HEALTH CARE INDUSTRY PERSPECTIVES ON HEALTH CARE REFORM[医疗保健行业PERSPECTIVES医疗改革](PPT73).ppt
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1、1,HEALTH CARE INDUSTRY PERSPECTIVES ON HEALTH CARE REFORM,Mississippi ChapterHealthcare Financial Management Association2010 Ethics,Accounting&Auditing and PFS WorkshopJune 11,2010Hilton Hotel,Jackson MS,2,STRATEGIC OPPORTUNITIES FOR HOSPITALS,3,Health Care Delivery System Reform,The Senate Finance
2、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/,Catalyst,
3、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-Existing Condi
4、tions,Protect Families from Medical Bankruptcy,Guarantee Choice of Docs and Health Plans,5,Selected Provisions,Administrative SimplificationMoving to standardized processes by evaluation of systems every 3 years using input from the National Committee on Vital Statistics,the Health Information Techn
5、ology 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 ChangesBundling beginning 2013 pilots thru
6、 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 acquired conditions-Act Sec.2702 Accou
7、ntable 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.1899Innovation Center 2011 creates a Center for Medicare and Medica
8、id 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 Legislation Will Include Expanded Bundled Payment Demo
9、nstration 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 the Patient Protection and Affordable Care Act(P.L.11
10、1-148)Binding payment recommendations on Medicare and non-binding on private insurers payments to providersExclusion such as hospitals(except CAH)until 2019340B drug program extended Act Sec.7101(a)of the Patient Protection and Affordable Care Act(P.L.111-148),amending Public Health Service Act Sec.
11、340B(a)(4)by adding subparagraphs(M)through(O)Market basket update adjustments-Affordable Care Act Sec.3401RAC expansion-Affordable Care Act Sec.6411Graduate Medical Education no reductions in IME payments but re-distributes 65 percent of unused residency to primary care and surgeons SSA Sec.1886(h)
12、(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 organizationIgnoring the delivery and payment system changes will be detrimentalMost importantly,understand totally where your revenue comes fr
13、om and how this will changeTax Exemption,9,Financially Positive or Negative for Health Care Providers,ModelingMarket Basket UpdateDSH-UPLHospital Acquired ConditionsPhysician Payment RevisionsContracts with other payers,10,Being Pro Active,Model impacts of Medicare and MedicaidEstimate income/volume
14、 levels of“new patients”Evaluate service linesEvaluate costsDirect careSupport,11,Know the margins The Driving Forces,12,Model of Governmental Payers,13,Non Governmental Payers,Impact of Health Insurance Exchanges on traditional insuranceImpact of family coverage and shifts to employersImpact of“pay
15、 the penalty”un or under insuredRemember“bend the cost curve”,14,Being Pro Active,Model impacts of Medicare and MedicaidEstimate income/volume levels of“new patients”Evaluate service linesEvaluate costsDirect careSupport,15,Reviewing Service lines,Outpatient Rehabilitation Services Primarily two ser
16、vices Occupational&Speech TherapyDetermined 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
17、 of Medicare and MedicaidEstimate income/volume levels of“new patients”Evaluate service linesEvaluate costsDirect careSupport,17,Analysis of Costs,The Cost structureDirect patient careComponents of OverheadIdentified areas for cost savingsInvested in premier database to benchmark both cost and quali
18、tyExpended Information Technology funds for capturing data and developing standardized processes,18,Labor Costs,Productivity standard which was an integration of standards established by a proprietary database and adapted Hospitals cultureReview of standards began with a bi-weekly process which was
19、historical and reactionaryMoved to a daily matrix which was successful due to the step transition(key moving from reactionary to integrated)Savings as a result of the intense use of standardsFTEs decreased from 4.5 to 3.9 per adjusted occupied bedReduction of salary costs of$6.8 millionOther conside
20、rations including freezing merit increases and elimination of contract staffing,19,Purchased Services,Retirement Plan Hospital operated under a defined benefit“Freeze”implemented with alternative retirement planWith matching mechanism through 403(b)savings of$700k annuallyReal Estate and other renta
21、l agreementsNegotiated through consolidations and space eliminations resulted in$270k savingsManagement of professional servicesHired a director for key areas including IOP,BIO Med,Rehab and Housekeeping-savings of$1million,20,Quality&Efficiency,Chief Medical Officer established a work group to eval
22、uate the clinical effectiveness of the following programs:CardiologyPediatricsOrthopedicsBehavioral HealthWomens Health Services including NurseryGeneral medical Surgical,21,Key Finding,Length of Stay too highWith 60%of total expense representing labor costs,the Hospital began an intense review of d
23、aily activities and labor hoursGreatest opportunity Review standards and protocols for delivery of patient careIntensified use of Hospitalist programIndexed length of stay 100%of standard,22,Other Considerations,Mindset review of expenseFormulary review of Pharmacy-$200kCourier alignment with outpat
24、ient-$175kBenefit plan sync with industry-$1.5 milOverall,everything is matched up with:Board Policy and MissionRating Agency Capital AccessBudget constraints,23,Analysis of PPACAs Impact on Employers,24,September 23,2010 Plan Changes,UNAVOIDABLE AND/OR NON-GRANDFATHERABLE PROVISIONS1.No Lifetime Li
25、mits on“Essential Benefits”2.Restrictions on Annual Limits for“Essential Benefits”3.No Pre-Existing Conditions Exclusions for Children Under 194.If a child under 26 is not eligible for enrollment in a separate employer sponsored plan,then plan already providing coverage to children must extend cover
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