Becker's ASC Review

59 HEALTHCARE NEWS Providence owes physician $1 in damages over lost hospital privileges By Alia Paavola P rovidence owes a plastic surgeon just $1 in damages for unlawfully terminating his hospital privileges, the Alaska Supreme Court ruled May 19. Michael Brandner, MD, had hospital privileges at Renton, Wash.-based Providence from 1995 to 2009 and at two other local hospitals. In 2009, Dr. Brandner had emergency open- heart surgery and took a leave of absence from his practice, returning to work in 2010. However, Dr. Brandner was not approved to resume hand surgeries at Providence, and his surgical caseload decreased aer his return — but his caseload at the two local hospitals increased. In 2011, Providence ended Dr. Brandner's hospital privileges without a hearing. He eventually received a hearing several months later, which upheld his termination, according to the lawsuit. As a result, Dr. Brandner sued Providence for medical malpractice to recoup income he allegedly lost as a result of injuries he attributed to his heart surgery. During the hearing, Dr. Brandner stated that "all [his] lost earnings" were caused by medical problems following the surgery. e malpractice suit was unsuccessful. However, Dr. Brandner then revamped the suit against Provi- dence, alleging denial of due process, defamation and contract violations for termination of his hospital privileges. e Superior Court ruled against Dr. Brandner on all points; thus, in 2015, he appealed to the Alaska Supreme Court. e Alaska Supreme Court in 2015 ruled that Providence violated Dr. Brandner's procedural due process rights by termi- nating him before the hearing, remanding the case to the lower court to allow Dr. Brandner to pursue damages for any loss of income between the initial date his privileges were terminated and the hearing that confirmed the termination. At the lower court damages hearing, Providence presented expert testimony and hospital records stating that Dr. Brand- ner's economic loss was minimal. Dr. Brandner alleged that he faced an income loss of about $230,000. e court ultimately awarded Dr. Brandner nominal damages. Dr. Brandner then appealed the nominal damages award to the state Supreme Court, which ruled May 19 that he presented insufficient proof of lost income, upholding the nominal dam- ages award. "ere was an adequate basis for the trial court's finding that no actual damages resulted from the improper termination. erefore, the award of nominal damages was not clearly er- roneous," the Alaska Supreme Court ruled. n 5 largest health insurance companies by membership By Patsy Newitt UnitedHealthcare is the largest insurer in the U.S., according to a March 2021 Value Penguin report. The U.S. has more than 900 health insurance companies that provide medical coverage, but the industry is dominated by five companies that own 44 percent of the market. Here are the top five largest health insurance companies by membership: 1. UnitedHealthcare: 70 million members 2. Anthem: 39.9 million members 3. Aetna: 22.1 million members 4. Cigna: 20.4 million members 5. Humana: 16.6 million members n Renown, UnitedHealthcare end contract By Morgan Haefner R eno, Nev.-based Renown Health and UnitedHealthcare have terminated their in-network contract agreement, according to News 4. The organizations reached a contract impasse in May over reimbursement rates and have been unable to negotiate a new contract since. As a result, Renown patients with United- Healthcare insurance may face higher out-of-pocket costs to access care and services at Renown. In a statement to News 4, UnitedHealthcare called Renown "the most expensive health system in the Reno area." The in- surer said Renown is requesting a nearly 16 percent increase in reimbursement "that will drive up the cost of health care for the members and customers we serve." UnitedHealthcare also accused Renown of "introducing new demands less than two weeks before the contract's termination date" after the two had reached an agreement on rates. "United's claims that Renown is demanding a 16 percent increase are false," Renown said in an emailed statement to Becker's. "We are asking for a nominal, single digit increase over the life of the contract to make health, and healthcare more accessible and affordable. Unfortunately, a new agree- ment has not been reached and all impacted contracts with United remain terminated." The change affects all Renown services for members of Unit- edHealthcare and its subsidiaries, Health Plan of Nevada and Sierra Health and Life. n

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