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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

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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.
slide21

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
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