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Grady, Blue Cross at impasse as contract expires

Contract standoffs between hospital systems and health insurers typically have a way of being resolved — often right before a deadline.

But high-stakes negotiations between Grady Health System and Georgia’s biggest insurer failed to produce a new contract before the midnight deadline Sunday.

Grady Memorial Hospital

Grady Memorial Hospital

That means Grady Memorial Hospital is now “out of network” for Blue Cross and Blue Shield of Georgia members. Patients with Blue Cross insurance will face higher out-of-pocket costs at the Atlanta hospital and its clinics.

Both Grady and Blue Cross expressed disappointment that a deal was not reached. Contract negotiations had been under way for a year.

Grady recently had launched a publicity campaign to call attention to low reimbursements from Blue Cross, saying those payments were lower than the insurer’s rates for other comparable hospitals in Atlanta and throughout the state. full story

State panel meets over ailing rural hospitals

Struggling to stay afloat financially, a northwest Georgia rural hospital has opted to file for bankruptcy protection from its creditors.

Officials at Hutcheson Medical Center in Fort Oglethorpe said Wednesday evening that the filing would allow it to continue operations, restructure debt, and help protect it from a Chattanooga system’s effort to foreclose on the hospital’s property.

Erlanger Health System has tried to recoup about $20 million it loaned Hutcheson as part of a management agreement.

Hutcheson Medical Center

Hutcheson Medical Center

The bankruptcy action came just hours before Gov. Nathan Deal’s Rural Hospital Stabilization Committee met in Lavonia on Thursday at Ty Cobb Regional Medical Center — another rural hospital experiencing severe financial challenges.

The panel heard speakers outline the depth of the state’s rural health care crisis.

Four rural hospitals have closed in Georgia over the past two years. Jimmy Lewis of HomeTown Health, an organization of rural hospitals, told the committee that 15 more facilities are “financially fragile.” Six of those, he said, “could go tomorrow due to low cash.”

“We’re approaching Third World care in the state of Georgia,’’ Lewis said.

More than 40 Georgia counties lack obstetrical providers, and just 75 of 180 hospitals in the state have labor and delivery units, Pat Cota of the Georgia OB/GYN Society told panel members. full story

27% of state’s hospitals earn top safety rating

One in four Georgia hospitals earned an “A’’ grade in recently released ratings on patient safety.

clipboardThe 27 percent figure put Georgia hospitals roughly in the middle of the pack among states, according to the Leapfrog Group’s safety scores report.

The ratings measure the ability of hospitals to prevent errors, injuries and infections. The report on the ratings is intended to help consumers as they choose a facility for health services.

More than 1,000 people die each day in the United States because of preventable hospital errors, according to the Leapfrog Group, a nonprofit, Washington-based organization that focuses on patient safety.

Nationwide, one in 25 patients actually picks up an infection in the hospital.

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Suit claims WellCare improperly pocketed funds

Six former WellCare officials are suing the Tampa-based company over health care fraud allegations related to its services in Georgia and other states.

The six claim that WellCare improperly kept money that should have been paid to hospitals or been repaid to Medicare or state Medicaid programs in Florida, Georgia, Illinois, New York, Ohio, Kentucky and Missouri.

logo_corporateThe plaintiffs say they each were fired Dec. 3, 2012, after resisting pressure from top officials to deny payment for medically necessary hospital stays.

The False Claims lawsuit, filed in the U.S. District Court in Tampa in May 2013, had been sealed while the U.S. Attorney’s Office decided whether to intervene in the case, Health News Florida reported this week. The case was unsealed last week after federal prosecutors decided not to step in.

WellCare serves more than 590,000 Georgians in the state’s Medicaid and PeachCare programs.

The company operates one of three care management organizations in Georgia that oversee the care of  a total of more than 1 million members in the two government insurance programs. These organizations operate like HMOs for patients in the programs.

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Grady appeals to public in battle over contract

Charles Armbrust had severe headaches from what was eventually diagnosed as a brain aneurysm. He received surgery at Grady Memorial Hospital in Atlanta.

“Grady saved my life – that’s the bottom line,’’ said the former patient.

A video of a tearful Armbrust expressing his gratitude for his medical care is posted on a Grady web page describing problems that the health system says it’s experiencing in reaching a new contract with Blue Cross and Blue Shield of Georgia. Armbrust’s insurer is Blue Cross.

Grady Memorial Hospital

Grady Memorial Hospital

The powerful video is part of a campaign by Grady to call attention to low reimbursements from Georgia’s largest health insurer.

Those payments are lower than Blue Cross rates for other comparable hospitals in Atlanta and throughout the state, says Grady CEO John Haupert.

For trauma services, “it’s much lower than other hospitals,’’ Haupert told GHN on Monday. Overall, he said, Grady loses money when it treats most Blue Cross and Blue Shield of Georgia patients.

Haupert said the two sides have been negotiating for a year. While these talks are continuing, he said, Grady has sent Blue Cross a termination notice that would be triggered Nov. 25.

Both Grady and Blue Cross say they hope an agreement is reached before the November deadline. The contract affects Grady’s hospital and other facilities, but not its physicians. full story

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