Rural Health Advocacy Missouri Rural Health Conference November

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Rural Health Advocacy Missouri Rural Health Conference November 18, 2015 Tim Wolters, Director of

Rural Health Advocacy Missouri Rural Health Conference November 18, 2015 Tim Wolters, Director of Reimbursement Citizens Memorial Hospital, Bolivar Lake Regional Health System, Osage Beach

Rural Advocacy Overview • Meeting with legislators – tell your story – What makes

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

FY 13 Medicare and Medicaid Discharges by Hospital Type Number Medicare Medicaid Total of

FY 13 Medicare and Medicaid Discharges by Hospital Type Number Medicare Medicaid Total of Discharges Discharges Hospitals Percent All Hospitals 4, 683 9, 583, 416 31. 5% 3, 872, 807 12. 7% 30, 425, 687 Urban 2, 565 8, 035, 725 30. 0% 3, 354, 041 12. 5% 26, 786, 587 All Rural 2, 118 1, 547, 691 42. 5% 518, 766 14. 3% 3, 639, 100 CAH 1, 202 298, 666 49. 4% 64, 825 10. 7% 604, 217 MDH 192 171, 974 48. 5% 50, 784 14. 3% 354, 279 SCH 377 533, 742 41. 4% 182, 658 14. 2% 1, 289, 173 Other Rural 347 543, 309 39. 0% 220, 499 15. 8% 1, 391, 431 Source: FY 2013 Medicare cost report data from CMS HCRIS file, 1 st 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).

Medicare Programs CMH Operates • • • Inpatient acute care PPS Inpatient psychiatric PPS

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 •

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

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

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. •

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 340 B • TRICARE rules for sole community hospitals • MO Health. Net rules – Medicaid DSH funding, NDC coding requirement

Thank you for your efforts! Tim Wolters tim. wolters@citizensmemorial. com 417 -328 -7286

Thank you for your efforts! Tim Wolters tim. [email protected] com 417 -328 -7286