Becker's Hospital Review

27 CFO / FINANCE 'Medicare for All' would force Colorado hospital to close, CFO says By Ayla Ellison E stes Park (Colo.) Hospital would be forced to shut down in less than a year if the U.S. adopted a "Medicare for All" system, hospital CFO Tim Cashman told the Estes Park Trail Gazette. Mr. Cashman told the Trail Gazette his prediction is based on industry research and advice from other healthcare leaders. "If this were to become a reality, most of your rural hospitals will dis- appear because by definition, if you lose money for everything you do, then it won't take long to run out of money," he told the Trail Ga- zette. "All of our commercial patients will go away, everybody will be on Medicare, and I won't be able to keep the doors open because I won't be bringing in enough money to pay for my staff." A Navigant Consulting analysis found a Medicare public option could put up to 55 percent of rural hospitals at high risk of clo- sure. The study was supported by the Partnership for America's Healthcare Future, an alliance of insurance companies, private hospitals and pharmaceutical companies that lobbies against Medicare for All. The study has received criticism since it was published in early Au- gust. Rep. Joe Neguse, D-Colo., who was appointed vice chair of the Medicare for All caucus in February, called it an "inaccurate lob- byist-funded study," according to the report. n Cigna plans major expansion of Medicare Advantage business By Alia Paavola C igna is planning to expand its Medicare Advantage footprint by 14 percent next year, according to Forbes. The insurer plans to enter 37 new counties with in- dividual health maintenance organization plans and 43 new counties with individual preferred provider organization Medicare Advantage plans in 2020. "We see tremendous growth opportunity in MA, starting in 2020," Cigna CEO David Cordani told analysts on the company's second-quarter earn- ings call, according to Forbes. Cigna is joining a group of well-known health plans and startups looking to capitalize on new rules that allow Medicare Advantage plans to of- fer more benefits to seniors. Cigna's Medicare Advantage business had 440,000 members at the end of the second quar- ter, significantly fewer than such rivals as United- Health, Aetna and Humana. n United-TeamHealth snafu may have industrywide effects: Moody's By Morgan Haefner A contract dispute between United- Health Group and physician staffing company TeamHealth could indi- rectly affect hospitals and other providers, according to credit rating agency Moody's Investors Service. UnitedHealth is set to end high-reimburse- ment in-network contracts with Team- Health. e change would take effect be- tween Oct. 15, 2019, and July 1, 2020, and affect contracts across 18 states. Earlier in 2019, UnitedHealth reduced TeamHealth's reimbursements for certain out-of-network claims by about 50 percent, prompting Team- Health to sue UnitedHealth in eight states, according to Moody's. To understand the implications of United- Health's feud with TeamHealth, Moody's an- alysts examined a similar dispute between Nashville, Tenn.-based Envision Healthcare and UnitedHealth. In the end, Envision agreed to lower reimbursements, resulting in an earnings decline for Envision. Moody's es- timated TeamHealth's revenue would decline if it too agrees to a lower rate. Notably, Moody's said by canceling higher-rate in-network contracts, UnitedHealth would essentially lower median reimbursement rates in certain areas. As current proposals in Congress aim to address surprise medical bills by paying out-of-network providers a median or market rate based on in-network rates for providers in the same area, lower rates from UnitedHealth would pull down the median industrywide. Additionally, increased pressure on physician staffing companies like TeamHealth would indirectly affect hospitals, Moody's said. Should staffing companies receive lower re- imbursements from payers, the firms would likely seek higher subsidies from hospitals. "Disagreements between insurers and staff- ing companies could also disrupt hospitals if staffed physicians are no longer in-net- work. Unless legislation to curb surprise billing is implemented, patients could be on the hook for out-of-network charges, raising reputational and social risk for hos- pitals," Moody's said. n

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