Tag Archives: insurance companies

Report: Calif. hospital chain profited from ER admissions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.

The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.

The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”

State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.

That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.

And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.

Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.

She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”

“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.

There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.

It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.

Reform opponents got millions from industry

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Caitlin Ginley, of the Center for Public Integrity, used data from the National Institute on Money in State Politics to demonstrate that the state officials who have joined forces to file a lawsuit challenging American health care reform have, together, received more than $5 million in campaign contributions from hospitals, pharmaceutical companies, doctors and insurers. Among the governors and attorneys general in the 20 states supporting the suit, a few stood out.

… the Center found that top recipients of industry money include Texas Attorney General Greg Abbott, who has received more than $1 million from health care professionals since 1996, and former Georgia Governor Sonny Perdue, who took in at least $970,163 from the industry starting in 1992, when he was a state senator, until he left the governor’s office this week. Other major recipients involved in the lawsuit include former Pennsylvania Attorney General and newly-elected Governor Tom Corbett, who has received about $830,000, and Mississippi Governor Haley Barbour, with more than $770,000.

Ginley provides details on the donations each of those officials received, as well as several others. No word on how this compares to other samples of 40 high profile state politicians. Physician groups and private doctors played a major role in many of the cases she examined.

Reporter uncovers $86 million from insurers to fight reform

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The flow of money into politics in general, and health reform in particular, has been thoroughly opaque this election season, yet Bloomberg‘s Drew Armstrong has still managed to pull back the curtain and figure out that insurers gave $86 million to the U.S. Chamber of Commerce, which then lobbied heavily to either hamstring reform or to reshape it in the insurers’ favor. Armstrong traced the money to America’s Health Insurance Plans through classic reporting tools: public records and well-placed sources.

Tax forms require organizations to list only the amounts granted or received from other groups, not the organizations’ identities. Health insurers expressed opposition to parts of the health-care legislation while they conferred with congressional Democrats writing the bill and the White House. At the same time, the Chamber of Commerce was advertising its opposition.

The Chamber spent $45.5 million on a campaign against the bill in 2009, according to TNS Media Intelligence/Campaign Media Analysis Group, an Arlington, Virginia-based company that tracks political advertising.

The Chamber began in March 2010, weeks before the bill became law, another $10 million effort focused on pressuring lawmakers to vote against the bill. Blair Latoff, a spokeswoman for the Chamber, wouldn’t say how much of the money was spent in 2009 and how much, if any, was used in 2010.

Why California hospitals can charge so much

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

California hospitals, especially those in the Bay Area, seem to be able to set prices with impunity, a fact we know in part because the state requires an unusual level of hospital finance disclosure. This week, Kaiser Health News reporter Jordan Rau took advantage of the available records and dug through hospital spending databases and a long list of sources to figure out just what gave certain hospitals the leverage to charge so much more than competitors offering equivalent services. For a quick review of the data unleashed by this law, I recommend reviewing the map and charts that ran alongside the story.

As you might expect, the underlying explanation is complicated. When Rau asked the hospitals why prices were rising, he got a familiar refrain. They blamed it on the need to make up for low Medicare and Medicaid reimbursements, as well as charity care, and reminded him that technology is expensive and that their particular patient populations were unusual in ways that naturally obliged them to charge extra.

Those are certainly all part of the equation, but Rau investigation seems to point in another direction: Garden variety economic clout.

State laws have inadvertently given hospitals even more leverage. California requires health maintenance organizations to have “adequate networks” that offer all major specialties reasonably close to where patients live. Lisa Rubino, president of Molina Healthcare of California, an insurer, says the law makes it difficult for insurers to drop big hospitals from their networks.

“You have to work with them or make a strategic decision to get out of the area because they can dig in,” says Rubino.

Rau elaborates on this idea in a companion piece on NPR’s health blog, in which he points out how the industry has deftly squashed two different efforts to increase transparency in their pricing practices.

Report cards and rankings for 227 HMOs

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The National Committee for Quality Assurance, a nonprofit health plan accreditation organization, has unleashed its annual ranking of private health insurance plans, which have also been published in Consumer Reports. As present, the list only contains health management organizations.

The full list, in PDF format

Only the top four providers received the full five points in consumer satisfaction, treatment and prevention. New England providers took top honors this year, with Harvard Pilgrim taking first (Massachusetts and Maine) and third (New Hampshire), and Tufts Associated coming in second. Florida’s Capital Health plan came in fourth.

In addition to the list, NCQA released a detailed report card for each HMO (241-page PDF). There, plans are rated for specific satisfaction measures, diseases and patient groups.

Look for similar rankings of Medicare and Medicaid plans to come out in the next month or so.

CPI: Insurers prepare $20 mil lobbying effort

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On the Center for Public Integrity’s PaperTrail blog, Peter Stone reports that five of biggest insurers in America are preparing to go to the mat for round two, this time with the intertwined goals of swinging midterm elections and influencing health reform implementation regulations.

According to Stone, Aetna, Humana, United HealthCare, WellPoint and (maybe) Cigna will pool something like $20 million. Look for the new lobbying organization, probably a 501(c) (4) nonprofit, in the next few months. Television ads and a variety of other campaigns will likely follow.