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Healthgrades: Lancaster General Hospital among best in country

Lancaster General Hospital. Submitted photo.

Lancaster General Hospital was named one of the country’s top 50 hospitals by Healthgrades, ranking it in the top one percent.

Four other local hospitals made Healthgrades Top 100 and Top 250 list.

Healthgrades recognizes national leaders in overall clinical excellence annually as a guide for people to find a doctor or hospital.

LGH, which has made the list for three consecutive years, also earned a top 50 rating for cardiac surgery and a top 100 rating for cardiac care, gastrointestinal surgery and stroke care.

“Using proprietary data, Healthgrades simplifies the research process and empowers consumers to choose experienced doctors who practice at high-quality hospitals” Healthgrades said in a statement.

To determine the top 250 U.S. hospitals, Healthgrades evaluated clinical performance for nearly 4,500 hospitals across more than 31 of the most common procedures and conditions. In tandem with the national recognition, Healthgrades measured the hospitals across 18 key specialty areas to identify the highest-ranking hospitals in 32 eligible states.

WellSpan Chambersburg Hospital, UPMC Harrisburg Hospital and Milton S. Hershey Medical Center were named to the Top 100 Hospitals list, which places them in the top two percent; and WellSpan York made the Top 250 Hospitals list, placing it in the top five percent.

“Healthgrades makes it easy for consumers to choose a doctor based on the three factors that matter most: compatibility, relevant experience, and the quality of the hospital where you’ll be treated,” said Burt Kann, executive vice president and head of product at Healthgrades. “With these awards, we are helping consumers identify the highest quality care in their community by celebrating the hospitals that consistently deliver better-than-expected clinical outcomes.”

WellSpan Chambersburg was also recognized in the Top 100 for coronary intervention and critical care.

UMPC Harrisburg earned the Top 100 rating for cardiac care, gastrointestinal care, gastrointestinal surgery, pulmonary care and stroke care.

Milton S. Hershey received Top 100 status for gastrointestinal care, gastrointestinal surgery and stroke care.

WellSpan York also made the Top 100 for gastrointestinal care and stroke care.

A recent Healthgrades survey revealed that 64% of consumers are more concerned with their health and wellness than they were before the pandemic, and more than half of Americans (57%) are more concerned with the quality of care provided by the doctors and hospitals they choose today.

By making hospital performance more transparent, Healthgrades said it helps increasingly engaged consumers become informed healthcare customers.

“Healthcare decisions are often complicated and fraught with emotion,” said Dr. Brad Bowman, chief medical officer and head of data science at Healthgrades. “By giving consumers an easy-to-understand, data-driven way to identify the hospitals in their area with the best outcomes, Healthgrades is helping all patients – no matter their background – confidently choose higher quality care.”

Update: Capital Blue Cross fined $85,000 for claims violations

The story has been updated with a comment from Capital Blue Cross on the violations.

Harrisburg-based Capital Blue Cross has been ordered to pay an $85,000 penalty by the Pennsylvania Insurance Department (PID) after an Affordable Care Act market conduct examination found claims violations.

Acting Insurance Commissioner Michael Humphreys recently announced the results from an examination of Capital Blue Cross’s Capital Advantage Assurance Company, Capital Advantage Insurance Company, and Keystone Health Plan Central, Inc. covering practices from Jan. 1, 2017 to March 31, 2018.

Michael Humphreys

The department ordered Capital Blue Cross to take corrective action to address the violations. Claims that were incorrectly processed must be reprocessed and accurately paid with applicable interest, including claims that were denied based on non-compliant session limits.

The company must also adjust internal controls to address accuracy and clarity in its communications with members, specifically regarding its explanation of benefits, certificate of coverage, and schedule of benefits.

“Market conduct examinations are a way for the department to ensure that consumers are being afforded the rights and protections guaranteed to them by Pennsylvania law,” said Humphreys. “Our top priority will always be protecting consumers, and we aim to hold businesses to the high standards that their customers deserve. The results of this exam will see consumers receiving restitution for claims that were incorrectly processed, as well as applicable interest.”

Humphreys said Blue Cross has been cooperative in its response to the exam and expects to see continued improvement when re-examinations occur.

Capital Blue Cross, in a statement to Central Penn Business Journal said, “Capital Blue Cross is pleased that the Pennsylvania Insurance Department’s recent comprehensive Affordable Care Act market conduct examination identified no violations in most areas reviewed and imposed the lowest penalty reported to date of any insurer undergoing such an examination.”

“Capital continually evaluates its operations and procedures to ensure it is meeting the needs of our members, and we appreciate the department’s thorough and thoughtful review of our efforts. Capital already has taken action to address the issues noted in this exam, which covered a 15-month period in 2017 and 2018.”

The company went on to say, “It is important to our leaders and employees – and vital to our mission – that Capital act with integrity and in compliance with all regulatory requirements, while continually improving our members’ access to high-quality, affordable healthcare.”

The Insurance Department is charged with upholding fair business practice standards for consumers, companies, and insurance professionals. This work involves researching and resolving complaints from consumers, investigating allegations of misconduct by insurance companies, agents, brokers, and others, and ensuring that practicing professionals are properly licensed.

“It is important to our leaders and employees – and vital to our mission – that Capital act with integrity and in compliance with all regulatory requirements, while continually improving our members’ access to high-quality, affordable healthcare,” Capital Blue Cross said.

The Capital Blue Cross examination identified concerns with claims processing, including claims being denied for lack of prior authorization when prior authorization had already been obtained, and a coordination of benefits issue that has since been updated.

The examination also reported additional Unfair Insurance Practices Act violations relating to unclear communications with members.

The exam also found mental health parity violations, as Quantitative Treatment Limitations (QTLs) were not applied correctly in some plans.

PID said licensed insurers are required to provide mental health and substance use disorder (MH/SUD) benefits equal to medical/surgical benefits. For quantitative treatment limitations, this means that a licensed insurer may not apply any financial requirement or quantitative treatment limitation (QTL) to MH/SUD benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification.

The report said examiners requested proof of compliance for each plan type affected, for each classification of benefits, and for each type of FR/QTL separately. The company imposed QTLs with respect to mental health benefits not equal to medical/surgical benefits.

Specifically, the company provided data that failed the substantially all or predominant level tests within certain specified classifications of benefits such that cost sharing was charged to consumers when it should not have been, the level of cost sharing charged was too high, or session limits restricted access to benefits.

Where these limitations were carried out in practice, the companies will be expected to provide remediation through restitution during the post-exam reporting period, the report said.

“We acknowledge the department’s findings and are committed to implementing the recommendations set forth in the report,” Patricia Higgins, senior vice president, risk management, and chief compliance officer for Capital Blue Cross wrote in to the PID in response to the findings. “Capital is pleased to note that the department identified no violations in most areas under review. We would also like to emphasize that we value the department’s partnership as we continue our efforts to provide high quality and affordable coverage consistent with all relevant laws and regulations.”

To date, approximately 60,000 Pennsylvanian consumers have received $5.87 million in restitution as a result of the department’s ACA market conduct examinations of other major health insurers.

The Insurance Department will continue to monitor and verify that Capital Blue Cross’s corrective actions have taken place, including through quarterly reporting, as well as through a reexamination process in the future.

Study: Focus of health care changed after pandemic

People are seeking a deeper and more meaningful relationship with their health care providers after enduring the global pandemic.

Dr. Joel Helle

Dr. Joel Helle, vice president of Physician Services for CVS Specialty, a division of CVS Health, said, “They view their health as encompassing social, emotional, mental health and physical health, and are increasingly searching for a health care experience that is more holistic, collaborative, affordable, and convenient.”

The CVS Health’s 2022 Health Care Insight Study (HCIS) reveals that U.S. consumers – many of whom delayed care over the past several years because of COVID-19 – are now eager to restart their health and wellness journeys.

Consumers said in the study that they want more meaningful and engaging relationships with health care providers and want them to know about and address their holistic health goals.

The annual HCIS data is shared across the CVS Health enterprise and used by multiple teams to infuse their understanding of consumer needs and the health care marketplace, CVS said. Numerous complex inputs help drive corporate strategy, and the HCIS is one component of the company’s social listening and consumer mindset.

“The study revealed that people want a more personalized and engaging experience regarding their health care,” Helle said, adding they said more communication via digital messaging, email, text, or patient portals would benefit their health care journey.

The study showed 83% of consumers say coordination among their health care providers is important to their health and 85% said it is important that their primary care provider knows what prescription drugs are prescribed by other health care providers.

“While we can’t speak to how the study’s findings will affect every individual, we hope that the insight gathered from the survey can help providers understand what consumers need and what a better health care journey can look like,” he said.

The goal of the HCIS is to look at the needs and mindsets of consumers, as they pursue their individual health journeys, and providers, as they support patients.

“The findings highlight how the health care industry is evolving, what’s next in primary care, how we can build healthy communities, and how we can improve clinical care,” Helle said. “Our mission is to reimagine health care that is centered around people—simpler, more accessible, and more affordable, with better health outcomes—and the study’s findings help us, and the industry, recognize what remains to be addressed.”

Health and wellness top of mind for shoppers, says NPD

— It’s not all that shocking to note that over the course of the pandemic consumers focused more intensely on health and wellness. However, what is surprising is the fact that nearly two years after the pandemic hit the U.S., retail sales of products in health and wellness categories continue to match peak growth rates, according to the NPD Group.

“Comparisons to 2020 show that revenue growth of health and wellness categories slowed in 2021 but that’s just part of the story,” said Marshal Cohen, chief retail industry advisor for NPD. “Retail sales revenue from those same categories, compared to 2019, have continued to grow by double-digits. This growth seems to indicate that health and wellness is an enduring pandemic trend, which could provide opportunities for continued consumer spending.”

The general consumer focus on health encompasses the mind, body, and home, and is evident in the many industries exhibiting growth: from food and apparel to books and beauty. Leading the way are air purifier filters, massaging appliances, free-weight equipment and sound machines. Sales revenue in each of these categories more than doubled in 2021, versus 2019. Many categories related to cleaning, fitness, and food preparation, storage, and preservation continued to grow by double digits last year, as did books about home, gardening, crafts, hobbies, self-help and cooking.

“As consumers get out into the world and start to spend more on vacations and other experiences, health and wellness is likely to continue to play a role in their lives,” Cohen said. “Now it’s time for retailers and manufacturers to not only retain, but also generate new consumer attention, in a retail landscape where competition for the shopper’s share of wallet will soon expand.”

State insurance consumers received over $15 million in restitution payments in 2021

The Pennsylvania Insurance Department reclaimed over $15 million last year for more than 41,000 consumers who had funds stolen, payments improperly processed or other forms of restitution or credit as a result of errors or unethical conduct.

State Acting Insurance Commissioner Michael Humphreys announced the returned money last week, noting that 41,032 consumers around Pennsylvania received some form of restitution payment or credit.

Examples include restoration of stolen funds when an agent collected payment from a consumer for a policy or annuity but did not send that money to the insurance company or refunding or overcharged premiums when an insurance company was found to be charging premiums above the Insurance Department’s approved rate.

“Pennsylvania consumers’ rights and protections are guaranteed to them through state law and the Insurance Department works diligently to hold the businesses we regulate accountable,” said Humphreys. “We protect consumers by holding these businesses to the highest standards.”

In some cases, the department’s findings can result in additional penalties, such as suspension or revocation of a license, being assessed against the offending party.

In 2021, the department issued more than $512,000 in enforcement penalties for violations of Pennsylvania’s insurance laws.

Federal safety regulators blasted for letting companies call the shots in report

BOB strollers, pictured, were recalled multiple times due to falling hazards, but Congressional overseers say the Consumer Product Safety Commission didn’t provide enough oversight throughout the recall process PHOTO/U.S. CONSUMER PRODUCT SAFETY COMMISSION

The U.S. Consumer Product Safety Commission (CPSC) was excoriated by overseers in the Senate for allegedly failing to adequately protect U.S. consumers from unsafe and defective products.

The BOB jogging stroller, the Fisher-Price Rock ‘n’ Roll Play inclined infant sleeper and several residential elevators have each been recalled in the last decade after causing injury and death during, but Democratic minority members of the Senate Committee on Commerce, Science and Transportation say the commission put business interests before consumer safety when conducting recalls.

The commission’s alleged lapses in oversight are detailed in a recent report released by minority members on the committee, illustrating instances when the commission, under the leadership of then-Acting Chair Ann Marie Buerkle, relaxed regulations intended to protect consumers.

“An examination of documents associated with both products by Senate Commerce Committee staff shows, however, that the ‘recalls’ agreed to by the commission function less as true remedies for consumers, and more as incentive programs to bring more business to the companies involved in the recalls,” the report’s executive summary says. “Instead of offering refunds for many consumers with defective BOB strollers, the CPSC instead settled for allowing the company to offer coupons towards the purchase of additional products.”

The report alleges the commission’s failures were due to “a pattern of inappropriate deference to industry that has characterized CPSC leadership in recent years,” rather than a lack of legal authority.

Instead of issuing a proper recall and refunds for customers, the commission issued coupons from the company as part of “incentive programs to bring more business to the companies involved in the recalls,” said Sen. Maria Cantwell, D-Washington, a ranking member of the committee.

“Consumers and their families should have confidence in the products they buy,” Cantwell said. “Industry and the (commission) need to take action to ensure that consumers aren’t buying dangerous or defective products and that those who do receive a real remedy.”

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Health and wellness top of mind for shoppers, says NPD

State insurance consumers received over $15 million in restitution payments in 2021

Federal safety regulators blasted for letting companies call the shots in report