Becker's Hospital Review

15 CFO / FINANCE Health systems balancing elective care, COVID-19 hospitalizations By Alia Paavola H ospitals across the U.S. are working to care for more COVID-19 patients without halt- ing lucrative elective procedures, accord- ing to e Wall Street Journal. Aer facing significant financial pressures from voluntary and state-mandated shutdowns this spring, U.S. hospitals are reluctant to again halt moneymaking elective procedures. Previous de- lays of elective procedures led to steep financial losses for many health systems and resulted in an average 30 percent to 40 percent revenue drop for nonprofit hospitals, according to Moody's Investors Service. Amid the resurgence of COVID-19 cases in Oc- tober and early November, fewer states ordered broad shutdowns, leaving elective procedure deci- sions up to hospitals. Advocate Aurora Health, which operates 16 Wis- consin hospitals, hadn't postponed elective pro- cedures as of Oct. 26, despite a COVID-19 surge in the state. e system also said it doesn't have a fixed threshold for when it would postpone elec- tives, Jeff Bahr, MD, chief Aurora medical group officer, told the Journal. Dr. Bahr said that the system is bringing nurses from Illinois to help in Wisconsin, and that it can transfer patients to its Illinois hospital if needed. "We are able to coexist in the midst of COVID," Dr. Bahr said. To help make decisions on elective cases, Nash- ville, Tenn.-based HCA Healthcare is tracking local COVID-19 cases and hospital capacity rates, staffing levels and supplies. at data is then sent to corporate, and executives use experiences from surges across the country to inform decisions. "e net effect of that is they are better able to manage capacity, and therefore, defer as long as possible these decisions to delay or to have to re- schedule certain scheduled cases," Jon Foster, an HCA president, told the Journal. n Cedars-Sinai submitted incorrect claims to Medicare for bariatric surgeries, inspector general says By Morgan Haefner C edars-Sinai Medical Center in Los Angeles submitted incor- rect claims for bariatric surgery, leading to overpayments from January 2015 to December 2016, according to HHS' Office of Inspector General. Patients with morbid obesity may receive bariatric surgery to help them lose weight by making changes to their digestive system. The audit, which was conducted from February 2018 through July of this year, analyzed the $1.3 million Cedars-Sinai re- ceived in Medicare payments for 62 bariatric surgery claims from 2015-16. They paired the claims with patients' medical records to determine if they matched billing requirements for Medi- care and Cedars-Sinai's Medicare claims administrator, Noridian Healthcare Solutions. The auditors found Cedars-Sinai didn't comply with all of the billing requirements in 25 of the 62 claims analyzed. The inspector general and an independent medical review contractor found information in patients' medical records that didn't support eligibility requirements for bariatric surgery. Cedars-Sinani should repay Medicare $154,074 in overpayments and update its billing procedures to correct the problem, the audi- tors said. The medical center agreed with most of the auditors' rec- ommendations. n UnitedHealth posts $3.2B profit in Q3 By Morgan Haefner U nitedHealth Group recorded higher revenue and $3.2 billion in profit during the third quarter of 2020 as the company saw care volumes move closer to pre-pandemic levels. Three things to know: 1. In the three months ended Sept. 30, UnitedHealth's revenues grew 7.9 percent to $65.1 billion when compared to the same pe- riod a year prior. The increase was driven by 21 percent growth in the company's Optum health services line, as well as growth in its public sector and senior business lines within its UnitedHealthcare health insurance segment. 2. UnitedHealth's earnings from operations fell 7.2 percent year over year to $4.7 billion in the most recent quarter. The company said the declines reflect consumer and customer financial relief measures it has taken during the COVID-19 pandemic, along with costs related to COVID-19 treatment and testing. 3. UnitedHealth ended the third quarter with a $3.2 billion profit, down 10.3 percent year over year. Year to date, the company's profits have risen 28.1 percent, thanks in part to deferred services during the pan- demic that helped the insurer double its earnings in the second quar- ter of this year. n

• Cover