Breaking News: NSLIJ, and Brooklyn’s Maimonides Announce Strategic Partnership on Wednesday. Both side shave been in talks since February.
Eventually North Shore-LIJ and Maimonides will fully integrate, “in a phased approach that will begin immediately,” the two jointly announced Wednesday. In the meantime, both institutions maintain their independence and separate governance structures. Lynam said there was no specific time frame for full integration.
Maimonides gets much-needed cash — tens of millions of dollars — for capital and operational investments. That will help it compete with Presbyterian-backed Methodist and Langone-backed Lutheran. North Shore-LIJ gets its first real foothold in #Brooklyn, one of the most competitive health care markets in the nation. But it does so without the commitment that a full-scale merger would entail. An affiliation agreement also protects North Shore-LIJ from unknown liabilities related to the Federation of Jewish Philanthropies, a malpractice insurer that covers Maimonides and several other hospitals
North Shore-LIJ has made strategic partnerships and acquisitions before. For North Shore-LIJ, the relationship means it has a hospital or hospitals in every borough as well as blanketing Westchester and Long Island. North Shore-LIJ, the country’s 14th largest health care system, owns 19 hospitals. In the city that includes Lenox Hill Hospital in Manhattan, Staten Island University Hospital, and, in Queens, Forest Hills Hospital, Long Island Jewish Medical Center, Cohen Children’s Medical Center and Zucker Hillside Hospital, a behavioral health center.
They are also actively insuring members today in the Downstate NY area under the CareConnect NSLIJ holding company. With important advantages under ACA and mindful of delivering value the insurance arm is priced affordably. In fact they had lowered their rates 15-20% for 2015 and and industry low 3.3% for 2016.
With first new star rankings released yesterday by CMS (Center for Medicare & Medicaid Services) this will be a little easier for consumers. The role of Government in medical transparency have long been touted as a qualitative and cost factor. The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality.
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
• How well nurses and doctors communicated with patients
• How responsive hospital staff were to patient needs
• How clean and quiet hospital environments were
• How well patients were prepared for post-hospital settings
Only 251 hospitals–or 7 percent of those ranked–received a five-star rating under the new system, Kaiser Health Newsreported. The largest share of hospitals (40 percent) received three stars, including highly respected institutions such as Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. Only 3 percent of hospitals netted one star.
Consumers will now see 12 HCAHPS Star Ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures, plus a summary star rating that combines or rolls up all the HCAHPS Star Ratings. These star ratings will be updated each quarter. Also, the Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality.
Consumer complaints about receiving inadequate reimbursement from their insurers for medical services that they received outside of a provider network have been answered by New York’s “Emergency Medical Services and Surprise Bills” law. As of March 31, 2015, consumers will have protection from “surprise” medical bills for emergency medical services and certain out-of-network medical services.
The state of affairs today for small business plans offering both in and out of network is an exception with only 2 insurers in Downstate covering out of network at catastrophic high deductible levels. For Individual Marketplace it is even more dire with NO OUT OF NETWORK coverage at all.
The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012). According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem. Officials say that this is now “an overwhelming amount of consumer complaints.” Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.” Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.
The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices. The NY Dept of Financial services is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”
Balance Bill Protection. The long awaited bill passed last April protects patients from out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.
Provider Disclosure Requirements. Hospitals will now be required to disclose anticipated charges. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them. Its not unusual for a Provider to come into the picture who may read your tests or touch you thats not in network. Under the new law all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.
Providers will need to provide patients with disclosures of the health plans with which they participate and the names of the providers that may be billing them. They are also required to disclose procedures to follow with the an independent dispute-resolution entity (IDRE) which will be the arbiter of disputes under the law if a patient feels that a bill is inappropriate.
Network Adequacy. While the Affordable Care Act didn’t address surprise bills, the government has imposed network adequacy requirements that prevent health plans from having too few providers, which may reduce the number of cases where patients find themselves inadvertently out-of-network. New York will now require doctors and hospitals to disclose their network status before treatment in non-emergency procedures. Insurers will have to update online provider directories within 15 days of a change.
Prior to the Surprise Bill Law, these network adequacy rules only applied to health maintenance organizations (HMOs) and other “managed care” plans. HMO’s normally have more Provider/Insurer responsibility shifting form the patient. As with most non-HMO plans, however, the responsibility rests with patient to make sure everything is pre-authorized and in network is possible. Starting next month Health plans that are also based on more comprehensive PPO and EPO are also required to be certified as having provider networks that can meet the health needs of their members without having to rely on more expensive out-of network services.
A patient protection law is a welcome respite form the unfair unwelcome surprises out of one’s control. Common sense finally prevails!
WestMed Medical Group has now joined the North Shore LIJ’s insurance – CareConnect Network! This is not a purchase. This partnership expands their footprint and makes CareConnect a compelling fit for individuals and groups located in Westchester. In addition, CareConnect has just announced CareConnect’s Network Expansion! Yale-New Haven Health and all their facilities are now in-network with CareConnect. Tools are available to search for providers with updated expansion to be added shortly.
A combined Hospital Insurance system is an intriguing concept thats not all that new. Pittsburgh’s UPMC has been delivering the same model in Western PA successfully. In NYS an integrated medical approach is new on the other hand and challenging in an open competitive loop. A high quality smaller network that is priced affordably and can offer Patient Concierge like service may be what the market is asking for. They may also be in a better position to manage patient health and Preventative Medicine. For Jan 2015, NSLIJ CareConnect will have a 20% reduction in most regions such as Westchester and NYC. For new rates, benefits and provider listings click – CareConnect NSLIJ
For more information, please
Press Release#
Award-Winning WESTMED Joins CareConnect!
We’re pleased to announce our continued network expansion with the addition of WESTMED Medical Group. With this practice, CareConnect members now have more access in Westchester County:
• 289 physicians in eleven office locations • On-site laboratory and radiology services • Four urgent care centers • Three NCQA recognized programs including the patient-centered medical home and diabetes Stay tuned as we continue to add access for your groups around the CareConnect service area
Interfaith Hospital Planning Shutdown. The Bedford Stuyvescent Hospital entered bankruptcy court this week to approve its closing and send layoff warning notices to its 1,544 employees. Pending court and state approval, on Aug. 12 the hospital will end inpatient admissions and divert ambulances to other hospitals. Elective surgeries will end Aug. 19, the emergency department will shut Sept. 11, and all patients will be transferred from the hospital by Sept. 12. Outpatient programs will end Oct. 12 and detoxification and rehabilitation programs Nov. 11.
The bankruptcy court hearing for Interfaith is August 15. The hospital services 175,000 people with closest hospital in this predominantly minority community is about two and a half miles away.
The threatened closing of another Brooklyn hospital, Long Island College Hospital in Cobble Hill, has become an issue in the mayoral campaign. The 506-bed hospital — which it said to be losing $4 million was taken over by Downstate in 2011, inheriting a $170 million debt. The Hospital’s location is very sought after and will likely be purchased by developers. Developers are coveting LICH’s $1 billion in prime brownstone Brooklyn waterfront buildings.
Breaking Westchester Health Care News: As reported in The Journal News earlier. A Stellaris Hospitals Break Up is planned; Phelps, Lawrence, Northern Westchester and White Plains may form new alliances. Stellaris had been in the news in recent years with down to the wite negotiations with Empire Blue Cross Empire & Stellaris Reach Pact effective 8/1/10.
A Stellaris Hospitals Break Up is not surprising. This is viewed as possible strategic move for acquisition form larger local hospitals or even national chains such as Cardinal Health or HCA. Insurers have also purchaszed recenlty medical groups,see UnitedHealthcare Buying Medical Groups? Will it our market allow an Insurer to purchase a Hospital?
4 hospitals seek to cut Stellaris ties
By Jane Lerner
Four hospitals in Westchester County want to cut ties with their parent organization — a move that could signal their interest in forming new consolidations and alliances with other health-care facilities.
Phelps Memorial Hospital Center in Sleepy Hollow, Lawrence Hospital Center in Bronxville, Northern Westchester Hospital in Mount Kisco and White Plains Hospital are seeking to leave the Stellaris Health Network.
“Stellaris and its member hospitals made this decision after a lengthy strategic review that evaluated a variety of alternatives to respond to a dynamic and ever more challenging health-care environment,” Stellaris said in a statement.
The state Department of Health has to approve any change in ownership of a hospital. Requests from the four hospitals to “dis-establish” Stellaris as “active parent and co-operator” were filed with the state last week.
Leaving Stellaris will enable each hospital to seek new partners.
“By becoming independent, each hospital can move forward in the direction that each feels is best for its community,” said Arthur Nizza, who is on his way out as president and chief executive officer of Stellaris.
All four hospitals declined to comment.
As the parent organization of the four hospitals, Armonk-based Stellaris handled their negotiations with commercial insurance companies, purchasing and information technologies.
Stellaris will continue to provide IT support and some other services to the hospitals. But once they leave the network, they will be able to seek new partners to increase their bargaining power and share services and expenses.
Numerous hospital consolidations and mergers are taking place nationwide.
“I think in time — not immediately — the idea of a freestanding community hospital is going to be passe,” said Kevin Dahill, president of the Northern Metropolitan Hospital Association, an industry group.
Sound Shore Medical Center in New Rochelle and its Mount Vernon Hospital are seeking to merge with Montefiore Medical Center in the Bronx once the Westchester County institutions emerge from Bankruptcy Court. In New York City, Mount Sinai Medical Center and Continuum Health Partners, a network that includes Beth Israel and two St. Luke’s-Roosevelt campuses, agreed last week to merge.
“Hospitals are doing what they have to do to position their organizations,” Dahill said.
Stellaris was formed in 1996 as an alliance between White Plains and Northern Westchester hospitals. In 1997, Phelps and Lawrence joined and, in 2000, the company formed an emergency medical service to provide paramedic service to part of Westchester.
Nizza will become CEO of St. Francis Hospital and Health Centers in Poughkeepsie next month. Sharon Lucian, who has been with Stellaris since 1999 and is vice president and chief financial officer, will replace him.
No More Surprises – NY Surprise Medical Bill Law
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