Pricey Land Complicates Options For Ailing NYC Hospital

This article by Pete Brush first appeared Law360.com on March 27, 2013.

Law360, New York (March 27, 2013, 10:10 PM ET) — Sky-high valuations for the real estate on which Brooklyn, N.Y.’s nearly insolvent Long Island College Hospital sits, estimated to be as much as $500 million, are creating a “perverse financial incentive” and complicating legal efforts by labor unions to save it, bankruptcy and other experts said Wednesday.

The comments come as unions, including the New York State Nurses Association and their political allies, have vowed to take legal steps to keep the 155-year-old hospital in Brooklyn’s Cobble Hill neighborhood from being shuttered and sold to developers.

Labor won a round in March, when a state trial judge said an initial vote to shut down the hospital ran afoul of open meetings law. That ruling marked only a fleeting victory, however.

The Board of Trustees of the State University of New York, which owns LICH after an ill-fated 2010 merger, promptly held another meeting and voted for closure a second time, in full view of hundreds of doctors and nurses who work there. Continue reading →

Navigating The Rapids of Health Care Reform Without a Paddle

This article first appeared in Corporate Compliance Insights on March 28, 2013.

“The only fence against the world is a thorough knowledge of it.”  – John Locke, philosopher (1632-1704)

In its bid to restructure the nation’s health care system, the 2010 Patient Protection and Affordable Care Act (the “ACA”) has created both challenges and opportunities in the areas of corporate compliance, governance and risk communities. In three short years, myriad regulatory clarifications have swollen this 906-page statutory giant into a 70,000-page behemoth whose might has been enough to overcome the judicial and electoral challenges of 2012, eliminating any doubts as to whether reform is here to stay.

At its core, the ACA means different things to different people. Patients typically focus on the promise of new guarantees and protections for health insurance for the populace, as well as the penalties for those who remain without coverage. But the ACA has also captured the attention of health care providers as they shift from a formerly cost-based system toward one that gauges success or failure primarily on patient experience. Even the insurance industry must yield to the new law and wend its way through a changing landscape complete with medical loss ratio requirements, the end of lifetime limitations, challenges to any increase in premiums over a certain percentage, and the soon to be introduced Health Insurance Exchanges.

While the infusion of elements such as innovation, preventative care and overall wellness provide the Federal Government with a new and as yet untested backup plan to ensure the success of health care reform, plenty of room still exists within the ACA to combat health care fraud, abuse and waste. The False Claims Act stands at the forefront in the government’s battle to preserve the integrity of health care resources, although the law has evolved considerably since first signed into effect by President Lincoln in 1863.  By ensuring the legacy of the FCA for future generations, however, the ACA has also created several compliance risks for companies across the nation.  Here are the top five: Continue reading →

Internet Hospital Ratings (from Kaiser Health News)

The excerpt below is from the March 18, 2013, article written by Jordan Rau of Kaiser Health News.

Here is a guide to understanding the ways in which hospitals are rated on the Internet:

Medicare’s Hospital Compare: This government site publishes dozens of quality measures that private ratings groups use for their own rankings [comparing three hospitals at a time].

Consumer Reports: This nonprofit calculates a “safety score” on a 100-point scale based on infection, error and readmission rates as well as good communication from doctors and nurses [subscription needed].

Healthgrades: This private company rates hospitals in up to two dozen specialties and provides some of the Hospital Compare data in a user-friendly format. Healthgrades also gives out awards and distinctions in various specialties.

The Joint Commission: This accrediting group tells you if a hospital has passed its certification reviews.

Leapfrog Hospital Safety Score  This nonprofit group uses information from its own surveys as well as government data to come up with a letter grade for how well hospitals protect patients from unnecessary harm.

Truven Health Analytics 100 Top Hospitals This private company selects best hospitals in five categories based on their size and whether they are teaching institutions or community hospitals. It also picks 15 top hospital systems and best cardiovascular hospitals.

U.S. News and World Report Alone among raters, this media company surveys specialists for their opinions in choosing the best national and regional hospitals in different specialties. For 12 specialties, reputation makes up a third of the score, with data determining the rest. In four specialties the ratings are entirely based on reputation. U.S. News also ranks best children’s hospitals.

Inland Empire Provider Positioning for Growth in Reform

This article first appeared on March 11, 2013, in California Healthline.
(by Lauren McSherry, California Healthline Regional Correspondent)

SAN BERNARDINO — Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year.

Experts said the expansion is likely part of the health system’s strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a result of the Affordable Care Act.

In recent years, Loma Linda University Health has undertaken a number of construction projects in San Bernardino County, where its main medical campus is based, and in Riverside County. The health system, which includes the region’s only Level 1 trauma center and children’s hospital, now has more than 1,000 beds in six hospitals in the Inland Empire.

In 2009, the health system opened a 90,000 square-foot outpatient satellite campus in Beaumont. Through partnerships with Beaver Medical Group and Redlands Community Hospital, Loma Linda University Health’s Highland Springs Medical Plaza offers specialty services, such as oncology, cardiology, neurosurgery and orthopedics. Continue reading →

Two Strikes and Contraception Is Out

On February 1, 2013, the Federal Government issued proposed rules that may finally end the contraception controversy and its challenge to the Affordable Care Act’s commitment to preventative services, including addressing requirements relating to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive ability.

The proposed rules lower the bar for employers engaged in secular and religious purposes, as well as those religious employers who hire outside the fold. The latest version acquiesces to eligible organizations opposed to contraceptive coverage, finally offering absolution from the requirements of Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act and Section 9815(a)(1) of the Internal Revenue Code.  In essence, the proposed rules let these employers practice what they preach. Continue reading →

7 Healthcare Leaders Share Thoughts on Sequestration

This article was first published in Becker’s Hospital Review on March 1, 2013.

Unless Congress passes a replacement budget bill tonight to save the federal government $1.2 trillion over the next 10 years, $85 billion in spending cuts known as sequestration will be struck from the federal budget automatically, including a 2 percent reduction in Medicare funding and a drying up of discretionary spending such as medical research grants. Here are healthcare leaders’ predictions on the effect sequestration would have on the healthcare industry.

Craig Garner, JD, Healthcare Attorney and Former CEO of Coast Plaza Hospital in Norwalk, Calif.: When investigating the overall strength of our nation’s healthcare system under the Affordable Care Act, lessons learned from the “debt ceiling” and “fiscal cliff” debacles provide ample insight in predicting that the sequestration story will end with a resounding “to be continued.” Although this message may be overlooked if a purported last-minute compromise wins the day, regardless of any healthcare related casualties incurred, the fact remains that there are not many ways to reduce the level of domestic healthcare spending other than by reducing the level of spending overall.

To an industry already in the depths of economic instability, it is difficult to identify any meaningful benefits resulting from lost revenue. At the same time, this remains a fundamental tenet within the [Patient Protection and Affordable Care Act], as providers shift from cost-based to performance-based reimbursement. Whether as a result of value-based purchasing, penalties due to readmissions, denials for hospital-acquired conditions or the anticipated 2 percent reduction from sequestration, today’s providers must find ways to accomplish more in exchange for less. Continue reading →

The Affordable Care Act: A Not-So-Little Train That Must

This article was first published in the Los Angeles Daily Journal on February 25, 2013.

“Things do not change. We change.”  - Henry David Thoreau

Finally free from the uncertainty of looming elections or Supreme Court decisions questioning consititutionality, modern American health care can now be compared to a speeding train serving infinite destinations, with conductors and passengers alike learning the routes along the way. Public transportation is usually forgiving, as the tardy or confused passenger always has the opportunity to catch the next train, but such is not always true in matters of public health.  Whether fan or foe of the Affordable Care Act (the ACA), this epic codification of health care reform is something that America cannot afford to miss.

At the time the ACA was passed in March 2010, by a margin of seven of the collective 431 Congressional votes, few of those involved had any real working knowledge of the 10,909 sections contained within the Patient Protection and Affordable Care Act, which were quickly adjusted and finalized by congressional changes the following week in the form of the Health Care and Education Reconciliation Act. Weighing in at over 900 pages, hindsight makes it clear that the ACA was only the beginning of the federal government’s plan to restructure the nation’s health care system, a fact that has been compounded by an estimated 70,000 pages of further regulations in the three years since President Barack Obama signed the ACA into law. Continue reading →

CCOs to Use Tools of Trade in New Payment Models, Delivery Systems

This article was first published on February 18, 2013 at AISHealth.

Compliance officers are starting to apply the tricks of their trade to new payment models and health care delivery systems.To keep up with the major transformations rippling through the industry, some compliance officers will need to monitor datathat are used to evaluate their health systems’ performance, tap into new resources and work more closely with finance,revenue cycle and other departments, experts say.

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More hospital revenue will depend on its performance on quality, value and patient satisfaction measures, which impactsthe way compliance officers identify risks. “Establishing a link between finances and compliance makes sense becauseperformance is now integral to compliance,” said attorney Craig Garner, who spoke at a recent Health Care ComplianceAssociation webinar. Continue reading →

Return of the Hall Monitor

Say Hello to the Chief Compliance Officer at a Pharmaceutical Company Near You

This article first appeared in Pharmaceutical Compliance Monitor on February 11, 2013.

As any teenager will tell you, nobody likes a snitch. When it comes to the antics of the adolescent, rarely is unwanted disclosure or unsolicited intervention met with appreciation.  And yet, in observing the conduct displayed recently throughout many fields in our nation’s business sector, similar sentiment rang true across corporate America, and the moral “high road” was rarely found to intersect with the path most traveled. The health care industry was no different, and any strict constructionist interpretation of the Hippocratic Oath usually limited “do no harm” to the delivery of patient care in its most literal sense, foregoing the machinations conspiring behind the scenes to keep a hospital’s doors open in the face of a souring economic climate.

Now Is the Time for Compliance

The ethical transformation in health care that gained momentum one score and seven years ago has its origins in a law signed on March 2, 1863, by the president famous for the words “four score and seven years ago” uttered that same year.  The False Claims Act (the “FCA”), also known as “Lincoln’s Law” and the “Informer’s Act,” has evolved considerably since its enactment to become the “primary litigative tool for combating fraud” (see S. Rep. 99-345, at 2 (1986)).  Continue reading →

The Poor Get Poorer: The Fate of Distressed Hospitals Under the Affordable Care Act

This article, written by Samuel R. Maizel and Craig Garner, first appeared at 2012 No. 12 Norton Bankr. L. Adviser 1 in December 2012. 

Synopsis

Distressed hospitals in America operate on small or non-existent profit margins.3 For many of those hospitals, the federal Medicare program and the individual States’ Medicaid programs are the largest payors. While the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act”) was designed in part to increase the number of insured nationwide, the result of which should be positive for hospitals, any cause for celebration must first address the cost containment provisions in the Affordable Care Act that create new concerns for financially distressed hospitals. Included among the multitude of provisions in the Affordable Care Act are an immediate 1% cut in Medicare revenue, phased in reductions in disproportionate share payments to hospitals, future, permanent penalties of up to 1% of Medicare payments for hospitals which perform poorly under the Hospital Value Based Purchasing Program, and additional penalties for hospitals with unacceptable rates of re-admission or too many hospital acquired conditions rates.4 Together these cuts create a daunting challenge for the many financially distressed hospitals in America that simply lack the resources to establish an infrastructure designed to treat Medicare patients in this era of change.

Background

Medicare is the federal program that provides health care coverage to individuals aged 65 or older. Medicaid offers similar access for medical services on a state level for qualifying individuals, many of whom are poor. Medicaid covers 69 million people.5 By 2020, under the Affordable Care Act the number of Medicaid beneficiaries is likely to increase to 93 million.6 Combined, Medicare and Medicaid pay for more than half of the annual hospital bills in America. Continue reading →

 

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