Rural Health AdvocacyMissouri Rural Health Conference

November 18, 2015Tim Wolters, Director of Reimbursement

Citizens Memorial Hospital, BolivarLake Regional Health System, Osage Beach

Rural Advocacy Overview

• Meeting with legislators – tell your story– What makes rural different• Fluctuating volume• Higher Medicare volume• Lower commercial volume to subsidize Medicare cuts• Lower overall volume over which to spread fixed costs• Fewer resources to deal with complex, ever-changing

government programs

• Don’t forget the regulatory side – comment on proposed regulations

FY13 Medicare and Medicaid Discharges by Hospital Type

Number of

Hospitals

Medicare Discharges

Medicare Discharge Percent

Medicaid Discharges

Medicaid Discharge Percent

Total Discharges

All Hospitals 4,683 9,583,416 31.5% 3,872,807 12.7% 30,425,687Urban 2,565 8,035,725 30.0% 3,354,041 12.5% 26,786,587All Rural 2,118 1,547,691 42.5% 518,766 14.3% 3,639,100CAH 1,202 298,666 49.4% 64,825 10.7% 604,217MDH 192 171,974 48.5% 50,784 14.3% 354,279SCH 377 533,742 41.4% 182,658 14.2% 1,289,173Other Rural 347 543,309 39.0% 220,499 15.8% 1,391,431Source: FY2013 Medicare cost report data from CMS HCRIS file, 1st quarter 2015 update. Note the ‘CAH’ category includes rural CAHs only – urban CAHs are in the urban category. The ‘Other Rural’ category includes only rural hospitals with no special payment status (i.e., non-SCH, non-MDH, non-CAH).

2.60%

5.68%

8.43%

11.14%

14.36%

17.79%

21.32%

24.96%

28.59%

32.19%

35.89%

39.69%43.61%

2.10%4.04%

3.83%

5.60%

7.92%

10.51%

12.44%14.30%

15.84%

18.28%

20.88%

23.54%

26.25%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23

Impact of Medicare ACA ProductivityCuts, Fixed Cuts & Sequestration

Actual Expense Growth Projected Expense Growth Actual Payments Projected Payments

Medicare Programs CMH Operates

• Inpatient acute care PPS• Inpatient psychiatric PPS• Inpatient skilled nursing PPS• Outpatient PPS• Home health PPS• Hospice PPS

Medicare Programs CMH Operates

• Physician fee schedule• Outpatient rehabilitation fee schedule• Outpatient laboratory fee schedule, for tests

not bundled under outpatient PPS• Ambulance fee schedule• Durable medical equipment fee schedule• Pharmacy fee schedule

HR 3225- Save Rural Hospitals Act

• Eliminates Medicare sequestration cuts for rural hospitals

• Permanently extends low-volume and Medicare dependent hospital programs

• Reinstates sole community hospital hold harmless program for outpatient services

• Eliminates rural Medicare & Medicaid disproportionate share funding reductions

HR 3225- Save Rural Hospitals Act

• Reforms RAC program• Extends rural ambulance base rate increases• Reduces CAH outpatient coinsurance rates• Eliminates 96-hour inpatient certification

requirement for CAHs• Revises physician supervision requirements• Establishes community outpatient hospital

program

Regulations - Evaluate & Comment

• Annual proposed rules for IPPS, OPPS, etc. • Special CMS rules – EHR (meaningful use),

CCJR initiative, discharge planning• HRSA proposed mega-guidance on 340B• TRICARE rules for sole community hospitals• MO HealthNet rules – Medicaid DSH funding,

NDC coding requirement

Thank you for your efforts!

Tim Wolterstim.wolters@citizensmemorial.com

417-328-7286