Becker's Hospital Review

67 CFO / FINANCE Ascension expands footprint with acquisition of Presence Health: 4 things to know By Ayla Ellison S t. Louis-based Ascension Health, the largest nonprof- it health system in the nation and the largest Catholic health system in the world, has finalized its acquisition of Presence Health, a Catholic health system in Chicago. Here are four things to know about the transaction. 1. Ascension and Presence signed a letter of intent in Au- gust 2017 and entered into a definitive agreement in early February. Ascension announced the completed acquisition March 2. 2. Ascension now owns Presence, and most of Presence's facilities are part of Amita Health, a joint venture of Ascen- sion's Alexian Brothers Health System in Arlington Heights, Ill., and Hinsdale, Ill.-based Adventist Midwest Health, which is part of Altamonte Springs, Fla.-based Adventist Health. 3. Presence's skilled nursing, assisted living and indepen- dent living facilities are now part of Ascension's senior care subsidiary. 4. "We are so pleased to welcome the associates, providers and volunteers of Presence Health to Ascension," said An- thony Tersigni, EdD, president and CEO of Ascension. "By combining our strengths and learning from one another, we will strengthen Catholic healthcare and our ability to pro- vide compassionate, personalized care in Illinois and in ev- ery community across the country where we are privileged to serve." n UnitedHealth takes aim at costly ED visits with new policy: 5 things to know By Morgan Haefner U nitedHealth Group's insurance arm, UnitedHealthcare, changed its emergency department reimbursement policy for commer- cial and Medicare Advantage plans. Here are five things to know about the policy, according to a December 2017 bulletin. 1. Effective March 1 nationwide, UnitedHealthcare will review and pos- sibly adjust or deny facility ED claims submitted with level 4 and level 5 evaluation and management codes, with facilities able to submit recon- sideration or appeal requests. Levels are based on patient interventions, with level 4 and 5 codes dictating the most costly and intensive ED care. Blunt and/or penetrating trauma, severe infections and chest pain are some examples, according to the American College of Emergency Phy- sicians. 2. A UnitedHealthcare spokesperson told Becker's Hospital Review, "Pro- moting accurate coding of healthcare services is an important step in achieving the Triple Aim of better care, better health and lower overall costs." e policy change applies to all facilities and freestanding EDs submitting level 4 and 5 codes for UnitedHealthcare members, regard- less of in-network status. 3. UnitedHealthcare will use the Optum ED Claim Analyzer tool to de- termine appropriate evaluation and management coding levels. Data such as diagnostic testing, comorbidities and the patient's presenting problem will be considered by the tool. 4. In the December 2017 bulletin, UnitedHealthcare said the policies were developed to "address inconsistencies in coding accuracy and were based on the [evaluation/management] coding principles created by the Centers for Medicare & Medicaid Services that require hospital ED fa- cility E/M coding guidelines to follow the intent of [Current Procedural Terminology] code descriptions and reasonably relate to hospitals' re- source use." 5. UnitedHealthcare listed several exceptions to the policy in its bulletin, including claims for: • admissions from the ED • critical care patients • patients less than 2 years old • certain diagnoses requiring greater than average resource use when performed the ED • patients who die in the ED • facilities whose billing of level 4 and 5 E/M codes does not abnormally deviate from Optum's EDC Analyzer tool determination n Quorum Health sells 70-bed Illinois hospital By Ayla Ellison B rentwood, Tenn.-based Quorum Health com- pleted the sale of 70-bed Vista Medical Center West in Waukegan, Ill., to New York City-based US HealthVest March 1. Although this transaction has closed, Quorum still has other deals in the works. The company inked definitive agreements in late 2017 and early 2018 to sell three hospitals: Henderson County Commu- nity Hospital in Lexington, Tenn.; McKenzie (Tenn.) Regional Hospital; and Clearview Regional Medical Center in Monroe, Ga. Quorum, the 29-hospital spinoff of Franklin, Tenn.- based Community Health Systems, saw its net loss widen from $7 million in the third quarter of 2016 to $29.5 million in the third quarter of 2017. n

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