BERKELEY, Calif.-Alta Bates Summit Medical Center has been formally notified that it is at risk of losing its accreditation because of lapses in patient care and record-keeping. The not-for-profit hospital, owned by Sacramento, Calif.-based Sutter Health, is preparing to appeal the preliminary denial of accreditation, issued by the Joint Commission on the Accreditation of Healthcare Organizations last month, at a May 12 review-panel hearing. JCAHO inspectors issued the preliminary denial after an inspection in November 2004 found problems with obtaining patient consent, storing medication, responding to medication errors, taking appropriate steps to reduce the risk of hospital-related infections, maintaining medical records and assessing pain. Another California hospital, Los Angeles-based Martin Luther King/Drew Medical Center, was officially stripped of its accreditation Feb. 1. The JCAHO accredits about 4,600 hospitals nationwide; only 13 hospitals have had their accreditation revoked since 1998, the commission said.
OLYMPIA, Wash.-Washington will require most insurers to cover medically necessary mental-health services at the same level as medical care, phased in over five years beginning in 2006, under a law signed earlier this month by Gov. Christine Gregoire. The mandate does not apply to Medicaid, self-insured companies, businesses with 50 or fewer employees, or plans purchased by individuals. It potentially will benefit about 900,000 people statewide and increase average premiums by 1.1%, or $2.93 per member per month, according to the Washington Coalition for Insurance Parity, which supported the legislation. Twenty-nine states now have some sort of mental-health parity law, and several others have laws mandating coverage of certain mental-health services, the National Conference of State Legislatures said. A similar parity bill has also advanced in the Oregon Legislature.
SACRAMENTO, Calif.-For-profit California HMOs, as a group, spent considerably less of their premium dollars on patient care than their not-for-profit counterparts, according to the California Medical Association's 12th annual report examining health- plan expenditures. Among the 38 HMOs studied, eight of the 10 companies with the lowest medical-loss ratios in fiscal 2003-04 were for-profit, while all 10 with the highest medical-loss ratios were not-for-profit. Among major insurers, not-for-profit Kaiser Permanente ranked the highest, spending 92.8% of its premium revenue on patient care, 3.2% on administrative costs and 3.9% on profits. For-profit Blue Cross of California, a unit of WellPoint, was the lowest-ranked major insurer, devoting 79.9% of premium revenue to healthcare, 12.3% to administrative costs and 7.8% to profits. California Insurance Commissioner John Garamendi approved the $16.4 billion merger of Anthem and WellPoint Health Networks last year after the companies agreed to numerous concessions, including improving Blue Cross' medical-loss ratio. Overall, not-for-profit Alameda Alliance for Health, a 94,500-member HMO in Alameda, Calif., ranked the highest among all health plans, spending 99.6% of premium dollars on medical care. Not-for-profit SmartCare Health Plan, a 65,000-member Medicare HMO in Long Beach, Calif., ranked the lowest, with a medical-loss ratio of 73.8%, down from 91.8% the previous year.
ALBUQUERQUE-Albuquerque Regional Medical Center, a 128-bed for-profit Lovelace Sandia Health System hospital, was probed by New Mexico's Department of Health after complaints about healthcare quality, said department spokeswoman Deborah Davis. The four-day examination ended March 3, Davis said, though she declined to discuss the findings of the visit until a report is released by the department. The report is expected within a few weeks. Lovelace Sandia officials will act on the findings of the investigation, which was conducted alongside an unannounced CMS survey, as soon as it's released, said Shea Davis, a spokeswoman for Ardent Health Services, the system's owner.