Update on georgias hospitals enterprise innovation institute march 27
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Transcript of Update on georgias hospitals enterprise innovation institute march 27
INNOVATIONS IN HEALTHCARE
GLENN E. PEARSON, FACHEGEORGIA HOSPITAL
ASSOCIATIONEXECUTIVE VICE PRESIDENT
MARCH 27, 2014
Update on Georgia’s Hospitals
Outline
About GHAHospitals’ Positive Economic ImpactThe 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 ClimateThe Regulatory ClimateQuality and Patient SafetyHealthcare Personnel SupplyElectronic CommunicationsOpportunities
About GHA
About GHA
Founded in 1929Represents Georgia’s 170 acute-care hospitalsPromotes 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
Hospitals’ PositiveEconomic Impact
The Payment Situation
Medicare11%Medicaid
14%
Employer/Private Insurance
52% Uninsured19%
Other Pub-lic3%
Georgia Health Insurance Coverage Status
SOURCE: 2011-2012 State Health Factswww.kff.org
Medicare37%
Medicaid14%
Employer/Private Insurance
40%
Unin-sured5%
Other3%
GeorgiaSources of HospitalNet Patient Revenue
SOURCE: 2012 AHA Annual Hospital Survey
Health Insurance Coverage
Medicare
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
-6%
-5%
-4%
-3%
-2%
-1%
0%
1%
2%
3%
Georgia HospitalsMedicare Operating Margins
2000 - 2011
Medic
are
Marg
in (
%)
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
-16%
-14%
-12%
-10%
-8%
-6%
-4%
-2%
0%
$(1,000.0)
$(750.0)
$(500.0)
$(250.0)
$-
-$171
-$302
-$475
-$540
-$645 -$636
-$737
-$789
-$842
-$791
-4%
-6%
-9%
-10%
-12%-12%
-13%-14%
-14%
-13%
Losses in Medicare Revenue Due to Federal Budget Reductions
2013 - 2022
Medicare Revenue Reduction % Reduction Over Baseline
% R
educti
on o
ver
Base
line R
eve
nu
e R
edu
ction
s (in m
illion
s)
Medicaid
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%
The Uninsured
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
Supplemental Payments
Medicaid Disproportionate Share
Federal Funding ACA Reductions (in millions)
Year National Allotment Georgia DSH Allotment
2013 $11,544 $282
YearAnnual 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)
The Need to Shift Costs
What’s Coming Under theAffordable Care Act
Platinum Gold Silver Bronze0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
10%
20%
30%
40%
90%
80%
70%
60%
Health Insurance MarketplaceCost Sharing based on Plan Type
Paid by the Consumer Paid by the Insurer
Health Insurance Marketplace Plan Type
Perc
ent
of
Healt
h C
are
Cost
s P
aid
The Impact of theFinancial Climate
Georgia Hospitals with Negative Margins2011
Number Percentage
Patient Care Margin
All Hospitals 89 51%
Rural Hospitals 43 66%
Total Margin
All Hospitals 67 38%
Rural Hospitals 36 55%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011-2.00%
-1.00%
0.00%
1.00%
2.00%
3.00%
4.00%
-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%
Trends in Hospital Margins
Patient Care Margin Total Margin
Year
Marg
in
The Regulatory Climate
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
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
Healthcare Personnel Supply
PhysiciansGeorgia ranks #41 in number of active
physicians per capitaGeorgia has 21% fewer physicians per capita
than the national average2 million Georgians live in primary care
personnel shortage areasNursesBy 2020, Georgia will need an additional 4.550
nursesThe number of new nurse graduates is not
projected to be adequate to meet this demand
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
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