Com­mu­nity hits back

De­fends ad­mis­sions poli­cies in face of Tenet’s suit

Modern Healthcare - - The Week In Healthcare - Vince Gal­loro

The fight over data and what they mean con­tin­ued last week, as Com­mu­nity Health Sys­tems pro­vided its de­tailed re­sponse to the al­le­ga­tions Tenet Health­care Corp. made in a fed­eral law­suit re­gard­ing Com­mu­nity’s ad­mis­sions poli­cies.

Ex­ec­u­tives from Franklin, Tenn.-based Com­mu­nity spoke pub­licly for the first time last week re­gard­ing the law­suit filed April 11 in U.S. District Court in Dal­las. Com­mu­nity made its case us­ing more than 100 slides avail­able in a se­cu­ri­ties fil­ing and on the com­pany’s web­site.

Tenet’s law­suit al­leges that Com­mu­nity ex­ec­u­tives failed to dis­close the com­pany’s po­ten­tial Medi­care-fraud li­a­bil­ity in its un­so­licited, $7.3 bil­lion bid to ac­quire Tenet. Tenet con­tends that Com­mu­nity is at risk be­cause of its low rate of ob­ser­va­tional stays, sug­gest­ing that Medi­care pa­tients have been im­prop­erly ad­mit­ted for one-day stays in­stead of ob­ser­va­tional vis­its.

“Tenet is mis­guided and in fact, wrong,” said Wayne Smith, chair­man, pres­i­dent and CEO of Com­mu­nity. Com­mu­nity con­tends the ob­ser­va­tion rate is an in­valid met­ric, and one slide noted that Tenet’s anal­y­sis ex­cluded Uni­ver­sal Health Ser­vices, King of Prus­sia, Pa., which had an ob­ser­va­tion rate sim­i­lar to Com­mu­nity’s.

Com­mu­nity notes in the slides that it has up­dated its Blue Book ad­mis­sions cri­te­ria guide six times since its ini­tial ver­sion was com­pleted in 2000. Prior to the law­suit, Com­mu­nity has said, it de­cided to adopt the more widely used In­terQual ad­mis­sions cri­te­ria. More­over, Smith said, at­tend­ing physi­cians alone make al­most ev­ery ad­mis­sion de­ci­sion at Com­mu­nity hos­pi­tals, “not Blue Book, not In­terQual and not Pro-MED.”

The com­pany uses soft­ware by Pro-MED Clin­i­cal Sys­tems at most of its hos­pi­tals to col­lect in­for­ma­tion about emer­gency room op­er­a­tions. Only three Com­mu­nity hos­pi­tals have used its “check mod­ule” to help with ad­mis­sion de­ci­sions, and the com­pany found that this mod­ule was lit­tle used, said Dr. Bar­bara Paul, se­nior vice pres­i­dent and chief med­i­cal of­fi­cer of Com­mu­nity.

Other pre­sen­ters in­cluded Andi Bosshart, vice pres­i­dent-cor­po­rate com­pli­ance and pri­vacy of­fi­cer; Larry Cash, ex­ec­u­tive vice pres­i­dent and chief fi­nan­cial of­fi­cer; and Dr. Lynn Si­mon, se­nior vice pres­i­dent-qual­ity and re­source man­age­ment.

Com­mu­nity also con­tends that it is near the in­dus­try av­er­age on what it says are more rel­e­vant, widely used met­rics, such as emer­gency room ad­mis­sion and dis­charge rates, length of stay and var­i­ous met­rics re­lated to one-day stays. Com­mu­nity’s anal­y­sis com­pared it not only to its in­vestor-owned

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