State Roundup: Calif. hospitals billing questioned; N.Y. hospitals among the weakest financially in the nation

Apr 20 2010

The Sacramento Bee: An analysis of financial data from 300 California hospitals "shows they collected $25 billion from insurance companies between September 2008 and October 2009 - an increase of more than a third since 2005. Hospitals are charging insurance companies, and by extension their customers, billions of dollars for expenses not directly related to care. These include new hospital wings, new technology and services for the uninsured. ... Hospitals say their charges to insurers are justified and necessary. But their byzantine pricing policies make it difficult to understand why costs are rising so quickly. Under state law, hospitals have to report the total amount of money they spend to provide services to insured patients each year, how much they bill insurance companies and how much they wind up collecting. Based on those numbers, The Bee found that California hospitals charged insurers an average of 53 percent more than what they told the state it cost them to provide services. In 2005, the gap was 40 percent" (Calvan and Reese, 4/18).

The Sacramento Bee, in a separate story: Amador County's "only hospital, Sutter Amador in Jackson, has struggled to expand services because there aren't the necessary doctors, surgeons and other specialists around. The hospital's chief executive officer would like to do more to attract physicians to the foothills, but California is one of five states that forbid private hospitals from directly hiring their own doctors. [Dr. Bob Hartmann, a rural practitioner], who also serves as Amador County's public health officer, wants the law changed so rural hospitals can lure more doctors into medically underserved communities by promising a steady income - something that can't always be guaranteed by the financial instability of a country practice." The California Hospital Association is pushing the legislature to revisit this law (Calvan, 4/19).

The Associated Press, on the financial well-being of New York hospitals: "The state's money for health care is spread so thin among its 'too many hospitals' that its medical facilities are financially among the weakest in the nation, the health commissioner said. Dr. Richard Daines spoke to The Associated Press on Friday as health officials were fielding proposals for St. Vincent's Hospital, a 160-year-old Greenwich Village facility. ...  Asked whether he's concerned that lower Manhattan had lost a top-level trauma hospital, he said, 'We have whole counties in the state that don't have a hospital.' The nearest, most high-level trauma center, Bellevue Hospital Center, is two miles away" (Dopnik, 4/17).

The Portland Press Herald: "A plan to merge southern Maine's two largest cardiology practices with Maine Medical Center is on hold because of concerns about reduced competition and antitrust challenges. The merger would be one of the biggest examples in Maine of a trend that is transforming the nation's medical industry as private-practice physicians trade their independence for a salary from the hospitals where they do much of their work. And it is sparking debate about whether competition or consolidation is the best way to deliver care and contain costs in the post-reform business of health care. Under the plan, MaineHealth, owner of Maine Medical Center, would hire the 40 cardiologists now with Maine Cardiology Associates, which is based in South Portland, and Cardiovascular Consultants of Maine, based in Scarborough" (Richardson, 4/18).

The Associated Press/Miami Herald: "Most of Florida's 2.7 million Medicaid recipients in all 67 counties would be placed in private managed care plans under a pair of bills up for a House vote. Both plans would expand an existing five-county managed care experiment pushed by then-Gov. Jeb Bush in 2005 as a way to cut rising costs and fraud. Miami-Dade County would be added in the next year, and the rest of Florida's 67 counties would be added over five years" (4/19).