1. HFMA February 18, 2014

2. Today’s Update What’s Happening in Western Pennsylvania -Highlights from Hospital Council’s Flash Survey State Budget Update Healthy Pennsylvania: Medical Assistance Waiver State Political Update Federal Update

3. No. of Facilities Charity Care 4th QTR FY 12 Charity Care 4th QTR FY 13% Change Western Pennsylvania58$483,313,170$571,243,51318.19% Eastern11$36,688,748$40,482,70910.34% Northwest17$54,501,566$90,676,48566.37% Southwest30$392,122,857$440,084,31912.23%

4. No. of Facilities Bad Debt 4th QTR FY 12 Bad Debt 4th QTR FY 13 % Change Western Pennsylvania58$470,880,527$445,857,606-5.31% Eastern11$51,703,789$52,545,6441.63% Northwest17$115,917,339$92,538,873-20.17% Southwest30$303,259,399$300,773,089-0.82%

5. No. of Facilities Uncompensated Care 4th QTR FY 12 Uncompensated Care 4th QTR FY 13 % Change Western Pennsylvania58$954,193,697$1,017,101,1196.59% Eastern11$88,392,536$93,028,3535.24% Northwest17$170,418,905$183,215,3587.51% Southwest30$695,382,256$740,857,4086.54%

6. No. of Facilities Admissions 4th QTR FY 12 Admissions 4th QTR FY 13 % Change Western Pennsylvania58533,352515,820-3.29% Eastern1158,53356,556-3.38% Northwest1799,77994,773-5.02% Southwest30375,040364,491-2.81%

7. No. of Facilities Inpatient Surgical Operations 4th QTR FY 12 Inpatient Surgical Operations 4th QTR FY 13 % Change Western Pennsylvania58162,514155,801-4.13% Eastern1115,38114,242-7.41% Northwest1725,27024,682-2.33% Southwest30121,863116,877-4.09%

8. No. of Facilities Outpatient Surgical Operations 4th QTR FY 12 Outpatient Surgical Operations 4th QTR FY 13 % Change Western Pennsylvania58308,412297,769-3.45% Eastern1150,01548,432-3.17% Northwest1755,45953,908-2.80% Southwest30202,938195,429-3.70%

9. No. of Facilities Emergency Room Registrations 4th QTR FY 12 Emergency Room Registrations 4th QTR FY 13 % Change Western Pennsylvania581,754,1361,776,4871.27% Eastern11242,115240,199-0.79% Northwest17435,144437,1940.47% Southwest301,076,8771,099,0942.06%

10. No. of Facilities Operating Margin Ratio 4th QTR FY 12 Operating Margin Ratio 4th QTR FY 13 Western Pennsylvania584.44%1.81% Eastern113.75%2.39% Northwest172.98%1.82% Southwest304.86%1.72%

11. No. of Facilities Total Margin Ratio 4th QTR FY 12 Total Margin Ratio 4th QTR FY 13 Western Pennsylvania584.76%3.15% Eastern114.77%5.00% Northwest172.62%3.77% Southwest305.25%2.75%

12. State Budget Update PA is facing a nearly $2 Billion Deficit Because of: A $100 to $200 million shortfall in revenues Nearly $1.2 billion to continue MA programs and to meet the state’s pension obligations Includes Pennsylvania’s loss of more than $300 million in federal medical assistance percentages (FMAP) payments Almost $100 million of those payments go to hospitals

13. State Budget Update Governor Corbett’s Proposed Budget is $29.4 Billion Total Impact on Healthcare is a reduction of $325 million Majority of this is related to Nursing Homes-estimates are the cuts are approximately 4 percent in reimbursement

14. State Budget Update Impact on Hospitals Tobacco Settlement Funds - Budget does include funding for tobacco settlement uncompensated care and health research - Budget does not restore or include tobacco settlement funds list in this current fiscal year Impact: $50.8 million

15. State Budget Update Supplemental Payments State budget provides level state funding for supplemental payments to hospitals, but payments are lower because of FMAP reduction Graduate Medical Education Provides $4 million for 12 hospital residency slots and loan repayment awards for 70 individuals as incentive for recruitment and retention of health care professionals in underserved areas

16. State Budget Update Healthy Pennsylvania: Medical Assistance Estimates savings of $125 million for implementation of the Medicaid waiver effective January 1, 2015 Managed Care Payment Delay Includes $394 million in savings for delaying payments for managed care for one month

17. State Budget Update Restoring Tobacco Settlement Funding and FMAT Funding: HAP Proposes: Increasing the state cigarette tax Establish a new tax on all other non-taxed tobacco and nicotine products including e-cigarettes (would raise $53 million) Assess ambulatory surgical centers in a manner similar to hospitals to raise new monies for the state’s General Fund

18. State Budget Update Other Budget Considerations: No reductions to hospital rate-based or supplemental payments Uphold the Quality Care Assessment agreement Implement the MA waiver provisions by July 1, 2014 Source: Hospital and Healthsystem Association of Pennsylvania

19. Healthy Pennsylvania Pennsylvania opted out of creating a statewide insurance exchange Pennsylvania became part of the Federal insurance exchange As such, Pennsylvania did not expand the exchange to include Medical Assistance recipients Several economic impact studies show that expansion of the exchange would increase revenue to the state, create jobs and cover more Pennsylvanians

20. Healthy Pennsylvania The Governor and administration applied for a waiver from the Centers for Medicare and Medicaid to expand the exchange but with modifications Hearings were held in December, comments were accepted The waiver application was submitted to CMS CMS will also have a comment period. The waiver can be accepted, rejected or CMS and the Administration will enter into discussions and negotiations.

21. Healthy Pennsylvania Some concerns: Coverage would be delayed until January 2015 The plan is complex and could delay coverage and create barriers to access Limits on care and services could increase hospital uncompensated care Consumers and those with disabilities also have some concerns

22. The Political Scene Governor’s Race Republican: Governor Tom Corbett - Incumbent - Low Polling Numbers (as of today)

23. The Political Scene Democratic Candidates for Governor: Congresswoman Allyson Schwartz Auditor Jack Wagner Kathleen McGinty Treasurer Rob McCord Thomas W. Wolf Jo Ellen Litz (Former candidate John Hanger)

24. Federal-Political Update Federal Mid-Term Elections: 2014 Entire House of Representatives are up for Election

25. Federal Update Debt Ceiling Discussion Sequestration (2 percent cut continues)

26. Federal Update Other Considerations: Impact of Health Insurance Exchanges RAC and Other Audits

27. Contact Information Patricia J. Raffaele Vice President, Professional Services Hospital Council of Western PA raffaelp@hcwp.org 724/772-7202