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Of Interest

How healthcare providers make, spend, borrow and invest money.
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By Melanie Evans
 

The price of bronze

6:30 pm, Apr. 27

Deductibles for patients covered by the leanest insurance under health reform could see deductibles that easily exceed average commercial deductibles, a new estimate shows.

High deductibles have been named as one culprit behind unpaid medical bills that contribute to hospital write-offs and household financial distress.

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Then there were six—ACOs

Ten physician groups agreed in 2011 to extend their test of Medicare accountable care, which began in 2005, for another two years. Now, six remain.

Three did not go far. Dartmouth Hitchcock in New Hampshire, Park Nicollet Health Services in Minnesota and the University of Michigan all moved into another more sophisticated Medicare accountable care experiment known as the Pioneer program in January.

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An insurer branches out into venture capital

11:45 am, Apr. 16

Mutual interest between private equity and the healthcare industry has produced some headline-grabbing deals in recent years: Oak Hill Capital Partner's joint venture with the largest U.S. Catholic health system; venture funds launched by large health systems, including the latest by Rex Healthcare ; and the buyout of a struggling Boston health system by Cerberus Capital Management.

But beyond these flashy deals is an influx of capital into healthcare from private investors, including a string of deals during the past 12 months by the newly formed investment arm of Cambia Health Solutions.

Cambia, a not-for-profit, was previously the Regence Group, an insurer in the Pacific Northwest.

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Study finds end-of-life cancer care varies widely

12:45 pm, Apr. 10

Researchers found striking variation in care for cancer patients in the final months of their lives at hospitals in the National Comprehensive Cancer Network, a newly published study shows. The same was true for patients treated by another group of hospitals with recognition from the National Cancer Institute.

In fact, cancer patients in the final months of their lives received widely varying treatment at academic hospitals and community hospitals as well.

As my colleague Jessica Zigmond reports, the study, published in Health Affairs, found no hospital group did better than another when it came to adhering to a handful of National Quality Forum measures of end-of-life cancer care.

Those measures include visits to the intensive-care unit during the last month of life and chemotherapy during the final 14 days of life. Such care may be of little use, as is likely the case with chemotherapy, and out of line with patients' preferences, the authors said.

The study, which looked at data for about 215,000 Medicare enrollees between 2003 and 2007, cited research that found a “majority of patients prefer comfort over curative care and would rather die at home than in the hospital.”

Here's a look at the results for the percentage of patients who died in the hospital, from an analysis by the study's authors published in the journal Health Affairs:

Source: Health Affairs

As the authors noted: “no hospital group excelled on other measure of end-of-life care, such as in hospital death rate or days in the intensive care unit during the last month of life. These results indicate a need for a broad re-examination of end-of-life cancer care and whether it meets the needs and wants of patients.”

That examination may also have implications for healthcare spending. An analysis published in 2010 found one-quarter of 2006 Medicare expenses went toward spending for patients in the last year of life.

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Disclosing direct bank loans

12:15 pm, Apr. 5

Hospitals last year turned to direct bank loans to limit risk from another short-term vehicle to finance capital spending, known as variable-rate demand bonds. Now, the body that oversees transparency in the tax-exempt market is asking borrowers to voluntarily disclose direct bank loans to investors.

The plea, announced by the Municipal Securities Rulemaking Board this week, acknowledges that rules largely do not require such disclosure, but says the information would help promote “a fair and efficient market.”

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Maybe it's worth it: The benefits of high-cost hospitals

Hospitals that do more—more tests, more procedures—when a critically ill patient arrives in the emergency room cost more (price being equal). They may also get better results, according to a newly published working paper for the National Bureau of Economic Research.

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