News In Healthcare

I love to see where the largest pay­ers rank when it comes to per­cent­age of claim denials, days in A/R, denial trans­parency.  That is why I was so excited to see the new report issued by Athena Health.  This site allows you to ana­lyze payer per­for­mance by region and by issue.  Can you believe that Unit­ed­Health Group ranks #1 in the nation for the per­cent­age of denied claims that close with only one addi­tional resub­mis­sion?  Of course they ranked 4th in the per­cent­age of denied claims requir­ing addi­tional work on the back-end.

Busi­ness Week reported that Unit­ed­Health Group, Inc., the nation’s largest man­aged care com­pany by rev­enue, spent $1.5 mil­lion dur­ing the first quar­ter of 2009 to lobby Con­gress, the Depart­ment of Health and Human Ser­vices, the Con­gres­sional Bud­get Office, and the Cen­ters for Medicare and Med­ic­aid Ser­vices.  It seems to me that that money would have been bet­ter spent pay­ing patients’ med­ical bills.

In a recent blog post, Sen­a­tor Mike Enzi spoke out about Sen­ate Bill 625, oth­er­wise known as the Fam­ily Pre­ven­tion and Tobacco Con­trol Act.  In a nut­shell, he is not a sup­porter of a bill that gives the pub­lic the per­cep­tion that tobacco prod­ucts have been reviewed and approved by the FDA.   Although cer­tain changes have been made to the lan­guage of the leg­is­la­tion, remov­ing the FDA approval process and replac­ing it with merely an approval to be mar­keted, the bill still does not have the goal of get­ting peo­ple to stop smok­ing.  Sen­a­tor Enzi got it right when he said, “Tobacco is one of the biggest con­trib­u­tors to our nation’s grow­ing health care cri­sis.  We need to address this issue head on, not sign a peace treaty with the com­pa­nies who per­pet­u­ate and profit from the cri­sis.”  The bill is cur­rently pend­ing before the Sen­ate Com­mit­tee on Health, Edu­ca­tion, Labor and Pen­sions (HELP).

Do you remem­ber 2 years or so ago hear­ing all about the illicit prac­tices of not-for-profit hos­pi­tals and health sys­tems for charg­ing unin­sured patients full price for their health care?  One attor­ney, Richard Scruggs, led the charge in fed­eral court on behalf of the class of unin­sured vic­tims to get the tax-exempt sta­tus of these not-for-profits revoked.  Well, that really didn’t go any­where but there was one hos­pi­tal sys­tem that fell vic­tim at the hands of a local author­ity who took mat­ters into their own hands.  Four years ago, Provena Covenant Med­ical Cen­ter in Illi­nois had their tax-exempt sta­tus revoked by the Cham­paign County Board of Review.  After years of fight­ing the revo­ca­tion, and pay­ing over $6 mil­lion in taxes, the hos­pi­tal has finally won.  Mod­ern Health­care recently reported that a cir­cuit court judge sided with the hos­pi­tal to rein­state its prop­erty tax exemp­tion.  The county has not yet decided to appeal. 

And that is exactly what a board mem­ber of Grady Hos­pi­tal in Geor­gia did recently.  Fed up with unpaid expenses for treat­ing poor and unin­sured res­i­dents of a nearby county, Bill Loughrey took a $4 mil­lion dol­lar bill to the Cobb County Board of Com­mis­sion­ers for pay­ment.  The Atlanta Jour­nal Con­sti­tu­tion reports that Loughrey’s actions did not sit will with the Com­mis­sioner of Ful­ton County, the per­son who appointed him to the board, and Loughrey was replaced.  

What is the Pres­i­dent talk­ing about?  Excer­cise.  May is Phys­i­cal Fit­ness month and in cel­e­bra­tion, the Pres­i­dent went on a bike ride.  But before doing so, joined by Sec­re­tary Mike Leav­itt and a bunch of reporters, he spoke about the impor­tance of excer­cis­ing 30 min­utes a day to keep our bod­ies in top shape.  Pre­ven­ta­tive care goes along with the President’s plan to have Health Sav­ings Accounts fix the health­care cri­sis in Amer­ica.  In any event, it was a very impor­tant mes­sage that every­one, no mat­ter what side of the debate you are on, should lis­ten to.

Well, read the Senator’s entry on The Hill’s Con­gress Blog and you will find out.   Yes­ter­day, Sen­a­tor Bernie Sanders of Ver­mont com­mented on all of the recent action regard­ing pre­sprip­tion drugs and the power of the phar­ma­ceu­ti­cal indus­try lobby.   In a nut­shell, Sen­a­tor Sanders’ view is “What this debate on pre­scrip­tion drugs is really about is not safety.  It is about the power of the phar­ma­ceu­ti­cal indus­try, which in this city of enor­mously pow­er­ful spe­cial inter­ests stands alone as the most impor­tant, and in my view the greed­i­est lobby in the entire United States of America.” 

John Edwards, 2008 demo­c­ra­tic pres­i­den­tial can­di­date, is a man with a plan.  Sure he joins the other demo­c­ra­tic can­di­dates in say­ing that health care reform is one of his plat­forms for the race.  How­ever, he is actu­ally lay­ing out a plan to extend health insur­ance to every Amer­i­can.  The Raleigh News & Observer reports that the Edwards plan would require every Amer­i­can to have health cov­er­age by 2012.  Employ­ers would be required to either pro­vide cov­er­age to their employ­ees or to fund cov­er­age through some other means.  Insur­ance com­pa­nies would be required to sell cov­er­age at a fair price regard­less of a person’s med­ical his­tory.  Tax cred­its would be offered to help indi­vid­u­als of mod­est means to pur­chase health insur­ance.  How much would this cost?  Edwards says between $90 bil­lion to $120 bil­lion per year — which would be paid for by repeal­ing tax cuts Pres­i­dent Bush pre­vi­ously pushed through on fam­i­lies with tax­able incomes of more than $200,000 per year.

Yes­ter­day, Pres­i­dent Bush cel­e­brated Cinco de Mayo in the White House Rose Gar­den with sev­eral famous and influ­en­tial Mexican-Americans.  The Pres­i­dent took the oppor­tu­nity to touch upon our need for immi­gra­tion reform.   He had spo­ken sev­eral times this week on our need for com­pre­hen­sive immi­gra­tion reform.   Since many peo­ple spec­u­late that the unin­sured cri­sis in Amer­ica is largely due to our exist­ing immi­gra­tion poli­cies, this is a topic that health­care providers should fol­low closely — despite the fact that the reform pack­age does not specif­i­cally address health­care.  The reform pack­age has five main goals:

1.  Secur­ing the Border

2.  Cre­at­ing a Tem­po­rary Worker Program

3.   Hold­ing Employ­ers Account­able for the Work­ers They Hire

4.  Resolv­ing the Sta­tus of the Mil­lions of Ille­gal Immi­grants Already in the Country

5.  Find­ing New Ways to Help New­com­ers Assim­i­late Into Our Society

Well­Point recently announced that it is start­ing a plan where its own employ­ees will get their bonuses if they prac­ticed pre­ven­ta­tive mea­sures such as can­cer screen­ings, immu­niza­tions, and dia­betes man­age­ment tools.  The Amer­i­can Med­ical News explains that Well­Point has devel­oped a mea­sure­ment and track­ing tool to assess an employee’s health sta­tus.  The goal of the pro­gram is to ensure that WellPoint’s employ­ees stay their healthiest.