Insurance Director Thwarts Aetna/Humana Merger Plans In Missouri
Staff Contact: Jane Drummond
John Huff, Director of the Missouri Department of Insurance, issued an order prohibiting Aetna from obtaining a license to sell comprehensive group and individual health plans and group Medicare Advantage plans in Missouri if federal officials approve its proposed merger with Humana. The director also found that the combined market share of the two companies in the individual MA market violated the competitive standard in 64 Missouri counties, along with the City of St. Louis. Under his preliminary order, the combined entity is barred from issuing individual MA plans in those markets. Aetna has 30 days to submit a plan to remedy the anticompetitive effect of the merger. If it is unable to do so, the director’s order will become final. MHA opposed the merger and submitted evidence suggesting that there are few opportunities for divestitures necessary for Aetna to overcome the presumptively unlawful effect of the merger.
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Congressional Committee Advances Hospital Bill
Staff Contact: Daniel Landon
The U.S. House of Representatives’ Committee on Ways and Means has approved H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016.” The committee advanced a new version, making several changes. Its components include an exemption from Medicare payment caps for off-site hospital outpatient departments that were being developed when Congress passed a payment restriction in November 2015. The bill also revises Medicare readmission payment standards to include an adjustment for differences in patients’ sociodemographic characteristics. A previous article summarized its components.
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Trajectories — Hospital Preparedness
Staff Contact: Jackie Gatz
The May issue of Trajectories highlights the importance of hospital preparedness. In addition to natural disasters, hospital leaders are closely monitoring the unconventional incidents that result in significant disruptions to the health care delivery system. These events include highly infectious diseases, security threats and cybersecurity. In the area of emerging threats, the all-hazards approach to preparedness planning is critical. An all-hazards emergency management program considers the critical functions of a successful response. Training and exercises focus on developing capacity in the broad activities that most likely will occur during response, regardless of threat. Incident command activation, staff notification, surge management and evacuation/shelter-in-place, are four functional activities that would result for a variety of hazards identified by a risk assessment. Further, ensuring staff competency in fundamental response objectives provides a competitive advantage to the unexpected hazards.
Through 2014, as public health officials monitored the rapidly spreading Ebola virus disease in West Africa, hospitals across the country strengthened surveillance systems to ensure effective safety and infectious-disease practices. The initial lack of understanding of the transmission paths of the virus, as well as hyper-vigilance to adequately outfit health care workers in appropriate personal protective equipment, resulted in a tremendous expenditure of human and financial resources. While these preparedness expenditures have yet to be quantified, the financial burden of not being prepared was evidenced by the declining revenue of Texas Presbyterian Hospital, in Dallas. Following the hospital’s failure to recognize and appropriately treat Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., the facility reported a decline in revenue of $8.1 million — a 25 percent decrease from the previous nine months.
Investing in daily practices to routinize infectious-disease and hazardous-incident management would reduce the reactionary efforts by hospitals at the onset of each new threat, such as Middle East respiratory syndrome coronavirus (MERS-CoV) and Zika. Further, the efforts would mitigate recurring threats, such as annual influenza and hospital-acquired infections.
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