Since the Covid-19 pandemic started, the apparent good relationship between Spanish hospitality and Booking.com has been blown up. The disagreements started when the OTA decided to allow customers to cancel non-refundable reservations at no cost without checking with hoteliers.
The Madrid Hotel Business Association has now decided to take legal action against Booking.com asking for their practices to be investigated.
They explained the OTA charges its customers up to 40 percent in commissions, which they believe to be “abusive and contrary to competition law”.
The Spanish hotels didn’t seem to have complaints with the platform before the pandemic, as Booking.com accounts for 80 percent of their billing.
However, and after numerous complaints, the Hotel Association is now urging authorities to look into Booking.com’s practices.
Spain is one of the hardest hit countries with a loss of 67 million euros and a drop of 77 percent in tourism.
Hotel owners believe the fact that the platform charges up to 40 percent more than the property’s real price in commissions has a direct negative impact on the tourism establishments, which are already struggling due to the pandemic.
They also claimed there were unethical practices regarding “the control the website has over the guests, as with the booking management and the payment of the service, Booking.com also obtains the control of the client, which has a negative effect on the hotel establishment, which is the one that provides this service”.
Back in April, the Spanish Association of Hotel Directors had already filed a complaint about Booking’s rates and commissions.
However, the travel operator replied to that saying “it is fair that hotels offer at least the same price on Booking.com as on their own website.”
It argued its rates are “fair” due to the promotion it carries out on the hotel’s offer.
In this war, it seems that Google has taken part on the hotel side.
This year, the American multinational has made public its proposal to offer free booking links to hotels.
Google’s goal is to break the duopoly of Booking and Expedia, which account for 50 percent of world tourism.
Express.co.uk has approached Booking.com for comment.
Currently, Booking.com is being investigated by the Italian Government for tax evasion.
They claim the travel company has evaded 153 million euros of value added tax (VAT) in connection with holiday rentals booked through its platform.
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Italian police said they “uncovered a massive tax evasion of more than 150 million euros in unpaid VAT from 2013 to 2019 by a multinational online travel agency based in the Netherlands”.
Booking.com confirmed it has received the audit report “which we intend to discuss in full cooperation with the Italian tax authorities”.
However, the company argues that hotels owners that use the platform are responsible for collecting and paying the VAT they owe in Italy and other European Union countries.
Colonel Ivan Bixio, head of the Genoa police group leading the investigation, told Reuters the sort of evasion they had uncovered “generates huge profits to the beneficiaries, harming public budgets and altering the rules of competition.”
A new study suggests that private investor ownership of dermatology practices has little impact on spending, but does result in a small increase in the number of patients seen per dermatologist, and slightly higher reimbursement per clinician.
The authors reported that — with an average of five quarters postacquisition — there was no statistically significant differential between investor-owned and non–investor-owned practices “in total spending, overall use of dermatology procedures per patient, or specific high-volume and profitable procedures.”
Dr Robert Tyler Braun
Essentially, the study findings were equivocal, reported Robert Tyler Braun, PhD and his colleagues at Weill Cornell Medicine, New York. “The results provide mixed support for both proponents and opponents of private equity acquisitions,” they wrote in the study, which was published in Health Affairs.
But two dermatologists not involved with the study said the analysis has significant limitations, including a lack of pathology data, a lack of Medicare data, and a lack of insight into how advanced practice clinicians, such as nurse practitioners and physician assistants, were used by the private equity (PE)–owned practices. The study was not able to track “incident to billing.”
Leaving out Medicare data is a “huge oversight,” Joseph K. Francis, MD, a Mohs surgeon at the University of Florida, Gainesville, said in an interview. “The study is fundamentally flawed.”
“With all of these limitations, it’s difficult to draw meaningful conclusions,” agreed Clifford Perlis, MD, Mbe, of Keystone Dermatology in King of Prussia, Pa.
Both Francis and Perlis also questioned the influence of one of the study’s primary sponsors, the Physicians Foundation, formed out of the settlement of a class action lawsuit against third-party payers.
In addition, Francis and Perlis said they thought the study did not follow the PE-owned practices for a long enough period of time after acquisition to detect any differences, and that the dataset — looking at practice acquisitions from 2012 to 2017 — was too old to paint a reliable picture of the current state of PE-owned practices. Acquisitions have accelerated since 2017.
In March 2021, Harvard researchers reported in JAMA Health Forum that PE purchases in health care peaked in the first quarter of 2018 and surged to almost as high a level in the fourth quarter of 2020, with 153 deals announced in the second half of the year. Of the 153 acquisitions, 98, or 64%, were for physician practices or other health care services.
Braun said his study focused on 2012-2017 because it was an available data set. And, he defended the snapshot, saying that he and his colleagues had as much as 4 years of postacquisition data for the practices that were purchased in 2013. He acknowledged there were less data on practices purchased from 2014 to 2016.
“It is possible that our results would change with a longer postacquisition period,” Braun said in an interview. But, he said there was no way to predict whether that change “would look better or worse for private equity.”
Modest Price Increases
The authors analyzed data from the Health Care Cost Institute, which aggregates claims for some 50 million individuals insured by Aetna, Humana, and United Healthcare. The data do not include Medicare claims.
They examined dermatologists in practices bought between 2013 and 2016 and compared them to dermatologists who were in practices not owned by private equity. Each dermatologist had to have at least 2 years of data, and the authors compared preacquisition with postacquisition data for those in PE-owned practices.
They identified 64 practices – with 246 dermatologists – bought by private investors. Preacquisition, PE practices were larger than non-PE practices, with 4.2 clinicians (including advanced practitioners) per practice, compared with 1.7 in non–investor-owned practices.
The authors looked at volume and prices for routine office visits (CPT code 99213), biopsies (11101), excisions (11602), destruction of first lesion (cryotherapy; 17000), and Mohs micrographic surgery (17311).
Prices for a routine office visit rose nominally in the first quarter after acquisition (under $ 1), stayed at 0 in the second quarter, decreased in the third quarter, and was 0 again in the fourth quarter. It was not until the fifth quarter post acquisition that prices rose, increasing by 3% ($ 2.26), and then rising 5% ($ 3.20) in the ninth quarter.
Braun said the price increases make sense because practices get “rolled up” into larger platforms, theoretically giving them more negotiating leverage with insurers. And he said the paper’s results “are consistent with physician practice consolidation research — mainly hospitals acquiring practices — that prices increase after acquisition.” He acknowledged that the dermatology paper found “more modest effects,” than other studies.
Francis, however, said the increases are basically “pocket change,” and that they reflect a failed promise from private investors that clinicians in PE-owned practices will be paid more. The small differences in pay may also mean that insurers are likely not acquiescing to the theoretical leverage of larger dermatology entities.
PE-owned dermatologists saw about 5% more patients per quarter initially, rising to 17% more per quarter by eight quarters after purchase, according to the study.
The study reported a significant increase in Mohs surgery and cryotherapy in the first quarter post purchase, and a significant increase in biopsies after eight quarters. But Braun and colleagues concluded that total spending per patient did not change significantly after acquisition. “That says that maybe physicians aren’t changing their behaviors that much,” Braun said in an interview.
Perlis disagreed, noting that practices rarely change quickly. “Anecdotally, most groups that are taken over, nothing changes initially,” while the new owners are getting a feel for the practice.
He also said the paper erred in not addressing quality of and access to care. “Quality and patient satisfaction and access are also other important factors that need to be examined.”
Not Benign Players
Both Perlis and Francis said the study may have been improved by having a dermatologist as a coauthor. Braun countered that he and his colleagues consulted several dermatologists during the course of the study, and that they also conducted 30 interviews with proponents and opponents of PE ownership.
The authors warned of what they viewed as some disturbing trends in PE-owned practices, including what Braun called “stealth” consolidation – investors making small purchases that fall outside of federal regulation, and then amassing them into large entities.
He also commented that it was “alarming” that PE-owned practices were hiring a larger number of advanced practitioners. The authors also expressed concern about leveraged buyouts, in which investors require a practice to carry high debt loads that can eventually drive it into bankruptcy.
“These are not benign players,” said Francis. He noted that it took “an act of Congress to stop surprise billing,” a tactic employed by PE-owned health care entities. “Policy makers should be looking at what’s best for patients, especially Medicare and vulnerable patients.”
Perlis also has qualms about PE-owned practices. “The money to support returns to investors has to come from somewhere and that creates an inherent tension between patient care and optimizing revenue for investors,” he said. “It’s a pretty head-on conflict.”
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
But, in spite of all his success, the 39-year-old still has hard days. “I go through a roller coaster with mental health,” he told HollywoodLife EXCLUSIVELY. “I mean being an actor, that’s already a roller-coaster and then when you add in how busy we are with all the things that we have going on.”
“I would like to say that I practice good mental health habits every day,” he continued, “but in reality I don’t. And I think that’s something I want to make sure that I do more of. Things that really are good for my mental health, like I love cycling. When I do my spin bike it really changes the way I feel for the day.”
“To each their own when it comes to mental health and what works for them, but for me what I’ve learned is exercising is something that really helps my mental health,” Jonathan shared. “And as much as I’d like to say do it every day, I don’t. So I think a great thing for me for Mental Health Awareness Month will be to try and exercise at least once every single day, to try and help keep my mind right.”
Another daily activity that Jonathan uses to boost his mental health is meditation and he revealed that he loves the Calm App. “I love a good guided meditation. Tamara Levitt on Calm, her voice is so soothing, she can calm anyone down,” he enthused.
“If you have never done meditation I would suggest getting the Calm app and starting with the Daily Calm,” he added. “It’s a 10 minute guided meditation with Tamara and it is so good. Her voice is exactly what you want to hear when you’re doing a meditation.”
As fans of Jonathan know he came out in 2017 and announced that he was in a happy relationship with Jaymes, 37. And, although the journey wasn’t easy Jonathan is now reaping the rewards of living his truth.
“Being afraid to come out, to being a closeted gay teen heartthrob for decades, I never thought in a million years, I would be on the cover of the biggest wedding magazine in the world with my fiance. Living loudly and proudly,” he beamed.
And Jonathan has a message for anyone struggling to be true to who they are. “I would say to them, you’re never too much, and you’re always enough. Just you being you, in this moment, is all you need to be.”
Jonathan and Jaymes are planning their upcoming wedding for Spring 2022. In the meantime they’re busy running their LGBTQ+ travel company, OUTbound Travel. And, they can be seen on the cover of The Knot Summer 2021 issue, on stands now.
WASHINGTON — The Justice Department is opening a sweeping investigation into policing practices in Minneapolis after a former officer was convicted in the killing of George Floyd there, Attorney General Merrick Garland announced Wednesday.
The new investigation is known as a “pattern or practice” – examining whether there is a pattern or practice of unconstitutional or unlawful policing – and will be a more sweeping probe of the entire police department and may result in major changes to policing there.
It will examine the use of force by police officers, including force used during protests, and whether the department engages in discriminatory practices. It will also look into the department’s handling of misconduct allegations and its treatment of people with behavioral health issues and will assess the department’s current systems of accountability, Garland said.
It’s unclear whether the years under investigation will begin when Floyd died or before. Garland said a public report would be issued, if the department finds a pattern or practice of unconstitutional policing. The department could also bring a lawsuit against the police department, which in the past have typically ended in settlement agreements or consent decrees to force changes.
The Minneapolis Police Department is also being investigated by the Minnesota Department of Human Rights, which is looking into the department’s policies and practices over the last decade to see if it engaged in systemic discriminatory practices.
Minneapolis Mayor Jacob Frey said city officials “welcome the investigation as an opportunity to continue working toward deep change and accountability in the Minneapolis Police Department.” The city council also issued a statement supporting the investigation, saying its work had been constrained by local laws and that it welcomes “new tools to pursue transformational, structural changes to how the City provides for public safety.”
Floyd, 46, was arrested on suspicion of passing a counterfeit $ 20 bill for a pack of cigarettes at a corner market. He panicked, pleaded that he was claustrophobic and struggled with police when they tried to put him in a squad car. They put him on the ground instead.
The centerpiece of the case was bystander video of Floyd, handcuffed behind his back, gasping repeatedly, “I can’t breathe,” and onlookers yelling at Chauvin to stop as the officer pressed his knee on or close to Floyd’s neck for what authorities say was about 9 1/2 minutes, including several minutes after Floyd’s breathing had stopped and he had no pulse.
Floyd’s death May 25 became a flashpoint in the national conversation about the deaths of Black Americans at the hands of law enforcement and sparked worldwide protests.
At trial, Chauvin’s defense attorney persistently suggested Chauvin’s knee wasn’t on Floyd’s neck for as long as prosecutors argued, suggesting instead it was across Floyd’s back, shoulder blades and arm.
The decision to announce a sweeping Justice Department investigation comes as President Joe Biden has promised his administration would not rest following the jury’s verdict in the case. In a Tuesday evening speech, he said much more needed to be done.
“‘I can’t breathe.’ Those were George Floyd’s last words,” Biden said. “We can’t let those words die with him. We have to keep hearing those words. We must not turn away. We can’t turn away.”
The Justice Department had previously considered opening a pattern or practice investigation into the police department soon after Floyd’s death, but then-Attorney General Bill Barr was hesitant to do so at the time, fearing that it could cause further divisions in law enforcement amid widespread protests and civil unrest, three people familiar with the matter told the AP.
Garland said the challenges being faced “are deeply woven into our history.”
“They did not arise today or last year,” Garland said. “Building trust between community and law enforcement will take time and effort by all of us, but we undertake this task with determination and urgency knowing that change cannot wait.”
Forliti contributed to this report from Minneapolis.