Summer 2016

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heartbeat Volume 69 | Issue 1 Summer 2016 H E A LT H C A R E F I N A N C I A L M A N A G E M E N T A S S O C I AT I O N S E R V I N G T H E K A N S A S C I T Y C H A P T E R Programming .............................2 Webinars ....................................2 President’s Corner ......................3 Region 8 Connection...................5

Summer Institute........................6 Officers/Board of Directors .........7 Corporate Sponsorship ...............7

Chapter Leadership Meeting.......8 BKD Spotlight .............................9 Annual National Institute.............9

Bank of America Spotlight.........10 New Members ..........................11 Get to Know A Member.............12 Legislative Update ....................13 HFMA Golf Tournament .............14

Committees................................7

New HFMA Certification Program Congratulations to the Heart of America Chapter’s latest members to successfully pass the Certified Healthcare Financial Professional (CHFP) examination: Tom Hutsel and Kelli Schroeder.

Tom Hutsel, Director Rev Cycle, Cerner Corp Kelli Schroeder, Director of Patient Accounts, North Kansas City Hospital

The CHFP program has been recently updated to provide the broad range of business and financial skills essential for succeeding in today’s high-value healthcare environment: - Business acumen - Collaboration - Financial strategy - Understanding future trends

The new CHFP is geared toward financial professionals, clinical and non-clinical leaders, and payers. The new CHFP program includes two modules: Business of Health Care and Operational Excellence. We recently asked Tom and Kelli about their experience with the examination. Please tell us what you do and who you work for. Tom: I serve as the Director of Solution Strategy for the Cerner Millennium Patient Access Solutions. This includes Scheduling, Registration, Practice Management and the services that support these workflows. Kelli: I am the Director of Patient Accounts for North Kansas City Hospital.

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mark your calendars National Webinars

HFMA Virtual Conference

August 10 Digital Payments and Consumerism – The New Normal!

September 15, 2016

August 23 5 Signs It’s Time to Outsource Your Revenue Cycle: Key Focus Areas to Improve Financial Health at Your Hospital

• Interactive, live event from the convenience of your computer • Free for members • $175 for non-members (includes membership for those new to HFMA through May 31, 2017) - Influential speakers - Dynamic education sessions - Online networking opportunities - Industry solutions - Up to 4 CPE credits

August 24 Work-From-Home Strategies: Creating Effective Programs to Increase Productivity and Improve Employee Satisfaction

Heart of America Programs

August 16 2017 Proposed Rule Changes to Outpatient Payment Systems (OPPS) and Ambulatory Service Centers (ASC)

August 30 Moving Patient Access to the Front Lines: How the MetroHealth System is Embracing Consumerism Register at: www.hfma.org/webinars

Mark your calendars now for the upcoming local programs. Times and locations will be announced later: September 27, 2016 November 17, 2016 January 26, 2017 February 23, 2017 March 23, 2017 April 27, 2017

View all upcoming on-demand webinars HFMA provides webinars available one calendar year following the live webinar date. Most on-demand webinars are free for HFMA members and $99 for non-members, unless otherwise noted.

AVAILABLE UNTIL: Understanding Medicare’s Proposed FY 2016 Inpatient Prospective Payment System Rule - Available until August 3, 2016 An Overview of Medicare’s Proposed Comprehensive Care for Joint Replacement Model - Available until Sept 1, 2016 Inspire: Women in Leadership Roles - Available until Sept 9, 2016 If you are interested in presenting a webinar, please contact Kurt Belisle at [email protected]. – page 2 –

Regulatory Update and Legislator Panel Executive Panel Hot Topics in Healthcare Women in Healthcare Luncheon Healthcare 101 Leadership and Awards Ceremony

Michelle L. Narayan, President

As the new HFMA year begins, I reflect on the experiences, connections and friendships I have developed over the years. I am honored to serve as President of our Heart of America Chapter. I thank the Past Presidents, Officers, Board Members, Committee Chairs and members for entrusting me with the privilege of serving as President. I also thank the sponsors as their support contributes to our education and networking events that are the basis of the Heart of America Chapter. A special note of appreciation also needs to go to Paul Knudtson for his leadership over the past year as our President. Paul led a successful year in which the chapter exceeded membership goals, had four members earn their HFMA certification and collaborated with MGMA for the first time on an executive panel program. The chapter also earned two Yerger Awards in the areas of improvement and innovation. These awards reflected the work towards evaluating chapter needs based on chapter member surveys and educating members on certification benefits. Congratulations to Paul and his leadership team for the many accomplishments. The chapter celebrates your successes with you! Paul set the bar high, demonstrating what it takes to lead with commitment and to “Go Beyond” within his leadership year. With a strong board, officer team and committee volunteer base, I am confident we will continue to be a strong resource for the Heart of America Chapter. During this year’s Leadership Training Conference in Ft. Lauderdale, Mary Mirabelli, 2016-2017 National Chair, announced her theme, “Thrive.” Mary Mirabelli said, “I wanted to foster a spirit of resiliency and encourage people to grow and flourish. One word summarized the vision for me, and that word was thrive. So I’ve committed to spending the next twelve months encouraging my fellow HFMA members to thrive—personally, professionally, and as an organization.”

Social Media and Website Committees – Assist with the updating of the website as well as the Heart of America Chapter LinkedIn, Facebook and Twitter pages. Certification Committee – Educate members about the certification and assist individuals with the test. Publications Committee – Plan and organize the quarterly newsletter. Networking Committee – Coordinate networking events, including the golf tournament, happy hours and sporting events. In conclusion, the chapter leadership has reviewed the results from the membership satisfaction survey in preparation for this year’s educational program lineup. I can assure you the Heart of America Chapter is committed to providing high quality education combined with more networking opportunities, all while having a good time along the way. The Heart of America Chapter has also set forth certain goals for the coming year: Stronger Volunteer Base: Ensure new volunteers are appointed so that fresh ideas can be introduced as well as developing a stronger volunteer succession plan. This will be a nice complement to our current veteran volunteers who continue to provide a great foundation to the Heart of America Chapter. Improved Use of Social Media: We hope to get up and going on Twitter this year as well as have a higher profile LinkedIn and Facebook presence. Thanks to visionary members, we are looking to greatly increase our use of social media.

As I look forward, I ask all of you for your ideas and thoughts to help us fulfill our commitment to thrive within our chapter. We are over 300 members strong and have the resources to stay at the forefront of the issues facing healthcare finance today.

Continued Education Excellence: We are fortunate to have some of the best volunteers leading our educational programs. Together, we are committed to bringing members valuable information to help them navigate the change in healthcare today.

Truly this chapter is yours as members and I urge to make your voice and skills known. If you have not volunteered yet within this chapter, please consider doing so. I know that every chapter member has skills and assets that this chapter could truly benefit from. This leads me to our Call for Committee members for the new year.

Networking Opportunities: Organize meaningful networking opportunities especially for those currently designated as students or early careerists within healthcare.

The Heart of America Chapter is planning for the 2016-2017 fiscal year, and we are looking for committee volunteers. Being a part of a committee provides you with the opportunity to network and work with the membership base. The following provides a description of the various committees available to members. Programming Committee – Assist in the planning of educational events during the year. Typically a member will assist in one event during the chapter year. Membership Committee – Assist with coordinating events for new members, including lunch meetings and meeting new members at programs.

Sponsorship: Introducing new sponsorship opportunities that meet the needs of our valued sponsors. A key area is also increasing our sponsors as well to ensure we can continue to provide quality education at lower registration fees for members. Sponsors are critically important to the viability of the chapter. Strategic Plan: Development of a five year strategic plan to not only address the needs of our chapter and its members today but also look towards securing long term stability and satisfaction. I look forward to seeing everyone at our programs and networking events throughout the year. If there are any recommendations or questions, please do not hesitate to contact me. Now go out there and “THRIVE” personally, professionally and within our Heart of America Chapter!

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New HFMA Certification Program, continued...

How long have you been with HFMA/Heart of America Chapter, and what has benefited you most from membership? Tom: I have been a member of HFMA for over 3 years. I benefit the way many people do, by staying current with issues impacting our industry. Specifically, I stay plugged into current events via chapter newsletters, seminars and industry conferences. Truthfully, I am looking forward for more opportunities to engage with the chapter. Kelli: I’ve been a member of HFMA for about eight years. I’ve benefited the most from the relationships I’ve developed both within our chapter and also in our region. It’s great to have a group of colleagues to share information with. Tell us how long you studied for the CHFP exam? Tom: I had a great opportunity to align my study time for the CHFP during a work sabbatical, also known as Cerner’s Long-Term Service Award. At Cerner, you become eligible for this award after seven years of continuous employment. This award designates time to be used towards an area of professional development that adds value to your role. I chose to use this time for completing the CHFP certification, and I studied approximately 40 hours prior to taking the exam. Kelli: I actually didn’t study. I clicked through the review online that you must complete in about an hour, and decided to just take the test for module one and see how I did. Then about a week later took the module two test. Tell us more about the purpose for pursuing the certification and what impact will it have on your work? Tom: I chose this certification to stay close to the inner workings of our industry. The breadth of content for the certification covered both a nuts and bolts perspective as well as strategic content. This is helpful as these topics come up during strategic discussions with clients and other leaders. The content allowed me to brush up on areas I am familiar with, and re-introduced me to areas I need to know. This experience paved the way to add more skills and tools to my toolkit, adding value to interactions with clients, other Cerner associates, and healthcare leaders alike. Kelli: I have always told myself that when I finished my MBA I would take this test. I graduated almost 18 months ago with my MBA, and decided it was time! I feel the credentials are an excellent way of attesting to your level of understanding about our industry. In fact, I’m not a fan of studying a large study guide because I believe you should pass this exam by having a high level of understanding about healthcare finance. I have seen many people with several sets of credentials behind their name because they took a “boot camp class”; however, they had no real understanding or experience in the area of their credentials. I think this is why I believe strongly that there should be minimal studying if one truly understands the area for which they are seeking credentials in.

Talk about your preparation and any recommendations you have for others currently pursuing/interested in the certification? Tom: My preparation was similar to the Certified Revenue Cycle Representative (CRCR) course I completed a year and half ago. I went through all sections of the program in order, utilizing the resource guide alongside the online content. I found the guide to be a handy tool to complete as you are reviewing the online content, as there are activities that tie back to the material. Sticking to a timeline to complete each section was an important step in my preparation. I would recommend those currently preparing for the exam to develop a timeline to complete the material and take the exam. In our busy lives, it is easy to get distracted and impede one’s progress. Plan your time to study for each section. Put a date on your calendar that you plan to take the exam and stick to that schedule. I would also recommend reaching out to others preparing for the exam in your organization or within your network to review the content and bounce concepts off each other. These discussions can be particularly helpful if you are having difficulty with a section that you aren’t familiar with in your day-to-day role. Kelli: My preparation was basically the 20+ years in healthcare IT, coding, and case management. My recommendation for anyone interested in pursuing the certification would be to try it first without many hours of studying. At the end of the exam you get a great feedback report that tells you what areas were your strengths and weaknesses. I think it’s important that you really understand the areas you need more knowledge in whether you pass it the first time or not. If you don’t pass, then use that report as you guide to further knowledge.

What was the most difficult part? Tom: I personally found the Cost Analysis Principles section to be the most challenging. This was an area that wasn’t as familiar to me as other sections, so I spent more time reviewing this material. Kelli: The second module section on physician practice alignment was the hardest for me and was also my weakest spot. That’s one area I haven’t had as much experience in and I struggled. It’s also the area I want to focus on with some further education so I have a better understanding. Thank you Tom and Kelli, and Congratulations!

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Bill Fenske, Region 8 Executive

This is my first newsletter to you and I am very proud and honored to be serving as your Region 8 Executive. My name is Bill Fenske and I am the incoming Region 8 Executive. It is a privilege to serve you and to work with so many dedicated volunteers. In my initial visits to some of the Chapters, I am so impressed by the commitment of your leaders and your members to continue serving HFMA and making HFMA the strongest professional association within the healthcare industry. We have a lot going on in Region 8 led by the Mid-America Summer Institute August 24-26 in Minneapolis. I hope that you will consider attending as the Committee has done an excellent job in preparing a great educational program along with many networking opportunities. As a reminder to all members who work for providers that there is a Provider Scholarship available for conference registration and lodging. Please go to the Region 8 website at http://www.hfmaregion8.org/ for further information.

During the week of April 17, 2016, your chapter leaders attended the Leadership Training Conference (LTC) in Fort Lauderdale. LTC is held each year to allow your elected leaders and various committee chairs to receive the training needed to fulfill their responsibilities. LTC is very rewarding and sets the tone for the upcoming year. I would encourage each of you to support your leaders in reaching the goals set for the June 2016 through May 2017 chapter year. How can you support your leaders? It takes a team to reach the goals set at each chapter and each of our members are part of that chapter’s team. It can be as simple as attending chapter meetings, attending national meetings or volunteering for a committee. Based on my experience, you will get more out of it than what you put into it. That is one of the many outstanding things about HFMA. Thank you for the opportunity to serve Region 8, by far the best region in HFMA! I look forward to working alongside your dedicated Chapter Leaders!!

I am very pleased that Kyle Lee, your Region Executive Elect, and I will be working to visit all of the Chapters this upcoming year. We have been in contact with your Chapter leaders and are working our schedules to attend at least one Chapter event during the year. As I mentioned above, I have already visited a couple of Chapters that are new to me and was very impressed and pleased by the experience. I hope that as you see us, you will reach out and introduce yourself and feel free to ask any questions that you may have about HFMA, Region 8, or National HFMA. So what does a Region Executive do besides travel to Chapter events? There are five main responsibilities of the Region Executive and Executive Elect: - To serve as the primary volunteer and policy liaison between the Chapters and HFMA National. - To assist chapter leaders in serving its members - To foster dialogue and effective communications between HFMA National and the local Chapter - To represent the needs and interests of chapter leaders to the HFMA National Board and management - To encourage chapters to collaborate with each other and with other organizations I would like to extend a sincere thank you to my predecessor, Stephanie Hultman. Stephanie continued the tradition of excellence within Region 8 and we are all appreciative of all of her efforts. As I mentioned above, Kyle Lee is the Region Executive Elect for this upcoming year. Kyle has already begun working with your President Elects and will be very involved with our Region 8 Webinars and in the planning for our upcoming Fall Presidents Meeting in Memphis.

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Officers and Directors 2016 HEART OF AMERICA CHAPTER OFFICERS

BOARD OF DIRECTORS 2016

President President-Elect Vice President Secretary Founders/DCMS Treasurer

Donna Findley Kalinda Calkins Michelle Decker

Michelle Narayan Todd Kenney Damara Harper Todd Goforth Todd Goforth Loraine Uebele

2016 PUBLICATION COMMITTEE

Sue Brammer Tammy Shepherd

Tammy Shepherd, Co Chair Deb Gregory, Co Chair Pablo Marquez Jeremy Pelski

913-945-5596 913-574-2307 816-218-1699 816-914-5274

2017 Kelli Schroeder Mary Johnscher Mary Knollmeyer Miccole Bowen

Deadline for submission of articles for the next newsletter is October 5, 2016.

2016 Corporate Sponsorship PLATINUM

SILVER

Bank of America Merrill Lynch BKD, LLP Human Arc RSM, LLP

Cardon Outreach Country Club Bank HCFS, Inc. Mercer Relay Health

Sincere appreciation is extended to our corporate sponsors for 2016-17. Your support of our Chapter significantly improves our ability to offer quality programs to our members. Please consider joining our fantastic group of sponsoring organizations. If you are a service provider, please contact: Paul Knudtson 816-502-0648 Mary Knollmeyer 913-791-3500 x 4018

GOLD Bank of Kansas City Commerce Bank

Come join us! HFMA volunteers receive opportunities for professional development, information, networking, and advocacy and earn Founders points when they participate in a chapter committee. The 2015-16 committee chairs and co-chairs are as follows: Audit Committee Keeley Roach 816-474-4253 x21507

Website Kelli Schroeder, Chair 816-691-1333

Certification Mary Jonscher, Chair 800-278-5135 x7163

By-Laws Committee Mary Knollmeyer, Chair 913-791-3500 x4018

Fall Workshop Committee Michelle Narayan, Chair 913-791-4260 Todd Kenney, Co-Chair 816-701-0266

Publications Committee Tammy Shepherd, Co-Chair 913-945-5596 Debra Gregory, Co-Chair 913-574-2307

Sponsorship Committee Mary Knollmeyer, Co-Chair 913-791-3500 x4018 Paul Knudtson, Co-Chair 816-502-0648

Social Media Shaeley Walsh, Chair 913-890-5005

Programs Committee Damara Harper, Chair 816-691-2010

Networking Committee Erica Derks, Chair 913-213-0860

Nominating Committee Paul Knudtson, Chair 816-502-0648

Membership Committee Sue Brammer, Chair 816-701-0222 Michelle Decker, Co-Chair 913-515-2655

Link Committee Frankie Forbes, Chair 913-341-8600 – page 7 –

Chapter Leadership Meeting

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On June 17th, Chapter officers and leaders gathered at Top Golf to learn about the chapter goals for the upcoming year, and begin committee work. Afterwards, leaders enjoyed the fun at Top Golf.

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President Michelle Narayan reviewed the Chapter goals for the upcoming year. Membership Committee members Sue Brammar, Paul Kim, Michelle Decker, and Jim Lemos. Michelle Decker takes a swing. Chapter leaders await their turn to golf.

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Annual National Institute Several chapter members recently attended HFMA’s Annual National Institute, held in Las Vegas. During the event, the Heart of America Chapter received 2 Yerger Awards. One award was for improvement in member satisfaction, and the other award was for innovation in certification of chapter members. Attending the awards banquet were 2015-16 President, Paul Knudston, 2016-17 President, Michelle Narayan, and Past President, Mary Knollmeyer.

Spring Sponsor Spotlight: BKD BKD NATIONAL HEALTH CARE GROUP Health care providers face countless regulations and industry issues. With

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Sue Brammer Director Director

Keeley Roach Audit Chair

Spring Sponsor Spotlight: Bank of America Merrill Lynch Bank of America Merrill Lynch Healthcare Banking is committed to supporting healthcare providers through customized financial strategies and innovative solutions. With over 30 years of industry experience, 16,000 clients and $38 billion in total commitments to the Healthcare Industry, Bank of America Merrill Lynch is one of the largest providers of financial services to this important sector. Our expansive global footprint includes more than 100 healthcare bankers and product specialists across the United States and Europe who connect payers, providers, pharmaceutical and medical device manufacturers, and distributors to more than 140 currencies in more than 190 countries and 50 territories. Clients value our experience in their industries as well as our ability to provide a complete range of financial products and services. With a clear understanding of market dynamics, Bank of America Merrill Lynch brings a refined focus to clients’ specific needs, seamlessly delivering an unrivaled range of services, including: advisory, capital raising, treasury management, retirement, and financial wellness solutions for hospitals and healthcare providers. Examples of our healthcare industry support include the following: - Offer regular webcasts and whitepapers on industry hot topics - Support the Healthcare Financial Management Association (HFMA) and the Association of Financial Professionals (AFP) - Serve on key healthcare payment initiatives, including CAQH Core and the NACHA Healthcare Payments Task Force - Share key findings from our healthcare research analysts

Connecting industry expertise with customized solutions is how healthcare systems and patients grow stronger. Bill Timmons Senior Vice President 314.422.0080 bofaml.com/healthcare

Whether you need to manage new regulations or shifts in the financial markets, we can help you prepare and pursue strategies to help you succeed in a rapidly-changing landscape. Bank of America Merrill Lynch is a powerful ally to healthcare providers of every size. To learn more, please contact your Bank of America Merrill Lynch Kansas City coverage team, Bill Timmons and Matt Michalak, or visit bankofamerica.com/healthcare. Bill Timmons – 314.422.0080; [email protected] Matt Michalak – 214.209.8812; [email protected]

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Welcome New Members! Jeff Bogart, Enterprise Client Executive Allscripts - [email protected]

Lance E. Neal, Decision Support Analyst Mosaic Life Care - [email protected]

Raymond G. Delano, III, Director Revenue Cycle Cerner - [email protected]

Deborah Neilly Human Arc - [email protected]

David DeWees, Health Systems Sales Executive, Quest Diagnostics [email protected]

Marie Reese, Director of Client Services eSolutions - [email protected]

Victoria L. Duffel, CRCR, Strategist Cerner - [email protected] Patty Easterday, Revenue Cycle Analyst eSolutions - [email protected] Devin S Easton, Revenue Cycle Analyst COMPASS HEALTH - [email protected] Jenny E. Fach, Client Relationship Associate KForce - [email protected] Heather Frazier, Senior Director of Revenue Cycle, Liberty Hospital [email protected] Rick Goodman, EDI Segment Leader GE Healthcare - [email protected]

Steve Smith, Managing Consultant BKD CPAs & Advisors - [email protected] David B. Spizman, Vice President Children’s Hospital Association [email protected] Susan Stern, MHA, Executive Director Business Development and Sales Quality IT Partners - [email protected] John Sugden, Data Scientist Cerner - [email protected] Dianna M. Thompson, Consultant Cerner Corporation [email protected]

Jason Green [email protected] Kathy R Henrich, Controller HCA- Belton Regional Medical Center [email protected] Bob Maas, Director of Product Development eSolutions, Inc. - [email protected] Christine M McLagan, Healthcare Payments Account Executive, Commerce Bank [email protected]

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Get to Know a Member Jenny Fach

What is your personal or professional motto? Work your socks off, but make sure you are working on what’s important.

Kforce Client Relationship Associate Why did you join HOA-HFMA? My first week at Kforce, I was sent me to the HealthCare 101 event. I loved learning about the behind the scenes of healthcare and making new connections. I knew I wanted to continue exploring what HFMA had to offer. I quickly learned that Kforce is a huge believer in the value HFMA adds to the firm’s employees with healthcare focused staffing. Since 2014 our revenue cycle staffing has grown 195% and KForce currently has 1,080 Revenue Cycle Consultants billing across the firm. Kforce has 15 different markets across the country with multiple memberships and involvement in HFMA. After learning all the value HFMA offers, on top of loving the people I have already met, I was excited to join and volunteer this year!

Please describe some of your favorite accomplishments or biggest challenges met: I obtained my Master’s while working a 40 hr/wk job and being a single mom. With planning and hard work, goals are achievable. What advice would you give to someone entering the healthcare field? What you do is important and impacts lives no matter what role you play.

Steve Smith, MBA, CMPE BKD CPAs & Advisors Managing Consultant Why did you join HOA-HFMA? To continue to expand my knowledge in the continually changing industry of Healthcare Financial Management as well as to share the knowledge I’ve learned throughout my career with colleagues.

What do you like most about your job? With my job, I like that I get to meet new people and be a part of a culture that I love. I enjoy exploring how Kforce adds value to the connections made and relationships that are built, along with spreading our culture. Although the favorite part of my job is learning from the people I meet, not just about their business but life experiences. Marital status? Children? I am newly married with no kiddo’s. I have been with my husband for 7 years but married for 2. What is your personal or professional motto? Positivity, positivity, positivity!! No matter what gets thrown your way always stay genuine and positive. Positivity is something I work on daily and am not perfect at. However, if you always look on the bright side the world will surprise you.

Marie Reese

How long and why do you work in healthcare? I have worked in healthcare for 12 years and enjoy the challenge of adapting to new industry trends and mandates related to financial management. What do you like most about your job? There’s never a dull moment! Marital status? Children? I am married with two sons, ages 2 years and 2 months. What is your personal or professional motto? “It comes down to finding something you love to do and then just trying to be great at it.” - Mark Cuban

eSolutions Director, Client Services Why did you join HOA-HFMA? Within the world of technology, healthcare needs the best of services to create efficiencies.

How long and why do you work in healthcare? I work in healthcare because I am passionate about helping others. I have been in this line of business for almost 10 years. What do you like most about your job? The people I work with and the ever changing environment.

Please describe some of your favorite accomplishments or biggest challenges met: Overseeing revenue cycle operations for radiology and ED clients throughout the country totaling more than $43M annually. Increasing post-acute practice revenue for IPC’s Kansas City region by more than 80%. What advice would you give to someone entering the healthcare field? Flexibility is key. Our industry is constantly changing and the individuals who are most successful are able to identify the opportunities that arise from those changes.

Marital status? Children? Married with 4 children and one fur baby.

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Legislative and Regulatory Update Because 2016 is an election year for many U.S. congressional members, major legislative change affecting health care is unlikely. Although congressional action is likely to be modest, the Centers for Medicare & Medicaid Services has issued several far-reaching proposals within the 2017 payment and policy updates. To date, CMS has released 2017 payment and policy updates for the acute inpatient, long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and hospice payment systems. The payment implications for IPPS, IRF, SNF and LTCH proposed rules will increase payments in Missouri by 0.2 percent or $6.2 million. Other proposed payment system updates are expected soon. Links to each payment system Issue Brief and the projected change in reimbursement are as follows. 2017 Medicare Payment Update Missouri

IPPS IRF SNF LTCH Total

Estimated 2016 $2,566,419,300 $176,727,800 $22,184,700 $122,289,500 $2,887,621,300

Projected 2017 $2,579,969,900 $178,112,400 $22,649,800 $113,079,400 $2,893,811,500

Change $13,550,600 $1,384,600 $465,100 $(9,210,100) $6,190,200

Percent Change 0.5% 0.8% 2.1% -7.5% 0.2%

CMS has proposed several payment and policy updates that can have a significant impact on Missouri’s hospitals. CMS proposes to distribute the Medicare disproportionate share hospital uncompensated care pool based on information included within the Medicare cost report, Worksheet S-10. The S-10 is a better method of distributing the UCC pool because it would replace the use of Medicare SSI and Medicaid days as a proxy of distribution. The proposed IPPS rule also includes a proposal and request for comment about the use of a “z-score” to determine a hospital’s ranking under the hospital-acquired conditions pay-for-performance program. As anticipated, CMS proposed how hospitals should implement previously passed legislation – the Notice of Observation Treatment and Implication for Care Eligibility Act. The NOTICE Act requires hospitals to notify patients of their outpatient status when staying overnight for observation. CMS proposed how the process should work and also has published the notification known as the Medicare Outpatient Observation Notification, or MOON. The proposal can be found within the proposed FY 2017 Medicare acute inpatient and LTCH payment and policy updates. Some have expressed concerns about the timing of the new requirements. LTCH payments are projected to see a significant decrease in reimbursement because of the implementation of a site-neutral payment adjustment for certain admissions. The proposal is projected to decrease LTCH payments in Missouri by 7 percent or $9.1 million. CMS has published proposed rules for hospice and the new Merit-Based Incentive Payment and Alternative Payment Model for physicians. CMS also has published a final rule which will change the rates for clinical diagnostic laboratory services. MHA continues to push for the repeal of Section 3141 of the Affordable Care Act, also known as the Bay-State Boondoggle. As published in the FY 2017 Medicare IPPS and LTCH payment and policy updates, states like Missouri will see some relief as less money will be siphoned off for payments to Massachusetts hospitals, because of errors within the Medicare cost report made by a Massachusetts hospital. Although the deadline for requesting wage data corrections has ended, many hospitals in Massachusetts are asking CMS for an exception. If granted, the FY 2017 rural floor adjustment for Missouri will increase, costing hospitals even more. MHA’s President and CEO Herb Kuhn shared concerns, which were published by Modern Healthcare and The Hill, by the use of an analogy. “Imagine a bank robbery gone wrong. Now, imagine the robbers ask the police for a do-over.” MHA does not support CMS granting an exception and is concerned about the implications of such precedent. If you have any thoughts on any of these issues, please send me a note. Andrew B. Wheeler Vice President of Federal Finance Missouri Hospital Association

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