UnitedHealthcare/Oxford Contract with East End Hospitals in Jeopardy of Cancellation

The East End Health Alliance Hospitals (Southampton, Peconic Bay and Eastern Long Island) and UnitedHealthcare/Oxford are currently in good faith efforts to negotiate a new contract.  If they are unable to reach an agreement the current agreement may terminate on July 15, 2011.

In the event of a contract termination, the State of New York requires insurance carriers and hospitals to observe a two month “cooling off period,” which is simply a period of time after the termination of a contract when fully insured commercial and Medicare members can still access the terminated hospitals on an in-network basis in the hopes that the hospital and the carrier can reach a new agreement.

Since this cooling off period does not apply to commercial self-funded groups and members, in the event of a termination, EEHA would become non-participating for those members on July 15, 2011. For fully insured commercial, Medicare and Medicaid members, EEHA, and physicians without admitting privileges somewhere other than an EEHA hospital, would become non-participating on September 15, 2011

UnitedHealthcare/Oxford will have Transitional Care guidelines in place so members who have scheduled or ongoing medical treatments at EEHA hospitals will continue to get care as appropriate.

Fully insured commercial, Medicare and Medicaid members would continue to have access to EEHA hospitals on an in-network basis through the New York State cooling off period, which would end September 15, 2011. Transitional Care may be available after the cooling off period in accordance with the member’s Certificate of Coverage.

After July 14, 2011, a primary care physician or specialist should not refer members to an EEHA hospital for any treatment or test. Instead, members should be referred to one of the major neighboring hospitals in the network listed below.

Brookhaven Memorial, John T. Mather Hospital, St. Charles Hospital, Stony Brook University Medical Center, St. Catherine of Siena Medical Center and Southside Hospital.

Health Grades Announcing 2011 Hospital Patient Saftey Excellence Awards

What does it mean to achieve Patient Safety Excellence? It means realizing the lowest comparable risk-adjusted incidence of patient harm. HealthGrades is celebrating National Patient Safety Week by recognizing the nation’s top-performing hospitals with our eighth annual Patient Safety Excellence Award. 

In this annual study of patient safety, HealthGrades evaluates the impact of 13 types of patient safety events that occur in American hospitals. Preventable medical errors are so pervasive and costly to the government that the proposed rule for the hospital value-based purchasing program for Medicare inpatient services released in January 2011 contains four measures of patient safety utilizing the AHRQ Patient Safety indicators.

New York had seven hospital receive this honor, go to page 18 to see the recepients. Southampton Hospital didnt receive this honor this year but they received a 5-star rating for the quality of its Hip Fracture Repair, Treatment of Pneumonia and GI Surgeries and Procedures. Eastern long Island Hospital also received a 5-Star rating for the quality of its Hip Fracture Repair.

Beginning in 2014, these indicators will be weighted and contribute to each hospital’s total performance score and will drive the value-based incentive payment for the facility. Which ones will directly impact your hospital’s compensation in the near future? Find out!

Primary doctors are transforming offices into patient-centered medical homes

 

Over the past 12 months I have discussed a multifaceted approach with the support of the East End Supervisors and Mayors Association to establish an Article 47 Municipal Cooperative Health Plan to consolidate municipal corporations on the eastern end of Long Island for the purpose of establishing local control and delivering long-term sustainability.

I have maintained that consolidation in and of its self will not deliver long-term sustainability and that we need to address the model on which care is deliver in order to achieve long-term sustainability.

The delivery models that are being discussed to support this sustainability objective will be the Patient Centered Medical Home and a local Clinical Integration effort lead by the East Ends three hospitals; Southampton, Peconic Bay and Eastern Long Island.  In addition to these delivery components this initiative will require participating municipal corporations to institute an incentive based Health and Wellness program.

I have attached below a terrific article about how doctors are transforming practices into Patient Centered Medical Homes.  I will continue to write about this initiative and keep you abreast of our progress.

Patient-centered medical home: Primary doctors are transforming offices into patient-centered medical homes – dailypress.com.

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