient's income each year unless the he or she had assets exceeding the income levels in the eligibility guidelines.

To learn more about the bill:
- read this Modern Healthcare piece (reg. req.)

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St. Louis hospitals give uninsured discounts

Wed, 19 Mar 2008 07:59:58 -0400

St. Louis-based BJC Healthcare, a 13-hospital system that cares for about 30 percent of the hospital patients in the metro area, has agreed to give a 25 percent discount to all hospital patients without insurance. Uninsured patients who were treated at a BJC hospital since Jan. 1, 1999, and paid some or all of the cost, may be eligible for a partial refund or bill reduction. The discounts also will apply to uninsured patients getting treatment until at least 2012.

Patients in families earning less than 400 percent of the federal poverty level, or about $82,600 for a family of four, will continue to get additional charity care discounts. Those at less than 200 percent of the poverty level, or about $41,300 for a family of four, will get free care. Those discounts were put into place in 2005, the year after the lawsuit was filed.

The settlement, if approved by a judge, will become effective in early September. The decision settles a class-action suit filed in 2004, one of several on behalf of patients complaining that their bills were two to three times as high as those for patients with insurance. Other area hospitals avoided getting caught up in the suit by voluntarily discounting prices aggressively to the uninsured, but BJC's discounts didn't satisfy the plaintiffs.

To learn more about the case:
- read this St. Louis Post-Dispatch piece

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SC court examines discounts for uninsured. Report
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SC court says uninsured not guaranteed discounts

Wed, 12 Mar 2008 07:59:57 -0400

A high court in South Carolina has ruled that state law doesn't force hospitals to give uninsured patients the same discounts offered insured patients. A lower court had held that a loophole in state law gave all patients access to the same discounts through 2004, which could cut 50 percent or more off a standard hospital bill according to some estimates. However, the South Carolina Supreme Court didn't buy this argument, noting that the type of contracts referred to by the 1960s-era law weren't used by hospitals any more.

Attorneys for the uninsured patients, meanwhile, say they aren't going to give up. They're going to continue to press a lawsuit against several state hospitals alleging that the uninsured patients were cheated. Because they can no longer base their case on state law--which required hospitals to offer anyone the best rate possible if the bills were paid within seven days--they're going forward using the notion of common law and fairness.

To learn more about the case:
- read this piece from The State

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SC court examines discounts for uninsured

Tue, 08 Jan 2008 06:59:57 -0500

The South Carolina Supreme Court is considering a case which could result in discounts of 50 percent off of hospital bills for patients billed through 2004. The dispute arises from a state law, since altered, which required hospitals to offer anyone the best rate possible if bills were paid within seven days. The court, which is hearing the case this week, will decide whether uninsured and underinsured patients should get those discounts, or even get money back. Lawyers for the patients want to get the case certified as a class action.

In reality, the dispute is academic for many patients. Since the state law was changed in 2006, hospitals have the right to charge whatever they like from now on. However, the American Hospital Association is recommending to members that they write off bills for uninsured patients with annual incomes 300 percent of the poverty rate, and offer a sliding scale to all other patients.

To learn more about the dispute:
- read this piece from The State

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Palo Alto Medical Foundation adds MDs, hospital

Mon, 22 Oct 2007 06:59:57 -0400

Things are humming along for the Palo Alto (CA) Medical Foundation (PAMF), which has just announced not only approval for its $375 million-odd dollar hospital project but also a merger with two area medical groups. PAMF, which is part of Sutter Health, is merging with Camino Medical Group and the Santa Cruz Medical Clinic as of January 1, 2008; the combined entity will have a roster of about 850 physicians. Meanwhile, PAMF has gotten the green light to move ahead with its planned 97-beds, $375 million hospital and medical complex in San Carlos, despite strong opposition from the Service Employees International Union and Catholic Healthcare West-affiliated competitor Sequoia Hospital. In the future, PAMF hopes to bulk up to about 1,500 doctors, a move which should help Sutter compete with Kaiser Permanente in northern California.

To learn more about PAMF's plans:
- read this San Francisco Business Times article

Insurance-free CA hospital empire keeps growing

Sun, 08 Jul 2007 20:01:38 -0400

A maverick California cardiologist continues to expand his burgeoning hospital empire, which now stands to challenge some of the biggest chains in the state. While the rapid pace of his acquisition is drawing attention--he's acquired six hospitals during the past year alone--what's really got the industry buzzing is the fact he's canceling all of the hospitals' contracts with health insurance plans.

Dr. Prem Reddy's Prime Healthcare Services now owns eight hospitals in California, putting the upstart firm on a footing similar to giants like Kaiser Permanente and Catholic Healthcare West. While some critics contend Reddy's hospitals turn away the uninsured, and state regulators have accused them of occasional safety violations, Reddy has termed the problems "insignificant" given the scale of his operation. He's more prone to cite his financial success, which include several stunning turnarounds of struggling hospitals into profit centers.

Once Prime acquires a hospital, it usually takes some aggressive steps to improve margins, frequently closing less-profitable services like mental health and chemotherapy and terminating insurance contracts. Critics say that on large scale, this approach could destabilize the state's healthcare market, as it could cut access to critical treatments. Reddy, for his part, says he's merely more efficient than his competitors.

To find out more about Prime:
- read this Los Angeles Times article

Related Article:
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California hospital system launches pro-reform ads

Sun, 01 Jul 2007 20:01:35 -0400

Catholic Healthcare West (CHW) has begun running a series of ads advocating healthcare reform in California. The health system, which operates 42 hospitals in California, Arizona and Nevada, plans to run print ads in several national and regional publications, including the Wall Street Journal, New York Times and Newsweek. The ads don't detail a specific reform scheme, but rather, agitate for broad healthcare accessibility. CHW also belongs to a pro-reform healthcare coalition, Together for Health Care, that includes employers, providers, health plans, unions and consumer groups.

Meanwhile, it's worth noting that CHW provided $800 million in charity care, community benefits and unreimbursed care last year. Though it's unlikely to say so publicly, CHW doubtless hopes a reform scheme will reduce that amount in the future.

To find out more about the campaign:
- read this article from the Silicon Valley/San Jose Business Journal

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