1. 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

2. 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

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

4. 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 1.3001 – All MA hospitals receive the rural floor One hospital in Phoenix re-classed to rural AZ WI is now 1.0569 The national adjustment for the rural and imputed floor is.991340. Nationally, all wage indices were reduced by.009

5. 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

6. 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

7. 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 1-.199.53% 2-.535.62% 3-.191.22% 4-.393.03% 5-.493.22% -1.7922.62%

8. 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 1.1024 to.9814 $35.9 million in malpractice removed from Part A MD’s upon audit

9. 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

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

11. 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

12. Honesty, Integrity and Results…You Can Depend On! Hospital Participation HHC Reviewed by R-C Prov #HospitalProv#Hospital 330080Lincoln Med/Mental Health330204Bellevue Hospital Center 330127Jacobi Medical Center330231Queens Hospital Center 330128Elmhurst Hospital Center330240Harlem Hospital Center 330196Coney Island Hospital330385North Central Bronx Hospital 330199Metropolitan Hospital Ctr330396Woodhull Hospital Center 330202Kings County Hospital Center

13. Honesty, Integrity and Results…You Can Depend On! Hospital Participation Continuing R-C Clients Prov #HospitalProv#Hospital 330014Jamaica Hospital Medical Ctr 330193Flushing Hospital Med Ctr 330019 NY Comm. Hospital Of Brooklyn330201Kingsbrook Jewish Med Ctr 330055NY Hospital Of Queens330233Brookdale Hospital 330056The Brooklyn Hospital Ctr330236NY Methodist Hospital 330059Montefiore Medical Center330270Hospital For Special Surgery 330101NY Presbyterian Hospital330395Episcopal Health Services

14. Honesty, Integrity and Results…You Can Depend On! Hospital Participation New R-C Clients Prov #HospitalProv#Hospital 330162N. Westchester Hospital330261Phelps Memorial 330214NYU Hospitals Center330306Lutheran Medical Center 330221Wyckoff Heights Medical Ctr330397Interfaith Medical Center

15. Honesty, Integrity and Results…You Can Depend On! Hospital Participation Through GNYHA Contract Prov #HospitalProv#Hospital 330064New York Downtown330304Mount Vernon 330184 Sound Shore Med Ctr of Westchester

16. Honesty, Integrity and Results…You Can Depend On! Hospital Participation Using Other Third Party Prov #HospitalProv#Hospital 310008Holy Name330160Staten Island Univ Hospital 330024Mt. Sinai Hospital330169Beth Israel Medical Center 330046St. Luke’s Roosevelt330194Maimonides Medical Center 330100New York Eye & Ear330195Long Island Jewish Hospital 330119Lenox Hill330353NSUH @Forest Hills 330152Long Island College Hospital330399St. Barnabas 330158Good Samaritan Hospital

17. Honesty, Integrity and Results…You Can Depend On! Hospital Participation Self/No Third Party Prov #HospitalProv#Hospital 310001Hackensack Univ Med Center330009Bronx Lebanon Hospital Ctr 310003Palisades Medical Center330028Richmond University 310006St. Mary’s Hospital Passaic330208St Johns Riverside Hospital 310012The Valley Hospital330267Hudson Valley Hospital Ctr 310016Christ Hospital 330276Putnam Hospital Ctr 310074Jersey City Medical Center330234Westchester Medical Center 330006St Joseph’s Medical Center330316Westchester Square 330350Univ Hospital Of Brooklyn

18. Honesty, Integrity and Results…You Can Depend On! Hospital Participation Non-Responding Prov #HospitalProv#Hospital 310019St. Joseph's Hosp & Med Ctr330061Lawrence Hospital Center 310025Bayonne Medical Center330104Nyack Hospital 310040Hoboken University Med Ctr330290Saint Vincent CMC(Remove) 310045Englewood Hospital330304White Plains Hospital Center 310058Bergen Regional Med Ctr330390North General Hospital 310116St. Joseph's Wayne Hospital330404Burke Rehabilitation Hospital 310118 Meadowlands Hospital Medical Center330405Helen Hayes Hospital 330002Peninsula Hospital Center

19. 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

20. 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

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

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

23. 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