1. HomeTown 2011 Fall Meeting LEARNING OUTCOMES OF PRESENTATION: 1.Describe the findings of the 4 policy maker field trips that included 28 hospital facilities. 2.Out of the 28 hospitals visited during the policy maker field trips, identify the best practices among them. 3.Discuss the upcoming legislative session. Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

2. HomeTown 2011 Fall Meeting Premise of HomeTown Health Findings 1. 27 Hospital visits May 2011-October 2011 2. Six Hospital Board Interventions Oct-Nov 2011 3. About 50 webinars 2011 4. Input from 5000 HTHU enrollees Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

3. HomeTown 2011 Fall Meeting What 10 years will do! 1)Cost to Charge Ratio fall has created major damage to CAH’s 2)PPS at 85.6% of cost has done irreversible damage They got the message! Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

4. HomeTown 2011 Fall Meeting Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011 Typical CAH Typical CAH Hospital Actual Data Payor% cost reimbursement% Net Revenue by Payor Weighted Reimbursement by Payor Medicare95.000%55%52.250% Medicaid95.000%12%11.400% No Pay2.000%12%0.240% Commercial150.000%21%31.500% Profitability 100%95.390% Hospital NameNet RevenueCostProfit $12,000,000.00$12,579,935.00-$579,935.00

5. HomeTown 2011 Fall Meeting Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011 Typical PPS Actual Data PPS Hospital Cash Flow Payor% cost reimbursement% Net Revenue by Payor Weighted Reimbursement by Payor Medicare93.000%55%51.150% Medicaid85.600%15%12.840% No Pay2.000%10%0.200% Commercial150.000%20%30.000% To Break even 100%94.190% Commercial - equals commercial cross subsidization Net RevenueCostProfit $22,000,000.00$23,357,044.27-$1,357,044.27

6. HomeTown 2011 Fall Meeting We Learned Current State of Rural Hospital Affairs a.Cash flow first half 2012 awful a.Add-ons b.DSH only half distributed c.Unsettled cost reports – several hundred d.Outliers e.Qualified Medicare Beneficiaries b.17 hospitals in “Transition” c.DSH only half distributed d.CEO Turnover and Turmoil Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

7. HomeTown 2011 Fall Meeting Findings - Cons 1. Overall Financial Crisis Among Rural Hospitals A/R less than 5 days for many hospitals Minimum cash reserves Payables over acceptable days Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

8. HomeTown 2011 Fall Meeting Findings Cons 2. Lack of readiness for EHR in many cases Have not filed with state Who is Terri Brannigan? The closest thing to the silver bullet! Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

9. HomeTown 2011 Fall Meeting Findings Cons 3. C-suite Denial of severity of problems Slow to reduce FTE’s or fix physician contracts Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

10. HomeTown 2011 Fall Meeting Findings Cons 4. Poor Physician contracts - no RVU Compensation Models or Performance Basis Contracts Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

11. HomeTown 2011 Fall Meeting Findings Cons 5. Hospitalists programs being forced on Hospitals Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

12. HomeTown 2011 Fall Meeting Findings Cons 6. CMO Denials have wiped out cash Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

13. HomeTown 2011 Fall Meeting Findings Cons 6. Failure to believe the following a.$103,000 Net Revenue/FTE b.43% salaries for net revenue c.Bad Debt at 8-10% d.Net A/R less than 50 days e.33%-35% commercial f.40,000 population required to support a hospital g.Baby Deliveries must exceed 350 Annually Otherwise translates into necessary subsidy from DSH, UPL or County Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

14. HomeTown 2011 Fall Meeting Findings Pros 1.Excellent best practices identified 1.Examples 2.MSO’s 3.Quadax 4.Health Trust 5.nTelagent 6.RVU Doc Contracts Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

15. HomeTown 2011 Fall Meeting Findings Pros 2. Incredibly creative and hardworking leadership a. Vent patients at Miller b. Geriatric Psych Berrien c. Certifying HTHU students d. Figuring out how make payroll Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

16. HomeTown 2011 Fall Meeting Findings Pros 3. Exceptionally active and informed community leadership Miller – in the rain Elbert – political Morgan – community and politicians Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

17. HomeTown 2011 Fall Meeting Findings Pros 4. Great communication with State Alec Steele and his team a.Earl Whitely – Calhoun b. Robin Rau - Miller a.Kim Savage - Charlton Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

18. HomeTown 2011 Fall Meeting Findings Pros 5. Great Political Involvement Rep Mickey Channell Rep Butch Parrish Senator Jack Hill Speaker David Ralston Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

19. HomeTown 2011 Fall Meeting Findings Pros 5. Great Patient Care However getting buried in bureaucracy Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

20. HomeTown 2011 Fall Meeting Findings Pros 6. EHR – Financial Attestation Calhoun SunLink Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

21. HomeTown 2011 Fall Meeting Legislative Forecast 1.Budget – may be $250 million short 2.State Health Benefit Plan $800 million problem 3.Redistricting impact 4.Provider Tax 5.Senate Power Structure Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

22. HomeTown 2011 Fall Meeting Legislative Forecast 1.Budget – may be $250 million short 2.State Health Benefit Plan $800 million problem 3.Redistricting impact 4.Provider Tax 5.Senate Power Structure Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

23. HomeTown 2011 Fall Meeting Congressional Forecast Super committee proposals could shut rural hospitals...Super committee proposals could shut rural hospitals...‎ Wichita Business Journal - 1 day ago The congressional supercommittee charged with finding ways to reduce the federal deficit is reviewing several proposals that would target "critical access... 1.It’s their attitude that is troubling! Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

24. HomeTown 2011 Fall Meeting Cash Flow Forecast 1.HIPAA 5010 Jan 1, 2012 2.State Health Benefit Plan $800 million problem 3.ICD10 October 2013 4.Four cash flow items – early 2012 1.Add-ons 2.Outliers 3.Unsettled cost reports 5.Qualified Medicare Beneficiaries 6.DSH – HS&R’s 7.alified Medicare Beneficiaries Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

25. HomeTown 2011 Fall Meeting Best Practices Observed on Trips 1.MSO’s 2.Quadax 3.nTelagent 4.Health Trust Purchasing 5.Telemedicine – Blue Tooth 6.DSH – HS&R’s 7.EHR Plan for attestation 8.CMO Appeal process 9.Business Partner adoption Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

26. HomeTown 2011 Fall Meeting THERE IS NO SINGLE SILVER BULLET OF RELIEF So.. what is the answer? Bundles of little Silver bullets! 1)Absolute control of Revenue Cycle 2)Trend is employment of Docs with RVU contracts 3)CAH’s MUST manage variance while squeezing dollars 4)Consolidation and elimination of duplicative services 5)Adoption of known Best Practices 6)Develop leadership at local level 7)Go to a new level of board and political education Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011

27. HomeTown 2011 Fall Meeting LEARNING OUTCOMES OF PRESENTATION: 1.Describe the findings of the 4 policy maker field trips that included 28 hospital facilities. 2.Out of the 28 hospitals visited during the policy maker field trips, identify the best practices among them. 3.Discuss the upcoming legislative session. Jimmy Lewis CEO, HomeTown Health, LLC, 10-21-2011