HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

A Nashville district court judge allowed the shareholders’ case to move forward by rejecting the hospital chain’s arguments that the plaintiffs had missed ‘multiple opportunities’ to learn more about the company before buying shares.

Reuters: U.S. Hospital Chain HCA Must Face Class Action Over 2011 IPO

HCA Holdings Inc., one of the largest U.S. hospital chains, must face a shareholder class-action lawsuit accusing it of concealing revenue declines and its routine performance of unnecessary cardiac procedures prior to its $4.35 billion initial public offering in March 2011. U.S. District Judge Kevin Sharp in Nashville, Tennessee, rejected HCA’s claim that the plaintiffs had missed “multiple opportunities” to learn more about the company before buying their shares, including from media reports, conference calls, and disclosures during the IPO road show. Shareholders alleged that HCA, its directors, its former private equity owners and its investment banks concealed how the company was seeing adverse trends in Medicare revenue including cardiology, and Medicaid revenue per admission and accounted improperly for a 2006 reorganization and a 2010 restructuring (Stempel, 9/23).

Meanwhile, the CEO of a growing medical lab steps down amid a federal probe –

The Wall Street Journal: Health Diagnostic Laboratory CEO Resigns

The chief executive officer of a fast-growing medical laboratory that has collected hundreds of millions of dollars from Medicare resigned amid a federal investigation into its payments of blood-sample fees to doctors. Health Diagnostic Laboratory Inc. CEO Tonya Mallory ceded the reins of the Richmond, Va., company to Joe McConnell, a former Mayo Clinic scientist who co-founded HDL with her five years ago. Ms. Mallory will remain on HDL’s board and serve as an adviser to Dr. McConnell, she said in a note to employees (Carreyrou, 9/23).

HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

Wal-Mart and CVS Eye Expanded Roles In Health Care Delivery

Marketplace reports that Wal-Mart is opening up clinics in a handful of states, while Kaiser Health News details a the dynamics of a partnership between CVS and MedStar Health. Also, in Connecticut, a group of independent hospitals joins forces to gain the benefits of scale.

Marketplace: At Some Wal-Marts, Health Care In Your Shopping Cart

Maybe you’ve picked up a prescription medication or been fitted for a pair of eyeglasses at Wal-Mart. But would you trust Wal-Mart with your larger medical care? The retailer is trying to figure that out, opening up clinics in a handful of stores in South Carolina, Georgia and Texas (McCammon, 9/23).

Kaiser Health News: Win-Win? CVS Joining Forces With Hospitals, Doctors

Neglected to pick up your prescription? Now, there’s a good chance your doctor will know and do something about it, thanks to a slew of new partnerships between CVS Health and various health systems. One of the most recent, which is slated to begin by early next year, will integrate the electronic medical records from MedStar Health’s 10 hospitals and 4,000 doctors – located in Washington, D.C. and Maryland — with CVS pharmacies as well as the chain’s 900 Minute Clinics located across the country (Luthra, 9/24).

Connecticut Mirror: As Competitors Join Big Chains, Independent Hospitals Join Forces

With several Connecticut hospitals poised to join larger chains, a group of five health care systems announced plans Tuesday to take another tack — forming an alliance aimed at giving them the benefits of scale while remaining independent. The “Value Care Alliance” is intended to give the systems better purchasing power, share best practices and adapt to a changing health care environment that favors larger companies. It won’t change the ownership of the hospitals and won’t require state approval, said Ken Roberts, a spokesman for Griffin Hospital in Derby, one of the alliance members (Levin Becker, 9/23).

Wal-Mart and CVS Eye Expanded Roles In Health Care Delivery

For Gay Men, Gaps In HIV Knowledge And Treatment Persist

This KHN story can be republished for free. (details)

Saturday is National Gay Men’s HIV/AIDS Awareness Day, but the news about knowledge and treatment of HIV in the gay community is dispiriting.

(Photo by Mario Tama/Getty Images)

Just 30 percent of gay and bisexual men say they were tested for HIV within the last year as recommended; another 30 percent say they have never been tested.

And even when they are tested, only half of those who have been diagnosed with HIV are receiving care and treatment for their infection.

Those statistics come from two reports released Thursday, the first a survey of gay and bisexual men from the Kaiser Family Foundation and the second, an analysis of men diagnosed with HIV in 2010 from the Centers for Disease Control and Prevention. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

“It’s unacceptable that treatment, one of our most powerful tools for protecting people’s health and preventing new HIV infections, is reaching only a fraction of gay men who need it,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention in a statement. “A top prevention priority at CDC is making sure every gay man with HIV knows his status and receives ongoing medical care – otherwise, we will never tackle the HIV epidemic in the country.”

At least part of the problem may be a lack of education about the disease.

Fewer than half of gay and bisexual men surveyed in the KFF poll were aware that antiretroviral treatment should begin immediately after an HIV diagnosis, and one quarter knew that treatment can reduce the risk of passing their infections along to a partner. Just 26 percent knew about PrEP, a daily pill for HIV-negative individuals that can lower their risk of becoming infected.

“It is surprising to a lot of us who spend a lot of time thinking of these issues and live in places where they’re talked about a lot,” says Liz Hamel, lead author of the KFF poll. “But this survey is nationwide and doesn’t necessarily reflect what gay men in activist circles in San Francisco are hearing and talking about.”

The results of the survey mean that there’s a tremendous opportunity to increase awareness, Hamel adds. Some of that education could come from physicians. More than half of those polled in the KFF survey report that a doctor has never recommended they get tested for HIV; 61 percent say they rarely or never discuss HIV with their doctor.

“When you look at the growing epidemic among young gay and bi men, I’m not sure the results aren’t all that surprising, but certainly hugely disappointing,” says Michael Kaplan, President & CEO of AIDS United, a Washington D.C.-based advocacy and grant-making group. ”It is amazing at a time when testing and treatment offer so much hope in this epidemic, and when gay and bi men face such high rates, we’ve yet to succeed in more regular screening and educating gay and bi men about treatment.”

The KFF poll found that the gay and bisexual community has also shifted to other priorities besides HIV.  HIV was still listed as the top health priority, but when asked to name the most important issue facing gay and bisexual men today, HIV ranked behind discrimination/lack of acceptance and was on a par with equal rights and marriage equality.

Just 35 percent said they were personally concerned about becoming infected with HIV.

Once diagnosed with an HIV infection, the CDC analysis found that about three-quarters of those were linked to care within three months. But only half retained that care, and fewer than half were prescribed antiretroviral therapy.

Just 42 percent achieved viral suppression, the level at which their virus is considered under control. That number was even bleaker for young men age 13-24: just 26 percent achieved viral suppression.

Gay and bisexual men make up a just 2 percent of the U.S. population but account for 66 percent of new HIV infections.

The KFF survey was conducted from July 17-August 3 with a sample of 431 men age 18 and over who self-identified as gay or bisexual based on a nationally representative, probability-based online research panel. The margin of sampling error is plus or minus 7 points.

For Gay Men, Gaps In HIV Knowledge And Treatment Persist

Consumer Group Sues 2 More Calif. Plans Over Narrow Networks

This KHN story can be republished for free. (details)

Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles.

“As a result, many patients were left without coverage in the course of treatment,” said Laura Antonini, staff attorney for Consumer Watchdog, a Santa Monica-based advocacy group that filed the case.

Both cases allege that the insurers offered inadequate networks of doctors and hospitals  and that the companies advertised lists of participating providers that were incorrect.  Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status.

Cigna and Blue Shield officials said they had not seen the complaints and declined to comment.

In July, Consumer Watchdog filed a lawsuit against insurance giant Anthem Blue Cross of California with similar allegations. No court date has been set.

The cases are part of growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the state and federal insurance marketplaces created by the Affordable Care Act.  Insurers say such plans are necessary to hold down premium prices. Consumer Watchdog is also putting a measure on the November ballot that would give the state insurance commissioner greater authority to veto rate increases.

The new lawsuits relate to Blue Shield plans sold through the state-run Covered California website, and Cigna plans sold outside of that marketplace.

According to the Cigna complaint, Sheila Davidson, a 61-year-old from Orange County suffering from pelvic inflammatory disease and other health problems, selected a plan after her former policy was cancelled, and after checking to make sure her specialists were included.  At first, the plan paid her doctors’ bills and counted her share of the payments toward her annual deductible.

But the complaint alleges that when Davidson was about to reach the $6,350 annual maximum she had to pay for in-network care, Cigna switched all her doctors to out-of-network status.  That meant she had to pay a $12,500 deductible before the insurer reimbursed anything.  She has appealed that decision with the insurer, but has not yet received a decision, she said.

“Now I am left with thousands of dollars in medical bills and I am scared to continue treatment with my doctors or use my Cigna plan,” Davidson said in a statement released by Consumer Watchdog.

In the Blue Shield case, plaintiffs Kevin and Jane McCarthy of Ventura County say they checked that their doctors were participating in the plan before signing up. But after Kevin McCarthy saw his doctor and had some tests, he received a notice that the doctor was not in network. The McCarthys had to pay for the care and it did not count toward their annual deductible or out-of-pocket limit, the complaint says.  In addition, it alleges the nearest in-network doctor listed on the insurer’s website was 30 miles away in another county.

Blue Shield of California Foundation helps support KHN coverage of California.

Consumer Group Sues 2 More Calif. Plans Over Narrow Networks

Report: Difficulties Likely To Persist In Enrolling Asian-Americans, Pacific Islanders

Language and cultural issues, along with immigration concerns, could still pose major barriers to enrolling Asian-Americans, Native Hawaiians and Pacific Islanders in Health Insurance plans this fall, according to a report released Wednesday by Action for Health Justice, an advocacy coalition that aims to educate these populations about the health law.

The report argues that efforts to enroll people from those ethnic groups were undermined last year by ineffective translations of health law guides; limited language options on the federal online marketplace, healthcare.gov; insufficient training for enrollment assisters and complications in processing applicants’ immigration information. If those issues are not addressed by this year’s open enrollment – which begins Nov. 15 – they will likely continue to be a roadblock to expanding coverage, according to the report.

“Even with some of the advocacy efforts, both on the national level and also in the state-based marketplaces, I think some of the challenges will remain the same,” said Priscilla Huang, senior director of impact at the Asian and Pacific Islander American Health Forum, one of the AHJ’s member associations.

Previous reports indicate Asian-American enrollment was disproportionately high last year – 5.5 percent of people who enrolled in insurance plans were Asian-American, despite that group making up 5.1 percent of all uninsured people in 2012. But one of those studies indicated much lower enrollment by Native Hawaiians and Pacific Islanders. They made up 0.06 percent of enrollees in the federal marketplace, despite constituting 0.2 percent of all the uninsured. That study also noted the wide differences in uninsured rates among different Asian-American groups. For instance, in 2012, 7 percent of Japanese Americans did not have insurance, compared with 26 percent of Tongan Americans.

Call centers, online insurance applications and other documents all currently offer insufficient Asian-language services, according to the AHJ report. Phone operators at federal call centers spoke only Spanish or English, and online applications were also available only in those languages.

“If you don’t speak English or Spanish, only two out of four avenues are available,” Huang said. That is, consumers can find an in-person assister who speaks their language, or they can go through a call center and “hopefully getting connected to the right interpreter.”

And these difficulties are unlikely to change this year, she added.

The report also cited translation errors in documents intended to explain the law, which authors argued often limited consumers’ ability to navigate the insurance market. In some cases, the report notes, advocates working with AHJ chose not to distribute translated flyers because of language inaccuracies.

On healthcare.gov, instructions say services are available in 13 non-English languages, six of which are Asian. But the material available in each language varies. While some, such as Chinese and Vietnamese, have multiple explanatory documents and a print application, the only listed service for Hindi and Gujarati speakers is in-language assistance over the phone.

Additionally, AHJ concluded that federal training for in-person assisters – people designated to help consumers navigate enrollment – fell short, particularly in regard to helping people with complicated immigration statuses. About 60 percent of Asian-Americans and 14 percent of Native Hawaiians and Pacific Islanders were born outside of the United States, according to the report.

This isn’t the first time concerns have been raised about the training. A survey published in July by the Kaiser Family Foundation found that 92 percent of assister programs would have liked more training, with 39 percent of programs noting they would have particularly liked more training in dealing specifically with immigration status.

Enrollment will likely be more difficult this year, Huang said, noting that last year’s enrollment picked “the low-hanging fruit” in terms of accessible consumers. But the most successful enrollment for Asian-Americans, Pacific Islanders and Native Hawaiians involved in-person outreach, she said – and limited numbers of assisters means “a lot of capacity constraints as well.”

Legally residing immigrants also often faced difficulties verifying their immigration status or indicating their correct income when applying for insurance — challenges that in many cases jeopardized or stalled enrollment, according to the report.

Earlier this month, the Obama administration announced that more than 100,000 legal residents could lose insurance purchased through the Affordable Care Act because missing paperwork meant they hadn’t properly verified their immigration status, while more than 300,000 could lose subsidies for their insurance because they had not correctly indicated their income.

Although technology is expected to improve this year, “we’re very concerned that may happen again this year,” Huang said.

“The consumers did their parts in terms of submitting documents or mailing them in,” she said. “And due to website glitches or other things – that were not in the hands of the consumer but really the responsibility of the states and [the Centers for Medicare and Medicaid Services] – they’re now facing termination of their coverage.”

Report: Difficulties Likely To Persist In Enrolling Asian-Americans, Pacific Islanders

Drugmakers Warned Against Giving Coupons To Medicare Beneficiaries

While brand-name drugmakers regularly use coupons to boost sales, it is illegal to induce Medicare Part D enrollees to use them. Meanwhile, a researcher asks members of the public how they would fix Medicare.

<a href="http://blogs.wsj.com/pharmalot/2014/09/22/what-safeguards-Medicare-part-d-patients-use-drug-coupons-anyway/?KEYWORDS=Medicare“>The Wall Street Journal’s Pharmalot: Did Someone Say Kickbacks? HHS Warns About Medicare Part D Coupons

Brand-name drug makers regularly use coupons to woo consumers and boost sales. But inducing Medicare Part D beneficiaries to use coupons is illegal. So drug makers are supposed to use safeguards to ensure these consumers do not use coupons to obtain prescription medicines (Silverman, 9/22).

<a href="http://www.modernhealthcare.com/article/20140922/NEWS/309229940/Medicare-gives-first-glimpse-of-aco-quality-performance”>Modern Healthcare:  Medicare Gives First Glimpse Of ACO Quality Performance

The CMS for the first time publicly released individual performance data for Medicare accountable-care organizations on 33 measures of healthcare quality (Evans, 9/22).

<a href="http://capsules.kaiserhealthnews.org/index.php/2014/09/how-to-fix-Medicare-ask-the-people/”>Kaiser Health News: Capsules: How To Fix Medicare? Ask The Public

Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered. Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program (Carey, 9/23).

Drugmakers Warned Against Giving Coupons To Medicare Beneficiaries

First Edition: September 23, 2014

Today’s headlines include reports about work being done on healthcare.gov in anticipation of the next open enrollment period, which begins in mid-November.  

Kaiser Health News: Insurers Hesitant To Cover Many Proton Beam Therapy Treatments

Kaiser Health News consumer columnist Michelle Andrews writes: “Everyone seems to agree that proton beam therapy–a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue–is an exciting technology with a lot of potential. But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine” (Andrews, 9/23). Read the column.

<a href="http://capsules.kaiserhealthnews.org/index.php/2014/09/how-to-fix-Medicare-ask-the-people/”>Kaiser Health News: Capsules: How To Fix Medicare? Ask The People

Now on Kaiser Health News’ blog, Mary Agnes Carey reports: “Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered. Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program” (Carey, 9/23). Check out what else is on the blog.

The New York Times: Healthcare.gov Is Given An Overhaul

The Obama administration is redesigning HealthCare.gov and says that 70 percent of consumers will be able to use a shorter, simpler online application form to buy health insurance when the second annual open enrollment period begins in mid-November. Federal health officials said Monday that the shorter application had fewer pages and questions, fewer screens to navigate, and would allow people to sign up with fewer clicks of a computer mouse (Pear, 9/22).

The Associated Press: Government Hackers Try To Crack Healthcare.Gov

The government’s own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability — but also came away with respect for some of the health insurance site’s security features. Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud (9/23).

Politico: Court Tosses Obamacare Mandate Lawsuit Brought By Doctors

A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president. This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue (Haberkorn, 9/22).

The Associated Press: Spin Meter: Those Changing Health Law Numbers

The Obama administration has had to revise and refine some initial enrollment numbers for health insurance sign-ups after they turned out to be too optimistic. At other times, metrics less favorable to the president’s overhaul leaked out after officials claimed not to have such data. Parsing the numbers is a new pursuit for administration officials from President Barack Obama on down, to lawmakers of both parties and a gaggle of outside analysts (9/22).

Los Angeles Times: 30,000 Californians Face Obamacare Enrollment Delays, Dropped Coverage

California’s health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall. Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage. Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said (Terhune, 9/22).

The Wall Street Journal: Hospitals Cut Costs By Getting Doctors To Stick To Guidelines

A hospital group in Delaware was concerned it was spending too much on cardiac monitoring for patients outside of intensive care who didn’t need it. So it changed its computer system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group’s daily costs for such monitoring, fell by 70% without any harm to patient care, researchers from Wilmington, Del.-based Christiana Care Health System report in a study in JAMA Internal Medicine (Whalen, 9/22).

NPR: Avoid The Rush! Some ERs Are Taking Appointments

Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada (Gorman, 9/23). Read the Kaiser Health News’ earlier, related story The Latest In Medical Convenience: ER Appointments (Gorman and Colliver, 7/3). 

<a href="http://blogs.wsj.com/pharmalot/2014/09/22/what-safeguards-Medicare-part-d-patients-use-drug-coupons-anyway/?KEYWORDS=Medicare“>The Wall Street Journal’s Pharmalot: Did Someone say Kickbacks? HHS Warns About Medicare Part D Coupons

Brand-name drug makers regularly use coupons to woo consumers and boost sales. But inducing Medicare Part D beneficiaries to use coupons is illegal. So drug makers are supposed to use safeguards to ensure these consumers do not use coupons to obtain prescription medicines (Silverman, 9/22).

NPR: As Run-Ins Rise, Police Take Crash Courses On Handling Mentally Ill

A number of high-profile police shootings, including that of Michael Brown in Ferguson, Mo., last month, have led to increased scrutiny of police interactions with civilians. One group that is disproportionately subject to police uses of force is people with mental illness. Many local departments hold special sessions to train officers about mental illness and how to help the people they interact with. Walking up and down the aisle of a police academy classroom in downtown St. Louis, Lt. Perri Johnson tells the officers here that responding to calls where a person is in mental distress is never easy (Bouscaren, 9/23).

<a href="http://online.wsj.com/articles/medicaid-bankruptcy-ruling-could-bolster-health-care-facility-turnarounds-1411405325?KEYWORDS=Medicare“>The Wall Street Journal: Medicaid Bankruptcy Ruling Could Bolster Health-Care Facility Turnarounds

A federal judge’s recent ruling blocking Medicaid officials from cutting off a struggling nursing home could help troubled health-care facilities survive using bankruptcy, according to restructuring professionals. U.S. Bankruptcy Court Judge Michael Williamson told Medicaid officials that bankruptcy’s protective powers meant they must continue paying for patients at the Rehabilitation Center of St. Petersburg while the Florida facility’s bankruptcy lawyers work through problems. The nursing home’s Medicaid funding was at risk after health inspectors found “rampant, serious problems” at the 159-bed facility earlier this year. After the inspections, Medicaid threatened to terminate the facility’s provider agreement (Stech, 9/22).

Politico: Scott Brown Splits With New Hampshire GOP On Abortion

Republican Scott Brown has something to run against besides Democrat Jeanne Shaheen: His state GOP’s abortion stance. The New Hampshire Republican Party adopted Saturday a socially conservative party platform that supports “the pre-born child’s fundamental right to life and personhood under the Fourteenth Amendment” as well as the “Life at Conception Act.” Those policies are at odds with the New Hampshire GOP’s Senate nominee’s stances on abortion, and Brown’s Democratic opponent Shaheen attacked him on Monday for the “disturbing” message sent by the New Hampshire Republicans (Everett, 9/23).

The Washington Post: Southern States Are Now Epicenter Of HIV/AIDS In The U.S.

Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease and the most people dying from it, according to Rainey Campbell, executive director of the Southern AIDS Coalition, a nonprofit serving 16 Southern states and the District. Fifty percent of all new HIV cases are in the South. And the HIV infection rate among African American and Latina women in the South now rivals that of sub-Saharan Africa. In some Southern states, blacks account for more than 80 percent of new HIV diagnoses among women (Wiltz, 9/22).

The Associated Press: Citing Joan Rivers, Texas’ Perry Backs Clinic Law

Republican Texas Gov. Rick Perry on Sunday invoked comedian Joan Rivers’ death at a surgical clinic while defending a law he signed that would close the majority of abortion facilities in the nation’s second-most populous state (9/21). 

 

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First Edition: September 23, 2014