Elliot Jacobson is out as Insurance Commissioner Karen Weldin Stewart’s Chief of Staff. He will apparently remain as a “special adviser” for a little while. His demotion seems to be the result of his June 17 announcement that Blue Cross Blue Shield will stop requiring doctors to obtain permission before performing nuclear stress tests.
The tests — which use a radioactive tracing material and advanced imaging machines to detect artery blockages that can cause heart attacks — are at the center of a Delaware controversy over whether health insurers should second-guess doctors.
David Ramos, a Dover cardiologist, called Blue Cross’ decision to stop denying coverage for nuclear stress tests “promising news.” “Less interference in the practice of medicine I always favor,” Ramos said.
Jacobson said it’s “the responsible thing to do.”
Blue Cross would not comment on proposed changes to its pre-authorization program, though it is expected to announce a set of changes soon. The carrier has been considering changes since March, when it was accused of endangering patients’ health by refusing to pay for diagnostic exams that doctors believed were necessary to properly diagnose and treat patients.
Eliott either stole some thunder away from KWS, who probably wanted to announce this development herself; or she and/or BCBS did not intend to end the pre-authorization program and Jacobson’s announcement put them in a corner. If it is the former, this is a petty reaction on the part of KWS. If it is the latter, it is insidious, and more proof that she is in the pocket of Big Insurance.
UPDATE: The News Journal now has the story, and it reveals another layer to this mess.
Stewart said the decision to replace Jacobson was a “business decision” and had nothing to do with issues regarding outside contractors or the investigation of insurance companies. “I’m not happy with Elliott’s management style,” she said.
But the manner in which word of the shake-up emerged suggests deeper turmoil within Stewart’s office.
A letter announcing the removal of Jacobson and the naming of lawyer Michael Gould, previously a senior adviser, as acting chief of staff, was circulated in Legislative Hall on Thursday, as an attachment to an e-mail from Gould. The attached letter was ostensibly from Stewart but lacked her signature.In an interview, Stewart said she did not write it — nor authorize it.
“I think somebody is going to get a two-week vacation very shortly,” Stewart said. “I’m not a rotten manager. I’m a really good manager. So somebody’s in lots of trouble.”
This is priceless. Stewart is firing, or rather, demoting, Jacobson for getting out in front of her and announcing the BCBS changes before she could, but before she could do that, her new Chief of Staff, Michael Gould, got out in front of her and announced Jacobson’s firing. Doesn’t that mean that Gould must now be demoted?
Or does that mean the IC office, and Karen Weldin Stewart, is incompetent.