Becker's ASC Review

60 HEALTHCARE NEWS 60 This hospital CEO is done playing nice with Medicare Advantage By Rylee Wilson B ristol Health CEO Kurt Barwis says Medicare Advantage is killing the healthcare industry — but when 64% of his system's Medicare beneficiaries have MA, he has no choice but to keep contracting with plans. "It's not an option for me. e reason it's not an option is I have an older community, and they need care." Mr. Barwis told Becker's. "If you look at the rules, and the disruption it would cause in the community, I'm not sure I can face the community if I was to use that as one of my approaches." In March, Bristol (Conn.) Health eliminated 60 positions, 21 of which were occupied, resulting in layoffs at Bristol Hospital. A lack of payments from Medicare Advantage was a major factor in the decision to cut staff, Mr. Barwis said previously. e system is short millions in revenue as a result of delayed and denied payments from MA plans, Mr. Barwis said. In the past year, Bristol Health has received 13.8% less in payments from MA plans than from fee-for-service Medicare, according to Mr. Barwis. "When you look at the math, I'm 72% government pay. I'm not going to be able to make that up on my commercial book of business," Mr. Barwis said. "So I have no choice — it's a race to the bottom — how can I get rid of as much cost as possible without impacting the safety and the quality of care?" e 17-year CEO is far from the only hospital executive frustrated with prior authorization and delayed payments from MA plans. A handful of systems have chosen to drop contracts with some or all MA plans. Rather than drop contracts, Mr. Barwis said he's advocating for reform. In March, he testified in support of prior authorization reform at the Connecticut Legislature. "I am taking an approach, because of the significance of Medicare Advantage in my community, to go aer advocacy, and change, and to educate. I feel really good about what CMS came out with in 2024, but it didn't go far enough," Mr. Barwis said. In addition to lobbying policy makers for change, Mr. Barwis said he's holding Medicare Advantage plans accountable. "If you're going to come in here and abuse me, I am going to fight you on every single point," he said. Mr. Barwis's advice for other systems handling MA reimbursement issues: Be collaborative across teams and stick to the contract. e CEO oen joins weekly revenue cycle meetings with stakeholders from across Bristol Health, where they talk through issues and next steps. "e unfortunate thing is that a monthly KPI dashboard is not enough anymore. You have to be looking at this stuff, real time, every week," Mr. Barwis said. "If you're not doing that, and if you haven't brought all the pieces of your system together — medical management, contracting team — if you haven't brought those together, you can't assume that they are collaborating together the way they should." Mr. Barwis also tells his staff not to go back and forth with insurers on the phone — once they've received a final denial, the contracting team should go aer a dispute resolution process. Staff oen wants to be collaborative and "nice," Mr. Barwis said — but they have to stay focused on Bristol Health's mission. "Our mission is our primary focus, in sustaining this organization in every which way we can to provide access to our community," Mr.Barwis said. "Know that the insurance person you're talking to on the phone is 100% focused on shareholder value, not our patients, not all the great things we do to take care of people. at is my consistent message to my team." n How AdventHealth is advancing responsible AI By Naomi Diaz A ltamonte Springs, Fla.-based AdventHealth is participating in two initiatives that focus on implementing and developing artificial intelligence responsibly and safely. AdventHealth joined the Coalition for Health AI (CHAI), a nonprofit organization aiming to establish a network of laboratories across the country to test healthcare artificial intelligence tools. The health system is a founding member of the organization, according to an April 17 news release from AdventHealth. Additionally, AdventHealth is collaborating with the Trustworthy and Responsible AI Network (TRAIN). This network is dedicated to responsible development and use of artificial intelligence in healthcare. Sixteen health systems, including AdventHealth, have signed on to the network and will collaborate with Microsoft, the network's technology partner, and OCHIN, a national network of community health organizations. "By sharing our knowledge and collaborating with other health care leaders through CHAI and TRAIN, we can significantly accelerate the development of AI solutions that will improve patient outcomes and shape the future of healthcare," Rob Purinton, vice president of analytics and performance improvement for AdventHealth, said in the release. n

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