Augusta Georgia Hospital's Worksheet E Series Comparison
Today we’re going to take a look at the Worksheet E series. This series of worksheets are used to calculate the settlement of Medicare and/or Medicaid reimbursement. There are separate worksheet for Inpatient Acute, Outpatient Acute, Rehab (IP & OP), Psych (IP & OP), swing-bed SNF, and much more. There’s also a settlement worksheet for DGME - direct graduate medical education. This leads to something I should point out.
The Medicare program has a lot of add-on payments. There’s an add-on payment for disproportionate share hospital, which just means that more than 15% of the inpatients at a hospital have Medicaid. There’s an add-on payment to help cover the costs of training doctors (IME/GME) and to help cover the costs of organ acquisitions. There’s an add-on payment to help cover the cost of uninsured patients (UC DSH). That’s just a few examples. Given these diverse add-on payment programs, it becomes a little bit hard to just compare one hospital to another….but we shall give it a go anyway.
Inpatient Acute
Let’s take a look at the Medicare reimbursement for inpatients who received services in acute areas of the hospital.
| Type | AU Medical | University Hosp | Doctors Hosp | Burke Medical | Univ-McDuffie |
|---|---|---|---|---|---|
| Payments | $118,616,976 | $76,370,022 | $45,646,255 | $443,797 | $2,595,840 |
| Cost | $81,305,072 | $83,268,958 | $42,858,032 | $840,641 | $1,538,005 |
| Difference | $37,311,904 | -$6,898,936 | $2,788,223 | -$396,844 | $1,057,835 |
I can’t say for sure - and things can & will change at audit - but it appears University Hospital may be providing some services that cost them more than they receive in Medicare payments. This is interesting and something I may dive into deeper in another blog. Again, while it looks this way (losing money on Medicare patients), the truth could be completely different.
Outpatient
| Type | AU Medical | University Hosp | Doctors Hosp | Burke Medical | Univ-McDuffie |
|---|---|---|---|---|---|
| Payments | $59,440,056 | $41,370,528 | $14,423,945 | $500,236 | $2,098,038 |
| Cost | $72,400,824 | $39,092,318 | $16,622,148 | $956,622 | $2,592,579 |
| Difference | -$12,960,768 | $2,278,210 | -$2,198,203 | -$456,386 | -$494,541 |
It’s interesting that it appears that most of the hospitals are losing money on outpatient services provided to Medicare patients. Interesting, but again, may not be true. Need to see more data and dig so much deeper.
Add-On Payments
| Type | AU Medical | University Hosp | Doctors Hosp | Burke Medical | Univ-McDuffie |
|---|---|---|---|---|---|
| UC DSH | $14,437,045 | $7,376,139 | $4,984,536 | $746,540 | |
| DSH | $2,180,481 | $1,298,932 | $1,130,756 | $16,892 | |
| New Technology | $230,363 | $543,863 | $166,516 | ||
| IME/GME | $36,399,427 | $788,937 | $0 | $0 | $0 |
UC DSH stands for Uncompensated Care DSH which is a pool of money used to compensate hospitals for some of the services they provide to uninsured patients.
DSH is also called empirical DSH. This is the “original” DSH on the cost report and this add-on helps cover the cost of taking care of Medicaid patients.
New Technology is an add-on payment for the purchase of certain new and costly services or technologies.
IME/GME - Medicare pays for both indirect medical education cost and direct. Direct is called direct graduate medical education or DGME or GME. When training doctors, there are additional costs to the hospitals. The docs in training generally order more tests and such. They are also training under someone, so there is additional salaries involved in the administration of these programs. But the hospitals in general desperately need new doctors, so they bear the burden of the expense of training them. CMS tries to offset some of the cost burden through this add-on payment.
There are many additional add-on payments. I just wanted to cover a few here in this blog.
Musing Revelation
I am a little concerned with how the data “appears” regarding costs versus payments for these hospitals. Of course, Medicare is not the only payor for these hospitals. And there are multiple funding streams that help these hospitals survive. It’s easy to look at how much our patient bills are and think the hospital is flush with cash. This may or may not be true. Next week, we’ll take a look at the Worksheet G series which includes some financial statement information. This may shed a little more light on how much profit (or less) these hospitals are incurring.
Note: I use this blog as a tool for me to learn more about individual hospitals and Medicare reimbursement. I could be completely wrong about everything I posted here. :)
University Hospital Worksheet E series
Doctors Hospital Worksheet E series