27. February 2008 by Jon Moss.

The Department of Justice (DOJ) has filed an antitrust lawsuit in U.S. District Court in Washington in an effort to impede UnitedHealth Group Inc.’s proposed $2.6 billion acquisition of Sierra Health Services Inc.

According to the Department, UnitedHealth must sell portions of its business first to ensure competition.

Although UnitedHealth has agreed to those conditions, the DOJ’s antitrust lawsuit cited concerns that the merger would reduce competition in the Medicare health insurance market in Nevada, according to reports.

The Department’s proposal, which must be approved by the court, asks that UnitedHealth sell portions of its Medicare Advantage business in the Las Vegas-area for the merger to proceed, according to reports.

Otherwise, officials with the Department argue, the new company would control 94 percent of the Medicare Advantage market in that area.

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27. February 2008 by Jon Moss.

In an effort to increase the funding and efficiency of health care for Native Americans, the Senate voted 83-10 to approve legislation intended to provide the group with greater access to health care services — including screening and mental health programs.

Native Americans typically experience higher death rates due to alcoholism, drug use, diabetes, cardiovascular disease and suicide rates, according to reports.

In addition to expanding tribal access to Medicare and Medicaid, the bill — which would authorize approximately $35 billion for Indian health care programs over the next 10 years — would also enhance programs at the Indian Health Service, help construct and revamp health clinics on reservations, and attempt to recruit more Native Americans into the health care industry, according to reports.

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27. February 2008 by Jon Moss.

A new study, released today by the National Association for Insurance Commissioners (NAIC), indicates that although 84 percent of baby boomers say access to health insurance is important when choosing a retirement date, 64 percent do not have a comprehensive understanding of their Medicare eligibility.

Only 36 percent of the 377 boomers surveyed — all born between 1946 and 1964 — say they knew that Medicare eligibility begins at age 65, 21 percent thought Medicare coverage began at age 62, and 9 percent said age 67.

Additionally, 6 percent think the eligibility age for Medicare is 59 ½ and 28 percent say they are unsure of the age, according to findings.

According to the NAIC, only 43 percent of respondents say Medicare eligibility is an important factor in determining when they will retire, but 48 percent expect to use Medicare to cover their health care needs in retirement.

Researchers conclude that many baby boomers are unclear about access and eligibility to Medicare and could be missing out on benefits that have already qualified for.

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27. February 2008 by Jon Moss.

Aetna announced today that it has launched a secure, provider Web site with NaviMedix, a leading innovator in automating health care provider communications.

Through NaviNet, NaviMedix’ s multi-sponsor health care communication platform, health care providers have easy, one-stop access to most major payers and select regional carriers, improved security options and improved electronic administrative transaction capabilities, according to reports.

Aetna’s secure provider Web site via NaviNet offers many easy-to-use features to both participating and nonparticipating physicians, hospitals and other health care professionals, the company says.

Free, real-time transactions are available with Aetna as well as other payers including major health plans and the Medicare program and enhanced administrative options provide one-stop service, as only one user name and password is needed to interact with Aetna or other health plans.

Meanwhile, health care providers can check eligibility and benefits in real time, submit or inquire about claims, review claim payment policies, view and print explanation of payments online within 24 hours of claims processing, obtain electronic remittance advices, access Aetna’ s education site and conduct many other activities, according to Aetna.

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27. February 2008 by Jon Moss.

Last Sunday the Wichita Eagle published a story on how a local Kansas hospital has discounted  slashed their price on a common type of heart surgery.  They did it to be more competitive in the marketplace.  Apparently they felt strongly about gaining more share of the market.  They’re even advertising in Canada and the UK (for people who don’t want to wait for their government-provided medical plans to schedule procedures, and are willing to pay)  Here’s the story in it’s entirety:

Galichia Heart Hospital says it will begin charging a flat fee of $10,000 for one of the most common types of open heart surgery — undercutting hospital charges by at least $25,000.

The discounted fee is the latest plan by the physician-owned hospital to attract more patients. The hospital also promises a 15-minute wait time and a $50 co-pay in its emergency room.

Galichia officials say the discounted rate applies to standard coronary artery bypass graft surgery, but only for cases where there is little chance for complications. Patients with risky health issues such as diabetes or who have had the surgery before are not eligible.

Hospital officials are frank about their motives: They want a bigger piece of the patient base in Wichita and beyond.

“We’re very serious about presenting cost-effective products and options for our community and for the region and nationally,” Galichia hospital chief executive Steve Harris said.

“I think it will turn some heads. This isn’t just a good rate. It’s a world-class rate.”

Getting patients

About five of every 1,000 people need open-heart surgery every year, so a community this size produces roughly 2,000 procedures annually, Harris said.

Surgeons at Galichia Heart Hospital perform about 200 open-heart surgeries a year. Harris said he would like to see that increase by 100 this year.

The idea behind the rate cut is threefold, he said. The hospital wants to attract cash-paying uninsured workers, get the attention of insurance providers and cost-conscious employers in Wichita, and tap into medical tourism — the trend of patients going out of the country to purchase affordable surgery.

“We’re making money at this rate,” Harris said. “We’re challenging our colleagues to really square off against rising health care costs.”

Physician-owned hospitals in Wichita have historically struggled for market share in a city where the two major hospital systems — Via Christi Regional Medical Center and Wesley Medical Center — contract exclusively with insurance providers.

Galichia officials are hoping their new rate causes the area’s largest insurers — Blue Cross and Blue Shield of Kansas and Via Christi-owned Preferred Health Systems — to consider steering some of their client base to Galichia.

“This is a much better rate than anybody else is giving Blue Cross or Preferred Health,” Harris said. “We’re not an in-network provider. We’re sort of challenging (them) to rethink their contracting strategies.”

Blue Cross, at least, is intrigued, although the state’s largest insurer said it would abide by its contractual obligations.

“Blue Cross… members are free to receive services from any hospital they choose with the understanding that their benefits will be applied differently when they use non-contracting facilities,” spokeswoman Mary Beth Chambers said.

“We direct members to the hospitals where we have contracts because of the discounts we receive from those contracting providers. If one hospital is charging less than others in the area then that is good for the community and could help lower overall health care costs for everyone.”

Making waves

Galichia’s new rate could threaten larger community hospitals, although executives at each declined to comment.

Administrators at Kansas Heart Hospital, of which Via Christi is a minority owner, said the Galichia plan is “very interesting” but unlikely to make a dent in their business, which is based largely on physician referrals.

“I’m not sure what impact it could have,” said Lynn Jeane, chief operating officer. “And I’m not sure how many people needing heart surgery are going to be out shopping for the lowest price.”

Supporters say physician-owned hospitals are extremely efficient, making such cost-cutting strategies possible.

“It’s a gutsy move, but I understand what they’re trying to get done,” said Jim Sergeant, past president of the Kansas Surgical Hospital Association and chief executive of Salina Surgical Hospital. “If you take a hard look at costs, you can do premier services at a very good price.”

Galichia hospital also is running ads this weekend in Canada and the United Kingdom, targeting countries where government health plans have created long waits for elective surgeries. Such environments have fostered medical tourism to such places as India, where patients can get procedures done inexpensively.

“The price… is absolutely stunning,” said Rick Baker, a Canadian who founded Timely Medical Alternatives and North American Surgery. His companies connect clients with specialty hospitals that agree to perform certain surgeries at low, contracted rates.

“The solution to America’s health care problems is (for) people to find a way to negotiate very good prices,” he said.

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