Tuesday Tidbits

Fascinating move. Wellpoint, one of the country’s largest health insurers, has tapped a hospital executive Joseph Swedish to be its new chief executive officer. Will this move help to bridge the gap between health insurers and the health care providers that they finance? Time will tell.

CAQH, an alliance of health insurers, has announced

[T]he launch of a new, universal electronic funds transfer (EFT) enrollment tool for providers that facilitates the use of electronic payments between payers and providers by offering a single point of entry for adopting EFT. By streamlining and automating the EFT enrollment process, the tool creates efficiencies and cost savings for both payers and providers by eliminating the need for providers to enroll in EFT separately for each health plan in which they participate.

Beginning January 2014, all payers will be mandated to offer EFT under the requirements of the Patient Protection and Affordable Care Act (ACA) and Medicare will only reimburse providers through EFT. However, the Department of Health and Human Services (HHS) reports that only 32 percent of healthcare claims were paid electronically in 2010, partially due to the current cumbersome and burdensome enrollment processes which require that providers enroll separately with each payer. The switch to EFT for provider reimbursement will eliminate the need for redundant paperwork, reduce the time spent on printing, mailing and receiving checks, lower lockbox fees, as well as enable tighter security on monetary transactions. 

The CAQH press release indicates that Aetna and Cigna currently are making the new tool available. Quicker access to cash – that could improve relations between the Hatfield and McCoys too.

Following up on the last two FEHBlog posts on hospital readmissions, Kaiser Health News reports that

Writing in the Journal of the American Medical Association, researchers found no relationship between readmissions and mortality rates for Medicare patients who had heart attacks or pneumonia between 2005 and 2008. The paper did find a “modest” inverse relationship between readmissions and death rates for heart failure patients, where hospitals with low death rates tended to have somewhat higher readmission rates. But that was only for a small portion of hospitals and not strong even then.

“I feel we’ve dispelled the notion that your performance in mortality will dictate your performance in readmission,” said Dr. Harlan Krumholz of Yale University School of Medicine, the lead author of the study. “This result says they appear to be measuring different things, they’re not strongly related to each other and you can clearly do well on both.”

In other words, readmissions are not a sign of quality care.

Finally, the FEHBlog read with interest the report of a $50 million class action against a Long Island hospital whose patients were victimized by an identity theft ring.

Terence Lynam, spokesman for Great Neck, N.Y.-based North Shore-LIJ, confirmed in an e-mail that two people have been convicted and “multiple” other people have been arrested for operating “a widespread identity theft ring that victimized a number of organizations and about 1,000 individuals throughout the Northeast, including about 200 North Shore University Hospital patients.”

The victims say the 11-hospital system failed to notify them that their information had been compromised, even as thieves traveled the country opening credit lines and bank accounts in patients’ names, buying iPhones, maxing out patients’ existing credit cards and even filing bogus tax returns using victims’ information

This will be an interesting case to follow.

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