Becker's Hospital Review

15 CFO / FINANCE Ascension, CommonSpirit and Trinity see finances rebound By Ayla Ellison T he largest nonprofit health systems, Ascension, CommonSpirit Health and Trinity Health, saw their financial performance begin to bounce back in fiscal year 2021 aer the COVID-19 pandemic hurt performance a year earlier. Ascension, a 146-hospital system based in St. Louis, reported net income of $5.7 billion on revenue of $27.2 billion in the fiscal year ended June 30. e health system posted a net loss of $1.04 billion on revenue of $25.3 billion a year earlier. ough Ascension ended the most recent fiscal year with higher revenue, operating income and net income, its stronger fi- nancial performance wasn't tied to higher patient volume. Hospital admissions, emergency room visits and urgent care visits declined year over year because of surges of COVID-19 and patient hesitation to seek care, the system said. Chicago-based CommonSpirit Health, which operates 140 hospitals, reported net income of $5.2 billion on revenue of $33.3 billion in fiscal year 2021. e health system posted a net loss of $551 million on revenue of $29.6 billion a year earlier. CommonSpirit said a one-time sale of joint venture shares and funds received through the Coronavirus Aid, Relief and Economic Security Act pushed the system's income higher in the most recent fiscal year. Trinity Health, a 92-hospital system based in Livonia, Mich., reported net income of $3.9 billion on revenue of $20.2 billion in the most recent fiscal year. e health system posted a $75.5 million net loss on $18.8 billion in revenue a year earlier. e revenue growth was primarily attributed to a $1.3 billion year-over-year increase in net patient service revenue, which Trinity said was caused by payment rate increases and improvements in case mix. 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 HCA shrinks Georgia footprint, sells 5 hospitals in the state for $1.6B By Ayla Ellison N ashville, Tenn.-based HCA Healthcare sold five Georgia hospitals between August and October. HCA completed the sale of Redmond Regional Medical Center in Rome, Ga., to AdventHealth Oct. 1. The Altamonte Springs, Fla.-based sys- tem purchased the 230-bed hospital and its related businesses for about $637 million, according to bondholder documents filed Oct. 5. As a result of the divestiture of Redmond Regional, HCA said it no longer has a presence in northwest Georgia. The deal with AdventHealth closed about one month after HCA sold four Georgia hospitals to Atlanta-based Piedmont Healthcare. HCA an- nounced plans in May to divest the hospitals, which have more than 800 beds combined, for about $950 million. Though HCA's footprint in Georgia is smaller after selling the five facilities for a combined $1.58 billion, the company still operates five hospitals in the state. The system added a hospital in the southeast part of the state in May when it acquired Meadows Regional Hospital in Vidalia. HCA is the largest for-profit hospital operator in the U.S. The company posted revenues of $14.4 billion in the second quarter of this year, up from $11.1 billion in the same period a year earlier. The system ended the sec- ond quarter of 2021 with net income of $1.5 billion, up from $1.1 billion in the same quarter of 2020. n

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