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Mississippi Hospital Association 2008 Advocacy Agenda

Mississippi Hospital Association 2008 Advocacy Agenda. Pointing in the Right Direction. TOP ISSUES Medicaid Workforce Certificate of Need Trauma Care. Hospitals and legislators need to work together in the upcoming session to ensure access to quality care for all Mississippians.

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Mississippi Hospital Association 2008 Advocacy Agenda

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  1. Mississippi Hospital Association 2008 Advocacy Agenda

  2. Pointing in the Right Direction TOP ISSUES • Medicaid • Workforce • Certificate of Need • Trauma Care Hospitals and legislators need to work together in the upcoming session to ensure access to quality care for all Mississippians.

  3. Hospitals in Mississippi • Private Class – 59 hospitals • Public/State Class – 4 hospitals • Public/Non-State Class – 40 hospitals Some specialty hospitals (LTAC, Psych, etc.) are not included in the totals. MHA membership – 118 hospitals Readingthe Signs

  4. Readingthe Signs • Mississippi’s hospitals annually contribute more than $9 billion to the state’s economy. • Operating expenses of $5.2 billion per year • Capital expenditures of over $758 million per year • 50,260 full time employees • Payroll of $2.5 billion per year • Average health care employee salary of $39,512 (compared to a Mississippi average of $25,051)

  5. 75% of the average hospital’s billed charges are from Medicare and Medicaid patients. 11% of the average hospital’s billed charges are from uncompensated care. Only 14% of the average hospital’s billed charges are from insured patients. For every $1.00 in charges, the average hospital receives less than $0.50. Readingthe Signs

  6. Reading the Signs The simple average operating margin of hospitals in Mississippi is 1.23% (based on 2005 cost reports). Approximately 50% of all hospitals operate at a loss or a margin of less than 1%.

  7. MEDICAID MEDICAID

  8. Readingthe Signs • Federal/state funded program, administered by the state. • Covers approximately 600,000 of the state’s poorest citizens. • Mississippi receives the nation’s highest federal match – currently at 76.29%. • The program consists of federally mandated services as well as optional services. • The amount, duration, scope, and reimbursement levels are determined by the Mississippi legislature.

  9. Hospital Contributions to the Medicaid ProgramSFY2002-2005 Total Medicaid Payments made to Hospitals $3,648,964,490 (SFY2002-2005) State Match needed for Hospital Payments $ 796,668,626 SFY2002-2005) Taxes and transfers from Hospitals $ 812,591,053 made to Medicaid (SFY2002-2005) Overpayments made to Medicaid for $ 15,902,427 Hospital Payments (SFY2002-2005)

  10. Readingthe Signs DSH Events Prior to 2006 72% Medicaid 76% Medicaid 148% Medicaid 100% Hospitals - 48% used by Medicaid to draw down more FMAP to pay other claims. - This 48% equaled $80-$90 million. Individual Hospital DSH payments were calculated. Hospitals FMAP DSH Payment Medicaid

  11. Readingthe Signs • UPL Events • 24% Medicaid • 76% Medicaid • 100% Medicaid • 100% Hospitals • Increasing the assessment amount to 72% equaled approximately • $80 million in SFY2004. Individual hospital UPL payments are calculated Hospitals FMAP UPL Payment Medicaid

  12. Reading the Signs The simple average profit margin of hospitals in Mississippi is 1.23% (based on 2005 cost reports). An additional 1% GRT would bring the simple average profit margin down to a NEGATIVE 0.82%. (based on 2005 cost reports). A 1% GRT on hospitals would result in a levy of $135 million on the sick people (based on 2005 cost reports). Do we ask grocery stores to pay for the food stamp program? Medicaid is a state program and should be funded by the state – not providers.

  13. Pointing in the Right Direction Medicaid should be fully funded without additional taxes on the sick, aged, and infirmed. Hospitals already pay Medicaid over $140 million in taxes, IGTs, and other matching funds each year. The revenue from hospitals funded almost $450 million of the $685 million paid to hospitals for inpatient and outpatient services (66%) in 2006.

  14. Questions or Comments

  15. WORKFORCE MEDICAID

  16. Readingthe Signs RNs The RN vacancy rate in Mississippi hospitals is 9.3%, which translates into a deficit of 1,280 nurses. Difficulty recruiting RNs is reported in 72% of hospitals. The number of RN graduates from MS nursing schools increased 86% between 2001 and 2008, yet demand continues to increase. Mississippi hospitals expect to need an additional 883 RN positions staffed by 2009. The current shortage of nursing faculty is anticipated to result in a vacancy rate of 29% by 2010.

  17. Reading the Signs Physicians Nationally, there are three doctors to every 1000 residents. In Mississippi, there are only two per 1000 (the lowest in the country). Mississippi physicians are not evenly distributed geographically. 56% of physicians are located in four urban counties. Fifty-one of our 82 counties are underserved. Only 12% of the state’s doctors are located in the Mississippi Delta. Mississippi hospitals report a need for 455 additional physicians, particularly in internal medicine, family practice and pediatrics.

  18. Pointing in the Right Direction Work with the University of Mississippi Medical Center and the Mississippi State Medical Association to combat physician shortage and geographic disparity issues. Provide funding for statewide nursing clinical simulation labs to increase capacity in schools of nursing. Fund the Office of Nursing Workforce to ensure accurate and timely workforce data, to develop replicable models to improve the availability of all allied health professionals and to combat the nursing faculty shortage.

  19. CERTIFICATEOF NEED MEDICAID

  20. Readingthe Signs Mississippi is a rural state with scarce resources, limited access to capital, and shortages of skilled workforces. The certificate of need process is important to Mississippi because it helps to ensure that resources, capital and workforce are used only for truly needed services. The CON process is particularly critical in promoting the economic viability and stability of Mississippi’s public safety-net hospitals and the services they provide in their communities. A recent independent study agreed that the CON planning processes are beneficial to our state’s hospitals, though modifications can be made for improvement.

  21. Require CON review of single specialty ASCs to improve quality and patient safety. Adjust Capital Expenditure Review to address higher construction costs. Exempt expansions of medical office buildings and parking lots from CON review (up to $5 million). Expand the number and type of CON applications that qualify for expedited review. Patient-Level Health Data System Pointing in the Right Direction

  22. TRAUMA CARE MEDICAID

  23. Pointing in the Right Direction MHA supports the recommendations of the Trauma Care Task Force on increasing trauma funding to approximately $40 million and concentrating on improvements in the administrative structure and operational directives of the state program.

  24. Pointing in the Right Direction MEDICAID – Full state funding of program without additional provider taxes WORKFORCE – Work together to provide data and solutions to prevent future shortages CON – Create a level playing field for all providers TRAUMA CARE – Provide funding to strengthen this critical access-to-care issue for our state

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