Becker's Hospital Review

19 CFO / FINANCE 30 Alabama hospitals in jeopardy as pandemic pressures persist By Ayla Ellison M ore than 800 hospitals — 40 percent of all rural hospitals in the country — were either at immediate or high risk of closure before the COVID-19 pandemic, and continuing financial pressures have some Alabama hospitals on the brink of shutting down. Of the 800 hospitals at risk of closure before the pandemic, 30 were in Alabama, according to a January report from the Center for Healthcare Quality and Payment Reform. Since the report was released, many hospitals in the state have seen their financial situation deteriorate because of the pandemic, Alabama Hospital Association President and CEO Don Williamson, MD, told the Alabama Public Reporter Sept. 17. Dr. Williamson said Alabama hospitals need about $200 million in federal funds to cover lost revenue and higher expenses tied to the pandemic. Hospitals lost revenue because they halted nonemergency procedures, and they're facing higher expenses tied to the cost of travel nurses hired to bolster staff. Seven rural hospitals in Alabama have closed since 2005, according to the Cecil G. Sheps Center for Health Services Research. With about 80 percent of Alabama's hospitals losing revenue before the pandemic, Dr. Williamson said he fears more hospitals will be forced to shutter. "What I'm worried about is when we get through this spike we'll have hospitals that spent all of their reserves to get through this spike, then we end up losing the hospitals from the system before we get to another spike," Dr. Williamson told the Alabama Public Reporter. "We need dollars now to help address the crisis we're in now." Alabama is one of 12 states that has not expanded Medicaid, and it is among states with the highest adult uninsured rates. n UnitedHealthcare, Anthem behind on billions of payments to hospitals By Nick Moran T he country's two largest insurers — UnitedHealthcare and Anthem — are behind on billions of dollars of payments to hospitals because of new reimbursement rules, claims issues and retroactive claims denials, according to a Kaiser Health News article republished in USA Today. For instance, Richmond-based Virginia Commonwealth University Health alleged Anthem owes the provider $385 million, according to the Oct. 5 article. Over 40 percent of payments are more than 90 days old, violating state law dictating that insurers must pay claims within 40 days. The American Hospital Association told reporters that complaints span across the country. Between June 30, 2019, and June 30, 2021, Anthem's unpaid claims rose from 43 percent to 53 percent, ac- counting for $2.5 billion. UnitedHealthcare's unpaid claims have remained at 54 percent over the past two years, according to the report. Anthem delays payments through new paperwork, requirements for prior authorization or requests to speak with doctors directly, according to the report. It also creates hurdles that encourage pa- tients to use facilities it owns, the report said. Anthem said many of these steps are taken to control excessive prices from hospitals. Patients complained that UnitedHealthcare denied payments be- cause of a lack of documentation of medical necessity or delayed payments because of prior authorization system outages, according to the report. The insurer told reporters that facilities may appeal claims decisions and that the July prior authorization downage was "resolved quickly." n Per-person healthcare spending up to $6K a year, but growth rate hits 5-year low: HCCI By Marissa Plescia I n 2019, per-person healthcare spending in- creased by 2.9 percent from 2018 to about $6,000, which is the lowest growth rate in five years, according to the Health Care Cost Insti- tute's October "Health Care Cost and Utilization Report." The report analyzed data on healthcare spend- ing, utilization and average prices from 2015-19 for those under the age of 65 who have their health insurance covered by an employer. Other key findings: 1. Average per-person out-of-pocket spending was $829 in 2019. 2. Average prices grew 3.6 percent in 2019, which was the lowest growth rate over the five-year pe- riod, but 18.3 percent higher than 2015. 3. Utilization declined 0.7 percent between 2018 and 2019, mostly because of a 4.9 percent de- crease in inpatient admissions in 2019. 4. Prices made up almost two-thirds of per-per- son spending growth between 2015 and 2019. n

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