ARO U N D T H E NATION
NORTHEAST
Genesis Healthcare has settled
allegations that 12 of its facilities in Massachusetts and Rhode Island denied admission to potential residents who were prescribed opioid use disorder treatments.
The provider will pay more than $700,000 over the allegations, adopt nondiscrimination policies and train admissions personnel, under terms of the agreement. Genesis could waive as much as $50,000 of the fines if the facilities comply with the terms of the agreement.
“(HHS) Secretary (Xavier) Becerra has made advancing the goal of ending the opioid crisis a key priority for HHS, particularly since the COVID-19 pandemic has exacerbated this deadly crisis,” Robinsue Frohboese, acting HHS director of the Office of Civil rights, said in a statement. “This agreement and the steps that Genesis is taking across its facilities advances this important goal by ensuring civil rights laws protect healthcare access for people who are in treatment for opioid use disorder.”
The U.S. Attorney’s Office in Massachusetts has reached four settlements with nursing facility operators for similar claims.
MIDWEST
Chicago-based Health Care Service Corp. plans to expand its Medicare Advantage offerings to more than 90 counties that are home to 1.1 million Medicare-eligible residents.
HCSC billed the Medicare Advantage expansion as the largest in its history. The company covers almost 17 million people through Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas.
Over the last decade, Medicare Advantage enrollment has skyrocketed—particularly among Black beneficiaries and those from medically underserved areas. Insurers want more of this profitable business.
HCSC’s Medicare Advantage bid is part of a larger trend among Blue Cross and Blue Shield companies, said Ari Gottlieb, principal at A2 Strategy Corp.
“Medicare Advantage offers them an opportunity to capture much more of the premium dollar, to influence care more and to leverage their existing customer relationships and brand to help drive growth,” Gottlieb said.
Wayne State University is opening a new center focused on the study of infectious diseases and strategies to combat future pandemics.
The Center for Emerging and Infectious Diseases—which is not a physical building but a collection of doctors, researchers and professors at the Detroit-based university—will enhance training and research in the field of public health.
The center will cost approximately $4 million annually to operate, mostly funded by external grants, the university told Crain’s Detroit Business in an email.
Work done at the center will focus on vaccine development, clinical vaccine evaluational, deployment strategies for vaccines in underserved populations and research on pandemic mitigation efforts.
WEST
More of Kaiser Permanente’s 12.5 million members returned for healthcare services once COVID-19 cases waned in the spring and early summer, contributing to an unusually slim operating margin in the second quarter of 2021.
Typically, higher patient volumes would boost a health system’s bottom line, but Oakland, Calif.based Kaiser operates differently than most. As an integrated system, its patients are also its health plan members, so Kaiser foots the bill for their care. The system’s operating margin was just 1.5% in the quarter ended June 30, down significantly from 9.4% in the prior-year period.
Not-for-profit Kaiser spent less than usual on medical services in the second quarter of 2020, a period that includes most of the pandemic’s first wave, because much of its operations were shut down, said Tom Meier, Kaiser Permanente’s corporate treasurer.
Kaiser generated $349 million in operating income in the second quarter of 2021, down from about $2.1 billion in the prior-year period. The high operating profit in the earlier quarter was because of state shelter-in-place orders that required providers to suspend elective procedures. The shutdowns strained most providers, but Kaiser has a prepaid model where its members pay the same rates whether they use services or not, Meier said.