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Hospital assessment program produces winners and losers

Hospital assessment program produces winners and losers

The state’s updated hospital assessment program, which went into effect this month, could produce winners and losers among the more than 200 participating hospitals.

Nearly 60 hospitals have the potential to receive less in return payments than the amount they are assessed by the program, according to an analysis by Matt Werner Consulting provided to Health News Illinois.

However, the payment amounts could shift based on Medicaid utilization and rates negotiated between hospitals and managed care organizations, which now administer the bulk of the state’s Medicaid program.

Federal regulations no longer allow states to tell MCOs to pay hospitals specific amounts, according to Matt Werner.

“They can specify funds are for hospital services or even set rate floors but they can’t say pay hospital A $100,” he said. “The process is more complicated than when the last assessment plan was approved.”

Also, several hospitals are part of larger health systems, which could offset some of the expected losses.

According to initial estimates from the Department of Healthcare and Family Services, which Werner analyzed, Mount Sinai Hospital is set to net $143.4 million under the updated program, while the University of Chicago Medical Center could receive $110.5 million in net payments. Advocate Crist Medical Center is estimated to receive $93.2 million more than it pays.

Meanwhile, Edward-Elmhurst Health’s Edward Hospital is facing a $17.8 million loss and Cancer Treatment Centers of America – Midwestern Regional Medical Center is set to lose $15.6 million. NorthShore University HealthSystem could be down $12.6 million.

A spokesman for the Illinois Health and Hospital Association said he could not comment on specific hospital numbers but said IHA “supports the Department of Healthcare and Family Services as they move forward to implement the program.”

“We strongly believe that this newly redesigned assessment program will preserve access to healthcare for rural and urban communities, for vulnerable populations across the state,” Danny Chun said.

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