Issue link: https://beckershealthcare.uberflip.com/i/1161749
26 CFO / FINANCE California hospital seeks lucrative title change By Ayla Ellison E nloe Medical Center in Chico, Calif., is fight- ing to be recognized as a Sole Community Hospital to increase its federal funding aer a devastating wildfire in 2018 forced a hospital in Paradise, Calif., to close, according to the Chico En- terprise-Record. Hospitals must meet a few criteria to be designated a Sole Community Hospital by CMS. One require- ment is that no more than 25 percent of patients in the hospital's service area go to another nearby hos- pital for care. CMS denied Enloe Medical Center's request to become a Sole Community Hospital be- cause of this requirement, according to the report. Enloe Medical Center President and CEO Mike Wil- termood told the Enterprise-Record that the hospital has a 95 percent share of the market that includes Paradise, Durham, Gridley, Orland, Chico and En- loe, Calif. However, when Oroville, Calif., is added in, the hospital has less than 75 percent market share. "If all the people in Oroville went to Sacramento instead, we would ironically qualify," Mr. Wilter- mood told the Enterprise-Record. "But because we're pulling out of the Oroville zip codes, 200 out of 20,000 admissions are stopping us from receiv- ing the designation." Enloe Medical Center leaders applied for Sole Community Hospital status after Adventist Health Feather River in Paradise closed. The hos- pital shut down after sustaining significant dam- age in a deadly wildfire in 2018. Enloe Medical Center absorbed many of the hospital's patients, according to the report. Due to the Camp Fire's destruction, funds are need- ed to rehabilitate healthcare infrastructure and en- sure residents have access to care. Receiving Sole Community Hospital status would provide Enloe Medical Center with additional funds it needs to care for patients. Mr. Wiltermood and his team are appealing CMS' denial. If the hospital is designated a Sole Communi- ty Hospital, it would likely receive a roughly 10 per- cent bump in Medicare reimbursements, according to Mr. Wiltermood. "Even if they give this to us just for three to four years, it would be funding our county could des- perately use to rebuild aer the fire," he told the En- terprise-Record. "We're hoping this will call atten- tion to our situation and hopefully send some more funding into the county for health services. n HCA defeats false claims lawsuit over office deals By Ayla Ellison T he 11th Circuit Court of Appeals refused to revive a False Claims Act lawsuit against HCA Healthcare, alleging the Nashville, Tenn.- based hospital operator illegally induced physician referrals. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act by real estate appraiser Thomas Bingham, accord- ing to Law360. Mr. Bingham filed his first amended complaint in August 2014, and he pursued the case on his own after the Department of Jus- tice declined to intervene in the suit in February 2015. The whistleblower's false claims allegations were predicated on his as- sertion that HCA violated the Anti-Kickback Statute by giving certain phy- sicians sweetheart lease deals in buildings owned by HCA in exchange for referrals. The buildings are in Aventura, Fla., and Independence, Mo. In 2016, the district court granted HCA's motion for summary judgment on the claims regarding the office building in Missouri and dismissed the whistleblower's claims regarding the office building in Florida. Mr. Bingham filed an appeal in the case, arguing the district court erred in granting both motions. After reviewing the case, the appellate court affirmed the lower court's judgment in favor of HCA on July 31. The appellate court agreed with the district court that Mr. Bingham's alle- gations lacked the "indicia of reliability" to support his claims regarding the office building in Florida. The appellate court also concluded the whistleblower failed to show that HCA conveyed any remuneration to physician tenants of the office building in Missouri. n Average price of treating primary care conditions in ED? $2,032, UnitedHealth says By Morgan Haefner E ach time a patient enters the emergency department with a con- dition that can be treated in a primary care setting, it comes at an average cost of $2,032 to the healthcare system, according to an analysis published by UnitedHealth Group. UnitedHealth said the average cost is 12 times higher than visiting a physi- cian's office, which costs an average of $167. It also said the $2,032 price tag is 10 times higher than an urgent care visit, which costs an average of $193. "In other words, visiting either a physician's office or an urgent care fa- cility instead of a hospital would save an average of more than $1,800 per visit — creating a $32 billion annual savings opportunity systemwide," according to UnitedHealth. UnitedHealth said the 10 most common conditions treated in the ED that could be treated in a primary care setting are bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection. UnitedHealth projects 18 million of the 27 million ED visits made by privately insured Americans each year are avoidable. n