MedPAC Recommendations Could Impact North Texas’ Dozens of Stand-alone ERs

In June, when the Medicare Payment Advisory Commission issued a two-pronged recommendation regarding stand-alone emergency departments, it pointed to one metropolitan area to illustrate growth in independent freestanding ERs: Dallas. From 2013 to 2017, the Dallas metro went from having 25 such facilities to 73. The entire U.S. has just 200. The recommendation issued by MedPAC calls for changes in the way Medicare bills stand-alone ERs and, to be clear, has nothing to do with independent freestanding ERs, which are not associated with a hospital and which the federal government doesn’t recognize. It has everything to do with stand-alone ERs… Full Story

Texas Tribune Runs Through Factors On States’ Side in Fight To Dismantle ACA

All arguments have been submitted in the case that pits Texas and 19 other states against the Affordable Care Act, according to the Texas Tribune. That means a federal judge, right here in North Texas, now holds the key to the healthcare law’s future. Experts say a ruling should come in the next few months, according to the Trib, which ran through several factors in Texas’ favor in a story this week: It’s not the first time Texas has sued over Obamacare, but this attempt has several weighty advantages. One comes from Congress, which in December shrunk the penalty for… Full Story

BCBSTX Emergency Room Claims Policy Proceeds Without Changes From TDI

A Blue Cross Blue Shield of Texas policy that has garnered controversy officially went into place on Monday. The policy implements a review process for HMO members that could leave those members on the hook for their entire bills if they visit an out-of-network ER for a non-emergency. In May, the Texas Department of Insurance got the insurer to delay implementation of the rule for 60 days so that TDI could meet with BCBSTX representatives to learn more about the plan. BCBSTX members were first notified of the policy in April. A spokesperson for the insurer said Wednesday that no… Full Story

Baylor Scott & White’s ACO Signs A Deal With BCBSTX

Baylor Scott & White Quality Alliance inked an agreement with Blue Cross Blue Shield of Texas on Tuesday to bring 140,000 of the insurer’s members under its purview. BSWQA is the accountable care organization of Baylor Scott & White Health, encompassing 6,000 primary and specialty care physician members, 50 hospitals, and 95 post-acute care facilities. ACOs are set up to tie payments to quality metrics, with reimbursements based on improving outcomes and cutting costs. The agreement goes into effect this month. The organizations are not releasing financial terms. “Members enrolled in this new ACO arrangement have access to BSWQA’s comprehensive… Full Story

Conversation With: Integrity Marketing CEO Bryan Adams On His Company’s Strategy to Buy, Buy, Buy

Insurance distributor Integrity Marketing Group announced another acquisition on Wednesday, buying Minnesota-based National Independent Brokers, Inc. Integrity has bought out firms in Ohio, Connecticut, and Arizona this year, continuing a trajectory that has allowed the company to triple revenue since the middle of 2016. That was when the Dallas-based company brought on capital from private equity firm HGGC, the shop co-founded by NFL Hall-of-Famer Steve Young. (Young now serves as the managing director of Integrity.) Founded in 2006, Integrity sells insurance—Medicare Advantage and Medicare Supplement—products to senior citizens and the families of senior citizens through a network of independent agents… Full Story

WFAA: North Texas Couple Mulling Over Divorce To Qualify For Medicaid

WFAA ran a story this week that speaks to the country’s billowing healthcare costs. Maria and Jake Grey, residents of Sanger, are considering getting a divorce so that Maria can qualify for Medicaid as a jobless, single mother of two. Jake makes about $40,000, and as it stands, the family doesn’t qualify. That makes it difficult to pay for what they need to care for their six-year-old daughter Brighton, who has a developmental disability. The couple also has a two-year-old. Although the Grey’s have insurance—the story doesn’t get into what kind—they pay $15,000 a year out of pocket to care… Full Story

Irving-based HMS Settles $60 Million Breach of Contract Verdict for $20 Million

Irving-based HMS Healthcare has settled litigation with the founders of a business it bought in 2010, agreeing to pay plaintiffs Dennis Demetre and Lori Lewis $20 million. In November, a New York jury ruled in favor of Demetre and Lewis’ breach of contract claim, awarding the two $60 million in damages. HMS had filed a post-trial motion for an order granting it judgment notwithstanding the verdict or to set aside the award of damages, according to the most recent quarterly report of HMS-parent HMS Holdings. The two sides signed the settlement on June 27, and HMS—which surpassed $500 million in… Full Story

Where DFW’s Healthcare Community Stands On A Price Transparency Proposal From CMS

Ask a random selection of people about whether they’d appreciate more up-front knowledge about the prices they pay for healthcare, and you’d be hard-pressed to find anyone that’s happy flailing around in the dark. As the public becomes more aware of inflated costs, the drumbeat for price transparency grows louder. But even so, practicality issues abound in transitioning a market whose prices have long sat largely beyond consumer view. As a result, the Centers for Medicare and Medicaid Services have proposed a rule that would force hospitals to post their lists of standard charges on their websites. At a minimum,… Full Story

Second Person Pleads Guilty In Massive Frisco Fraud Scheme In Which CEO Allegedly Accelerated Patient Deaths

Two people have now pled guilty in a fraud scheme involving a major North Texas hospice provider. Jessica Love became the second when she entered a plea this week in U.S. District Court in Dallas. The February 2017 indictment alleges Love and 15 others engaged in a $60 million scheme under Novus Health Services and Optim Health Services, which were effectively run as one entity known as Novus. Love, a 38-year-old registered nurse manager and regional director at Novus, participated via recruiting doctors to a kickback scheme, arranging kickback payments to assisted living facilities, falsifying documents, and collecting unused medications… Full Story

No Surprise Here: Texans’ No. 1 Health Policy Priority Is Lower Cost

Texans’ number one priority when it comes to health policy issues is lowering the amount that individuals pay for healthcare. That’s according to a statewide survey out Thursday from the Kaiser Family Foundation/Episcopal Health Foundation. Of those polled, 61 percent marked that option as a “top priority” while an additional 28 percent called it “important but not a top priority.” Just beyond that: Reducing the number of women who die from causes related to pregnancy and childbirth (59% top priority/30% important but not top priority), lowering the cost of prescription drugs (56%/32%), increasing access to health insurance (55%/32%), and increasing… Full Story