Becker's Hospital Review

10 CFO / FINANCE California hospital reverses $15,666 trauma fee for baby who napped, drank formula in ER By Morgan Haefner Z uckerberg San Francisco General Hos- pital agreed to waive a $15,666 trauma response fee it charged a vacationing South Korean family aer their son, who had experienced a fall, received no critical care but slept and drank formula in the hospital's emergency room, according to Vox. Jang Yeo-im called an ambulance aer her son, Park Jeong-whan, fell 3 feet off a hotel bed. Despite little outward injury, her son was inconsolable and she feared he might have internal injuries. During the three- hour and 22-minute visit at Zuckerberg San Francisco General Hospital, a triage nurse evaluated Jang Yeo-im's son and sent him to an emergency department resuscitation bay. Aside from minor bruising to his nose and forehead, the baby did not show any signs of major injury and was not given any critical care. During his time at the hospital, he took a quick nap, drank formula and was trans- ferred to an exam room for observation be- fore being released. When the family, which had travel insur- ance covering $5,000 of treatment, received the final $18,836 bill two years later, most of the charge reflected a $15,666 trauma re- sponse fee. Patients face trauma fees when they present to the emergency room with potentially serious injuries and the trauma center assembles a team of physicians to respond. Trauma fees are billed in addition to ER physician, procedure, equipment and facility fees. Vox, in partnership with Kaiser Health News, reported the story June 28. On July 20, aer the hospital conducted a clinical review of the case, Zuckerberg San Francisco Gener- al reversed the charge. A patient experience manager issued "a sincere apology for any distress the family experienced over this bill." e hospital manager told Vox/KHN the case "offered us an opportunity to review our system and consider changes." n Former CEO of Sentara-owned insurer to hospitals: 'Don't think you can duplicate' Kaiser's health plan By Morgan Haefner M ichael Dudley, former senior vice president of Norfolk, Va.-based Sentara Healthcare and CEO of its Optima Health plan, served as an executive with Sentara for 21 years. He previously spent 19 years at Oakland, Calif.-based Kaiser Permanente, and across near- ly four decades has "observed multiple cycles of providers rushing into the health plan business followed by the rapid exit of providers who fail in managing risk," he wrote in a blog post on Gist Healthcare. Based on his experience, Mr. Dudley mapped out three "Be's," as he calls them, that every hospital thinking about launching a health plan should consider: "Be cautious, but not cowardly," "Be courageous, but not careless" and "Be cognizant, but not cocky." Under the "Be cautious, but not cowardly" advice, Mr. Dud- ley explained how operating losses will begin to mount once the first member is enrolled in a new health plan. "Yes, every startup health plan will experience losses for a period of time," he wrote. "Detailed preparation and thoughtful execution will not eliminate losses in the early years, but they will hasten the march to profitability." Mr. Dudley also said while hospitals should be cognizant and learn from history — such as successful hospital-spon- sored health plans like Kaiser Permanente — they shouldn't be "cocky." "Don't think you can duplicate Kaiser," he wrote. There are lessons to be learned from successful and unsuccessful provider-sponsored health plans, he said. "The tolerance and patience for early losses; the balance between integration and separation of the health plan and the providers; and the clarity of purpose and mission. Hav- ing a health plan to fill hospital beds is not a sustainable mission," Mr. Dudley said. n "Having a health plan to fill hospital beds is not a sustainable mission." — Michael Dudley, former CEO of Optima Health and senior vice president of Sentara Healthcare

• Cover