Mississippi Hospital Association

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• Mississippi Hospital Association
• 2008 Advocacy Agenda

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Pointing in the Right Direction
Hospitals and legislators need to work together
in the upcoming session to ensure access to
quality care for all Mississippians.

• TOP ISSUES
• Medicaid
• Workforce
• Certificate of Need
• Trauma Care

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Hospitals in Mississippi

• Private Class 59 hospitals
• Public/State Class 4 hospitals
• Public/Non-State Class 40 hospitals
• Some specialty hospitals (LTAC, Psych, etc.) are
  not included in the totals.
• MHA membership 118 hospitals

Readingthe Signs
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Readingthe Signs

• Mississippis hospitals annually contribute more
  than 9 billion to the states economy.
• Operating expenses of 5.2 billion per year
• Capital expenditures of over 758 million per
  year
• 50,260 full time employees
• Payroll of 2.5 billion per year
• Average health care employee salary of 39,512
  (compared to a Mississippi average of 25,051)

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75 of the average hospitals billed charges are
from Medicare and Medicaid patients. 11 of the
average hospitals billed charges are from
uncompensated care. Only 14 of the average
hospitals billed charges are from insured
patients. For every 1.00 in charges, the
average hospital receives less than 0.50.
Readingthe Signs
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Reading the Signs
The simple average operating margin of hospitals
in Mississippi is 1.23 (based on 2005 cost
reports). Approximately 50 of all hospitals
operate at a loss or a margin of less than 1.
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MEDICAID
MEDICAID
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Readingthe Signs

• Federal/state funded program, administered by the
  state.
• Covers approximately 600,000 of the states
  poorest citizens.
• Mississippi receives the nations highest federal
  match currently at 76.29.
• The program consists of federally mandated
  services as well as optional services.
• The amount, duration, scope, and reimbursement
  levels are determined by the Mississippi
  legislature.

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Hospital Contributions to the Medicaid
ProgramSFY2002-2005
Total Medicaid Payments made to Hospitals
3,648,964,490 (SFY2002-2005) State Match needed
for Hospital Payments 796,668,626 SFY2002-20
05) Taxes and transfers from Hospitals
812,591,053 made to Medicaid (SFY2002-2005) Overp
ayments made to Medicaid for
15,902,427 Hospital Payments (SFY2002-2005)
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Readingthe Signs
DSH Events Prior to 2006 72
Medicaid 76
Medicaid 148
Medicaid 100
Hospitals - 48 used by Medicaid to draw down
more FMAP to pay other claims. -
This 48 equaled 80-90 million.
Individual Hospital DSH payments were calculated.
Hospitals
FMAP
DSH Payment
Medicaid
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Readingthe Signs

• UPL
  Events
• 24
  Medicaid
• 76
  Medicaid
• 100
  Medicaid
• 100
  Hospitals
• Increasing the assessment amount to 72 equaled
  approximately
• 80 million in SFY2004.

Individual hospital UPL payments are calculated
Hospitals
FMAP
UPL Payment
Medicaid
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Reading the Signs
The simple average profit margin of hospitals in
Mississippi is 1.23 (based on 2005 cost
reports). An additional 1 GRT would bring the
simple average profit margin down to a NEGATIVE
0.82. (based on 2005 cost reports). A 1 GRT on
hospitals would result in a levy of 135 million
on the sick people (based on 2005 cost reports).
Do we ask grocery stores to pay for the food
stamp program? Medicaid is a state program and
should be funded by the state not providers.
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Pointing in the Right Direction

• Medicaid should be fully funded without
  additional taxes on the sick, aged, and infirmed.
• Hospitals already pay Medicaid over 140 million
  in taxes, IGTs, and other matching funds each
  year.
• The revenue from hospitals funded almost 450
  million of the 685 million paid to hospitals for
  inpatient and outpatient services (66) in 2006.

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Questions or Comments
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WORKFORCE
MEDICAID
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RNs
Readingthe Signs

• The RN vacancy rate in Mississippi hospitals is
  9.3, which translates into a deficit of 1,280
  nurses.
• Difficulty recruiting RNs is reported in 72 of
  hospitals.
• The number of RN graduates from MS nursing
  schools increased 86 between 2001 and 2008, yet
  demand continues to increase.
• Mississippi hospitals expect to need an
  additional 883 RN positions staffed by 2009.
• The current shortage of nursing faculty is
  anticipated to result in a vacancy rate of 29 by
  2010.

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Reading the Signs
Physicians
Nationally, there are three doctors to every 1000
residents. In Mississippi, there are only two per
1000 (the lowest in the country). Mississippi
physicians are not evenly distributed
geographically. 56 of physicians are located in
four urban counties. Fifty-one of our 82 counties
are underserved. Only 12 of the states doctors
are located in the Mississippi Delta. Mississippi
hospitals report a need for 455 additional
physicians, particularly in internal medicine,
family practice and pediatrics.
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Pointing in the Right Direction

• Work with the University of Mississippi Medical
  Center and the Mississippi State Medical
  Association to combat physician shortage and
  geographic disparity issues.
• Provide funding for statewide nursing clinical
  simulation labs to increase capacity in schools
  of nursing.
• Fund the Office of Nursing Workforce to ensure
  accurate and timely workforce data, to develop
  replicable models to improve the availability of
  all allied health professionals and to combat the
  nursing faculty shortage.

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CERTIFICATE OF NEED
MEDICAID
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Readingthe Signs
Mississippi is a rural state with scarce
resources, limited access to capital, and
shortages of skilled workforces. The certificate
of need process is important to Mississippi
because it helps to ensure that resources,
capital and workforce are used only for truly
needed services. The CON process is particularly
critical in promoting the economic viability and
stability of Mississippis public safety-net
hospitals and the services they provide in their
communities. A recent independent study agreed
that the CON planning processes are beneficial to
our states hospitals, though modifications can
be made for improvement.
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Require CON review of single specialty ASCs to
improve quality and patient safety. Adjust
Capital Expenditure Review to address higher
construction costs. Exempt expansions of medical
office buildings and parking lots from CON review
(up to 5 million). Expand the number and type of
CON applications that qualify for expedited
review. Patient-Level Health Data System
Pointing in the Right Direction
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TRAUMA CARE
MEDICAID
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Pointing in the Right Direction
MHA supports the recommendations of the Trauma
Care Task Force on increasing trauma funding to
approximately 40 million and concentrating on
improvements in the administrative structure and
operational directives of the state program.
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Pointing in the Right Direction
MEDICAID Full state funding of program without
additional provider taxes WORKFORCE Work
together to provide data and solutions to prevent
future shortages CON Create a level playing
field for all providers TRAUMA CARE Provide
funding to strengthen this critical
access-to-care issue for our state