Issue link: https://beckershealthcare.uberflip.com/i/1147537
10 CFO / FINANCE UPMC enters unprecedented 10-year contract with Highmark By Morgan Haefner P ittsburgh rivals UPMC and Highmark entered into an agreement that allows Highmark members to access UPMC hospitals and physicians at in-network prices for the next decade. Talks that led to the agreement, announced by Pennsylvania Attorney General Josh Shapiro June 24, began aer UPMC President and CEO Jeffrey Romoff spoke with Mr. Shapiro direct- ly. Mr. Shapiro, who is in an ongoing legal bat- tle with UPMC over the dispute, said he then spoke with Highmark CEO David Holmberg be- fore bringing the two together for "honest, tough and productive dialogue," Mr. Shapiro said. e 10-year agreement spans across western Pennsylvania and includes an extension of agreements between Highmark and UPMC Children's Hospital of Pittsburgh and UPMC Western Psychiatric Hospital, also in Pittsburgh. e new agreement is different than state-bro- kered consent decrees between UPMC and Highmark that were set to expire June 30. e agreement, which Mr. Shapiro said is the lon- gest deal UPMC has ever made with a com- merical insurer, will only stand between the two companies and exclude the state government. UPMC said June 24 that aer a June 14 deci- sion from the Commonwealth Court stating Highmark members will lose in-network ac- cess to many UPMC physicians, "UPMC held a productive, congenial meeting with High- mark to outline its offer to provide in-net- work access to the UPMC Hillman Cancer Center for Highmark members with a sus- pected or confirmed cancer or hematologic diagnosis. ose discussions then quickly expanded to other areas, and an agreement in the best interests of the patients and communities we serve was reached." n Sanford Health, UnityPoint to merge: 5 things to know By Ayla Ellison S ioux Falls, S.D.-based Sanford Health and West Des Moines, Iowa-based UnityPoint Health signed a letter of intent June 27 to combine the two systems, according to The Wall Street Journal. Five things to know: 1. The combined system would operate 76 hospitals and outpatient and long-term care services across 26 states, according to WSJ. Sanford Health includes 44 hospitals and UnityPoint Health includes 32 hospitals, according to a press release from the organizations. 2. If the deal is finalized, the combined system would be among the top 15 largest nonprofit health sys- tems in the U.S., according to the Argus Leader. 3. Sanford and UnityPoint have more than $11 bil- lion in combined operating revenue, more than 83,000 staff and 2,600 physicians, according to the Argus Leader. 4. "Our organizations share a deep commitment to exceptional patient care and a vision for transforming and sustaining healthcare in our communities," Kev- in Vermeer, president and CEO of UnityPoint Health, said in a press release. "Working together, we will find new ways to broaden access to care — beyond the traditional settings — and take greater responsi- bility for the health of the populations we serve." 5. The transaction is subject to customary regulatory approval and could close by the end of 2019, accord- ing to the Argus Leader. n HCA fires back in lawsuit over ER 'cover charge' By Ayla Ellison H CA Healthcare is arguing a proposed class-action lawsuit alleging the company and several of its hospitals bill patients an emergency room "cover charge" should be thrown out. In a lawsuit filed in May, three patients who received emergen- cy care at hospitals in Florida operated by Nashville, Tenn.- based HCA Healthcare alleged they were hit with an ER fee. They claimed the surcharge is not disclosed to patients before care is provided. The plaintiffs, who filed the lawsuit in the U.S. District Court for the Southern District of Florida, alleged that HCA violated Florida's Deceptive and Unfair Trade Practices Act by billing patients for the ER surcharge. In a motion to dismiss the complaint, HCA said the plaintiffs' claims fail for several reasons. HCA argued the improper "surcharges" plaintiffs refer to in their complaint are codes for ER facility fees, which are a standard industry charge recognized by CMS. HCA further argued that the complaint should be dismissed be- cause plaintiffs were never charged for or paid the facility fees in question and the fees are not "concealed," as plaintiffs alleged. "They are disclosed in the hospitals' charge masters, which are made available to patients upon request, and incorporated into admission contracts," stated HCA's motion to dismiss. "By the same token, federal and state transparency laws and regulations require that hospitals post their charges online, rendering plaintiffs' claims for injunctive relief all the more moot." HCA and its hospital affiliates requested that the lawsuit be dismissed with prejudice. n