Surprise Billing Dispute Resolution Process Gets More Complex

Modern Healthcare: Arbiters To Expand Surprise Billing Dispute Resolution Reviews, CMS Says
CMS still has not opened the portal providers will use to file dispute resolution claims, even though the surprise billing rule has been in effect since Jan. 1. The agency previously said the utility would open the week of April 11, which ends Friday. The updated guidance comes in response to a federal judge vacating part of the dispute resolution process laid out in the interim final rule implementing the surprise billing ban. That regulation required independent dispute arbiters to begin with the assumption that the median contracted rate is the appropriate out-of-network amount to pay the items or services in question. (Goldman, 4/14)

In financial news —

San Francisco Chronicle: S.F.’s Laguna Honda Hospital Has 30 Days To Avoid A Shutdown After Feds Freeze Funding
Federal officials severed critical funding from San Francisco’s Laguna Honda Hospital and Rehabilitation Center on Thursday, a move that threatens to shut down one of the largest skilled nursing facilities in the country and displace more than 700 patients with complicated medical or psychiatric needs. The hospital does not have to immediately close. But after a round of inspections this week, state officials found new deficiencies on the Laguna Honda campus “primarily having to do with hand hygiene, documentation and infection prevention and control,” according to a statement by the San Francisco Department of Public Health, which runs the hospital. (Swan and Whiting, 4/14)

Bloomberg: ADHD Startup Ahead Is Shutting Down
Ahead, an online provider of ADHD treatment, is shutting down, its top investor said Thursday. The company will immediately stop taking new patients and will continue to provide current patients with care through June 24, said Sid Viswanathan, the chief executive officer of Ahead backer Truepill. As Truepill has shifted its focus to serving corporate and business customers, “we made the difficult decision to no longer invest in Ahead,” Viswanathan wrote in an email to Bloomberg. (Davalos and Melby, 4/14)

Iowa Public Radio: Top DHS Official Says Glenwood Will Close Because State Is Unable To Comply With Federal Demands 
A top state officials said the Glenwood Resource Center will close because the state is unable to comply with federal requirements. At a Council on Human Services meeting Thursday, Kelly Garcia, the director of the Department of Human Services, called the decision to close Glenwood "devastating." But Garcia said she and Gov. Kim Reynolds determined no financial investment would be enough to get the facility in compliance with federal demands. "Neither one of us, at any point, have had a desire to get to this point. But ultimately, I have to assure her and everyone out there that we are able to provide safe care and I can't do that right now," she said. (Krebs, 4/14)

Stat: Hospitals Prop Up Med Schools, But Now It's Squeezing Their Bottom Lines
Before Banner Health agreed to shore up a pair of financially struggling medical schools, leaders framed such partnerships as a “must” for Arizona. It’s come with a hefty price tag. Financial statements show the Phoenix-based health system has dedicated roughly $2 billion to the schools and a faculty medical group it bought as part of the deal, which closed in 2015. Meanwhile, Banner’s operating margin has slipped from 5% before the deal to 1%. Health systems nationwide are in similar situations. They see a lot of benefit from partnering with medical schools, it’s just that the value is harder to capture in numbers. The prestige of an academic affiliation draws patients and the promise of breakthrough cures. The doctors they’re training will one day save lives. (Bannow, 4/14)

Wyoming Public Radio: Riverton Hospital Project Gets A Huge Financial Boost 
The effort to build a medical facility with enhanced medical services in Fremont County took a major step forward. Monday, the Riverton Medical District announced that it received a $37 million U.S. Department of Agriculture Rural Development grant that will be put towards the effort of creating a locally owned and governed health care facility. The project came about over three years ago after services from the current hospital were either being eliminated or moved out of town. Medical district treasurer Vivian Watkins said that’s when the community decided to take control of its health care options. “It’s something we felt we were not willing to accept…for our community to lose significant medical services,” said Watkins. (Beck, 4/12)

In other health care industry news —

Georgia Health News: Can An Out-Of-State Hospital System Block A New Project In Georgia?  
The owners of an aging northwest Georgia hospital want to replace it with a smaller state-of-the-art facility about 5 miles away and closer to I-75. Under the state’s regulatory certificate-of-need (CON) system, other hospitals can contest CHI Memorial Hospital Georgia’s bid to get state approval for the replacement hospital, which would be located in Ringgold. No Georgia hospital system has objected. But the road to construction has an unusual obstacle. (Miller, 4/14)

Modern Healthcare: Kaiser Permanente Doubles Its Affordable Housing Fund
Kaiser Permanente plans to double the size of its efforts to address housing instability with another $200 million, the integrated health system said Thursday. Since the Thriving Communities Fund's inception in 2018, the initiative has preserved or produced more than 7,000 affordable housing units across the U.S. and is on track to hit 15,000 by 2025. Kaiser also worked with SDS Capital Group to create 1,800 supportive housing units in California using $50 million from its initial investment, the health system said in a news release. (Abrams, 4/14)

Modern Healthcare: Northwell Health, Aegis Ventures Launch Healthcare AI Platform Company
Northwell Health, the largest health system in New York, and Aegis Ventures, an investment group that builds and launches startups, announced the creation of a jointly owned healthcare AI platform company, Ascertain. Ascertain will have $100 million in seed funding to develop and commercialize healthcare AI solutions and emerging companies on its platform. The solutions on this platform will focus on improving quality and access to care, while closing health equity gaps, the companies said. The companies developing solutions on Ascertain’s platform will be given access to Northwell’s datasets, as well as access to the health system’s clinical and technical teams. (Perna, 4/14)

Modern Healthcare: Cigna's Evernorth Launches Initiative For Patients With Autism
Cigna's health services division, Evernorth, and Behavioral Health Center of Excellence are collaborating to develop treatment standards to ensure patients with autism receive services that meet clear quality and efficacy metrics. The organizations will work together to improve access to autism treatment, advance patient-centered and value-based care using patient and provider input, increase transparency surrounding care quality and incentivize more providers to deliver high-quality services to people with autism. Around one in 44 children have been diagnosed with autism spectrum disorder, and the rate has been steadily increasing over the past decade, according to a Centers for Disease Control and Prevention study released in 2021. (Devereaux, 4/14)

Colorado Sun: Big Hospital Systems Are Combining Mental Health And Medical Care
Laura Andrus, who has battled cancer and lung problems for years, told her doctor it felt like she was slipping into a depression worse than she had ever felt before. As inconclusive medical tests piled up, offering no information about why Andrus wasn’t feeling well and whether the cancer was back or if she had an autoimmune disease, her mood deepened. Then Andrus’ doctor suggested she speak to the psychologist who works in the same Littleton family medicine practice. After a few weeks, including a virtual visit with a psychiatrist who prescribed medication, Andrus was “feeling more positive and able to deal with life,” she said. By the time she learned a couple of months later that she had a rare lung disease, Andrus was ready to cope with it. (Brown, 4/14)