Where are We Headed/Outlook for Texas HTH 14 th Annual Fall Conference November 14, 2013 Texas Organization of Rural & Community Hospitals

Page  2 Background  Founded in 1990  501(c)(6) trade association for rural and community hospitals of 150 beds or less  151 member hospitals (80 of which are CAHs)  345 total members (hospital, corporate, affiliate, ect.)  The largest statewide rural hospital association in the U.S.  Like THA, TORCH is a full-service hospital association dedicated exclusively the needs and issues of rural and community hospitals. Texas Organization of Rural & Community Hospitals

Page  3 Our Mission and Vision  Vision – Rural Texas has access to the highest quality health care.  Mission – To be the voice and principal advocate for rural and community hospitals in Texas, and to provide leadership in addressing the special needs and issues of these hospitals.  We accomplish these tasks through the support and direction of our: 21 member volunteer Board of Directors 9 staff at the Austin, TX Headquarters 2 employees in Anahuac and Nordheim, TX 1 contract lobbyist in Lubbock, TX Texas Organization of Rural & Community Hospitals

Page  4 Our Family of Organizations We also manage the following organizations: Texas Rural Health Association Northwest Texas Hospital Association Texas Association of Rural Health Clinics Texas Hospital Home Health Association

Page  5 Our Programs and Services  Advocacy – Rural health and hospital issues at the state and national level  Public Relations – Raise the visibility of TORCH and its members  Communications – Raise awareness of the issues and solutions  Research – Data and policy analysis to support rural providers  Membership Services – Quality programs that deliver value and address member needs  Education – Conference and distance education that increases knowledge and understanding of rural health issues and solutions  Networking – Creating opportunities for peer-to-peer interaction

Page  6 What Legislation and Policy Impacts Rural Healthcare?  Funding is increasingly being threatened at the state and federal level.  Rural designations, exemptions are being undermined as well.  Our piece of the pie and therefore, our influence is shrinking.  The rural population in Texas has been relatively stable, but urban growth has been explosive.  The overall health and now even our life expectancy in rural areas is on the decline.  The supply and demand equation is way off in many areas.

Page  7 How about the Affordable Care Act or Obamacare?  There is a great deal of uncertainty among rural providers.  Texas ‘checked out’ of many aspects of the ACA that might have led to an expansion in health coverage.  We are now totally reliant on the federal government and uninsured individuals to ‘do the right thing’.  Texas has recently requested a variance from ACA mandates, but will anyone pay attention or will that fall on deaf ears?  Can hospitals count on any positive ROI due to the ACA or will we continue to rob Peter to pay Paul and at what cost?

Page  8 What Other Trends Are Your Hospitals Facing?  The frequency and severity of interruptions in funding has become a nearly constant issue.  The amount of hoops that hospitals and other providers must go through just to keep the funding they had is phenomenal.  The amount of ex post facto audits and payment reviews has reached epidemic proportions.  There’s an ongoing push to implement 21 st century technology and delivery models within a 20 th century infrastructure.  Our ability to support needed improvements will soon have to reconcile with the inadequacy of available local tax support.

Page  9 What Else Keeps You Up at Night?  The constant pressure that our members feel to do more with less, when less is all that is left.  The drumbeat of reform and efficiency on providers that are as lean as possible and providing equal quality for lower cost.  The unfairness and aggressive nature of RAC and other auditors and the payment models that are driving that activity.  The need to reform our delivery system and use our resources more appropriately, when the train has already left the station.  The rising turnover in the leadership and the control of rural and community hospitals and the issues that can create.

Page  10 It was a pleasure to speak to you! But remember: “It's tough to make predictions, especially about the future” - Yogi Berra David Pearson