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Community Forum. Rehoboth McKinley Christian Health Care Services February 12, 2014. RMCHCS Board of Trustees- Officers. Priscilla Smith, Chair; Business Owner – 2006 Kathy Head, RN, MSN, Vice Chair; Nursing Program Instructor– 2007

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Community forum

Community Forum

Rehoboth McKinley

Christian Health Care Services

February 12, 2014


Rmchcs board of trustees officers

RMCHCS Board of Trustees-Officers

  • Priscilla Smith, Chair; Business Owner – 2006

  • Kathy Head, RN, MSN, Vice Chair; Nursing Program Instructor– 2007

  • Yogash Kumar, Secretary; Business Owner, City Council member – 2011

  • David Bischoff, Treasurer; Business Owner – 2009

  • Michelle Stam-MacLaren, MD, RMCHCS Chief of Staff; Pediatrician – 2010


Rmchcs board of trustees county appointees

RMCHCS Board of Trustees-County Appointees

  • Mary Ann Armijo, Media Executive – 2014

  • Dave Dallago, Business Owner – 2014

  • Brett Newberry, Professional Services Owner – 2014

  • Yogash Kumar, Business Owner, City Council member – 2011


Rmchcs board of trustees community members

RMCHCS Board of Trustees-Community Members

  • David Bischoff, Business Owner – 2009

  • Angelo DiPaolo, Public School Administrator (retired) – 2011

  • Jennifer Dowling, Business Owner – 2009

  • Sue Eddy, Private School Department Manager – 2009

  • Kathy Head, RN, MSN, Nursing Program Instructor– 2007

  • John Luginbuhl, Pastor – 2012

  • Priscilla Smith, Business Owner – 2006

  • Shannon Tanner, Business Owner – 2009


Rmchcs administration

RMCHCS Administration

  • Barry L. Mousa, FACHE

  • Chief Executive Officer

  • High School:New Bremen, Ohio

  • Bachelors Degree: Indiana University, IPFW, Ft Wayne,Indiana

  • Masters Degree: Trinity University, San Antonio, Texas

  • Professional Certifications:

    • Certified Public Accountant (inactive)

    • Board Certified Health Care Executive

  • Health Care Experience: Florida, Georgia, Illinois, Indiana, Louisiana, New Jersey, New Mexico, Ohio, Texas, Virginia


  • Rmchcs administration1

    RMCHCS Administration

    • Robert Baker, Director of Plant Operations – 2011

    • Ina Burmeister, Chief Development Officer – 2008

    • Bart Hansen, Chief Financial Officer – 2011

    • John Mezoff MD, Chief Medical Officer – 2013

    • Mike Nye – Vice President, Professional Services and Compliance Officer – 1983

    • Nancy Santiesteban – Chief Nursing Officer – 1998

    • Kimothy Sparks – Chief Quality Officer – 2013

    • Tracy Towns – Chief Human Resources Officer - 2012


    Rmchcs department directors

    RMCHCS Department Directors

    Jim Bancuk – Clinic Operations - 2013

    Larry Booker – Diagnostic Imaging - 2009

    Donna Corley – Emergency Services - 1989

    Rosemary Coyne – Home Health/Hospice - 2010

    Melinda Graton – Health Information Management (interim) - 2014

    Phillip Hager – Patient Financial Services (interim) - 2013

    Patty Johnson – Surgical Services (staff interim) - 1994

    Harry Kallipolitis – Case Management - 2013

    Misty Leyba – Medical/Surgical/ Pediatrics/ICU - 1998

    Cassandra Lopez –

    Laboratory - 1997

    Art Macias – Pharmacy - 1996

    Tom Gonzales – Information Technology - 1996

    Edward Placencio – Materials Management - 1992

    Doug Turner –Cardiopulmonary, Physical and Respiratory Therapy, Sleep Lab - 2008


    Key issues being addressed

    Key Issues Being Addressed

    • Revenue and Services

    • Medicaid Program Reimbursement Shortfall

    • Sole Community Provider Payment Program

    • Emergency Services

    • Decisions that Positively Affect the Medicaid “Gap”

    • Critical Access Hospital Designation

    • East Campus


    Rmchcs services

    RMCHCS Services

    ICU

    Laboratory

    Medical / Surgical

    Pediatrics

    Pharmacy

    Physical and Speech Therapy

    Respiratory Therapy

    Sleep Lab

    Surgery

    Women’s Health

    • Cardiopulmonary / Cardiac Rehabilitation

    • Clinic Services—medical and surgical specialties

    • Counseling - Outpatient Behavioral Health

    • Diagnostic Imaging (MRI, CT, Mammography, Ultrasound, X-Ray)

    • Emergency Services

    • Home Health / Hospice

      -


    Rmchcs statistics

    RMCHCS Statistics


    Rmchcs revenue sources

    RMCHCS Revenue Sources


    Non patient supplemental payments

    Non-Patient Supplemental Payments


    Rmchcs revenue challenges

    RMCHCS Revenue Challenges


    Rmchcs underfunding impact

    RMCHCS Underfunding Impact


    Sole community provider program 1

    Sole Community Provider Program -1

    Since 1994 the Sole Community Provider program has been a core funding mechanism to supplement Medicaid payments for many New Mexico hospitals

    • June 2011—HSD suspends SCP payments

      • CMS alleges that sources of funds from counties were non-bona fide donations or in-kind transfers from hospitals

      • SFY 2011 SCP total = $279M

  • January 2012—HSD agrees to settlement with CMS

    • NM hospitals to repay $7.9M of CMS-calculated $53M overpayment (for 2009). NMHA says $1B SCP overpayments for 2000-2008.

    • RMCHCS repays $843,000 for 2009 (SCP reduced $2.5M in SFY 2012)

    • SCP payments restored at a lower amount—SFY 2012 = $221M


  • Sole community provider program 2

    Sole Community Provider Program -2

    • December 2012—HSD suspends SCP payments

      • 2nd time in 18 months

        • CMS determines SCP payment errors in HSD’s historical calculations

        • CMS investigation jeopardizes entire SCP program

    • May 2013—HSD agrees to settlement with CMS

      • SCP program transitions under Centennial Care waiver effective 1/1/14

      • CMS agrees to not review other years funding source and payment calculations.

    • January 2014—Centennial Care SCP program for 28 rural hospitals plus UNMH, if the underlying funds source is predictable and stable

      • Safety Net Care Pool (SNCP) program = $192.1M total amount

      • $68.9M for indigent care (maximum CMS would permit)

      • $132.2M for Medicaid Inpatient rate increase (HSD estimates ~75%)


    Safety net care pool funding plan

    Safety Net Care Pool Funding Plan

    • House Bill (HB) 350 and Senate Bill (SB) 368 establish county gross receipts tax equivalency—generates $36.4M

    • Governor Martinez proposes $9M of general state funds to augment county funding

    • Total of $45.1M needed by state to maximize federal match—total funds $192.1M


    Emergency services

    Emergency Services

    Emergency Physician Providers contacted

    • Apogee

    • EmCare

    • Hospital Physician Partners (Lovelace Health System provider)

    • Pegasus Emergency Management (CHS system provider)

    • Presbyterian Hospital & Healthcare Services

    • Schumacher Group

    • University of New Mexico Medical Group


    Three ways to positively affect the gap in medicaid reimbursement

    Three Ways to Positively Affect the “GAP” in MEDICAID reimbursement

    • Reduce overall costs of operations—

      • costs for the proportionate share of Medicaid will be reduced

    • Decrease Medicaid volume—

      • direct reduction on Medicaid costs, reimbursement gap, and losses

    • Increase revenue from non-Medicaid volume—

      • profit generated from these services will reduce the Medicaid reimbursement gap


    Increasing medicare reimbursement by critical access hospital designation 1

    Increasing Medicare Reimbursement by Critical Access Hospital Designation -1

    • Critical Access Hospitals (CAH) receive cost-based reimbursement from Medicare versus prospectively determined inpatient and outpatient fixed reimbursement rates.

    • Some hospitals find that cost-based reimbursement is advantageous, and some will not. Each hospital must perform its own financial analysis.

    • The Critical Access Hospital program is a Medicare reimbursement status only.

    • Critical Access Hospital is a change in hospital provider designation for Medicare, and not a downgrade.


    Community forum

    Increasing Medicare Reimbursement by Critical Access Hospital Designation -2

    • Conversion to Critical Access Hospital (CAH) status does not mean losing services. Many hospitals can expand services knowing that Medicare costs will be 100% reimbursed.

    • CAHs must maintain an annual average length of stay of 96 hours or less for their acute care patients.

    • CAHs may have a maximum of 25 acute care inpatient beds.

    • CAHs must provide 24-hour emergency services.

    • As of June 30, 2013, there are 1,332 certified Critical Access Hospitals located throughout the United States and nine in New Mexico.


    East campus changes

    East Campus Changes

    • Behavioral Health Services (BHS) Service Lines

      • inpatient addictions recovery program

      • outpatient individual therapy counseling

    • The BHS service lines have lost significant money for many years. Medicaid volume in Addictions Program = 94% in 2013

    • The buildings at East Campus are aging and very expensive to maintain

    • Inpatient Addictions Recovery program closing 2/28/14

    • Outpatient Therapy Counseling relocating to Main Campus on Red Rock Drive


    Rehoboth mckinley christian health care services

    Rehoboth McKinleyChristian Health Care Services


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