Honesty, Integrity and Results…You Can Depend On! Greater New York Hospital Association Medicare Wage Index PPS 27 (FY 2014 AWI) FYE December 31, 2010 Review

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! History of NYC Wage Index (WI)

Honesty, Integrity and Results…You Can Depend On! 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 – All MA hospitals receive the rural floor One hospital in Phoenix re-classed to rural AZ WI is now The national adjustment for the rural and imputed floor is Nationally, all wage indices were reduced by.009

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! Influencing Factors on WI – Micro Specific to NYC Five hospitals representing 22.62% of CBSA salary accounted for all WI decline from prior year HospitalContribution to -1.77% Change Hosp Salary % of CBSA % % % % % %

Honesty, Integrity and Results…You Can Depend On! 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 to.9814 $35.9 million in malpractice removed from Part A MD’s upon audit

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! Influencing Factors on WI – Micro Funded Benefits Other vendor - Health Insurance Adjustments

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! Hospital Participation HHC Reviewed by R-C Prov #HospitalProv#Hospital Lincoln Med/Mental Health330204Bellevue Hospital Center Jacobi Medical Center330231Queens Hospital Center Elmhurst Hospital Center330240Harlem Hospital Center Coney Island Hospital330385North Central Bronx Hospital Metropolitan Hospital Ctr330396Woodhull Hospital Center Kings County Hospital Center

Honesty, Integrity and Results…You Can Depend On! Hospital Participation Continuing R-C Clients Prov #HospitalProv#Hospital Jamaica Hospital Medical Ctr Flushing Hospital Med Ctr NY Comm. Hospital Of Brooklyn330201Kingsbrook Jewish Med Ctr NY Hospital Of Queens330233Brookdale Hospital The Brooklyn Hospital Ctr330236NY Methodist Hospital Montefiore Medical Center330270Hospital For Special Surgery NY Presbyterian Hospital330395Episcopal Health Services

Honesty, Integrity and Results…You Can Depend On! Hospital Participation New R-C Clients Prov #HospitalProv#Hospital N. Westchester Hospital330261Phelps Memorial NYU Hospitals Center330306Lutheran Medical Center Wyckoff Heights Medical Ctr330397Interfaith Medical Center

Honesty, Integrity and Results…You Can Depend On! Hospital Participation Through GNYHA Contract Prov #HospitalProv#Hospital New York Downtown330304Mount Vernon Sound Shore Med Ctr of Westchester

Honesty, Integrity and Results…You Can Depend On! Hospital Participation Using Other Third Party Prov #HospitalProv#Hospital Holy Name330160Staten Island Univ Hospital Mt. Sinai Hospital330169Beth Israel Medical Center St. Luke’s Roosevelt330194Maimonides Medical Center New York Eye & Ear330195Long Island Jewish Hospital Lenox Hills Long Island College Hospital330399St. Barnabas Good Samaritan Hospital

Honesty, Integrity and Results…You Can Depend On! Hospital Participation Self/No Third Party Prov #HospitalProv#Hospital Hackensack Univ Med Center330009Bronx Lebanon Hospital Ctr Palisades Medical Center330028Richmond University St. Mary’s Hospital Passaic330208St Johns Riverside Hospital The Valley Hospital330267Hudson Valley Hospital Ctr Christ Hospital Putnam Hospital Ctr Jersey City Medical Center330234Westchester Medical Center St Joseph’s Medical Center330316Westchester Square Univ Hospital Of Brooklyn

Honesty, Integrity and Results…You Can Depend On! Hospital Participation Non-Responding Prov #HospitalProv#Hospital St. Joseph's Hosp & Med Ctr330061Lawrence Hospital Center Bayonne Medical Center330104Nyack Hospital Hoboken University Med Ctr330290Saint Vincent CMC(Remove) Englewood Hospital330304White Plains Hospital Center Bergen Regional Med Ctr330390North General Hospital St. Joseph's Wayne Hospital330404Burke Rehabilitation Hospital Meadowlands Hospital Medical Center330405Helen Hayes Hospital Peninsula Hospital Center

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! 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

Honesty, Integrity and Results…You Can Depend On! Web Portal

Honesty, Integrity and Results…You Can Depend On! Web Portal

Honesty, Integrity and Results…You Can Depend On! 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