RMCHCS-Community-Forum-Feb-12-2014

Report
Community Forum
REHOBOTH MCKINLEY
CHRISTIAN HEALTH CARE SERVICES
February 12, 2014
RMCHCS Board of TrusteesOfficers
• Priscilla Smith, Chair; Business Owner – 2006
• Kathy Head, RN, MSN, Vice Chair; Nursing Program Instructor–
2007
• Yogash Kumar, Secretary; Business Owner, City Council
member – 2011
• David Bischoff, Treasurer; Business Owner – 2009
• Michelle Stam-MacLaren, MD, RMCHCS Chief of Staff;
Pediatrician – 2010
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RMCHCS Board of TrusteesCounty Appointees
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Mary Ann Armijo, Media Executive – 2014
Dave Dallago, Business Owner – 2014
Brett Newberry, Professional Services Owner – 2014
Yogash Kumar, Business Owner, City Council member – 2011
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RMCHCS Board of TrusteesCommunity Members
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David Bischoff, Business Owner – 2009
Angelo DiPaolo, Public School Administrator (retired) – 2011
Jennifer Dowling, Business Owner – 2009
Sue Eddy, Private School Department Manager – 2009
Kathy Head, RN, MSN, Nursing Program Instructor– 2007
John Luginbuhl, Pastor – 2012
Priscilla Smith, Business Owner – 2006
Shannon Tanner, Business Owner – 2009
4
RMCHCS Administration
Barry L. Mousa, FACHE
Chief Executive Officer
High School: New Bremen, Ohio
Bachelors Degree: Indiana University, IPFW, Ft Wayne,
Indiana
Masters Degree: Trinity University, San Antonio, Texas
Professional Certifications:
Certified Public Accountant (inactive)
Board Certified Health Care Executive
Health Care Experience: Florida, Georgia, Illinois, Indiana,
Louisiana, New Jersey, New Mexico, Ohio, Texas, Virginia
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RMCHCS Administration
Robert Baker, Director of Plant Operations – 2011
Ina Burmeister, Chief Development Officer – 2008
Bart Hansen, Chief Financial Officer – 2011
John Mezoff MD, Chief Medical Officer – 2013
Mike Nye – Vice President, Professional Services and
Compliance Officer – 1983
Nancy Santiesteban – Chief Nursing Officer – 1998
Kimothy Sparks – Chief Quality Officer – 2013
Tracy Towns – Chief Human Resources Officer - 2012
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RMCHCS Department Directors
Jim Bancuk – Clinic Operations 2013
Larry Booker – Diagnostic Imaging 2009
Donna Corley – Emergency Services 1989
Rosemary Coyne – Home
Health/Hospice - 2010
Melinda Graton – Health
Information Management
(interim) - 2014
Phillip Hager – Patient Financial
Services (interim) - 2013
Patty Johnson – Surgical Services
(staff interim) - 1994
Harry Kallipolitis – Case
Management - 2013
Misty Leyba – Medical/Surgical/
Pediatrics/ICU - 1998
Cassandra Lopez –
Laboratory - 1997
Art Macias – Pharmacy - 1996
Tom Gonzales – Information
Technology - 1996
Edward Placencio – Materials
Management - 1992
Doug Turner –Cardiopulmonary,
Physical and Respiratory Therapy,
Sleep Lab - 2008
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Key Issues Being Addressed
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Revenue and Services
Medicaid Program Reimbursement Shortfall
Sole Community Provider Payment Program
Emergency Services
Decisions that Positively Affect the Medicaid
“Gap”
• Critical Access Hospital Designation
• East Campus
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RMCHCS Services
- Cardiopulmonary / Cardiac
Rehabilitation
- Clinic Services—medical and
surgical specialties
- Counseling - Outpatient
Behavioral Health
- Diagnostic Imaging (MRI, CT,
Mammography,
Ultrasound, X-Ray)
- Emergency Services
- Home Health / Hospice
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ICU
Laboratory
Medical / Surgical
Pediatrics
Pharmacy
Physical and Speech
Therapy
Respiratory Therapy
Sleep Lab
Surgery
Women’s Health
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RMCHCS Statistics
2011
2012
2013
Utilization Statistics
Acute Inpatients
3,287
3,041
2,628
495
505
486
3.04
3.00
2.89
22,138
21,884
20,300
Inpatient Surgeries
1,004
954
554
Outpatient Surgeries
1,859
1,792
1,705
Births
Average Length of
Stay
Emergency Room
Visits
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RMCHCS Revenue Sources
Net Patient Revenue
2011
2012
2013
$ 49.3 M
$ 47.1 M
$ 42.4 M
Gross Patient Revenue by Payor Source
Medicare
33%
36%
34%
Medicaid
29%
28%
29%
BCBS/Commercial
31%
28%
28%
Self-Pay
7%
8%
9%
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Non-Patient Supplemental Payments
2011
2012
2013
$ 278.8 M
$ 220.7 M
$ 159.3 M
$ 11.4 M
$ 8.4 M
$ 5.7 M
% of State
4.1%
4.0%
3.6%
% of Net Patient
Revenue
23%
19%
13%
$ 1.6 M
$ 1.5 M
$ 1.5 M
Sole Community Provider payments
All of New Mexico
RMCHCS
Mill Levy Receipts
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RMCHCS Revenue Challenges
2011
2012
Revenue Cycle Woes:
2013
Claim Filing Errors
$ 3.5 M
$ 4.7 M
$ 1.9 M
Filed, Not Medically
Necessary
$ 0.7 M
$ 1.2 M
$ 0.6 M
Other
$ 0.0 M
$ 0.3 M
$ 0.3 M
Health Fair / POS
Discounts
$ 0.0 M
$ 0.4 M
$ 0.3 M
Total
$ 4.2 M
$ 6.6 M
$ 3.1 M
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RMCHCS Underfunding Impact
Net Cost of
YEAR
Medicaid Care and
Inpatient Indigent Care
SCP
Payments
Net Underfunding
(made up by other
payers and reserves)
2011
$ 15.7 M
$ 11.4 M
$ 4.3 M
2012
$ 12.1 M
$ 8.4 M
$ 3.7 M
2013
$ 8.5 M est.
$ 5.7 M
$ 2.8 M est.
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Sole Community Provider Program -1
Since 1994 the Sole Community Provider program has been a
core funding mechanism to supplement Medicaid payments for
many New Mexico hospitals
• June 2011—HSD suspends SCP payments
o CMS alleges that sources of funds from counties were non-bona fide
donations or in-kind transfers from hospitals
o SFY 2011 SCP total = $279M
• January 2012—HSD agrees to settlement with CMS
o NM hospitals to repay $7.9M of CMS-calculated $53M overpayment
(for 2009). NMHA says $1B SCP overpayments for 2000-2008.
o RMCHCS repays $843,000 for 2009 (SCP reduced $2.5M in SFY 2012)
o SCP payments restored at a lower amount—SFY 2012 = $221M
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Sole Community Provider Program -2
• December 2012—HSD suspends SCP payments
o 2nd time in 18 months
o CMS determines SCP payment errors in HSD’s historical calculations
o CMS investigation jeopardizes entire SCP program
• May 2013—HSD agrees to settlement with CMS
o SCP program transitions under Centennial Care waiver effective 1/1/14
o CMS agrees to not review other years funding source and payment
calculations.
• January 2014—Centennial Care SCP program for 28 rural
hospitals plus UNMH, if the underlying funds source is
predictable and stable
o Safety Net Care Pool (SNCP) program = $192.1M total amount
o $68.9M for indigent care (maximum CMS would permit)
o $132.2M for Medicaid Inpatient rate increase (HSD estimates ~75%)
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Safety Net Care Pool Funding Plan
• House Bill (HB) 350 and Senate Bill (SB) 368 establish
county gross receipts tax equivalency—generates
$36.4M
• Governor Martinez proposes $9M of general state
funds to augment county funding
• Total of $45.1M needed by state to maximize federal
match—total funds $192.1M
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Emergency Services
Emergency Physician Providers contacted
– Apogee
– EmCare
– Hospital Physician Partners (Lovelace Health System
provider)
– Pegasus Emergency Management (CHS system
provider)
– Presbyterian Hospital & Healthcare Services
– Schumacher Group
– University of New Mexico Medical Group
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Three Ways to Positively Affect the “GAP” in
MEDICAID reimbursement
• Reduce overall costs of operations—
– costs for the proportionate share of Medicaid will be
reduced
• Decrease Medicaid volume—
– direct reduction on Medicaid costs, reimbursement gap,
and losses
• Increase revenue from non-Medicaid volume—
– profit generated from these services will reduce the
Medicaid reimbursement gap
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Increasing Medicare Reimbursement by
Critical Access Hospital Designation -1
• Critical Access Hospitals (CAH) receive cost-based
reimbursement from Medicare versus prospectively
determined inpatient and outpatient fixed reimbursement
rates.
• Some hospitals find that cost-based reimbursement is
advantageous, and some will not. Each hospital must
perform its own financial analysis.
• The Critical Access Hospital program is a Medicare
reimbursement status only.
• Critical Access Hospital is a change in hospital provider
designation for Medicare, and not a downgrade.
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Increasing Medicare Reimbursement by
Critical Access Hospital Designation -2
• Conversion to Critical Access Hospital (CAH) status does not
mean losing services. Many hospitals can expand services
knowing that Medicare costs will be 100% reimbursed.
• CAHs must maintain an annual average length of stay of 96 hours
or less for their acute care patients.
• CAHs may have a maximum of 25 acute care inpatient beds.
• CAHs must provide 24-hour emergency services.
• As of June 30, 2013, there are 1,332 certified Critical Access
Hospitals located throughout the United States and nine in New
Mexico.
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East Campus Changes
• Behavioral Health Services (BHS) Service Lines
o inpatient addictions recovery program
o outpatient individual therapy counseling
• The BHS service lines have lost significant money for many
years. Medicaid volume in Addictions Program = 94% in
2013
• The buildings at East Campus are aging and very expensive
to maintain
• Inpatient Addictions Recovery program closing 2/28/14
• Outpatient Therapy Counseling relocating to Main Campus
on Red Rock Drive
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Rehoboth McKinley
Christian Health Care Services
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