Pay future compensation to teaching hospitals

You are reading the web version of Health Care Inc. STAT’s weekly newsletter that tracks the flow of money through the healthcare system. Register here To get it in your inbox.

Medicare Advantage Stocks Rise

If you’ve ever needed proof of how much Wall Street drools on Medicare Advantage profitability, look no further than Humana Investor Day last week.

Humana executives have given investors everything they want: The company will be registering big loads of seniors over the next three years; Outside MA brokers clean up their actions so that fewer people give up on their plans; It will direct more of its members to its growing division of clinics and home health services; All of this will increase dividends, share repurchases and surplus dividends.


Those were very big promises. Wall Street will penalize Humana shares with the slightest whiff of a slower-than-expected record, which begins within a month. But it’s worth noting that Humana—the company that is essentially a MA for pure play—has blown up the stock market over the past decade. It doesn’t even compare to the broader S&P 500 and the Dow Jones. It’s all backed by this taxpayer-funded alternative to traditional Medicare. And things that Humana executives haven’t talked about, like highly questionable risk-adjusting practices that whistleblowers and auditors have advocated for years, have also paid off much of its fortunes.

Read the storywhich also includes details on how many physician clinics Humana will acquire and build each year — an obvious nod that Humana is copying UnitedHealth Group to get more doctors so it can keep more of that sweet sweet dollar.


Benefit from residents and colleagues

Earlier this month, Brigham and Women’s Hospital A lawsuit against the federal government. The famous Boston hospital, which is part of Mass General Brigham, said it was underpaid to train its junior doctors. It turns out that teaching hospitals across the country will soon get the corrected amounts to account for those few payments.

Medicare is the largest funder of graduate medical education. The payment formula for teaching hospitals to train these doctors is complex, but it does relate to the number of residents and fellows in each hospital. A few years ago, other hospitals sued and said Medicare was shortening them if they had too many colleagues. The court agreed, and in Latest base in inpatient hospitalMedicare has updated its formula and said it will apply that formula retroactively to “all teaching hospitals.”

A hospital spokesperson said Brigham and the woman’s suit was essentially a way to get hospitalized on a waiting list and “facilitate timely payment.”

Ron Connelly, an attorney who led the initial lawsuit from Milton S. Hershey Medical Center in Pennsylvania, which has since been merged to include 63 hospitals, said.

Medicare has already sent out notices that it is recalculating payments, and Connelly expects to have its hospital clients paid by the end of this year. Depending on how many years of underpayment the hospital has resumed, the payments can range anywhere from $30,000 to $10 million. “It’s going to be a lot different really,” Connelly said.

Expensive travel nurses: the new norm?

Pay rates for travel nurses The situation subsided earlier this year, but hospitals are still paying far more than they did in the pre-pandemic period. My colleague at Health Care Inc. , Tara Banu, that it could remain that way indefinitely.

AMN Healthcare, one of the largest in the country nurse recruitment companies, billing rates for travel nurses are expected to fall 30% between the first and fourth quarters of 2022, Chief Financial Officer Jeff Knudson said at a banking conference last week. But even that low rate last quarter is still 35% higher than the fourth quarter of 2019.

Susan Salka, AMN’s outgoing CEO, said at the conference that much of the demand today is due to the nurse shortage that preceded the pandemic. Covid-19 has made the problem worse because it has prompted many exhausted nurses to retire, change professions or take nursing jobs outside of hospitals.

Congress is calling for an investigation into whether recruiters like AMN have used the pandemic as an excuse for price gouging hospitals. Salka acknowledged that “passenger billing rates have gone up,” but he countered that some of the biggest cost increases in hospitals were in higher wages and premium pay for working nurses. “There are demands for an increase in these wages by the nursing staff,” she said.

Medicare randomized trial of dialysis repair

Not enough people with kidney failure get a transplant or home dialysis, and Medicare wants to change that, my colleague Isabella Quito reports.

A new model from the government will allocate higher payments to dialysis providers if patients use dialysis at home instead of going to the clinic and if providers get more patients on a waiting list for transplants. The interesting part of the model is that it forces 30% of the dialysis companies to participate – and the other 70% will be used as a control group.

Read the full story of Issa, which includes some valid concerns about whether DaVita and Fresenius’s dialysis monopoly “could try to manipulate the system” by promoting transplants, waiting list, and home dialysis at facilities that have to participate, and promoting these things less in facilities that do. They don’t do that. t share.

Industry conflict and its ends

  • Friday’s breaking news: Daniel Haller, the New York surgeon who sued the federal government to overturn the sudden new billing law, sacked his lawyer. It is unclear whether this means that he will appeal his case, which is the judge eviction Last month.
  • Have you noticed that some drug websites have the phrase “talk to a doctor”? Currently“Button? Well, my classmate Katie Palmer did, and she mentioned How these telehealth prescriptions are a “dream” for pharmaceutical companies looking for an easy (and clinically questionable) increase in sales.
  • UnitedHealth won a six-year class-action lawsuit from doctors who argued that their insurance company tightened their facility fees, Jacqueline Wylie reports from Bloomberg.
  • Catholic hospital chain Ascension posted -3.1% operating margin in fiscal 2022 that ended in June, new Audited Financial Documents turns out. Ascension’s net margin was -6.6%, as the stock market slump continues to curtail hospital investment.
  • Rep. Bill Pascrell is asking the feds to investigate whether HCA Healthcare is inappropriately getting people out of the emergency room, my colleague Rachel Kohrs reports. Envision Healthcare also appears in Pascrell’s letter.
  • The Statistics Office has created a file Annual Report on health insurance. The 8.3% rate of uninsured was the main figure, but two other pieces of data tell a clearer story: Hispanics are still twice as likely to be uninsured (18.3%), and people who live in states that haven’t expanded Medicaid They continue to lack insurance at much higher rates (11.9%).

Mimi Ward

Leave a Comment