Health Care Checkup: Hospitals fined, Express Scripts teams with Walgreens

The Health Care Checkup, a weekly rundown of the state’s top health care headlines, is sponsored by Heyen Wellness Therapies.


Photo courtesy of Creative Commons.
Courtesy of Creative Commons.

Taking the Pulse

Missouri hospitals slapped with Medicare fines for readmissions

The Centers for Medicare and Medicaid Services will penalize 66 Missouri hospitals for the coming year for preventable patient readmission rates that were higher than the national average. That comes to 2.5 percent of the 2,610 hospitals receiving fines nationwide, the highest number since the penalties began in 2012. The fines come for patients suffering from heart attacks, heart failure, pneumonia, lung ailments or knee or hip replacements who make return visits within 30 days of initial treatment. The last two categories were new for this year and contributed to the rise in penalties. The fines will come out of the Medicare reimbursements hospitals receive as part of the Affordable Care Act. The maximum penalty allowed this year is 3 percent of each Medicare stay, and only one Missouri hospital incurred it: Western Missouri Medical Center in Warrensburg. The fines began Oct. 1 and will continue until Sep. 30 of next year. The penalties are expected to total about $428 million over the course of the year, according to Medicare estimates.

Express Scripts partners with Walgreens on Medicare Part D plans

More than 400,000 seniors will have a new place to get significant discounts on prescription drugs next year. Beginning in January, Express Scripts will change its preferred network of pharmacy retailers for Medicare Part D prescription drug coverage, which is offered through private insurers to the elderly and disabled. Walgreens pharmacies will take over as the leading chain in the Express Scripts preferred network, replacing a collection of stores that included Safeway, Kroger, Costco, Walmart, Kmart and Rite-Aid. Although Part D plan holders will still be able to fill their prescriptions at those and other stores, doing so at Walgreens will come with a copy that’s either free, $1 or otherwise greatly reduced, depending on the drugs prescribed. The news comes on the heels of Walgreen’s best quarterly sales in three years, driven by a 9.3 percent increase in prescription sales.

Small business health insurance marketplace readies online launch

With Missouri’s Small Business Health Options Program (SHOP) going online later this month, brokers and counselors attended a closed-door meeting last week to go over the program’s new website and its features. Missouri is one of five states chosen to have early access to the SHOP program, which serves businesses with 50 or fewer employees. SHOP was originally supposed to launch last year, online and in full, but the program was mostly shelved while the federal government worked on fixing HealthCare.gov, the insurance exchange for individuals. SHOP was available last year only as a paper application, and the only carrier for it in Missouri was Blue Cross Blue Shield.

Open enrollment in the SHOP program begins November 15.

Shots in the Arm

Big numbers dominated Missouri health care financing, with Adarza Biosystems, a medical diagnostics startup housed at the St. Louis BioGenerator, receiving a total of $6.8 million in funds from Cultivation Capital and Siemens. The money is expected to help with launch and further development of products identifying proteins and genetic markers in medical samples.

Meanwhile, St. Louis-based EndoStim, which makes an implantable device to help curb acid reflux disease, announced details of an initial public offering for 3.2 million shares of common stock for between $10 and $12 per share, putting the total raised at an estimated $32 million to $38.4 million.

Stat of the Week I: $53.3 million

The amount of compensation Missouri-based doctors and teaching hospitals received from drug companies and medical device manufacturers between August and December of last year, according to data from the Centers for Medicare and Medicaid Services Open Payments program. The majority of that came either from research-related payments or money collected by hospitals through partial ownership dividends, but it still leaves $1.6 million paid in travel costs for Missouri doctors and $1.9 million in meal expenses. Put another way, the latter number would pay for the roasted marrow bones and three two-bone Colorado lamb chops at 801 Chophouse — the most expensive dinner appetizer and entree at one of St. Louis’s priciest restaurants — for 22,619 people, before tax and without wine.

Stat of the Week II: 72.5 percent and 44.68 percent

That’s how much Mallinckrodt and Sigma-Aldrich stocks have risen, respectively, since the beginning of 2014. Mallinckrodt’s surge is credited in part to its acquisitions. Although Sigma-Alrdich was recently purchased by Merck, it has been busy adding to its portfolio.

Quote of the Week

“Part of the premise around the Affordable Care Act is we are going to empower consumers to make good purchasing decisions. To do that they have got to be able to see the rate and have somebody asking questions about them.”

Andrea Routh, executive director of the Missouri Health Advocacy Alliance, commenting on a lawsuit filed by the Consumers Council of Missouri to force the disclosure of health insurance rate information by insurers. Unlike in many other states, regulators in Missouri do not require insurers to disclose their rates or their reasons for rate changes under the Affordable Care Act. An earlier attempt to force disclosure through a Freedom of Information Act request was denied by the Department of Health and Human Services.

Tweet of the Week

Mercy was named one of the top 100 hospitals in the country for its use of social media as determined by NurseJournal.org, one of three Missouri hospitals to make the list. The rankings combine metrics from Facebook and Twitter, including page likes, followers and how much the hospital is discussed on each. Mercy came in at No. 60 with 28,358 likes/fans on Facebook, 2,290 Twitter followers and the occasional showing of its softer side in tweets such as this one. The other hospitals to make the list were Barnes-Jewish Hospital (No. 48) and North Kansas City Hospital (No. 94).


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