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AdventHealth To Manage Polk County Hospital
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AdventHealth will take over management of community-owned St. Luke's Hospital in Polk County in October.
The deal includes the Columbus hospital's satellite physicians offices and clinics. This serves as yet another addition to AdventHealth's growing presence in Western North Carolina's health care system.
St. Luke's is a 25-bed critical access hospital — a designation the Centers for Medicare and Medicaid give to hospitals that provide services to rural, underserved regions. In October, St. Luke's Hospital will officially become AdventHealth Polk.
Despite the hospital's name, St. Luke's Hospital had no religious affiliation prior to this deal with AdventHealth, a Florida-based nonprofit under the Seventh Day Adventist Church that operates 50 hospitals across nine states.
Atrium Health has managed the hospital for more than a decade. According to members of St. Luke's Hospital's board, Atrium Health is downsizing operations and taking less of an interest in managing rural hospitals.
St. Luke's Hospital and AdventHealth entered into a 20-year lease agreement, with an option to extend another 20 years at the end of the contract. Financial details are not yet available, with governmental and regulatory approvals still pending.
"We want to keep this hospital in our community for a long, long time, and this partnership with Advent helps us guarantee that we've got a hospital in our community for the next 40 years," Bill Miller, chair of St. Luke's Hospital's board of trustees, told Carolina Public Press.
"AdventHealth provided the best opportunity to meet our two goals: the first is that we are not interested in selling St. Luke's, and the second is that we don't want to turn into an urgent care."
AdventHealth has agreed to bring new service lines and expand health infrastructure in Polk County, according to Paul Beiler, who serves on the county Board of Commissioners and the hospital's board of trustees. The hospital launched an expanded cardiology program recently, and the board hopes that AdventHealth will continue progress in this direction.
AdventHealth spokesperson Victoria Dunkle says AdventHealth plans to build a new outpatient surgery center in Henderson County, which will increase access to surgical and physician care, as well as expanded lab and imaging services.
Beiler says AdventHealth is working with St. Luke's to retain as much of its staff as possible.
AdventHealth manages AdventHealth Hendersonville, formerly Park Ridge Health, in adjacent Henderson County, just 25 miles away from St. Luke's Hospital.
Polk County infrastructure is influenced by the area's unique geographical location. Polk County, just southeast of Henderson County along Interstate 26, straddles the Eastern Continental Divide. Columbus, the location of the hospital and the county seat, is in the highest part of the Piedmont, along with the neighboring town of Tryon. But to the west on the Henderson County line is Saluda, well into the mountains and roughly a 1,000 feet higher in elevation than the eastern Polk County towns.
"A lot of folks here in Polk County already go up the mountain, as we say, to Hendersonville to go to AdventHealth," Joshua Kennedy, Polk County Health and Human Services director, told CPP.
"So having those kinds of resources available here will be very beneficial, especially to our large population of older adults."
One focus in the boardroom has been on ensuring that some of the shared services between Henderson County and Polk County would be located in Polk, Belier said.
A partnership with AdventHealth will give St. Luke's access to economies of scale in terms of Advent's supplies and resources, according to county Health and Human Services director Kennedy.
"There is an inherent threat to rural hospitals in the medical world right now," Marche Pittman, Polk County manager, told CPP.
"Small rural hospitals cannot afford the risk of not being attached to bigger companies. St. Luke's has been doing relatively well in the last few years, but we do not want to take that chance."
Polk move expands presence in WNCNext month, AdventHealth plans to open AdventHealth Medical Group Multispeciality in Graham County, providing primary care, walk-in care, and imaging services, according to spokesperson Victoria Dunkle. Graham is located in the state's far southwestern corner on the Tennessee line and does not currently have its own hospital.
In 2025, AdventHealth plans to add 40,000 square feet of clinical space in Buncombe, Haywood, Transylvania, and Henderson counties, cementing the health system's position in Western North Carolina.
AdventHealth was selected by community members and approved by the state to open a 42-bed hospital in Weaverville, in Buncombe County north of Asheville. Advent purchased the land for the facility in March.
However, Tennessee-based hospital chain HCA has appealed that decision, delaying construction of AdventHealth Buncombe for at least two years.
For-profit HCA operates the Asheville-based Mission Health system, which owns hospitals in Buncombe, Transylvania, McDowell, Mitchell, Jackson and Macon counties, as well as other health facilities across the region.
"We strongly believe Mission Hospital can best meet Western North Carolina's growing need for complex medical and surgical care," Nancy Lindell, HCA spokesperson, wrote CPP in an email.
"Last year Mission accepted over 10,000 transfers from other hospitals because those patients needed services available only at Mission Hospital. Meanwhile, other hospitals in our region have unutilized beds, but they continue to send patients to Mission. We consider it a privilege to care for our region's sickest patients but need more beds to do so."
State Sen. Julie Mayfield, D-Buncombe, sees another motivation behind HCA's appeals.
"HCA likes its monopoly," Mayfield told CPP.
"They're going to do everything they can to hold onto it and keep any and all competition out of Western North Carolina. They win when they are the only thing in town. People have no other option, and they're taking advantage of that. My view is that they're not actually interested in keeping people healthy. Their interest is in getting us into their hospitals."
HCA is currently the target of lawsuits from the North Carolina Department of Justice and several Western North Carolina governments over alleged breaches of the company's obligations under its purchase agreement for formerly nonprofit Mission Health in 2019.
Advent Health's own operations in North Carolina have not been immune from controversy. Whistleblowers at its Hendersonville brought a federal lawsuit against the nonprofit in 2012 over fraud allegations, which was joined by multiple state governments and the U.S. Department of Justice. At the time Advent settled the lawsuit for more than $118 million in 2015, various news media reported that it was the largest settlement by a hospital group in history.
While Mission/HCA and Advent are two of major players in Western North Carolina health care, they are not alone. UNC Health operates Pardee Hospital and related facilities alongside Advent in Henderson County, as well as UNC Blue Ridge Hospital in Burke County, Caldwell Memorial in Caldwell County and multiple facilities under the Appalachian Health Care group based in Watauga County.
Duke Lifepoint has hospitals in Rutherford, Haywood, Jackson and Swain counties. Chattanooga-based Erlanger owns a hospital in Cherokee County. Atrium Wake Forest Baptist operates hospitals in Wilkes and Alleghany counties. The Eastern Band of Cherokee Indians has a tribal hospital in Swain County.
Correction: A new outpatient facility that AdventHealth is planning will be going in Henderson County. An earlier version of the article identified the wrong county, based on the information that was available at the time.
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Picketers Aim To 'send Strong Message' To Adventist Health
Lindsie HiattLindsie is your northern San Luis Obispo County community reporter, covering San Miguel, Paso Robles, Templeton, Atascadero and Santa Margarita.
A group of protesters from the Service Employees International Union (SEIU) picketed in front of Adventist Health Twin Cities - speaking out against low wages and high health care costs.
CT Scan and X-ray Technologist under Adventist Health, Anna Polanco, said the union is hoping to send a strong message to Adventist Health - which owns both Adventist Health Twin Cites and Adventist Health Sierra Vista.
"We're serious about keeping the same benefits that we've had for all of these years and remaining competitive when it comes to bringing in employees to work at this hospital. People are going to leave if it becomes more expensive to work their job," Polanco said.
According to the protesters, Adventist Health will now require employees to pay for their health benefits out of pocket. The workers didn't pay for this cost previously and say they're concerned because their wages are already low.
Adventist Health gave a statement in response, which said:
"Providing safe, high-quality care is our top priority at Adventist Health. Patient care is not impacted by today's event, and all services continue to be available. Adventist Health is proud of our commitment to providing competitive wages and benefits in all of our markets. We will continue to negotiate with SEIU in good faith and look forward to finding a solid path forward that will care for our valued associates and deliver exceptional-quality care to our patients."
Copyright 2024 Scripps Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Exploring The Role Of AI In Uniting RCM And Payment Integrity
The transformative potential of AI is a vision worth pursuing for healthcare's future.
CanvaIn today's healthcare environment, the convergence of Revenue Cycle Management (RCM) and payment integrity is a strategic necessity for both providers and payers. Historically, these functions have operated in silos, leading to inefficiencies, increased costs, and friction between stakeholders.
However, the advent of artificial intelligence (AI) is transforming this dynamic. By leveraging AI, healthcare organizations can look to bridge the gap between RCM and payment integrity, creating a unified, transparent, and efficient financial ecosystem that benefits all parties involved, including patients and plan members.
For healthcare leaders, the challenge is clear: harness AI to streamline financial operations, reduce administrative burdens, and foster greater collaboration between providers and payers. The opportunity lies in automating existing processes and reimagining how AI can integrate these functions to deliver long-term value and sustainability, which will benefit individuals as patients and plan members.
The Strategic Importance of Aligning RCM and Payment IntegrityThe future of our health system is strongly linked to how effectively we can collectively and synergistically help to simplify the business of care. Aligning RCM and payment integrity will play a key role.
RCM ensures efficient reimbursement for services, while payment integrity guarantees the correct disbursement of funds and compliance with policies and regulations. Without a cohesive strategy integrating these functions, the healthcare industry faces inefficiencies, financial losses, and administrative overload—issues that impact patients through higher costs and unpredictable care experiences.
According to the Healthcare Financial Management Association (HFMA), the average cost to rework a denied claim is close to $48 and $64 for Medicare Advantage and commercial plans, respectively. AI can help improve these challenges by automating complex processes, analyzing vast data, and enhancing collaboration between providers and payers.
The result is a more streamlined, transparent, and accurate financial transaction process that can transform the industry and provide clearer financial interactions for patients.
AI in Enhancing RCM for ProvidersRCM is central to a healthcare provider's financial stability. Ensuring timely and accurate reimbursement is crucial for maintaining operations and investing in patient care. AI enhances RCM by automating tasks traditionally prone to error, such as patient eligibility verification, coding accuracy, and claims processing.
Steve Roberts, CEO at Vyne, underscores the importance of AI in modernizing RCM: "As rising costs and staffing shortages confront organizations, they will increasingly look to artificial intelligence and automation to modernize and optimize their revenue cycle practices and operations."
By integrating AI into RCM, providers reduce payment delays, minimize denials, and improve cash flow, allowing them to focus more on patient care.
For patients, these improvements mean fewer billing errors, faster claim resolutions, and less time navigating complex medical bills. Quick, accurate claims processing provides patients with greater financial predictability and transparency.
Example: Predictive Analytics in RCMAI-driven predictive analytics can transform RCM. By analyzing historical claims data, AI identifies patterns and predicts claim approval or denial, allowing providers to adjust billing practices proactively. AI has the potential to significantly reduce claim processing time and lower denial rates, bringing greater financial benefit and stability for providers and reducing patients' wait times for claim resolution.
AI in Strengthening Payment Integrity for PayersFor payers, ensuring accurate disbursements and maintaining compliance with regulatory standards is critical to financial integrity. The integration of AI into payment integrity processes offers a powerful solution by automating claim reviews, identifying errors, and ensuring alignment with the true cost of care. The scope of payment integrity extends beyond basic claim verification; it is about reducing fraud, waste, and abuse (FWA) while enhancing the efficiency of financial operations.
Fraud, waste, and abuse represent significant financial drains on the healthcare system. According to JAMA, roughly 25% of annual healthcare spending in the U.S. Is considered wasteful, with 3-10% attributed to fraudulent and abusive billing practices.
This highlights the urgent need for AI-driven solutions that can provide real-time insights into claims data, detect anomalies that human reviewers might miss, and ensure that every dollar spent is aligned with legitimate care costs.
For example, in the Medicare and Medicaid sectors alone, more than $100 billion in improper payments were made in fiscal year 2023, according to the U.S. Government Accountability Office (GAO). AI's ability to analyze vast datasets and cross-reference them against payer policies and historical data positions can be a crucial tool in reducing errors and improving payment accuracy and efficiency—while reducing related administrative costs.
The application of AI in payment integrity results in tangible benefits for plan members. As payers achieve higher precision in claims processing, members experience fewer denied claims, quicker resolution times, and clearer benefit explanations, reducing the likelihood of unexpected costs. This improves the members' experience and builds greater levels of trust.
Bridging RCM and Payment Integrity: The Unifying Power of AIAI offers a unique opportunity to bridge traditionally separate RCM and payment integrity functions, creating a more cohesive financial ecosystem. Integrating AI across RCM and payment integrity ensures every transaction step—from claim submission to payment authorization—is streamlined, accurate, and transparent.
AI-Driven Data Sharing and TrustA significant barrier to aligning RCM and payment integrity has been the lack of data sharing and transparency between providers and payers. AI overcomes this by enabling real-time data sharing, providing insights for aligned processes. For example, AI can analyze payer requirements and provide providers with up-to-date coding and documentation guidelines, reducing errors and denials and ensuring smooth claim processing.
This ensures patients' providers have the latest information, reducing delays or unexpected costs due to errors.
Building Trust Through AI-Enabled TransparencyTrust is foundational to successful provider-payer relationships. Historically, a lack of transparency around payment integrity policies and rules has eroded this trust, leading to disputes, delays, and inefficiencies. AI rebuilds this trust by making payment integrity rules more transparent and accessible, allowing providers to align coding and billing practices with payer expectations.
Example: AI-Powered Transparency in Payment PoliciesImagine a health plan using an AI platform to create a dynamic, real-time database of payment integrity rules that providers can access anytime. This resource would include detailed payer-specific coding requirements, documentation standards, and payment policies. Integrating this into RCM ensures compliance with the latest guidelines, reducing denials and speeding reimbursements. It results in fewer denied claims, fewer disputes, and clearer financial obligations for patients.
AI-Driven Innovation: Transforming RCM and Payment IntegrityAI's integration into RCM and payment integrity is about more than automating tasks—it transforms how these functions interact and deliver value. By harnessing AI, healthcare organizations can move from reactive to proactive, strategic operations, benefiting all stakeholders, including patients and plan members.
AI in Optimizing Financial OperationsAI's predictive analytics in RCM identify trends in claims data, optimizing billing practices and reducing errors. Automating prior authorizations reduces approval times, improving service delivery and patient satisfaction.
AI in Enhancing Payment Integrity and Reducing CostsAccording to a recent McKinsey study, the authors stated the following on AI related to payment integrity:
Analytical AI, machine learning (ML), and gen AI have the potential to transform many industries, including healthcare. The effects could be particularly profound in payment integrity because PI capabilities depend on the rapid review and synthesis of a variety of data sources.
Furthermore, even relatively small increases in accuracy and efficiency of claims adjudication can represent substantial financial impact for a range of healthcare stakeholders because of the complexity and scale of the US healthcare payments ecosystem.
AI enhances payer payment integrity by providing real-time validation, detecting fraud, and ensuring policy compliance. Reducing overpayments and fraud protects payers financially and contributes to a sustainable healthcare system.
Building Better Bridges: AI as the Path ForwardAI integration across RCM and payment integrity is a strategic imperative for healthcare organizations in an increasingly complex environment. Leaders must align these critical functions to foster collaboration, transparency, and trust.
By prioritizing data sharing, leveraging AI-driven insights, and embracing transparency, healthcare organizations can create a financial ecosystem that is resilient, efficient, and valuable to all stakeholders, including those who rely on their services.
The convergence of RCM and payment integrity through AI redefines financial operations, offering enhanced financial stability, improved patient experience, stronger compliance, and strategic growth. AI integration represents a vision for a more efficient, transparent, and patient-centered healthcare system.
Organizations must commit to innovation, collaboration, and continuous process improvement through AI to achieve this. By embracing this unified approach, healthcare providers and payers can navigate industry complexities confidently, positioning themselves to meet future challenges and opportunities.
Aligning RCM with payment integrity through AI is about more than operational excellence—it's about building a sustainable, future-ready healthcare system that benefits providers, payers, patients, and plan members alike.
This vision demands bold leadership, strategic foresight, and a deep understanding of AI's transformative potential—a vision worth pursuing for healthcare's future.
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