honesty, integrity and results…you can depend on! greater new york hospital association medicare...

Honesty, Integrity and Results…You Can Depend On!

Greater New York Hospital Association

Medicare Wage IndexPPS 27 (FY 2014 AWI)

FYE December 31, 2010

Review


Agenda• Medicare Wage Index History in Metro NY• Factors Influencing Wage Index

–Macro Effects–Micro Effects

• R-C Healthcare & GNYHA–Project Approach–Hospital Participation–Ongoing Efforts


History of NYC Wage Index (WI)


Influencing Factors on WI – Macro PPACA

• Budget neutrality was returned to national level from the state level

• One hospital in Massachusetts reverted from CAH Rural MA WI is now 1.3001 – All MA hospitals receive the rural floor

• One hospital in Phoenix re-classed to rural AZ WI is now 1.0569

• The national adjustment for the rural and imputed floor is .991340. Nationally, all wage indices were reduced by .009


Influencing Factors on WI – Macro Occupational Mix

• Factor is RN hours to total nursing hours. 71.4% nationally, so if RN percentage was greater, you received a negative Occupational Mix Adjustment (OMA). If less, then the adjustment was positive

• The NYC WI increased by 1.1 percentage points due to the OMA

• The National AHW decreased by .05%• The 1.1 percentage point WI increase is

approximately $55 per Medicare PPS discharge or $14 million for the NYC CBSA


Influencing Factors on WI – Micro CA RN Requirements

• CA hospitals by law are required to have minimum percentage of RNs.

• The negative OMA is offset by the higher total salaries, resulting in higher WI

• This, along with other factors, results in CA having some of the highest WIs in the country


Influencing Factors on WI – Micro

Specific to NYC• Five hospitals representing 22.62% of CBSA

salary accounted for all WI decline from prior year Hospital Contribution to

-1.77% ChangeHosp Salary % of CBSA

1 -.19 9.53%

2 -.53 5.62%

3 -.19 1.22%

4 -.39 3.03%

5 -.49 3.22%

-1.79 22.62%


Influencing Factors on WI – Micro

Specific to NYC• Errors corrected in malpractice and teaching

physicians• $60 million reduction in malpractice reserve• Correction of lunch hours worked• Normalization of AHW resulting in 6.1% reduction on

Line 1. Previous AHW was $59.14• $15.7 million in wage related costs removed upon

audit• Occupational mix index declined 12 percentage

points from 1.1024 to .9814• $35.9 million in malpractice removed from Part A

MD’s upon audit


Influencing Factors on WI – Micro Parking

• Parking provided to employees can be claimed under benefits if it exceeds 1% of total salaries

• Hospitals have been able to utilize this provision

• R-C has looked at this for GNYHA members but has not been a factor


Influencing Factors on WI – Micro Funded Benefits

• Other vendor - Health Insurance Adjustments


Project Approach

• R-C Healthcare Management analyzed HCRIS and October PUF data

• Conducted onsite seminars for both GNYHA and HHC

• RCHMS contacts all hospital staff regarding any out-of-standard line items

• In-depth reviews for HHC hospitals through GNYHA contract

• In-depth reviews for member hospitals at reduced rate


Hospital Participation HHC Reviewed by R-C

Prov #

Hospital Prov# Hospital

330080 Lincoln Med/Mental Health 330204 Bellevue Hospital Center

330127 Jacobi Medical Center 330231 Queens Hospital Center

330128 Elmhurst Hospital Center 330240 Harlem Hospital Center

330196 Coney Island Hospital 330385 North Central Bronx Hospital

330199 Metropolitan Hospital Ctr 330396 Woodhull Hospital Center

330202 Kings County Hospital Center


Hospital Participation Continuing R-C Clients

Prov #


330014 Jamaica Hospital Medical Ctr 330193 Flushing Hospital Med Ctr

330019NY Comm. Hospital Of Brooklyn 330201 Kingsbrook Jewish Med Ctr

330055 NY Hospital Of Queens 330233 Brookdale Hospital

330056 The Brooklyn Hospital Ctr 330236 NY Methodist Hospital

330059 Montefiore Medical Center 330270 Hospital For Special Surgery

330101 NY Presbyterian Hospital 330395 Episcopal Health Services


Hospital Participation New R-C Clients

Prov #


330162 N. Westchester Hospital 330261 Phelps Memorial

330214 NYU Hospitals Center 330306 Lutheran Medical Center

330221 Wyckoff Heights Medical Ctr 330397 Interfaith Medical Center


Hospital Participation Through GNYHA Contract

Prov #


330064 New York Downtown 330304 Mount Vernon

330184Sound Shore Med Ctr of Westchester


Hospital Participation Using Other Third Party

Prov #


310008 Holy Name 330160 Staten Island Univ Hospital

330024 Mt. Sinai Hospital 330169 Beth Israel Medical Center

330046 St. Luke’s Roosevelt 330194 Maimonides Medical Center

330100 New York Eye & Ear 330195 Long Island Jewish Hospital

330119 Lenox Hill 330353 NSUH @Forest Hills

330152 Long Island College Hospital 330399 St. Barnabas

330158 Good Samaritan Hospital


Hospital Participation Self/No Third Party

Prov #


310001Hackensack Univ Med Center 330009 Bronx Lebanon Hospital Ctr

310003 Palisades Medical Center 330028 Richmond University

310006 St. Mary’s Hospital Passaic 330208 St Johns Riverside Hospital

310012 The Valley Hospital 330267 Hudson Valley Hospital Ctr

310016 Christ Hospital 330276 Putnam Hospital Ctr

310074 Jersey City Medical Center 330234 Westchester Medical Center

330006 St Joseph’s Medical Center 330316 Westchester Square

330350 Univ Hospital Of Brooklyn


Hospital Participation Non-Responding

Prov #


310019 St. Joseph's Hosp & Med Ctr 330061 Lawrence Hospital Center

310025 Bayonne Medical Center 330104 Nyack Hospital

310040 Hoboken University Med Ctr 330290 Saint Vincent CMC(Remove)

310045 Englewood Hospital 330304 White Plains Hospital Center

310058 Bergen Regional Med Ctr 330390 North General Hospital

310116 St. Joseph's Wayne Hospital 330404 Burke Rehabilitation Hospital

310118Meadowlands Hospital Medical Center 330405 Helen Hayes Hospital

330002 Peninsula Hospital Center


Hospital Participation• All Hospitals in the CBSA Were Contacted in

Regard to the Medicare Wage Index

• Participation Breakdown– Reviewed as part of Contract – 14

– RCHMS In-Depth Review – 18

– Reviewed by Other Vendors – 13

– Doing Internally – 15

– Non-Responding - 15

• Additional attempts will be made to contact non-responding hospitals


Ongoing Efforts - FFY 2014

• All Hospitals Contacted for In-Depth Review• S-3’s sent with highlighted areas of

concern & offers to consult• Hospitals directed to Web Portal for S-3

review and consultation• Hospitals alerted to possible Medicaid

impact• Cash-Strapped Hospitals Provided In-depth

Reviews through GNYHA Contract


Web Portal


Conclusions

• Macro issues have effected almost all CBSAs negatively

• Issues specific to NYC hospitals reduced WI

• Items used to bolster the WI of other CBSAs are not applicable for NYC, or are not valid changes

• Diligent maintenance assures WI is optimized for maximum reimbursement

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