Chief Financial Officers
This Committee develops and implements strategies specific to policy, operations, and reimbursement that impact the fiscal viability of members. The Committee continues to work on issues and develop strategies related to the Medicare Wage Index, and medical assistance modernization. Recent topics of discussion have included uncompensated care, rate transparency, budgeting, sequestration, Medicare Managed Care Organizations (MCO), Medical Assistance MCOs, revenue cycle opportunities, and payor behavior.
The Committee’s Continued Focus
The Chief Financial Officers Committee continues to work on Medicare Wage Index improvement strategies, including expanding the wage index scrubbing initiative to include Pittsburgh, Johnstown and PA Statewide Rural improvement projects. The Committee is also completing an Occupational Mix project, which has returned over $120 million in revenue to western Pennsylvania hospitals since FY 2009. Through this forum, Healthcare Council, along with its members, has developed additional strategies for the improvement of reimbursement. In addition, this Committee reviews opportunities for participation in national level appeals of Medicare issues. The Committee also discusses payor related issues and impacts related to healthcare reform and regulatory changes, including health insurance exchange products and Medicaid expansion.
Reimbursement & Payor Relations
Medicare Wage Index
- Healthcare Council continues to lead strategies for improvement of the Pittsburgh and other Pennsylvania Urban Wage Index levels. This initiative includes an annual review process which is designed to improve each hospitals’ reporting that generates the Pittsburgh Wage Index.
- Similarly, Healthcare Council initiated a statewide PA Rural Wage Index review in 2013 that has continued annually resulting in a substantial increase in reimbursement for these hospitals.
- The Pittsburgh CBSA, despite significant efforts, has the lowest wage index of any metropolitan CBSA with a population in excess of 2 Million people. HCWP continues to focus on methods to establish a minimum wage index level that would benefit this region through legislation and collaboration with other regions of the country.
- Healthcare Council reviews payments levels within the state of Pennsylvania for consistency and appropriateness and has identified areas needing focus and improvement.
- Healthcare Council has led initiatives for the reform of Inpatient, Outpatient and Observation payments by Medical Assistance in Pennsylvania, and over the past several years provided particular focus on the excessively low payment for outpatient services ranging from 30-40% of cost.
- Healthcare Council has also worked with state agencies to appropriately maximize the level of Federal Matching dollars available to fund more reasonable levels of Outpatient payments.
Commercial and Managed Care
- Healthcare Council has provided focus on payor behaviors that negatively impact the payment levels received from these payors. Areas such as inappropriate denials, underpayment of contracted rates, inappropriate application of Medicare Sequestration, and other contract related issues, have resulted in substantial increase to hospitals’ Net Patient Revenues.
Patient Responsibility Amounts
- Healthcare Council has initiated a complete focus on the level of Patient Financial Responsibility, particularly related to the ever-increasing level of deductibles being employed by payors and employers that effectively result in a substantial reduction of the effective rate paid to providers. Healthcare Council is working to educate the region on this issue and provide effective strategies for hospitals to implement.
Since its beginning, Healthcare Council has played a vital role in turning the vast quantities of data into timely meaningful information and knowledge for the membership, the communities we serve and the people that represent us. Healthcare Council continues to provide members with credible data on a regional level, which is designed to assist members with their operations.