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1 Maryland Health Services Cost Review Commission Overview of the Uncompensated Care Methodology 03/20/2014.

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Presentation on theme: "1 Maryland Health Services Cost Review Commission Overview of the Uncompensated Care Methodology 03/20/2014."— Presentation transcript:

1 1 Maryland Health Services Cost Review Commission Overview of the Uncompensated Care Methodology 03/20/2014

2 2 Objectives 1. Update results of applying uncompensated care policy  Approx ½% increase in uncompensated care 2013> Consider impact of Affordable Care Act and Medicaid Expansion  Reduction in UCC by about 1% due to PAC expansion 3. Evaluate variables given changing uninsured  Expansion populations  Undocumented immigrant populations  Other contributors to bad debts and charity care

3 3 What is Uncompensated Care (UCC) in Maryland?  The HSCRC’s provision for uncompensated care in hospital rates is one of the unique features of rate regulation in Maryland.  Uncompensated care (UCC) includes bad debt and charity care.  By recognizing reasonable levels of bad debt and charity care in hospital rates, the system enhances access to hospital care for those citizens who cannot pay for care.

4 4 Maryland UCC Methodology  The HSCRC uses a regression methodology as a vehicle to predict actual uncompensated care costs in a given year.  The uncompensated care regression estimates the relationship between a set of explanatory variables and the rate of uncompensated care observed at each hospital as a percentage of gross patient revenue.

5 5 Maryland UCC Methodology (continued)  A 50/50 blend of the predicted value for the hospital’s uncompensated care rate based on the last available year of data and three-year moving average is used to calculate a hospital’s preliminary amount in rates.  The hospital’s preliminary amount in rates is then adjusted for charity care and the amount of uncompensated care in rates across all hospitals are 100% Pooled.

6 6 Current UCC Explanatory Variables The following variables are included as explanatory variables:  The proportion of a hospital’s total charges from inpatient non-Medicare admissions through the emergency room;  The proportion of a hospital’s total charges from inpatient Medicaid, self-pay, and charity cases;  The proportion of a hospital’s total charges from outpatient non-Medicare emergency department charges; and  The proportion of a hospital’s total charges from outpatient Medicaid, self-pay, and charity visits.

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8 8 New UCC Explanatory Variables under Consideration  The current emergency room variable is no longer working, so a replacement variable is needed  Existing variables may need to be replaced as nature of uninsured changes  Evaluate alternative variables  Remaining contribitors to uncompensated care

9 9 Impact of Medicaid Expansion on UCC  PAC population  PAC represents about 1% of charges  Estimated to account for about 15% of uncompensated care, based on historical data  Up to 1/3 of uncompensated care for some hospitals  Focus on considering in 2015 UCC estimates

10 10 What is the Primary Adult Care Program (PAC)? PAC is a health care program for low income adults age 19 and over who have minimum income. Individual Maryland residents age 19 or over who do not qualify for full coverage through Medicaid or receive Medicare are eligible if their income does not exceed $1053 a month.  PAC covers the cost of prescriptions, primary care, mental health care, hospital emergency room services, treatment for addiction, and other limited services.  PAC does not cover inpatient or outpatient hospital services or specialty services.  You do not need to have a medical condition to qualify.

11 11 PAC Inpatient and Outpatient Charges, Gross Patient Revenue, Uncompensated Care Amount and Percent by Hospital for Fiscal Year 2013 HOSPIDHospital NamePAC Inpatient ChargesPAC Outpatient Charges Gross Patient Revenue ($) Uncompensated Care ($) Uncompensated Care Percent Meritus Medical Center 3,873,372 1,094, ,350,700 21,682, % Univ. of Maryland Medical Center 19,401,160 3,097,748 1,241,601,500 67,006, % Prince Georges Hospital 2,230, , ,192,600 38,639, % Holy Cross Hospital of Silver Spring 1,053, , ,351,200 42,720, % Frederick Memorial Hospital 2,542, , ,093,700 20,318, % Harford Memorial Hospital 1,250, , ,451,400 12,160, % Mercy Medical Center, Inc. 3,491,140 2,693, ,759,600 39,008, % Johns Hopkins Hospital 12,251,177 3,902,844 2,132,419,000 90,951, % Univ. of Maryland Shore Medical Center at Dorchester 998, ,738 59,897,900 4,186, % St. Agnes Hospital 4,747,087 1,013, ,669,900 32,204, % Sinai Hospital 5,865,969 1,594, ,516,800 37,059, % Bon Secours Hospital 5,758,774 1,183, ,044,100 23,113, % Franklin Square Hospital 3,776, , ,792,200 33,166, % Washington Adventist Hospital 1,264, , ,716,100 34,587, % Garrett County Memorial Hospital 178, ,072 42,302,400 4,593, % Montgomery General Hospital 1,090, , ,869,100 10,997, % Peninsula Regional Medical Center 3,851,304 1,403, ,641,500 28,334, % Suburban Hospital Association,Inc 708,260 76, ,578,500 14,223, % Anne Arundel General Hospital 2,096, , ,867,800 28,229, % Union Memorial Hospital 4,215,526 1,644, ,581,900 33,074, % Braddock Hospital 2,191,586 1,118, ,237,300 21,637, % St. Marys Hospital 1,056, , ,603,000 13,099, % Johns Hopkins Bayview Med. Center 8,814,346 1,375, ,807,300 55,404, % Univ. of Maryland Shore Medical Center at Chestertown 367, ,179 62,791,800 6,363, % Union Hospital of Cecil County 1,582,610 1,173, ,372,900 13,323, % Carroll County General Hospital 1,523, , ,075,200 11,694, % Harbor Hospital Center 2,528, , ,141,000 17,275, % Univ. of Maryland Charles Regional Medical Center 888, , ,003,900 10,219, % Univ. of Maryland Shore Medical Center at Easton 867, , ,358,600 10,917, % Univ. of Maryland Medical Center Midtown Campus 4,571,084 2,918, ,173,800 32,904, % Calvert Memorial Hospital 1,001, , ,862,900 8,548, % Northwest Hospital Center, Inc. 2,094, , ,252,700 20,881, % Univ. of Maryland Baltimore Washington Medical Center 3,224, , ,812,800 36,844, % Greater Baltimore Medical Center 1,184, , ,137,700 13,135, % McCready Foundation, Inc. 43, ,212 17,975,600 1,495, % Howard County General Hospital 1,282, , ,901,600 16,701, % Upper Chesepeake Medical Center 1,268, , ,588,000 16,858, % Doctors Community Hospital 1,067, , ,854,500 20,137, % Laurel Regional Hospital 1,074,031 72, ,542,100 17,298, % Good Samaritan Hospital 2,120, , ,736,800 19,525, % Shady Grove Adventist Hospital 1,797, , ,706,200 23,215, % Univ. of Maryland Rehabilitation and Orthopaedic Institute 1,078, , ,227,400 5,988, % Fort Washington Medical Center 236, ,459 46,176,400 5,723, % Atlantic General Hospital 521, ,566 99,487,100 7,638, % Southern Maryland Hospital 2,048, , ,983,300 9,922, % Univ. of Maryland St. Josephs Medical Center 2,051, , ,661,500 17,305, % Univ. of Maryland (MIEMSS) - 474, ,680,900 42,108, % Statewide Totals 127,131,631 37,222,989 15,101,850,200 1,092,424, %


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