IPPS Final Rule Federal FY14
2 Midnight Rule
Potential Impact on Revenue
Observation Cases by Hospital
LOS
6.4% of
Observation
cases have LOS >
48 Hours
Cases
Hours
Charges
0 - 24
72,361
1,121,498 Avg 15.5
$245.1 M
25 - 48
45,054
1,629,691 Avg 36.2
$244.6 m
> 48
8,027
535,699 Avg 66.7
$68.1 M
Total
125,442
3,286,888 Avg 26.2
$557.8 M
12 Months ended March 2013
2
Observation Cases by Payor
LOS
Cases
Hours
Charges
MC
44,935
1,298,347 Avg 28.9
$211.4 M
MA
22,688
578,299 Avg 25.5
$96.5 M
Other
57,819
1,410,242 Avg 24.4
$249.9 M
Total
125,442
3,286,888 Avg 26.2
$557.8 M
3
Excess > 48 Hours Observation Charges
12 Months ended March 2013
Cases
Up to
48
Hours
Cases
w/
Excess
Hours
Allowed
OBV $
Excess
OBV $
MC
41,768
3,167
$91.8 M
$4.5 M
MA
21,008
1,680
$41.6 M
$2.5 M
Other
54,639
3,180
$103.6 M
$4.2 M
Total
117,415
8,027
$237.0 M
$11.2 M
4
Excess Observation Charges
Maryland Statewide Observation Data Cases > 48 Hours
All Payers
Period: April 2012 - March 2013
Hospital
PG
GBMC
Bon Secours
Southern MD
Howard County
Wash Cty
UMMC
JH Bayview
Maryland General
BWMC
St Agnes
Shady Grove
Carroll Hospital Ctr
Frederick
Fort Washington
St. Mary's
Civista
Wash Adv
Peninsula
Easton
Montgomery
Suburban
St Joe's
Union of Cecil
Dorchester
Laurel Regional
Calvert
Holy Cross
Atlantic General
Mercy
Doctors
Sinai
Garrett
Anne Arundel
Chester River Hospital
Franklin Sq
Northwest
Harbor
Western MD
UM Cancer Center
JHH
McCready
Harford
Union Memorial
Good Sam
UM Shock Trauma
Upper Chesapeake
Grand Total
Total
Per Case
Case
OBV Hours
OBV
Hours up
OBV
OBV Hours
OBV
to 48
Hours > 48
up to 48
Hours > 48
3,664
710
92,618
44,592
4,698
558
113,952
35,265
1,024
342
29,637
22,629
3,616
449
92,441
28,365
3,098
333
80,828
24,994
5,406
489
101,970
34,043
4,404
292
85,596
19,851
2,914
331
78,046
22,107
2,518
314
57,688
18,999
5,189
449
117,357
30,982
4,150
366
97,618
23,088
3,595
243
82,994
16,060
2,917
256
68,861
15,776
2,031
339
44,089
27,719
959
252
26,741
16,286
1,670
329
43,102
23,882
1,940
182
48,055
11,078
1,295
174
34,704
11,325
1,677
284
41,845
19,664
734
187
17,458
15,126
2,200
174
48,753
10,907
2,947
75
58,752
4,457
1,504
115
32,635
7,120
1,176
91
26,240
5,569
395
72
9,270
7,388
907
102
21,798
6,469
1,127
47
27,866
2,623
5,292
88
119,344
5,121
1,216
51
25,891
3,069
1,252
60
22,797
3,773
3,570
62
64,290
3,625
1,032
49
21,417
3,109
453
59
10,994
3,672
2,010
18
38,799
1,350
263
34
6,642
2,382
8,379
14
251,074
859
381
10
8,798
578
3,083
12
97,206
805
3,697
5
66,386
258
54
3
1,122
183
3,345
2
37,759
189
174
2
3,633
120
2,378
1
69,085
96
3,633
2
90,516
146
3,832
81,890
15
247
5,601
152,385
117,415
8,027
2,751,189
535,699
125,442
OBV Charges
TOT_CHG
OBV Hours up
to 48
$
7,957,409
$
9,182,655
$
3,219,140
$
6,819,175
$
7,774,864
$
5,998,808
$
7,930,105
$
6,391,411
$
4,666,357
$
6,654,585
$
6,563,590
$
7,354,296
$
5,642,519
$
2,683,010
$
2,061,141
$
2,277,616
$
4,230,250
$
2,793,699
$
1,918,238
$
1,237,463
$
2,725,598
$
6,209,220
$
2,159,374
$
2,172,312
$
739,009
$
1,104,540
$
2,779,958
$
6,482,424
$
2,444,506
$
1,650,658
$
3,876,309
$
1,503,772
$
399,885
$
3,916,623
$
347,189
$ 16,328,901
$
559,998
$
5,099,857
$
4,684,709
$
102,024
$
4,134,560
$
304,693
$
6,730,442
$
5,292,548
$
5,092,291
$
23,053
$ 17,776,831
$ 207,997,614
OBV Hours >
48
$ 3,908,521
$ 2,843,730
$ 2,455,728
$ 2,079,773
$ 2,430,470
$ 2,008,485
$ 1,865,400
$ 1,816,072
$ 1,558,355
$ 1,741,524
$ 1,558,104
$ 1,493,792
$ 1,305,429
$ 1,695,422
$ 1,230,458
$ 1,271,586
$
989,983
$
922,887
$
901,530
$ 1,057,372
$
625,903
$
468,058
$
477,577
$
449,717
$
566,016
$
317,484
$
265,871
$
274,261
$
267,301
$
281,319
$
214,554
$
217,623
$
145,960
$
134,040
$
125,953
$
63,261
$
36,876
$
37,170
$
19,709
$
17,376
$
22,357
$
10,799
$
9,504
$
6,295
$
1,771
Allowed OBV Charges
OBV Hours >
48
$ 7,194,870
$ 4,368,207
$ 4,074,355
$ 3,522,429
$ 3,430,921
$ 3,493,753
$ 3,070,884
$ 2,997,036
$ 2,844,413
$ 3,136,350
$ 2,726,924
$ 2,156,435
$ 2,014,977
$ 3,018,434
$ 1,889,828
$ 2,283,000
$ 1,490,213
$ 1,417,611
$ 2,005,873
$ 1,717,505
$ 1,238,487
$
772,615
$
917,496
$
708,100
$
907,772
$
790,863
$
441,680
$
523,737
$
545,912
$
546,856
$
371,060
$
360,132
$
310,305
$
172,808
$
246,161
$
99,474
$
66,955
$
78,120
$
29,651
$
70,400
$
28,353
$
20,732
$
12,199
$
13,158
$ 40,189,607
OBV Hours up
to 48
$ 20,119,466
$ 19,999,928
$
7,323,978
$ 16,268,110
$ 14,886,080
$ 14,555,213
$ 23,533,762
$ 14,005,681
$ 11,770,417
$ 18,251,026
$ 19,967,992
$ 15,968,920
$ 12,048,864
$
7,024,828
$
3,883,057
$
5,743,169
$
8,319,347
$
6,883,358
$
6,601,513
$
3,014,409
$
8,501,853
$ 13,702,529
$
6,420,187
$
4,844,408
$
1,613,213
$
4,011,424
$
5,650,437
$ 16,085,436
$
7,163,524
$
5,189,466
$
9,550,736
$
4,133,343
$
1,348,817
$
7,622,390
$
987,307
$ 34,877,859
$
1,402,690
$ 12,833,549
$ 10,990,305
$
306,020
$ 11,329,852
$
952,160
$ 12,720,144
$ 14,394,709
$ 12,629,898
$
117,398
$ 30,147,576
$ 489,696,347
$
$
$
5,007
4,171
$ 68,127,044
150,403
$ 11,176,715
OBV Hours up
to 48
$
7,957,409
$
9,182,655
$
3,219,140
$
6,819,175
$
7,774,864
$
5,998,808
$
7,930,016
$
6,391,411
$
4,666,357
$
6,654,585
$
6,563,590
$
7,354,296
$
5,642,459
$
2,683,010
$
2,060,860
$
2,277,616
$
4,230,250
$
2,793,699
$
1,918,238
$
1,237,463
$
2,725,598
$
6,209,220
$
2,159,374
$
2,172,312
$
739,009
$
1,104,540
$
2,779,958
$
6,482,424
$
2,444,506
$
1,650,658
$
3,876,309
$
1,503,772
$
399,885
$
3,916,623
$
347,189
$ 16,328,901
$
559,998
$
5,099,857
$
4,684,709
$
102,024
$
4,134,560
$
304,693
$
6,730,442
$
5,292,548
$
5,092,291
$
23,053
$ 17,776,831
$ 207,997,185
OBV
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Hours > 48
2,979,162
2,159,672
1,783,159
1,579,999
1,554,738
1,386,562
1,313,220
1,305,391
1,236,397
1,211,898
1,186,220
1,075,050
1,015,647
994,248
913,992
844,618
779,137
680,233
625,056
623,502
481,547
378,073
369,066
351,984
271,055
240,198
227,784
226,447
214,451
214,112
175,904
164,626
112,080
85,649
84,215
50,740
30,545
25,184
18,313
13,678
11,356
8,639
4,752
4,595
29,012,892
8,487
$ 248,187,221
$ 557,823,391
$
$
1,979
Excess Hours
10,512
8,481
6,213
6,813
9,010
10,571
5,835
6,219
3,927
9,430
5,520
4,396
3,488
11,447
4,190
8,090
2,342
2,973
6,032
6,150
2,555
857
1,600
1,201
3,932
1,573
367
897
621
893
649
757
840
486
750
187
98
229
18
39
93
24
48
50
Excess OBV
Charges
$
929,360
$
684,058
$
672,569
$
499,773
$
875,732
$
621,923
$
552,180
$
510,682
$
321,959
$
529,626
$
371,884
$
418,742
$
289,782
$
701,174
$
316,465
$
426,968
$
210,846
$
242,654
$
276,474
$
433,869
$
144,357
$
89,986
$
108,511
$
97,733
$
294,961
$
77,286
$
38,088
$
47,814
$
52,851
$
67,207
$
38,650
$
52,997
$
33,880
$
48,391
$
41,738
$
12,520
$
6,332
$
11,986
$
1,396
$
3,698
$
11,001
$
2,160
$
4,752
$
1,701
4,447
5
Maryland Revenue Implications
• Overall there is minimal revenue impact to the system
All Payers
Medicare
IP ODS to OBV $35,185,521
$13,723,941
OBV to IP
$(28,834,429)
$(12,201,621)
Net Impact
$6,351,902
$ 1,522,321
- The Observation Hourly Rate and Rate realignment shifts
are driving this impact
• See Attached for Hospital Specific Impacts
For the twelve months ended March 2013
6
Maryland Revenue Implications
• IP ODS cases that should convert to Observation
Total
Stay
as IP
ODS
IP Only Surg Proc
Deaths
AMA
Trans Out
All Payers
IP ODS
IP ODS
108,683
$ 693,902,610
(25,560)
(2,409)
(3,898)
(4,024)
72,792
$ (331,039,175)
(9,700,212)
(16,327,029)
(13,257,003)
$ 323,579,191
Medicare & Medicare HMO
IP ODS
IP ODS
37,707
$ 238,519,082
(8,336)
(1,505)
(1,777)
(965)
25,124
$ (112,485,650)
(6,314,830)
(7,597,462)
(3,395,373)
$ 108,725,767
Re-price at Current OBV Rate
$ 358,764,712
$ 122,449,708
Net Increase at Current OBV Rates
$ 35,185,521
$ 13,723,941
For the twelve months ended March 2013
If these cases stay
IP, Hospital is at
risk for denials
and RAC review
7
Maryland Revenue Implications
• OBV Cases that become IP (assumed OBV LOS 36+ hours)
Medicare & Medicare
HMO
OBV
OBV
All Payers
OBV
OBV
Total
125,427 $ 557,778,273
44,935 $ 211,419,673
LOS less than 36 Hours
94,079 $ 348,337,113
30,828 $ 118,398,100
LOS 36 + Hours
31,348 $ 209,441,159
14,107 $ 93,021,573
$ 180,606,731
$ 80,819,952
$ (28,834,429)
$ (12,201,621)
Reprice as IP
Net Decrease as IP
Will Other Payers adopt
the same policy?
For the twelve months ended March 2013
These cases admitted to IP
on Day 2 and bill OBV hours
from day 1 and IP Day from
Day 2 on Part A Bill
8