Transcript A Different Order for Difficult Times

Alamance Regional Medical Center • Albemarle Health • Alleghany Memorial Hospital • Angel Medical Center • Annie Penn Hospital • Anson
Community Hospital • Ashe Memorial Hospital, Inc. • Betsy Johnson Regional Hospital • Blowing Rock Hospital • Blue Ridge Regional Hospital •
Broughton Hospital • Brunswick Community Hospital • Caldwell Memorial Hospital, Inc. • Cape Fear Valley - Bladen County Hospital • Cape Fear
Valley Health System • CarePartners Rehabilitation Hospital • CarolinaEast Health System • Carolinas Medical Center • Carolinas Medical Center Lincoln • Carolinas Medical Center - Mercy • Carolinas Medical Center - Northeast • Carolinas Medical Center - Pineville • Carolinas Medical Center
- Union • Carolinas Medical Center - University • Carolinas Rehabilitation • Carteret County General Hospital • CaroMont Health, Inc. • Catawba
Valley Medical Center • Central Carolina Hospital • Central Regional Hospital • Charles A Cannon, Jr. Memorial Hospital • Chatham Hospital •
Cherokee Indian Hospital • Cherry Hospital • Cleveland Regional Medical Center • Coastal Plain Hospital • Columbus Regional Healthcare System •
Cone Health Behavioral Health • Davie County Hospital • Davis Regional Medical Center • Department of Veterans Affairs Medical Center Asheville
• Department of Veterans Affairs Medical Center Durham • Duke Raleigh Hospital • Duke University Hospital • Durham Regional Hospital •
FirstHealth Montgomery Memorial Hospital • FirstHealth Moore Regional Hospital • FirstHealth Richmond Memorial Hospital • Forsyth Medical
Center • Franklin Regional Medical Center • Frye Regional Medical Center • Grace Hospital • Granville Health System • Halifax Regional Medical
Center • High Point Regional Health System • Highland-Cashiers Hospital • Highsmith-Rainey Specialty Hospital • Holly Hill Hospital • Hugh
Chatham Memorial Hospital • Iredell Health System • J. Arthur Dosher Memorial Hospital • Johnston Medical Center - Smithfield • Kindred
Hospital • Kings Mountain Hospital, Inc. • Lake Norman Regional Medical Center • Lenoir Memorial Hospital, Inc. • Lexington Memorial Hospital,
Inc. • LifeCare Hospitals of North Carolina • Margaret R. Pardee Memorial Hospital • Maria Parham Medical Center • Martin General Hospital •
The McDowell Hospital • Medical Park Hospital • MedWest - Harris • MedWest - Haywood • MedWest - Swain • Mission Health System •
Morehead Memorial Hospital • Murphy Medical Center, Inc. • Nash Health Care Systems • New Hanover Regional Medical Center • North Carolina
Specialty Hospital • Northern Hospital of Surry County • Onslow Memorial Hospital • Our Community Hospital • The Outer Banks Hospital • Park
Ridge Health • Pender Memorial Hospital • Person Memorial Hospital • Presbyterian Healthcare • Presbyterian Hospital Huntersville •
Presbyterian Hospital Matthews • Presbyterian Orthopaedic Hospital • Randolph Hospital • Rex Healthcare • Rowan Regional Medical Center •
Rutherford Regional Medical Center• Sampson Regional Medical Center • Sandhills Regional Medical Center • Scotland Health Care System • Select
Specialty Hospital-Durham • Select Specialty Hospital-Winston-Salem • Southeastern Regional Medical Center • St. Luke’s Hospital • Stanly
Regional Medical Center • Stokes-Reynolds Memorial Hospital, Inc. • The Moses H. Cone Memorial Hospital • Thomasville Medical Center •
Transylvania Regional Hospital • UNC Hospitals • Valdese Hospital • Vidant Beaufort Hospital • Vidant Bertie Hospital • Vidant Chowan Hospital •
Vidant Duplin Hospital • Vidant Edgecombe Hospital • Wake Forest Baptist Medical Center • Vidant Medical Center • Vidant Pungo Hospital •
Vidant Roanoke-Chowan Hospital • Wake Forest Baptist Health – Davie Hospital • Wake Forest Baptist Health – Lexington Medical Center •
WakeMed • WakeMed Cary Hospital • WakeMed Fuquay-Varina • WakeMed Zebulon/Wendell SNF and Outpatient Diagnostic Center •
Washington County Hospital • Watauga Medical Center • Wayne Memorial Hospital • Wesley Long Community Hospital • Wilkes Regional Medical
Center • Wilson Medical Center • Women’s Hospital of Greensboro • Yadkin Valley Community Hospital
Bill Pully, President
North Carolina Hospital Association
•
•
•
•
Threats
Weaknesses
Opportunities
Strengths
2
• Governor’s budget
– Drops outpatient payments to 70% of costs from 80%
• $80 million minus MRI offset
– Increases MRI/GAP retention to $43 million plus 29%
• Impact estimated at $137 million annually
• Can’t be recouped through MRI/GAP
• Medicaid expansion
– $4.4 billion / 10 years
• Certificate of Need
– $400 million/year for orthopedics plus ENT
procedures
3
• Tax reform
– $250 million/year for sales tax exemption
• Mental Health
– Community services, inpatient beds needed
• Medicaid HMO
– $943 million/year, plus payment cuts, plus
administrative hassles
4
Programs / Actions Causing Cuts
10-Year NC Impact
Affordable Care Act
ACA / CMS Medicare Payment Reductions
($4,593,501,000 )
ACA Medicare DSH Reductions
($
Effect of Massachusetts’ Manipulation of Medicare “rural
floor” wage index calculation (national budget neutrality)
($ 218,000,000)
47,659,000)
Total ACA Reductions
($5,659,160,000)
Hospital Acquired Conditions
($
72,265,014 )
Value-Based Purchasing Projection 2014
$
2,258,695
Readmissions Reduction Program
($ 208,627,000 )
2% Medicare Deficit Reduction Sequestration Requirement
($1,259,248,500 )
Bad Debt Reimbursement Restrictions
($ 296,441,265 )
American Taxpayer Relief Act of 2012
($ 354,756,838)
Total Known Cuts (January 15, 2013)
($7,848,239,922)
Sources: American Hospital Association, DataGen. Value-Based Purchasing cannot be projected on a ten-year basis. Period of
this table, 2012 - 2021
• Healthcare Affordability
• Erosion of Public Trust
• Federal politics
– Partisan Gridlock
• State politics
– Majority of legislators have two years or less of
experience
6
72 Freshmen and Sophomores among 120 Representatives
31 Freshmen and Sophomores among 50 Senators
• Strengthen Community Care of North Carolina
• Take more ownership in the system
• Develop a more politically active workforce
9
• Hospitals’ Missions
– Care for everyone, every hour, every day without
regard to ability to pay
– Provide good jobs that don’t leave the community
– Act as an incentive for economic development
• Quality Improvements
• Unified Hospital Field
10
• Helping hospitals’ friends in the legislature
11
North Carolina
Hospital Association
Core Services
Transformation
Mission: Improve delivery of quality, affordable
healthcare in North Carolina through leadership,
advocacy, information, & education
Principles: Transparency, Collaboration,
Innovation, Evidence-Based, Patient-Centered
NC Center for
Affordable
Health Care
Community Health
Improvement
Collaborative
NC Center for
Rural Health
NC Quality Center
Education
Communication &
Public Relations
Financial Services
Advocacy &
Representation
Policy Development
Payment Systems
13
Aggregate Optimal Care Trends for N.C. Hospitals
6-Month TimeFrames
100.0%
State Percent Compliance Score
97.5%
95.0%
92.5%
90.0%
87.5%
85.0%
82.5%
80.0%
Heart Attack
Heart Failure
Pneumonia
Surgical Care
14
North Carolina
Hospital Association
Core Services
Transformation
Mission: Improve delivery of quality, affordable
healthcare in North Carolina through leadership,
advocacy, information, & education
Principles: Transparency, Collaboration,
Innovation, Evidence-Based, Patient-Centered
NC Center for
Affordable
Health Care
Community Health
Improvement
Collaborative
NC Center for
Rural Health
NC Quality Center
Education
Communication &
Public Relations
Financial Services
Advocacy &
Representation
Policy Development
Payment Systems
FY 09: 7.7
FY 10: 8.2
FY 11: 4.2
FY 12: 8.7
$9,000,000
$8,000,000
Return on Total
Investment =
5.2 to 1
(Hard Savings only)
$7,000,000
$2,300,000
$6,000,000
$5,000,000
Soft Savings (potential)
$4,000,000
Hard Savings (verified)
$3,000,000
$5,479,600
$2,000,000
$1,000,000
$1,053,500
$-
Total Savings
Total Savings vs Total Investment
Third quarter 2012 Activity Summary
Total Investment
North Carolina
Hospital Association
Core Services
Transformation
Mission: Improve delivery of quality, affordable
healthcare in North Carolina through leadership,
advocacy, information, & education
Principles: Transparency, Collaboration,
Innovation, Evidence-Based, Patient-Centered
NC Center for
Affordable
Health Care
Community Health
Improvement
Collaborative
NC Center for
Rural Health
NC Quality Center
Education
Communication &
Public Relations
Financial Services
Advocacy &
Representation
Policy Development
Payment Systems
WA
ND
MT
MN
ID
OR
ME
WI
SD
VT
MI
WY
NE
NV
IL
UT
CO
KS
IN
MD
WV
AZ
MA
TN
AR
RI
NJ
DE
VA
KY
OK
CT
PA
OH
MO
CA
NM
NH
NY
IA
NC
33th
SC
MS
TX
AL
GA
LA
Top 10
FL
11-20
21- 30
Alaska #28
Hawaii #2
Source: www.americashealthrankings.org, 2012
31-40
41-50
Where NC was
2 years ago
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•
•
•
•
•
•
Children in Poverty
Violent Crime
Prevalence of Obesity
Prevalence of Smoking
Premature Deaths
Infant Mortality
Lack of Health Insurance
39nd
27th
34th
27th
37th
46th
34th
42rd
30rd
39th
36rd
37th
44th
38st
– Since 1990, the U.S. uninsured rate has increased by 46%
Source: www.americashealthrankings.org, 2010, U.S. Census Bureau
North Carolina
Hospital Association
Core Services
Transformation
Mission: Improve delivery of quality, affordable
healthcare in North Carolina through leadership,
advocacy, information, & education
Principles: Transparency, Collaboration,
Innovation, Evidence-Based, Patient-Centered
NC Center for
Affordable
Health Care
Community Health
Improvement
Collaborative
NC Center for
Rural Health
NC Quality Center
Education
Communication &
Public Relations
Financial Services
Advocacy &
Representation
Policy Development
Payment Systems
•
•
•
•
•
Decrease avoidable ED utilization
Reduce avoidable Medicaid admissions
Maximize Medicaid’s Preferred Drug List
Improve collaboration with CCNC
Enroll all eligible Medicaid patients in CCNC
22
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Alamance Regional Medical Center • Albemarle Health • Alleghany Memorial Hospital • Angel Medical Center • Annie Penn
Hospital • Anson Community Hospital • Ashe Memorial Hospital, Inc. • Betsy Johnson Regional Hospital • Blowing Rock Hospital •
Blue Ridge Regional Hospital • Broughton Hospital • Brunswick Community Hospital • Caldwell Memorial Hospital, Inc. • Cape Fear
Valley - Bladen County Hospital • Cape Fear Valley Health System • CarePartners Rehabilitation Hospital • CarolinaEast Health
System • Carolinas Medical Center • Carolinas Medical Center - Lincoln • Carolinas Medical Center - Mercy • Carolinas Medical
Center - Northeast • Carolinas Medical Center - Pineville • Carolinas Medical Center - Union • Carolinas Medical Center - University
• Carolinas Rehabilitation • Carteret County General Hospital • CaroMont Health, Inc. • Catawba Valley Medical Center • Central
Carolina Hospital • Central Regional Hospital • Charles A Cannon, Jr. Memorial Hospital • Chatham Hospital • Cherokee Indian
Hospital • Cherry Hospital • Cleveland Regional Medical Center • Coastal Plain Hospital • Columbus Regional Healthcare System •
Cone Health Behavioral Health • Davie County Hospital • Davis Regional Medical Center • Department of Veterans Affairs Medical
Center Asheville • Department of Veterans Affairs Medical Center Durham • Duke Raleigh Hospital • Duke University Hospital •
Durham Regional Hospital • FirstHealth Montgomery Memorial Hospital • FirstHealth Moore Regional Hospital • FirstHealth
Richmond Memorial Hospital • Forsyth Medical Center • Franklin Regional Medical Center • Frye Regional Medical Center • Grace
Hospital • Granville Health System • Halifax Regional Medical Center • High Point Regional Health System • Highland-Cashiers
Hospital • Highsmith-Rainey Specialty Hospital • Holly Hill Hospital • Hugh Chatham Memorial Hospital • Iredell Health System • J.
Arthur Dosher Memorial Hospital • Johnston Medical Center - Smithfield • Kings Mountain Hospital, Inc. • Lake Norman Regional
Medical Center • Lenoir Memorial Hospital, Inc. • Lexington Memorial Hospital, Inc. • LifeCare Hospitals of North Carolina •
Margaret R. Pardee Memorial Hospital • Maria Parham Medical Center • Martin General Hospital • The McDowell Hospital •
Medical Park Hospital • MedWest - Harris • MedWest - Haywood • MedWest - Swain • Mission Health System • Morehead
Memorial Hospital • Murphy Medical Center, Inc. • Nash Health Care Systems • New Hanover Regional Medical Center • North
Carolina Specialty Hospital • Northern Hospital of Surry County • Onslow Memorial Hospital • Our Community Hospital • The
Outer Banks Hospital • Park Ridge Health • Pender Memorial Hospital • Person Memorial Hospital • Presbyterian Healthcare •
Presbyterian Hospital Huntersville • Presbyterian Hospital Matthews • Presbyterian Orthopaedic Hospital • Randolph Hospital •
Rex Healthcare • Rowan Regional Medical Center • Rutherford Regional Medical Center• Sampson Regional Medical Center •
Sandhills Regional Medical Center • Scotland Health Care System • Select Specialty Hospital-Durham • Select Specialty HospitalWinston-Salem • Southeastern Regional Medical Center • St. Luke’s Hospital • Stanly Regional Medical Center • Stokes-Reynolds
Memorial Hospital, Inc. • The Moses H. Cone Memorial Hospital • Thomasville Medical Center • Transylvania Regional Hospital •
UNC Hospitals • Valdese Hospital • Vidant Beaufort Hospital • Vidant Bertie Hospital • Vidant Chowan Hospital • Vidant Duplin
Hospital • Vidant Edgecombe Hospital • Wake Forest Baptist Medical Center • Vidant Medical Center • Vidant Pungo Hospital •
Vidant Roanoke-Chowan Hospital • Wake Forest Baptist Health – Davie Hospital • Wake Forest Baptist Health – Lexington Medical
Center • WakeMed • WakeMed Cary Hospital • WakeMed Fuquay-Varina • WakeMed Zebulon/Wendell SNF and Outpatient
Diagnostic Center • Washington County Hospital • Watauga Medical Center • Wayne Memorial Hospital • Wesley Long Community
Hospital • Wilkes Regional Medical Center • Wilson Medical Center • Women’s Hospital of Greensboro • Yadkin Valley Community
Hospital
Questions?