Docstoc

Slide 1 - Texas State University

Document Sample
Slide 1 - Texas State University Powered By Docstoc
					Healthcare Challenges and Your Career

Presenter:
Ernie Schmid, MSHP 97, FACHE



October 29, 2010




                                        1
Part One
 Environmental Observations




                               2
TEXAS


Year    Total Population
2010    25,409,530
2040    45,388,036



                           3
TEXANS and the Cash Economy

 26.1% of Population Uninsured
  – 6.4 million
 Large homeless population
 Large number of first generation Americans
  – 13.9% of population foreign born
 6.7% of population undocumented
  – 1.6 million
 17.3% of Texans in poverty (4.26M) (14.3% US) A family of four is
  below the federal poverty level if its annual household income is less than $21,954.

                                                                                         4
AND What Does the Future Hold?

Poverty growing in Texas schools
More than half of state’s students disadvantaged, report finds
By ERICKA MELLON
   HOUSTON CHRONICLE
Jan. 2, 2010, 10:36AM


Almost six out of 10 Texas public
 schoolchildren hail from low-income
 families, marking a troubling spike in
 poverty over the last decade, a new
 state report finds.
AND What Does the Future Hold?

In 2009,Texas ranked sixth in the percentage
  of people in poverty, behind Mississippi (23.1
  percent), Arizona, Arkansas, Georgia and the
  District of Columbia.




                                                   6
US Income Distribution




http://www.census.gov/prod/2010pubs/p60-238.pdf7
2010-2011 Texas Budget all Funds-$182B

             0%   6%             Judiciary
                       2%
                                 Public Safety

                                 Natural Resources

                     11%         Economic Development
                            1%
                                 General Provisions, Regulatory,
      42%                   3%   Legislature
                            2%   American Recovery and
                                 Reinvestment Act
                       7%        General Government

                                 HHS without Medicaid/CHIP

                                 Medicaid/CHIP
               26%               Education




                                                                   8
Reform and State Budget Over Ten
Years

 Adds 2.3 M Texans to Medicaid rolls
 Cost $27 B in GR




                                        9
Current Government Sponsored Health
Care

 6.4 million uninsured
 3.2 million Medicaid Beneficiaries
 2.7 million Medicare Beneficiaries
 .537 million CHIP Participants


At a minimum half the state’s
 population relies upon government
 for health care
                                       10
600 TEXAS Hospitals






                      11
81,000 Hospital Beds


            Hospital Beds by Ownership 2007



                 5%
      12%

                                        41%   For Profit
                                              Not for Profit
                                              Public
                                              State

     42%
42% of Texas Hospital Net Patient
Revenue from Medicare and Medicaid


   Net Medicare   Net Medicaid   Total Net Patient
                                     Revenue
     $13.3B          $5.4B            $44.4B
       30%            12%




                                                     13
MedPac Payment Approach

“From 2007 to 2008, the overall Medicare margin
  fell from –6.0 percent to –7.2 percent…”
“Most of our payment adequacy indicators for
 hospitals are positive, but profit margins on
 Medicare patients remain negative for most
 hospitals.”
“A key question is whether Medicare payments
  are adequate to cover the costs of efficient
  providers.”

                                                  14
  Medicaid Payments to Texas Hospitals

            2007 Medicaid Hospital Payment Sources
                           All Funds

      20%
                                               Medicaid Service
                                               Payments
                                               Upper Payment
                                               Limit Payments
                                               Disproportionate
                                   57%         Share Payments
23%




                                                                  15
Government does not pay for all services
it mandates

In 1986, Congress enacted the Emergency
 Medical Treatment & Labor Act
 (EMTALA) to ensure public access to
 emergency services regardless of ability
 to pay.
  – hospitals must provide a medical screening examination
  – Hospitals are then required to provide stabilizing treatment for patients with
    Emergency Medical Conditions
  – If a hospital is unable to stabilize a patient within its capability, or if the patient
    requests, an appropriate transfer should be implemented.

                                                                                              16
Private or Public?

Government sees hospitals/providers as
 private enterprises but treat them like
 public utilities.
Government and providers see each other
 as bad business partners.
“In 2008, the weighted average of the operating and capital payment
   updates was roughly 3 percent. (Medicare inpatient costs per
   discharge increased 5.5 percent in 2008-speakers addition)
   However, inpatient payments per discharge increased by 4.5
   percent. The difference between the update and payment growth
   was primarily due to reported increases in case mix. “ MedPac
   March 2010                                                         17
Part Two
 Reform in Texas




                    18
REFORM: Quality-Price-Access




                               19
Case for Reform

                  17.5
                   %




                    20
Access: Senate Finance

                              Original Agreement   Chairman’s Mark
Coverage all persons in                94%                  91%
US (including undocumented)
Coverage of all legally                97%                  94%
residing in US
Left without coverage               18 million           25 million
Hospital reductions                 $155 billion        $155 billion
Reduced                             $171 billion      $140-$152 billion
uncompensated care




                                                                          21
Access

 Medicaid Expansion
 – State funding
 – Eligibility systems
 Insurance Subsidy computation—need and
  subsidy always unsynchronized
 Funding during gaps in coverage




                                           22
Access Continued

 Coverage goals
 – Will goals be reached in Texas?
 – What if they are not?
 Rural provisions support current favorable
 provisions but they are not transformative




                                               23
Price

 US administrative costs 31% of health care expenditures (16.7% in
  Canada)
  – Stimulus invests $19 B for HIT
 Uninsured cause cost shifting?
  – 1.6 m undocumented and others who will remain uninsured in
    Texas
  – 25 million uninsured in US-----cost shifting still necessary, but is it
    possible?
  – Future of disproportionate share and UPL payments?
 Unsustainable price increases
  – Demand will increase in short run

                                                                          24
Price Continued

 Payments
 – Super MedPac or (IMAC) Independent Medicare
   Advisory Commission---base closing model
 – Exchanges; negotiated rated or rate setting?
 US per capita spending highest among
 industrial nations
 – Spending disparities
 – Physician referral and ownership
 – Liability reform
 – End of life care
                                                  25
Price: Contributions in Billions—Taxes
Roll Downhill

 RX                     $ 80
 Medical Device Tax     $ 40
 Hospital cuts          $ 155
 Insurance tax          $ 60
 Lab Tax                $   8
 Medicare Advantage     $120
 Individual Mandates    $150
 Employer mandates      $200
 Other                  $100
 Total                  $900
                                         26
  Quality: US Vs Organization for
  Economic Cooperation and Development




                                                                            The 30 member countries of OECD are:
Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland,
 Ireland, Italy, Japan, Korea, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Poland, Portugal, Slovak
                                      Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States.
                                                                                                                27
Quality and Reform

 Unnecessary Readmission Penalties (-$2 B)                                                20 percent of
 hospitalized Medicare patients are back within 30 days, according to a 2009 study published in the New England
 Journal of Medicine

  – Who manages patient care?
 Value Based Purchasing (-$12.1 B)
  – Reward the good, penalize the bad…..self fulfilling prophecy?
 Bundling pilots
  – State laws adequate?
 Accountable Health Care Organizations
  – How does the $ move?
  – Control

                                                                                                                  28
AND for Texas?
  – Will increase in hospital beds keep up with demand?
     Where are the investment dollars?
  – Will Texas have enough health care workers?
  – How will Texas laws need to change?
     Corporate practice of medicine prohibition?
     Charity care expectations?
  – How many Texans will be left uninsured?
  – Will State and Local government spend more on health care?
     Is tax system adequate for the new demands?
  – How will the delivery system change?
     Impact on ownership types?
     What will happen in rural Texas?
     Hospital/Physician incentives aligned?
                                                                 29
Access improved. Price and Quality, a work in progress.
And what will the future hold????




                                    30
Speaker

Ernie Schmid, FACHE
ernie2010@sbcglobal.net




                          31

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:5/14/2013
language:English
pages:31
xiangpeng xiangpeng
About pengxiang