AMA, AHA Sue Govt., Saying Surprise Billing Arbitration Favors Insurers

Modern Healthcare: AHA, AMA Sue Over Surprise Billing Arbitration Process
The American Hospital Association and the American Medical Association sued the federal government Thursday over its planned surprise billing arbitration process, which the groups say unfairly favors insurers and goes against Congress' intent. The organizations asked the U.S. District Court for the District of Columbia to block only the provisions of the interim final rule that require arbitrators assisting payers and out-of-network providers through a billing dispute should first consider a plan's median in-network rate when parties can't resolve the situation themselves. (Goldman, 12/9)

KHN: Suit By Doctors, Hospitals Seeks Change In How Arbitrators Settle Surprise Billing Cases
Two of the largest lobbying groups representing physicians and hospitals filed a lawsuit Thursday challenging a Biden administration decision on how to implement the law shielding patients from most surprise medical bills. The lawsuit from the American Hospital Association and the American Medical Association does not seek to halt the law from going into effect in January. Instead, it seeks a change in a key provision in regulations issued in September. At issue is how arbitrators will decide the amount insurers pay toward disputed out-of-network bills. (Appleby, 12/9)

In other health care industry news —

Houston Chronicle: United Memorial Medical Center Loses Medicare Contract Over Safety, Health Violations
United Memorial Medical Center, a hospital system with four locations in Houston, will lose its contracts with Medicare after several inspections found health and safety violations from failing to screen staff for COVID-19 to rusted equipment to cockroaches in the operating room, according to the Centers for Medicare and Medicaid Services. The centers, which oversee the government health insurance for the elderly, said they will terminate the contract with United Memorial Medical Center on Dec. 11, meaning Medicare will no longer cover patients who use the hospital system. That likely will cost United Memorial millions of dollars in reimbursements from and potentially force the closure of the hospital system. (Carballo, 12/9)

AP: Report: Hospitals, Health Systems Took Pandemic Revenue Hit 
Hospitals and health care systems across the state took a major revenue hit during the height of the COVID-19 pandemic but most have managed to remain profitable, according to a new report from the Connecticut Office of Health Strategy. The total statewide gain in operating revenue for Connecticut hospitals was nearly $41 million over the recent federal fiscal year, which ended Sept. 30. That’s a 93% decline compared to the operating revenue gains from the prior fiscal year. (12/9)

Philadelphia Inquirer: Tower Health Will Close Brandywine And Jennersville Hospitals After Sale Collapses
Tower Health’s sale of Jennersville and Brandywine Hospitals, announced just a few days before Thanksgiving, has collapsed because the buyer had no secure financing. Instead, the two Chester County hospitals will close, Tower officials said Thursday. The closures, slated for Dec. 31 at Jennersville and Jan. 31 at Brandywine, will force residents of western Chester County, including those who live in poor sections of Pennsylvania’s wealthiest county, to travel farther for emergency care. (Brubaker, 12/10)

ProPublica: Legislator Pushes For Law Requiring Illinois Hospitals To Report All Assaults To Police
An Illinois lawmaker said she will propose legislation to require hospital employees to report suspected patient-on-patient sexual assaults to law enforcement.The proposal, from State Sen. Julie Morrison, a Lake Forest Democrat, was prompted by a ProPublica investigation that found that Roseland Community Hospital officials failed to report a possible sexual assault of a patient in its psychiatric ward, even though it was captured on surveillance video. (Briscoe and Eldeib, 12/10)

KHN: A Rural Georgia Community Reels After Its Hospital Closes
Lacandie Gipson struggled to breathe. The 33-year-old woman with multiple health conditions was in respiratory distress and awaiting an ambulance. About 20 minutes after the emergency call, it arrived. The Cuthbert home where Gipson lived was less than a mile from Southwest Georgia Regional Medical Center, but the ambulance couldn’t take her to the one-story brick hospital because it had closed three months earlier, in October 2020. Instead, the EMTs loaded Gipson into the ambulance and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead. “They said it was a heart attack,” said Keila Davis, who, along with her husband, lived with Gipson. “If the hospital was still open, it could have saved her.” (Miller, 12/10)

AP: CVS Outlines Push Into Primary Care Services
CVS Health is launching a plan to use telemedicine, new clinics and teams of doctors, nurses and pharmacists to push deeper into managing customer health. (Murphy, 12/10)

The Wall Street Journal: Former Unilever CIO Moves Into Health Care 
Jane Moran, a former global chief information officer at Unilever PLC, is working to improve technology at a Boston-based health system, including by enhancing the hospital experience for patients and their families. Ms. Moran joined Mass General Brigham Inc. in September as chief information and digital officer, a newly created position, overseeing some 2,000 people. Mass General Brigham has 14 hospitals, including Brigham and Women’s Hospital and Massachusetts General Hospital, and is affiliated with Harvard Medical School. (McCormick, 12/3)

Modern Healthcare: Hydrogen Health Banks On Texting, AI In Crowded Virtual Care Market
Digital health startup Hydrogen Health expects to double its user base by the end of 2022 to cover more than 10 million enrollees through new partnerships with health plans and employers. Hydrogen Health, the result of a recently inked joint venture between Anthem and private equity group Blackstone, is a tool that uses artificial intelligence to answer common consumer health questions and diagnose routine conditions via text. If necessary, Hydrogen Health connects members to one of its clinicians virtually or can schedule an in-person visit to one of its 400 affiliated Knowledge Health clinics across the U.S. (Tepper, 12/9)

Also —

The CT Mirror: Health Care Workers' Union Reaches Deal To End Strike Against Nonprofit
Connecticut’s largest health care workers’ union reached a tentative agreement this week, ending its two-month-long strike against a major provider of residential and other services for the developmentally disabled. More than 180 members of SEIU District 1199 New England must now vote on the tentative deal with Sunrise Northeast Inc., which operates 28 group home and day services programs spread across 17 communities in eastern and central Connecticut. They serve more than 160 disabled clients. (Phaneuf, 12/9)