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Proximity to village benefits hospital
Trumbull Memorial to get Medicare boost
WARREN — It came down to two-tenths of a mile.
Trumbull Memorial Hospital in Warren will get an estimated $1.2 million increase a year in reimbursements for Medicare patient care because it is 14.8 miles from the West Farmington Village boundary, not 15 miles.
Hospital officials had not realized it, but last year it was determined that there is a route that is 14.8 miles from TMH to West Farmington, which is part of the Cleveland district, said Kathy Kendall, director of reimbursement for Forum Health.
West Farmington, a village, is located in the center of Farmington Township in Trumbull County’s extreme northwest corner.
To be eligible to switch districts, the U.S. Department of Health and Human Services requires that a hospital be within 15 miles of the reimbursement district into which it wants to transfer.
TMH, part of the Forum Health system, achieved the increase in Medicare revenue by switching from the Trumbull-Mahoning-Mercer core based statistical area (CBSA) to the Cleveland-Elyria-Mentor CBSA, which pays a higher rate of Medicare reimbursement.
TMH applied for the change in August 2008, and it was approved Jan. 8 for three years beginning Oct. 1, Kendall said.
“We estimate that we will see an improvement in Medicare payments at TMH of $1,234,824 for the federal fiscal year beginning Oct. 1, 2009,” Kendall said. She projected similar Medicare reimbursement increases for TMH in fiscal 2010 and 2011.
Kendall said TMH qualified for transfer to the Cleveland-Elyria-Mentor district based on a formula involving, among other things, the three-year average hourly wages of hospital employees and being within 15 miles of the nearest boundary of the Cleveland district.
A process called wage indexing, which is used to determine Medicare reimbursement in the core based statistical areas, has been a sore point with hospitals in Mahoning and Trumbull Counties since 2005, when their wage indexing district was altered.
The change was to lop off Columbiana County, which had been in a district with Mahoning and Trumbull, and add Mercer County in Pennsylvania. The result was to lower the wage index, which is multiplied by the Medicare reimbursement to determine the actual reimbursement hospitals receive in the district. The change has cost hospitals in Mahoning and Trumbull millions of dollars in lost revenues.
The wage index is determined by the wages and benefits for hospital workers in the area in which the hospitals are located. When Mercer replaced Columbiana County, the wage index was lowered, resulting in lower Medicare payments, according to Forum Health.
Kendall said the change cost TMH and the Western Reserve Care System (Northside Medical Center) a combined $8.5 million for fiscal years 2005 through 2008, $4.2 million for TMH and $4.3 million for Northside. The Medicare fiscal year runs from Oct. 1 to Sept. 30.
Northside Medical Center, which has lost money for several years while TMH and Hillside Rehabilitation Hospital in Howland, Forum’s other hospital in Trumbull County, have either earned money or broke even, does not qualify for transfer to the Cleveland district.
Though Northside may qualify in some areas, such as employee wages and being within Trumbull County, it cannot meet the 15-mile requirement, Kendall said. The only way it could work for Northside to switch districts is if all the hospitals in Trumbull County, including Humility of Mary Health Partners’ St. Joseph Health Center in Warren, applied to do the same.
That has not happened, Kendall said.
As a result, Walter Pishkur, Forum president and chief executive officer, wrote to President Barack Obama asking for help.
Specifically, he asked the president to approve incorporation of Western Reserve Care System (Northside Medical Center) into the Cleveland district with TMH. If approved, the action would increase wage index payments from Medicare to Northside in an amount similar to TMH’s, Pishkur said in his letter. He also asked that the effective date for the TMH wage index change be accelerated to Oct. 1, 2008.
So far, Obama has not re-sponded.
alcorn@vindy.com