Issue link: https://beckershealthcare.uberflip.com/i/984530
22 PRACTICE MANAGEMENT Envision sues UnitedHealthcare over a bevy of payment issues — 8 insights By Eric Oliver E nvision Healthcare alleged Unit- edHealthcare unilaterally lowered contracted payments to Envision physicians and refused to add new Envision physicians to its insurance network, Axios re- ports. Prior to the lawsuit, United was reported- ly interested in acquiring AmSurg, Envision's ambulatory unit, but pulled out of talks due to the lawsuit, according to Bloomberg. Nei- ther United nor Envision commented on the matter. Here's what you should know. 1. Envision is suing United, saying its physi- cians faced pressure "to contract with United on unreasonable terms or to be out-of-net- work." 2. According to court documents, Envision is seeking monetary compensation for United's alleged continued breaches of the 2009 Medi- cal Group Participation Agreement. 3. Envision claims United "willfully" disre- garded the 2009 agreement. 4. e lawsuit stems from when Sheridan and United entered into the 2009 Medical Group Participation Agreement. In December 2016, Envision merged with AmSurg and as a result, Sheridan became an Envision subsidiary. e 2009 agreement had a provision where if Sheridan was purchased, the acquiring party would become subject to the 2009 agreement. To comply with the contract, Sheridan noti- fied United of the Envision merger. Sheridan sought guidance from United on how to add new physicians to United's network in De- cember 2016. Aer the acquisition, Envision claims United failed to provide "meaningful guidance," and as a result began a formal notification process in August 2017. Envision provided a roster of Envision's non-participating groups to be af- filiated within 30 days. United affiliated some of the providers, but not all of the providers, in defiance of the 2009 agreement. 5. Concerning the unilaterally lowered con- tracted payments, Envision claims United unilaterally adjusted its percentage payment rate but failed to notify Envision. Envision also claims United failed to recognize Envision's multiple objections to the PPR adjustments. United allegedly moved forward in multiple instances adjusting the PPR downward, while Envision frequently objected. 6. Envision is requesting a jury trial. 7. Axios believes the lawsuit is in response to legislative and investor pressure concerning the companies' alleged surprise medical bills. e report said, "e company is attempting to reverse the narrative in court," by attributing its surprise billing to UnitedHealthcare's lack of entering Envision's providers into its network. 8. Concerning Envision acquisition ru- mors, Bloomberg reports the loss of Unit- edHealthcare could complicate a sale of the company. Separate private equity firms previ- ously expressed interest in acquiring all of or part of Envision. n 2018 Main Residency Match: Who matched into the most competitive specialties? By Shayna Korol T he 2018 Main Residency Match is the largest in the National Resident Matching Program's history, with a record 37,103 U.S. and international applicants submitting program choices for 33,167 positions. Here are five things to know. 1. The number of available first-year (PGY-1) positions rose 1,383 from 2017 to 30,232 positions. 2. Of the first-year positions offered, nearly half — 14,695 — were for primary care specialists. 3. Match results can indicate specialty competitiveness, which the NRMP measures by the percentage of positions filled overall and the percentage filled by senior U.S. allo- pathic medical students. 4. Specialties with more than 30 positions that filled all available positions include integrated interventional ra- diology, neurological surgery, physical medicine and reha- bilitation and thoracic surgery. 5. Specialties with more than 30 positions that were filled more than 90 percent with U.S. allopathic seniors include: • Integrated interventional radiology: 95.5 • Orthopedic surgery: 93.1 percent • Integrated Plastic Surgery: 92.9 percent • Radiation Oncology: 91.5 percent • Neurological Surgery: 90.2 percent • Otolaryngology: 90.2 percent n