Great Plains Regional Medical CenterLogo Refresh Exploration

February 8, 2013

2013 NEBRASKA POLICY & ISSUES SUMMIT New Norms and Innovation in Health Care Delivery

November 18, 2013

Greg Nielsen, FACHE

Affordable Care Act

• Delivery System Changes– Insurance exchanges– Value-based purchasing programs– Bundled payments– Accountable care organizations – Geographic variation adjustments– Medicare and Medicaid quality

reporting– Meaningful use (product of ARRA)

Reimbursement Cuts• Medicare reductions since ACA

enacted– ACA, sequestration, bad debt and coding

adjustment cuts • $1.3 B over ten years• -8.0% reduction

– Cuts under consideration • Outpatient E/M, Indirect Medical Education,

Direct Medical Education, Bad Debt, SCH program and CAH payments

• $608 M over ten years

Nebraskans by FPLs

246,80014%

129,9007%

372,40021%

397,50022%

663,00036%

Distribution by Federal Poverty Level, 2010-2011

Under 100%100-138%139-250%251-399%400+%

Source: Kaiser Family Foundation. Note: Nebraska Total Population 1,809,700

Transitions of Coverage

Employer54%

974,000

Individual8%

140,100

Medicaid11%

204,400

Medicare12%

225,800

Other Pub-lic2%

33,100

Uninsured13%

232,300

Employer51%

914,400

100%-400% FPL10%

187,400

Medicaid13%

237,000

"New Med-icaid"

5%87,000

Medicare12%

225,800

Other Pub-lic2%

33,100

Uninsured7%

125,000

Source: Kaiser Family Foundation. Note: Nebraska Total Population 1,809,700

2010 2014

Reform Effects• Living it since 2010

– Reimbursement cuts– Value-based purchasing– Reimbursement penalties– Transparency– New IT requirements– FTE reductions– Supply negotiations– Benefit plan changes

Status of Hospitals?“Not-for-Profit hospitals saw declines in volumes, revenue growth” – Moody’s Investor Service

“2012 may have been the ‘high water mark’ year for hospitals” – Fitch

“Moody’s predicts slow revenue growth, confirms negative outlook’ – Advisory Board Daily Briefing

“In states that say no to Medicaid, hospitals worry about ‘death by 1,000 cuts’” – Advisory Board

Status of Hospitals?

“In exchanges, many plans will limit hospital choices.”

“Many young Americans have not heard of the exchanges.”

“Hospitals want an ACA delay too.”

“Doctors may see pay delays in ACA exchanges.”

Source: Advisory Board Daily Briefing

Status of Hospitals?

Strong, vulnerable, fragile and scared• Declining volumes and reimbursements• No clear business model• Inconsistent quality results being

published• Run to safety through mergers and

alliances

Great Plains Regional Medical CenterLogo Refresh Exploration

February 8, 2013 Q&A