Becker's Hospital Review

October 2021 Issue of Becker's Hospital Review

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22 CFO / FINANCE New Kaiser-Providence hospital to cost $1B, open in 2028 By Morgan Haefner K aiser Permanente and Providence Southern Cal- ifornia expect to spend up to $1 billion on their joint hospital in Victorville, Calif., according to an Aug. 5 report from Kaiser Health News. Prior estimates pegged the price tag for the new hospi- tal at $750 million. A filing with California's attorney gen- eral's office disclosed that Oakland, Calif.-based Kaiser will put up 30 percent of the capital needed to build the hospital, with Renton, Wash.-based Providence funding 70 percent of the project. The new hospital is a replacement for the 65-year-old Providence St. Mary Medical Center in Apple Valley, Ca- lif. St. Mary will be closed because it doesn't meet Cali- fornia's new seismic requirements slated to take effect in 2030. The new 260-bed hospital planned for Victorville will be a full-service acute care facility and may include a medical office building and other ambulatory services. The health systems intend to sign a definitive agreement on the hospital by the end of 2021, pending regulatory approval. The new hospital is expected to be fully func- tional by 2028, according to Kaiser Health News. n Optum revamps online pharmacy, sells virtual care for cash By Ayla Ellison U nitedHealth subsidiary Optum is offering virtual care and discounted drugs to patients who pay with cash, presenting new competition to digital health startups and telehealth providers, according to Insider. UnitedHealth said the company's push into direct-to-con- sumer healthcare is a way to increase access to affordable care. The company, which is the parent of health insurer UnitedHealthcare, now is providing care and prescriptions to those who can't afford health insurance. The Optum Store, which launched in late 2020, added new healthcare services, including virtual care and pharmacy in June. After a quiet revamp, Optum Store now is offer- ing more than 800 generic drugs at discounted prices for those without insurance, according to the report. The move into direct-to-consumer healthcare is one of UnitedHealth's plans to expand. The company also has amassed surgery centers and medical groups in recent years, and it contracts with or employs more than 50,000 physicians, according to Insider. n Wellstar sues Kaiser, claiming underpayments and nonpayments totaling $41.7M By Alia Paavola W ellstar Health System in Atlanta is suing Kaiser Permanente In- surance Co., and its Georgia af- filiate, claiming they owe the health system more than $41.7 million, according to court documents. In the lawsuit, filed Aug. 18 in the Supe- rior Court of Gwinnett County, Wellstar claims Kaiser has refused to pay or under- paid Wellstar for services provided. Wellstar also alleges that Kaiser has not justified the non-payments or alleged underpayments. In particular, Wellstar claims Kaiser took an unauthorized 20 percent discount on goods and services Wellstar provided to Kaiser members from July 2017 to Dec. 31, 2020. Wellstar also claims Kaiser has paid zero dol- lars for the healthcare services the Georgia health system provided to Kaiser health plan members from Jan. 1 of this year through the date of the filed complaint. Wellstar said it is owed about $19 million to date from claims it properly submitted to Kaiser, and the amount will continue to grow. Wellstar claims in the lawsuit that it didn't authorize the discounts and wrote to Kaiser in November 2020, notifying the health plan that it improperly took the discounts and requested appropriate reimbursement. Well- star claims Kaiser didn't respond to its letter. "By taking such unauthorized discounts, Kaiser underpaid Wellstar during this time period, and Wellstar is entitled to a judgment against Kaiser in an amount to be proven at trial for the unauthorized discounts," the lawsuit reads. Additionally, Wellstar said that Kaiser has not provided a letter or electronic notice stat- ing the reasons for failing to pay the claims from Jan. 1 to the present. "Kaiser's failure to make payment or notify Wellstar about its reason for nonpayment within 15 days of receipt of such claims vio- lates Georgia's Prompt Payment Statute," the lawsuit claims. "Kaiser Permanente is committed to keep- ing healthcare affordable and paying fair and reasonable rates for emergency services pro- vided to our members by non-Kaiser Perma- nente hospitals," Kaiser Permanente said in a statement to Becker's Hospital Review. "We look forward to a court reviewing Wellstar's claim for high charges, and are confident we will prevail following an impartial review of the facts." n

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