Provider Assessment Work Group Holds First Meeting

Last week we reported that the Certificate of Public Need (COPN) workgroup established by the General Assembly held its first meeting.  This week a second workgroup was established during this past General Assembly Session to review the notion of provider assessments to partially fund the state share of Medicaid costs met for the first time.  Novel Martin, Medical Facilities of America, serves as the Virginia Health Care Association (VHCA) representative on this panel.  Much like the COPN workgroup origin, the impetus of the workgroup is around provider assessments for hospital services; however, the workgroup is not necessarily limited to considering only hospital assessments. 

At this first meeting, a national Medicaid expert from Manatt Health Solutions discussed the various provider assessment approaches nationally, followed by a presentation by staff from the Virginia Department of Medical Assistance Services (DMAS) on the potential financial impact of various approaches in the Commonwealth.  Finally, work group members shared their thoughts on provider assessments, with Mr. Martin pointing out that provider assessments undertaken for budget gimmickry may lead to longer-term issues down the road as substitution of provider assessments for state’s general funding has occurred in other states.  Meeting materials can be accessed here.

The General Assembly directed Secretary of Health and Human Resources William A. Hazel Jr., M.D. to create the work group in response to certain hospitals’ desire to use such a mechanism for increased Medicaid funding. The authorizing language directs the Secretary to “conduct an analysis and develop a plan with options for a hospital provider assessment program (emphasis added)” but goes on to state “including a review of other issues deemed necessary” which potentially opens the discussion to other provider types.  Requirements are that the plan:

  • complies with applicable federal law and regulations.
  • is designed to operate in a fashion that is mutually beneficial to the Commonwealth and affected health care organizations.
  • addresses health system challenges in meeting the needs of the uninsured and preserving access to essential health care services (e.g. trauma programs,   obstetrical care) throughout the Commonwealth.
  • supports the indigent care and graduate medical education costs at hospitals in the Commonwealth.
  • advances reforms that are consistent with the goals of improved health care access, lower overall costs and better health for Virginians.
  • takes into account the extent to which it provides equity in the assessment and funding distribution to affected health care organizations.

The appointees to the Provider Assessment Workgroup are:

  • Anna Healy James – Richmond – Policy Director, Office of the Governor
  • Cindi B. Jones – Richmond – Director, Department of Medical Assistance Services
  • Beth A. Bortz – Henrico – President & CEO, Virginia Center for Health Innovation
  • Anthony Keck – Bristol, TN – Senior VP & Chief Development Officer, Mountain States Health Alliance
  • C. Novel Martin – Roanoke – CFO and Treasurer, Medical Facilities of America
  • Nancy Howell Agee – Roanoke – President & CEO, Carilion Clinic
  • Peter Gallagher – Staunton – Senior VP and CFO, Valley Health System
  • Debbie Burcham – Chesterfield – Executive Director, Chesterfield CSB
  • Matthew Turner – Richmond - VP of U.S. Employee Benefits, Genworth Financial
  • George Reiter – Reston – Senior VP of Total Rewards, Leidos
  • Sheryl Garland – Richmond – VP of Health Policy and Community Relations, VCU Health System
  • Massey S.J. Whorley – Richmond – Senior Policy Analyst, The Commonwealth Institute for Fiscal Analysis
  • Roderick Manifold – New Canton – Executive Director, Central Virginia Health Services
  • Linda D. Wilkinson – Richmond – CEO, Virginia Association of Free and Charitable Clinics
  • Kurt Hofelich – Norfolk - President, Sentara Norfolk General Hospital
  • Richard V. Homan, M.D. – Norfolk – President & Provost, Dean of the School of Medicine, Eastern Virginia Medical School
  • Sterling Ransone, M.D. – Deltaville – Immediate Former President, Medical Society of Virginia
  • James Cole – Arlington – President & CEO, Virginia Hospital Center
  • William A. Hazel, Jr., MD – Richmond - Secretary of Health and Human Resources, Commonwealth of Virginia, Ex officio

The work group will meet again on September 30 and hold a third meeting in late October.  The work group has been asked to provide a final report to the House Appropriations and Senate Finance Committees by November 1, 2015.  VHCA will monitor the work group’s activities and provide future updates in the fall.