Issue link: https://beckershealthcare.uberflip.com/i/759246
8 SPINE LEADERSHIP Wal-Mart adds Mayo Clinic to Spine Centers of Excellence, 50% Copay for Out-of-Network Care By Laura Dyrda I n an effort to ensure employees with back pain received correct and timely treatment, Wal-mart developed the spine centers of excellence program in 2012. e centers included Geisinger Medical Center in Danville, Pa., Mercy Hospital in Spring- field, Mo., and Virginia Mason Medical Center in Seattle. "We've seen more than one-third of the folks that are told they need spine surgery go to a center of excellence and find they need anoth- er type of care," says Kory Lundberg, director of national media relations at Wal-mart. "We want to make sure our associates are getting the appropriate care for their illness and are able to recover." Wal-mart has since expanded the benefit to total joint replacements, cancer care and weight loss, among other medical conditions. e company announced changes to their coverage to encourage more employees to use the program; going forward, employees must use a center of excellence or pay 50 percent of the cost of care for an out-of-network pro- vider. "We hope this will encourage our asso- ciates to go to centers of excellence," says Mr. Lundberg. "It's a wonderful benefit and something we helped pioneer in 2012. Whether you are a cashier in Wyoming that has been with us for less than a year or a long-term associate, if you have Walmart health insurance you have access to some of the most renowned experts in the country to diagnose and treat your back pain. We want to make sure our associates have ac- cess to the right care at the right time; that's what the centers of excellence are all about." Mr. Lundberg says there are still several op- portunities for Wal-mart employees to see local orthopedists for issues outside of spine care. e company focused on spine for the centers of excellence because they were see- ing a high volume of spine surgeries, some of which may have been unnecessary. "is initiative is about eliminating unneces- sary care," says Mr. Lundberg. "We want as- sociates to get spine surgery if they need it, but if there is other care out there that would be better, we want them to have that option." Wal-mart also expanded its centers of excel- lence hospitals to include Mayo Clinic facil- ities in Minnesota, Arizona and Florida. All centers of excellence facilities are chosen for their ability to provide high quality, cost-ef- fective care. "We think that by adding the Mayo Clinic lo- cations, we can expand the geographic loca- tions where the program is available to make sure our associates are getting the right care at the right time," says Mr. Lundberg. Employees that seek care at a center of excel- lence will have 100 percent of their bill cov- ered, including travel, lodging and expense allowance for the patient and caregiver. e benefit is extended to all employees that have Wal-mart health insurance. In a blog post announcing the news, Wal- mart Senior Vice President-Global Benefits Sally Welborn wrote the company decided to expand the spine surgery centers of ex- cellence benefit to focus on evidence-based guidelines, incentivize appropriate care and seek surgery as a last option. n Medicaid Expansion Linked With $2.8M Decrease in Uncompensated Care per Hospital By Morgan Haefner H ospitals benefited financially from the 2014 Med- icaid expansion under the ACA, a study published in the Journal of the American Medical Associa- tion found. Specifically, in 2014 hospitals in 19 states that expanded Medicaid recorded significant decreases in uncompensat- ed care costs and increases in Medicaid revenue compared to the 25 states that did not expand Medicaid. The study analyzed American Hospital Association and CMS data for nonfederal general medical or surgical hos- pitals in fiscal years 2011 through 2014. Hospitals in states where Medicaid was expanded prior to January 2014 were not included in the analysis. Below are four study findings. 1. Between 1,200 and 1,400 hospitals per fiscal year in states with Medicaid expansion each saw a $2.8 million de- cline in annual uncompensated care. 2. Hospitals in states with Medicaid expansion saw a $3.2 million increase in annual Medicaid revenue per hospital. 3. The 2014 Medicaid expansion was associated with im- proved excess margins, which increased from 1.1 percent- age points to 2 percentage points. 4. Hospitals in states where Medicaid was expanded did not see an improved operating margin. n