Becker's Hospital Review

28 CFO / FINANCE UnitedHealth puts Envision's ED billing policies in its crosshairs: 5 things to know By Morgan Haefner U nitedHealthcare, the health insurance arm of UnitedHealth Group, created a website targeting Nashville, Tenn.- based Envision Healthcare's emergency depart- ment billing policies amid an ongoing payment dispute. Here are five things to know. 1. e website, which focuses on why Unit- edHealthcare is renegotiating a contract with Envision, asks members, "Shocked by your ER bill? Learn why the cost of ER services are sky- rocketing and what we're doing to protect you." e site links to a fact sheet on Evision's out-of- network rates. 2. In the fact sheet, UnitedHealthcare states Envision is the "largest ER physician staffing firm in the country and its outrageous billing practices are increasing costs for hospitals and consumers." 3. Among the statistics UnitedHealthcare lists on its fact sheet, it argues Envision charges 975 percent of Medicare for its ER physicians. "Hospitals are working hard to lower costs and create a better patient experience, but out- sourced ER companies are setting their efforts backward," UnitedHealthcare writes. 4. e website is the latest in an ongoing feud between the payer and provider. On March 14, Bloomberg reported UnitedHealth tossed its attempt to acquire Envision's ambulatory ser- vices unit, according to sources familiar with the matter. e news came as Envision sued UnitedHealth for allegedly lowering contract- ed payments to Envision physicians and not al- lowing new Envision medical practices to join its network. 5. In a statement to Becker's Hospital Review, Envision said, "As stated in our complaint against UnitedHealthcare, UnitedHealthcare is in breach of contract by failing to recognize Envision medical providers, unfairly adjusting rates it pays Envision and refusing to comply with the contract's process for handling dis- putes. is is the next step aer multiple at- tempts to resolve the situation. We are asking the courts to hold United accountable for its contractual agreements and obligations. "Envision believes that UnitedHealthcare is choosing to place dedicated physicians and pa- tients in the middle of a contractual dispute to further its competitive business strategies." n 6 things to know about US healthcare spending compared to 10 other high-income countries By Morgan Haefner L abor, supply and administrative costs are key rea- sons why the U.S. outpaces other high-income coun- tries in healthcare spending, according to a study published in JAMA. The research, led by Irene Papanicolas, PhD, from the de- partment of health policy and management at the Harvard T. H. Chan School of Public Health in Boston, examines 98 indicators across 10 high-income countries. The indicators, derived from data spanning 2013 to 2016, fell into seven fac- ets: general spending, population health, structural capacity, utilization, pharmaceuticals, access and quality and equity. Here are five findings from the study. 1. The U.S. spent nearly two times as much on healthcare as 10 high-income countries in 2016. This expense didn't lead to higher health outcomes, as the U.S. performed poor- er on several population health outcomes than the other countries, the authors found. 2. While the U.S. spent 17.8 percent of its gross domestic product on healthcare in 2016, spending in the 10 other countries ranged from 9.6 percent of GDP in Australia to 12.4 percent of GDP in Switzerland. 3. In terms of physician workforce, the U.S. didn't differ large- ly from the other countries, with 2.6 physicians per 1,000 people. The U.S. also didn't differ much in terms of health- care use. The U.S saw 192 discharges per 100,000 people. 4. However, the authors found pronounced differences in administrative costs. Administrative costs of care reflected 8 percent of healthcare spending in the U.S., while admin- istrative costs ranged from 1 to 3 percent in the other coun- tries. U.S. spending on pharmaceuticals also outpaced oth- er countries, with spending at $1,443 per capita in the U.S. compared to $466 to $939 in other countries. 5. Lastly, physician and nurse salaries were higher in the U.S. than in other countries. A generalist physician was paid $218,173 in the U.S. during the study period, compared to $86,607 to $154,126 in the other countries. 6. "Efforts targeting utilization alone are unlikely to reduce the growth in healthcare spending in the United States; a more concerted effort to reduce prices and administrative costs is likely needed," the authors concluded. n

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