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HomeTown Health - Ga Health Care Fall Industry Update 2010. Current Georgia Rural Hospital Scenario. HomeTown Health - Ga Health Care Fall Industry Update 2010. Basis for HomeTown Health Observations Approximately 50 hospital visits since May 1, 2010
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Current Georgia Rural Hospital Scenario
Basis for HomeTown Health Observations
Approximately 50 hospital visits since May 1, 2010
Four 2 day Budget Writer Visits to rural hospitals
Recent 2-3 Dinner with Senator Goggans, Rep Channell, Lunch w Sen. Tommie Williams
Two national conferences
Study Forecast with Dr Carolyn Bordeaux SBO
19 Hospitals currently in consolidation or major financial distress, i.e. major cuts
Higher Insurance Premiums driving industry from providing health care
Obamacare has caused insurance premium increase for small business to be at least 15% up to 35%
Essentially have created a class of insured self pays
Consequence Rural Ga Hospital Net Revenues down 5%-15% since Jan1 2010
Payor Mix has amplified Self Pay to an overwhelming component of net revenue
Next slide illustrates
Rural PPS Hospitals in Georgia – Status?
Positives for Stand Alone Rural PPS Hospitals
Virtually No operational positives except best administrators in the industry
Medicaid Rate Increase designed to offset Provider Tax – 1st Medicaid Rate Increase since 1998
Negatives for Rural PPS Hospitals
Very poor Payor Mix
85.6% of cost paid for Medicaid
In counties of highest unemployment
Cannot support specialties like surgery due to demographics
Encumbered by cost to charge ratio
Major subsidy dependent
Demographics do not support surgeons or specialist except on part time basis thus insufficient Commercial
Provider Tax-Medicaid Rate Increase disparity from 2008 baseline
Provider tax could be reopened leading to an expanded provider tax and loss of CAH exemption, especially if model revisions are used to reopen the subject
Days Cash below 10 days
Can’t recruit physicians
Bank covenant violation
State Computer Conversion – ACS to HP
Medicaid expansion to + 33 million
Simply run out of cash
Loss of UPL and dilution of Private DSH
Gubernatorial Transition – no state budget experience
The Issues - What Are They?
Budget $2 billion more to cut in 2012
Half billion more to cut in 2011
Revenues down this year as much as 15%-20%
Unemployment still over 10% in most rural areas
Self Pay soaring to 15%-20%
2012 State Budget Implications
Cut another $2 billion
2012 Possibly to $15 billion
Health Care Silos
And then there is the provider tax will it be reopened?
HomeTown Health - Ga Health Care Fall Industry UHomeTown Health - HomeTown Health - Ga Health Care Fall Industry Update 2010pdate 2010
This election may tip the balance of power away from old sources
Posted: August 2, 2010 - 12:19am | Updated: August 2, 2010 - 3:19am
By Walter C. Jones
ATLANTA - The makeup of the ballot shows how unusual this election is and provides evidence of how much Georgia is changing.
For one thing, it's already clear that South Georgia has lost much of its influence. The remaining candidates for U.S. Senate and governor are all from above the Gnat Line.
Veteran politicians from below the line saw their careers and hopes sputter as the primary returns were counted July 20, including Democrats Dubose Porter and David Poythress from Middle Georgia and Republicans Eric Johnson and Jeff Chapman from the Coast.
Another South Georgia giant fell in the Democratic primary for labor commissioner, former House Speaker Terry Coleman of Eastman to metro Atlantan Darryl Hicks, at least unless a challenge changes the decision.
The only candidates from below the Fall Line remaining on the statewide ballot are Democrats Ken Hodges of Albany, the nominee for attorney general, and J.B. Powell of Blythe near Augusta, the nominee for agriculture commissioner.
Carter: Budget math hard to figure
This new math is killing me!
Seriously, how can 4.7 percent and 12.7 percent average out to be 1.3 percent?
When it comes to the state of Georgia's budget, that's what a lot of financial gurus are saying actually has happened during the first two months of this fiscal year.
In July of this year, revenues were up 4.7 percent from a year ago and in August they were up 12.7 percent from the same time last year. So that means that revenues are up 8.6 percent from where they were for the same two months last year, right?
Not necessarily. After all, if we look closely at the numbers much of the gain in revenue this year is due to fewer individual income tax refunds being issued by the state than last year. Many will remember that overdue income tax refunds were processed and paid out in July and August of '09 and subtracted from that month's total tax collections.
This year the state was timely in paying out the refunds in May and June. Couple this with the number and amount of tax refunds are down this year and the number comparisons are understandably inaccurate.
Nevertheless, there is reason for celebration and optimism, albeit guarded. August marked the fourth month in a row for growth in tax collections after 17 straight months of declines.
So, if we are trending in a positive manner and revenues are increasing, why has the governor ordered all state agencies except the Department of Education to brace for a 4 percent cut in this year's budget and prepare for up to a 10 percent cut next year?
Remember is that the current fiscal year 2011 budget has a revenue growth of 5.09 percent built into it and if the actual growth thus far has only been 1.3 percent then we need to be prepared for a shortfall. The next few months should give us a clearer picture.
Another reason is that Gov. Sonny Perdue is being conservative so that the next governor won't immediately have to order more cuts.
But the overriding factor in the 4 percent cut is to cover the shortfall of $140 million in the federal Medicaid assistance funding percentages (FMAP) that Congress failed to approve late last month.
Medicaid is the government's health insurance program for the poor that is primarily funded by federal matching funds drawn down with state dollars. It is the fastest growing entitlement program in government, as states have expanded eligibility and benefits.
Unlike other states, Georgia has been fiscally responsible in managing Medicaid. We spend $6,000 per person in poverty on Medicaid. New York spends $18,000 per person. Only 18 percent of Georgians are on Medicaid as opposed to 26 percent in New York. Unfortunately, federal funding allows states that spend more on Medicaid to receive more matching funds, leaving states like Georgia holding the bag. For instance, while Georgia will receive about $240 million in FMAP from this latest approval, New York will receive $2.4 billion.
The 10 percent budget cut preparation that Perdue has ordered for FY '12 is in anticipation of a $1.8 to $2 billion shortfall that is expected due to slow revenue growth as well as the loss of federal one-time stimulus funds.
State Sen. Buddy Carter, R-Pooler, represents portions of C
Georgia Legislative Changeover Coming
30+ new Representatives Nov 2010
16 new Senators Nov 2010
Pending Census Change
Up to 8 Rural Representatives lost
Up to 3-4 rural Senators Lost
Loss of institutional knowledge
Georgia Legislative Medicaid Politics
Rep Mickey Channell
Senator Greg Goggans