Becker's Hospital Review

15 CFO / FINANCE based EmpowerHMS, closed aer suspend- ing its license. In March, the hospital filed for Chapter 11 bankruptcy. Ohio 12. Belmont Community Hospital, a 99-bed hospital in Bellaire, Ohio, closed April 5. Hos- pital officials cited a decline in patient volume as the reason for the closure. "Utilization of BCH has continued to decline despite efforts to offer varying services at the facility," the hospital said in a press release. "e decline has place[d] a financial strain on the BCH that cannot be sustained in the long term." 13. East Ohio Regional Hospital in Martins Ferry closed Sept. 27. e hospital's president and CEO cited mounting financial losses as one of the factors that forced the hospital to shut down. Oklahoma 14. Mercy Hospital El Reno (Okla.) closed April 30. St. Louis-based Mercy said it ended its lease of the hospital due to declining inpatient volumes, which caused financial losses. Before the hospital closed, the City of El Reno had already secured a new agreement to ensure lo- cal residents would continue to have access to emergency care. Under a lease agreement that took effect May 1, Oklahoma City-based SSM Health St. Anthony Hospital began operating the emergency department of the hospital in El Reno. Pennsylvania 15. Harrisburg, Pa.-based UPMC Pinna- cle closed its hospital in Lancaster, Pa., on Feb. 28. e health system announced plans in December 2018 to close UPMC Pinnacle Lancaster and transition inpatient services to another one of its hospitals located about 7 miles away. In a Feb. 15 news release, UPMC Pinnacle President and CEO Philip Guarne- schelli said consolidating inpatient services on one campus would make care more convenient for patients. 16. Hahnemann University Hospital in Phila- delphia closed in early September. Hahnemann announced in June that it would close Sept. 6. e hospital pushed back the closure date aer a bankruptcy judge approved the sale of its res- idency programs on Sept. 5. Tennessee 17. Jamestown (Tenn.) Regional Medical Center closed on June 13. e 85-bed hos- pital abruptly shut down just one day aer its Medicare and Medicaid funding was cut off. In a June 7 statement to the Independent Herald, West Palm Beach, Fla.-based Renno- va Health, which owns Jamestown Regional, said mistakes made during the transition to a new billing company in December 2018 led to financial challenges at the hospital. 18. Cumberland River Hospital in Celina, Tenn., closed March 1. In January, officials an- nounced that the hospital was shutting down due to financial challenges. ey said Cum- berland River Hospital had experienced sig- nificant losses in recent years due to declining reimbursements and lower patient volumes. Texas 19. Chillicothe (Texas) Hospital closed July 22. e critical access hospital shut down aer a decline in patient volume due to patients trav- eling to other hospitals for care. e hospital also experienced decreasing reimbursements. 20. Financial challenges forced Hamlin (Texas) Memorial Hospital to close July 31. Declining patient volume and dwindling re- imbursement rates were among the factors that led to the hospital's closure, according to a July 2 announcement from the hospital's board of directors. Washington, D.C. 21. Washington, D.C.-based Providence Hos- pital closed April 30 aer 158 years of ser- vice. In July 2018, St. Louis-based Ascension, which owns Providence, said it was shutting down the hospital and making investments in other types of services, including telehealth, care coordination, home care and communi- ty-based behavioral healthcare. West Virginia 22. Ohio Valley Medical Center in Wheeling, W.Va., closed in September. Hospital officials said the "unwanted, yet unavoidable," deci- sion was made due to an unsuccessful search for a strategic partner, lack of interest from potential buyers and a more than $37 million operating loss over the last two years. n UnitedHealthcare's policy will limit outpatient surgery payments to hospitals By Kelly Gooch U nitedHealthcare has expanded prior authorization requirements and site of service medical necessi- ty reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations, according to Modern Healthcare. The outpatient surgery policy will limit the circumstances under which UnitedHealthcare will pay for certain surger- ies in a hospital outpatient setting. Taking effect in November for fully insured groups in most states, UnitedHealthcare will only pay for a surgical proce- dure performed in an outpatient hospital setting if the insurer determines the site of service for the procedure is medically necessary, UnitedHealthcare told Becker's Hospital Review. "Medical necessity reviews for site of service occur during our prior authorization process and are only conducted if the surgical procedure will be performed in an outpatient hospital setting," UnitedHealthcare said. "We utilize our Outpatient Surgical Procedures – Site of Service Utilization Review Guideline to help make our site of service medical necessity determinations. Site of service medical necessity reviews are currently being conducted for certain surgical procedures and will apply to additional surgical proce- dures beginning on Nov. 1, 2019 for most states." In California, Colorado, Connecticut, New Jersey and New York, medical necessity reviews will begin for certain sur- geries occurring on or after Dec. 1, according to a Unit- edHealthcare bulletin. Site of service medical necessity reviews do not apply to providers in Alaska, Kentucky, Mas- sachusetts, Maryland and Texas. With the outpatient surgery policy, the insurer said it hopes to reduce healthcare spending by guiding patients toward ambulatory surgery centers, where care may be cheaper when there isn't a substantial medical reason for the sur- gery to be performed in a hospital outpatient setting. n

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