1. 2013 Legislative Update March 26, 2013 WV Chapter HFMA 2013 Spring Revenue Cycle Workshop

3. Healthcare Reform - Ready or not, here it is!! Affordable Care Act – yes, it’s still here –1,000’s of pages, 100’s of new regulations –Value Based Purchasing –Hospital Acquired Conditions –HCAHPS –Readmissions –Partnership for Patients –Meaningful Use, ACO, Etc etc etc!!!

4. Journey Through Change Change Process Starts Promised Land Journey Through Hell TIME Morale “Everything looks like failure in the middle”

5. Medicare Payment at Risk under CMS Quality-based Payment Reform Initiatives 20102011201220132014201520162017 Readmissions Hospital Acquired Conditions Meaningful Use Value-based Purchasing (VBP) Inpatient Quality Reporting Requirement (IQR, formerly RHQDAPU) Hospital Acquired Conditions (HAC) 2% of APU 2% 1% 3% © 2011 Press Ganey Associates, Inc. Meaningful Use

6. Value Based Purchasing Summary - CURRENT ESTIMATE West Virginia: ($789,508) West Virginia: ($3,112,100) Readmissions

7. Domain Weighting for FFY2013 30% Patient Experience Process of Care

8. Domain weighting for FFY14 HCAHPS 30% Clinical Process of Care 40% Outcomes 30%

9. Readmissions reduction program began Oct. 1 34.9% with no penalty 40.4% with penalty <0.5% 24.7% with penalty between 0.5% and 1% NO adjustment for all planned or unrelated admissions NO adjustment for socio-economic status Readmissions

10. Source: KNG Analysis of 2009 100% Medicare inpatient file and FY2011 Hospital IPPS final rule impact file. 30-Day Readmissions

11. ….the Stakes are High! 20

12. 2013 Legislative Session Started: February 13 th Ends: April 13th

13. Jeff Kessler Rick Thompson Senate President Speaker of the House Ron Stollings Don Perdue Senate Health House Health Corey Palumbo Tim Miley Senate Judiciary House Judiciary West Virginia Governor Earl Ray Tomblin

14. Important Dates March 25 - marks the 41st day of the legislative session and the last day to introduce bills in the Senate and House. March 31 - Bills due out of committees in house of origin (47th day). April 3 - Last day to consider bills on 3rd Reading (passage stage) in house of origin (50th day). April 13 - Session adjourns at midnight. (60th day)

15. Status Report – Keys Bills of Interest UPL - SB 195 – Hospital Upper Payment Limit (UPL) Program. Bill has already been approved by the Senate Health Committee and is currently in the Senate Finance Committee likely to be considered this week. The bill as it stands:SB 195 Extends the UPL for one year, through June 30, 2014, in order to maximize the financial benefits of the Program. Reduces the hospital tax rate for this Program from the current rate of 0.88% to 0.45%, almost a 50% reduction; If the UPL program is not extended past June 30, 2014, the legislation states that any remaining funds (unmatched tax funds) will be split evenly between the Medicaid program, and the hospitals that participated in the private hospital UPL program.

16. Status Report – Continued SANE - HB 2583 – Creating a Sexual Assault Forensic Examination Commission.HB 2583 MEDICAL RECORDS – a bill advocated by some members of the House and plaintiff attorneys around the issue of medical records copying costs. NAME TAG BILL - SB 21 - Creating Health Care Provider Transparency Act – aka “Name Tag Bill.”SB 21 MATERNITY HEALTH INSURANCE COVERAGE - SB 22 and HB 2383 – Relating to mandatory maternity coverage for all health insurance plan dependentsSB 22HB 2383 CIGARETTE TAX BILL INTRODUCED - SB 593 – Introduced last week, increasing excise tax on cigarettes and tobacco products.55 cents to $1.55

18. Questions March 26, 2013 Jim Kranz VP Professional Activities West Virginia Hospital Association 100 Association Drive Charleston, WV 25311 (304) 353-9712 Jim.Kranz@wvha.org