Senators: Home-care visits overbooked

WASHINGTON — Senate investigators are accusing three of the nation’s biggest home-care providers of deliberately increasing their visits to patients to get higher payments from the government’s Medicare program.

A report released Monday by the Senate Finance committee lays out more than a half-dozen strategies used by executives at Amedisys, LHC Group and Gentiva to increase home care, even when patients may not have required extra attention. Staffers for Sens. Max Baucus, D-Mont., and Charles Grassley, R-Iowa, reviewed internal documents by the companies.

“Elderly patients in the Medicare system should not be used as pawns to increase a company’s profits,” Baucus said in a statement. “Especially in these tough economic times, taxpayers simply cannot afford for their dollars to be wasted on unnecessary care.”

Grassley said the government must “fix the policy that lets Medicare money flow down the drain.”

The company records show caregivers targeted their number of visits to trigger bonus payments from Medicare. In one case, a company tasked a special team of workers to develop the most profitable treatment regimens possible.

The government program provides health coverage to more than 47 million seniors. The program spends $19 billion on home care annually, according to the report.

Shares of home-care providers fell in trading Monday. Baton Rouge, La.-based Amedisys Inc. fell 71 cents, or 4.8 percent, to $14.11. The stock is down 58 percent in the year to date. The company said in a statement it was “disappointed with the committee’s conclusions” and stands by its “integrity, ethics and patient care practices.”

Shares of Atlanta-based Gentiva Health Services Inc. fell 66 cents, or 12 percent, to $4.86 in trading. It has declined 82 percent in the year to date.

And shares of LHC Group Inc. fell 80 cents, or 4.7 percent, to $16.26. Since the start of the year, the stock has shed 46 percent of its value. On Friday, the Lafayette, La., company announced it would pay $65 million to settle a civil inquiry with the federal government over whether some government-reimbursed patient care was medically necessary.

NPR's new chief vows to focus on news and 'depoliticize' network

WASHINGTON — The man who helped bring Sesame Street to a global audience for the past 11 years will take over as president and CEO of NPR, the public radio network announced Sunday.

Gary Knell, the longtime president and CEO of Sesame Workshop, will start at NPR on Dec. 1.

Knell succeeds Vivian Schiller, who resigned under pressure in March after a former NPR fundraiser was caught on camera calling the tea party racist. The episode led some conservatives to call for an end to federal funding for NPR, but Congress ultimately retained the money as part of a budget deal in April.

Schiller was also criticized for firing analyst Juan Williams over comments about Muslims.

Knell, 57, told the Associated Press on Sunday that he wanted to “depoliticize” NPR by highlighting its commitment to hard-hitting local, national and international journalism across multiple platforms. He said he does not believe that NPR is biased and wants to try to change the minds of those who perceive it as such.

“I think NPR needs to do a better job of telling a story,” Knell said. “It’s about journalism, it’s about news. It’s not about promoting one political agenda or another.”

Unanimous pick

NPR’s board of directors voted unanimously to hire Knell .

“Gary is an extraordinary leader with extensive experience in public media, programming and education,” board chairman Dave Edwards said in a statement. “As CEO of Sesame Workshop for more than a decade, he has led a large, complex organization through a tumultuous media environment, helping it grow by providing innovative, engaging content in new and creative ways.”

At Sesame Workshop, Knell created co-productions in South Africa, India, Northern Ireland and Egypt and made the organization’s programming available on a variety of digital platforms.

“Despite the fact that it may appear that I’m a guy who’s doing puppet shows, that’s not really true,” Knell said. “It’s a complex media organization that’s global in size.”

Nikki Usher, an assistant professor at the George Washington University school of media and public affairs who has studied NPR extensively, said Knell was a smart hire.

“Public broadcasting is a world that sort of demands that you know a lot about the way that things get financed,” Usher said. “I think it’s a really good decision to go with someone who’s inside public broadcasting because of the difficult situation that public broadcasting is in.”

Hotel Indigo has new owner

Bob Winston, president of Winston Hospitality in Raleigh, N.C., snaps up troubled hotels with various financial woes at bargain prices — then tries to renew their life.

For his latest venture, he came to Nashville.

Winston on Friday bought a Hotel Indigo operation — a boutique hotel on Union Street downtown — for$14 million in a bankruptcy sale, according to Davidson County property records.

That Hotel Indigo location, a $30 million investment that struggled amid the recession, sold its property and building for $11.8 million, and the remaining sum was attributable to the hotel’s business operations, confirmed Robert Waldschmidt, the sale’s trustee.

The hotel’s former property owner, 315 Union Street Holdings LLC, filed for Chapter 11 bankruptcy protection in December in an effort to broker a deal with Branch Banking & Trust of Atlanta to restructure a troubled loan.

A deal was never reached.

Hotel Indigo, with 96 rooms and 3,000 square feet of meeting space, opened in two historic buildings: 301 Union and 315 Union, which were combined. The 301 Union structure, built in 1909, was formerly the American Trust Building; the other, built in 1926, was the Nashville Trust Co.

Mark Lineberry, the hotel’s former property owner, could not be reached for comment on Friday.

The Hotel Indigo on West End Avenue was not involved in Friday’s developments.

Buyer plans overhaul

Winston, who manages five upscale hotels, mostly in the South, said the flailing Hotel Indigo was “right down the middle of our sweet spot.”

He continued: “We take over loans in markets all over the country that have been in financial trouble. It’s very difficult to have really robust sales with a hotel in bankruptcy. But we bring in our team and reposition the business.”

Earlier this year, the company acquired two yet-to-open luxury hotels in Connecticut with troubled loans.

Here, Winston has some overhauling in mind. In particular, he plans to install reinforced windowpanes throughout the building becaus, he said, customers often complain about the level of noise.

Winston’s additional renovations to the Indigo building will be “in the millions,” he said.

“The hotel itself is a great box,” Winston said. “But because of cost overruns and other issues associated with the building, it just got overleveraged.”

Winston suggested that the investment, his first in Nashville, signals an acute interest in the local hospitality market.

“We’ve been looking for the right project in Nashville for years,” Winston said. “And we’d like to add to our portfolio in Nashville. There are some other potential opportunities we’re now considering.”

Ready, aim, Fire: Amazon targets the iPad

NEW YORK — Amazon is taking on the untouchable iPad with a touch-screen tablet of its own.

The company on Wednesday introduced its entry in the rapidly expanding market for handheld computers — a device called Kindle Fire that connects to the Web, streams movies and TV, displays e-books and supports thousands of apps.

It’s half the size of an iPad and will be less than half the price when it goes on sale Nov. 15. Amazon is offering the Kindle Fire for $199. The bare-bones iPad sells for $499, the most expensive for $829.

Of course, competing with the iPad won’t be as easy as swiping a finger.

Analysts at one research firm, Gartner Inc., say three of every four tablets sold this year will be iPads. Apple sold almost 29 million of them from April 2010 through June of this year.

Amazon sells more than 1 million e-books, 100,000 movies and TV shows, and 17 million songs. It hopes it will succeed where other companies have failed because the tablet is designed to tap into Amazon’s massive storehouse of media content.

“The reason they haven’t been successful is because they made tablets. They didn’t make services,” CEO Jeff Bezos told The Associated Press in an interview.

Bezos unveiled the Kindle Fire at a New York media event that was stage-managed much the same way Apple choreographs its product launches. He extolled the product while technology sites blogged the event.

The CEO also introduced three versions of its popular Kindle e-reader, all with black-and-white screens — a basic model for $79, a touch-screen version for $99 and a touch-screen with 3G wireless service for $149.

Those devices will further pressure competitors such as Barnes & Noble as they try to break Amazon’s dominance in electronic book sales.

The Kindle Fire’s size, with a screen that measures 7 inches diagonal, makes it a close match to Barnes & Noble’s Nook Color tablet, which came out last year. But while Barnes & Noble sees the Nook Color as jazzed-up e-reader, Amazon has broader goals for the Fire as a platform for games, movies, music and other applications.

All that content makes the Fire the only credible competitor to the iPad this year, said Sarah Rotman Epps, an analyst with Forrester Research.

Seniors face tough Medicare decisions

The annual marketing season for private Medicare health and prescription drug plans is under way, and for seniors that should mean a flood of TV ads and direct mail touting the extra benefits offered by various plans.

This fall, seniors must decide earlier on which plans to enroll in for next year. And with the premiums on some large drug plans shifting, as well as new zero-premium Medicare Advantage and prescription plans being rolled out, insurance experts advise seniors to study their options even more closely and shop around before signing on the dotted line.

“You’ve got to be a very careful shopper,” said John Gorman, chief executive with Gorman Health Group LLC, a Medicare consulting firm. “You can’t just look at the monthly premiums. You have to look at what your out-of-pocket costs would be.”

Starting this weekend, plans can start marketing to seniors, who have from Oct. 15 to Dec. 7 to sign up. In the past, the sign-up period started a month later and lasted until year-end.

“That’s something people can easily miss if they’re not paying attention,” said Mary Beth Best, program director with MedAssurance, a nonprofit that provides education about Medicare to beneficiaries. “My advice to people is to try to take care of it before Thanksgiving.”

For next year, seniors statewide can choose among 71 Medicare Advantage health plans, down slightly from the 74 available in Tennessee this year, according to Avalere Health, a consulting firm.

However, the total number of plans available in Davidson County remains unchanged at 25. Meanwhile, 32 Medicare prescription drug plans are available statewide, two fewer than this year. (Three new plans entered the state, but five were discontinued.)

Government business sought

In the Nashville area, choices include a zero-premium Medicare Advantage plan with prescription drug benefits being reintroduced by BlueCross BlueShield of Tennessee, the state’s largest insurer.

In other developments, Humana lowered the premium on its Gold Plus HMO plan with out-of-network benefits by 44 percent to $26 a month, cut the copays for doctors’ office visits in half to $5 and added HCA hospitals to its network.

BlueCross’s aggressive offering and Humana’s recent acquisitions of two California-based Medicare Advantage operations illustrate how commercial insurers hope to expand their government-related business.

“They’re awakening to the fact that the commercial market is shrinking … and about the only growth you’re seeing right now is in government programs,” Gorman said. “And so the Blues are throwing down the gauntlet, particularly against HealthSpring right in their backyard.”

UnitedHealthcare added a benefit through which members can get new hearing aids at significant discounts. It also cut the copay for office visits on its AARP MedicareComplete plan by a third to $10; but it raised the copay for emergency room visits by 30 percent to $65.

Among prescription drug plans, monthly premiums on UnitedHealthcare’s AARP MedicareRx Preferred plan (4.7 million members nationwide) will increase 14 percent to $39.70 on average.

More hikes coming

Meanwhile, premiums for a stand-alone prescription drug plan that Franklin-based HealthSpring Inc. offers as a result of its Bravo Health acquisition last year are rising 10 percent to $36.09 a month on average.

HealthSpring is the local Medicare Advantage plan market leader. But that price increase affects people mostly on the West Coast and not the HealthSpring plans here, said Greg Allen, HealthSpring of Tennessee’s president.

Avalere Health expects monthly premiums for prescription-drug coverage for Medicare recipients to fall next year by 4 percent on average overall, which means consumers who fully assess their options could trim some of their costs.

In addition to premiums, seniors should review deductibles, drugs covered by each specific plan and copays or co-insurance.

For people with no medications, the lowest premium plan should work, said Campbell Johnson, the CEO and online editor of Q1 Group, a medical analysis firm.

Marketing strategies among the competing plans vary.

UnitedHealthcare, for instance, expects to send out 50 million pieces of direct mail nationally and use newspaper ads and probably billboards in some markets, said Dale Cutler, executive director of the company’s Medicare Solutions Tennessee unit.

New rating method

Next year, Medicare’s overseer, the Centers for Medicare and Medicaid Services, also plans to begin rewarding Medicare Advantage plans based on a new Five-Star quality rating methodology. For drug plans, ratings are based on factors such as members’ experience in plans, customer service and accuracy of drug plan information.

For Medicare Advantage plans, the ratings also would be based on clinical outcomes of patients.

Those financial incentives are driving a sharper focus on quality among Medicare Advantage plans such as HealthSpring as they strive to reach five stars. And in some markets, that is leading to conflicts with providers.

In Rutherford County, for instance, about 2,000 members with physicians linked to independent practice association Stones River Regional IPA face a choice by the Dec. 7 open enrollment deadline of staying in HealthSpring’s provider network but with a new doctor, switching plans or going back to traditional Medicare.

The patients face such a dilemma because their doctors chose not to sign a new contract with HealthSpring, which wanted to bring more physician and practices into a quality of care program that involves more coordination and oversight.

For some patients, the changes have meant disruptions — especially because they have to wait until open enrollment to sign up with a plan and network that includes their former doctor and must wait after year-end to see them.

Gorman, the industry consultant, expects more such disputes as “accountability” becomes a bigger buzzword and affects health-care delivery.

“It’s just a whole new pay-for-performance revolution that we’re seeing,” he said. “… Eventually, that’s going to move from being pay for performance to perform or die.”

Texas refineries may get back $135M in tax refund

PASADENA, Texas — Three commissioners appointed by Gov. Rick Perry may grant some of the nation’s largest refineries a tax refund of more than $135 million — money Texas’ cash-strapped schools and other local governments have been counting on to help pay teachers and provide other public services.

The property tax refund would mean more pain for some communities after a year in which state lawmakers grappled with a $27 billion shortfall and slashed spending on public schools by more than $4 billion. Nearly half the refund would be taken from public schools, and those in cities where the refineries are based would be hurt most.

“We were already cut at the knees as it is, but more cuts? It’s appalling,” said Patricia Gonzales, a single mother of 13-year-old twins at Park View Intermediate School in Pasadena, a refinery town just south of Houston. Gonzales is president of the school’s new parent-teacher organization, formed this summer after the state budget cuts left the school lacking everything from pencils to paper towels.

The Texas Commission on Environmental Quality is evaluating 16 requests for the refund, which concerns a piece of pollution-controlling equipment.

If granted, the refund total for those requests could add up to more than $135 million, according to county tax data and application documents analyzed by The Associated Press. What’s more, agency documents show that if the commission grants the requests, at least 12 other refineries that have not sought a refund also could qualify.

The three-person commission last year expressed some support for the refund, prompting concern the panel is preparing to side with the industry in the middle of a budget crisis.

Should the commission approve the request, it would fall in line with Perry’s argument on the GOP presidential campaign trail that by being friendly to business he has attracted businesses and jobs to Texas while other states suffered.

“Gov. Perry appoints individuals who are qualified and willing to serve, and expects they will consider all of the facts and make the appropriate decision,” said Lucy Nashed, a spokeswoman for Perry.

Technology refund

The refund request has to do with a piece of technology used by refineries to minimize pollution. Beginning in 2006, the U.S. Environmental Protection Agency began requiring refineries to remove sulfur dioxide from diesel and gasoline in an attempt to reduce vehicle pollution. Many refineries had to either upgrade existing “hydrotreater” units or purchase new, more effective equipment.

Valero first asked for the refund for six of its refineries in 2007, and wants payment retroactive to that year.

Nashville People in Business

Awards

Gordon Bonnyman, attorney and co-founder of the Tennessee Justice Center, was recently honored with a Lifetime Achievement Award during the annual Health Care Heroes event in Nashville.

Steven Field, principal of Stantec Consulting Services Inc., has received a Presidential Citation for his leadership of the American Council of Engineering Companies of Tennessee’s annual Engineering Excellence Awards program.

Arnold Air Force Base Police Chief Richard Trull was selected as the first Arnold Police Department officer to attend the FBI National Academy in Quantico, Va. Trull also was named as the District 6 representative on the board of the Tennessee Association of Chiefs of Police.

Education

Stefanie Gerber Darr has joined Watkins College of Art, Design & Film as director of community education. She had worked at the Frist Center for the Visual Arts as educator for public programs.

The Tennessee Board of Regents said Bruce Scism will serve as interim president of Volunteer State Community College, beginning Oct. 1. Scism, currently the vice president for academic affairs at the college, replaces Warren Nichols, who is taking over as vice chancellor for community colleges at the Regents’ central office.

Finance

Megan Brearey has joined Fifth Third Bank as a large corporate relationship manager in the National Healthcare Finance group of the Tennessee affiliate. She had been employed at National City Bank/PNC Bank in Cleveland, Ohio. The bank also hired John Herald as an institutional investment sales representative. He was with the Kentucky Housing Corp.

Compass EMP Funds said Jim Perry and Mike Smith have joined the Advisor Services team as account executives. Perry, a graduate of Rhodes College, has 18 years of client servicing experience, holding posts with Southwestern Investments, at Cumberland Bank and SunTrust Bank. Smith, a graduate of California State-Fullerton, has 15 years of sales and wholesaling experience with SunLife, and Genworth Financial, among others.

Groups

The Nashville Sports Council named its board for the 2011-12 fiscal year. Pete Ezell of Baker, Donelson, Bearman, Caldwell & Berkowitz is chairman. The executive committee includes immediate past chairman Dave Cooley of Cooley Public Strategies, finance chairman Jim Armistead of Regions Bank, events chairwoman Melissa Eads of Kroger, human resources and compensation chairman Joe Kelley, government relations chairwoman Diane Neighbors, vice mayor of Nashville, legal counsel Jim Murphy of Bradley Arant Boult Cummings, corporate membership chairman John Short of Pepsi Beverages Co., individual membership chairwoman Jaynee Day of Second Harvest Middle Tennessee, public relations chairwoman Deb McDermott of Young Broadcasting, speakers management chairman Hunter McCarty of RJ Young, e-commerce chairman Marty Paslick of HCA, NCAA Women’s Final Four chairwoman Margaret Behm of Dodson Parker Behm & Capparella, at-large members David Williams of Vanderbilt University, Ronald Roberts of Dye Van Mol & Lawrence, Bo Roberts of NetCom LLC, and Kent Thomas of Delek US Holdings and ex-officio Matt Wiltshire of the mayor’s office.

The Nashville Symphony has added 13 members to its board for the 2011-12 season. New directors, elected to serve three-year terms: are Carol Daniels; Bob Dennis, president and CEO of Genesco; Bob Ezrin, partner in Bigger Picture Group; Ben Folds, a composer and musician; Carl Haley, CEO of Grand Avenue Chauffeured Transportation; Larry Larkin, president of LMB; Dr. Victoria Pao; Jennifer Puryear; Michael Schatzlein, president and CEO of Saint Thomas Health; Nelson Shields, CEO and president of NexTime Inc.; Renata Soto, executive director of Conexion Americas; Van Tucker; and Mark Wait, dean and professor of music at Blair School of Music. Newly appointed ex-officio members include Lisa Cooper, president of the Nashville Symphony Chorus; Susannah Culbertson, president of the Nashville Symphony Orchestra League; and James Zimmermann, orchestra representative. Officers include James C. Gooch, board chairman; Ed Goodrich, board chairman-elect; John T. Rochford, vice chairman; David Williams, treasurer; Betsy Wills, secretary; and Lee A. Beaman, immediate past chairman.

The Nashville Local Organizing Committee for the 2014 NCAA Women’s Final Four said Nashville first lady Anne Davis and Tennessee first lady Crissy Haslam will be honorary chairwomen for the April 2014 women’s basketball championship at Bridgestone Arena.

Health care

Kidney disease specialists Drs. Christie A. Green, Ranjan Chanda and Ling Yu have joined Nephrology Associates. Green was an associate professor of Medicine at the University of Tennessee College of Medicine in Memphis. Chanda recently completed a Transplant Nephrology fellowship at the University of California at San Francisco and a Nephrology fellowship at Baylor University Medical Center. Yu recently completed a Nephrology fellowship at Vanderbilt University Medical Center.

Desiree Jones has joined Radiology Alliance, a private radiology practice, as a marketing representative. She was an assistant marketing manager with Abington Press. The company also promoted Christina Spitters to marketing representative. She has been with Radiology Alliance since 1997.

Tim Strickland has joined health-care public affairs firm Jarrard Phillips Cate & Hancock. He has 20 years of experience in hospital marketing and journalism and previously worked at Onslow Memorial Hospital in North Carolina, where he was a senior vice president.

HCA has named Dr. Michael Cuffe as president and chief executive officer of Physician Services, a position created as part of an internal reorganization announced in February. Cuffe currently serves as vice president for ambulatory services and chief medical officer of Duke University Health System.

Dr. H. Scott Baldwin, chief of pediatric cardiology at the Monroe Carell Jr. Children's Hospital at Vanderbilt, has been selected to serve as chairman of the Scientific Board of the Sarnoff Cardiovascular Research Foundation.

Law

Hall Booth Smith & Slover PC has added Patrick Millsaps as a partner in its litigation and transactional practice areas. Millsaps has worked for more than a decade as a litigator and business transaction attorney. Most recently, he was the proprietor of the Millsaps Law Firm in Camilla, Ga.

The law firm of Parker, Lawrence, Cantrell & Smith has added two new attorneys and moved its offices to the Fourth & Church Building, formerly SunTrust Bank. The new attorneys are: J. Spencer Fair and Jessica M. Van Dyke, both of whom graduated from the University of Tennessee College of Law. Fair has practiced law in Kingsport, Tenn., with Gilly & Associates. He received a bachelor of arts degree from the University of Tennessee, where he was Phi Beta Kappa and graduated magna cum laude. Van Dyke has a bachelor’s degree from Knox College in Illinois and a master’s in political science from Vanderbilt University. The law firm also is welcoming back partner Brad Gilmore, who has been practicing in Sydney for the past year and a half.

Attorney Albert J. Bart has rejoined Sherrard & Roe PLC as a member, returning to the firm’s corporate practice group after serving as senior vice president and associate general counsel for Ceridian Corp. for three years. Bart was previously a member of Sherrard & Roe from 2005 to 2008.

Buerger, Moseley & Carson PLC has added Scott C. Gardner to its practice as a specialist in health-care operations law. Before joining the firm, he was an associate at Kay, Griffin, Enkema & Colbert.

Tiffany A. Dunn, an associate in Loeb & Loeb’s Nashville office, has been promoted to senior counsel. She works primarily in the music, television and motion picture industries with a focus on entertainment, corporate and intellectual property transactions, copyright and trademark protection as well as a talent practice.

Barbara Boone McGinnis has joined the Elder Law Practice of Timothy L. Takacs as an associate attorney. McGinnis was with Amedisys Home Health Inc. for seven years.

Baker, Donelson, Bearman, Caldwell & Berkowitz PC has hired Wendell Moore and Jeremy Nagoshiner as public policy advisers in its State Public Policy Group. Moore and Nagoshiner were with The Capitol Group, a government relations and public affairs consulting firm founded by Moore in 2004.

Miscellaneous

Darrin Yappen, a regional sales director for American United Life Insurance Co., a OneAmerica company, is responsible for securing a $2,500 grant for Gilda’s Club Nashville from OneAmerica Financial Partners Inc. Yappen became involved in the fundraising effort after a member of his sales team was diagnosed with brain cancer.

Services

Lattimore Black Morgan & Cain has hired Maria Harris as an accounting specialist in the company’s Nashville-based internal accounting department. She had been a client-billing specialist with Take Care Health Systems.

Centerstone Research Institute has promoted Russell L. Galyon to director of analytics. Galyon joined the company two years ago as a data architect.