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Health Reform

Potential merger sparks concern on prices

As merger talks continue between Emory Healthcare and WellStar Health System, a consumer advocacy group has voiced concerns about the potential impact of a deal in the metro Atlanta market.

Beth Stephens

Beth Stephens

Georgia Watch said such provider consolidation “is leading to higher prices for consumers with little to no improvement in the quality of care individuals receive.”

Beth Stephens, the group’s health access program director, also said she is concerned that the public comment period about the merger lacks transparency.

“We want to know what stakeholders are being engaged, and why consumer advocacy organizations are being left out of the conversation,” said Stephens, who submitted her organization’s comments to Emory and WellStar this week.

Emory and WellStar issued a statement Thursday that said the two organizations “remain in discussion on this initiative and anticipate providing additional information in early April. We look forward to engaging with the community throughout the planning process.’’   full story

Mandl named to top posts at Emory Healthcare

Emory University announced Wednesday that Michael J. Mandl will take over as president and CEO of the university’s health care operations.

Michael J. Mandl

Michael J. Mandl

Mandl currently serves as chairman of Emory Healthcare’s board of directors.

The appointment comes at a pivotal time for Emory Healthcare, which is in negotiations on a potential merger with another metro Atlanta medical heavyweight, WellStar Health System.

Mandl has led those merger discussions on behalf of Emory from the outset and will continue to do so, the university said.

He will replace John Fox, who surprised industry experts in leaving as Emory Healthcare CEO and president for the same positions with a Detroit-based health system. full story

Is tobacco cessation being improperly slighted?

State insurance officials are investigating whether health insurers are covering tobacco-cessation products as a free benefit, as required under the Affordable Care Act.

“We have received several inquiries from [medical] providers and consumer groups,’’ said Glenn Allen, spokesman for the state insurance department, confirming the investigation.

Cigarette BurningThere are questions about several Georgia insurers — operating through the ACA exchange, the regular insurance market or both — not covering the tobacco cessation products.

The health law requires that certain “preventive” benefits be covered without a co-pay, co-insurance or a deductible. Besides tobacco cessation, these include immunizations, as well as screenings for cholesterol, blood pressure, depression and HIV.

Allen said the state office of Insurance Commissioner Ralph Hudgens is working with the federal Centers for Medicare and Medicaid Services on the cessation product investigation.

“We’re not aware of other states that are having the same issue,’’ Allen told GHN. But he noted that some of the same health insurers in Georgia operate in other states. full story

A few words could affect millions of people

Benjamin Wills of Atlanta is among the more than 400,000 Georgians receiving a subsidy to afford health insurance in the Affordable Care Act exchange.

With the subsidy, Wills is paying a monthly premium of $370 for family medical and dental coverage through the exchange.

benwills

Benjamin Wills

If he loses the subsidy, Wills said Wednesday, he could be forced to drop his family’s dental coverage, and perhaps re-enroll his daughter in the government PeachCare program.

“The way [the ACA] is now is working for our family,’’ said Wills, who recently left a job with benefits to start a private Christian school in Atlanta.

The fate of the insurance subsidies – and the future of the Affordable Care Act in general – were on the line as the U.S. Supreme Court heard arguments Wednesday on the legality of the credits in the exchanges in Georgia and 36 other states.

This case, King v. Burwell, is not officially a challenge to the ACA. Instead, the plaintiffs in the case say the law is not being followed. They argue that the subsidies, which help people afford coverage, are not permitted by the health law in the 37 states that have federally operated insurance exchanges.

After more than an hour of arguments in the case Wednesday, the justices appeared divided over the subsidies issue. full story

Rural health panel offers plan to cut ER use

A special state panel created by Gov. Nathan Deal has proposed a pilot program that would use telemedicine and other techniques to bolster rural health care in Georgia.

The Rural Hospital Stabilization Committee report, released Monday, supports a “hub and spoke’’ model to relieve the burden on rural hospital emergency rooms. It would use telemedicine-equipped ambulances to facilitate remote diagnoses of patients in rural areas.

clipboardTelemedicine basically is the transmission of video and digital vital signs of a patient to a physician at another location who can evaluate that information for a diagnosis. Georgia has been a pioneer in this field.

The four pilot sites would be based in hospitals that serve different rural regions of the state: Union General in Blairsville, Appling HealthCare in Baxley, Crisp Regional in Cordele and Emanuel Medical Center in Swainsboro.

The report of the Rural Hospital Stabilization committee makes no mention of the possibility of Medicaid expansion in the state, which is opposed by Deal and the Republican legislative leadership due to cost concerns. full story

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