AMA Launches Campaign to Cut Waste From Chaotic Insurance Claims Process, Unveils New Health Insurer Report Card
CHICAGO — To help reduce the substantial administrative burden of ensuring accurate insurance payments for physician services, the American Medical Association (AMA) launched the Cure for Claims campaign to help heal the ailing system of processing medical claims with health insurers, and unveiled the first AMA National Health Insurer Report Card on claims processing.The inefficient and unpredictable system of processing medical claims adds unnecessary cost to the health care system, estimated as much as $210 billion annually, without creating value. Physicians divert substantial resources, as much as 14 percent of their total revenue, to ensure accurate insurance payments for their services.
The AMA’s new National Health Insurer Report Card provides physicians and the public with an objective and reliable source of information on the timeliness, transparency and accuracy of claims processing by health insurance companies. Based on a random-sample pulled from more than 5 million electronically billed services, the report card provides an in-depth look at the claims processing performance of Medicare and seven national commercial health insurers: Aetna, Anthem Blue Cross Blue Shield, CIGNA, Coventry Health Care, Health Net, Humana and United Healthcare.
The Practice Management Center’s library of education materials and practical tools are available online at: www.ama-assn.org/go/pmc.
Researchers Identify Cancer Preventive Properties in Common Vitamin Supplement
PHILADELPHIA — Early laboratory research has shown that resveratrol, a common dietary supplement, suppresses the abnormal cell formation that leads to most types of breast cancer, suggesting a potential role for the agent in breast cancer prevention. Resveratrol is a natural substance found in red wine and red grapes. It is sold in extract form as a dietary supplement at most major drug stores.Resveratrol has the ability to prevent the first step that occurs when estrogen starts the process that leads to cancer by blocking the formation of the estrogen DNA adducts. Eleanor G. Rogan, Ph.D., a professor in the Eppley Institute for Research in Cancer and Allied Diseases at the University of Nebraska Medical Center said that this could stop the whole progression that leads to breast cancer down the road.
Rogan was the lead author of the report that was published in the July 2008 issue of Cancer Prevention Research, a journal of the American Association for Cancer Research.
The current study was conducted in laboratory cultures, and will need to be confirmed in larger human trials, Rogan said.
Bipartisan Policy Center Releases Comprehensive Report On Financing Health Reform
Washington, DC — Recently, the Bipartisan Policy Center (BPC) formed by former U.S. Senate Majority Leaders Baker, Daschle, Dole, and Mitchell, released a report cataloguing the range of financing reform options that policymakers will have to consider in any major health reform effort.The report is entitled, “Financing the U.S. Health System: Issues and Options for Change.”
Highlighting the rise in health care costs that is straining the budgets of government, families and employers, the paper notes the importance of containing future cost growth. It makes the unique contribution of documenting and discussing the implications of the finance options that policymakers will likely consider for the upcoming health reform debate.
In addition, the report explores the principal financing alternatives proposed by presidential candidates Senator John McCain and Senator Barack Obama, as well as other systematic approaches that have been proposed to restructure the health care finance system.
To read the complete financing report, visit www.bipartisanpolicy.org.
AMA Inaugurates Dr. Nancy Nielsen As President
CHICAGO — Nancy H. Nielsen, M.D., Ph.D., a board-certified internist from Buffalo, N.Y., was inaugurated today as the 163rd president of the American Medical Association (AMA), the nation’s largest and most influential physician organization. She is the second woman to hold the AMA’s highest elected office.In her inaugural address as AMA president, Dr. Nielsen spoke to the nation’s physician leaders gathered for the AMA Annual Meeting and pledged to bridge the obstacles to a better American health care system.
Dr. Nielsen began her a leadership role with the AMA in 2000, serving four consecutive annual terms as speaker of the House of Delegates, the AMA policy-setting body, and three consecutive annual terms as vice-speaker.
Alacare’s John G. Beard, Mba/jd Appointed To Alabama Quality Assurance Foundation Board Of Directors
John G. Beard, MBA/JD, Chairman and President of Alacare Home Health & Hospice, has been appointed to the Board of Directors of the Alabama Quality Assurance Foundation (AQAF). As an AQAF board member, Mr. Beard will work with the Foundation to improve the quality of health care for the state’s 780,000 Medicare beneficiaries. He will continue to work directly with state and federal government officials, as well as private organizations, to coordinate contracts that ensure the constantly improving caliber of health care throughout Alabama.
Mr. Beard has shown a commitment to providing excellent care for Alabamians throughout his career in the field. He was recently appointed to the Statewide Health Coordinating Council by Governor Bob Riley. Mr. Beard begins his three-year appointment to the AQAF Board at the end of June.
Mr. Beard has been employed with Alacare Home health & Hospice for over 32 years. He earned his BS in Business Administration from Auburn University in 1972 and a Masters in Business Administration at Samford University in 1976. That same year, Mr. Beard earned a Juris Doctorate degree at Cumberland School of Law. Mr. Beard is a Member of the Alabama Bar Association, American Bar Association and American Health Lawyers Association.
Brookwood Medical Center receives American Heart Association’s Awards
Brookwood Medical Center recently received the American Heart Association’s Get With The Guidelines –Coronary Artery Disease (GWTG–CAD) Gold Performance Achievement Award as well as the Get With The GuidelinesSM–Heart Failure (GWTG–HF) Silver Performance Achievement Award. Brookwood is only Birmingham-area hospital to receive the Gold award, and is one of only two recipient hospitals in the state of Alabama. The Gold award recognizes Brookwood’s commitment and success in implementing a higher standard of cardiac care that effectively improves treatment of patients hospitalized with coronary artery disease.
The Silver award signifies that Brookwood has reached an aggressive goal of treating heart failure patients with 85% compliance for one year to core standard levels of care as outlined by the American Heart Association/American College of Cardiology secondary prevention guidelines for heart failure patients.
Hospitals that receive the GWTG-CAD Gold Performance Achievement Award have demonstrated for 24 consecutive months that at least 85 percent of its eligible coronary patients (without contraindications) are discharged following the American Heart Association’s recommended treatment guidelines.
The GWTG-Heart Failure module, developed with support from an unrestricted educational grant from GlaxoSmithKline, is being implemented in hospitals around the country.
Waldrum and Sisck Elected to Board of AlaHA
Michael R. Waldrum, MD, MS, chief executive officer for UAB Hospital and UAB Highlands, and Glenn C. Sisk, CEO of Coosa Valley Medical Center, Sylacauga, were elected to serve as a board member and officer, respectively, of the Alabama Hospital Association (AlaHA) at its recent annual meeting. Mr. Sisk was chosen as the chairman-elect of the organization, and Dr. Waldrum as a board member representing the Birmingham Regional Hospital Council.Dr. Waldrum received his bachelor’s degree in English from The University of the South, his medical degree from The University of Alabama at Birmingham, his master’s in epidemiology from the Harvard School of Public Health, and his executive MBA from the Stephen M. Ross School of Business, University of Ann Arbor, Michigan. Since 1995, Dr. Waldrum has been a member of the University of Alabama Hospital medical staff in the Division of Pulmonary & Critical Care Medicine, served as co-director for the Pulmonary Rehabilitation Program from 1995 to 1999, served as medical director of the Medical Intensive Care Unit from 1995 to 2001, served as medical director of Information Services, UAB Health System, and served as chief information officer, UAB Health System. Dr. Waldrum served as the chief operating officer at University Hospital from 2004 to 2006, and currently serves as the chief executive officer for both University Hospital and UAB Highlands.
Mr. Sisk received his Bachelor of Science degree from The University of Alabama at Birmingham and his master’s degree in health services administration from the University of St. Francis. He began his health care career in 1980 with Baptist Health System (BHS). During his tenure with BHS, Sisk served as human resources coordinator at Baptist Medical Center Montclair in Birmingham, as vice president of Cullman Regional Medical Center in Cullman and as president of BMC Marion in Hamilton. In 2001, he was named CEO of BMC Coosa Valley, now known as Coosa Valley Medical Center.
In addition to his board service, Mr. Sisk is currently serving on the Blue Cross Blue Shield of Alabama Advisory Board and the state’s Certificate of Need Board. He is also a member of the American College of Healthcare Executives, a national professional organization for health care leaders.
St. Vincent’s Health System Senior Executive Earns Top Healthcare Management Credential
St. Vincent’s Health System announced that Tim Stettheimer, FACHE, has recently become a Fellow of the American College of Healthcare Executives, the nation’s leading professional society for healthcare leaders.Tim Stettheimer, PhD, FACHE, FCHIME is Senior Vice-President and Chief Information Officer at St. Vincent’s Health System in Birmingham, Alabama.
Fellow status represents achievement of the highest standard of professional development. In fact, only 7,500 healthcare executives hold this distinction. To obtain, Fellow status, candidates must fulfill multiple requirements, including passing a comprehensive examination, meeting academic and experiential criteria, earning continuing education credits and demonstrating professional/community involvement. Fellows are also committed to ongoing professional development and undergo recertification every three years.
Stettheimer is privileged to use the FACHE credential, which signifies board certification in healthcare management and ACHE Fellow status.
MAG Mutual Insurance Company names Darrell Grimes as new president
ATLANTA – MAG Mutual Insurance Company (MAG Mutual) recently announced that Darrell O. Grimes has been promoted to President of the multi-state medical liability insurer. MAG Mutual’s past president, Tom Gose, retired in March after leading the company for 23 years. Grimes has been serving MAG Mutual as the Sr. Vice President and CFO for the past 16 years and recently held the title of Chief Operating Officer.
A 19-year veteran of MAG Mutual, Grimes, a CPA, brings a balanced resume to the President’s position. His 30 years experience in insurance and financial services, with prior positions at KPMG and Cotton State Insurance Company; provides a strong background for his new position.
Started and owned by the physician policyholders it serves, MAG Mutual Insurance Company is a medical professional liability insurer and was founded in 1982.
Youngblood Joins Staff At Pediatrics East In Deerfoot
BIRMINGHAM (July 25, 2008) – Gigi Youngblood, MD, recently joined the medical staff of Pediatrics East’s Deerfoot office.Youngblood graduated summa cum laude from the University of Tennessee with a bachelor of science degree in engineering science in 2001. She received her medical degree from the University of Alabama School of Medicine in 2005 and completed her internship and residency at the University of Washington (Children’s Hospital and Regional Medical Center in Seattle).
A native of Homewood, Youngblood recently moved back to her hometown. She is a member of the American Academy of Pediatrics along with Alpha Omega Alpha. Youngblood and her husband Mitchell are avid football fans and enjoy cooking and entertaining, traveling and hiking in their spare time.
Serving families in eastern Birmingham since 1947, Pediatrics East (both Roebuck and Deerfoot offices) were recently recognized by the Alabama Health Department for excellence in vaccinating its patients.
UAB Hospital Named Among Top 12 In Nation
The UAB Hospital has been selected as one of 12 U.S. finalists for Hospital of the Year Award.The selection was made by the American Alliance of Healthcare Providers, which ranks accredited hospitals based on their consumer friendliness, medical performance and other professional standards.
The alliance’s highest scores are given to those who meet or exceed criteria outlined in the Hospital of Choice Awards, a consumer-choice ranking announced quarterly by the alliance. UAB Hospital earned the quarterly award earlier this year.
The award criteria include such things as a review of patient literature and hospital Web pages to assess their helpfulness. It also includes an analysis of steps taken to insure doctors and other healthcare providers communicate openly to patients so that treatment decisions are reached mutually.
The award also involves a review of hospital staff development, and a comparative look at data, such as the number of physicians, nurses, licensed beds and surgical procedures performed at each hospital.
UAB’s Marchase Leads National Scientific Organization
UAB Vice President for Research and Economic Development Richard Marchase, Ph.D., has been named the 93rd President of the Federation of American Societies for Experimental Biology (FASEB). Robert R. Rich, M.D., UAB’s Senior Vice President for Medicine, served as FASEB President in 2001-2002.FASEB is composed of 21 professional societies representing the various biomedical research specialties with more than 80,000 members, making it the largest coalition of biomedical research associations in the United States. It serves as the principal voice for research scientists on issues affecting the biomedical sciences, advocating for research funding and policies that promote scientific progress and education and lead to improvements in human health.
Marchase is the principal investigator on several awards for research infrastructure from the National Institutes of Health, including $15.9 million for the construction of a biosafety facility. The NIH also supports his laboratory, which studies the effects of hyperglycemia on resuscitation and tissue viability.
Marchase received his bachelor’s degree in engineering physics from Cornell University and was the recipient of the Hamilton Award as the outstanding graduate in science and engineering. He received his doctorate with distinction in biophysics from The Johns Hopkins University. He completed his postdoctoral training and then was named an assistant professor at Duke University, where he was an initial recipient of the Presidential Young Investigator Award from the National Science Foundation. He came to UAB in 1986 and has served as Chair of the Department of Cell Biology and Senior Associate Dean for Research of the School of Medicine. He is a past-president of the Association of Anatomy, Cell Biology, and Neurobiology Chairpersons and served on the steering committee of the Group on Research Advancement and Development for the Association of American Medical Colleges.
Baptist Health System Announces Plans to Build Hospital in Hoover
Baptist Health System (BHS) announced recently its plans to build a hospital in Hoover, Alabama, the only city in the state with more than 60,000 residents without a hospital. Shane Spees, BHS President and CEO, was joined in making the announcement by Hoover Mayor, Tony Petelos. “Our health system was formed in 1922 to fill a void in healthcare services. Today, we’re announcing our intentions to fill a void in healthcare services in Hoover, which has matured greatly over the past several years, growing to be the sixth largest city in Alabama,” said Spees. “But access to healthcare in Hoover is essentially the same as when the city was established in 1967. Pending regulatory approval, our intention is to build a much-needed hospital in Hoover.”
Baptist officials will file today with the State Health Planning and Development Agency (SHPDA) a request for an amendment to the state’s Health Plan which would allow the System to move licensed hospital beds from Princeton Baptist Medical Center to the proposed Hoover Baptist Medical Center. If the amendment is adopted, Baptist officials plan to seek approval to move up to 140 beds, and offer a full complement of clinical services at the new hospital, including a physician-staffed, 24/7 emergency department.
“Access to healthcare is critical. And the City of Hoover, which has experienced explosive growth over the past several years, has great quality of life, great schools, as well as ample business opportunities. But we lack critical access to healthcare,” said Mayor Petelos. “The announcement today means we’re one step closer to meeting that need for our community.”
Within the first six months of taking office in 2004, Mayor Petelos commissioned a study to assess the City of Hoover’s need for a hospital. “The report clearly showed that with our population growth, the need existed. And as we’ve continued to grow, the need is even greater today,” said Petelos.
Trinity Medical Center to Have Single Owner Again
Trinity Medical Center and Baptist Health System (BHS) have announced the execution of an agreement that returns the hospital to single ownership. BHS has entered into an agreement to sell its 35 percent interest in the hospital to a subsidiary of Community Health Systems, Inc. The CHS subsidiary previously owned 65 percent of the medical center, and has served as managing partner of the joint venture.“When Baptist Health System entered into a joint-venture agreement for Trinity Medical Center, our goal was to assure the community’s healthcare needs would be met with a new hospital to replace Montclair Baptist,” said Shane Spees, President and CEO of Baptist Health System. “That goal is now being realized.”
“Trinity Medical Center has experienced an extremely productive year and is well-positioned for the future,” said Trinity Chief Executive Officer Bill Heburn. “With our Certificate of Need in process, and with the continued support of our medical staff, employees and community, we look forward to continued growth and success.”
August 2008