In Brief: Blue Shield Owes $82.8 Million In Rebates; Hospitals Will Have To Pay Readmission Penalty
Blue Shield Owes $82.8 Million In Rebates
Blue Shield of California says it owes $82.8 million in rebates to health plan enrollees that were accrued in 2014.
The Los Angeles Times reported the amount, which is the result of Blue Shield spending less than 80% of its premium dollars on medical care. According to the newspaper, Blue Shield’s medical loss ratio last year was 76.8% for the individual and small group markets.
The large majority of the money, $61.7 million, is going to more than 450,000 individual enrollees, who will receive an average rebate of $136. The remainder will go to 19,000 small group employers.
The money Blue Shield is refunding is fairly significant, representing about 20% of the rebates all insurers paid nationally last year for coverage that was effective in calendar 2013.
Two other large California insurers, Anthem Blue Cross and Kaiser Foundation Health Plan, say they do not owe any rebates to consumers or employers.
Hospitals Will Have To Pay Readmission Penalty
About 65% of hospitals in California participating in the Medicare program to reduce readmissions within 30 days of discharge will have to pay a penalty for failing to make their numbers.
Of the 313 hospitals participating in the Hospital Readmissions Reduction Program, 224, or 65%, face penalties ranging from one-hundredth of 1%, to 3% of their Medicare payments. The average penalty statewide was 0.4%.
Providence Tarzana Medical Center in the San Fernando Valley had the largest penalty -- one of 38 nationwide to receive the 3% charge. Six hospitals statewide had the lowest penalty.
Nationwide, 799 out of the 3,400 hospitals participating, or about 24%, escaped penalties for meeting the readmissions threshold. About 200 hospitals that were penalized last year avoided penalties this year.
Yelp, ProPublica Team Up To Provide Healthcare Listings
Online review tool Yelp has teamed up with the non-profit investigative website ProPublica to provide detailed lstings and critiques of healthcare providers.
Yelp will post information that ProPublica has gathered from its own research, as well as databases operated by the Centers for Medicare & Medicaid Services and other agencies.
Among the information that is being posted are hospital emergency room waiting times, fines paid by nursing homes for subpar care, or hospital readmissions data for dialysis centers.
But Yelp will also post its ubiquitous consumer comments on their interactions as customers.
“Doctors and health professionals everywhere could learn a valuable lesson from the archives of Yelp: Your officious personality or brusque office staff can sink your reputation even if your professional skills are just fine,” ProbPublica posted on its website.
