How Massachusetts Blue Cross audited hospitals

There’s nothing really exciting or interesting about this story except this: since I’ve been putting this blog portfolio together, I’ve been struck by how similar the news 30-40 years ago was to now. We’re still seeing stories about medical costs, insurance and reimbursements, not unlike this story from the early 1970s. Hospitals are still complaining about their insurance reimbursements, and insurance companies are still moaning about how much hospitals charge for their services. I found this clip in the Lowell (Mass.) SUN, which apparently didn’t know quite how to play the story — they ran it on the OP-ED page.


BOSTON (UPI) – Hospital costs in Massachusetts are audited to determine Blue Cross reimbursement rates, and the 37 men who do the audits are on the Massachusetts Blue Cross payroll.

The auditing procedure has been allowed since May 18, 1956. Chapter 176A of the General Laws says the state Rate Setting Commission can require that an audit be conducted prior to having Blue Cross reimbursement rates established at hospitals.

The Commission contracts Blue Cross to do the auditing. The auditors answer to the Rate Setting Commission, but are paid by Blue Cross and receive Blue Cross fringe benefits.

Blue Cross pays hospitals either what a given treatment costs the hospitals, or what they charge for that treatment, whichever figure is lower. The hospital’s cost of treatment is generally lower than what it charges, and that is usually the figure paid the hospital by Blue Cross.

The audit determines what the hospital costs are.

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Irish nurses recruited for New England hospitals


BOSTON (UPI) – Faced with a nursing shortage and no relief in sight, New England hospitals are looking for nurses in Ireland, where there is a surplus of trained medical personnel.

“There are so many Irish nurses going abroad to work, they are leaving by the thousands,” said Maria Dolan, 30, a Dublin native now working at New England Baptist Hospital in Boston. “At the moment, the job situation in Ireland is very bad and the job situation around the globe is very good.”

“There are some very attractive offers.”

Maine’s largest hospital, Maine Medical Center in Portland, recently hired 20 registered nurses in Ireland and is making arrangements to get them settled, said hospital vice president Ron Baril.

The hospital recently shut down several beds because of the shortage. Baril said the nursing vacancy rate nationally has doubled since 1985, to about 14 percent of registered nurses.

The Maine hospital has been recruiting around the nation for help, and not long ago began looking overseas.

Dolan said newspapers in Ireland are filled with ads from New York and Boston hospitals. Some offer incentives to nurses like free plane flights or lodging for a month.

The Nurses are allowed into the United States on temporary visas. They can work from one to three years, and after that time they can re-apply if the need still exists.