Issue link: https://beckershealthcare.uberflip.com/i/1084691
10 CFO / FINANCE BCBS of Mississippi to change policy for care it deems nonemergent By Morgan Haefner F ollowing the footsteps of other Blue plans, Blue Cross & Blue Shield of Mississippi will change how it pays for emergency room services it decides weren't emergent aer care is delivered, according to the Daily Journal. Five things to know: 1. Mississippi providers became aware of the proposed policy in a bulletin issued to in-net- work providers in December. e bulletin said that starting in 2019, "If the office visit level is not in alignment with the diagnosis severity, the payment for the office visit level will be adjusted to align with the diagnosis se- verity," according to the publication. 2. Last year, Anthem Blue Cross Blue Shield debuted a similar policy in Georgia, Indiana, Kentucky, Missouri, New Hampshire and Ohio. 3. Emergency physicians in Georgia sued the health insurer for implementing the policy, arguing that when determining if a visit is an emergency, the prudent layperson standard is the general guideline for state and federal law. 4. Mississippi and national chapters of the American College of Emergency Physicians spoke out against BCBS of Mississippi's pro- posed policy. ey claim the proposed policy will leave hospitals, physicians and patients on the hook for uncovered medical bills. While the Mississippi Insurance Department said it has received physician complaints about the change, no hospitals or physicians have reported inappropriate downcoding by the health insurer. 5. BCBS of Mississippi said the emergency physicians misunderstood its bulletin. "In emergency situations, our members should always seek care at the nearest health- care facility and can trust their care will be covered," Meredith Bailess, BCBS corporate communications director, said in a written statement to the Daily Journal. n Hospital chain delinquent on taxes in 7 states By Ayla Ellison K ansas City, Mo.-based EmpowerHMS owes roughly $1.8 million in real es- tate and property taxes for hospitals it operates across seven states, according to the Arkansas Democrat Gazette. Nine hospitals affiliated with EmpowerHMS are in delinquent tax status. The facilities are spread across Arkansas, Kansas, Okla- homa, Missouri, North Carolina, Tennessee and Florida, according to the report. The tax issues were reported as several hospitals managed by EmpowerHMS have faced financial challenges, including pay- roll problems, in recent months. On Jan. 18, a judge appointed a receiver to op- erate and manage one of EmpowerHMS' hospitals in Oklahoma after a bank moved to foreclose on the facility. EmpowerHMS did not respond to the Arkansas Democrat Gazette's request for comment. n Rural California hospital 'defying gravity' as it changes strategy to survive By Kelly Gooch C ash-strapped Sonoma Valley Hospital faces the same issues as many rural hospitals, including a disproportionate share of Medicaid and Medicare funding and a lower number of privately insured patients. But the California hospital is managing to defy gravity and remain open with some savvy strategizing, the North Bay Business Journal reported. One cost-cutting move was closing the hospital's obstetrics department in October 2018. The hospital also transferred ownership of home care service for free to Larkspur, Calif.-based Hospice by the Bay. And an ad-hoc task force is studying a third potential cost-saving measure: whether to close its skilled nursing facility. Outside of cost-cutting moves, the Sonoma Valley Hospital Foundation announced in November that it would undertake a $20 million fundraising campaign to build an outpatient diagnostic center for the hospital. On Jan. 14, Sonoma Valley Hospital CEO Kelly Mather told the Sonoma City Council that the foundation raised $15.5 million, the Journal report- ed. The hospital projects the diagnostic center will increase net revenue by about $1.5 million annually partially because physicians won't have to refer patients to other locations for advanced diagnostic care. In other efforts, Sonoma Valley Hospital last year finalized an affiliation with San Francisco-based UCSF Health to create an integrated healthcare net- work for Sonoma Valley residents. n