Becker's Hospital Review

26 CFO / FINANCE CMS axes a Medicare Advantage star rating measure: 5 things to know By Morgan Haefner C MS is removing a star rating unit for Medicare Advantage plans, accord- ing to its 2019 Rate Announcement and Call Letter. Here are five things to know. 1. Medicare ranks Medicare Advantage plans on a quality scale of one to five stars, and pays bonuses to plans with high ratings. Beginning in 2019, CMS will remove its Beneficiary Access and Performance Prob- lems measure from its star rating calcula- tions. 2. e BAPP measure considers CMS' sanc- tions, civil money penalties and compliance data like notices of noncompliance, warning letters and corrective action plans. 3. When CMS solicited feedback on BAPP in 2018, commenters recommended revis- ing the measure due to "differences in meth- odologies and goals, the subjective nature of audits, and the absence of audit information for each plan each year." Advocates of the measure strongly opposed omitting BAPP. 4. "Based on the feedback, the strong sup- port for a change to the measure specifica- tion, and concerns for providing additional notice and time to prepare for the significant changes, CMS decided to retain the current BAPP measure in the 2018 Star Ratings." However, BAPP will be retired in 2019 and CMS will "introduce a new measure for the display page." 5. CMS received mixed reactions to its deci- sion to axe the BAPP measure from its 2019 star ratings. ose opposed to the decision were beneficiary advocacy groups, who said the removal will "mask plan behaviors that could pose a serious threat to the health and safety of beneficiaries." Insurers, conversely, largely supported the decision. n California hospital looks to boost finances after losing lucrative toxicology revenue By Ayla Ellison L eaders at Sonoma West Medical Center in Sebastopol, Calif., are explor- ing ways to increase revenue after the hospital shut down its lucrative tox- icology program in late February, according to The Press Democrat. SWMC suspended the program after Anthem sent hospital leadership a letter claiming the hospital was involved in a lab testing scheme. In its letter to the hospital, Anthem claimed the scheme resulted in the insurer making $13.5 mil- lion in payments to the hospital. "Sonoma West appears to have conspired with several third parties to fabricate or misrepresent claims for toxicology testing services that were improperly billed to Anthem," the letter stated. Anthem threatened to take legal action against SWMC and its owner, Sebas- topol-based Palm Drive Health Care District, if the funds were not returned immediately. The insurer also said it would deny all claims for urine testing the hospital submitted as of Jan. 22. The alleged lab testing scheme gained national attention in late March when CBS aired a special investigative report. In June 2017, the governing board of SWMC and the Palm Drive Health Care District approved a lab man- agement agreement with Durall Capital Holdings, a Florida-based company owned by Aaron Durall. The agreement reportedly generated more than $31 million over an eight-month period, according to CBS. Now that the agreement with Durrall Capital has been terminated, SWMC is exploring ways to generate new revenue. Dennis Colthurst, president of the board of directors of the Palm Drive Health Care District, told The Press Dem- ocrat he remains optimistic about the hospital's future. "We're treating patients, our emergency room, our surgery department are open," he said. "We're looking at the next steps to increase revenue through extra lines of work." n Bon Secours sees operating income climb 30% in Q2 By Ayla Ellison M arriottsville, Md.-based Bon Secours Health System reported higher revenue and operating income in the second quarter of fiscal year 2018 than in the same period of the year prior. Bon Secours said total operating revenue was up 1.2 percent in the second quarter of fiscal year 2018 compared to the same period of fiscal 2017. After factoring in expenses, Bon Secours ended the second quarter of fiscal year 2018 with operating income of $44.6 million, up from $34.2 million in the same period of the year prior. The system's financial gains were fueled by growth in patient volumes, includ- ing a 4 percent year-over-year increase in outpatient visits, and revenue cycle improvements. Bon Secours ended the second quarter of fiscal year 2018 with a 2.7 percent operating margin, compared to a 2.1 percent operating margin in the second quarter of the year prior. n

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