Executives at some of the big for-profit health systems were not shy about discussing "increasingly aggressive behavior" from insurers during recent financial results calls.
"We think it's excessive and inappropriate," Dallas-based Tenet Healthcare Saum Sutaria, MD, said on the company's Oct. 30 third quarter earnings call, according to a transcript from Seeking Alpha. "And we continue to work on our appropriate documentation, both for us and obviously with Conifer for all of our clients in order to push back on the volume of clinical denials on the basis of having excellent documentation, and we think that's the right path out of that." Conifer is the system's revenue cycle management division.
His comments followed complaints from King of Prussia, Pa.-based Universal Health Services, whose executives were similarly vocal in their criticisms.
"We recognize the need to counter the increasingly aggressive behavior on the part of our payers and seek appropriate price increases to offset the impact of inflation on our cost structure and to seek further contractual protection to ensure we are properly reimbursed for the level of care provided to our patients," Marc Miller, UHS CEO, said on an Oct. 26 conference call to discuss the system's third-quarter financial results.
UHS CFO Steve Filton backed Mr. Miller up, highlighting the back and forth over how patients should be classified when they are in hospital facilities, whether they are under observation or admitted as inpatients.
"We note that managed care behavior has become more aggressive in 2023 as it relates to denials and patient status classification changes," he said. "This is frustrating for us because a lot of these patients are in the hospital for multiple days."
The comments come against the backdrop of increasing controversy over the Medicare Advantage program. A growing number of facilities across the country will not accept some or all MA patients in the new year, citing excessive prior authorization denial rates and slow payments from insurers.
"It's become a game of delay, deny and not pay,'' Chris Van Gorder, president and CEO of San Diego-based Scripps Health, previously told Becker's. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed."
That said, CFO Kevin Hammons of Franklin, Tenn.-based Community Health Systems said on the for-profit system's Oct. 26 earnings call they are seeing a continued shift out of traditional Medicare into Medicare Advantage, "and that always continues to pressure the revenue, because we collect less on MA compared to traditional fee-for-service."
CHS reported a net loss of $91 million for the third quarter with changes in the payer mix cited as a contributing factor in the healthcare system's continuing financial challenges.