Becker's Hospital Review

15 CFO / FINANCE Top 100 US hospitals charge patients 7 times their actual care cost, study shows By Katie Adams M ore than a quarter of the 100 hospitals with the highest revenues in the U.S. sued patients over unpaid bills between 2018 and mid- 2020, according to research from Baltimore-based Johns Hopkins University, first reported by Axios June 14. Researchers looked at the billing and debt collection practices for the 100 U.S. hospitals with the highest revenues between Jan. 1, 2018, and July 31, 2020. Below are three notable findings from the report: 1. During the time period researchers examined, the 100 hospitals pursued 38,965 lawsuits and other court actions against patients, seeking more than $71.7 million. 2. Of the 100 U.S. hospitals with the highest revenues, 26 filed 38,965 court actions against patients, which is likely an undercount since some court re- cords remained inaccessible during the investigation. Six of the 26 hospitals were in New York. 3. The top 100 hospitals charged patients an average of seven times the actual cost of the care they provided. The hospital with the highest mark- ups was HCA Healthcare's Chippenham Hospital in Richmond, Va., which charged nearly 13 times the actual care cost. n Sutter Health to lay off 400 workers By Alia Paavola A s part of a financial restructuring plan, Sacramento, Calif.-based Sutter Health issued another round of layoffs, according to a June 3 Sacra- mento Business Journal report. The health system said in June it laid off 400 more employees. The newer lay- offs are in addition to 277 information technology jobs that were cut April 2. Sutter said most of the layoffs affect employees in administrative positions in benefits, human resources, data services and accounting. The layoff notice said many of these employees were working remotely or in the field. Sutter told the Business Journal that it's working to evaluate every aspect of its business model. "Moving forward, we will continue to work to minimize staff reductions and their impact on our dedicated employees as we look for ways to eliminate variation, streamline resources and more efficiently manage our indirect costs," Sutter told the Business Journal. Sutter ended 2020 with a $321 million operating loss, including $800 million in funding from the Coronavirus, Aid, Relief and Economic Security Act. With- out the funding, Sutter's operating loss would have been $1.1 billion. As a result, Sutter initiated a sweeping review of its finances in March 2021. Sutter also gave voluntary severance packages to 800 workers in 2020. n • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021

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