Becker's Hospital Review

33 CFO / FINANCE California health plan fined $55M for care authorization delays By Alia Paavola L .A. Care, a publicly operated health plan in Cal- ifornia with 2.5 million members, was fined $55 million for failing to authorize members' needed care, ensure timely access to care and address patient complaints, according to e Los Angeles Times. e fine, the largest such penalty in the state's history, was levied March 4 by the California Department of Managed Health Care and the Department of Health Care Services. While patients covered by L.A. Care have access to some private physicians, many rely on getting care through the county-owned safety-net hospital, as they are low-income. e fine to L.A. Care came aer a 2020 LA Times inves- tigation that found many of the health plan's members faced large and sometimes deadly delays to see special- ists. Specifically, the investigation found that patients who needed specialty care aer a referral from their primary physician had to wait 89 days for approval, in- stead of the required 15-day limit. e state agencies said their investigation was prompt- ed by the LA Times report. e state's investigation found several instances where care was delayed, in- cluding one case where a cancer patient was le with- out treatment despite deteriorating health and another case where a cancer patient who was given only six to nine months to live le L.A. Care for another insurer because of the delays. e state regulators also found that L.A. Care had a backlog of 67,000 formal grievances that had not been resolved. "e scope and breadth of its violations indicate deep-rooted, systemic failures that threaten the health and safety of its members," Michelle Baass, director of the California Department of Health Care Services, told the LA Times. L.A. Care said it has taken corrective actions in re- sponse to the findings, but called the fines "unreason- able and not based on facts," according to the LA Times. "What the state does not seem to factor into their equa- tion is that a financial penalty of this magnitude creates yet another financial hurdle for a public health plan that is a crucial part of the health care safety net in Los Angeles County," the statement from L.A. Care read. n Hundreds of organizations reject CMS' direct contracting model rebrand By Marissa Plescia M ore than 250 organizations sent a March 8 letter to HHS Secretary Xavier Becerra condemning its rebranding of the Global and Professional Direct Contracting model. The new model was announced by CMS Feb. 24 and is now called the Accountable Care Organization Realizing Equity, Access and Community Health model, or ACO REACH. The letter — signed by organizations representing seniors, people with disabilities, consumers and health professionals — calls for an end to the new model and a rejection of the privatization of tradi- tional Medicare. It also alleges that ACO REACH gives third-party middlemen the power to manage older adults' care without their full understand- ing or consent and states that there is a lack of transparency with the program. "Hundreds of community leaders joined forces to say: You can't fool us, we know Medicare privatization when we see it," Susan Rogers, MD, president of Physicians for a National Health Program, said in a news release. "HHS gave Direct Contracting a fresh coat of paint, but we can see right through it." n MUSC Health CFO's attention is on inflation, supply chain issues, work fatigue By Marissa Plescia L isa Goodlett, CFO of Charleston, S.C.-based MUSC Health, dis- cussed inflation problems, budget planning and digital trans- formation on an episode of "Becker's Healthcare Podcast." Here is an excerpt from the podcast. Editor's note: This response was lightly edited for length and clarity. Question: From your vantage point as CFO, what are some of the trends you're following most closely in healthcare today? Lisa Goodlett: Right now, I'm giving a lot of attention to inflation. Obviously, the activities between Russia and the Ukraine are disap- pointing, and that's going to put more stress on our resources. Not only the supply chain, but just coming out of the impacts of COVID, so really economic and inflationary pressures. We will have to find ways to replenish all the COVID funds that have flown through the federal and state level. So there are going to be challenges when our reimbursement stream has really been somewhat steady over the past eight or 10 years. … No. 2 on our list is really work fatigue and finding that right balance between, how do we have a remote working staff? n

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