Healthcare Regulations

IL hospital must prove community benefit, or else

Wed, 11 Jul 2007 20:01:38 -0400

Of late, state and federal regulators have been challenging non-profit hospitals to prove they deserve their tax exemption. Hospital associations, health systems and individual facilities have responded by aggressively touting their estimates of the community benefit and levels of uncompensated care that they provide.

This exercise is important for all U.S. non-profits, but there's even more at stake for Mokena, Ill.-based Provena Health. The Catholic hospital chain has been fighting to keep its state property tax exemption in the face of claims it hadn't done enough. State's Department of Revenue Director Brian Hamer contends Provena Covenant Medical Center's 2002 charity care level, which he said represented less than 1 percent of its revenue, wasn't enough to merit its tax exemption. The Champaign County Board of Review pulled the property tax exemption in 2003, arguing the facility had been too aggressive in collecting money from indigent patients.

This year, Provena hopes to turn perceptions around. The chain says its community benefit efforts had $61.7 million in total impact on the 750,000 people served by its six hospitals and affiliated facilities. That includes $17 million in free care, $38.9 million in "non-reimbursed" services to Medicaid patients and $5.7 million in community services, hospital officials said. Now, let's see how this report goes down. If officials don't buy it, Provena could be in worse trouble.

To find out more about Provena's situation:
- read this Chicago Tribune piece

Related Articles:
Chicago voluntary hospitals face tax-exemption loss. Report
VHA: Charity policy must come from the top. Report
PwC: Time to prove community benefit. Report
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State stops acquisition by growing CA hospital chain

Wed, 11 Jul 2007 20:01:36 -0400

Earlier this week, we told you about the growing California hospital empire controlled by cardiologist Dr. Prem Reddy. Victorville, Calif.-based Prime Healthcare Services, which has made its mark with its insurance-free business model, has picked up eight California hospitals in recent times, drawing much attention and some opposition. Now, questions about the chain have stopped its next planned acquisition. State officials have nixed its attempt to buy non-profit Anaheim Memorial Medical, one of the largest medical centers in its region.

Anaheim's parent company, Memorial Health Services, had accepted a roughly $55 million bid for the 217-bed hospital in February. But in a nearly unheard of move, the state attorney intervened to cancel the deal, saying the proposed buy wasn't good for the region and didn't come with a high enough pricetag. The AG's office also said it was uncomfortable with the bidding process for acquiring the facility, which went up for sale about a year ago. Prime has said it intends to keep pursuing the deal, and is willing to participate in a new, alternative bidding process.

To learn more about the proposed deal:
- read this Los Angeles Times article

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CA law would ban patient dumping. Report
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Los Angeles-based King-Harbor may lose state license. Report

BC of California faces hearing on complaints

Tue, 10 Jul 2007 20:01:38 -0400

Over the past three years the state of California has logged more than 1,600 consumer, physician and hospital complaints about Blue Cross of California (BCC) business practices. Sparked by these complaints, the state's Department of Managed Health Care (DMHC) now plans to hold a public hearing to look at whether the Blue plan has kept promises it made when it was acquired in 2004 by WellPoint. The hearing, which will take place next week, follows a Department of Insurance report contending WellPoint unit BC Life & Health improperly revoked nearly 2,000 individual policies in 2004 and 2005.

When WellPoint acquired Blue Cross of California in 2004, state regulators made WellPoint promise it wouldn't use BCC's premium revenues to pay for the acquisition or finance executive payouts. (Regulators and critics were unhappy about a planned executive payment of up to $600 million.) Now, the plan is cutting physician fees while raising premiums, according to the California Medical Association. The DMHC also is scrutinizing a $950 million payment BCC made to WellPoint this spring to determine whether the payment violates the terms of the buyout deal.

To find out more about the hearing:
- read this Los Angeles Times piece

Related Articles:
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Flood of new MDs overwhelms TX board

Mon, 09 Jul 2007 20:01:37 -0400

Texas's new limits on medical malpractice awards has triggered a substantial migration of doctors into the state, overwhelming the state medical board and slowing down the process of screening newly-arriving physicians. These days, the Texas Medical Board is so bogged down that some doctors must wait months before they can actually begin seeing patients. In 2006, the board received 4,000 applications for medical licenses, a huge increase over the 2,992 it got last year. That has led to a backlog of almost 2,400 applications.

To speed things up, state legislators have approved funds to hire six more employees to process applications. It also has hired temporary workers and is paying overtime. Still, in some cases it takes more than six months to process an application, which includes verifying an applicant's medical education and doing a criminal background check. Insiders say it could be a year or more before the screening backlog goes away.

To find out more about the Texas MD licensing backlog:
- read this Associated Press article

Related Articles:
MD says Texas tort limits work. Report
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Doctor shortage slows Massachusetts health reform

Mon, 09 Jul 2007 20:01:36 -0400

Making sure uninsured citizens get health coverage sounds good--but it won't work if physicians aren't on board. And it looks like that's a real hurdle for Commonwealth Care, the new insurance-for-all plan offered by the state of Massachusetts.

Primary care physicians aren't thrilled with the requirements for participating in Commonwealth Care products, which include making sure a patient has a first appointment within 45 days and is seen within 48 hours for urgent-care issues. Not only that, physicians are complaining about Commonwealth care reimbursement levels, which are comparable to rates paid by state Medicaid program Mass Health. So with few primary care physicians participating, many Commonwealth Care patients are waiting weeks or even months to find practices who will see them--even to refer them to specialists.

To get more information on the shortage:
- read this Cape Cod Times piece

Related article:
Shortage of primary care docs in Massachusetts. Report

U of Pitt Med Center plans drug, device gift ban

Wed, 04 Jul 2007 20:01:38 -0400

The University of Pittsburgh Medical Center (UPMC) is poised to implement a new policy banning physicians and other employees from accepting virtually any type of pharma or device-maker freebies. If it moves ahead, UPMC would join a growing list of academic medical centers and other facilities that have instituted tight controls on such gifts. Employees and physicians who break the rules could face written reprimands and even loss of hospital privileges.

To address concerns raised by the plan's biggest critics--who say barring the acceptance of samples would harm poor patients--the school would look into setting up a voucher program giving patients access to meds at no cost to them. Only if the voucher approach failed would providers be allowed to make a special request for samples. The problem, critics say, is that such an approach could dramatically delay drug access by the poor and uninsured. Some institutions instituting similar controls, such as the Henry Ford Health System, have continued to permit physicians to accept samples under some circumstances.

To find out more about this trend:
- read this Pittsburgh Post-Gazette piece

Related Articles:
Stanford bans sales rep gifts to doctors. Article
UC Davis mulls pharma freebies ban. Article
"Let he who is without conflict-of-interest cast the first stone." Editor's Corner
Doctors reading FierceHealthcare weigh in on the pros and cons of accepting drug/device freebies is unethical. Things get pretty heated ... Letters
Group: Few med schools free of pharma influence. Report

WellPoint plan cited for cancellations

Mon, 02 Jul 2007 20:01:36 -0400

Continuing with an ongoing industry-wide investigation, the California Department of Insurance has cited WellPoint subsidiary BC Life & Health for improperly revoking individual health insurance policies. BC Life & Health, which revoked 1,880 individual policies during 2004 and 2005, already was being sued by consumer advocates and lawyers for policyholders over the cancellations. Now it's facing the wrath of the Department of Insurance, which has found that more than half of the BC Life & Health recessions it examined weren't handled appropriately. It has issued 49 citations, each of which could result in a $10,000 fine. The Department of Insurance also is investigating the policy-cancellation practices of Blue Shield, HealthNet, Cigna and Aetna.

This is not the first time WellPoint has faced charges its policy cancellation practices are out of line. WellPoint subsidiary Blue Cross of California was recently fined $1 million by another state agency, the Department of Managed Health Care, after it was found to have consistently violated state law regarding rescissions.

To get more information on the cancellations:
- read this Los Angeles Times article

Related Articles:
Blue Cross of CA settles plan-cancellation suits. Report
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Kaiser pushes for policy cancellation rules. Report

WV court says drugmakers must warn consumers

Sun, 01 Jul 2007 20:01:37 -0400

A West Virginia high court has ruled pharmas can be held partially liable for harm caused by drugs, despite the fact that physicians with medical expertise prescribe the drugs. The West Virginia Supreme Court of Appeals ruled Janssen Pharmaceutica was partially responsible for the death of patient Nancy Gellner, who died in 1999 after taking the company's Propulsid. Gellner's estate argued that despite her physician's role in prescribing the drug, Janssen should have better warned Gellner about its risks. Janssen argued, for its part, that under a legal doctrine known as "learned intermediary," the physician was completely responsible for any negative results from prescribing the drug. But the appeals court held Janssen (and by extension, other drugmakers) should be doing more to inform consumers about the risks of taking their products.

"When the learned intermediary doctrine was developed, direct to consumer advertising was utterly unknown," wrote Chief Justice Robin Davis. "... For good or ill, that has all changed."

To find out more about this case:
- read this LegalNewsline.com piece
- and this Charleston Gazette report

Officials make case for Los Angeles hospital closure

Sun, 01 Jul 2007 20:01:34 -0400

California regulators laid out their case this week for closing Martin Luther King Jr.-Harbor Hospital, arguing it continues to provide substandard care and is putting patients at risk. In a 32-page report, the California Department of Health Services cited findings from inspections between October 2004 and June 2007, that suggest the hospital hasn't made sure nurses are competent or that patients are protected from harm.

Incidents cited include the death of Edith Isabel Rodriguez, a 43-year-old woman who died on King/Harbor's emergency department's floor while being ignored by hospital staff. Los Angeles County, which runs the hospital, has asked county health officials to begin making closure plans just in case regulators succeed in getting the hospital's license revoked.

To find out more about the proposed closure:
- read this Los Angeles Times article

Related Articles:
King-Harbor state restructuring in jeopardy. Article
After death, LA hospital faces training demand. Report
LA officials grapple with King-Harbor hospital death. Report
Senator questions CMS on King-Harbor. Report

Congress debates pharma gift disclosure

Wed, 27 Jun 2007 20:01:36 -0400

While state efforts to require disclosure of pharma gifts to doctors have proven a bit, well, wobbly, federal legislation is still on the table.

Yesterday, members of Congress were discussing just such a measure--a national registry that would publicize the value of gifts and payments to physicians. The hearing, before the Senate Special Committee on Aging, was tagged "Paid to Prescribe?"

At the hearing, chairman Herb Kohl (D-Wisc) cited a study published by The New England Journal of Medicine suggesting that 94 percent of doctors get gifts and perks from pharmas.

"Gifts and payments can compromise physicians' medical judgment," he said.

Other speakers, including Peter Laurie of consumer advocacy group Public Citizen, noted that disclosure laws in states like Minnesota, Vermont and the District of Columbia are ineffective, with pharmas using loopholes like labeling the gifts as trade secrets to avoid disclosures. The AMA, meanwhile, argues physicians can self-police their pharma relationships adequately.

To learn more about the debate:
- read this United Press International article

Related Articles:
Psychiatrists getting largest pharma gifts. Report
NY bill would require pharmas to report MD gifts. Report
Doctors weigh in on pros and cons of accepting drug/device freebies. Letters
States tighten screws on pharma marketers. Report