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The standoff over staff at Lutheran Hospital in Fort Wayne, Ind., and executives at parent company Community Health Systems Inc. (CHS) provides a window into how CHS, once the largest for-profit hospital chain in the U.S., has allowed facilities to languish, possibly compromising care and destroying investor value in the process, according to a commentary in Bloomberg Businessweek. CHS Chief Executive Officer Wayne Smith presided over a decade-long acquisition binge that saddled CHS with total debt of almost eight times its earnings and a network of underperforming facilities. The company lost $2 billion in the past six quarters, during which doctors from Key West to Spokane have accused the chain of pinching pennies and regulators have fined it for overcharging Medicare. Says Indiana Republican Representative Jim Banks, who has sided with the Fort Wayne doctors: “It’s buy, squeeze, and repeat.”

Bankruptcy Judge Benjamin Kahn on Sept. 19 approved a motion allowing for the sale of Morehead Hospital’s assets, the Winston-Salem (N.C.) Journal reported on Saturday. The order is supported by the hospital. Excluded assets include cash and cash equivalents that include investments. Morehead filed for chapter 11 protection on July 10 in the Middle District of North Carolina as part of an attempt at financial reorganization. Hospital trustees have been attempting to find a new operator for more than a year. The bankruptcy filing listed assets and liabilities as both being between $10 million and $50 million, along with between 5,001 and 10,000 creditors. Dana Weston, the hospital’s chief executive, said Friday that the debt is about $58 million.

HCR ManorCare Inc.’s landlord, publicly traded real-estate investment trust Quality Care Properties Inc., sued to remove the management of the operator of skilled-nursing and assisted-living facilities and replace them with a court-appointed receiver, the Wall Street Journal reported. QCP’s move follows months of frustration over unpaid rent at HCR ManorCare, even after the REIT made a deal with the skilled-nursing-facility operator on its rent in April. HCR ManorCare manages 292 skilled-nursing and assisted-living facilities. For its part, HCR ManorCare says that it is spending all of its free cash flow in rent to QCP, a spokesman for the company said. Now QCP wants the court to appoint a receiver who will have the power to collect rent from Carlyle Group-owned HCR ManorCare, according to a lawsuit filed in a California court last week.

Pending final review, U.S. Bankruptcy Judge Magdeline D. Coleman said yesterday that she would approve the sales of North Philadelphia Health System’s properties at Eighth Street and Girard Avenue for a combined $10.25 million, Philly.com reported. The bulk of the property, including Girard Medical Center and the associated Goldman Clinic, a methadone clinic, will go to Ironstone Real Estate Partners for $8.5 million. Ironstone intends to maintain the property as a behavioral-health and drug-treatment center as long as it has an agreement with a care provider to operate the facilities. Additional parcels are being sold to Project HOME, which will pay $1.75 million.

Ten years ago, Fumiko Chino was the art director at a television production company in Houston, engaged to be married to a young Ph.D. candidate. But today she's a radiation oncologist at Duke University, studying the effects of financial strain on cancer patients, and a widow, according to an NPR feature yesterday. In 2005, Chino's husband was diagnosed with neuroendocrine carcinoma, an aggressive cancer of endocrine cells that can strike in a variety of places in the body and can be hard to treat. Soon, his medical costs surpassed his insurance policy's $500,000 lifetime limit, but the bills kept coming. Ten years after Ladd's death, Chino is still dealing with the aftereffects. "I still owe the debt," she says. "I stopped answering phone calls from debt collectors." Chino is co-author of a research letter, published yesterday in JAMA Oncology, that shows that some cancer patients, even with insurance, spend about a third of their household income on out-of-pocket health care costs outside of insurance premiums. The JAMA Oncology study shows that on average, cancer patients spend about 11 percent of their income on out-of-pocket health care costs, not including insurance premiums.

Lewisville, Texas-based Adeptus Health will refund up to $250,000 to an undisclosed number of patients as part of an attempt to save face by the nation’s largest operator of freestanding emergency rooms, the Dallas Business Journal reported today. Bankruptcy Judge Stacey G. Jernigan last week approved a request by Adeptus to make refunds to patients who were owed money before the ER operator filed for bankruptcy protection in April. The company sought the court's permission to make the refunds to avoid “bad publicity,” according to court filings. The Adeptus bankruptcy filing in the Northern District of Texas court came amid a sharp decline in the company’s earnings, the departure of top executives and a consumer lawsuit alleging fraud.