Becker's Hospital Review

17 CFO / FINANCE are unilaterally yours, but sometimes you will be in a war room-type situation, and you can help shape the best de- cision." 11. Britton Tabor, executive vice president, CFO and treasurer at Chattanooga, Tenn.-based Erlanger Health System, on the greatest risk or surprise related to COVID-19 that he navigated as CFO. "From a public hospital standpoint, we don't have the strong balance sheet that some of the for-profits have. We were surprised about not only the electives dropping, but also heart attack, stroke and emergency room visits dropping as well. We literally had a hospital that was very empty [this spring.] We had to act very quickly regarding staffing, furloughs and overtime. We also even got to the issue of having to curtail some of the benefits, [paid time off ] and retirement matching. Being a public hospital, all of these decisions are highly critiqued by the public. But we had to do that for the sustainability of our mission." 12. Doug Watson, CFO of Dignity Health's Ar- izona service area, on the greatest risk or sur- prise related to COVID-19 that he navigated as CFO. "We spend a tremendous amount of time planning for disasters, planning for all the things that we think could happen. When this really started, we faced things that we hadn't really thought we would have to deal with. We're part of a large health system, so if we get short of some- thing in a disaster, usually you can have another part of the system send you more of whatever that is. But what happened was everyone was short of things. … We had to think differently, and thankfully, we had folks that were able to get creative fairly quickly. e biggest lesson is to not wait around trying to solve it." 13. Jeanette Wojtalewicz, senior vice president and CFO of CHI Health in Omaha, Neb., on di- rect contracting relationships with employers. "We have entered into several direct-to-employer ar- rangements over the past 10 years, including full-risk arrangements, and learned a ton, some good and some not so good. To date, while we continue to have that be an option in our portfolio for employers, we're just trying to be available and be a resource now more than ever. We're actually going together with the insurance company and the broker as a team of three to the employer to explain options. How do we use virtual care in this new model? How do we develop primary care networks with no co- pays to help keep your people out of the ER? ese are just some examples of the conversations we're having." 14. Bert Zimmerli, executive vice president and CFO of Salt Lake City-based Intermountain Healthcare, on a piece of advice he remembers clearly. "When I was early in my career, I was complaining to an executive of one of my clients about several problems I was experiencing. He listened patiently and then told me that everything I had listed as a problem wasn't real- ly a problem since it could be 'fixed' with money. Actual problems are those that can't be solved with money." n 'There are bound to be loopholes': Americans may face unexpected bills with COVID-19 vaccination By Alia Paavola A lthough there are rules in place to protect Americans from paying anything out-of-pocket for a COVID-19 vaccine, consumer advocates fear that patients still may face unex- pected vaccine bills, according to The New York Times. In spring 2020, Congress passed legislation to prevent insurers from applying member cost-sharing, which includes copays, deductibles and coinsurance, to costs associated with novel coronavirus vaccinations. It also tacked on rules barring phar- macies, physicians and hospitals from billing patients for vac- cine administration. The increased protections around vaccine administration costs are unique in that there are requirements on both the insurers and providers, according to the Times. However, consumer advocates say that suprise vaccine bills may end up in patients' hands, just like they did with COVID-19 testing and treatment in 2020. "It is the American healthcare system, so there are bound to be loopholes we can't anticipate right now," Sabrina Corlette, co-di- rector of the Center on Health Insurance Reforms at Georgetown University, told the Times. Americans vaccinated in 2020 and early 2021 won't be on the hook for the vaccine itself, because the federal government is pur- chasing the doses for them. As of December, the federal govern- ment had purchased 100 million doses from Pfizer and up to 200 million from Moderna. Even with increased consumer protections, consumer advocates see ways patients may end up with bills, including "grandfa- thered" health insurance plans that were established before the ACA and not required to cover preventive services like the coro- navirus vaccine. Additionally, experts are worried about uninsured Americans. There is no national program that will cover their vaccination costs. Instead, the federal government said health providers should sub- mit applications for vaccine cost reimbursement to HHS, which will come from the $175 billion Provider Relief Fund. The Times also reported that more fees may be associated with vaccine administration. In particular, some providers charge a visit fee for in-person appointments. The laws passed by Congress this spring do not address whether this fee can be billed to patients. "The question that I'm still not clear on is what happens if someone walks into an outpatient department that charges a facility fee and gets a vaccine," Kao-Ping Chua, MD, PhD, an assistant professor of pediatrics at the University of Michigan in Ann Arbor, told the Times. "Is there a possibility they could get charged? I think the answer is yes." n

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