Roundup: Texas insurance regulator pulls out-of-network notice rules; Bay-Area Komen fundraising suffers after flap; Mass.'s Steward pushing to buy Maine hospital

Aug 22 2012

A selection of health policy news from Texas, California, Massachusetts, Georgia and Oregon.

The Dallas Morning News: Rules To Help Texans Avoid Surprise Hospital Bills Are Pulled
Texas' top insurance regulator has rescinded new rules designed to help consumers avoid a common pitfall when they seek medical treatment -- big bills for out-of-network care -- a move that angers consumer advocates and doctors groups. The rules were meant to give more than 4 million Texans covered by preferred provider organization health plans, or PPOs, more information about whether they'd pay the higher out-of-network costs if they were hospitalized and seen by a specialist. Many have been surprised to be on the hook for higher bills for the specialists' services, even though the hospital itself was part of their insurer's preferred network (Garrett, 8/20).

San Francisco Chronicle: Komen Controversy Hurts Local Affiliate
Donations to the Bay Area affiliate of Susan G. Komen for the Cure and participation in the breast cancer group's major local fundraising events next month are down about 30 percent in the wake of the organization's controversial decision earlier this year to stop funding Planned Parenthood. Komen, the world's largest breast cancer charity, came under harsh criticism in late January when news emerged that it had ended about $680,000 in grants to Planned Parenthood for breast-screening services based on a new internal rule that barred the group from giving money to organizations under government investigation. … Now, just weeks before Komen's biggest San Francisco events -- the Susan G. Komen 3-Day walk and the Race for the Cure -- the effects of that debacle are still being felt (Colliver, 8/20).

The Boston Globe: Steward Pursued Struggling Maine Hospital
Pushing forward with its plans to expand out of state, Steward Health Care System LLC, which has amassed a chain of 10 community hospitals in Massachusetts, signed a letter of intent to buy financially struggling Mercy Health System of Maine from a Catholic hospital group. The letter, which does not spell out financial terms, gives Boston-based Steward exclusive rights to negotiate with Mercy's owner, Catholic Hospital East, a Pennsylvania-based network of 35 hospitals and other health care facilities operating in 11 states from Maine to Florida (Weisman, 8/20).

Georgia Health News: Savannah Strategy: Skip The Middleman, Cut Deals With Providers
With 148 employees, Lummus has seen its health costs flatten out in the past four years -- rising no more than 5 percent a year. In addition, says Sharon Herrera, Lummus' human resources director, the company has improved employee benefits. Copays for medications have been lowered and wellness benefits have been added, along with other benefit enhancements for workers. "We believe we've improved the health of our employee population," Herrera says (Miller, 8/20).

The Oregonian: PeaceHealth To Merge With Colorado's Catholic Health Initiatives
Vancouver-based PeaceHealth announced Friday a plan to merge with Catholic Health Initiatives, creating a system with 16 hospitals, 26,000 employees and nearly $4 billion in revenue in the Northwest. Englewood, Colo.-based CHI operates seven hospitals in Oregon and Washington, including Mercy Medical Center in Roseburg and St. Anthony Hospital in Pendleton, and employs 10,000 in the region. It is the second-largest Catholic health care system with $10.5 billion in revenue and operations in 19 states, including nursing-home facilities, nursing colleges and home health agencies (Hunsberger, 8/20).

California Healthline: Legislators, Advocates Urge Care In Healthy Families Transition
Legislative leaders last week joined the chorus of children's health advocates urging state officials to move slowly and carefully in their dismantling of the Healthy Families program. In a letter addressed to California Health and Human Services Agency Secretary Diana Dooley, Senate President Pro Tempore Darrell Steinberg (D-Sacramento) and Assembly Speaker John Pérez (D-Los Angeles) urge the Brown administration "to develop a transition timeline that is based first and foremost upon the careful and thorough completion of key readiness activities." Steinberg and Pérez point to specifics in the budget trailer bill, as well as the Knox-Keene Act, California's 37-year-old legislative framework for managed health care (Lauer, 8/20).

California Healthline: Keeping Providers In The Loop
With so many changes in Medi-Cal services and reimbursement rates, the state has been working on a system to constantly update and alert physicians, nurses and other providers about the latest wrinkles in Medi-Cal administration. "We've never offered this before," said Dan Nand, web content lead at Xerox State Healthcare, which is working with the state Department of Health Care Services on the updating project. "Providers have never had a chance to do this before. Now they'll be able to read all of the announcements by desktop, or by mobile phones." The idea is to have a series of networks, like an advanced kind of listserv system, Nand said, in which providers can sign up for specific specialty areas, such as acupuncture or long-term care (Gorn, 8/21).