hri technical workgroup technical workgroup 03/27/2013
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HRI Technical Workgroup
Hospital Reimbursement Initiative
Technical Workgroup03/27/2013
HRI Technical Workgroup
WelcomeIntroduce PacketsHousekeepingAgenda
2
Introduction
HRI Technical Workgroup
Introduction (10 minutes) A message from the Medicaid Director (10 minutes) Today’s Landscape (20 minutes) Principles, Goals, and Outcomes (15 minutes)
o Break (10 minutes)
Scope (20 minutes) What is Success? (15 minutes) Possible Solutions (50 minutes)
o Break (10 minutes)
Logistics (10 minutes) Wrap Up (10 minutes)
3
Agenda
HRI Technical Workgroup
Steve FittonMedicaid Director
4
A Message from the Medicaid Director
HRI Technical Workgroup
Brian Keisling, Director, Actuarial Division
Jason Jorkasky, Manager, Federal Regulation & Hospital Reimbursement Policy
Section
5
Today’s Landscape
HRI Technical Workgroup
Inpatient Operating Rates Inpatient Capital Rates Outpatient Rates Pool PaymentsoMedicaid Access to Care InitiativeoHospital Rate Adjustmento Rural Access PooloGraduate Medical EducationoOutpatient DSHo Regular DSH
Today’s Landscape
6
HRI Technical Workgroup
MS-DRG grouper Hospital-specific rates for non-CAHs Statewide rate for CAHs Outliers
◦ High day◦ Low day◦ High cost
Transplants Transfers Readmissions Rebased every three years w/ annual updates between
Inpatient Operating Rates
7
HRI Technical Workgroup
Cost-based reimbursement Full Medicaid share of capital if…
◦Sole Community Hospitals with no exceptions
◦Rural hospitals with 60% occupancy rate◦Other hospitals with 75% occupancy rate
MHP capital is prospective rate
Inpatient Capital Rates
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HRI Technical Workgroup
OPPS Rates percentage of Medicare No area wage adjustment
Outpatient Rates
9
HRI Technical Workgroup
Supplemental FFS payment pool Size established as UPL gap Funded with provider tax Allocation based on historical FFS
rate payments
Medicaid Access to Care Initiative
10
HRI Technical Workgroup
Supplemental payment pool Component of MHP and PIHP capitation rates Funded with provider tax Technical guidance based on historical MHP
and PIHP rate payments
Hospital Rate Adjustment
11
HRI Technical Workgroup
Pool to hospitals that serve low-income rural residents
FFS & MHP component◦OP and IP up to cost + OB pool◦Boilerplate limits hospitals and systems
Reduced FY 2013 MACI by $8.3 M
Rural Access Pool
12
HRI Technical Workgroup
Supplemental funding pools for teaching hospitals FFS & MHP components 2 pools
◦ GME Funds – FTEs adjustment for case mix and Medicaid share of days
◦ Primary Care – FTEs adjustment for Medicaid share of outpatient charges
Case mix based on FFS claims
Graduate Medical Education
13
HRI Technical Workgroup
Supplemental payment pool 50% split between large urban vs. small
or rural hospitals Funded with provider tax Allocation based on outpatient
uncompensated care
Outpatient DSH
14
HRI Technical Workgroup
Supplemental payment pool Allocated to hospitals with significant
indigent volume (IV) IV thresholds◦20%◦50%
Regular $45M DSH
15
HRI Technical Workgroup
FFS payment limits: OP = costs & IP = charges◦FFS Payments against limits = operating, capital,
GME, MACI, Rural Access Pool DSH Payment limits: unreimbursed Medicaid and
uninsured cost◦Payments against limits = FFS and MHP operating,
capital, GME, MACI, HRA, Rural Access Pool, payments for uninsured
◦Overpayments recovered w/ FY 2011 audit
Individual Hospital Payment Limits
16
HRI Technical Workgroup
Category Amount (in millions)
Percent
FFS & MCO Rates $1,900.5 52.4%MACI & HRA $1,423.7 39.2%Rural Access $35.7 1.0%GME $162.9 4.5%Outpatient DSH $60.0 1.7%Regular DSH $45.0 1.2%Total $3,627.8 100%
Hospital Reimbursement
17
HRI Technical Workgroup
18
Principles, Goals and Outcomes
Dick Miles,Deputy Director
Bureau of Medicaid Policy and Health System
Innovation
HRI Technical Workgroup
19
Principles, Goals and Outcomes
Guiding Principles State Goals Key Concepts Acknowledge varying interests Obstacles Approach
HRI Technical Workgroup
20
Guiding Principles
More predictability Less volatility Efficiency Cost effectiveness More simplicity
HRI Technical Workgroup
21
State Goals
Manageable system Ability to respond to business needs of providers Flexibility to adapt to program and policy changes Access to hospital services for Medicaid
beneficiaries Quality services Desirable health outcomes Adequate funding
HRI Technical Workgroup
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Key Concepts
FairnessEquitySuccess
HRI Technical Workgroup
23
Acknowledge Varying Interests
Urban hospitals Rural hospitals Teaching hospitals Non-teaching hospitals Critical access hospitals Large hospitals Small hospitals
HRI Technical Workgroup
24
Obstacles
Varying interests Competing systems resources Federal approval
HRI Technical Workgroup
25
Approach
Define and measure successReasonable expectationsGive process a chance
HRI Technical Workgroup
Break Time
26
HRI Technical Workgroup
Anything is on the table Input to come from the group, not the state Recognition of obstacles previously addressed
◦ Competition for system resources, ◦ Federal approval, ◦ State policy requirements
Project structure ◦ Recommendation and decision process, ◦ Role of Technical Workgroup, ◦ Makeup and Role of Steering Committee,
Constrained time frame◦ Phased Implementation?
27
Scope
HRI Technical Workgroup
Define Success Discussion How will we measure success? Define Key Terms
28
What is Success?
HRI Technical Workgroup
“What would you like to get out of this process?”
“What can you do to make this process better?”
29
Possible Solutions
HRI Technical Workgroup
Break Time
30
HRI Technical Workgroup
Big Ideas What problem is this idea/solution trying
to solve?
What is the proposed solution?
What are the barriers to success of the idea/solution?
31
Possible Solutions
HRI Technical Workgroup
Future meetings◦ April 11th 9-12 – Already Scheduled◦ May 10th 1-4◦ May 22nd 1-4◦ June 17th 9-12◦ July 16th 1-4
Remote access Possible subgroups
Logistics
32
HRI Technical Workgroup
What did we accomplish today? Agreements Additional Information?
Wrap Up
33
HRI Technical Workgroup
Technical Workgroup ParticipantsMicheal BrunnerAllegiance Health
Fred KagariseMidMichigan Health
Mike Tomkovich Trinity Health
Scott FlowerdayBeaumont Health System
Steve LeachMunson Healthcare
Michael KlettUniversity of Michigan Health System
Kristi BelmoreBronson
David Fiero Oaklawn Hospital
Marilyn Litka-KleinMichigan Health & Hospital Association
Jerry RivetCovenant Medical Center, Inc.
Bob PlaskeyOakwood
Vickie KunzMichigan Health & Hospital Association
Debra HansonDickinson County Memorial Hospital
Connie DownsPennock Health Services
Tom MarksHealth Management Associates
Carol BaileyDetroit Medical Center
Terry LutzScheurer Hospital
Cheryl BuppHealth Management Associates
Mark McIntoshHenry Ford Health System
Craig ClaradySparrow Health System
Farah Hanley State Budget Office
Tom CrystalHurley Medical Center
Cathy SinningSpectrum Health
Erin BlackDepartment of Community Health
Anna PeroskyMcLaren Health Care
Dave BuckleySt. John Providence Health System
34
HRI Technical Workgroup
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State ParticipantsDick Miles milesr6@michigan.govBrian Keisling keislingb@michigan.govJason Jorkasky jorkaskyj@michigan.govPaul Abid abidp@michigan.govBen Ayres ayresb@michigangovBobby Becsey becseyr@michigan.govSherri Gensterblum gensterblums@michigan.govSteve Ireland irelands@michigan.govCraig Castagnasso castagnassoc@michigan.gov
HRI Technical Workgroup
36
netlogx ParticipantsNick Taylor ntaylor@netlogx.comDave Luter dluter@netlogx.comMelanie Hobbs mhobbs@netlogx.comSara Jordan sjordan@netlogx.comTina Smith tsmith@netlogx.com
HRI Technical Workgroup
37
Questions ?
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