Becker's Hospital Review

28 CFO / FINANCE Kentucky health system to reduce million-dollar 'shock claims' up to 45% under Anthem deal By Morgan Haefner S t. Elizabeth Healthcare, a five-hos- pital system in Edgewood, Ky., is voluntarily participating in a new effort launched by Anthem Blue Cross and Blue Shield to lower unexpected, sometimes million-dollar medical bills Under the agreement, announced to Becker's in an emailed statement Aug. 13, St. Elizabeth will cut charges for these «shock claims» by as much as 45 percent. Shock claims can include treatment for neonatal intensive care units, cancer treatments, heart centers, immunotherapy treatments and other expensive services. Claims for these treatments can total up to $6 million. "Health events at this cost level can have a devastating impact on employers be- cause many have self-funded health plans and pay for individual healthcare claims directly," according to the organi- zations. "Even employers that don't pay directly can face drastically increased insurance premiums which can also im- pact costs for their employees." Anthem unveiled the initiative in late May and hopes all hospitals in Kentucky will join. n CMS to cover CAR-T therapy nationwide By Alia Paavola M edicare has finalized its long overdue national coverage decision on CAR-T therapy, an innovative but expensive new cancer treatment that uses patients' immune cells to fight against the disease. Under the policy, Medicare will pay for CAR-T therapy providing "consis- tent and predictable patient access na- tionwide," CMS Administrator Seema Verma said. e agency will cover CAR-T therapy when it is administered in healthcare facilities enrolled in the Risk Evalua- tion and Mitigation Strategies program, mandated by the FDA for safety. Medicare will also pay for the therapy even when it is used to treat conditions that aren't FDA approved if it is "recom- mended by CMS-approved compendia." e policy is different from the agency proposal released in February, which would have required hospitals to collect and report data on patient outcomes over a long period of time. e final decision dropped that requirement and instead will rely on patient information collected by the FDA and National Can- cer Institute, according to the coverage decision. e FDA is requiring the two manufacturers that market CAR-T ther- apies, Gilead and Novartis, to follow pa- tients and report on outcomes. Ms. Verma said the coverage decision was initially scheduled for late May, but the agency struggled to figure out how to cover and pay for the treatment, which costs $375,000 to $475,000, ac- cording to e Washington Post. e agency announced Aug. 2 it would boost what Medicare would reimburse for CAR-T from 50 percent to 65 percent. Currently, the two CAR-T treatments on the U.S. market are Gilead's Yescarta and Novartis' Kymriah. Yescarta is ap- proved to treat non-Hodgkin lympho- ma, and Kymriah is approved to treat acute lymphoblastic leukemia. n Humana completes $1B debt offering By Morgan Haefner H umana completed its public offering of $1 billion in senior notes Aug. 15. The insurer expects net proceeds from the debt offering to be about $990 mil- lion, after subtracting underwriters' discounts and estimated offering expenses. Humana plans to combine the proceeds of the debt offering with available cash to repay $400 million in senior notes Oct. 1, as well as other outstanding debts. n How buying a failing hospital can pay off By Ayla Ellison H ahnemann University Hospital entered Chapter 11 bankruptcy in late June, but the Philadelphia-based hospital's real estate was not included in the bankruptcy filing. City and state officials, a nurses union, and presidential hopeful Bernie Sanders say Hahnemann's owner let it fail to sell the valuable real estate, according to The Philadelphia Tribune. Philadelphia Academic Health System, which owns Hahnemann, separated the op- erating business from the land beneath the hospital and its adjacent buildings. The separation, which is common in private equity purchases, helps ensure the owner makes a profit whether Hahnemann succeeds or fails. The hospital was originally slated to shut down Sept. 6, and the closure will likely be followed by a lucrative land sale, according to the report. The closure was pushed back to Sept. 13. Buying and closing businesses and then selling the land they sit on is more common in the grocery and retail sectors. The potential payoff from selling Hahnemann's real estate may set a dangerous precedent, Eileen Appelbaum, a private equity expert and co-director of the left-leaning Center for Economic and Policy Research, told CNN. "If you have a success like Hahnemann — that will blow up," she told CNN. "Every- body will know that you can make money on the real estate of a hospital." n

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