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For
the
most current ABL Healthcare Online
and access to ABL.org, go to
http://www.abl.org/new/html/resources_news_hc.asp
-- Click on Titles Below to Go to Each News Item --
AIM to be Acquired by WellPoint
Abraxis to Separate into Two Independent Public Companies
AT&T
Extends Contract with Dr. Leonard's Healthcare
CMS Proposes Policy,
Payment Changes for Physicians
DWT Discusses IRS Guidance on HIT Cost-Sharing Arrangements
DestinationRx Provides Video Presentation on its Service
Kaiser
Study Finds Benefits of Patient-Doctor Email
MZI's
EZ-CAP Teams with HealthCare Insight
Newport's
Ventilator Chosen by Virginia, San Bernardino
PCG & HCIM Streamline Billing Process
Pediatrix
Acquires San Antonio Pediatric Cardiology Practice
Walgreens to Acquire Option Care, Inc.
MEMBER RESOURCES: TALENT WANTED
Cost
Does Not Equal Quality
Almost
as Good as an ABBY: RWJF Awards $$ for Innovations
NCQA
to Require Quality Measurements for Certification
When Helen
Hunt's character in the movie As Good As It Gets
berated HMOs, audiences across the country cheered - and the
wave of negative press became a tsunami. And it was just
a line in a romantic comedy. Not so with Michael
Moore's latest documentary, SICKO, which is a
two-hour attack on the American health system in general, and
health plans in particular. After all, everyone knows
being uninsured is risky. But the point that SICKO
drives home is that being insured is equally risky -
given the opportunity for the plans to retrospectively
deny claims when they catch a previously unreported
pre-existing condition, or even a condition unknown to the
insured that a "prudent person" should have known was
a pre-existing condition.
When a group of healthcare
executives - assumably all of whom are insured - have
second thoughts about just how well covered they are, you've
got to know that Moore's onto something. It took Al Gore
decades to get the attention of the national psyche with
An Inconvenient Truth. As a Master Spinner, it's a safe
bet that Michael Moore will make his impression a lot
faster. Will it impact the 2008 elections? We'll know better
in 16 months. But, in the meantime, one thing is certain, when
it comes to health plan bashing, Moore's is definitely as bad
as it gets.
AIM to be Acquired by WellPoint
WellPoint, Inc. has entered into an agreement to acquire American Imaging
Management, where David Soffa, MD, is a senior executive, a radiology benefit management company, for approximately $300 million. AIM, with health plan clients representing
over 20 million
consumers, pioneered the integration of
technology and clinical content for radiology management through the
introduction of web-based prior authorization in 2002. This
allows ordering physicians to directly submit information and receive
real-time evaluation against widely accepted clinical guidelines. AIM also introduced the first set of web-enabled tools
to install cost and quality transparency into the selection of the best
value in diagnostic imaging facilities.
Abraxis to Separate into Two Independent Public Companies
Abraxis BioScience, Inc., where Patrick Soon-Shiong, MD, is CEO,
intends
to separate its hospital-based product business, Abraxis Pharmaceutical Products,
from its proprietary product
business, Abraxis Oncology and Abraxis Research (the new Abraxis
BioScience), resulting in two independent,
highly focused public companies. Deutsche Bank and Wachovia Bank, N.A.
have provided an underwritten commitment for $1.45 billion of bank
financing of which Abraxis BioScience will receive approximately $1
billion to strategically focus on its nab technology platform, the
development of its deep proprietary pipeline and expanded
commercialization of ABRAXANE. The transaction is subject
to obtaining a ruling from the IRS.
AT&T
Extends Contract with Dr. Leonard's Healthcare
AT&T Inc., where
Judi Manis heads the Healthcare Market Group, has announced that
Dr. Leonard's Healthcare, an online retailer of healthcare and personal
care products, has extended its contract for AT&T's e-mail defense and
management service, Secure E-mail Gateway, for an additional two years. AT&T Secure E-mail Gateway helps
protect Dr. Leonard's e-mail infrastructure through the use of spam
filters and virus blockers. In general,
employees spend substantially less time managing e-mail messages,
increasing overall productivity. Additionally, the service's disaster recovery
features help prevent the loss of
important, mission-critical messages.
CMS
Proposes Policy, Payment Changes for Physicians
CMS, where Jeff Flick is Regional Administrator and Dave Sayen is
Associate Regional Administrator, projects that it will pay approximately $58.9 billion to
900,000 physicians and other healthcare professionals in calendar year 2008, under a proposed rule
recently released that would revise
payment rates and policies under the Medicare Physician Fee Schedule. It also includes
a new initiative to
encourage the use of electronic prescribing to improve the speed and
accuracy of care furnished to beneficiaries. Comments will be accepted on the
proposed rule until August 31, 2007, and a final rule will be published in the fall. For more information, see:
www.cms.hhs.gov/center/physician.asp.
DWT
Discusses IRS Guidance on HIT Cost-Sharing Arrangements
Davis Wright Tremaine, where Gerry Hinkley is a Partner,
has
published an advisory regarding the IRS' efforts to allay concerns
regarding its position on health information technology (HIT)
cost-sharing arrangements between tax-exempt hospitals and medical staff
physicians. The IRS has released a series of
six questions and answers, available on the
IRS website. The Q&As follow up on an IRS internal
directive issued to IRS staff in May 2007 regarding the treatment of
cases in which tax-exempt hospitals engage in HIT cost-sharing
arrangements to allow physicians to connect with the hospitals’
electronic health records systems.
Click here for complete DWT
advisory.
DestinationRx
Provides Video Presentation on its Service
DestinationRx,
where Michael Cho is CEO, has launched a video presentation, "Getting the Most Out of Your Pharmacy
Benefits - Transparency is Not Enough," to educate employers, employees
and consumers about new technology available to achieve substantial
savings in out-of-pocket expenditures for the purchase of
prescription drugs:
Video link
Kaiser Study Finds Benefits of Patient-Doctor Email
Kaiser
Permanente, where Christine Paige is a senior executive, has released the largest study to date on how secure e-mail changes
the way patients choose to access medical care. Highlights include: *Patients
with online access to an electronic health record are choosing to use
secure e-mail, thereby decreasing the number of primary care office
visits and telephone contact rates. *Patients who use secure e-mail were
7% to 10% less likely to schedule an office visit, and made about 14%
fewer phone contacts than those not using online services.
MZI's
EZ-CAP Teams with HealthCare Insight
EZ-CAP,
the flagship product of MZI HealthCare, LLC, where Darryl Low is
President, has formed a strategic alliance with HealthCare Insight
to help benefit administrators improve payment accuracy and
prevent unnecessary losses associated with fraudulent claims. The combination of EZ-CAP’s benefit
and claims adjudication software, which provides instant access to data,
coupled with HCI’s clinical review and fraud analysis services that
identify outliers, decreasing overpayments, and detect potential fraud
schemes, will help to reduce payors’ medical expenses and lower their
cost ratios.
Newport's
Ventilator Chosen by Virginia, San Bernardino
Newport Medical Instruments, Inc., where Hong-Lin Du is President, has signed an agreement with The Virginia
Hospital and Healthcare Association, the group that manages the State of
Virginia's Emergency Preparedness program, to provide HT50 ventilators
for deployment to six regions throughout the state. Meanwhile, in California, the San Bernadino
County Department of Health, Office of Preparedness and Response, just
took delivery of over a quarter million dollars worth of HT50
ventilators as part of their ongoing disaster preparedness plan.
PCG
& HCIM Streamline Billing Process
PCG Software, where Andria Jacobs is COO, and
HealthCare Information Management, Inc. have announced SymKey
Virtual Auto-Post, a jointly developed solution for healthcare payor
organizations. The auto-adjudication system integrates with PCG's Virtual
Examiner to speed the healthcare
claims review process, including furthering automating the
claims process by automatically posting claim results to the system.
Pediatrix
Acquires San Antonio Pediatric Cardiology Practice
Pediatrix Medical Group, Inc., where Dave
Mintz is a senior executive, has completed the acquisition of
a pediatric cardiology physician group practice based in San
Antonio, Texas, which provides physician services to patients in
communities throughout south central Texas. During 2007,
Pediatrix has completed three physician group practice acquisitions,
including neonatal practices in San Francisco, CA, and Munster, IN,
as well as the San Antonio practice.
Walgreens to Acquire Option Care, Inc.
Walgreen Co., where Eileen Goodis, Pharm.D.
is VP of Walgreens Home Care, has announced a definitive agreement
to acquire Option Care, Inc. in a transaction with a total enterprise
value of approximately $850 million. The acquisition will create
national access to Walgreens specialty pharmacy and home infusion
services for patients and payors. Option Care provides a full spectrum
of specialty pharmacy and home infusion services from a national network
of more than 100 pharmacies in 34 states.
Cost
Does Not Equal Quality
In a Pennsylvania government survey of the state's 60 hospitals that
perform heart bypass surgery, the best-paid hospital received nearly
$100,000, on average, for the operation while the least-paid got less
than $20,000. At both, patients had comparable lengths of stay and death
rates. And among the 20 hospitals serving metro Philadelphia, two of the
highest paid actually had higher-than-expected death rates, the survey
found. The Pennsylvania findings support a growing national consensus
that as consumers, insurers and employers pay more for care, they are
not necessarily getting better care. (New York Times, 6/14/07)
Almost
as Good as an ABBY: RWJF Awards $$ for Innovations
The Pioneer Portfolio of the Robert Wood Johnson Foundation is
sponsoring "Disruptive Innovations in Health and Health Care,"
an open source competition to identify ways in which the health and
healthcare marketplace can offer services, tools and choices that
consumers want -- but are currently out of reach because of cost, complexity
or because the right idea hasn't come along. The competition is looking
for entrepreneurs both within and outside of the healthcare field with
ideas for new products, services, technologies, business models, or some
combination thereof, that enable consumers to manage health and receive
care in ways that are more affordable, accessible, simple and
convenient. Enter by July 18, 2007; Voting begins Aug
15, 2007; and Winners announced Aug 30, 2007.
Click here for more
information.
NCQA
to Require Quality Measurements for Certification
The NCQA is proposing that all health plans, including PPOs, seeking
accreditation from it be required to report on the quality of care
delivered to patients. Under the new program, NCQA will evaluate PPOs on
the same set of standards, clinical measures and patient experience
ratings on which it has evaluated HMOs and POS plans. PPOs seeking NCQA
accreditation would be required to report clinical quality results using
NCQA’s Health Plan Employer Data and Information Set (HEDIS). Plans
would also be required to report results from the Consumer Assessment of
Healthcare Providers and Systems (CAHPS), which evaluates patients’
experience with care and service. (Managed
Care Weekly Watch, 7/10/07)
Firms
Could Get Tax Breaks for Offering Wellness Benefits
Senator Tom Harkin
(D-Iowa), the Senate Appropriations Labor-Health-Education Subcommittee
Chair, and Sen. Gordon Smith (R-Ore.), a member of the Senate Finance
Committee, have introduced legislation that would provide a tax credit
to businesses that offer wellness programs for their employees. The
legislation would provide businesses a tax credit worth 50% of the costs
they incur per employee for wellness and preventive healthcare services.
Companies would receive a tax credit of up to $200 for the first 200
employees participating in a wellness program and up to $100 per
employee thereafter. (CQ Daily & CongressDaily, 7/9/07)
7/12 - Northern California Round Table
7/18 - Combined Orange County Healthcare & Life Sciences
Tables
7/20 - Los Angeles Round Table
7/27 -
Membership-wide Social at Bower's Museum: Treasures from
Shanghai, Gems!, and Mummies
For
the
most current ABL Healthcare Online and access to ABL.org, go to
http://www.abl.org/new/html/resources_news_hc.asp