Hartford Business Journal

HARTFORDBUSINESS.COM | JULY 24, 2023 17 Kainen, Escalera & McHale is a full-service employer defense law firm committed to providing outstanding representation and personalized legal services to each of our clients. We welcome the opportunity to serve your business. 21 Oak Street, Suite 601, Hartford, CT 860-493-0870 | www.kemlaw.com | Attorney Patrick J. McHale is responsible for the content of this advertisement. Your workplace is our business. SM nationwide that has caught the atten- tion of federal policymakers. A 2022 report from the federal inspector general's office of the U.S. Department of Health and Human Services concluded there were widespread and persistent problems related to inappropriate denials of services to patients and payments to providers by Medicare Advantage organizations, prompting the need for greater industry oversight. State regulators are also looking into the issue, according to Dr. Deidre Gifford, executive director of the Connecticut Office of Health Strategy. A law passed during the most recent legislative session calls for a report to state lawmakers on Medi- care Advantage provider payment practices, including the impact on the costs to hospitals. Joan W. Feldman, a partner with law firm Shipman & Goodwin and chair of its health law practice group, represents health- care institutions in Connecticut, but not Bristol Health. According to Feldman, reimbursement by commer- cial and government payers has not kept pace with the cost of providing high-quality health care, putting pressure on providers, particularly smaller, independent hospitals. "Without the ability to achieve econ- omies of scale and share resources, standalone community hospitals will continue to be financially chal- lenged," Feldman said. "Instead of trying to regulate (health) provider costs, greater focus should be on the adequacy of provider reimbursement for its reasonable costs." Righting the ship Bristol Health in recent months has been working with two national healthcare consulting firms — Illi- nois-based Impact Advisors and New York-based ToneyKorf Partners LLC — to address its financial issues. It has received several recom- mendations and has already begun implementing corrective actions. Barwis indicated the health network is seeing early positive results, noting that May 2023 was "cash positive." One recommendation was an evaluation of the health system's effi- ciency with scheduling patients and doctors. The network is also looking at improving its billing and collection processes and evaluating its labor force needs. "A lot of organizations will just say, 'I will cut my way to a bottom line, I am just going to lay off all these people.' But we are not doing that," Barwis said. Instead, leaders throughout the organization are evaluating staffing ratios to optimize the workers it has, Barwis said. He noted that staffing shortages are still an issue. One recommendation involves using artificial intelligence to reduce the number of insurance payment denials, including those related to Medicare Advantage claims. "A lot of insurance companies now use AI to just trigger and find anything to deny payments," Barwis said. Artificial intelligence can write an appeal letter in seconds, and handle many more appeals in an hour than humanly possible, he noted. "We are in the process now of likely being the first hospital in the state of Connecticut to actually use AI in that fashion," Barwis said. "I'm not aware of anyone else. We are in the process of kicking the tires." Using AI potentially will mean more insurance money for the health system, and freeing up time for staff to spend on other duties, he noted. "As a small organization, we don't have significant resources to deal with all the challenges that the insurance companies now present," Barwis said. "Our physicians are spending too much time fighting to get patients what they need." Partnerships 'always an option' When asked if Bristol Health would consider a merger with a larger health system to solve its financial woes, Barwis said that has always been an option. Consolidation can result in cost savings through sharing of resources and administrative costs. "We have never not contemplated the need to enter into a partnership," Barwis said. In the past, Bristol Health has engaged in conversations with Yale, but a deal ultimately fell apart, according to Barwis. Pursuing any potential future merger would be up to Bristol Health's board of directors. However, he noted Bristol Health needs to improve its financial position before any merger would even be an option. "Because of the financial downturn in our industry, it has been horrible for the last two years," Barwis said. "No one is doing a deal with a hospital that loses money. When you join an organization, you have to add value." "So, one way or the other, we have to turn this place into a financially sustainable model," he added. Bristol Health had similar financial challenges around the 2008 financial crisis, Barwis said, and survived. Since that time, it has added more services, improved quality and invested in its facilities. He pointed to projects such as a new emergency department and upgraded HVAC systems. Barwis said Bristol Health has continued to build its core services, including adding specialists in areas such as endocrinology, psychiatry and rheumatology. "We are going to fix financial performance, and we will grow stronger from it, as we always have in the past," Barwis said. "We aren't going anywhere." Joan Feldman Bristol Hospital's new emergency department was financed, in part, by a 2019 bond offering that totaled $34.6 million. HBJ PHOTO | STEVE LASCHEVER BRISTOL HEALTH'S DAYS CASH ON HAND FY 0 30 Bristol Health Statewide average 60 90 120 150 2018 2019 2020 2021 2022 Source: Office of Health Strategy No. of days

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