Ellen -- background

Ellen -- background
We are required by statute to adjust hosp. payment system for geographic difference in wages index.
The way we have done it from the start, what we have used for the basis office of management and budget definitions of MDAs, based on census updates.
Funny lag time, up until this year, paying based on census data from 1990.
In 2000, census done again, and based on data from that census, OMB, redrew core based statistical areas. We use theirs. We have looked at other ways of doing it. Nothing doing geographic adjustment -- nothing has presented itself.
Another aspect of this, I believe this is basically a budget neutral system. When some go down, others go up -- not within the MSA, but within the overall system.
With 2000 data, its created winners and losers.
Basically, it always works this way. There is a process by which hospital can apply for geographic classification, adjoining MSA.
They file a request individually, and all hospitals in county can band together and file with the Medicare Geographic Reclassification cation Board.
CMS provides board with hospital cost report data, but no role in the decision making.
We have had geographic reclassifications where we have had to press release -- we do not have any say over Medicaid. -- state administered within broad guidelines set by CMS.
Private payers we have no control over.
Board -- only does reclassifications. Need someone to talk about reclassifications process.
Should ask if they have requested reclassification.
If they haven't, deadline passed. Will be frozen for three years.