“The Best of Times……… The Worst of Times……” A Look Ahead to 2009 Wisconsin Chapter of...
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“The Best of Times……… The Worst of Times……” A Look Ahead to 2009 Wisconsin Chapter of American College of Healthcare Executives December 12, 2008
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Transcript of “The Best of Times……… The Worst of Times……” A Look Ahead to 2009 Wisconsin Chapter of...
“The Best of Times……… The Worst of
Times……”
A Look Ahead to 2009
Wisconsin Chapter of American College of Healthcare Executives
December 12, 2008
It’s 1983 all over again!
Democrat Governor
Democrat Senate
Democrat Assembly
Record State Budget Deficit
1983 Outcomes
Wisconsin hospital rate setting commission
Restrictive CON program including tertiary service decertification
Hospitals at ground zero because of health care costs hysteria
WHA faced with member angst regarding strategies related to regulatory initiatives
Likely 2009 Environment
1. Health reform defined by coverage affordability.
* 65% - It’s the $!
51% insurance affordability
22% expanded coverage uninsured
10% Quality14% reduce
spending Source:Kaiser Foundation Tracking Poll
2. Dire state budget situation
Structural deficit of $2 billion +
Stagnant revenue growth
Built in expense growth of 5-7%
Potential that pending lawsuits will open $500 plus million dollar hole
$5 BILLION
Governor Doyle becomes gate keeper
Look at Illinois………
3. Political Dynamics Change
LaborWMCHealth Insurers
Health care spending
4. Healthy Wisconsin is in Play
16% Payroll tax Government imposed limits on annual
total spending growth.
What happens when $ is gone?• Payroll tax increases• Benefits reduce• Providers get a haircut
5. Doyle Administration Incrementalism
Medicaid tax
Medicaid expansion
Small group insurance reform
Encourage HIT
But will Doyle still be Governor?
6. Why The Tax?
14 Years
$600 Million cost shifting
Federal $ left on the table
8 hospitals = 40% of total Medicaid days.
It Will Happen!
2009 MA Payment Changes
-120,000
-60,000
0
60,000
120,000
180,000
240,000
Franciscan Skemp La Crosse ($110,442) ($112,221)
CAH $31,066 $205,411
Inpatient Outpatient
Matchable State Funds $176,785,046
Federal Government
State of Wisconsin
$249,702,962
+
Hospital Assessment
$249,702,962
Matching federal funds $ 265,177,569
An additional $1.50 for every $1 collected comes back to the state.
Available for Hospital Payment Increases
$441,962,615
Net Increase in Medicaid
reimbursements to hospitals:
$192,259,653($441,962,615 increase
less $249,702,962 assessment)
Diverted for Other State Purposes
$72,917,916
Hospital Assessment Proposal – FY09
Medicaid Coverage Expansions Quality and Safety ?Medical Malpractice Labor Issues Challenges to Hospital Finances/not-for profit status Billing and collection
++
––
––
7. Hospital Vulnerabilities and Opportunities
Essential Strategies to Prevail on Key Issue Areas
1. Support Doyle Adminsistration’s incremental reform agenda, including insurance reform.
2. Rally behind “moderate” Democrats
3. Be prepared to compromise on the small stuff.
4. Advance quality and safety agenda.
5. Advance value theme.
6. Accelerate community benefits initiative(s).
7. Accelerate/re-commit to billing and collection pledge.
Major 2008 Project List
Major 2008 Project List
Major 2008 Project List
Major 2008 Project List
December
Hospital Finances
January
Costs Report
February
Hospital Economic Impact/Value Report
Major 2008/2009 Project List
