Update on georgias hospitals enterprise innovation institute march 27

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Update on georgias hospitals enterprise innovation institute march 27

  1. 1. INNOVATIONS IN HEALTHCARE GLENN E. PEARSON, FACHE GEORGIA HOSPITAL ASSOCIATION EXECUTIVE VICE PRESIDENT MARCH 27, 2014 Update on Georgia’s Hospitals
  2. 2. Outline  About GHA  Hospitals’ Positive Economic Impact  The Payment Situation  Medicare  Medicaid  The Uninsured  Supplemental Payments  The Need to Shift Costs  What’s Coming Under Affordable Care Act  The Impact of the Financial Climate  The Regulatory Climate  Quality and Patient Safety  Healthcare Personnel Supply  Electronic Communications  Opportunities
  3. 3. About GHA
  4. 4. About GHA  Founded in 1929  Represents Georgia’s 170 acute-care hospitals  Promotes the health and welfare of Georgia’s citizens by supporting hospitals in their missions to provide the most cost-effective and highest quality of care possible through:  Representation at the Georgia General Assembly and U.S. Congress  Assistance with regulatory compliance  Educational programs  Quality initiatives  Data services  Programs and services to assist hospital operations
  5. 5. Hospitals’ Positive Economic Impact
  6. 6. The Payment Situation
  7. 7. Medicare 12% Medicaid 14% Employer/ Private Insurance 52% Uninsured 19% Other Public 3% Georgia Health Insurance Coverage Status SOURCE: 2011-2012 State Health Facts www.kff.org Medicare 36% Medicaid 14% Employer/ Private Insurance 40% Uninsured 5% Other 3% Georgia Sources of Hospital Net Patient Revenue SOURCE: 2012 AHA Annual Hospital Survey Health Insurance Coverage
  8. 8. Medicare
  9. 9. -6% -5% -4% -3% -2% -1% 0% 1% 2% 3% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 MedicareMargin(%) Georgia Hospitals Medicare Operating Margins 2000 - 2011
  10. 10. -$171 -$302 -$475 -$540 -$645 -$636 -$737 -$789 -$842 -$791 -4% -6% -9% -10% -12% -12% -13% -14% -14% -13% $(1,000.0) $(750.0) $(500.0) $(250.0) $- -16% -14% -12% -10% -8% -6% -4% -2% 0% 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 RevenueReductions(inmillions) %ReductionoverBaseline Losses in Medicare Revenue Due to Federal Budget Reductions 2013 - 2022 Medicare Revenue Reduction % Reduction Over Baseline
  11. 11. Medicaid
  12. 12. FY 2012 Georgia Medicaid Cost Coverage Hospital Service Type Payment Arrangement Percent of Cost Covered by Payment Inpatient Services FFS 92% CMO 85% Outpatient Services FFS 80% CMO 81% TOTAL 87%
  13. 13. The Uninsured
  14. 14. The Uninsured  1 in 5 Georgians (19% or 1,859,00) is uninsured  Georgia ranks fifth highest in the nation in the number of uninsured  1 in 8 children in Georgia (12% or 320,000) is uninsured
  15. 15. Supplemental Payments
  16. 16. Medicaid Disproportionate Share Federal Funding ACA Reductions (in millions) Year National Allotment Georgia DSH Allotment 2013 $11,544 $282 Year Annual ACA Reduction (National) Annual ACA Reduction (Est. Georgia) 2014 ($500) ($11) 2015 ($600) ($13) 2016 ($600) ($13) 2017 ($1,800) ($40) 2018 ($5,000) ($111) 2019 ($5,600) ($124) 2020 ($4,000) ($89)
  17. 17. The Need to Shift Costs
  18. 18. What’s Coming Under the Affordable Care Act
  19. 19. 10% 20% 30% 40% 90% 80% 70% 60% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Platinum Gold Silver Bronze PercentofHealthCareCostsPaid Health Insurance Marketplace Plan Type Health Insurance Marketplace Cost Sharing based on Plan Type Paid by the Consumer Paid by the Insurer
  20. 20. The Impact of the Financial Climate
  21. 21. Georgia Hospitals with Negative Margins 2011 Number Percentage Patient Care Margin All Hospitals 89 51% Rural Hospitals 43 66% Total Margin All Hospitals 67 38% Rural Hospitals 36 55%
  22. 22. -1.48% -0.66% 0.36% 0.91% 0.06% 0.23% 0.23% 1.03% 1.21% 0.91% 2.49% 1.92% 2.94% 3.20% 2.61% 2.09% 1.41% 2.56% 3.03% 2.71% -2.00% -1.00% 0.00% 1.00% 2.00% 3.00% 4.00% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Margin Year Trends in Hospital Margins Patient Care Margin Total Margin
  23. 23. The Regulatory Climate
  24. 24. Quality, Patient Safety and Regulatory Oversight Financial: IRS – Internal Revenue Service MAC – Medicare Administrative Contractor PERM - Payment Error Rate Measurement PRRB – Payment Reimbursement Review Board SEC – Securities & Exchange Commission Oversight: NRC – Nuclear Regulatory Commission EPA – Environmental Protection Agency FCC – Federal Commerce Commission FTC – Federal Trade Commission CMS - Centers for Medicare and Medicaid Services HFR – Georgia Healthcare Facility Regulation DCH - GA Department of Community Health Legal: CON – Certificate of Need DEA – U.S. Drug Enforcement Agency DOJ – U.S. Dept. of Justice FBI – Federal Bureau of Investigation Quality: DNV - DNV Healthcare HEN - Hospital Engagement Network QIO – Quality Improvement Organization TJC – The Joint Commission Medical: CDC - Centers for Disease Control HRSA – U.S. Health Resources & Service Administration UNOS – United Network for Organ Sharing USPTO – U.S. Patent and Trade Office SOS – Georgia Secretary of State Licensing Boards FDA – Food & Drug Administration ONC - Office of the National Coordinator for Health Information Technology Personnel: OCR – Office of Civil Rights NISOH – National Institute for Occupational Safety & Health NLRB - National Labor Relations Board OFCCP - Office of Federal Contract Compliance Programs OSHA – Occupational Safety & Health Administration DOL – U.S. Dept. of Labor YOUR HOSPITAL Program Integrity: CERT - Comprehensive Error Rate Testing MFCU – Medicaid Fraud Control Unit MIC – Medicaid Integrity Contractor MIP – Medicare Integrity Program OIG – CMS Office of Inspector General RAC – Recovery Audit Contractor SMRC - Supplemental Medical Review Contractor SUR – Medicaid Surveillance & Utilization Review ZPIC – Zoned Program Integrity Contractor Transportation: DOT – U.S. Dept. of Transportation FAA – Federal Aviation Administration
  25. 25. Quality and Patient Safety  GHA established the Partnership for Health and Accountability (PHA) in 1999 to provide education and data-driven tools for facilitate quality improvement  PHA works with hospitals to eliminate preventable healthcare-associated infections  In 2011, GHA became one of only 26 organizations designated as a Hospital Engagement Network to improve patient safety
  26. 26. Healthcare Personnel Supply Physicians  Georgia ranks #41 in number of active physicians per capita  Georgia has 21% fewer physicians per capita than the national average  2 million Georgians live in primary care personnel shortage areas Nurses  By 2020, Georgia will need an additional 4.550 nurses  The number of new nurse graduates is not projected to be adequate to meet this demand
  27. 27. Electronic Communications  Electronic Medical Records have the potential to improve care quality and reduce costs  Clinicians have the information needed at the point of care  Duplicate tests can be reduced  GHA is a founding member of the Georgia Health Information Network (GaHIN), a statewide group connecting various local electronic communications networks  The first transactions through GaHIN have already occurred, and many large providers are queuing up to join
  28. 28. Opportunities  Care delivery is being transformed  Greater coordination of care  Greater alignment of incentives  Both clinical and patient care management technology  Population health management is the key to the future  We are experiencing unprecedented financial stresses  Services to improve care delivery and efficiency are critical

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