Becker's Hospital Review

52 CFO / FINANCE Anthem cancels 25% reimbursement cuts on some same-day services By Morgan Haefner A nthem rescinded plans to cut reimbursement on certain same-day ser- vices following strong opposition from the American Medical Association, according to a letter Anthem sent to the AMA in February. Here are three things to know about the change. 1. Under Anthem's proposed policy, payments for evaluation and management codes under current procedural terminology modifier 25 would have been cut by 25 percent beginning March 1. The modifier concerned some separate services administered on the same day as a wellness exam or another procedure. 2. In a Feb. 23 letter to the AMA, Craig Samitt, MD, Anthem's executive vice pres- ident and chief clinical officer, wrote, "While Anthem is confident that duplication of payment for fixed/indirect practice expenses exists when physicians bill an [evaluation/management] service appended with modifier 25 along with a minor surgical procedure (0 or 10 day global) performed on the same day, the company believes making a meaningful impact on rising healthcare costs requires a differ- ent dialogue and engagement between payers and providers." 3. Anthem will formally notify providers about its decision within the next few days, the AMA said. Anthem's pullback comes as the insurer is facing pushback from providers and lawmakers concerning other policies aimed at slashing expenses. These include the payer's discretionary emergency room policy; its restrictive ad- vanced imaging policy in hospital outpatient facilities; and its denial of general anesthesia or monitored anesthesia during most cataract surgeries. n Baylor Scott & White closes 113-bed Texas hospital: 4 things to know By Ayla Ellison B aylor Scott & White Health, a nonprofit health system based in Dal- las, closed 113-bed Baylor Scott & White Medical Center-Garland (Texas) on Feb. 28. Here are four things to know about the hospital closure. 1. Baylor Scott & White decided to shut down the hospital, which has incurred significant financial losses over the last three years, after scaling back services and trying to secure a new owner for the facility without success. 2. According to a Worker Adjustment and Retraining Act notice, 711 workers were laid off when the hospital closed. Baylor Scott & White announced plans in De- cember to close the hospital. At that time, the health system told Becker's Hospital Review it intended to place a portion of the workers in comparable positions at other facilities in its network. 3. The closure also resulted in 105 workers at Aramark, a food service provider to the hospital, losing their jobs, according to a WARN notice. 4. "Although the hospital has closed, Baylor Scott & White and our affiliates will continue to serve the Garland community through several access points, includ- ing family medicine, cardiology, imaging, orthopedics, outpatient rehabilitation and more," the hospital said on its website. n Johns Hopkins Bayview Medical Center plans $469M expansion By Alia Paavola B altimore-based Johns Hopkins Bayview Medical Center plans to in- vest $469 million into a renova-tion and construction project aimed at mod- ernizing its aging facilities, according to the Baltimore Business Journal. e certificate of need application, filed with Maryland's Medical Health Care Commission, outlined plans to renovate its two existing hospital buildings and calls for the construction of a seven-story inpatient facility. If the application is approved, the project will transition all of Bayview's inpatient rooms to fully private rooms. Currently, about 60 percent of the inpatient beds on Bayview's campus are semi-private, which hospital of- ficials said can hinder patient satisfaction. In addition, the project will modernize and upgrade its facilities, which are now approximately 80 years old. e proposal not- ed the medical center's labor and delivery rooms, neonatal intensive care unit, burn center and some operating rooms are aging, un-dersized or poorly oriented, making care delivery more difficult. e proposed seven-story inpatient facil-ity will house an updated obstetrics unit, four new operating rooms and a burn unit with a rehabilitation gym. e project will also in- clude a 540-space parking garage and a new helipad. "[Bayview Medical Center] continues to lag behind other hospitals in the region in providing modern, state-of-the-art fa-cili- ties and accommodations for its inpa-tients, as well as for the faculty and staff who care for them," the hospital wrote in its filing, according to the Baltimore Business Journal. "Achieving these objectives is essential to the long-term viability of the hospital." n

• Cover