Finance, Insurance & GME

 

GNYHA draws on its vast expertise in the areas of health care finance, health insurance, and graduate medical education (GME) to help ensure that its members have the necessary information and fiscal resources to care for their patients, operate their facilities, and train the next generation of physicians.


Accreditation

The Accreditation Council for Graduate Medical Education (ACGME) is the primary accreditation agency for allopathic

training in this country. The ACGME has oversight of over 9,000 residency training programs across 133 specialties. Through their individual residency review committees and related standards and requirements, the ACGME accredits the training of the vast majority of physicians in this country. In 2012, the ACGME introduced their Next Accreditation System (NAS), which aims to enhance their oversight activities by moving towards a more outcomes-driven process. GNYHA works with members to understand all aspects of this accreditation activity. 

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Medicare GME

Medicare pays teaching hospitals its share of direct GME (DGME) and indirect medical education (IME) costs for training

physicians. Teaching hospitals must demonstrate that their residents are training in an approved program as defined by Medicare to be countable GME reimbursement using Medicare payment methodology. GNYHA advocates for policies that will appropriately support teaching hospitals in their mission of providing high-quality residency education. 

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Physician Workforce

GNYHA is involved in a variety of physician workforce initiatives in partnership with the New York State Department of Health

(DOH) and the Center for Health Workforce Studies. Many of these initiatives are aimed towards addressing the physician shortages in underserved areas in the State. The New York State Council on Graduate Medical Education oversees many of these programs and GNYHA continues to be actively involved in the planning of these initiatives. 

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Resident Wellness

GNYHA has been leading local efforts in the area of resident wellness through educational programming and ongoing

discussions about collaborations with hospital employee wellness programs. As increased attention is being paid to monitoring physician well-being and implementing strategies to prevent burnout, GNYHA has put together many resources to assist members in developing wellness programs at their own institutions. 

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Teaching Clinic Redesign

With the increased emphasis on primary care in the outpatient setting, GNYHA has embarked on an effort to improve care

delivery and residency education in hospital-based teaching clinics. This effort includes work associated with a grant-funded project through the New York State Health Foundation as well as efforts to support members participating in New York State’s Hospital-Medical Home Demonstration Program. 

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Affordable Care Act

The ACA represents the most comprehensive, fundamental reform of the nation’s health care system since the

establishment of Medicare and Medicaid. This complex legislation has the potential to impact nearly every facet of hospital operations. GNYHA is helping hospitals implement the new law and achieve its goals of improving the health of the population, enhancing the patient care experience, and reducing health care costs.

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Managed Care Policy

GNYHA advocates for a variety of managed care and insurance reforms. Previous successes include legislation affording

hospitals important protections from arbitrary or unfair insurer payment policies. As the insurance market evolves, GYNHA will continue to work to ensure that law and regulation provide appropriate safeguards for our members and their patients with respect to unreasonable insurer policies and procedures.

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Medicaid Managed Care

The New York State Medicaid program has adopted a policy of managed care for all, which includes expanding the Medicaid

managed care program in terms of previously excluded populations, counties, and benefits, as well as new care management programs for certain complex Medicaid populations. GNYHA provides updates and resources, including the population and benefit phase-in schedule, to help members stay abreast of implementation timelines and developments.

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Plan Enrollment

GNYHA collects and tracks enrollment in various New York State insurance programs, including Medicaid managed care,

Medicare Advantage, and managed long term care. As hospitals move forward with planning and contracting in this changing coverage environment, it is increasingly important that they have access to the most up-to-date and detailed enrollment data possible. GNYHA will continue to modify enrollment reports to accommodate the changing coverage landscape. 

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Plan Financials

GNYHA supports its members by tracking and analyzing plan financial performance and providing access to annual financial

statements for Article 42, 43, and 44 health insurers.

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Delivery System Reform Incentive Payment

GNYHA played an instrumental role in securing an $8 billion Medicaid waiver from the Federal government to support continued health systems

transformation and improved population health. Approximately $6.42 billion of that waiver funds the Delivery System Reform Incentive Payment (DSRIP) program, which requires hospitals and their performing provider system (PPS) partners to engage in projects and activities that will reduce avoidable hospital use. GNYHA is committed to supporting DSRIP’s 25 PPSs—including the 16 that are led by member hospitals—through advocacy and implementation support. 

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Indigent Care Pool

The New York State Indigent Care Pool (ICP) was established to offset a portion of the uncompensated care costs incurred by hospitals.

Initially termed the Hospital Bad Debt and Charity Care (BDCC) Pool, the ICP currently distributes over $1.1 billion in Medicaid funds to public and voluntary hospitals throughout the State. GNYHA worked closed with New York State to develop the new ICP distribution methodology, which was implemented in 2013.

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Medicaid Rates and Updates

GNYHA supports its members by providing updates for the New York State Medicaid program’s rates and service intensity

weights for inpatient, outpatient, and psychiatric facilities. GNYHA is committed to working closely with member hospitals to educate them about the continuing changes and refinements to this payment system and resolve any member issues.

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Medicaid Waiver

In August 2012, New York State submitted an amendment to the State’s Medicaid managed care waiver seeking $10 billion in

Federal funds to continue the implementation of cost-saving Medicaid reforms originally proposed by the Medicaid Redesign Team (MRT). The $10 billion in Federal funds would allow New York to invest in innovative models of care and provide vital funding for many of our safety net hospitals. GNYHA strongly supports the MRT waiver request and will continue to work closely with the State throughout the waiver process.

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IRF, IPF & ESRD Regulations

This section provides resources on the following Medicare prospective payment systems: inpatient rehabilitation facility (IRF), inpatient psychiatric facility (IPF), and end-stage renal disease (ESRD).

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Medicare GME

Medicare pays teaching hospitals its share of direct GME (DGME) and indirect medical education (IME) costs for training

physicians. Teaching hospitals must demonstrate that their residents are training in an approved program as defined by Medicare to be countable GME reimbursement using Medicare payment methodology. GNYHA advocates for policies that will appropriately support teaching hospitals in their mission of providing high-quality residency education. 

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Medicare Inpatient Regulations

The Medicare program provides payment for acute inpatient care through the inpatient prospective payment system (IPPS).

In addition to adjusting payments for the patient’s condition and the hospital’s geographic market conditions, the IPPS includes several policy adjustments (e.g., payment for medical education programs and disproportionate share hospital) and payment adjustments for quality-related programs such as the value-based purchasing (VBP), hospital readmissions reduction, and hospital-acquired conditions (HAC) reduction programs. As CMS updates the IPPS and associated policies, GNYHA provides members with analyses of the proposed and finalized policies and communicates comments to CMS on behalf of the membership.

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Medicare Outpatient Regulations

Medicare pays for hospital outpatient services through the outpatient prospective payment system (OPPS). In addition to

providing analysis of CMS’ OPPS regulations, GNYHA has developed an OPPS “calculator” to help facilities appropriately estimate hospital-specific OPPS payments.

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Other Medicare Regulations

In addition to the IPPS and OPPS, CMS has established prospective payment systems for other services, including

rehabilitation, psychiatric, and end-stage renal care. As updates to these payment systems are available, GNYHA provides members with analyses of the proposed and finalized policies and tools to estimate fiscal impact.

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Capital Access

Access to capital is critical to the long-term viability of health care organizations and an essential part of hospital planning and

development of growth strategies. The capital formation process has changed significantly over the past few years. GNYHA provides member hospitals with support and resources as they begin to investigate potential new financing options.

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ICD-10 Implementation

On October 1, 2015, CMS will implement the International Classification of Diseases, 10th Edition (ICD-10) code sets,

which are used to report medical diagnoses and inpatient procedures. GNYHA provides hospitals with news on the upcoming migration and resources to facilitate implementation of the new code sets.

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MACRA

To help members prepare for the Medicare Access and CHIP Reauthorization Act (MACRA), GNYHA and its national affiliate Premier have partnered to create an online library of MACRA

resources, including fact sheets, webinars, and other educational materials.

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Pay for Performance Systems

GNYHA provides member support for CMS’ quality-related programs and resources for other quality-related initiatives. CMS

has established multiple quality-related programs, including hospital value-based purchasing (VBP), hospital readmissions reduction, hospital-acquired conditions (HAC) reduction, and inpatient quality reporting programs. Additionally, several national organizations have established quality measurement programs, including The Leapfrog Group, Consumer Reports, and US News & World Report. GNYHA provides members with resources to interpret and manage the multitude of quality measures, scoring methodologies, and quality reports.

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Shelter Placement

Hospitals discharging homeless patients to shelters are required to follow the placement process established by the New York

City Department of Homeless Services. GNYHA provides members with referral forms and informational materials to facilitate the process of placing hospitalized shelter residents in the New York City Shelter System. 

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