CHOP ends Medicaid contract standoff | Philly Health Insider
And the role of the “inboxologist”
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Today, we bring you a late-breaking announcement that a long-running contract dispute between CHOP and a major Medicaid insurer is over. Plus, there’s news on a Penn-developed avian flu vaccine, the region’s newest “micro-hospital,” and doctors who specialize in clearing out inboxes for overwhelmed medical practices.
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— Aubrey Whelan and Abraham Gutman, Inquirer health reporters, @aubreywhelan and @abrahamgutman.
Late last night, CHOP and the Medicaid insurer Keystone First announced the end of their months-long contract fight: The pediatric health-care giant and Southeastern PA’s biggest Medicaid provider have reached a deal in a dispute that had left families in the lurch.
The organizations said they’ve reached a multiyear agreement and plan to notify families of the resolution this week. No further details were released.
For CHOP families insured through Keystone First, the drawn-out contract resolutions have been agonizing. If a new deal wasn’t reached by June 30, families would have had to either forgo care at CHOP or switch to another Medicaid provider.
Our colleague Sarah Gantz spoke to families who spent months terrified that they would have to leave a health system where they’ve built trust with doctors who fine-tuned their children’s care. Or, they weighed switching Medicaid providers and possibly losing coverage for devices and at-home care.
Some families panicked at the prospect of losing care that they specifically relocated to Philly to access. The Garner family, pictured above, moved here from New York to get care for their son Apollo, who has a form of cerebral palsy.
Read Sarah’s feature on CHOP families to learn about the contract dispute, how CHOP is seeing more patients with Medicaid, and how families coped amid the uncertainty. And follow Sarah and The Inquirer tomorrow for follow-ups to this developing story.
The latest news to pay attention to
Prime Healthcare, the California-based health system that owns Suburban Community Hospital, is downsizing the East Norriton hospital into a “micro-hospital” and closing its behavioral health unit. Harold Brubaker details how the micro-Suburban will include at least 10 beds and an emergency department — and advances a growing trend in the region.
Tower Health reported lower operating losses for the first nine months of 2024, an improvement for the struggling health system. But its cash reserves, Harold reports, are still “extraordinarily low.”
Rothman’s ill-fated push into New Jersey — with failed partnerships with two health systems there — has now resulted in the orthopedics giant suing both of them.
This week’s number: 103%.
That is how much sicker patients are at the Philadelphia-area hospital treating the most complex patients, compared to the least.
We got that number by calculating the percentage change of a measure called the case-mix index, or (CMI), a score based on the diagnoses of hospitalized Medicare patients in 2024.
Penn’s flagship Hospital of the University of Pennsylvania receives the most acutely ill patient population in the region. HUP’s 2.917 CMI is followed by Penn Presbyterian Medical Center (2.608) and Thomas Jefferson University Hospital (2.511), all in Philadelphia.
Holy Redeemer sees the least complex population of hospitalized patients (1.438), followed by Pottstown Hospital (1.484) and Jefferson Lansdale Hospital (1.501). All are in the Philadelphia suburbs.
Severely ill patients may seek care at smaller community hospitals, but they are increasingly transferred to larger institutions. Harold recently took a deep dive into how Penn has incorporated such transfers into its business model.
Here’s a chart showing how area hospitals stack up.
Each week, we highlight the results of various hospital inspections in the region. Up this week: Fox Chase Cancer Center. State inspectors did not conduct any on-site investigations between September 2023 and February 2024 at the Philadelphia cancer treatment center.
Electronic patient portals help patients communicate with health providers, but they have also swamped doctors with messages to the point of causing stress and burnout — not to mention the difficulty of quickly responding to all patients.
Enter “inboxologists,” or clinicians who specialize in clearing out overwhelmed inboxes and responding to patient concerns. Internist Jeffrey Millstein of Penn Primary Care explores the phenomenon and how practices can scale up these roles.
Making moves
Caron Treatment Centers, an addiction treatment and behavioral health-care system that provides services in Pennsylvania, Washington, D.C., Florida, Georgia, and New York, has promoted Adam Scioli to serve as its chief medical officer.
Scioli previously served as the corporate medical director and head of psychiatry at Caron. Scioli is a UPenn grad and, during his psychiatry residency training, served as chief resident at Einstein Medical Center in Philadelphia.
A correction: The “Making Moves” section in last week’s newsletter incorrectly described the role of Julia Puchtler, the incoming CFO for the entire University of Pennsylvania health system.
Penn researchers have developed an mRNA vaccine for the H5N1 avian flu — building on the same techniques used to create the COVID-19 vaccines also developed at Penn. The vaccine is effective against the virus in mice and ferrets, according to a study published last week in Nature Communications.
Avian flu has affected millions of birds across the country, including in Pennsylvania, and has been found in dairy cattle herds in at least nine states. It is not currently considered a major threat to people, though two cases were identified in U.S. agricultural workers.
But it’s better to be safe than sorry, said Scott Hensley, a Penn professor of microbiology and the study’s corresponding author. “It’s important to do a lot of these early clinical studies with viruses that pose a pandemic risk now, instead of in a pandemic,” he said.
That’s all for this week! As we sign off, we would be remiss if we did not recommend this health-related story from our colleague Wendy Ruderman on the accidental stoner canines of greater Philadelphia. A nationwide rise in dogs accidentally eating cannabis is coming as a shock to many — including Wendy and her own dog, Beau. (Don’t worry — eating THC can be unpleasant for a dog, but is not deadly, and all pups interviewed for this story are fine.)
📮 Have you seen an uptick in accidental cannabis ingestion cases in humans in your work? For a chance to be featured in this newsletter, email us here.
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