WSHA Provides Hospital Finance Staff with Hospital Specific Analyses of Federal Changes

May 17, 2017

WSHA recently produced and sent a series of hospital-specific analyses, described below, to the chief financial officer or other designated finance persons at each of our member hospitals. If you did not receive your report or need to be set up as a designated recipient, please contact Dane Karnick at If you have questions regarding the reports themselves, please contact Andrea Palmiter at   or Andrew Busz at

The analyses include:

  • S-10 Uncompensated Care Distribution Analysis

This analysis shows how inpatient revenue will be impacted as CMS transitions to using Worksheet S-10 as the basis for distribution of funds from the Medicare Disproportionate Share Hospital (DSH) Uncompensated Care Pool. Impact is dramatic and varies significantly among hospitals.  In aggregate, under the transition Washington hospitals are estimated to experience a reduction in Medicare DSH of about $15 million (13%) for 2018, $31 million (29%) for 2019 and $51 million (47%) for 2020.

  • Episode Payment Model Payment Analysis

This analysis estimates a hospital’s quality performance in the first year of the three episode payment models: acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment excluding lower extremity joint replacement.

  • FFY 2018 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule Analysis

This analysis shows how Medicare inpatient fee-for-service payments will change from FFY 2017 to FFY 2018 based on the policies set forth in the FFY 2018 proposed rule.  It compares the year-to-year change in IPPS payments and details the specific policies that influence the payment changes, including potential payment penalties under the inpatient quality reporting and electronic health record incentive programs;  the expiration of the Medicare Dependent Hospital and expanded Low Volume Hospital Adjustment programs; quality-based payment adjustments; Disproportionate Share Hospital uncompensated care payments; and CMS’ proposal of transitioning to the use of Medicare cost report worksheet S-10 for UCC payments.

In aggregate, Washington hospitals are expected to experience an increase in payment of 1.3 percent, though impact varies significantly by hospital.

  • FFY 2018 Medicare Inpatient Rehabilitation Facility (IRF) Proposed Rule Analysis

This analysis calculates and compares Medicare inpatient rehabilitation payments based on the FFY 2017 final rule and the FFY 2018 proposed rule for Washington’s 16 designated IRF facilities and units. In aggregate for the hospitals in Washington, a 2.7 percent market basket increase is decreased by several factors, resulting in a net decrease of about 1 percent.

  • FFY 2018 Medicare Skilled Nursing Facility (SNF) Proposed Rule Analysis

This analysis calculates and compares Medicare hospital-based SNF payments based on the final FFY 2017 rule and the proposed FFY 2018 rule. In aggregate, Washington SNFs will receive about a 1.7 percent increase.

  • 2018 Wage Index and Occupational Mix Data

This analysis provides a comparative review of the wage data that will be used to develop the FFY 2018 Medicare hospital wage index.  It uses hospital wage data from the 2014 Medicare cost report published by CMS in a public use file on April 28, 2017. Hospitals should review this information to identify and address any errors in calculation by the Medicare Administrative Contractors by May 30, 2017.  

(Andrew Busz,


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