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1、1,HEALTH CARE INDUSTRY PERSPECTIVES ON HEALTH CARE REFORM,Mississippi Chapter Healthcare Financial Management Association 2010 Ethics, Accounting & Auditing and PFS Workshop June 11, 2010 Hilton Hotel, Jackson MS,2,STRATEGIC OPPORTUNITIES FOR HOSPITALS,3,Health Care Delivery System Reform,The Senate
2、 Finance Committee Legislation Will Include Payment Reforms Aimed at Improving the Delivery System,Prerequisite,Tactics,The Goal,3.,2.,1.,4,A Roadmap to Reform,Most of President Obamas Ambitious Health Care Goals Depend on Bending the Cost Curve,Source: 1) http:/www.whitehouse.gov/issues/health_care
3、/,Catalyst,Primary Outcome,Secondary Outcome,Tertiary Outcome,Causal Relationship Between the Presidents Health Care Goals,Assure Affordable Coverage,Reduce Cost Growth,Invest in Prevention and Wellness,Improve Safety and Patient Care,Maintain Coverage During Job Transitions,End Barriers for Pre-Exi
4、sting Conditions,Protect Families from Medical Bankruptcy,Guarantee Choice of Docs and Health Plans,5,Selected Provisions,Administrative Simplification Moving to standardized processes by evaluation of systems every 3 years using input from the National Committee on Vital Statistics, the Health Info
5、rmation Technology Policy Committee, the Health Information Standards Committee, standard setting organizations and stakeholders -Public Health Services Act Sec. 399HH(a), as added by Act Sec. 3011 of the Patient Protection and Affordable Care Act (P.L. 111-148). Delivery System Changes Bundling beg
6、inning 2013 pilots thru 2015 (Social Security Act Sec. 1866D, as added by Act Sec. 3023 of the Patient Protection and Affordable Care Act (P.L. 111-148). Readmissions 2013 penalties for “excessive re-admissions” (SSA Sec. 1886(q)(3), as added by Act Sec. 3025 of the Affordable Care Act). Hospital ac
7、quired conditions -Act Sec. 2702 Accountable Care Organizations 2012, allows hospitals and physicians to provide leadership in voluntary ACOs. Some savings to be shared Section 3022 of the Patient Protection and Affordable Care Act (P.L. 111-148) adds Social Security Act Sec. 1899 Innovation Center
8、2011 creates a Center for Medicare and Medicaid Innovation designed to improve quality and reduce program expenditures- Section 3021 of the Patient Protection and Affordable Care Act (P.L. 111-148) amends Title XI of the Social Security Act by adding the new SSA Sec. 1115A,6,Global Payments,The Legi
9、slation Will Include Expanded Bundled Payment Demonstration Projects,Proposed Bundled Payment System:,Current Payment Methodology:,1:,2:,30 Day Episode of Care,Sample Inpatient Stay,MAC,Hospital Negotiated Pmts,Payment,7,Selected Provisions,Independent Payment Advisory Board (IPAB) Section 3403 of t
10、he Patient Protection and Affordable Care Act (P.L. 111-148) Binding payment recommendations on Medicare and non-binding on private insurers payments to providers Exclusion such as hospitals (except CAH) until 2019 340B drug program extended Act Sec. 7101(a) of the Patient Protection and Affordable
11、Care Act (P.L. 111-148), amending Public Health Service Act Sec. 340B(a)(4) by adding subparagraphs (M) through (O) Market basket update adjustments -Affordable Care Act Sec. 3401 RAC expansion -Affordable Care Act Sec. 6411 Graduate Medical Education no reductions in IME payments but re-distributes
12、 65 percent of unused residency to primary care and surgeons SSA Sec. 1886(h)(8)(B), as added by Act Sec. 5503(a)(4) of the Affordable Care Act,8,Something To Think About,Be proactive, explore how to make the new legislation work in your organization Ignoring the delivery and payment system changes
13、will be detrimental Most importantly, understand totally where your revenue comes from and how this will change Tax Exemption,9,Financially Positive or Negative for Health Care Providers,Modeling Market Basket Update DSH-UPL Hospital Acquired Conditions Physician Payment Revisions Contracts with oth
14、er payers,10,Being Pro Active,Model impacts of Medicare and Medicaid Estimate income/ volume levels of “new patients” Evaluate service lines Evaluate costs Direct care Support,11,Know the margins The Driving Forces,12,Model of Governmental Payers,13,Non Governmental Payers,Impact of Health Insurance
15、 Exchanges on traditional insurance Impact of family coverage and shifts to employers Impact of “pay the penalty” un or under insured Remember “bend the cost curve”,14,Being Pro Active,Model impacts of Medicare and Medicaid Estimate income/ volume levels of “new patients” Evaluate service lines Eval
16、uate costs Direct care Support,15,Reviewing Service lines,Outpatient Rehabilitation Services Primarily two services Occupational & Speech Therapy Determined the payer mix was unable to sustain the current level of expense. Due to the competition and availability in the service area, the Hospital elected to discontinue service. Net increase to contribution margin $600,000 annually.,16,Being Pro Active,Model impacts of Medicare and Medicaid Estimate income/ volume
