Becker's Hospital Review

11 CFO / FINANCE Why a shuttered California hospital pushed back its opening date By Andrew Cass A California hospital that closed in 2023 is now aiming to reopen in early 2025. Madera (Calif.) Community Hospital, a 106-bed acute care hospital, closed in January 2023 and filed for Chapter 11 protection in March 2023. American Advanced Management took over operations of the shuttered hospital in April. Madera Community Hospital CEO Steve Stark said in October that they were aiming to reopen the hospital by Mid-December, but that timeline has since been pushed back. "We've had to push back our opening date a couple of times," Mr. Stark said in a Dec. 20 video posted on the hospital's Facebook page. "As we started getting in and having to recertify the building and get it ready for patients, more and more things were uncovered. Unfortunately a building that sits empty for two years seems to age much quicker than [in use]." Mr. Stark said they are "probably in the high-90% completion with all the construction" and are asking the California Department of Public Health to schedule a Jan. 27 survey date. "With luck, if they can meet that date for us, we will be ready and we would open just as soon as they leave with a clean survey." Madera was originally scheduled to have the survey conducted on Jan. 6, but pushed it back. Mr. Stark said one of the reasons for the delay was IV fluid shortages stemming from Hurricane Helene. "We are being told that the plant is back online and is fulfilling orders, but right now orders are based off allocation, which means that the IVs that you've ordered in the past are how you receive your allocation for the present and future and because the hospital hasn't ordered IVs in the last couple of years, we are working with local and state stakeholders to help us track down and be stocked and ready for IV solutions." Mr. Stark said that he doesn't foresee any other delays or challenges to reopening the hospital at this point, "but again, we are somewhat at the mercy of the conditions of the supply chain." n How health systems can 'close the gap' in Medicare Advantage By Alan Condon A s a leader who has navigated both sides of the healthcare equation — payer and provider — Prime Healthcare CFO Steve Aleman brings a unique perspective to one of the most pressing challenges facing health systems today: closing the reimbursement gap in Medicare Advantage. Mr. Aleman recently joined the Becker's Healthcare podcast to discuss how health systems can adopt proactive strategies, robust systems and strong payer relationships to overcome challenges and unlock growth opportunities within Medicare Advantage. Editor's note: is is an excerpt from the Becker's Healthcare podcast. Responses were lightly edited for clarity and length. Question: What trends are you paying most attention to as a health system CFO? Steve Aleman: One key trend is the growing prevalence of Medicare Advantage programs, which now cover more than half of all Medicare beneficiaries. While many believe MA ultimately lowers costs, the fact is that it poses serious challenges to hospitals. Prior authorization denial rates are unquestionably high, which causes providers to absorb additional costs to refile a claim and adds uncertainty around how much we will be paid or, for that matter, if we're paid at all. Claim denials increase costs and create changes to defining the expected net reimbursement. It is imperative to be extremely active in engaging with MA plans to ensure we have state-of-the-art information in those discussions to close the gap between what we are reimbursed for providing care and the actual cost associated with providing that care. Q: The challenges associated with MA are many, but where do you see the biggest opportunities within the program, and how can health systems unlock them? SA: I previously was on the payer side, but earlier in my career I served as CFO for an organization that included both hospital providers and medical groups while managing capitation and relationships with hospitals. So, I've experienced firsthand the push and pull of the differing incentives between these entities. At the end of the day, when dealing with authorizations and the structure of contracts, direct interaction is crucial. You need robust systems, processes, and protocols in place to prevent missteps that could lead to denials. So, when it does reach the appeal stage, it should ideally be a straightforward, black-and-white issue, allowing you to address it in real-time and get the claim paid. Solid documentation and protocols are essential. At Prime, we've historically been very proactive in working with MA plans to ensure claims are paid. Whether it involves litigation or settlements, having comprehensive documentation and efficient systems makes all the difference. While it's a lot of work to get to that point, the importance of these measures has never been more important. n

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