Carefirst

Maryland's insurance commissioner ordered a hearing yesterday to determine whether the former chief executive of CareFirst BlueCross BlueShield should be allowed to receive a $17.65 million retirement and severance package from the health insurer. William L. Jews left his post a year ago in what CareFirst's board chairman, Michael R. Merson, described as "a mutual decision." Merson said at the time that Jews would receive "substantial" payments after his departure, but the amount hadn't been made public until the insurance commissioner specified it in his order yesterday.

Imagine an elderly patient arriving at a hospital emergency room with a stroke, says John Erickson, chairman and chief executive of Erickson Retirement Communities. A "clot-buster" drug, administered in the first few hours, can improve the patient's chances. Definitely. Unless that patient has been taking blood thinners, has had very recent surgery or has a history of brain bleeding - in which case the drug could cause life-threatening hemorrhaging. How is the doctor to know - quickly - the patient's medication schedule, recent surgical treatments and medical history?

Calvin Pierson, who steered the Maryland Hospital Association through an often-tumultuous decade and a half, announced yesterday that he would retire next July. He is just the second president in the association's history of nearly 40 years; his 16-year term followed the 22-year tenure of founding president Dick Davidson, who left to become president of the American Hospital Association. "He leads in a quiet, thoughtful way," said Albert "Skip" Counselman, vice chairman of the MHA's board, who will head the committee to search for Pierson's replacement.

Looking for a leader who could help it navigate an increasingly technology-centered health care world, CareFirst BlueCross BlueShield yesterday tapped the head of an electronic claims-processing firm to be its new president and chief executive officer. Chester "Chet" Burrell, 60, is currently chairman and CEO of Indianapolis-based RealMed Corp., which provides claims services for insurers - including CareFirst - and doctors. He previously founded and led Novalis Corp., a health technology and consulting firm.

Dr. Crystal L. Clark has been named chief medical officer and vice president of medical affairs for Bon Secours Baltimore Health System, where she is the primary liaison between administration and the medical staff. Before joining Bon Secours, Clark was a senior assistant vice president at the New York City Health and Hospitals Corporation, the city's public hospital system. Dr. Dung Le has joined the faculty of the Johns Hopkins Kimmel Cancer Center as an instructor in oncology. Dr. Maria Boradatcheva has joined the internal medicine practice of The Bose Medical Group at Mercy Medical Center's Burk Building.

State insurance regulators announced yesterday a $125,000 fine against CareFirst BlueCross BlueShield, the state's largest health insurer, for not following state laws and regulations in its denial of claims. While some cases involved failure to pay for legitimate claims, the largest number of errors found were in claims that were denied properly, but not within the 30-day limit set by state law. "The timeliness is the thing that gives us concern," said P. Todd Cioni, associate insurance commissioner for compliance and enforcement.

A computer glitch at the state's largest health insurer recently blew Sharon Nobles' life into disarray, leaving her family with overdue medical bills and, at times, vital prescriptions denied at the pharmacy. And she might not be the only one affected. CareFirst BlueCross BlueShield officials confirm that even as information technology specialists are working to resolve internal system problems, thousands of its members who participate in consumer-directed health plans (CDHP) could be affected, too. "I've spent months trying to fix this problem, but I've gotten nowhere," said Nobles, the mother of twin 11-year-old boys who were diagnosed three years ago with Asperger's syndrome, a neurobiological disorder that can produce autistic-like behavior.

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To address the continuing shortage of nurses in the Baltimore-Washington region, CareFirst BlueCross BlueShield has launched a new grant program intended to increase faculty at area nursing schools. Officials at the Owings Mills-based health insurer say nursing schools are turning away tens of thousands of applicants because they don't have enough teachers. And the problem is expected to get worse as older faculty members retire in a few years, because there are few graduate-trained nurses to replace them, according to a recent study commissioned by CareFirst.