Becker's Hospital Review

24 CFO / FINANCE Cancer misdiagnoses put Wake Forest Baptist's Medicare contract at risk By Ayla Ellison W ake Forest Baptist Medical Center in Winston-Salem, N.C., is at risk of losing its Medicare billing privi- leges aer an initial CMS survey revealed four patients received erroneous cancer diagnoses. An amended report released April 11 found at least 25 patients were affected. Due to lab oversight issues, three patients were incorrectly diagnosed with cancer and three other patients were wrongly told they did not have cancer. is resulted in unnecessary treatment for two of the three patients misdi- agnosed with cancer and a potential delay in treatment for the other patients, according to CMS. An additional 19 patients received erro- neous results, but CMS determined their treat- ment was not affected because additional tests caught the problem. CMS initially determined the issues identified in the survey put patients' safety and health in "immediate jeopardy." is status was removed April 9, retroactive to March 26. Wake Forest Baptist was required to submit an updated corrective action plan by April 19, and it has until June 12 to resolve the pathology issues. e hospital's Medicare billing privileges are at risk until all the issues identified by CMS are corrected. In a statement to Becker's Hospital Review, Wake Forest Baptist Health President Kevin High, MD, said the hospital became aware of the deficiencies in its pathology quality moni- toring process last fall. "We promptly notified all patients affected, as well as the physicians who cared for them. We have completed a review of hundreds of similar cases to satisfy ourselves that there are no other patients who have been affected," he said. "In our initial review, we determined that most, if not all, of the misdiagnoses centered on a single indi- vidual who is no longer with Wake Forest Bap- tist. We also determined that additional quality processes, laboratory equipment optimization as well as staff training and education were needed. All of these corrective actions are well underway and most have been completed." n 340B hospitals provided $26B+ in uncompensated, unreimbursed care: 3 study findings By Kelly Gooch H ospitals and health systems that participate in the 340B Drug Pricing Program play a crucial role in serving unin- sured, Medicaid, Medicare, low-income and other indi- gent patients, according to a new study. The study was prepared by health policy research firm L&M Policy Research and commissioned by 340B Health, a lobby group rep- resenting 340B healthcare organizations. For the study, research- ers examined Medicare data from fiscal year 2015 for 955 hospi- tals enrolled in 340B and 1,505 non-340B acute care hospitals. Here are three findings. 1. 340B hospitals treated significantly more low-income patients than their non-340B counterparts in fiscal year 2015, according to the study. Low-income patients make up nearly half (42 percent) of 340B hospitals' patient load compared to 27 percent for non- 340B hospitals. 2. 340B hospitals also provided more care without getting paid. The study found 340B hospitals provided more than $26 billion in uncompensated and unreimbursed care. The figure represents 60 percent of such care delivered nationwide and compares to $17 billion provided by non-340B hospitals. 3. Additionally, the study found 340B hospitals provided more outpatient alcohol/drug abuse treatment (24 percent compared to 12 percent), trauma care (51 percent compared to 31 percent) and HIV/AIDS services (43 percent compared to 24 percent) than their counterparts that don't participate in 340B. n Geisinger to cover lifetime hip surgery costs for Geisinger Health Plan member By Morgan Haefner D anville, Pa.-based Geisinger Health System is expanding its ProvenCare Total Hip program and covering any costs associated with or- thopedic surgeries for a Geisinger Health Plan pa- tient's lifetime. A 53-year-old woman is the first patient enrolled in Geisinger's pilot program, which the system intends to expand. Under the program, the patient underwent total hip replacement surgery Feb. 26, and any future surgical care and costs related to the surgery will be covered by Geisinger and Medacta International, a global orthopedic medical device manufacturer. "Rather than follow the prevalent fee-for-service model, Geisinger rewards value," said Michael Suk, MD, chair of the Geisinger Musculoskeletal Institute and the Department of Orthopaedic Surgery. "When it comes to the hip replacement pilot program, what we're saying to our patients is that the level of ser- vice we'll provide will be so exemplary that if there's a problem tomorrow or 20, 30, or 40 years from now, we'll take care of it." Geisinger and Medacta International will share po- tential costs, including the medical device replace- ment and hospital costs, as long as the patient stays a Geisinger Health Plan member and sees Geisinger providers. n

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