Becker's Hospital Review

12 CFO / FINANCE CMS terminates Kentucky hospital's Medicare contract By Ayla Ellison C MS ended its provider agreement with Southeastern Kentucky Medical Center in Pineville in late May. A survey of Southeastern Kentucky Medical Cen- ter on Jan. 30 by the Kentucky State Survey Agen- cy found the hospital was not in compliance with Medicare rules and revealed several deficiencies related to patient care. Inspectors identified an immediate jeopardy to patient health and safety due to the hospital's failure to maintain cardiology services, equipment to monitor patient medical conditions, medications for patient emergencies and staffing to provide required care to patients, according to a survey report provided to Becker's Hospital Review. In a March 29 letter, CMS notified Southeastern Kentucky Medical Center officials that the hospi- tal's Medicare contract would be terminated if it did not make changes to comply with Medicare rules. e hospital failed to make the necessary changes, and CMS terminated its provider agree- ment May 24, according to a letter the agency sent to Southeastern Kentucky Medical Center's CEO, a copy of which was provided to Becker's. e Medicare program will not reimburse Southeast- ern Kentucky Medical Center for services provided to patients whose treatment plan was established on or aer May 24, according to the involuntary termi- nation notice. Termination of the hospital's partici- pation in the Medicare program also resulted in the termination of its Medicaid agreement. Southeastern Kentucky Medical Center, formerly called Pineville Community Hospital, was owned and operated by the Pineville Community Hos- pital Association until two years ago. In 2017, the hospital association entered into an agree- ment with Fort Lauderdale, Fla.-based Americore Health. PCHA still owns the hospital real estate, but it entered a long-term lease deal and sold non-real estate assets to Americore. In May, the Middlesboro Daily News reported that Southeastern Kentucky Medical Center was rough- ly $400,000 behind on payroll and needed an influx of cash to overcome financial troubles and keep its doors open. During an emergency meeting May 9, the Pineville City Council voted unanimously to allow Mayor Scott Madon to gather information about acquiring the licenses to operate the hospital from Americore Health. n Massachusetts hospitals stockpile $1.6B in offshore accounts, nurses say By Ayla Ellison S ixteen hospitals and health systems in Massachusetts have more than $1.6 billion in the Cayman Islands and other tax havens, according to a report issued by the Massachusetts Nurses Association. The nurses union is calling on state lawmakers to support the Hospital Profit Transparency and Fairness Act, legislation that requires hospitals to disclose financial holdings and profits, including money kept in offshore accounts. The legislation would also place limits on nonprofit hospital and health sys- tem CEO pay and claw back excessive profit. Those funds would be placed in a newly created Medicaid Reimbursement Enhancement Fund. "We can improve our healthcare system by shining a light on hospital fi- nances, limiting excessive CEO pay and ensuring that the public has a stronger voice in shaping how our healthcare dollars are spent," Karen Coughlin, RN, vice president of the Massachusetts Nurses Association, said in a press release. Massachusetts Rep. Josh Cutler, D, a bill co-sponsor, said more financial transparency at nonprofit healthcare organizations is vital. "Our Medicare, Medicaid and other state tax dollars fund hospital corpo- rations, but what those corporations do with our money can be at odds with public service," he said. "This bill will allow the public to see exactly where our tax dollars are going — especially if they end up in the Cayman Islands — and limit excessive hospital CEO pay. We should instead spend that money helping our most vulnerable patients." n UnitedHealth CEO: Optum won't build hospitals By Morgan Haefner O ptumCare, the healthcare delivery unit of UnitedHealth Group, won't own inpatient care or post-acute care services, the health insurer's CEO said during an annual strategy conference, accord- ing to Business Insider. When asked by an analyst at the Sanford C. Bernstein 2019 Annual Strategic Decisions Conference in New York City whether UnitedHealth plans to expand OptumCare, CEO David Wichmann and CFO John Rex said they want to build out the com- pany to generate $100 billion in an- nual revenue by 2028. That's up from $16 billion last year. The executives said they'll expand their footprint in areas outside of the hospital. These include urgent care practices, surgical centers and primary care offices. Mr. Wichmann said while Op- tumcare won't be building any hospitals, he does see the in- surer partnering with health sys- tems for hospital-based services. "Those will occur in markets where there is maybe less as- sets for us to accumulate and build from," Mr. Wichmann said, according to Business Insider. Mr. Rex added UnitedHealth is looking to expand its services to senior members, especially those in Medicare Advantage plans, to further grow OptumHealth. "Certainly that represents a tremen- dous multidecade growth opportu- nity for that business," Mr. Rex said in relation to OptumHealth as a whole, according to Business Insider. n

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