Hospitals in Orange County and other areas are keeping their eyes on a long-running reimbursement case that could reach the California Supreme Court.
The state’s highest court is being asked to review an appeals court ruling that hospitals can no longer expect reimbursement in amounts that far exceed the actual value of services provided.
The Fifth District Court of Appeals ordered a new trial in Children’s Hospital Central California vs. Blue Cross of California. The court said in its ruling that it wanted to establish damages that reflect the “reasonable value” of services instead of the high prices that are typically listed on what are known as “charge masters,” or rates that almost no health plans actually pay.
Children’s Hospital Central California filed its suit over rates that Blue Cross paid for out-of-network services.
“The implications of this ruling have the potential to be widespread,” said Brian Conner, national practice leader for hospitals with Seattle-based accounting and consulting firm Moss Adams LLP.
“The setting of charges and the billing of non-contract services at established rates is part of a delicate ecosystem in the U.S. health [industry] and is often referred to as the ‘cost shift.’ ”
If the appellate court’s ruling is broadly applied, it “has the potential to certainly disrupt the contracting dynamics between health insurers and healthcare providers as it potentially reduces the incentive for plans to enter into contracts for providers,” Conner said.
Hoag Adds HB Urgent Care
Hoag Memorial Hospital Presbyterian has opened an urgent care center at its Huntington Beach health center.
The urgent care center, which is accessible from a separate entrance, is staffed by doctors from Hoag Medical Group and is open seven days a week, according to a news release.
It is one of six urgent care facilities Hoag operates in OC, including in Anaheim Hills, Huntington Harbour, Newport Beach, Orange and Tustin, the release said.
Hoag noted it will open urgent care facilities in Irvine and Aliso Viejo in early 2015.
Company Raises $1.5M
Med-Tek LLC, a Foothill Ranch-based medical technology company, has raised $1.5 million in a fourth round of venture funding, according to a Securities and Exchange Commission filing.
Its products include the Comprehensive Muscular Activity Profiler.
The company says on its website that the technology “provides physicians, patients, employers, third party administrators, insurance companies and care management professionals the ability to obtain objective, clinically useful data regarding soft tissue injuries.”
Med-Tek didn’t disclose the investor or what it will use the funding for.
The company has raised $15.5 million in its history, according to federal filings.
Bits & Pieces
Orange Coast Memorial Medical Center in Fountain Valley introduced awareness computing technology last month. The system is made by Denver-based Aventura Inc. and includes a “roaming aware desktop” that intrinsically recognizes clinicians by their role, location, patient and the computer they’re using, according to a news release. … UC Irvine said in a release that Leslie Thompson, a professor of psychiatry and human behavior at the university’s Sue and Bill Gross Stem Cell Research Center, received $515,717 from the California Institute of Regenerative Medicine to continue her efforts to create stem cell treatments for Huntington’s disease, which is “an inherited, incurable and fatal neurodegenerative disorder.” Thompson previously received $1.4 million from the institute to produce human embryonic and adult-derived stem cell lines from people who carried the Huntington’s genetic mutation, UCI said. … Children’s Hospital of Orange County received a seven-year reaccreditation for its pediatric psychology predoctoral internship from the American Psychological Association’s Commission on Accreditation.
