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Kaiser scores another annual top rating in Georgia

Kaiser Permanente is again Georgia’s top-rated health plan in commercial insurance, according to the National Committee for Quality Assurance.

photo.jpgIt’s the 11th straight year that Kaiser, a nonprofit, got NCQA’s No. 1 rating among commercial health plans in the state.

The NCQA rankings use a 1-to-5 scale, with 5 being the highest.

The 2015-2016 ratings also put Kaiser as the leader among Medicare insurers in Georgia – the only one operating in the state to achieve a 5 score. full story

Piedmont, WellStar cutting back on health plan

WellStar Health System and Piedmont Healthcare are dropping key parts of their joint health insurance plan after just two years of operation.

Healthcare CostCiting costs, the two metro Atlanta systems have told medical providers that they’re discontinuing their Medicare Advantage plan for next year. The current 12,000 Medicare beneficiaries will have options to switch to another Advantage plan or to receive care in the traditional program.

The health plan will also end its offering for employees of Piedmont and WellStar at the end of the year. About 35,000 employees and dependents were estimated to be eligible for coverage from the Piedmont WellStar HealthPlans at the launch of the program. They will be served by other health insurers in 2016.

The moves drastically reduce what was seen as a bold, high-visibility venture by the two nonprofit hospital systems to get into the health insurance business. WellStar and Piedmont leaders, at its outset, said the health plan was a new avenue to improve the quality of medical care and lower costs. full story

Big hospitals in Columbus take financial hits

Last week, the hospital business in Georgia’s second-largest city received a double dose of financial misery.

The first round of bad news centered on Columbus Regional Health.

LogoState Attorney General Sam Olens announced Friday that Columbus Regional and other related entities had agreed to pay Georgia and the United States up to $35 million to resolve allegations of false Medicaid claims.

Then the Columbus Ledger-Enquirer reported Saturday that the other hospital organization in town, St. Francis, has been told by the feds that it must repay $21.4 million and make major changes in the way it does business.

The federal audit report came 10 months after St. Francis said it could not account for about $30 million on its financial books.

The two situations are unrelated and very different, experts point out. But together they put a spotlight – and force large payouts – in Columbus. And what happens economically in the big city on the Chattahoochee River affects large areas of west Georgia and east Alabama. full story

Most Georgia hospitals face readmission fines

Two-thirds of Georgia hospitals will receive Medicare fines for having too many discharged patients return within a month for additional care, federal data show.

The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.

Piedmont Henry Hospital

Piedmont Henry Hospital

The readmission penalties, launched as part of the Affordable Care Act, seek to encourage hospitals to pay closer attention to what happens to patients after discharge.

Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News’ Jordan Rau reported this week.

The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.

The maximum possible fine is 3 percent. Piedmont Henry Hospital in Stockbridge will get the highest fine in Georgia, at 2.59 percent.  full story

Milestone: 50 years of Medicare and Medicaid

When signing the bill creating Medicare and Medicaid 50 years ago, President Lyndon B. Johnson held the ceremony in Independence, Missouri, where former President Harry Truman lived.

Truman, who had pushed unsuccessfully for national health insurance during his own presidency, was at LBJ’s side during the signing. (And in one of those of odd coincidences of U.S. political history, the two presidents from different eras would die less than a month apart in the early 1970s.)


President Lyndon Johnson signs the Medicare bill into law while former President Harry Truman (seated) looks on.

President Lyndon Johnson signs the Medicare bill into law while Harry Truman (seated) looks on.

The decades-long push to create the two health insurance programs was like “a long-distance run,’’ said Dr. David Satcher, a former U.S. surgeon general, at a Carter Center forum Wednesday.

Satcher added that it was also “like a relay race,’’ noting that Truman handed off the “baton’’ of national insurance to LBJ.

This week, federal officials along with many health care and community organizations are marking the 50th anniversary of Medicare and Medicaid, created July 30, 1965.   full story

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