Becker's Hospital Review

15 CFO / FINANCE Pennsylvania attorney general takes legal action against UPMC over patient access By Ayla Ellison T he Pennsylvania Attorney General's office filed a pe- tition against UPMC, arguing the Pittsburgh-based health system is not in compliance with the state's public charity law, according to the Pittsburgh Post-Gazette. Five things to know: 1. e petition seeks to modify a consent decree between UPMC and Pittsburgh-based Highmark that is set to expire June 30. Starting July 1, roughly 175,000 Highmark Medicare Advantage plan members will lose in-network access to 11 UPMC hospitals and most UPMC physicians. 2. At a press conference Feb. 7, Pennsylvania Attorney Gen- eral Josh Shapiro said he requested "common sense" changes to the consent decree, which Highmark accepted. However, UPMC refused to make the changes. 3. Mr. Shapiro claims UPMC has violated state law by re- stricting access to its network of hospitals and physicians. He said a legal review by his office revealed UPMC violat- ed its charitable obligations by not negotiating with self-in- sured employers and denying access to certain patients who are covered by a competing health plan, according to the Pittsburgh Business Times. "We have concluded that UPMC is not fulfilling its obliga- tion as a public charity," Mr. Shapiro said at the news con- ference, according to the Pittsburgh Business Times. "I can't sit by and see seniors and children and workers suffer be- cause of corporate greed. UPMC is simply taking more than its fair share." 4. At the press conference, Mr. Shapiro said modifications must be made to the consent decree "to keep UPMC from inflicting harm on the public," according to the Pittsburgh Post-Gazette. His petition is seeking changes that require UPMC to accept binding arbitration if an impasse is reached in contract negotiations with an insurer. e modified con- sent decree would protect patients from "excessive and un- reasonable billing practices." 5. In a statement to the Pittsburgh Business Times, UPMC said businesses and patients have had plenty of time to pre- pare for its split with Highmark since the organizations en- tered into the consent decree five years ago. "During that period, the region's insurance marketplace transformed from one of the nation's most highly con- centrated and least competitive to one of the most com- petitive and pro-consumer markets in the nation with some of the lowest cost health plans available anywhere," the statement read. n North Carolina hospital misses payroll By Ayla Ellison E mployees at Washington County Hospital in Plymouth, N.C., didn't receive their paychecks Feb. 8, according to local TV station NewsChannel12. The hospital's owner, Kansas City, Mo.-based EmpowerHMS, hasn't told employees why they weren't paid, according to the report. Washington County Hospital employees who spoke with NewsChannel12 on the condition of anonymity said the hospital also lacks needed supplies and they don›t know when the items will be restocked. Several other hospitals owned or managed by EmpowerHMS have also encountered financial issues. The company has also failed to pay staff at Prague (Okla.) Community Hospi- tal and Horton (Kan.) Community Hospital on Feb. 1. n Mayo's annual revenue climbs to $12.6B amid move to Epic EHR By Ayla Ellison R ochester, Minn.-based Mayo Clinic made significant in- vestments in a new EHR system in 2018 yet still ended the year on strong financial footing. Mayo Clinic reported net income of $706 million on revenue of $12.6 billion in 2018. That's compared to 2017, when Mayo posted net income of $707 million on revenue of $11.99 bil- lion, according to the Post Bulletin. Over the last several years, Mayo has been implementing a new EHR system. The systemwide Epic implementation is part of a multiyear technology upgrade, which Mayo officials esti- mate encompasses $1.5 billion worth of investments. Mayo's financial position and patient volume held steady last year, despite the investment in the new EHR system and lost revenue due to the transition, according to the Post Bulletin. CFO Dennis Dahlen estimates Mayo missed out on $50 million in revenue in 2018 because it cut back on the volume of sched- uled healthcare services for several weeks as the new EHR sys- tem went live, according to the Star Tribune. "In the overall scheme of things, it's not that material, but there was a footprint on revenue from the implementation," he said. An increase in donations and income from Mayo's for-profit units, such as Mayo Clinic Ventures, helped offset the lost reve- nue. During 2018, donations to Mayo were up 19 percent year over year, while income from its for-profit operations climbed 9 percent, according to the Post Bulletin. n

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