Category Archives: Hospitals

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Nonprofit Hospital Revenue Growth Slows

For the second straight year in a row, nonprofit hospital expenses have increased more than revenue, according to a study of 383 hospital systems by Moody’s Investors Service released on August 27, 2014.  In an article published the same day by the New York Times, nonprofit hospital financial performance for 2013 was characterized as the … Continue Reading

A “virtual merger” is underway between Chicago-area Alexian Brothers Health System and Adventist Midwest Health

Chicago-area Alexian Brothers Health System and Adventist Midwest Health signed a non-binding letter of intent to form a joint operating company, a collaboration commonly referred to as a virtual merger. As Alexian brings five hospitals to the agreement and Adventist brings four, the health systems combined would create the third-largest network of hospitals in the … Continue Reading

The Future of DSH Payments?

According to the Centers for Medicare and Medicaid Services (CMS), the federal government disburses $11.5 billion annually in disproportionate-share hospital (DSH) payments to states.  DSH payments are intended to offset the cost of treating the uninsured (uncompensated care) and Medicaid shortfalls in public hospitals.  A recent study published in Health Affairs on the impact of … Continue Reading

New York State budget negotiations contemplate private equity investment into hospitals…again

Should private equity play a bigger role in New York State healthcare facilities? This is the question facing New York State legislators for the second year in a row. Historically, investor-owned corporations have been essentially prohibited from owning and operating healthcare facilities in the state. Governor Cuomo’s proposed 2014-2015 budget and associated legislation would authorize … Continue Reading

Thinking Ahead – Opinions About Trends and Challenges in Today’s Health Care Industry: What Next for WellPoint After the CEO Selection?

By Eric Klein This week brought the announcement that WellPoint Inc. selected Joseph Swedish to become its next Chief Executive Officer. Swedish will leave his position as CEO of nonprofit Catholic health system Trinity Health, which has grown to almost $12 billion in assets under Swedish’s leadership and is moving through a merger to become … Continue Reading

Quality, Reimbursement and the Medical Staff

By Karie Rego The most difficult issue a hospital can face involves allegations of poor quality coupled with billing fraud. These allegations can be devastating to a hospital’s operations and its reputation. It is essential that hospital administration, the medical staff, legal and compliance officers work together quickly and efficiently to verify and address allegations.  Hospitals should have … Continue Reading

How to Avoid an Interventional Cardiology Billing and Quality Scandals

By Karie Rego Ever since the Redding Medical Center government investigation found inappropriate percutanteous coronary interventions (PCI), the medically necessity of PCI has been a highly debated topic. This past year, there have been two other similar cases involving providers in Maryland and Pennsylvania. In Maryland, the state even considered adopting it’s own quality guidelines. This is … Continue Reading

ACO Regulations: Still Waiting

By Eric A. Klein Healthcare providers must continue to wait for the Centers for Medicare and Medicaid Services (CMS) to release regulations governing accountable care organizations (ACOs), despite predictions the regulations would be issued last week. The regulations were not forthcoming, possibly due to the tense atmosphere in Washington over the federal budget. ACOs, created by a … Continue Reading

OIG Releases Fiscal Year 2011 Work Plan

By Ken Yood and Lynsey Mitchel The mission of the Office of the Inspector General ("OIG") is to protect the integrity of the programs and operations of the Department of Health & Human Services, for example Medicare, by detecting and preventing waste, fraud and abuse, and identifying opportunities to improve program economy, efficiency and effectiveness. The Work … Continue Reading
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