The first caregivers

Transcription

1 About the H

2 The first caregivers

3 The progress continues Deaths due to heart attack cut in half Days spent in hospitals cut by 56% Increased life expectancy by 3.2 years

4

5 Alabama s hospitals: 59,000 births annually 616,000 inpatient stays and 8.7 million outpatient visits

6 Constant Focus on Safety In the first year of the federal government s pay for performance program, Alabama s hospitals ranked number 1 in the country! In the most recent infection prevention report, Alabama s hospitals, performed better than the nation in all four categories reported.

7 MORE INFORMATION ON QUALITY

8 Tremendous Economic Impact More than $20.4 billion in total impact

9 Thousands of jobs Alabama s hospitals employ 88,876 people and indirectly support 95,000 jobs in other industries for a total of 183,884 jobs. Our hospitals provide approximately $4.5 billion in salaries and benefits for another $2.9 billion indirectly for a total of $7.4 billion.

10 In spite of their best efforts Alabama s hospitals are struggling financially: 69 percent are operating with a negative margin. 86 percent of rural hospitals were operating in the red. Between 2011 and 2018, eight hospitals have closed. Margins lowest in the country

11

12 Percent of revenue dependent on government funding sources

13 How hospitals are paid by Medicare Hospitals receive a fixed payment for each Medicare stay based on the diagnosis, thus placing the risk at the hospital level. Payments include a base payment adjusted by several factors, including wages. Hospitals in some states are paid twice as much as Alabama hospitals, and our margins are the lowest in the country.

14 Dollars at risk due to performance measures Reporting 2% 2% VBP 1% 1.25% 1.5% 1.75% 2% 2% Readmissions 1% 2% 3% 3% 3% 3% 3% HACs 1% 1% Meaningful Use 1% 1% 1% 1% %

15 Medicaid: Bare bones state program Medicaid is a joint state/federal program that provides health care to low-income individuals. Most of those covered are children, seniors and the blind and disabled. Very strict eligibility no childless adult covered, and a family of four must make less than $4300 a year to qualify.

16 Hospitals fund hospital services Out of $6.5 billion Medicaid budget, only 11% are General Fund dollars. Alabama gets 68 cents in federal matching funds for every 32 cents of state funding. Not one dime of General Fund dollars are used for hospital care. Payments come from hospital assessments and transfers matched with federal dollars.

17 State Medicaid reforms Alabama s Medicaid Agency is looking for ways to expand existing health home program to better coordinate care and lower costs. Enrollees will be connected to a specific provider who will be incentivized to ensure preventive measures are taken to avoid costly care in the future.

18 National health reforms Affordable Care Act created opportunities and challenges. Greater coverage with premium subsidies, but challenges collecting higher copays. Payments to help hospitals cover the cost of treating the uninsured are decreasing (supposed to be balanced with Medicaid expansion, which hasn t happened in Alabama).

19 Other challenges Recent court case - no grounds for denials. Constant audits: RACs identify payment errors. MACs conduct reviews for payment accuracy and medical necessity ZPICs look for billing fraud CERTS work with MACs and randomly review claims

20 Difficult to know what to do Strict admission criteria Observation too sick to go home, but don t meet criteria for admission Increase in observation less money for hospitals, more out-of-pocket for patients Two-midnight rule

21 Electronic health records Increase efficiency Improved care Expensive Penalties Security issues

22 It s your H Hospitals are only as strong as their local support. We need: Your ideas Your understanding Your patronage Your voice with lawmakers