In Pittsburgh Battle, Arbiters Order Highmark To Pay UPMC Hospital More For Oncology Care
The decision, which UPMC says could expand to all its facilities, is the latest skirmish in a long-term battle between the two health giants. In other news, one New Jersey hospital files suit against an insurer, while another New Jersey hospital agrees to a settlement for a tax dispute.
Modern Healthcare:
UPMC Wins Legal Victory In Dispute Over Highmark Oncology Patients
UPMC has won a key legal victory that could ultimately award the health system more than $188 million in back payments from insurance giant Highmark. The Pittsburgh-based system disclosed Tuesday that a three-person arbitration panel awarded it about $23.9 million, at an interest rate of 6%, after determining that Highmark had reimbursed UPMC Presbyterian Shadyside Hospital below contracted rates for certain oncology services. Although the ruling applies only to Shadyside, UMPC said the decision will ultimately extend to all of its hospitals. It is estimating the total amount owed, but said it believes it will be above $188 million. (Kutscher, 11/10)
Modern Healthcare:
N.J. Hospital Sues Horizon Blues For Exclusion From Discount Plan
St. Peter's University Hospital in New Brunswick, N.J., has filed a lawsuit against the state's largest insurer, Horizon Blue Cross and Blue Shield of New Jersey, claiming the hospital was wrongfully excluded from a discount insurance plan called Omnia Health Alliance. St. Peter's, a 478-bed teaching hospital, filed the complaint Nov. 6 in Middlesex County Superior Court. The hospital requested that Horizon be prevented from issuing Omnia policies and that Horizon disclose the criteria it used to determine which hospitals were part of the plan, according to the court documents. (Castellucci, 11/10)
Modern Healthcare:
Not-For-Profit Hospital Will Pay Up In Tax Dispute As Exemptions Draw Widespread Heat
In a closely watched case, a New Jersey hospital has agreed to pay $26 million to the town where it's located to end a dispute over the hospital's property tax exemption.The settlement between Atlantic Health System, which owns Morristown Medical Center, and the municipality of Morristown comes after a New Jersey tax judge ruled in June that the hospital should not be exempt, concluding that if all hospitals operate the same way, “then for purposes of the property-tax exemption, modern nonprofit hospitals are essentially legal fictions.” (Schencker, 11/11)
Also in today's reports -
The Philadelphia Inquirer:
Infections In Open-Heart Patients Found At Second Pa. Hospital
A second Pennsylvania hospital has reported a cluster of unusual infections in patients who underwent open-heart surgery, prompting the state Department of Health to require immediate replacement of "heater-cooler" devices that have been linked to similar illnesses elsewhere. Penn State Hershey Medical Center said Tuesday that in the last four years, three open-heart surgery patients had become infected with nontuberculous mycobacteria - a common bug found in tap water and soil that rarely causes illness. (Avril, 11/11)
NPR:
Budget Switch For Maryland Hospitals Is Starting To Pay Off
Results are in from the first year of a bold change to the way hospitals get paid in Maryland, and so far the experiment seems to be working. We recently reported on the unique system the state is trying to rein in health care costs. Maryland phased out fee-for-service payments to hospitals in favor of a fixed pot of money each year. (Hsu, 11/11)
The Denver Post:
Centura To Open Hybrid Centers In Colorado For ER, Urgent Care
Centura Health is edging away from its system of stand-alone emergency departments. Four new Centura facilities will offer urgent and emergency care under one roof, CEO Gary Campbell announced Tuesday. All will be open 24 hours a day, he said, and patients will be treated according to their needs. Stand-alone emergency departments have been spreading rapidly into affluent suburban neighborhoods in Colorado. Twenty have opened since 2014. (Olinger, 11/11)
