Healthcare Cost Index Reveals Pricing Disparities

   BRENTWOOD, Tenn.- (BUSINESS WIRE)- 6/30/2011 - Cost associated with health care imaging services have ballooned over the past decade, accounting for nearly 15 percent – or $100 billion – of the annual health care spend in the U.S. This quarter’s Healthcare Transparency Index from change:healthcare reveals cost disparities of CT and PET scans, MRIs, ultrasounds and mammograms across and within four key regions – highlighting key opportunities for cost transparency to enable patients and employers to save money on local imaging services.
   The Index found that patients who participate in consumer-directed health plans (CDHPs), and high-deductible plans, could be paying almost 700 percent more than they have to for imaging services simply because they don’t have access to critical healthcare pricing information. Individuals can save up to $2,000 on just one of the more expensive imaging services by comparing costs among facilities and selecting more affordable options. This has huge implications for employers who could cut an average of 30 percent off their imaging bill each year – shaving significant costs off what is considered a “big-ticket item” for payers and employers.
   The Index reveals an employer with 15,000 employees could save half a million dollars each year. Backed by claims data from more than 150,000 patients enrolled in employer-provided health plans in more than 200 companies across all 50 states, the findings underscore the central role that actionable cost transparency plays in reducing healthcare costs.
   The Index uncovered significant pricing disparities for the most widely prescribed imaging services at outpatient facilities, freestanding imaging centers and medical offices both from region to region and within the same region:
  • CT Scans: With more than 70 million CT scans performed each year in the U.S., the Index revealed an average of 40 percent possible savings across all regions for patients receiving the three most frequent CT scans (abdomen without contrast, abdomen with contrast, pelvis with contrast) – just by shopping local facilities. The greatest savings potential existed in the Southwest where a patient could pay up to 683 percent more for the same CT scan. However, patients in the Midwest who saw lower variances still paid an extra $290, or 120 percent.
  • MRI: The Index revealed a 25 percent average savings potential across all regions studied for patients receiving the three most frequent MRIs (lower extremity, brain and lumbar spine) by shopping local facilities. Patients receiving the same MRI in the same area of the Southeast could pay a high of $2,500 and a low of $560.
  • Ultrasound: For all regions, shopping local facilities can yield a 28 percent savings for patients receiving the three most frequent ultrasounds (breast, abdomen and transvaginal) by shopping local facilities. The highest price of an ultrasound reported was $700 for an abdominal examination, where the low price in the same area was $120. With an average of three ultrasounds performed per patient just for pregnancy, cost savings to patients and employers are significant.
  • PET Scans: Generally one of the priciest items in imaging, the Index found that patients across the U.S. could save an average of 36 percent by comparing prices. The reported cost in the Northeast ranged from $3,500 to $4,500, while patients in the Midwest paid a maximum of only $2,500 and a minimum as low as $1,400.
  • Mammography: The Index reveals that patients could save an average of 17 percent on mammography services per year by switching providers. With roughly 37 million mammograms performed each year and this number expected to rise with the aging U.S. population, insight into actual pricing and options for care could ultimately drive down costs for all of these routine services.
    “Because of a lack of cost information available, employers and their employees are spending billions needlessly nationwide for common, high-tech and low-tech imaging procedures when they could choose much more cost-effective choices in their own areas,” said Howard McLure, change:healthcare chairman and CEO. “This Healthcare Transparency Index demonstrates how making informed decisions around just one major line item in healthcare – in this case, imaging services – can not only save patients and employers money, but also make a significant impact on the nation’s overall healthcare spend.”

Illinois’ Data Website Gives Public Unique Access

   By Benjamin Yount (Illinois Statehouse News) - 6/25/2011 - On Illinois’ new data website, people can learn that the beach at the Conservation Club 100 in Marion County is a private beach on a lake.
   Or that in the second quarter of 2010, Rock Island County saw $449 million in retail sales.
   Or that two neighborhoods on Chicago’s south side and one on the west side lead the state in lottery ticket sales, each topping $20 million this year.
   But users of cannot find out Gov. Pat Quinn’s salary, companies to which the state owes money or the business resurfacing Interstate 39., launched this week, gives people access to raw data from the Illinois Department of Transportation, or IDOT, state Department of Revenue, state Department of Commerce and Economic Opportunity, and state Environmental Protection Agency.
   “As the summer rolls on, we plan to add data from a number of state agencies, with the goal of having this be a comprehensive, one-stop shop for everything that people want to know about information that comes from the state,” said Kayce Ataiyero, a spokeswoman for Quinn’s office.
   Ataiyero said that if anyone wants information on state salaries and contracts, they can file a Freedom of Information Act request.
   Quinn’s Innovation Council, which has been tasked with new ways to create jobs and spur economic growth, came up with the idea for the new website. Ataiyero said IDOT, which already was planning a data website, paid Sorcata, a Seattle-based web company, $33,395 to develop the site. Sorcata was given the contract, in part, because it had created similar data websites for the federal government and City of Chicago.
   The state’s threshold for bids begins at $33,500.
   David Morrison, associate director of the nonprofit watchdog group, the Illinois Campaign for Political Reform, said the new website has potential despite the minimal information currently posted.
   “The file cabinets that the government maintains are massive, and the more of that stuff that becomes public, the better,” said Morrison.
Although Morrison said open government is good, he worries about too much data being made public.
“Dumping raw data on the public can be tricky,” Morrison said.
   He said taxpayers don’t often know the questions to which they are seeking answers, or which pieces of information are worthwhile.
   Ataiyero said the state is hoping smartphone application developers will pick up the information and run with it.
   “We would love if people trolled the site, and get creative with ways they can suggest for us to use the data,” said Ataiyero.
  She said an app that highlights the amenities at rest stops on Illinois’ interstates is one example.
Morrison said it’s not a bad idea for the state to reach-out to “smart people outside of government.”
   “The more you make this stuff public, the more you’re going to find people who say, ‘Well I find these two data sets intriguing,’” Morrison said. “And that’s where the value comes from.”
   Story published courtesy of Illinois Statehouse News.

Former TBW CEO Gets 40-Month Prison Sentence

   WASHINGTON – 6/22/2011 - The former chief executive officer (CEO) of Taylor, Bean & Whitaker (TBW) was sentenced on June 21 to 40 months in prison for his role in a more than $2.9 billion fraud scheme that contributed to the failure of TBW. At one time, TBW was one of the largest privately held mortgage lending companies in the United States.
   Allen, 55, of Oakton, Va., pleaded guilty in April 2011 to one count of making false statements and one count of conspiring to commit bank and wire fraud. Co-conspirator Sean Ragland, a former senior financial analyst at TBW who reported to Allen, was also sentenced today by Judge Brinkema to three months in prison. Ragland, 37, of San Antonio, pleaded guilty in March 2011 to one count of conspiracy to commit bank and wire fraud. Allen and Ragland both admitted to conspiring with Lee Bentley Farkas, the former chairman of TBW, and others, to defraud financial institutions that had invested in Ocala Funding LLC, a facility wholly-owned by TBW.
   Farkas was convicted on April 19, 2011, on 14 counts of fraud for his role in masterminding the scheme, which was one of the largest bank frauds in the country. Farkas is scheduled to be sentenced on June 27, 2011. The Securities and Exchange Commission (SEC) has a civil action pending against Farkas in the Eastern District of Virginia.
   Co-conspirators Catherine Kissick, a former senior vice president of Colonial Bank and head of its Mortgage Warehouse Lending Division (MWLD); Teresa Kelly, a former operations supervisor in Colonial Bank’s MWLD; Raymond Bowman, the former president of TBW; and Desiree Brown, the former treasurer of TBW, have also pleaded guilty for their participation in the scheme. Earlier this month, Kissick was sentenced to eight years in prison, Brown was sentenced to six years in prison, Bowman was sentenced 30 months in prison and Kelly was sentenced to three months in prison. 
   “As TBW’s chief executive officer, Mr. Allen served as an accomplice to Lee Farkas and his massive fraud scheme,” Assistant Attorney General Lanny Breuer said. “He concealed TBW’s staggering deficits through false financial reports, which ultimately caused investors to lose more than $1.5 billion. Today’s sentence sends a strong message that corporate fraud by senior executives will not be tolerated. At the same time, it demonstrates that substantial assistance in the government’s investigation and prosecution of corporate fraud will be taken into account at sentencing.”
   According to court documents and information presented at trial, Allen and Ragland participated in the scheme from early 2005 through August 2009 by distributing materially false documents to investors in Ocala Funding that misrepresented the financial condition of the facility. The fraud scheme ultimately caused investors in Ocala Funding to lose more than $1.5 billion and Colonial Bank to lose $900 million.
   Furthermore, the documents suggest, TBW began running overdrafts in its master bank account at Colonial Bank because of TBW’s inability to meet its operating expenses, which included payroll, servicing payments owed to third-party purchasers of loans and/or mortgage-backed securities and other obligations. In or about 2002, Farkas and other co-conspirators engaged in a series of fraudulent actions to cover up the overdrafts, first by sweeping overnight money from one TBW account with excess funds into another, and later through the fictitious “sales” of mortgage loans to Colonial Bank, a fraud scheme the conspirators dubbed “Plan B.”
  The conspirators accomplished Plan B by selling Colonial Bank mortgage loans that did not exist or that TBW had already committed or sold to other third-party investors. As Plan B evolved, co-conspirators at TBW also caused TBW to engage in sham sales of groups of mortgage loans, known as “pools,” that other entities already owned to Colonial Bank. As a result, false information was entered on Colonial Bank’s books and records, giving the appearance that the bank owned interests in legitimate pools of mortgage loans, when in fact the pools had no value and could not be securitized or sold. Neither Allen nor Ragland participated in the effort to cover up TBW’s overdrafts or Plan B.
    Additionally, the co-conspirators at TBW caused TBW to misappropriate more than $1.5 billion in collateral from Ocala Funding. According to court documents, both Allen and Ragland played significant roles in the Ocala Funding misappropriation. The misappropriation caused Colonial Bank and the Federal Home Loan Mortgage Corporation (Freddie Mac) to falsely believe that they each had an undivided ownership interest in thousands of the same loans worth hundreds of millions of dollars.
   According to court documents, the fraud scheme also included an effort by certain conspirators in the fall of 2008 to obtain $570 million in taxpayer funding through the Capital Purchase Program, a sub-program of the U.S. Treasury Department’s TARP. In connection with the application, Colonial BancGroup submitted financial data and filings that included materially false information related to mortgage loan and securities assets held by Colonial Bank as a result of the fraudulent activity at TBW. Colonial BancGroup never received the TARP funding. According to court documents, Allen played a key role in causing materially false information to be submitted to and received by the government in connection with Colonial Bank’s TARP application. Ragland was not aware of this aspect of the fraud scheme.
  In August 2009, the Alabama State Banking Department, Colonial Bank’s regulator, seized the bank and appointed the FDIC as receiver. Colonial BancGroup also filed for bankruptcy in August 2009.
   “Instead of upholding his position of power and trust as CEO of TBW, Paul Allen chose the path of fraud and deception in helping facilitate the long-running fraud carried out by TBW and Colonial Bank. Fortunately, the scheme came to a halt when an attempt was made to steal more than a half billion dollars from the TARP,” said Acting Special Inspector General for the TARP Romero. “Today’s sentence appropriately recognizes the severity of Allen’s participation in the fraud along with his cooperation in the government’s investigation.”
   The case is being prosecuted by Deputy Chief Patrick Stokes and Trial Attorney Robert Zink of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Charles Connolly and Paul Nathanson of the Eastern District of Virginia. This case was investigated by SIGTARP, FBI’s Washington Field Office, FDIC-OIG, HUD-OIG, FHFA-OIG and the IRS-CI. The department recognizes the substantial assistance of the SEC. The department also recognizes the assistance of the Financial Crimes Enforcement Network (FinCEN) of the Department of the Treasury.
    Allen was sentenced by U.S. District Judge Leonie M. Brinkema in the Eastern District of Virginia.
   Source: U.S. Department of Justice release.

Best Buy, Employees Reach Settlement Over Suit

   SAN FRANCISCO - (BUSINESS WIRE) - 6/18/2011 - Best Buy and civil rights lawyers announced on June 17 a proposed settlement of an employment discrimination class action brought on behalf of women and minority employees of Best Buy. The settlement remains subject to court approval.
   Through this settlement, Best Buy agrees to changes to its personnel policies and procedures that will enhance the equal employment opportunities of the thousands of women, African Americans, and Latinos employed by Best Buy nationwide.
    One of the counsel for Plaintiffs, Eve Cervantez, said that “Best Buy’s commitment to these changes makes it a ‘best in class’ employer of women and minorities and a leader in the areas of diversity and inclusion.” Best Buy said that these changes are part of Best Buy’s continuous improvement of its employees' experience and the systems which support that experience.
    The settlement has been submitted for approval to the Hon. Phyllis J. Hamilton, United States District Judge for the Northern District of California.
   The lawsuit, filed in December 2005, alleged that Best Buy discriminates against women, African American, and Latino employees of Best Buy retail stores in the United States by denying them promotions and more lucrative sales positions. Best Buy has denied any wrongdoing throughout the litigation.
    In reaching this proposed settlement, the parties agreed that it was in the interest of Best Buy, the plaintiffs, and the employee classes to resolve the matter through a settlement that provides injunctive relief to all class members, rather than to proceed with litigation.
   The case is entitled Holloway v. Best Buy, Civil Action No. 3:05-cv-05056-PJH (N.D. Cal.).

Report: Caregiving Costs Weigh on Americans

  WESTPORT, Conn.- (BUSINESS WIRE) - 6/14/2011 - Americans who provide care for their aging parents lose an estimated three trillion dollars in wages, pension and Social Security benefits when they take time off to do so, according to “The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents.”
   Produced by the MetLife Mature Market Institute in conjunction with the National Alliance for Caregiving and the Center for Long Term Care Research and Policy at New York Medical College, the study reports that individually, average losses equal $324,044 for women and $283,716 for men. The percentage of adults providing care to a parent has tripled since 1994.
    The researchers analyzed data from the National Health and Retirement Study (HRS) to determine the extent to which older adult children provide care to their parents. They also studied gender roles, the impact of caregiving on careers and the potential cost to the caregiver in lost wages and future retirement income.
    “Nearly 10 million adult children over the age of 50 care for their aging parents,” said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. “Assessing the long-term financial impact of caregiving for aging parents on caregivers themselves, especially those who must curtail their working careers to do so, is especially important, since it can jeopardize their future financial security.”
    In addition, the study found that:
    Adult children age 50+ who work and provide care to a parent are more likely than those who do not provide care, to report that their health is fair or poor.
    The percentage of adult children providing personal care and/or financial assistance to a parent has more than tripled over the past 15 years and currently represents a quarter of adult children, mainly Baby Boomers.
   Working and non-working adult children are almost equally likely to provide care to parents in need.
   Overall, caregiving sons and daughters provide comparable care in many respects, but daughters are more likely to provide basic care (i.e., help with dressing, feeding and bathing) and sons are more likely to provide financial assistance defined as providing $500 or more within the past two years. Twenty-eight percent of women provide basic care, compared with 17 percent of men.
    For women, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $142,693. The estimated impact of caregiving on lost Social Security benefits is $131,351. A very conservative estimated impact on pensions is approximately $50,000. Thus, in total, the cost impact of caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals $324,044.
    For men, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $89,107. The estimated impact of caregiving on lost Social Security benefits is $144,609. Adding in a conservative estimate of the impact on pensions at $50,000, the total impact equals $283,716 for men, or an average of $303,880 for male or female caregivers age 50+ who care for a parent.
    “These family caregivers, the celebrated members of the sandwich generation, are juggling their responsibilities to their own families and to their parents,” said Gail Hunt, president and CEO of the National Alliance for Caregiving. “There is also evidence that caregivers experience considerable health issues as a result of their focus on caring for others. The need for flexibility in the workplace and in policies that would benefit working caregivers is likely to increase in importance as more working caregivers approach their own retirement, while still caring for their loved ones.”
    “As the percentage of employees who are caregivers continues to grow, there will be greater demand on employers for help and support. There are many workplace resources and programs that can be made available that benefit all stakeholders since financial stress can negatively impact physical health and workplace productivity,” Timmermann said.
   The study contains implications for individuals, employers and policymakers. It points out that employers can provide retirement planning and stress management information and can assist employees with accommodations like flex-time and family leave. Individuals, it says, should consider their own health when caregiving and should prepare financially for their own retirement. Policymakers are made aware of the fact that more states are considering paid family leave, especially as it is accrued through workers’ compensation funds. On the federal level, a voluntary long-term care insurance program is part of the Affordable Care Act and will likely increase public awareness of the issue.
    The MetLife Study of Caregiving Costs to Working Caregivers provides updated information first reported in two MetLife studies: Sons at Work: Balancing Employment and Eldercare (2003) and The MetLife Juggling Act Study: Balancing Caregiving with Work and the Costs Involved (1999).
    The study uses data from the Health and Retirement Study (HRS) conducted biannually by the University of Michigan with funding from the National Institute on Aging. First fielded in 1992, the HRS, a nationally representative sample, surveys adults over the age of 50 and provides extensive information on this population, including data on income, work and health status, and whether respondents provide basic, personal care and/or financial assistance to their parents. After cases with missing data were eliminated from the 2008 panel, the sample was restricted to 1,112 men and women who had a parent living.

NIH Autism Study Points to Molecular Differences

   (NIH) - 6/9/2011 - Autism blurs the molecular differences that normally distinguish different brain regions, a new study suggests. Among more than 500 genes that are normally expressed at significantly different levels in the front versus the lower middle part of the brain’s outer mantle, or cortex, only eight showed such differences in brains of people with autism, say researchers funded in part by the National Institutes of Health.
   "Such blurring of normally differentiated brain tissue suggests strikingly less specialization across these brain areas in people with autism," explained Daniel Geschwind, M.D., Ph.D., of the University of California, Los Angeles, a grantee of the NIH’s National Institute of Mental Health. "It likely reflects a defect in the pattern of early brain development."  .
   He and his colleagues published their study online May 26, 2011 in the journal Nature. The research was based on postmortem comparisons of brains of people with the disorder and healthy controls.
   In fetal development, different mixes of genes turn on in different parts of the brain to create distinct tissues that perform specialized functions. The new study suggests that the pattern regulating this gene expression goes awry in the cortex in autism, impairing key brain functions.
   "This study provides the first evidence of a common signature for the seemingly disparate molecular abnormalities seen in autism," said NIMH director Thomas R. Insel, M.D. "It also points to a pathway-based framework for understanding causes of other brain disorders stemming from similar molecular roots, such as schizophrenia and ADHD."
   In an earlier study, the researchers showed that genes that turn on and off together at the same time hold clues to the brain’s molecular instructions. These modules of co-expressed genes can reveal genetic co-conspirators in human illness, through what Geschwind and colleagues call "guilt by association." A gene is suspect if its expression waxes and wanes in sync with others in an illness-linked module.
   Using this strategy, the researchers first looked for gene expression abnormalities in brain areas implicated in autism – genes expressed at levels different than in brains of healthy people. They found 444 such differently expressed genes in the cortexes of postmortem brains of people with autism.
   Most of the same genes turned out to be abnormally expressed in the frontal cortex as in the temporal cortex (lower middle) of autistic brains. Of these, genes involved in synapses, the connections between neurons, tended to be under-expressed when compared with healthy brains. Genes involved in immune and inflammatory responses tended to be over-expressed. Significantly, the same pattern held in a separate sample of autistic and control brains examined as part of the study.
   Autistic and healthy control brains were similarly organized -- modules of co-expressed genes correlated with specific cell types and biological functions.
   Yet normal differences in gene expression levels between the frontal and temporal cortex were missing in the modules of autistic brains. This suggests that the normal molecular distinctions — the tissue differences — between these regions are nearly erased in autism, likely affecting how the brain works. Strikingly, among 174 genes expressed at different levels between the two regions in two healthy control brains, none were expressed at different levels in brains of people with autism. An analysis of gene networks revealed two key modules of co-expressed genes highly correlated with autism.
   One module was made up of genes in a brain pathway involved in neuron and synapse development, which were under-expressed in autism. Many of these genes were also implicated in autism in previous, genome-wide studies. So, several different lines of evidence now converge, pointing to genes in this M12 module (see picture below) as genetic causes of autism.
   A second module of co-expressed genes, involved in development of other types of brain cells, was over-expressed in autism. These were determined not to be genetic causes of the illness, but likely gene expression changes related to secondary inflammatory, immune, or possible environmental factors involved in autism.
   This newfound ability to see genes in the context of their positions in these modules, or pathways, provides hints about how they might work to produce illness, according to Geschwind and colleagues. For example, from its prominent position in the M12 module, the researchers traced a potential role in creating defective synapses to a gene previously implicated in autism.
   Follow-up studies should explore whether the observed abnormalities in the patterning of gene expression might also extend to other parts of the brain in autism, say the researchers. The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.
   Source: National Institutes of Health release of June 2, 2011.

Former Hospital Council Faces Multiple Charges

   PHILADELPHIA - 6/5/2011 - Roosevelt Hairston Jr. of Malvern, Penn., was charged in a three-count "information" or accusation, with mail fraud, money laundering, and filing a false tax return for his embezzlement of $1.7 million from the Children’s Hospital of Philadelphia, United States Attorney Zane David Memeger announced recently.
   Hairston was employed in various senior positions at CHOP, including most recently as general counsel and executive vice president.
   The information alleges that, between 1999 and February 14, 2011, Hairston used dozens of false invoices he created for shell companies to steal from CHOP. Hairston was able to steal for so long because he occupied a position of trust at the hospital and because he engaged in extensive efforts to conceal and prolong the scheme. For example, when CHOP accounting personnel questioned some of the bogus invoices Hairston submitted, Hairston stole the identity of a long-time friend and created bogus e-mail addresses in the name of his friend. Hairston then sent e-mail messages to CHOP personnel to make it appear that the invoices were real.
   Hairston allegedly used the funds he stole from CHOP to live a lavish lifestyle, purchasing luxury items like real estate, a luxury yacht with a captain to maintain the yacht, high-end automobiles, and many other luxury items.
  The case was investigated by the Federal Bureau of Investigation and the Internal Revenue Service Criminal Investigation Division. The case is being prosecuted by Assistant United States Attorney Richard J. Zack.
  Source: U.S. Department of Justice release.