Becker's Hospital Review

13 CFO / FINANCE CMS launches new payment model for emergency care: 5 things to know By Ayla Ellison C MS has selected 205 participants for its new, five-year Emergency Triage, Treat and Transport model. Five things to know: 1. e CMS innovation center unveiled the ET3 model in February 2019. e new model aims to give ambulance care teams more flex- ibility in how they triage emergencies. 2. Medicare currently pays for emergency ambulance services when beneficiaries are transported to hospitals, skilled nursing facil- ities and dialysis centers. Most beneficiaries who call 911 with a medical emergency are taken to a hospital emergency department. Under the ET3 model, Medicare will reim- burse for transport to an urgent care clinic or primary care office, or for providing care in place or using telehealth. 3. e goal of the five-year payment mod- el is to improve care quality and cut costs by reducing unnecessary hospital visits for low-acuity emergencies that do not require a trip to the hospital. 4. CMS said it is notifying ambulance provid- ers that have been selected for the ET3 mod- el to give them "ample time to establish the partnerships needed" with local urgent care centers, physicians and telehealth providers. e new payment model is slated to begin this spring. 5. Another component of the ET3 model in- volves state and local governments, or those they designate to receive 911 calls, to establish medical triage lines in regions where ambu- lance providers are participating in the new model. CMS said it plans to issue a notice of funding opportunity for up to 40 agreements that would last two years. n Insurer clinic competition 'very worrisome for hospitals' By Morgan Haefner C linics run by UnitedHealth Group, Blue Cross and Blue Shield, and CVS Health have hospitals wor- ried that patients may be steered away from their doors, according to The Wall Street Journal. There's a growing fear that large health insurers will take control of the delivery and payment of healthcare by guiding their members to providers they own. The trend especially threatens physician groups and hospi- tals that have acquired practices to gain more control over where patients are referred. A few of the insurer-led primary care initiatives hospitals are worried about are: • UnitedHealthcare's plan in Los Angeles that is built around Optum physicians • Aetna's decision to drop copayments for members who use CVS' MinuteClinics • BCBS of Texas' new plan to offer free primary care visits at clinics it opened with a partner in Houston and Dallas In these situations, a major concern for hospitals is insur- ers' ability to hold revenue inside their own businesses rather than pay it to outside providers. "It's very worrisome for hospitals," healthcare consultant Chas Roades told WSJ. "Suddenly, the plan you're re- lying on for payment is also competing with you at the front end of the delivery system." n Mayo Clinic projects $900M shortfall, implements cost- cutting measures By Morgan Haefner A fter reporting a record-setting $1 billion in operating income in 2019, Mayo Clinic predicts systemwide pay cuts and furloughs won't stop the Rochester, Minn.-based health system from facing a $900 million short- fall this year. The projected shortfall, which will be covered by Mayo Clin- ic's reserves, comes as the health system is currently operat- ing at 35 percent capacity, with surgery capacity even lower at 25 percent, Mayo Clinic Chief Administrative Officer Jeff Bolton told MPR News. In mid-March, Mayo Clinic halted elective surgeries and procedures to prepare for a surge in COVID-19 patients, a decision that "eliminated most of our revenue," Mayo Clinic said April 10. While Mayo Clinic previously said it would protect full pay and benefits through April 28, after that date the system will have to institute pay cuts and temporarily furlough staff to address significant reductions in revenues. The pay and work reductions, which will take effect in May, affect staff at Mayo's hospitals in Minnesota, Florida and Arizona. The cost-cutting measures will last until the end of 2020. Mayo Clinic CEO Gianrico Farrugia, MD, will take a 20 per- cent pay cut beginning this month, according to MPR News. Ten percent salary cuts will affect physicians and senior ad- ministrators, while other salaried employees will see a 7 per- cent reduction in pay. Mayo also instituted a hiring freeze, laid off contract employees and paused some construction projects, according to the report. n

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