Becker's Hospital Review

11 CFO / FINANCE Parents hit with $270K medical bill over 'birthday rule' inspire changes By Katie Adams I n January, a Kansas couple shared the story of how they received a $270,951 medical bill after the birth of their first child — even though they're both in- sured. Now, a state representative is proposing legislation to ensure stories like theirs don't happen again. ere is a little-known rule that stipulates a child born with double health insurance eli- gibility must be enrolled in the plan belonging to the parent whose birthday comes first in the calendar year. is regulation, known as the "birthday rule," was established by the National Association of Insurance Commissioners and adopted by most states. e rule determines which insurance will be primary for the child and which will be secondary, but premiums, deductibles and networks oen vary greatly between both par- ents' insurance plans, so parents don't always have the option to make the more compre- hensive plan their child's primary insurance. is rule resulted in new parents Kayla and Mikkel Kjelshus receiving a bill from HCA Overland Park (Kan.) Regional Medical Center for $270,951, including $207,455 for a NICU stay. Aer negotiating with insurers to pay the balance and getting in touch with the hospital, the bill was changed to a zero balance. e Kjelshuses' story was covered by several news outlets and caught the attention of state representative Sharice Davids. On July 22, Ms. Davids will introduce the Empowering Parents' Healthcare Choices Act, which would allow parents to eschew the birthday rule. Her proposed measure would give parents 60 days aer their child's birth to choose which parent's insurance will be their primary coverage. If the window passes and no decision is made, the birthday rule would still apply. "Welcoming a child into your family should be a joyful event, free from undue stress and financial surprises at the hands of insurance companies," Ms. Davids said in a statement. "is is a simple fix that gives parents the power over their baby's healthcare coverage, so they can make an informed choice about their family's future." 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 Tenet to shed $1.1B of debt By Alia Paavola D allas-based Tenet Healthcare will retire $1.1 billion of debt in September, the company said Aug. 11. The for-profit health system said it will redeem $1.1 billion of the $1.87 billion outstanding 4.625 percent senior secured first lien notes due in 2024. Tenet said the retirement of debt will be funded by proceeds from the sale of five Florida hospitals to Dallas-based Steward Health Care. Tenet said it expects the redemption of the notes to lower its annual cash interest payments by about $50 million. The redemption price will be just over 101 percent of the principal amount of the notes, plus accrued and unpaid interest. n

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