MHA Update
HFMA
Insurance & Reimbursement
Committee
May 21, 2013
Vickie R. Kunz
Senior Director
Health Finance
1
Who is the MHA?
• Advocacy organization representing all hospitals in
Michigan.
• Services include:
– State advocacy on proposed legislation, including
Medicaid funding and policy activities
– Federal advocacy and policy on Medicare and
Medicaid issues
– MHA Keystone Center – Quality Improvement
Initiatives
– BCBSM Contract Administration Process
• Unique to Michigan
2
Payer Issues
• Hospitals are reminded that a role of the
MHA is to assist in resolving systematic
payer issues.
• Hospital contracts determine many
terms and conditions and take
precedence.
• Communicate issues to Marilyn LitkaKlein or Vickie Kunz at the MHA.
3
Medicare
•
•
•
•
IPPS & LTCH Proposed Rules
IRF Proposed Rule
SNF Proposed Rule
Medicare Advantage
4
IPPS Proposed Rule Overview
•
Rate update = +0.5 percent
•
Limited coding adjustments
•
Medicare DSH policy changes
•
Inpatient admission guidance
•
VBP Program: FY 2016-2019 program proposals
•
Readmissions Reduction Program: FY 2014 and 2015
proposals
•
HAC Reduction Program: FY 2015 proposals
•
IQR Program updates voluntary EHR-based reporting
•
Expiration of low-volume adjustment criteria and MDH program
5
IPPS Proposed Rule
• For hospitals that comply with IQR requirements,
overall rate change after budget neutrality is a net 0.5
percent increase comprised of:
↑ Plus 2.5 percent marketbasket increase
↓Minus 0.4 percentage point productivity adjustment
↓Minus 0.3 percentage point ACA-mandated adjustment
↓Minus 0.8 percent ATRA-mandated coding adjustment
↓Minus 0.2 percent offset for - IP admission guidance
↓Minus 0.3 percent budget neutrality adjustment
This excludes the impact of the 2 percent sequester.
6
Retrospective Coding Adjustment
• The American Taxpayer Relief Act
(ATRA) included a coding reduction of
$11 billion (or 9.3%) over four-years.
• This authority allows CMS to
retroactively recoup for increases in IP
payments that the agency believes
occurred during FY 2008 – 2013 solely
due to hospital coding improvements.
7
Cont., Coding Adjustment
• For FY 2014, the CMS proposes to phase-in the
implementation with a 0.8 percent reduction.
 The adjustment will need to increase in the subsequent three
years in order for the CMS to recoup the mandated amount.
 ATRA analysis distributed to hospitals Jan. 10 indicates a
cut of nearly $437 million to Michigan IPPS payments during
FY 2014 – 2017.
8
Payment Rate Update
Federal Operating
and Hospital-Specific
Rates
Federal Capital Rate
Marketbasket (MB) Update/Capital Input Price
Index
+2.5%
+0.9%
ACA-Mandated Productivity MB Reduction
-0.4%
—
ACA-Mandated Pre-Determined MB Reduction
-0.3%
—
American Taxpayer Relief Act (ATRA)-Mandated
Retrospective Coding Adjustment Reduction
-0.8%
—
Inpatient Admission Guidance Offset
-0.2%
-0.2%
Net Rate Change
(EXCLUDING BUDGET NEUTRALITY)
+0.8%
+0.7%
9
Standardized Operating Amounts
For Hospitals with an Area Wage Index
Greater Than 1.0
(69.6 Percent Labor Share / 30.4 Percent Non-Labor Share)
Full Update
LaborRelated
NonlaborRelated
Reduced Update
LaborRelated
$3,741.72 $1,634.32 $3,668.21
NonlaborRelated
$1,602.21
10
Standardized Operating Amounts, cont’d.
For Hospitals with an Area Wage Index
Less Than or Equal to 1.0
(62.0 Percent Labor Share / 38.0 Percent Non-Labor Share)
Full Update
LaborRelated
NonlaborRelated
Reduced Update
LaborRelated
NonlaborRelated
$3,333.14 $2,042.90 $3,267.66 $2,002.76
11
Capital Payment Update
• Proposed federal capital rate of $432.03, up from the
current $425.49.
– a 1.5 percent increase.
12
MS-DRGs
• No major changes made for FY 2014.
• CMS proposes to maintain the current
751 MS-DRGs.
• 85% of MS-DRGs will have weight
change of +/- 6%.
• See Table 5 in final rule for Excel file
containing relative weights.
13
Cont., MS-DRGs
• See May 6 Monday Report article which
includes a link to an Excel file which
compares current to proposed relative
weights.
• Also see MHA Advisory Bulletin # 1344 in
May 6 Weekly Mailing.
• Hospitals can use their inpatient claims
analysis distributed November 2012 to
estimate impact of updated MS-DRG
weights.
14
Impact on Top MS-DRGs
MS-DRG
Medicare
Discharges
Description
% Change
470
16,847
Major Joint Replace/Reattachment Lower
Extremities w/o CC/MCC
↑2.7%
871
15,548
Septicemia w/o MV96+ hours with MCC
↓ 1.3%
392
10,047
Esophagitis, Gastro & Misc Digest
Disorder w/o MCC
↓ 0.5%
292
9,124
Heart failure & shock with CC
↓ 0.8%
291
8,989
Heart failure & shock with MCC
↓ 0.7%
15
Cost Outlier Threshold
• Final 2013 threshold:
• Proposed 2014 threshold:
$21, 821
$24,140
• Represents a 10.6% increase in the cost
outlier threshold, resulting in fewer cases
being eligible for outlier payments.
• Threshold is adjusted annually based on
CMS’ projections for total outlier payments to
ensure that total outliers payments equal 5.1
percent of total IPPS payments.
16
DSH & IME Payments
• CMS proposes to include days for labor & delivery
services in the Medicare GME payment adjustment
calculations for cost reporting periods beginning
on/after Oct. 1, 2013.
– This policy would reduce GME payments to hospitals and
may impact the eligibility of hospitals seeking SCH status.
• CMS recently adopted this policy change for the
Medicare DSH purposes.
17
Cont. DSH Changes
• CMS proposes to readopt its policy of
counting the days of patients enrolled in
MA plans in the Medicare fraction of the
traditional DPP percentage.
• CMS is appealing a recent court ruling
that disallowed the inclusion of these
days.
18
Medicaid SSI Category
• MSA recently announced that data is now available
for hospitals to validate their SSI ratio data provided
by CMS and used for Medicare DSH payment
calculations.
• Hospitals often find Medicaid patient days that are
not included in CMS file for individuals approved for
Michigan Medicaid in SSI category.
• Potential to increase Medicare DSH payments.
• See MHA Advisory Bulletin #1343 from May 6 WM.
19
FTEs at CAHs
• For purposes of IME and GME
payments, a hospital may not claim FTE
resident training that occurred at a CAH.
• However, if the CAH itself incurs the
costs of training, then the CAH may
receive 101% of the reasonable cost
incurred for resident training.
20
Expiring IPPS Provisions
• These provisions were extended by the
ATRA. Absent subsequent federal
legislation, these expire Sept. 30, 2012:
– Low volume adjustment
• Estimated $10.7 M increase to Michigan IPPS
payments in FY 2013.
– Medicare Dependent Hospital Status
• Estimated $1.2 M increase to FY 2013
payments.
21
Wage Index
• No major changes for calculating the wage indexes,
rural floor budget neutrality or administrative
reclassification rules.
• FY 2014 index based on hospital data from CRs
ending during FY 2011 and occupational mix data
from the calendar 2010 survey.
• National FY 2014 occupational-mix adjusted average
hourly wage: $38.3620.
• See link to Michigan AWI values in A/B #1344.
22
Labor Related Share
• Hospitals with an AWI > than 1.0:
– Slight increase from 68% to 69.6%
• Will result in a positive impact on hospitals
• Hospitals with AWI < or =1.0:
‒ By law, remains at 62%.
23
CBSA Definitions
• CMS does not propose to make any
changes to the current CBSA definitions
based on the 2010 census but indicates
that it will likely do so for FY 2015.
24
Occupational Mix Survey
• CMS required to collect data every three
years on the occupational mix of employees
for PPS hospitals participating in Medicare.
• 2010 survey data used for FY 2014.
• Hospitals completed and submitted the
revised survey by July 1, 2011.
25
Wage Index Timeline
• May 3 – CMS release of updated PUFs
• May 8 – MHA distribution of hospital-specific wage
and occupational mix worksheets that compare data
from May CMS file to that from February file.
• June 3 – Deadline for hospitals to submit correction
requests to both CMS and their FI/MAC.
• Oct. 1, 2013 – Effective date of FY 2014 AWI
• Early Oct. 2013 – Release of PUF for FY 2015 AWI
• Mid-to-Late Oct. 2013 – MHA Wage Index Workshop
(webinar)
• FY 2015 AWI will use data from cost report FYEs:
– Oct. 2011 – Sept. 2012
26
Overview: ACA DSH Changes Medicare
Current DSH $ ($11 B)
25%
Paid Under Traditional
Method
75%
Dedicated to New
Pool
Step 1:
Reduce Pool
[relative to insurance pick
up rates]
Step 2:
Distribute Pool
[base on uncompensated
care]
27
Medicare DSH Proposals:
Reductions
• By the numbers:
– Estimated total DSH funding for FY 2014 = $12.3 B
– Estimated 25% rate-based and paid under traditional formula = $3.1 B
– Estimated 75% for uncompensated care payments = 9.3 B
• Proposal for reducing funding dedicated to uncompensated
care payment:
– Use CBO’s March 2010 and February 2013 insurance rate
estimates
• FY 2013 = 18% uninsured
• FY 2014 = 16% uninsured
– Result = 11.2% reduction; amount for uncompensated care
payment = $8.2 B (about $1.0 B cut)
• [(16% / 18% - 1) = 11.1% plus legislated 0.1 percentage point = 11.2%]
28
Medicare DSH Proposals
Redistributions
• Proposal for distributing funding dedicated to
uncompensated care payment:
– Use low-income patient days as proxy
• Medicaid days and Medicare SSI days
• numerators of current DSH % calculation
– CMS may use cost report worksheet S-10 in future years
• Cites unreliable data as decision to use proxy
– Calculate uncompensated care payment factor
• Hospital's low-income patient days relative to all DSH hospital low-income
patient days
29
Cont., DSH Changes
• Projected changes would reduce Medicare DSH
payments to Michigan hospitals by $57m.
• $31 million due to total $1 billion cut
• $26 million cut due to methodology change
• Pending legislation to delay for 2 years.
30
Medicare Proposed Changes to Inpatient Status
• Proposal for patient to spend two midnights in
hospital
– RAC would “presume” these are ok
• Anything less than 2 two midnights would be
outpatient, unless documentation in medical
record supports need for inpatient care
– These have been most of RAC denials nationally
• CMS impact is $220 million increase, the 0.2%
reduction included in inpatient operating rate.
31
Readmissions Reduction Program
• Established by the ACA and designed to
reduce Medicare inpatient payments for acute
care hospitals with higher than expected riskadjusted readmission rates related to certain
conditions.
– CAHs are excluded.
• Began Oct. 1, 2012 (FY 2013)
• Medicare payment reduction increasing from
1 percent to 2 percent in FY 2014 and then
increasing to 3 percent in FY 2015.
32
Cont., Readmissions Reduction
• Uses 3 years of data from an updated 3-year period
to calculate readmission rates.
– July 1, 2009 – June 30, 2012
• Defines a readmission as a hospital admission within
30 days from the date of discharge from the index
hospital (the initial hospitalization hospital)
• Hospitals either maintain full payment levels or be
subject to payment penalty of up to 2% in FY 2014
for all IPPS discharges if readmission rate higher
than national average for 3 medical conditions.
33
Cont., Readmissions Policy
• CMS proposes to modify the calculation
of readmission rates to better account
for planned readmissions.
– Expected to reduce current national AMI
readmissions rate by 1 percentage point.
– Expected to reduce heart failure readmissions rate
by 1.5 percentage points.
– Expected to reduce pneumonia readmissions rate
by 0.7 percentage points.
34
Cont., Readmissions Reduction
• CMS is using the following measures,
currently included in the hospital IQR
program and collected from Medicare
FFS claims data, for use in FY 2014:
– Acute Myocardial Infarction
– Heart Failure
– Pneumonia
35
Cont., Readmissions
• Starting with FY 2015, CMS has the
authority to expand the policy to
additional conditions.
• Proposes to add two 30-day
readmissions measures to the program.
– COPD
– Total hip and knee arthroplasties
36
Cont., Readmissions
• Unlike VBP, readmissions reduction
program is not budget-neutral.
– Nationally, is expected to cut IPPS
payments by $175 million in FY 2014,
down from $300 million in FY 2013.
– FY 2013 policy was expected to reduce
Michigan IPPS payments by approximately
$14 million.
37
• Value Based Purchasing - What’s at Stake Under VBP?
• Program is self-funded by hospital “contribution”
 Contribution based on Medicare FFS payment*
– 1.0% reduction in FY 2013
– FY 2014 Reduction increases to 1.25%
– 2.0% reduction for FY 2017 and beyond
 VBP performance determines P4P amount
 Budget-neutral
– Redistributive
– Best performers win, others break even or lose
– VBP payments are netted against contributions
* Payment reductions exclude IME, DSH low-volume hospitals and outliers.
38
Medicare VBP Evolution
39
HAC Reduction Program Overview
• ACA-mandated – must start in FY 2015
• First program policies outlined in 2014
rule
• 1% reduction in IPPS payments for
hospitals with highest HAC “scores”
– Would penalize 25% of hospitals nationally
• For determining FY 2015 penalties,
CMS proposes to use up to 8 quality
measures grouped into 2 domains.
40
IPPS Proposed Rule Impact
• Hospital-specific DSH analysis to be
distributed week of May 20.
• Hospital-specific overall impact analysis to be
distributed via email to CEOs, CFOs and RDs
shortly after.
• Including detailed summary of proposed rule.
• Distribution to include Directors of Patient Safety & Quality
Improvement.
• Impact report reflects readmissions and VBP factors.
–
VBP factors not final at this time as the CMS continues to review the
data.
41
IPPS PROPOSED RULE SUMMARY
System Component
Change
Update Factor
(net of all rate
adjustments)
0.5%
Wage Index
No major policy changes; may redefine CBSAs for FY 2015 based on 2010
census.
VBP
-1.25% with chance to earn back some, all, or more of program contribution
and new rules for 2015 and 2016 programs
Readmissions
Remain whole or subject to up to - 2.0% (up to -3% for FY 2015)
GME/DSH
Technical changes/clarifications for counting beds, timely filing, and ACA
provisions for redistributing unused/closed hospital FTE slots
Low-Volume Adjustment
ATRA extension expires, program reverts to more restrictive rules
MDH/SCH Special Rural
Status
ATRA extension of MDH program expires; SCH status could be terminated
retroactively in certain circumstances
IQR Program
55 Measures maintained for FY 2014; 72 to 59 for FFY 2015 determinations.
60 for FFY 2016. HACs removed from IQR
Outlier Payments
10.6% threshold increase from $21,821 to $24,140.
HAC DRG Payment
Policy
2 new categories; 2 new diagnoses for current category.
42
2% Sequestration Cut
• ATRA delayed to March 1.
• 2% cut was applied to Medicare FFS payments
beginning for dates of service on/after April 1.
– effective 2013 – 2021
– mandated by the Budget Control Act of 2011.
• Michigan annual impact projected at $144M.
– IPPS payments reduced $95 million
– OPPS payments reduced $34 million
• May apply to MA payments depending upon
hospital contractual agreement with MA plans.
43
Outpatient Therapy Services
• 2013 collection of claims-based data on
patient functional status over an
episode of PT, OT and SLP services.
• All therapists will be required to report
new G-codes and modifiers on the claim
form:
– initial evaluation, every 10 visits and at
discharge.
– testing period thru June 30, after that date,
claims will reject.
44
LTCH Proposed Rule
• Base rate $40,622.06 for those that submit quality
data; $39,823.99 for those that don’t comply.
• Includes a net 1.1 percent update
• “25% Rule” - CMS is moving forward with full
adoption of the 25% rule after a 5-year moratoria
and additional one-year statutory relief.
– Reduces payment to an IPPS-comparable amount for
referrals from general acute hospitals that exceed a 25
percent threshold.
45
Cont., LTCH Proposed Rule
• CMS adopted an LTCH-specific
marketbasket value beginning with
FY 2013.
• Net 1.1% increase after:
↑ Plus 2.5 percent marketbasket increase
↓Minus 0.4 percentage point productivity adjustment
↓Minus 0.3 percentage point ACA-mandated adjustment
↓Minus 1.3 percent budget neutrality cut (second of three)
↑ Plus 0.6 percent for short-stay and high-cost outlier
46
Cont., LTCH Proposed Rule
• CMS’s ongoing research on a potential
approach to focus the LTCH setting on the
treatment of “medically stable but high-acuity
patients” known as “chronically critically ill”
(CCI).
• Encourages LTCHs to admit CCI patients and
ensure that these frame the “core patient
population”.
47
Cont., LTCH Proposed Rule
• Full LTCH payment would be limited to
patients who met CCI criteria upon
discharge from acute hospital.
• Non-CCI patients would be paid an
IPPS-comparable amount.
48
LTCHQR Program
• Beginning with FY 2014 payments,
LTCHs must submit data on 3 quality
measures being collected in FY 2012 or
be subject to 2 percentage point
penalty.
• Proposal to add three new measures for
the FY 2017 reporting program.
49
Inpatient Rehab Facilities
Net 1.8% increase after:
Plus 2.5 percent marketbasket update
↓Minus 0.4 percentage point
productivity adjustment
↓Minus 0.3 percentage point ACAmandated adjustment
50
IRF 60 Percent Rule
• Facility must demonstrate that at least 60% of its
patients meet specific criteria including the need for
intensive rehab services for 1 or more of 13 listed
conditions.
• For FY 2014, CMS proposes to remove a number of
codes from the “presumptive compliance” list since
without medical record documentation, thse codes do
not prove compliance.
51
SNF Proposed Rule
• Net 1.4% increase in per diem rates
after:
plus 2.3% MB update
minus 0.5 percentage point forecast error
adjustment.
minus 0.4 percentage point multifactor
productivity adjustment.
52
2013 OPPS Detailed Reports
• Hospital-specific Excel files distributed
March 27.
• Top 50 APCs
• Analysis of multi-level APCs
• Small hospital reports distributed
April 11.
53
Medicare Advantage Plans
• As of April 2013, 34 plans in Michigan, with 485,000 or
approximately 29% of Michigan’s 1.7 million Medicare beneficiaries
enrolled.
– Up to 20 plans in some counties.
• Review MA payment rate for all plans.
• CAH entitled to Medicare cost reimbursement.
• Each MA plan may determine own utilization model and is not
required to maintain electronic transactions.
• Many MA have instituted “RAC-like” utilization programs.
• Matrix of MA plans by county available at MHA website – updated
quarterly, with MHA Monday Report article.
– See April 29 Monday Report for latest info
54
Continued, MA Plans
• Unlike Medicare FFS, each MA plan may
determine its own utilization model and is not
required to maintain uniform electronic
payment processes with hospitals.
• As Medicare enrollees continue to select MA
plans, the variety of plans and payment
processes may result in increased utilization
scrutiny and administrative effort at hospitals.
• MA plans may conduct their own RAC-like
audits.
55
MA Plans & Sequestration
• CMS payments to plans will be reduced for
enrollment periods beginning on/after April 1,
2013.
• Individual hospital contracts govern whether
payments will be reduced.
• In cases of non-contracted plans, plans have
discretion whether to pass the 2% cut on to
hospitals.
• See May 13 Monday Report.
56
Medicare 10-Year Revenue Forecast
• Distributed to CEOs/CFOs/Directors of
Reimbursement and Government
Relations Nov. 29.
• Comprehensive analysis of Medicare
revenue and payment reductions for
2013 – 2022, including:
– Affordable Care Act-authorized changes
– Budget Control changes (Sequestration)
– American Taxpayer Relief Act (ATRA)
57
Medicaid Issues
58
Medicaid Payment Reform
• Jan. 1, 2014 target implementation – MSA is considering
a phase-in approach.
• Four meetings to date.
• Representatives include small, medium, and large
hospitals and CAHs
• Several ideas have been identified including:
• statewide inpatient rate with hospital adjustors,
• converting FFS capital to prospective system for fee-for-service,
• Increase in outpt payments financed with reduced inpt rates
• Recognition of hospital mission in payment adjustors.
59
Medicaid Expansion
• ACA allows states to voluntarily expand
Medicaid to uninsured adults.
• Gov. Snyder proposes to expand
Medicaid to cover individuals up to
138% of federal poverty level effective
Jan. 1, 2014.
• State legislature must appropriate the
federal funds.
60
Cont., Medicaid Expansion
• Expected to cover about 450,000 low-income
adults who are currently uninsured but fail to
meet current eligibility requirements.
• Who would qualify?
– Individuals that are at least 19 years old.
– Those that are single, working with annual
earnings up to $15,856 or in a family of
four with earnings up to $32,499.
61
• Based on 138% of 2013 FPL
MHA Expansion Resources
• MHA supports expansion and urges
member hospitals to use resources to
educate legislators, members of the
community, etc.
– Saves Money, Saves Lives
• Many tools available at:
www.expandmedicaid.com.
62
Primary Care Physician Services
• ACA provides certain physicians with
Medicare rates for specific primary care
services provided in 2013 and 2014.
• Higher payments implemented for
Medicaid FFS in early February.
• Waiting for CMS approval for services
paid through Medicaid HMOs.
63
Medicaid - Misc.
• Implementation of pilot project to integrate care
and payment for individual dually eligible for
Medicare and Medicaid has been delayed, likely
won’t begin until July 1, 2014
– Issue of payment rate remains unresolved
• Regional implementation
– 4 regions comprised:
– 8 SW counties
Macomb County
– UP
Wayne County
64
DSH Audits
• Beginning with audits of FY 2011 DSH
ceilings, hospitals subject to DSH
payment recoveries if audits indicate
DSH payments exceeded their actual
DSH ceilings.
• Prior year audit reports available on
MSA’s website.
65
Continued, DSH Audits
• FY 2009 DSH audit results indicate that
27 hospitals would have had payment
recoveries totaling $111 million.
• 2010 audits in process
• DSH payment recoveries begin with
FY 2011 DSH audit, expected to occur
a year from now.
66
Proposed DSH Policy
• MSA proposes multiple-step DSH
process:
– Initial DSH calculation
– Interim DSH settlement
– Final DSH audit-related redistribution
67
Initial DSH Calculation
• MSA would calculate near the end of the state FY
using data from hospital cost reports ending during
the second previous state FY.
• Hospitals would review MSA’s initial calculation.
– Cost reports for FYEs 2010 will be used for 2012
initial calculations.
– If hospital declines DSH during this step, the
decision is irrevocable and the hospital is not
eligible for any DSH for that FY.
68
Interim DSH Settlement
• MSA would recalculate DSH ceilings,
payments and Medicaid utilization rates
using new cost report data.
• MSA would recover and reallocate
funds to other eligible hospitals for that
specific pool.
– During 2013, the MSA would use data from
cost reports ending during calendar year
2012 to complete this step.
69
Final DSH Settlement
• Final DSH audit would occur three years after state
fiscal year.
• Would recover and reallocate funds for public
hospital DSH to remaining eligible hospitals for that
pool then funds recovered from other DSH pools plus
unspent funds recouped would be reallocated to
eligible hospitals.
70
FY 2013 DSH Payments
• Payments from $45 million regular DSH
pool and $60 million tax-funded DSH
pool to be distributed in September.
• Payment amounts by hospital not yet
available.
• Hospitals are encouraged to request
DSH ceiling info from MSA.
71
Medicaid Interim Payments
• MSA released a proposed policy to
change from bi-monthly to monthly MIP
and CIP payments effective July 1,
subject to CMS approval.
72
Medicaid RAC
• MSA contract with Health Management Systems, Inc.
(HMS) for both automated and complex reviews.
• Can review Medicaid fee-for-service (FFS) claims up
to 3 years after date of service.
– Can currently review claims back to May 1, 2010.
• May expand to Medicaid HMO claims in future.
73
Medicaid Provider Tax Bills
• As a result of reporting changes for bad debts,
MSA allowed hospitals to submit revised cost
reports in December.
‒ Approx. 70 hospitals submitted
• April tax bills incorporate revised tax base for the
month and 1/3 of the retroactive adjustment back
to Oct. 2012.
• Q3 FFS tax bills will reflect revised tax base and
retroactive adjustment
74
FY 2014 Hospital Tax Base
• Hospitals are encouraged to review
their FY 2012 filed cost reports and
submit an amended report if needed.
– FYEs Oct. 1, 2011 – Sept. 30, 2012
• Are bad debts reported as a reduction
to net patient revenues or an operating
expense?
• See MHA Advisory Bulletin # 1340
included in March 11 Weekly Mailing.
75
FFS QAAP
• FY 2013 Q3 MACI payments distributed
May 9.
• Corresponding tax bills distributed May
16, payments due June 10.
• Q3 tax amounts were adjusted retro to
Oct. 1, 2012.
76
2013 GME & HRA Payments
• May GME Payments
• May HRA Payments
• May HRA Tax Due
-
May 20
June 3
June 17
• June GME Payments • June HRA Payments • June HRA Tax Due
-
June 24
July 8
July 22
77
FY 2013 Psych HRA Payments
• Q3 payments
• Q3 tax due date
-
July 5
July 19
• Q4 payments
• Q4 tax due date
-
Oct. 3
Oct. 17
78
BCBSM
• BCBSM Board approved changes to PHA to:
– Include government shortfalls for traditional
product only
– Medicare and Medicaid fee-for-service
• PHAAC hospital contingent urged BCBSM
staff to consider method to include Medicare
and Medicaid managed care in calculation
79
Hospital Charge Transparency
• CMS recently released charge and
average Medicare payment on the most
common DRGs by hospital.
• Michigan ranks 41st in the country in
average Medicare billing by state.
• Michigan’s gross charge per equivalent
admission is 21% lower than the GL
state average and 24% lower than the
80
US average.
0%
-5%
-6.0%
-10%
-15%
-8.8%
-9.7%
-10.6%
-10.7%
-13.3%
-14.7%
-14.0%
-16.5%
-16.5%
-17.7%
-20%
-17.8%
-18.8%
-19.4%
-20.1%
-19.2%
-21.0%
-21.0%
-23.4%
-25%
-24.3%
-30%
2002
2003
2004
2005
2006
GL
2007
2008
2009
2010
2011
US
81
Auto No Fault
• HB 4612 would cap existing personal
injury protection benefit at $1 million.
• Create a new state-run insurance co. to
relieve auto insurers of the cost of
catastrophic injuries to policy holders.
• Impose a new tax on auto ins policies.
• Would trade significant catastrophic
coverage for a one-time premium rebate
82
of $125.
Cont., Auto No Fault
• Reduction of reimbursement rate from
controlled charges to fee screen or
average of other payers.
83
AHA Survey Results
• Annual MHA Advisory Bulletin that
compares 2011 AHA Survey results for
Michigan hospitals to those nationally.
• Includes margins, ED visits, OP visits,
IP admissions, days, births, ALOS, etc.
• See MHA Advisory Bulletin # 1341,
included in 03/18/13 weekly mailing.
• Powerpoint and Excel files available.
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8%
7.2%
6%
5.2%
4.9%
4.9%
5.5%
4.9%
4%
2.8%
2.4%
3.3%
3.4%
3.0%
1.8%
2.8%
2%
2.4%
1.9%
1.6%
1.7%
1.9%
0.8%
0%
-0.3%
-1.1%
-2%
-1.8%
-1.5%
-1.6%
-2.6%
-3.0%
-4%
2002
-1.6%
-2.8%
-2.6%
-3.2%
2003
2004
2005
Patient Margin
2006
2007
2008
Operating Margin
2009
2010
2011
Total Margin
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MHA Resources
• Monday Report is available FREE to anyone and is distributed
via email each Monday morning.
– Go to website and select “Newsroom”, then Monday Report
• MHA Monday Report – electronic publication issued weekly
• Request password if you don’t have one.
– Email Donna Conklin at dconklin@mha.org to obtain MHA
member ID number
• Advisory Bulletins – Extensive communications available only to
MHA members, as needed. (Require password to obtain from
website).
• Hospital specific mailings as needed for various impact
analyses, etc.
• Periodic member forums
• See mha.org for other resources.
• Monthly Financial Survey provides free benchmarking of
financial and utilization statistics.
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???Questions???
Vickie Kunz, Senior Director, Health Finance
Michigan Health & Hospital Association
110 West Michigan Avenue, Suite 1200
Lansing, MI 48933
Phone: (517) 703-8608
Fax: (517) 703-8637
email: vkunz@mha.org
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