“BREAKING NEWS” Cigna and Humana to Merge?

Posted on November 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Cigna and Humana are in talks for a combination that would create a new powerhouse in the health-insurance industry. The companies are discussing a stock-and-cash deal that could be finalized by the end of the year, assuming the talks don’t fall apart.

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A combination of the managed-care providers would be huge, given Cigna’s market value Wednesday morning of about $83 billion and Humana’s of roughly $62 billion.

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Cigna and Humana previously explored merging in 2015, but Humana instead struck a deal with another rival, Aetna, that was blocked by a judge on antitrust grounds, leaving Aetna to be scooped up by CVS in 2018. Another deal that would have combined Cigna with Anthem, now known as Elevance Health, also died after an adverse antitrust ruling.

CITE: https://www.r2library.com/Resource

Editor’s Note: Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. Across the country, doctors are grumbling about claim denials and onerous pre-approval requirements by Medicare Advantage plans. Some hospitals and physician practices are so fed up they’re refusing to accept the plans — even big ones like those offered by United Healthcare, Cigna and Humana.

“The insurance companies running the Medicare Advantage plans are pushing physicians and hospitals to the edge,” said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents the for-profit hospital sector.

And, just last week, the industry’s largest lobbying group, the American Hospital Association, fired off a letter to the Centers for Medicare and Medicaid Services warning that some insurers seem intent on circumventing new rules put in place by the Biden administration aimed at reining in some prior authorization and claim denials.

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DAILY UPDATE: HIPPA Web-Tracker Lawsuit and Bank Deposits Delayed as Markets Jump Again!

Posted on November 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

“FALL BACK WEEKEND”

By Staff Reporters

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The biggest U.S. hospital lobbying group just sued the Biden administration over new guidance barring hospitals and other medical providers from using trackers to monitor users on their websites. The American Hospital Association (AHA), along with the Texas Hospital Association and two nonprofit Texas health systems, filed a lawsuit against the U.S. Department of Health and Human Services (HHS) in federal court in Fort Worth, Texas. The lawsuit accuses the agency of overstepping its authority when it issued the guidance in December, 2022.

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Bank of America customers have been warned of delays to deposits following an unspecified issue that is affecting “multiple financial institutions”. The company reassured customers on Friday that their accounts remained “secure” and that no action was needed. A statement appearing on customer phone applications read: “Some deposits from 11/3 may be temporarily delayed due to an issue impacting multiple financial institutions.

Wells Fargo and Chase just reported similar situations.

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Here is where the major benchmarks ended:

  • The S&P 500 Index was up 40.56 points (0.9%) at 4,358.34; the Dow Jones Industrial Average (DJI) was up 222.24 points (0.7%) at 34,061.32, up 5.1% for the week; the NASDAQ Composite (COMP) was up 184.09 points (1.4%) at 13,478.28, up 6.6% for the week.
  • The 10-year Treasury note yield was down about 9 basis points at 4.577%.
  • CBOE’s Volatility Index (VIX) was down 0.75 at 14.91.

Banks and other financial companies led Friday’s gainers, on hopes easing Treasury yields will relieve some pressure on lenders’ balance sheets. The KBW Regional Banking Index (KRX) surged 3.3% to end at a seven-week high, while Goldman Sachs Group (GS) shares jumped 4.4% to lead Dow gainers.

Retailer shares were also strong, as were small-caps in general, as the Russell 2000 Index (RUT) posted a gain of 7.6% for the week.

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Pity the Poor Hospitals?

Posted on December 20, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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A Historical Look-Back to the Future?

wayne-firebaugh

By Wayne Firebaugh CPA, CFP® CMP™

www.CertifiedMedicalPlanner.org

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future. … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

In Agreement

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Today

More current healthcare statistics after the November 7th 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression.  The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

  • Hospitals provided $39 billion in uncompensated care to patients in 2010 representing 5.8% of their expenses.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.

More Metrics

A further review added more daunting numbers: [3]

  • In 2010, 22.4% of hospitals reported a negative total margin.
  • From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
  • Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
  • The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
  • From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment?

Latin Roots

The same Latin words that give rise to the word “dowry” also give rise to the word endowment.[4] Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance.

With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Hospital

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

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[1]   MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2]   Steinberg, C. Overview of the U.S. Healthcare System.  American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3]   “Trends Affecting Hospitals and Health Systems.”  TrendWatch Chartbook 2010.  American Hospital Association (2010).

[4]   Merriam-Webster Online.

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Physicians Seeking Financial Support from Hospitals

Posted on December 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Results of a New Survey

[By Staff Reporters]

Since domestic economic conditions began to deteriorate in September 2008, the number of doctors seeking financial support from hospitals has increased, according to a new report from the American Hospital Association. 

Study Results

  • Overall: 70%
  • Physicians Seeking Increased Pay for On-Call or other Services Provided to Hospital: 79%
  • Physicians Seeking Hospital Employment: 74%
  • Physicians Seeking to Sell Their Practice: 36%
  • Physicians Seeking to Partner on Equipment Purchases: 26%
  • Other: 13%

Source: American Hospital Association. The Economic Crisis: Ongoing Monitoring of Impact on Hospitals: Results from an AHA Rapid Response Survey, August/September 2009. www.aha.org

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This Time the Hospital Financial Crisis is Different

Posted on March 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Oh Really … No so Fast!

Submitted by J. Wayne Firebaugh, Jr; CPA, CFP®, CMP™ho-journal2

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… Our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been affected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect…

Source:  Steinberg, C. Overview of the US Healthcare System; American Hospital Association 2003.

Many hospital CXOs, healthcare administrators and physician executives would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. However, they might be startled to learn that Dr. MacEachern made these observations in 1932! There is the old truism that there is nothing new under the sun.

American Hospital Association Statistics

Healthcare statistics suggested that the financial crisis is much the same today as it was for hospitals during the Great Depression. The American Hospital Association’s (AHA) reported gloomy statistics for hospitals include:

  • In 2001, 29% of hospitals had negative total margins.
  • Approximately $101.3 billion of uncompensated care was provided between 1997 and 2001 with an average annual increase of 16% during that time period.
  • Emergency departments in 62% of all hospitals report operating at, or over, capacity.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.
  • Between 2000 and 2002, 33% of hospitals reported increases in liability premiums of more than 100%.
  • The average age of hospital plants has increased 21% from 7.9 years to 9.6 years in just one decade.
  • In the four years ending 2002, hospital bond downgrades have outpaced hospital bond upgrades by almost 5 to 1.

Editor’s Assessment

As editor’s of the premium subscription, two volume, 1,200 pages, institutional print-guide Healthcare Organizations [Financial Management Strategies], we prefer engaged readers and contributors like Mr. Firebaugh, who demand and create compelling content like the above. Please review these links for same.

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