Colorado Hosts Telemedicine Experiment.(Newsline Closer Look) - Health Data Management

Byline: Joseph Goedert

Colorado is the testing ground for an ambitious program by insurer UnitedHealth Group to develop a national telemedicine network connecting patients in underserved communities with specialists.

Minneapolis-based UnitedHealth recently launched the program with networking vendor Cisco Systems Inc., San Jose, Calif. Cisco brings the video-conferencing technology, and the insurer brings a commitment of 'tens of millions of dollars' and a national network of providers from which to recruit participants.

In Colorado, 12-hospital Centura Health is the partner as the program gets off the ground. The provider and payer had a mutual interest in telehealth; they already jointly conducted a pilot program to use video conferencing to enable home health clinicians to meet regularly with patients. 'It morphed into something much bigger with a new strategic plan to extend our rural health services,' says Gary Campbell, president and CEO at Centura Health. 'So, we took it out of the context of home care and broadened it.'

The Colorado Rural Health Center, which serves dual roles as the State Office of Rural Health and the State Rural Health Association, also joined the effort. Centura Health is getting significant interest from clinician members of the association to participate in the pilot, Campbell says.

Project leaders are recruiting four rural clinics linked to two or three Centura sites - hospitals or specialty group practices - to participate in the pilot that will begin in early 2010. The goal is to demonstrate that an integrated delivery system can extend its services into rural areas via telemedicine and deliver the same quality of care as if the care was provided face-to-face, says Mark Gennerman, vice president of connective care initiatives at UnitedHealthcare of Colorado. The division of UnitedHealth Group serves 760,000 members in the state. 'We want to augment the services of the clinics,' he adds. 'We want to know what specialties they have the greatest need for.'

Stepping Stone

UnitedHealthcare of Colorado views the project as a proof-of-concept pilot that could expand beyond rural areas to serve other underserved regions, says Beth Soberg, CEO. 'We want to eventually see this type of technology delivered to the point where patients can see two or three physicians at once, and also to bring in urban areas and eventually the home.'

UnitedHealth Group's national long-range goal envisions small telehealth programs in retail stores, pharmacies, drugstore clinics such as RediClinic and Minute Clinic, and workplaces. A trained medical attendant would present the patient to a remote physician and operate the telemedicine and diagnostic equipment.

Working with Project HOPE, UnitedHealth Group also will test in New Mexico the use of mobile clinics to expand services.

In the initial effort in Colorado, UnitedHealthcare will pay for the technology. Centura Health physicians will get reimbursed from UnitedHealthcare - and other insurers that may join the program - as if a telehealth session was an in-office visit, Campbell says. He expects Medicare and Medicaid to participate, and Cigna Healthcare has expressed interest.

UnitedHealthcare to Launch Connected Care Telehealth Program in Rural Colorado. - Computer Technology Journal

UnitedHealthcare, a UnitedHealth Group (NYSE:UNH) company, announced it will launch the Connected Care program in Colorado, giving patients in certain rural locations expanded access to physicians and specialists using advanced telehealth technology. The Colorado program is among the first in UnitedHealthcare's work with Cisco (NYSE: CSCO) and others to build a national telehealth network.

The new 'Connected Care' program combines audio and video technology and health resources to greatly expand physicians' reach into rural, urban and other underserved areas.

UnitedHealthcare is partnering with the State of Colorado and Centura Health, with assistance from the Colorado Rural Health Center, to implement the innovative program that leverages advanced technology to give residents access to physicians and medical specialists when in-person visits are not possible.

'This is just another example of where Colorado is leading the nation to a healthier future,' said Gov. Bill Ritter. 'Through innovative technology and impressive collaboration we're solving critical health care challenges and making care affordable and accessible in all parts of Colorado. We're pleased to have it happening in our state and congratulate the partners on the launch of this important project.'

Connected Care sites will be built in several Centura Health facilities as well as federally qualified community health centers in Colorado. The sites will feature sophisticated audio, video and health care technologies that will connect patients with medical specialists located hundreds of miles away, enabling for coordinated care with primary care physicians located in the rural communities. Connected Care uses Cisco's high-definition video conferencing and other collaborative network technologies to create an experience remarkably similar to having the doctor in the same room with the patient.

UnitedHealthcare is working with Centura Health, the Colorado Rural Health Center and the Colorado Community Health Network to identify communities and sites as initial pilot locations for the telehealth clinics. Possible locations include rural health clinics or federally qualified community health centers. The Connected Care sites, which will be installed starting during the first quarter of 2010, are expected to make available nearly 4,800 specialist visits per year in those communities.

The Colorado program initially will target specialties in rural areas that are either not currently available at a local level or only available on a part-time basis. These are likely to include Cardiology, Dermatology, Pulmonology, Diabetes Management and ENT, among others.

'Connected Care helps eliminate distance as an obstacle to accessing needed health care and provides underserved populations with a more convenient way to receive quality care,' said Beth Soberg, CEO, UnitedHealthcare of Colorado. 'We are excited to bring the 'house call of the 21st century' to Colorado and to expand upon the state's current health care infrastructure through the use of this innovative technology.'

UnitedHealthcare has a history of supporting Colorado health care programs. The company has this decade provided $7.5 million in grants to support rural health programs statewide, including for health information technology, facility improvements and wellness programs.

'Connected Care provides a real-time solution in rural Colorado, maximizing technology that bridges the distance to clinical knowledge, specialized expertise and quality health services,' said Gary Campbell, president and CEO of Centura Health. 'We believe Connected Care will enhance the rural health infrastructure and unlock new possibilities for how our physicians and medical staff interact with and touch our patients.'

For instance, Connected Care allows patients to simultaneously have group video consultations with multiple physicians who are in different locations. This will eliminate the need for follow-up referral appointments and allow for more collaborative diagnostic exams, likely reducing time and expense for both physicians and patients.

'The goal of this program is to augment the communities' existing health care systems and provide more convenient access to people who need health care services,' said Lou Ann Wilroy, executive director of the Colorado Rural Health Center, a nonprofit that functions as the State Office of Rural Health. 'For many people in rural areas, seeing a specialist means traveling hundreds of miles, which is especially challenging for the elderly and critically ill. Connected Care will help alleviate that problem.'

More details on the Connected Care program, and its collaboration in Colorado, can be found at www.ConnectedCareAmerica.com. About Centura Health Colorado's largest health care provider, the Centura Health family includes 12 hospitals, seven senior living communities, medical clinics, Flight For Life[R] and home care and hospice services. A nonprofit, faith-based organization, Centura Health is a joint venture organization that was formed in 1996 by Catholic Health Initiatives Colorado and Adventist Health System. Centura Health provides care and comfort to more than half a million people each year and is one of Colorado's largest private employers with nearly 13,000 associates. For more information on Centura Health, visit www.centura.org.

Centura Health hospitals are: Avista Adventist Hospital in Louisville; Littleton Adventist Hospital in Littleton; Parker Adventist Hospital in Parker; Porter Adventist Hospital in Denver; Penrose Hospital in Colorado Springs; St. Anthony Central Hospital in Denver; St. Anthony North Hospital in Westminster; St. Anthony Summit Medical Center in Frisco; St. Francis Health Center in Colorado Springs; St. Francis Medical Center in Colorado Springs; St. Mary-Corwin Medical Center in Pueblo; and St. Thomas More Hospital in Canon City. About the Colorado Rural Health Center The Colorado Rural Health Center (CRHC) was established in 1991 as Colorado's State Office of Rural Health. As a 501[c](3) nonprofit corporation, CRHC's serves dual roles as the State Office of Rural Health with the mission of assisting rural communities in addressing healthcare issues; and as the State Rural Health Association, advocating for policy change to ensure that rural Coloradans have access to comprehensive, affordable healthcare services of the highest quality. The Colorado Rural Health Center has a diverse and inclusive statewide constituency of over 3,500 people and organizations. CRHC collaborates with a variety of partner organizations such as public and private sector corporations, government agencies, foundations, hospitals, and other health facilities. For more information visit www.coruralhealth.org, call 303-832-7493, or call toll free 800-851-6782 from rural Colorado. About UnitedHealthcare UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of more than 25 million individual consumers, contracting directly with approximately 590,000 physicians and care professionals and more than 4,900 hospitals to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE:UNH), a diversified Fortune 50 health and well-being company.

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Keywords: Technology, Networks, Health, Hospitals, Public Policy and Government, Healthcare Reform, Other Policy I, Data Management, Information Technologies, Network Technologies, Networks, Technology, UnitedHealthcare.

Getting to know all about you. - Private Duty Homecare

Getting to know all about you

Benefits advisor develops rapport with payers

Getting proper authorization for insurance benefits during the referral stage can deflect bad debt and increase client satisfaction. One home health agency in Denver, which handles both Medicare and commercial accounts, has created a position -- health benefits advisor (HBA) -- just to verify benefits and develop a rapport with the insurance companies.

'The HBAs have built strong relationships with our payers,' says John Kettler, systems analyst for Centura Home Health in Denver. 'They know each other well.'

Lynn Goodman, an HBA with Centura, verifies benefits for about 200 patients a week. Centura Health System is the result of a merger between St. AnthonyEs Hospital system and Portercare Hospitals. Goodman verifies benefits for the home care coordinators at all the St. Anthony Hospitals and Portercare hospitals, as well as the benefits for Centura Home Health patients.

A large percent of Centura business has been on the Medicare side, but the commercial side is growing, says Kettler. 'We do mostly high-tech services on the private duty side.'

.sup.How the HBA operates

When a patient referral comes into the intake department, the department forwards the information to the HBA.

Using an insurance benefit certification authorization sheet that guides her, Goodman contacts the insurance company and verifies the benefits and effective dates of care. In most cases, she gets authorization for one visit. The patient is then given to CenturaEs case managers to get authorization for the rest of the visits. The agency has separate case managers for capitated accounts and fee-for-service accounts.

Most of the insurance companies only cover skilled care -- mainly care provided by physical therapists, occupational therapists, speech therapists, or RNs, Goodman says. 'Ninety-nine percent of commercial companies do not cover home health aides.' (For more information on insurance coverage, see p. 118.)

If Centura doesnEt have a contract with a certain insurance company, Goodman often finds herself in the position of negotiating rates.

'TheyEll say, eCan you negotiate rates?E and IEll say, eYes, I can.E Then theyEll ask our retail price.'

Goodman has the license to go down a certain percentage from the retail price, but unless the company names a figure, sheEll negotiate the retail price down bit by bit. 'They might tell me, eThis is what our contracts pay. Can you meet that price?E And usually I do unless itEs really low. Then I say, eNo, I need permission for that.E'

Here are some of the advantages of creating an HBA position, says Goodman and Kettler:

o You reduce bad debt.

'We rarely have to rebill a second insurance company because of incorrect insurance information,' says Kettler. 'The HBA not only limits headaches; [the position] also pays for itself many times over by reducing bad debt.'

o You have a designated contact person for the companies to call.

Centura didnEt have a contract with a certain insurance company, Goodman says. But after negotiating prices with the company and establishing a relationship, the company decided to use Centura. 'They know they can call me if they have a question or complaint. They like our services, so they feel comfortable using us and they know who to go to.'

o Your HBA becomes familiar with the requirements of the insurance companies.

HBAs begin to learn what they can and canEt do with each insurance company -- and when they have to give an absolute 'no' because the rates are just too low, she says.

o The position lessens the burden on other staff.

'Our nurses are so busy -- they donEt have the time to develop a rapport with the insurance companies. And the hospital home care coordinators donEt either.'

To aid communication with insurance companies, Goodman has created a database with information about each company she has contacted. This information includes the agencyEs phone number, address, what benefits the company offers in general, and the name of the contact person.

'The database has helped, especially with obscure commercial insurance companies,' she says. 'I was given five different phone numbers for one company. It will save a lot of time now to know who to call there in the future.'

Goodman also makes sure she documents every piece of information she receives. 'Our home care software system has a page where we can write notes. On this page, I write whatever IEm finding on the insurance side for each patient.'

Hospital lays off 14 transcriptionists. - The Pueblo Chieftain (Pueblo, Colorado)

Byline: James Amos

Jun. 22--St. Mary-Corwin Medical Center has laid off all its 14 transcriptionists as part of a move by its management company, Centura Health, to cut costs.

Centura outsourced the jobs of 90 to 95 transcriptionists across the company's system of 12 hospitals in Colorado. The workers were informed of the change last week.

In Colorado Springs, 18 transcriptionists were laid off from Penrose Hospital and St. Francis Medical Center hospitals.

Medical transcriptionists listen to dictated recordings made by doctors and other health-care professionals and type that information in medical reports and other records and correspondence. They use foot-pedal recorders to pause the recording and must know medical and anatomical terms in order to understand what the doctor was saying.

Outsourcing the transcriptionist jobs is expected to save Centura Health about $1 million a year in labor costs -- as well as the additional cost of updating computers and software to link transcriptionists to Centura's upcoming electronic medical records system, according to Centura Health spokeswoman Carrie Kalmanowitz.

The transcriptionists will be able to apply for jobs with the new company that will be providing the service, MedQuist, which is based in New Jersey.

Kalmanowitz said Centura chose MedQuist because it agreed to rehire any Centura transcriptionists who apply, set their pay 'comparable' to what the worker earned before and take their tenure into account when setting vacation and retirement benefits.

Centura still is negotiating the details of that agreement with MedQuist, Kalmanowitz said, 'but 'comparable' is what I can tell you.'

'They weren't the cheapest option,' she said of MedQuist, 'but they were willing to work with us as far as our associates.'

MedQuist already has more advanced computer equipment and software to handle transcriptions and electronic medical records, she said. So it made sense for Centura to hire the company instead of spending a substantial amount of money on that technology itself.

'It comes down to us to spend that money on the (technology), or do we spend the money on patient care?' Kalmanowitz said.

According to MedQuist's Web site, the company hires transcriptionists to work from home, with a minimum of one year of experience. The transcriptionists are paid by how much they produce, counted in lines of 65 characters. The company provides home training and the equipment needed.

The St. Mary-Corwin transcriptionists worked at the hospital.

Pueblo's other hospital, Parkview Medical Center, has 18 transcriptionists and five radiology transcriptionists on staff, according to spokeswoman Michelle Peulen. She said Parkview has no plans right now to outsource those positions.

To see more of The Pueblo Chieftain, or to subscribe to the newspaper, go to http://www.chieftain.com.

Copyright (c) 2007, The Pueblo Chieftain, Colo.

Distributed by McClatchy-Tribune Information Services.

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Colorado Hospitals Begin Offering Discounts for Uninsured Patients. - Knight Ridder/Tribune Business News

By Marsha Austin, The Denver Post Knight Ridder/Tribune Business News

Feb. 29--After a year of intense pressure from civil rights advocates, Colorado hospitals have started discounting what they charge uninsured patients for care.

Still, many patients are slipping through the cracks, paying thousands of dollars more than those covered by government or private health programs and battling collection agencies over unpaid bills.

Widespread financial relief may have to wait until hospitals hash out complex legal questions with regulators in Washington, hospital officials say.

Health and Human Services Secretary Tommy Thompson said Feb. 19 that hospitals face no federal penalties for discounting the cost of care for the uninsured. However, executives at Colorado's largest hospital systems said they have no plans to deepen current discounts or extend relief to more of the middle-income uninsured.

'To us it's a confirmation of what we're already doing,' said Jay Picerno, chief executive officer of Centura Health, Colorado's largest hospital system.

On Jan. 1, Centura started giving discounts to uninsured patients with incomes of up to 400 percent of the federal poverty level, or $73,600 for a family of four. Centura also stopped placing liens on patients' homes or garnisheeing wages to collect on debts. HCA-owned HealthOne implemented a similar program last October.

The discount plans don't go far enough, however, said K.B. Forbes, executive director of Los Angeles- based advocacy group Consejo de Latinos Unidos.

Forbes has pressured hospitals in several markets nationwide, including Denver, to give uninsured patients the same discounts given to managed-care plans.

Uninsured patients are charged on average four to five times what hospitals charge health plans and up to 10 times what the federal government pays for the same care, statistics show. That's because hospitals charge those paying out of their pockets the full retail rate, a price that even hospital executives say is not a true reflection of what medical procedures actually cost.

California-based Tenet Healthcare has tentatively agreed to charge all uninsured patients the prices it charges health plans.

But Colorado hospital executives said Thompson's directive did not sweep away all regulatory hurdles to a universal discount plan.

Picerno said Centura fears being sued under federal laws that prohibit hospitals from offering financial incentives to lure patients.

And the federal government's Medicare payments to hospitals are based on their full retail charges. Picerno said two attorneys told him that because of that rule, discounting uninsured patients' bills would drastically reduce the amount of Medicare money Centura would get.

'We're stuck on that legal opinion,' he said.

HHS spokesman Bill Pierce said hospitals can discount care without fear of fines, lawsuits or financial penalties.

'We could not be more clear,' Pierce said. 'Hospitals can give discounts to the uninsured. -- If the hospitals are unable to understand our guidance, they should call.'

Scott Ferguson, a retired artist too young to qualify for Medicare, found out how high a bill can be without a discount after he had a heart attack last December.

Ferguson, 51, was admitted to the hospital with what was thought to be severe pneumonia. A six-day stay at Centura's St. Anthony Central Hospital revealed major heart problems. His care cost $66,900.

Ferguson had dropped his Blue Cross Blue Shield insurance plan the month before because the rates shot up too high, he said.

Ferguson has paid Centura $6,700 and plans to pay another $1,300 -- a total of $8,000, which is more than Medicare would be billed for the same care, according to federal reimbursement guides.

Centura's Picerno said that if Ferguson's annual income falls below $35,920, he will qualify for a discount under Centura's new charity care discount plan, and his bill would be reduced to $36,839. Ferguson is fighting to have his bill discounted.

Ferguson was one of more than 100 Denver-area residents who responded to an advertisement Forbes ran on a Spanish-language radio station recently.

The ad featured a man who said he had paid too much at HealthOne's Medical Center of Aurora.

Thirty-two patients met with Forbes last week to learn how to negotiate price breaks with the hospitals and to tell him about their experiences. Most were Hispanic.

Patients' bills ranged from $1,050 for a visit to the emergency room with a high fever to $55,000 for a broken ankle. In all, their bills total more than $700,000.

Almost everyone had entered through the emergency room. Some spent a few hours there. Others were admitted overnight.

All but two of the patients said they were not offered financial counseling or told about discounts.

'They don't talk about that,' said Dora Velasquez, who owes the Medical Center of Aurora $4,500.

The mother of two went to the emergency room because she was vomiting and dehydrated from the flu on Oct. 3, three days after HealthOne implemented its discount plan for the uninsured.

Her story was echoed by Humberto Patron, who had his appendix removed at Aurora Medical Center. He now owes $22,329 and claims health workers 'never, never told me about discounts.'

HealthOne executives said they work very hard to extend discounts and can't explain why patients aren't getting help.

'We're bending over backwards to help,' HealthOne spokeswoman Linda Kanamine said. 'In many of these cases there is a lack of communication. If we don't hear from them, what kind of business in the world says, 'Oh, OK, you don't have to pay?' '

To see more of The Denver Post, or to subscribe to the newspaper, go to http://www.denverpost.com

(c) 2004, The Denver Post. Distributed by Knight Ridder/Tribune Business News.

Operator to Close, Sell 12-Story Retirement Center in Colorado Springs, Colo. - Knight Ridder/Tribune Business News

By Rich Laden, The Gazette, Colorado Springs, Colo. Knight Ridder/Tribune Business News

Sep. 26--Medalion West, a 12-story retirement center on downtown Colorado Springs' eastern edge that's home to 106 senior citizens, is being closed and sold by operator Centura Health and will be turned into apartments or condominiums.

The deal is a testament to the increasing demand for downtown housing.

But it also caught Medalion West residents off guard, said Karen Hoskins, vice president of senior services for Centura Health. The closing is planned for Jan. 31.

The Englewood-based Centura says it's committed to relocating residents and will work with them and their families during the next few months.

If space is available, some residents might move to Medalion East, a Centura-owned retirement home at Union Boulevard and Bijou Street in the Springs. Other alternatives are Centura facilities in Denver or Pueblo, as well as other non-Centura centers in the Springs or elsewhere.

Medalion West, near the southeast corner of Wahsatch Avenue and Kiowa Street, is being purchased by Belvedere Enterprises LLC, a company formed solely to acquire and remodel the property.

David Crane, Centura's executive vice president, said the closing of Medalion West was a financial decision. The 39-year-old building needs major upgrades and Centura lacks the capital to invest. The building has no central air conditioning system and needs improvements to its windows, elevators, kitchen, apartments and roof.

'I'm sure on the eve of this decision, they (residents) may disagree,' Crane said. 'But it's just not a facility that we think we can be proud of on a going-forward basis.'

Centura Health operates nine other senior-living facilitates along the Front Range, none of which is affected by the Medalion West decision. Money from the sale of the building will be pumped back into other Centura senior centers, Crane said.

Of the 106 residents, about three-fourths live independently and the rest receive assistance. The building is 87 percent occupied.

Les Gruen, a longtime downtown booster and owner of Urban Strategies, a local real estate consulting and development firm, is managing partner of Belvedere Enterprises.

Belvedere has contracted to buy the building for an undisclosed price, he said. He declined to reveal the date when the deal is scheduled to be completed, but said the goal is to market the property by the end of 2002.

What type of housing it will contain is unknown. Gruen said Belvedere hasn't decided whether the building will be converted to condominiums or apartments.

The next several months will be spent conceiving designs and plans for the 93,000-square-foot building, Gruen said.

Despite an economic slowdown, Gruen said Belvedere is 'firmly committed' to the project. Downtown backers long have identified the need for area housing, and Belvedere thinks the market will be there. The building is less than a 10-minute walk from downtown.

'People are looking for ways they can enhance their quality of life and getting out of their car, to be able to walk where they want to go, is a tremendous asset, and certainly will favor this building as downtown housing,' Gruen said.

To see more of The Gazette, or to subscribe to the newspaper, go to http://www.gazette.com

PORTERCARE LOSES INVESTMENT RATING STANDARD AND POOR'S CITES ONGOING LOSSES IN DOWNGRADING RATING TO A DOUBLE-B MINUS.(Business) - Rocky Mountain News (Denver, CO)

Byline: Michele Conklin News Staff Writer

PorterCare Adventist Health System, owner of three hospitals in the metro area, has lost its investment grade rating due to its involvement in financially struggling Centura Health.

Centura, the state's largest hospital system, is a joint management company formed in 1995 between PorterCare and the Sisters of Charity Health Services, now part of Catholic Health Initiatives. Centura manages PorterCare's Porter, Littleton and Avista hospitals.

After losing $8.2 million in the fiscal year ended June 30, Centura has lost $18 million in the first eight months of the current year. In addition, one-time losses from managed-care contracts, uncollectible accounts and a loan guarantee to Precedent Health Center could overshadow that amount, according to a report issued Monday by Standard & Poor's.

``It's going to be a pretty bad year,'' said Martin Arrick, a director in the New York office of Standard & Poor's. ``They have all this stuff happening at one time and they're going to take a huge hit this year. How much damage to the balance sheet is short term vs. long term is not clear. What is clear is they're having a lot of losses.''

The rating agency downgraded PorterCare from a triple-B rating to a double-B minus, a non-investment grade rating. It also has the organization on Credit Watch with negative implications, which means it could further lower the rating in coming months.

Catholic Health Initiatives, a national organization that is far less dependent on the Centura joint venture, has maintained its double-A rating.

Centura officials admit the organization is struggling but say efforts are under way to turn the situation around. Centura executives expect to have a plan in place by next month. They are looking at everything that will increase revenues and reduce costs, said Chief Executive Joe Swedish.

``A lot is just basic blocking and tackling,'' Swedish said. ``We cannot point to one issue over another. It's a combination of issues. All of them together created an operational performance that needs to be corrected and it will be corrected.''

Some of the steps that may be taken, according to a financial disclosure made to bondholders on April 28, include:

* Reducing the number of managed-care contracts that put Centura at financial risk when demand for hospital services increases.

* Staff reductions at Penrose-St. Francis Hospitals in Colorado Springs and St. Mary-Corwin Medical Center in Pueblo. Several hundred positions have been eliminated, primarily through attrition, Swedish said. No patient care positions were eliminated.

* Restructuring or closing the Centura Senior Life Center in Denver within six months. Closing the facility, which includes long-term care and nursing home units, is a remote option, Swedish said. It is more likely that the services will be restructured.

Centura's chief competitor, Columbia / HealthOne, anticipates much better news. That system, which owns five metro-area hospitals, expects to report a profit for 1998 after reporting a $46 million loss the year before.