Becker's Hospital Review

32 CFO / FINANCE UnitedHealth's Optum completes acquisition of Reliant Medical Group for $28M By Morgan Haefner U nitedHealth Group's Optum unit closed its $28 million purchase of Worces- ter, Mass.-based Reliant Medical Group, telegram.com reported. Optum announced its bid for Reliant Medical Group in May 2017. Reliant Medical Group employs roughly 500 physicians and other medical providers. In addition to the deal's price tag, Optum agreed to pay $186 million-plus for facilities and care restructuring. The company also committed to paying $35 million toward physi- cian recruitment and retainment. State documents obtained by telegram.com show Reliant pursued the deal due to slim- ming profit margins. Several factors, like an ag- ing physician workforce, a 200 percent uptick in rent at nearly half of its 27 sites and restruc- turing needs, contributed to the decision. n HCA TriStar, BCBS dispute generates $14M in balance bills By Morgan Haefner A network dispute between Brentwood, Tenn.-based TriStar Health, a subsidiary of Nashville, Tenn.-based HCA Healthcare, and BlueCross BlueShield of Tennessee produced $14 million in patient balance bills, according to an article submitted to the Ten- nessean by Alex Tolbert, founder of consulting group Bernard Health. While HCA TriStar hospitals are not part of BCBST's Network S, the two parties had an agreement under which BCBST Network S mem- bers would access HCA TriStar hospitals' emergency services at in-network rates. However, that agreement ended in January. As a result, HCA reported TriStar racked up 1,700 out-of-network claims totaling $14 million between January and March 22. HCA an- nounced it will soon begin balance billing BCBST members for the out-of-network claims, Mr. Tolbert writes. According to the Tennessean, BCBST said HCA's figures should not be taken at face value, and the insurer is going to review the num- bers. HCA also said it will at first cap the amount it balance bills from emergency room outpatients at $1,500 and ER inpatients at $4,500. Other BCBST members with self-funded plans could be on the hook for more. The sticking point of the dispute is rate negotiations. BCBST has said HCA is using aggressive balance billing practices, while HCA argues BCBST is reimbursing the hospital at too low of rates, according to Mr. Tolbert. n California files antitrust suit against Sutter Health: 5 things to know By Ayla Ellison C alifornia Attorney General Xavier Becerra filed an antitrust lawsuit against Sacramento, Calif.-based Sutter Health, alleging the health system used its market power to control prices, ac- cording to e Sacramento Bee. Here are five things to know about the lawsuit. 1. e attorney general filed the lawsuit against Sutter following a six-year investi- gation. At a news conference March 30, Mr. Becerra said the investigation revealed Sut- ter restricted health insurers from providing consumers with more low-cost health plan options, and the health system set excessively high out-of-network prices. Sutter also al- legedly restricted publication of provider cost information, which impeded transparency. 2. e suit, which is pending in San Francis- co County Superior Court, alleges Sutter uses improper tactics, such as "punitively high" out-of-network charges and gag clauses on prices, according to Kaiser Health News. 3. Sutter's actions "improperly block any and all practical efforts to foster or encour- age price competition between Sutter and any rival healthcare providers or hospital systems," states the attorney general's com- plaint, according to KHN. "Sutter's conduct injured the general economy of Northern California and thus of the state." 4. In a statement to e Sacramento Bee, Sutter said, "healthy competition and choice exists across Northern California" for con- sumers seeking medical care. "Sutter Health is proud to save patients, government pay- ers and health plans hundreds of millions of dollars each year by providing more efficient and integrated care," the statement said. 5. Sutter is also facing a class-action lawsuit filed in 2014 by employers and labor unions. e lawsuit accuses Sutter of abusing its market power to charge inflated prices. n

• Cover