Becker's Hospital Review

24 CFO / FINANCE How New York's 'baseball-style' arbitration process reduced surprise bills: 7 notes By Kelly Gooch A New York state law — and its "base- ball-style" arbitration process — has captured the attention of federal law- makers as they work on legislation to prevent surprise medical bills, according to a Vox report. Seven things to know: 1. Surprise medical bills occur when patients receive a bill from a healthcare provider who is out of network and the patient is respon- sible for the difference. Oen, the bill comes as a surprise to patients because they vis- it an in-network facility, but are seen by an out-of-network provider. 2. New York passed a law to protect patients from surprise billing situations in 2015. e law includes a binding arbitration process that is inspired from professional baseball, according to Vox. 3. Major League Baseball's arbitration pro- cess is reportedly used to settle salary dis- putes between newer players and their teams. e player and team both name an appropriate salary, and an arbiter makes one binding choice. 4. New York's law uses this baseball-style arbi- tration to settle price disputes between physi- cians and insurers. Jeffrey Gold, a senior vice president with the New York Hospital Associa- tion, who helped work on the law, told Vox the process incentivizes physicians and insurers to choose an amount that is reasonable because "whoever is closer to reality wins." 5. Over a two-year period, New York's law has helped settle about 2,000 billing disputes, ac- cording to the report. Research published in 2018, cited by Vox, also showed that out-of- network bills fell nearly 35 percent statewide aer the law was implemented. Addition- ally, prices charged by in-network emer- gency room physicians declined 9 percent, according to the research. 6. New York's law has been inserted into the national debate about federal surprise bill- ing legislation. It reportedly inspired pro- posed legislation from Sen. Maggie Hassan, D-N.H., who is working with colleagues in the Senate on an approach to prevent surprise emergency bills. 7. Vox noted that federal legislation inspired by New York's law would address unexpect- ed bills patients receive from out-of-network providers but would not significantly address the rising cost of healthcare. n Intermountain's operating income climbs 52% in FY18 By Morgan Haefner S alt Lake City-based Intermountain Health- care saw its revenues and operating income improve in fiscal year 2018, according to fi- nancial documents released March 18. For the year ended Dec. 31, 2018, Intermountain posted revenues of $7.7 billion. That's up 11.3 percent from $6.9 billion recorded in the previ- ous fiscal year. Increases in net patient services and premiums and administration fees contribut- ed to the year-over-year improvement. At the same time, Intermountain saw its expenses climb 8.7 percent year over year to $6.8 billion in fiscal 2018. Upticks in employee compensation, supplies and medical claims all contributed to the year-over-year increase in expenses. Intermountain posted net operating income of $547.1 million in fiscal 2018, up 52.4 percent from $359 million reported in the year prior. After incorporating nonoperating income, which was $240.2 million lower than the year before, In- termountain ended fiscal 2018 with net income of $598.5 million. That's down 8.6 percent from $655.1 million reported in fiscal 2017. n Employer wellness programs don't cut healthcare costs, study suggests By Morgan Haefner W hile the workplace wellness industry generates $8 billion in annual revenue, a new study found little evidence that the programs lower healthcare costs or change employ- ee behavior within a year, according to Scientific American. Researchers with the University of Chicago and the University of Illinois at Urbana-Champaign ran a large-scale randomized con- trolled trial to test how wellness programs affected employee health, well-being, productivity and healthcare spending. The researchers created a workplace wellness program dubbed iThrive at the University of Illinois at Urbana-Champaign. They ran- domly assigned some employees to a control group and enrolled others in iThrive, according to Scientific American. Of the employees enrolled in iThrive, 56 percent completed a health screening and a health risk assessment offered by the program, while 31 percent finished at least one wellness activity. When researchers offered a $100 incentive, screening rates significantly improved, but increasing the incentive to $200 changed the rates only a little. "One year later, when we compared the control group to the iThrive group, we found that the program didn't lead to healthi- er employees or reduce healthcare costs," the researchers wrote in Scientific American. "The program's failure to improve health outcomes or reduce costs was likely because employees who were interested in participating in the workplace wellness program were already quite healthy." n

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