New Hampshire Hospital Association

1. New Hampshire Hospital Association House Health & Human Services Committee January 10, 2007 Contact: Leslie Melby, VP, State Government Relations New Hampshire Hospital Association 125 Airport Road, Concord, NH 03301 (603) 225-0900 lmelby@nhha.org www.nhha.org

2. NEW HAMPSHIRE HOSPITAL ASSOCIATION  The Association�s mission is to enhance the clinical and economic performance of hospitals, improve public confidence in hospitals, and expand access to coverage and care for the citizens of New Hampshire.

3. New Hampshire�s Hospitals 26 acute care hospitals 24 non-profit 2 for-profit 6 specialty hospitals (rehabilitation, psych) 2 government 3 for-profit 1 non-profit

5. NH�s Acute Care Hospitals

6. NH�s Specialty Hospitals Crotched Mountain Rehabilitation Center Greenfield Hampstead Hospital Hampstead HealthSouth Rehabilitation Hospital Concord New Hampshire Hospital Concord Northeast Rehabilitation Hospital Salem Veterans� Affairs Medical Center Manchester

7. Critical Access Hospitals (CAH) Special federal designation to ensure access to hospital care in rural communities 13 of New Hampshire�s 26 hospitals designated CAH 25 inpatient bed limit Shorter hospitals stays (4 days or less) Disproportionately higher number of low income and elderly (Medicaid, Medicare)

8. 13 Critical Access Hospitals Alice Peck Day Memorial Hospital Lebanon Androscoggin Valley Hospital Berlin Cottage Hospital Woodsville Franklin Regional Franklin Huggins Hospital Wolfeboro Littleton Regional Hospital Littleton The Memorial Hospital North Conway Monadnock Community Hospital Peterborough New London Hospital New London Speare Memorial Hospital Plymouth Upper Connecticut Valley Hospital Colebrook Valley Regional Hospital Claremont Weeks Memorial Hospital Lancaster

9. Acute Care Hospital Facts, NH 2005 2,655 beds 116,800 inpatient admissions Average length of stay � 5.0 days 35,600 inpatient surgeries 13,700 births 3,160,800 million outpatient visits 621,000 emergency outpatient visits 90,400 outpatient surgeries

10. Hospital Trends, NH2001 - 2005 15.6% increase Emergency visits 32% increase Outpatient visits 1% increase Inpatient admissions

11. Emergency Visits � New Hampshire, New England, U.S.

12. Inpatient Admissions � New Hampshire, New England, U.S.

13. Quality of Care NH Health Care Quality Assurance Commission (HB 514) Core Measures Performance: to improve the rate at which NH hospitals provide all the appropriate care to every patient www.nhqualitycare.org � hospital specific information on core measures

15. Who Pays for Hospital Care? Commercial health insurance Federal Medicare program for seniors NH Medicaid program for low-income & disabled individuals Patients with no insurance � only 17% pay some or all of their bills

16. Rural Hospital examples: look at separate sheet. Use AVH, Huggins, New London and UCVHRural Hospital examples: look at separate sheet. Use AVH, Huggins, New London and UCVH

18. Cost ShiftingGovernment to Private Sector Government payers reimburse hospitals less than the actual cost to provide care: Medicare pays 87 cents per dollar of costs Medicaid pays 60 cents per dollar of costs In 2004, NH hospitals �shifted� $300 million to private insurers to make up for Medicare, Medicaid and uncompensated care shortfalls.

19. Medicaid & Medicare Pay Less than Cost

20. Medicaid Payment Inpatient DRG Rate per Point: 2006 $3,147 1994 $3,184 Outpatient: PPS Hospitals 81% of cost CAH Hospitals 91% of cost

21. Acute Care Hospitals Uncompensated Care - 2005 Charity Care Patients w/ no insurance - $70.1 million 79% Patients with insurance - $18.5 million 21% Bad Debt Patients w/ no insurance = $95.5 million 74% Patients with insurance = $33.4 million 26% Percent of patients with insurance will increase � charity and bad debtPercent of patients with insurance will increase � charity and bad debt

23. Transparency � Price; Quality NH PricePoint www.nhpricepoint.org NHQualityCare www.nhqualitycare.org

25. Hospitals are safety net providers Open 24 hours a day, 7 days a week, 365 days a year. Treat all persons � regardless of their ability to pay. Provide financial assistance NH Health Access Network (charity care) Hospital Access Plus (discount hospital bills) Medication Bridge (prescription assistance)

29. New Hampshire Hospital Association www.nhha.org 125 Airport Road Concord, NH 03301 (603)225-0900