Tag Archives: hospitals

TN hospitals get $53M in extra fed Medicaid funds under budget bill

Tennessee hospitals would share an additional $53 million a year in federal Medicaid funds under a special provision of a major health care bill that passed the House on Thursday, reports The Tennessean.

If the measure becomes law, Tennessee will no longer be the only state in the nation ineligible for the extra funding intended to help reimburse hospitals for providing care to people that aren’t able to pay.

The Tennessee-specific provision was endorsed by the Tennessee Hospital Association and the entire Tennessee congressional delegation.

The nonpartisan Congressional Budget Office estimates that adding Tennessee to the formula — known as disproportionate share or DSH — would cost about $500 million over 10 years. The formula also requires $27 million in matching funds from the state of Tennessee, for a total of $80 million a year for the state’s hospitals.

The delegation argued it was a matter of equity and fairness with other states.

“Tennesseans aren’t asking for special treatment or carve-outs. Our providers simply want access to the same resource that providers in 49 other states have,” said Rep. Diane Black, R-Gallatin.

Tennessee in 1994 transformed its Medicaid into TennCare and stopped receiving the DSH payments because it expected indigent care would be covered by TennCare. That “coverage experiment” ended in 2005, according to a letter the delegation wrote to House leaders earlier this month, prompting Tennessee to try and get back into the DSH formula.

Each hospital’s portion of the money is based on how much indigent care they provided in the previous year.

Pending Boehner-Pelosi Medicare deal helps TN hospitals

By Alan Fram, Associated Press
WASHINGTON — House aides released an outline late Friday of an emerging bipartisan deal shielding physicians from Medicare cuts and pumping more funds to popular programs for children’s health and community health centers.

In a first hint of some of the measure’s fine print, the bare-bones summary said lawmakers would raise money partly by targeting Medicare providers who are tax scofflaws. In the winner’s category, the agreement would also help Tennessee hospitals serving large numbers of poor patients and makers of medical equipment who bid for Medicare business.

The one-page document provides no price tags and few specifics. But as lawmakers, congressional aides and lobbyists have said for days, it would cost roughly $210 billion over a decade, with around $140 billion financed by adding to federal deficits, aides said Friday. The remaining $70 billion would be split about evenly between Medicare providers and beneficiaries.

House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif., have been seeking the agreement for two months in hopes of resolving a problem that has haunted Congress for years.

As medical inflation soared, a formula in a 1997 budget law aimed at reining in Medicare costs has ended up threatening doctors with deep cuts in Medicare reimbursements that lawmakers have staved off every year since 2003. Physicians have warned the constant threat of cuts could prompt them to stop treating Medicare patients.

The bipartisan compromise would erase that formula, including averting a 21 percent cut in physician Medicare reimbursements set for April 1. Instead, the plan would give Medicare physicians 0.5 percent annual fee increases for the next five years and offer financial incentives to charge patients for quality of care, not for each treatment.
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Prodded by legislators, board plans ‘do-over’ on public hospital’s executive bonuses

Following an attorney general’s opinion, the Erlanger Health System board says it plans to hold a “do-over” meeting to discuss and vote again on $1.7 million in management bonuses, according to the Chattanooga TFP.

But local lawmakers said Friday that the gesture may not be enough to keep them from taking more drastic measures against the board — including asking certain politically appointed members to resign.

Board Chairman Donnie Hutcherson wrote to state lawmakers on Friday that, following Attorney General Herbert Slatery III’s opinion regarding the state’s open meetings law, “we believe it would be in the best interest of the public we serve to have an open discussion at the February 26 board meeting about each of the four resolutions presented in December.”

One resolution at the Dec. 4 meeting approved the bonuses for 99 top managers at the public hospital. The decision caused an uproar among the lawmakers, who were outraged that the board discussed the bonuses behind closed doors before the public vote.

Slatery’s opinion, requested by lawmakers and delivered Wednesday, said state law does not permit public hospital boards to discuss issues like compensation in secret.

Lawmaker-appointed hospital trustee Dr. Phyllis Miller said Sen. Todd Gardenhire, R-Chattanooga, called her Thursday, the day after the AG opinion came out.

Miller said Gardenhire told her she had “committed an illegal act” and he wanted to give her the opportunity to step down before he and other members of the Hamilton County delegation formally asked her to do so.

…Gardenhire also told newly appointed trustee Henry Hoss that the delegation may ask trustees to step down, Hoss confirmed Friday. Hoss — whose very first board appearance was the controversial Dec. 4 meeting — said he still hoped to make peace with lawmakers and felt that re-doing the meeting was crucial to rebuild trust with the public.

AG opinion says public hospital boards can’t approve pay bonuses in closed meetings

A state attorney general’s opinion has Chattanooga area legislators calling for revocation of $1.7 million in bonuses paid out to Erlanger Health System’s management, reports the Chattanooga TFP.

Attorney General Herbert H. Slatery III’s opinion, issued Wednesday, states that Tennessee law does not permit hospitals such as Erlanger to meet in a closed session to discuss bonuses or salaries. (Note: Full text HERE.)

While the opinion does not specifically reference Erlanger, Rep. Mike Carter, R-Ooltewah, said it proves Erlanger’s public hospital board “clearly violated the law” in the process it used to approve executive bonuses for year-end performance — half of which of have already been paid out.

On Thursday, hospital officials did not disclose specific steps — if any — they would take in response to the AG opinion. But in a statement they struck a conciliatory tone, saying Erlanger “fully appreciates the legislative delegation’s involvement to help us obtain clarification” of open meetings law.

“Certainly, the more guidance we can get, particularly with more than 200 exemptions to the Act, the more prepared public hospitals like Erlanger will be in ensuring compliance under the [Open Meetings Act],” the statement said.

“Erlanger will continue to review and, if necessary, adjust our processes in order to avoid any appearance of noncompliance and govern itself in full accordance with applicable laws. Similarly, we fully intend to continue our work with the legislative delegation going forward. As always, Erlanger’s intention has been to comply with this act and we will continue to do so.”

The opinion was triggered by local lawmakers’ concerns about how the hospital board went about its decision at a Dec. 4 meeting to award the bonuses. The decision riled lawmakers, as well as rank-and-file hospital employees who had endured a series of major cuts to their own benefits as the hospital sought to recover financially.

The resolution concerning the bonuses was added to the agenda just hours before the public meeting; and besides outlining what the compensation entailed, trustees did not engage in any public discussion or debate about the bonuses before voting. All but one trustee voted to approve the resolution.

While the apparent abruptness of the decision sparked outrage, trustees said the performance goals had been made months earlier and the bonuses had been vetted in earlier closed committees.

Legislators question secret session discussion of public hospital executive bonuses

Hamilton County legislators say they will seek a state attorney general’s opinion on whether Erlanger Medical Center’s Board of Trustees violated the open meetings law when they discussed paying out $2.7 million in performance-related bonuses during two closed meetings before they publicly voted on Dec. 4.

Further from the Chattanooga TFP:

And the repercussions could extend beyond the Chattanooga hospital, lawmakers said during a roundtable discussion with Times Free Press reporters and editors.

Delegation members said Erlanger’s decision has now “clouded” their view of Gov. Bill Haslam’s plan to expand Medicaid and also spurred a bill that could remove public hospitals’ special strategic exemption to open meetings law.

Referring to potential political fallout, state Sen. Todd Gardenhire, R-Chattanooga, said the Erlanger payouts “could be the most expensive bonuses anybody has ever gotten.”

Erlanger officials could not be reached for comment by press time on Tuesday. Trustees said earlier the bonuses were earned according to benchmarks set in early 2014. Those benchmarks were not made public until December.

The vote to give bonuses to 99 managers came after a financially turbulent year. The hospital froze vacation time, tightened benefits and phased out pensions and retiree insurance. Then in the spring, the hospital received a $19 million infusion of federal funding after lobbying local, state and federal officials for access to the pool, and ended the year with a profit.

On hospitals providing funding for Haslam’s version of Medicaid expansion

The deal Gov. Bill Haslam struck with the Tennessee Hospital Association as part of his push to expand Medicaid in Tennessee is being closely followed by state leaders and hospital executives in other states that have rejected expansion, according to WPLN.

The deal was proposed to Haslam more than a year ago, according to Craig Becker, who heads the THA. Since Haslam’s unveiling, several of Becker’s counterparts in other Southern states have called him to explore whether it’s a model that can be replicated. The fact that Haslam now heads the Republican Governors’ Association shouldn’t hurt in terms of rallying support among other state leaders.

Months leading up to the announcement, Hospital lobbyists were imploring the governor to act behind closed doors, but because of all the program’s moving parts, including the Affordable Care Act waiver, receiving approval from federal officials took time.

During that time, however, uninsured patient bills were mounting, some hospitals in rural Tennessee were closing and the whole industry was feeling squeezed.

“We basically left over $800 million on the table in federal dollars. Which is a lot of money that could’ve done a lot of different things,” Becker said, referring to the year in which Haslam was deliberating about whether to accept federal Medicaid money tied to the Affordable Care Act.

“We’ve all been telling him, look, we’re stressed. Each individual hospital has come to him and said, look we’re gonna have to lay people off. We’ve seen layoffs. We’ve seen hospitals close. We’re not just crying wolf here,” Becker said.

… For years, hospitals have helped out the state’s TennCare program in the face of falling revenue by effectively taxing themselves in order to draw down federal matching money.

Instead of having to write-off the entire cost of care for an uninsured patient, the federal government would pick up 90 percent of the tab for the newly eligible, once the ACA is fully implemented. At first, the feds cover 100 percent.

Becker said uncompensated care was one of the major drags on rural hospitals and it’s what sent as many as 20 hospitals statewide on the financial brink — some counties even instituting a wheel tax in order to keep local hospitals afloat.

To the association, putting in the state’s portion was a no-brainer in terms of dropping the number of uninsured and letting the federal government pick up nearly all of the expense.

Supremes rule hospitals can’t keep a lien on your property after you’ve paid your bill

(Note: This expands upon the original post — which included only a news release, now at the bottom of this post.)
The higher hospital charges billed to people who are uninsured are not “necessary and reasonable” and thus cannot be used by hospitals to place a lien against those who had their bill paid by insurance companies, the state Supreme Court has ruled.

In a unanimous ruling Friday, the court threw out liens filed against two patients treated at the Regional Medical Center in Memphis, known as “the Med,” after traffic accidents. In a news release, court officials said it is “common practice” for Tennessee hospitals to accept insurance payment, then nonetheless seek a lien against the patient in anticipation of a lawsuit against the person — or “tortfeasor” — who caused the accident.

In one case, patient Diane West’s insurance company paid $3,215.72 to cover her bill, in accord with the hospital’s contract with the company and sent her a letter saying she owed nothing. Without the contract, the cost would have been $14,008.97.

Still, the hospital got a lien against West. Legally, that gives it standing to sue the third party causing the accident and collect the full $14,008.97. As explained in the decision:

“The Med continues its efforts to collect the full, nondiscounted cost of its treatment from the third-party tortfeasor. Whenever the Med is able to collect the full amount of its unadjusted cost from the third-party tortfeasor directly or from the patient’s recovery from the third-party tortfeasor, it refunds any payment or payments already received from the patient’s insurance company. The Med releases its lien only after it has been paid for the full, unadjusted cost of its services.”

The opinion notes that Tennessee’s hospital lien law, basically unchanged since enacted in 1970, requires that a lien applies only to “necessary and reasonable costs.” While accepting that the services provided were necessary, the justices held they are not reasonable and thus no lien can be imposed on the patient.

“The Med’s non-discounted charges reflected in the amount of the liens it filed against (the two patients) should not be considered reasonable charges for the purpose of (the lien law) for two reasons. First, the amount of these charges is unreasonable because it does not reflect what is actually being paid in the market place … because virtually no public or private insurer actually pays full charges.

“… The second basis for concluding that the Med’s non-discounted charges are not reasonable stems from its contracts with (the insurance companies). … The Med furthered its own economic interest when it agreed in these contracts to discount its charges for patients,” the opinion said. “Thus, with regard to an insurance company’s customers, ‘reasonable charges’ are the charges agreed to by the insurance company and the hospital,” the court said.

Note: The full opinion is HERE. A news release is below.
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Erlanger backs away from $1.7M in executive bonuses amid legislators criticism

Facing criticism and questions from state lawmakers after voting to award executives $1.7 million in bonuses, Erlanger Health System officials said Thursday night they will put the payments on hold and review their actions, reports the Chattanooga TFP.

Trustees for the public hospital voted Dec. 4 to approve bonuses for 99 managers, including more than $234,000 for CEO Kevin Spiegel.

The Hamilton County legislative delegation — which appointed three trustees to the 11-member board — harshly criticized the move, saying the hospital had not proven it could afford such bonuses after ending the last three years in the red and relying on a federal funding pool to end this year with a profit.

Legislators also questioned whether the board discussed the bonuses privately before the vote, possibly violating the state’s open meetings law.

“In light of those questions and in the spirit of cooperation, the board and management decided to hold payments until this issue has been addressed,” hospital officials said in a statement Thursday night.

Hospital trustee Jennifer Stanley said the decision to have an internal legal review is the “appropriate action” in order to be “respectful of a dialogue with our legislators.”

But state Sen. Todd Gardenhire, R-Chattanooga, who has led criticism of the board, said an internal review of the process is “like a fox determining the security of the hen house.”

“[The hospital attorney] is on the payroll of Erlanger. He’s one of the people that gets a bonus. He is not impartial,” Gardenhire said. “The board needs to hire a truly independent outside counsel who will rule on it and give them an opinion.”

Hospital’s payout of executive bonuses irritates legislators

State legislators and Hamilton County officials are criticizing a decision by the Erlanger Health System’s board to pay $1.7 million in bonuses to executives and management after a period of financial turmoil, reports the Chattanooga TFP.

“I felt betrayed. I felt embarrassed ” said state Sen. Todd Gardenhire, R-Chattanooga. He said the decision flies in the face of the work local, state and federal lawmakers did to help procure $19 million in federal funding, money that contributed directly to the hospital ending the year in the black.

“It will be difficult for [Erlanger] to come back and ask anything of us going forward,” Gardenhire said.

Erlanger trustees approved a series of last-minute resolutions Thursday to pay out the incentives to 99 managers. They include a $234,669 performance incentive for (CEO Kevin) Spiegel, bringing his total compensation this year to $914,669. Trustees also voted to give Spiegel a 10 percent raise next year, and approved a 2 percent nonbudgeted pay raise for hospital employees.

The payouts were tied to a series of financial benchmarks set up more than a year ago. Still, state Sen. Bo Watson, R-Hixson, said he was “stunned” by the move, given the hospital’s recent financial history.

“A year ago, this administration, this board was before us, hat in hand,” Watson said. “This delegation went to bat for this hospital system. And now this.”

Members of Hamilton County’s legislative delegation said they plan to discuss the Erlanger payouts today when they meet with county officials to discuss the upcoming legislative session. Several members said they plan to take “some kind of action” in response to the incentive payouts, though they were not specific.

“Tennessee has a hospital assessment fee. Erlanger’s exempt from it. Are we just providing bonuses for people? What do we do with that?” Watson said.

The delegation has been involved in several recent Erlanger-related measures, including the hospital’s recent efforts to gain 501(c)(3)-like nonprofit status. Rep. JoAnne Favors, D-Chattanooga…said Monday that the board’s decision reinforces her position not to support any bill that grants the hospital more independence. She said she took several “deeply troubling” calls throughout the weekend from upset Erlanger employees and retirees, who have had their health and retirement benefits slashed this year amidst cost-saving efforts and who were frustrated by the bonuses.

Hillary Clinton visits St. Jude Childrens’ Hospital

By Adrian Sainz, Associated Press
MEMPHIS, Tenn. — Hillary Rodham Clinton, who worked on a plan to expand health care coverage in the U.S. years before the Affordable Care Act, visited with young patients Thursday at St. Jude Children’s Research Hospital, where families of patients suffering from pediatric cancer and other illnesses pay nothing for treatment, travel, housing and food.

The former Secretary of State then spoke at the opening of the Marlo Thomas Center for Global Education and Collaboration on the campus of the Memphis hospital. Thomas, an actress and the daughter of St. Jude founder Danny Thomas, is the face of the hospital’s national outreach efforts and a winner of the 2014 Presidential Medal of Freedom.

St. Jude is considered a leading researcher of cancer and other life-threatening diseases that affect children. The hospital says it is working to increase the overall survival rate for childhood cancer to 90 percent in the next decade. The hospital relies heavily on donations from the public, which makes up three-quarters of the hospital’s funding, said Richard Shadyac Jr., president and CEO of St. Jude’s fundraising organization.

“This is what health care should look like. Patients before profits. Collaboration before competition. And that is particularly the health care that every single child deserves,” she said. The statement drew applause from the audience.

It was Clinton’s second visit to St. Jude. She first came in 1994, when she was first lady and her husband, Bill Clinton, was in his first term. She led a 1993 task force that unsuccessfully sought legislation in Congress to achieve universal health care coverage.
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