Strategic Initiative 3.0: Policy Economic Development
Fully utilize the collective leverage of our members in the areas of community development, economic development and public policy. Provide regular, timely and relevant information to C‐Suite leaders on emerging issues of opportunity and threat to members.
Overview
Wage Index is a mathematical factor established by The Centers for Medicare and Medicaid Services (CMS) that is applied to the inpatient reimbursement formula for Medicare patients in acute care hospitals to account for differences in the cost of care that arise from geographic hourly wage variations. CMS uses the relative level of hourly wages for hospital workers in each local labor market and compares it with the national average hospital hourly wage and uses the wage index to adjust payment rates accordingly. All hospitals in a given region are assigned the same wage index.
The Center for Health Affairs annual wage index review is a process in which experts are engaged to analyze the information submitted to CMS by the region’s hospitals for wage index determination purposes — such as Medicare cost reports, Occupation Mix Surveys, hospital payroll records and contracts. Based on the findings of the experts, hospitals can make documentation changes that maximize the wage index assigned to the region.
Core Value
The Center for Health Affairs annual wage index review enables the region’s hospitals to submit wage index information to CMS that will maximize the wage index for the collective, which in turn maximizes Medicare reimbursement for all hospitals in the region. In the past, the region has seen savings of millions of dollars thanks to The Center for Health Affairs’ wage index initiative. In addition, The Center for Health Affairs and its contracted partners ease the burden on hospital reimbursement departments by walking them through the steps necessary to optimize wage index documentation. From initial cost report audits to the CMS appeals process, hospitals in Northeast Ohio rely on The Center for Health Affairs’ and its wage index partners to guide them through the process.
Pivotal to achieving a favorable wage index is the ability of the regional hospitals to come together to achieve this goal. As coordinator of the wage index program, The Center for Health Affairs provides a forum for bringing together hospitals from around the region to work together on this important initiative, including the ability of the group to collectively engage expert consultants to lead the process.
Deliverables
- 3.1.1 Data Collection and Analysis: The Center for Health Affairs wage index partners support hospital reimbursement departments throughout the process of data collection by guiding them in strategies that will maximize their wage data. Analysis of data prior to submission to CMS by The Center’s wage index partners ensures that all of the region’s hospitals are providing data that maximizes Northeast Ohio’s reimbursement position.
- 3.1.2 Reimbursement Forum: Reimbursement professionals from Northeast Ohio hospitals are offered a forum for staying current on trends relating to hospital finance and reimbursement, including the annual wage index review. The Center for Health Affairs Reimbursement Forum also provides a platform for discussion on regional documentation protocol and best practices related to wage index.
- 3.1.3 Fiscal Intermediary: Analysis of wage index documentation during The Center for Health Affairs annual review often uncovers changes that should be made to maximize wage index information. Depending on the stage of the process, these changes must be communicated to the Fiscal Intermediary (FI). The Center for Health Affairs and its wage index partners work with hospital reimbursement departments to ensure that these communications meet all necessary specifications and that a strong working relationship between the hospital and the FI is maintained.
Overview
One of the core functions of The Center for Health Affairs is acting as the voice for its hospital members on issues of regional advocacy. With the uncertainty arising from local and state governments struggling to meet budget obligations, many policy initiatives that in past years were unthinkable are gaining serious consideration. Case in point; the state’s hospital franchise tax.
The Center has always viewed its role in the advocacy process as bringing context to policy discussions, and that function will certainly continue. But in this unpredictable environment, we will need to play a more aggressive role in day‐to‐day interaction with regional policymakers.
Core Value
The Center for Health Affairs has the ability to represent hospitals from the perspective of the entire community. Because The Center represents all hospitals in the region, we are able to position arguments in a way that offers a bit of impartiality and in appearance is less self serving. At its essence, The Center for Health Affairs can position issues for the entire hospital community in a way that individual hospitals or even hospitals systems would find difficult without appearing self serving.
Deliverables
- 3.2.1 New County Government: While our membership extends well beyond Cuyahoga County, the formation of a new county government in Cuyahoga County needs to take a high priority. We will need to conduct briefings for the new county council and the new county executive to help them understand the current county role in healthcare, as well as how they can play a more proactive role in advocating for the county’s leading industry.
- 3.2.2 Medical Mart: The development of the Medical Mart creates a significant opportunity to increase the leverage of our members’ economic power in the region. The Center will engage with Medical Martofficials to develop a regional component to coincide with the Medical Mart’s national strategy.
- 3.2.3 Tax‐Exempt Status: Hospital tax‐exempt status has been under attack at the local, state and national level for several years now. The Center needs to continue to build the case for the negative impact of taxing hospitals from both an economic perspective and a community service perspective.
- 3.2.4 Regional and Statewide Advocacy Collaboration: A multitude of organizations seek to represent the interests of hospitals at both a regional and statewide level. The Center will play a key role in coordinating this activity to maximize benefit to our members.
Overview
In years past, The Center for Health Affairs has contracted with the Economics Center at the University of Cincinnati to quantify the impact Northeast Ohio hospitals have on the region’s economy. The University of Cincinnati was selected based on their experience in assessing economic impact, and in particular their experience in doing so for hospitals. Generally, their model uses overall expenditures and wages and applies a multiplier so that both direct and indirect economic activity can be measured.
The study has also quantified the amount of activity that results from patients who live elsewhere but seek medical care in Northeast Ohio. In fact, hospitals have been found to be a significant export industry for the region. The reports received from the University of Cincinnati provide economic impact measurement for the region as a whole as well as for individual hospital systems.
Core Value
The economic impact data can be used to the benefit of the membership in a number of ways. Quantifying hospitals’ role in the region is a valuable tool in conversations between the hospital community and policymakers on issues related to reimbursement, tax status, regional economic development and a variety of others. In combination with other information, such as community benefit, employment growth and uncompensated care, economic impact data provide a powerful message regarding the tremendously important asset hospitals are in our area and the need to foster and invest in them. Individual hospitals can also use facility‐specific data during interactions with their own communities to help communicate their value not only from the perspective of the care they provide, but also related to the overall financial wellbeing of the community.
Deliverables
Data will be provided at a variety of levels, to meet its varied uses. Hospital‐ and health system‐specific data will provided to individual members to use as they see fit. The Center will publicly use and discuss only aggregated data.
- 3.3.1 Hospital‐Specific Data: Each facility will receive impact data specific to that entity and will be able to manage that data – including whether or how to release it publicly – on its own.
- 3.3.2 System‐Specific Data: Hospital systems will be provided with a quantification of the total impact of the system.
- 3.3.3 Regional roll‐up: An analysis at the regional level will be publicly released by The Center for Health Affairs and regional data will be used in the organization’s advocacy initiatives.
Overview
The Center for Health Affairs produces several tools that are intended to keep members informed and foster an understanding of health issues within the community. White papers, or Policy Snapshots as we refer to them, are published at least six and up to eight times each year and are succinct overviews of salient topics in health policy. Issue Briefs are published on a quarterly basis and are monographs that explore healthcare issues in greater depth. Both types of publications are distributed to more than
500 individuals in Northeast Ohio, including not only hospital executives but also members of the media, policymakers at all levels of government, and business leaders. Advocacy Alerts are distributed exclusively to the membership as needed and are used to engage hospitals when a critical policy issue requires their attention.
Core Value
While occasionally they are intended to provide information to hospital leaders, the primary value of the Policy Snapshots and Issue Briefs is in their reach beyond the membership. These publications are generally geared toward educating those who may not be entirely familiar with or have a deep understanding of important issues in healthcare. The Briefs and Snapshots provide information and context on issues affecting hospitals and the delivery of healthcare in order that those in positions of influence better understand and can make informed decisions. These publications are distributed in hard copy and electronically to a broad audience and are made available on The Center’s website. Members are also encouraged to make use of these publications in interactions with their boards. Conversely, Advocacy Alerts specifically target the membership. They are delivered electronically and are intended to keep members informed about developments affecting their institutions as well as provide hospital leaders an opportunity to engage with policymakers when appropriate.
Deliverables
- 3.4.1 White Papers: The Center will continue to publish white papers six to eight times per year and distribute them to those in the community that are in a position to influence opinions and policy affecting hospitals and healthcare.
- 3.4.2 Issue Briefs: The Center will continue to publish quarterly issue briefs and also distribute them to opinion leaders in the community.
- 3.4.3 Advocacy Alerts: The Center will alert members as appropriate regarding developments in the legislative and regulatory environment that will have an impact on their facilities and provide them with guidance when necessary about a means of response.
Overview
The Center for Health Affairs occasionally makes available to members opportunities to meet with key policymakers, such as Speaker of the Ohio House Armond Budish and then‐Director of Medicaid Cristal Thomas. Typically, hospital executive leadership is invited to attend and take advantage of the chance to have a dialogue about issues of importance to their facilities. The Center will continue to offer these opportunities at increased frequency.
Core Value
By inviting public officials with influential positions relative to healthcare to meet with the membership, The Center is providing hospitals with ready access to those they may not have the opportunity to meet with on their own. In addition, by coming together as a group, hospitals are often able to communicate a message they may not be able to, or may not wish to, communicate in one‐on‐one meetings with those same individuals. Meeting as a group can send a powerful message to public officials.
Deliverables
Several times per year The Center will host meetings between key public officials and the membership based on current policy developments impacting hospitals.
Overview
The hospital sector is one of the few industries experiencing growth in recent years in Northeast Ohio. Hospitals are not only some of the largest employers in the region, they also represents one of the largest purchasers of goods and services. The focus of the Buy NEO initiative is bringing new businesses and jobs to the region by leveraging the healthcare sector's buying power. Hospitals can begin using combined purchasing strength to grow existing business in the region and to convince medical device manufacturers and distributors to locate operations here.
Core Value
Cuyahoga County ranked second in the nation among counties with the largest population loss in 2009, new census estimates show. By working to reverse this trend, our membership and communities can benefit at various levels.
Hospital Administrators
An influx of new business with an associated boost in population would create a new base of potential patients and revenue. This increased demand for healthcare services supports investment in capital improvements to existing healthcare facilities as well as the need to create additional capacity by building new state‐of‐the‐art facilities.
Human Resource Executives
An increase in local population will give HR executives a broader workforce from which to recruit. Adding the innovation of the medical device industry to the already prestigious Northeast Ohio hospital community could make this area a healthcare destination, attracting additional talent from outside the area and potentially prevent new high‐tech graduates from leaving the area.
Educational Facilities
Growth in area jobs in fields requiring high levels of expertise will be a boon to educational facilities because the demand it will reate for an educated, highly‐trained workforce, which in turn will generate additional demand for higher education. Local Communities A reversal of job losses would be important to the region’s economic health. With increased populations, there would also be a boost in income, property and sales taxes.
Deliverables
- 3.6.1 Gain Commitment from Member Hospitals: The Center for Health Affairs will:
- Build consensus with member CEOs to commit purchasing volume to the initiative.
- Work with supply chain executives to identify product categories and vendors where market share shifts will create an impetus for negotiating a shift in geographic locale.
- Negotiate with these medical suppliers to bring research and development, production and distribution activities to Northeast Ohio.
- 3.6.2 Collaborate with Other Local Initiatives Focused on This Effort: Add the strength and purchasing power of our membership to the efforts of other organizations involved in stimulating the future of our regional economy including:
- Greater Cleveland Partnership
- Medical Mart
- Evergreen Industries
- Advance NEO
- COSE‐‐ I Buy NEO
- Northeast Ohio Council on Higher Education