HealthGrades Announces America’s 50 Best Hospitals

HealthGrades America’s 50 Hospitals are located in 28 cities in 19 states. The West Palm Beach, Fla. area leads the nation with six of these top-performing hospitals. Chicago and Cleveland come in next with four recognized hospitals each.  New York had no hospitals make the list this year but NJ had both Hackensack University Medical Center – Hackensack, NJ and Community Medical Center – Toms Rivers, NJ make the list.

To find out if one of these elite hospitals is in your community, click here.

America’s 50 Best hospitals demonstrated superior and sustained clinical quality over an eleven year time period, based on an analysis of more than 140 million Medicare patient records. To be recognized with this elite distinction, hospitals must have had risk-adjusted mortality and complication rates that were in the top 5% in the nation for the most consecutive years.

On average, patients treated at America’s 50 Best Hospitals had a nearly 30% lower risk of death and 3% lower rate of complications. HealthGrades study found that if all U.S. hospitals had performed at this level, more than a half million Medicare deaths could have been prevented between 1999 and 2009.

Oxford Changes Tier 3 Prescription Drug Rules for NY Small Groups

As drug costs continue to rise, carriers are creating innovative ways for members to maintain affordable access to a variety of medications. Oxfords Select Designated Pharmacy Program, for example, focuses on providing members with access to lower cost alternatives to a select number of Tier 3 (high-cost) medications. This program will be implemented for Oxford fully insured New York small groups (2-50 lives) on January 1, 2011. The program does not apply to Healthy NY plans, and is optional for self-funded groups. 

About the program  Members of the program are required to choose one of three cost-saving options to continue to receive medications at the in-network benefit level:              

  • Option 1: Switch to a lower-cost medication and save
  • Option 2: Fill the prescription through the Mail-Order Pharmacy and save
  • Option 3: Do both to save 

Members are allowed two “grace” fills of their current medication at the retail pharmacy before they must select a new option. If a member chooses to continue filling a Tier 3 medication at the local retail pharmacy after the second grace fill, the member will pay the full cost of the medication, as benefits are not payable under the plan.

 Medications included in the program The targeted medications and products listed below, all in Tier 3, represent 2% of all retail prescriptions. The majority of these have multiple, lower-cost alternatives.


Lyrica, Symbicort, Avodart, Uroxatral, Lexapro, Atacand, Atacand HCT, Avapro, Avalide, Asacol, Asacol HD, Axert, Frova, Maxalt, Maxalt MLT, Zomig, Zomig ZMT, Toviaz and Detrol.

All employers will receive a letter from Oxford about the Select Designated Pharmacy Program as well as all members that are currently taking these medications. Members will also receive an outgoing call from Oxford, and point -of-sale messaging at the retail pharamacy to help them understand their options for savings.

New York and New Jersey Establish “High Risk Health Insurance Pools”

The federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, which together comprise the new federal health care reform law, were signed into law by President Obama on March 23, 2010, and March 30, 2010, respectively. The health care reform law contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals.  Coverage through this program will be available until January 2014 when more health insurance coverage options become available through a Health Insurance Exchange.

New York

This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is called the NY Bridge Plan, and is administered by Group Health Incorporated (GHI), an EmblemHealth company.

The NY Bridge Plan provides health coverage to individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal residents.

The NY Bridge Plan covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  Eligibility is not based on income and the Plan does not charge a higher premium because of a pre-existing condition.  Coverage for a pre-existing condition begins right away, with no waiting period.

Applications are available now with coverage effective October 1, 2010. for more information go to NY Bridge Plan

New Jersey

NJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.

Applications for NJ Protect are now available.  Contact Horizon Blue Cross and Blue Shield of NJ to request the application.  Please be sure to explain you are asking about NJ Protect so the customer service representative can quickly provide information for the NJ Protect options.  More more information go to

The Age 26 Coverage Mandate vs. the Age 26 Tax Exclusion

This article was written by Gail Olsen (bio), of JD Reinhart Law and republished with her permission.

Two of the provisions in the health care reform act are causing substantial confusion.  They sound similar, but are really two different things:  the first is a coverage mandate; the second is a tax exclusion. 

The Patient Protection and Affordable Care Act (“PPACA”) enacted on March 23, 2010 contains a mandate that, effective with the first plan year beginning on or after September 23, 2010, all group health plans that provide coverage to an employee’s child must provide such coverage until the child’s 26th birthday, regardless of the child’s marital status, residency, student status or financial dependence on the employee.  The first agency guidance on this mandate was published on May 13, 2010. 

This coverage mandate is often confused with the provision in the Health Care and Education Reconciliation Act (“HCERA”) enacted on and effective on March 30, 2010, which expands the tax exclusion for employer-paid coverage of an employee’s child to the end of the calendar year in which the child has not yet attained age 27.  Put another way, the exclusion applies to the end of the calendar year in which the child attains age 26.  The first agency guidance on this tax exclusion was published on April 27, 2010, in IRS Notice 2010-38,  

The coverage mandate applies to “group health plans” including health reimbursement accounts (“HRAs”).  However, it does not apply to “HIPAA-excepted” benefits, such as non-integral dental and vision plans, and other excepted benefit coverages such as most Health FSAs.  Nevertheless, the favorable tax treatment does apply to dental, vision and health FSAs, even though they are not required to comply with the coverage mandate, so plan sponsors may wish to expand their eligibility provisions anyway. 

Sponsors of health FSAs may wish to amend their plans to permit participants to request reimbursements for children up to end of the year in which the child attains age 26.  Although retroactive amendments to cafeteria plans are generally not permitted, Notice 2010-38 specifically allows an amendment retroactive to March 30, 2010 for these purposes.  The Notice also permits employers to amend their plans to allow employees to change their FSA elections mid-year in light of the expanded eligibility for adult children.  These amendments must be adopted by December 31, 2010.

One last note:  Neither the health reform acts nor IRS Notice 2010-38 amended the definition of “dependent” for purposes of “qualifying medical expenses” eligible for tax-free reimbursement under a health savings account (“HSA”).  The prior rules apply for this purpose.

New York and New Jersey Hospitals making the Grade

In March of 2010 HealthGrades released the 7th Annual Report on Patient Safety in American Hospitals Study. Four out of the five New York Hospitals honored are Long Island Hospitals.  These hospitals are Southampton Hospital, Saint Francis Hospital-Roslyn, John T. Mather Memorial Hospital and North Shore LIJ Huntington Hospital.  

The New Jersey Hospitals honored are Jersey Shore University Medical Center, Morristown Memorial Hospital, Ocean Medical Center and Our lady of Lourdes Medical Center. 

Hackensack University Medcial Center has received the honor of being named one of America’s 50 Best Hospitals in 2010. No other hospital in the tri-state has received this honor in 2010. Jersey Shore University Medical Center and Hackensack University have also received the Womens Health Excellence Award” for 2010.

Congratulations to all of our Long Island and New Jersey Hospitals!

About HealthGrades: Health Grades, Inc. (Nasdaq: HGRD) is the leading independent healthcare ratings organization, providing quality ratings, profiles and cost information on the nation’s hospitals, physicians, nursing homes and prescription drugs.

NY & NJ Consumer Health Insurance “Hot Topics”

Please review the “Hot Topics” that the New York and New Jersey Departments of Insurance have released.

New York

NYS Age 29 Dependent Coverage Extension

COBRA and Premium Assistance-Information Index

Unemployment Health Insurance Options

New Jersey

Health Insurance Scams

Limits on Benefits under NJ Health Benefit Plans

COBRA and NJ Continuation

BREAKING NEWS: AP Story on Increased Costs Caused by Senate Finance Proposal

The Associated Press is out with another story on the new PricewaterhouseCoopers’ report highlighting the increased costs for individuals and families as a result of proposals from the Senate Finance Committee.  Here are some key excerpts:

  • “…a new accounting firm study that projects the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions in the bill would be in effect.  Premiums for a single person would go up by $600 more than would be the case without the legislation, the PriceWaterhouseCoopers analysis concluded.”
  • The study projected that in 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.”
  • It concluded that a combination of factors in the bill — and decisions by lawmakers as they amended it — would raise costs.”
  • “Other factors leading to higher costs include a new tax on high-cost health insurance plans, cuts in Medicare payments to hospitals and doctors, and a series of new taxes on insurers and other health care industries, the report said.”
  • ‘Health reform could have a significant impact on the cost of private health insurance coverage,’ it concluded.”
  • the industry stopped short of signaling all-out opposition.  ‘We will continue to work with policymakers in support of workable bipartisan reform,’ Ignagni said in her memo.”

Full AP Article

Is your Company Prepared for the H1N1 Virus

The Harvard School of Public Health study released several weeks ago found that two out of three U.S. businesses are unprepared to deal with the effects of a flu pandemic, when employee absences can be a major disruption.

The Kineo Group’s Crisis Practice has created a H1N1 Readiness Check List that leverages its principals’ expertise from work at the American Red Cross and other global organizations to help leaders manage their workforce effectively.

  • Don’t be taken off guard. Those companies with no crisis plan will be surprised by the extent of employee absences and other disruptions, forcing them to be reactive and accept higher losses;
  • Review your existing plan, if you have one. Firms with existing crisis communications plans should review and update their plans for H1N1 flu, referencing the latest government guidance, including visiting This effort should start immediately and be reviewed monthly;
  • Develop a plan now if you don’t. Organizations without existing crisis plans should immediately formulate a basic H1N1 response plan relying heavily upon published guidance from government agencies and medical associations;
  • Form an assessment team. Firms should form a team to quickly assess those recommendations, identify issues unique to their industry and develop an action plan;
  • Communicate regularly. All companies should communicate regularly to key stakeholders, particularly employees, about what the company is doing, and provide them clear information on what they need to do to sustain the enterprise.
  • H1N1  douments:  H1N1 Legislative Brief, H1N1 Employee Awareness Poster, H1N1 Flu Vaccine Poster. For more detailed flu pandemic planning guides please contact me at or 631-329-7268.

New Jersey Prepares to Launch Accountable Care Organization

New Jersey is one of the first states to experiment with accountable care organizations, or ACOs, a relatively new health care model that is similar to the patient-centered medical home, or PCMH, and that links primary care and subspecialist practices with area hospitals to create an integrated delivery system. Providers are accountable for costs and the quality of care delivered, and bonuses and penalties are tied to overall spending and quality measures. Learn more

Money Saving Tips on Brand Name Medications

The next time your doctor prescribes a name brand medication it may be worth checking online or with your local pharmacy to see if there is any special money saving offers available.  Many of these brand name drugs have their own dedicated websites that will provide  specific information to obtain savings.  

Provided below is a SAMPLE of medications that have special money saving offers.  This is not an all inclusive listing, so if you do not see a particular medication listed you may want to research the medication online.

Check here to see the sample Brand Name money savings list.

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