Becker's Hospital Review

17 CFO / FINANCE Primary care practices could take $15B hit this year due to COVID-19 By Ayla Ellison U .S. primary care practices are projected to lose up to $15.1 billion, or $67,774 per full-time physician, this year due to the COVID-19 pandemic, according to a July study published in Health Affairs. The researchers said the average revenue loss would go up if shelter-in-place policies are again instituted in November and December. In that scenario, the revenue loss for this year would rise to $85,666 per full-time primary care physician. Medicare and commercial insurance companies have been re- imbursing physician practices at higher rates for telehealth ser- vices during the COVID-19 pandemic. If those rates revert back to pre-COVID-19 levels starting in October, primary care prac- tices can expect to take an additional financial hit of $173,453 in 2020, according to the study. "Our results ultimately highlight vulnerability of primary care practices to financial demise due to fee-for-service and vis- it-based payment policies, indicating that capitation-based pay- ment reforms may be key to ensuring robustness of primary care into the future," study authors wrote. n Tougher audit needed to understand UTMC finances, Ohio lawmakers say By Morgan Haefner O hio lawmakers are calling for the state to conduct a foren- sic and performance audit of the University of Toledo to better un- derstand the financial picture of its medical center. In a July 8 statement, state Sen. Teresa Fedor, D-Toledo, and other lawmakers asked Ohio auditor Keith Faber to take a more extensive look at the university. e policymakers said the request came aer a cursory audit of the University of Toledo raised "new financial questions and concerns among doctors." e lawmakers said an accurate picture of the University of Toledo (Ohio) Medical Center's finances is needed. e hospital is accepting bids to purchase, lease or manage the facility. At a June 22 meet- ing of the board of trustees, the university said it was evaluating all options for the financially strained UTMC. Toledo-based ProMedica is one of the organizations that made a bid to assume the day-to-day operations of UTMC. ProMedica already has connections to the university. In 2015, a 50-year academic affilia- tion agreement was struck between ProMed- ica and the university's College of Medicine and Life Sciences. Critics have argued that the existing relationship has resulted in several of UTMC's top revenue-generating departments being transferred to ProMedica. Officials also argue that UTMC has lost many of its teach- ing physicians and students to ProMedica. However, the university has said the affilia- tion is between ProMedica and the universi- ty's college of medicine, not UTMC, and has enhanced medical education in Toledo, led to more physician graduates staying local and increased faculty size. University officials asked the state auditor to review the finances of both UTMC and the College of Medicine and Life Sciences since the 2015 agreement. e report, which was presented at the June 22 board meeting, "iden- tified no material causes for concern," the uni- versity told Becker's Hospital Review. e lawmakers disagreed. In a July 7 letter to the state auditor, the lawmakers questioned findings from the cursory audit that was pre- sented at the June 22 meeting. ey said it suggests UTMC was profitable from 2016-18, but "interdepartmental transfers caused the medical college to operate in the red." e lawmakers also questioned how an estimated $30 million in Graduate Medical Education funds from Medicare was used. In an emailed statement to Becker's Hospital Review, ProMedica said: "e academic affil- iation between ProMedica and the University of Toledo College of Medicine and Life Sci- ences was thoroughly vetted by both involved parties and reviewed by the Ohio Attorney General's Antitrust Division in 2015. e terms of the academic affiliation have been available to the public online since its incep- tion. Both parties continue to adhere to the terms as outlined to enrich the quality of medical education and expand clinical train- ing capacity in Toledo." n HHS cuts Medicare appeals backlog by 43% By Ayla Ellison H HS is making progress on reducing the backlog of Medicare appeals at the administrative law judge level, according to a June 26 status report. In 2018, a federal judge ordered HHS to incrementally reduce the backlog over four years. The department was ordered to cut the backlog by 19 percent by the end of fiscal year 2019; 49 percent by the end of fiscal year 2020; 75 percent by the end of fiscal year 2021; and to completely eliminate the backlog by the end of fiscal year 2022. According to the status report, HHS is ahead of the tar- gets established by the court. "By the end of the second quarter of 2020, a total of 242,995 appeals remain pending at OMHA [Office of Medicare Hearings and Appeals], which is a 43 percent reduction from the starting number of appeals identified in the court's order (426,594 appeals)," stated the report. The federal court imposed the deadline-based targets as a result of a lawsuit filed by the American Hospital Asso- ciation. n

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