Presented by:
Kim Hampton-Kennedy, CPA
Southeast Reimbursement Group, LLC.
SRG
History of the OMS
Implemented under the Benefits Improvement
& Protection Act of 2000
First applied to the wage index in FFY 2005.
First surveys covered a much shorter period of data
and consisted of 19 occupational categories.
Following surveys covered six months then twelve
months of data and shortened to only 5 occupational
categories.
SRG
Effect of OMA on Hospital Payments
Required for any hospital subject to IPPS.
PPS payments include a base operating payment and a
capital payment for each Medicare case.
Base operating payment rate is split into two components
labor-related amount
non-labor related amount.
Along with the wage index, the OMS adjusts the labor
related portion of the payment.
SRG
1
Creation of the OMS
The WI adjustment was created to capture the differences
in hospital costs due to market-driven cost of labor which
is beyond management’s control.
The OM adjustment was created to account for the mix of
professionals used to provide care which is within
management’s control.
SRG
Consider a Comparison
For example, let’s consider two labor markets where the
hospitals in both markets have the same case mix and face
the same AHR for all categories of labor and are treating
the same type of case.
SRG
Decisions of Management
Rural supporters raised concerns which led to the creation of
the occupational mix adjustment.
SRG
2
Occupational Mix Adjustment
What is the goal of the OMA?
How are market’s AHW adjusted when they have an
expensive occupational mix? Cheaper occupational mix?
SRG
Market Level
How are the occupational mix factors calculated and
applied?
SRG
The Effect of the OMS
How did the OM adjustment effect the rural market and
why?
SRG
3
2013 Occupational Mix Survey
The Occupational Mix Survey (OMS) is prepared every 3
years for each short-term acute care hospital subject to IPPS
participating in the Medicare program, in order to construct
an OM adjustment to the wage index.
SRG
The OM Survey
MEDICARE WAGE INDEX
OCCUPATIONAL MIX SURVEY
Date: ___/___/___
Provider Number: ______________
Provider Contact Name: _______________________________________
Provider Contact Phone Number: ______________
Reporting Period: Pay Periods Ending Between 01/01/2013 and 12/31/2013
Report Paid Salaries and Paid Hours in whole numbers. Round Average Hourly Wage to 2 decimal places.
Occupational Category
Paid
Salaries
Paid
Hours
Average
Hourly
Wage
(Salaries/Hours)
2ursing Occupations
R2s
LP2s and Surgical Technologists
2ursing Aides, Orderlies, & Attendants
Medical Assistants
Total 2ursing
All Other Occupations
Total (2ursing and All Other)
What does the OMS cover?
The current survey covers the 12 month period ranging
from 1/1/2013 through 12/31/2013 and the results will be
applied to the FY 2016-2018 wage index.
Includes total paid wages and salaries, as well as total paid
hours related to employed staff, contracted staff, and home
office and related organization personnel.
The survey does not include fringe benefits or wage
related costs.
SRG
4
When is the OMS due?
The current survey is due to CMS by July 1, 2014.
SRG
OMS Categories
The OMS requires the provider to categorize the
salaries and paid hours into five occupational
categories:
1.
2.
3.
4.
5.
RN’s
LPN’s & Surgical Techs
Nursing Aides, Orderlies & Attendants
Medical Assistants
All Other
Group the data into these categories using the category
definitions derived from the Bureau of Labor Statistic’s
definitions.
SRG
Completing the Survey
Nursing personnel working in the following cost centers must be included in the appropriate
nursing category:
COST CENTER DESCRIPTIONS
Cost Report Lines for
2552-10
Nursing Administration
13
Adults and Pediatrics (General Routine Care)
30
Intensive Care Unit
31
Coronary Care Unit
32
Burn Intensive Care Unit
33
Surgical Intensive Care Unit
34
Other Special Care (specify)
35
Nursery
43
Operating Room
50
Recovery Room
51
Delivery Room and Labor Room
52
Electrocardiology
66
Renal Dialysis
71
Ambulatory Surgical Center (Non-Distinct Part)
72
Other Ancillary
73
Clinics
90
Emergency
91
Observation Beds
92
Note: Subscripted cost centers that would normally fall into one of
these cost centers should be included on the survey.
SRG
5
Other Considerations
Do not include salaries and hours related to excluded areas
or occupations billable under Medicare Part B.
In addition to categorizing the staff, the provider must
apply the same methodology that is used in the wage
index calculation in excluding costs associated with
excluded areas and for allocating general service salaries
and hours to excluded areas.
SRG
2ational OM AHW by Category
Occupational Category
FY 2008 Final FY 2010 Final FY 2012 Final FY 2014 Final
National
National
National
National
AHWs by
AHWs by
AHWs by
AHWs by
Subcategory Subcategory Subcategory Subcategory
RN
LPN and Surgical Technicians
Nurse Aides, Orderlies, & Attendants
Medical Assistants
$
$
$
$
33.84
19.22
13.69
15.77
$
$
$
$
36.07
20.88
14.62
16.49
$
$
$
$
36.08
20.86
14.62
16.44
$
$
$
$
37.43
21.77
15.32
17.21
Total Nursing Category
$
28.73
$
30.48
$
30.46
$
31.85
SRG
TENNESSEE PROVIDERS
OCC MIX ADJUSTMENT FACTOR
FY 2014
PROV
440059
440073
440009
440025
440144
440072
440081
440058
440132
440050
440130
440068
440151
440031
440084
440137
440187
440033
440175
440061
PROV NAME
CBSA
COOKEVILLE REGIONAL MEDICAL CENTER
44
MAURY REGIONAL HOSPITAL
44
CUMBERLAND MEDICAL CENTER
44
LAUGHLIN MEMORIAL HOSPITAL
44
HARTON REGIONAL MEDICAL CENTER
44
DYERSBURG REGIONAL MEDICAL CENTER
44
LECONTE MEDICAL CENTER
44
SOUTHERN TENNESSEE MEDICAL CENTER
44
HENRY COUNTY MEDICAL CENTER
44
TAKOMA REGIONAL HOSPITAL
44
BAPTIST MEM HOSP-UNION CITY
44
ATHENS REGIONAL MEDICAL CENTER
44
RIVER PARK HOSPITAL
44
ROANE COUNTY MEDICAL CENTER
44
SWEETWATER HOSPITAL ASSOCIATION
44
BEDFORD COUNTY MEDICAL CENTER
44
LIVINGSTON REGIONAL HOSPITAL
44
ST MARY'S MEDICAL CENTER OF CAMPBELL 44
CROCKETT HOSPITAL
44
VOLUNTEER COMMUNITY HOSPITAL
44
Col A
Provider
unadjusted
wages
$ 97,479,631
$ 94,489,468
$ 46,353,442
$ 30,739,387
$ 29,027,390
$ 26,049,486
$ 25,265,169
$ 23,946,526
$ 23,178,134
$ 20,268,217
$ 17,494,288
$ 16,756,390
$ 16,739,918
$ 16,509,139
$ 15,260,006
$ 14,909,388
$ 14,097,199
$ 13,976,819
$ 13,753,716
$ 13,032,114
Col B
Col C
Col D
Col E
Provider
CBSA
Prov occ
Provider
unadjusted nurse occ nurse occ mix adjusted
AH W
mix factor mix factor
AHW
$
30.92
0.999
1.02 $
30.90
$
31.66
0.999
1.02 $
31.65
$
27.35
1.082
1.02 $
28.33
$
27.47
1.088
1.02 $
28.56
$
28.78
1.032
1.02 $
29.28
$
30.68
0.971
1.02 $
30.28
$
26.64
1.012
1.02 $
26.75
$
31.40
0.956
1.02 $
30.80
$
28.11
1.022
1.02 $
28.37
$
26.97
1.072
1.02 $
27.74
$
31.25
0.942
1.02 $
30.65
$
31.77
0.936
1.02 $
31.04
$
30.56
0.969
1.02 $
30.18
$
24.77
0.994
1.02 $
24.72
$
21.52
1.113
1.02 $
22.59
$
29.14
0.984
1.02 $
28.96
$
31.00
1.116
1.02 $
32.54
$
27.56
1.085
1.02 $
28.34
$
31.10
1.028
1.02 $
31.43
$
28.54
0.998
1.02 $
28.51
SRG
6
TENNESSEE PROVIDERS
OCC MIX ADJUSTMENT FACTOR
FY 2014
PROV
440153
440102
440180
440057
440109
440020
440083
440054
440148
440007
440051
440192
440016
440182
440008
440174
440115
440070
440060
440047
440181
440010
440141
440040
PROV NAME
BAPTIST HOSPITAL OF COCKE COUNTY
LINCOLN REGIONAL HOSPITAL
JELLICO COMMUNITY HOSPITAL
CLAIBORNE COUNTY HOSPITAL
HARDIN MEDICAL CENTER
HILLSIDE HOSPITAL
JAMESTOWN REGIONAL MEDICAL CENTER
DOCTORS HOSPITAL OF MCMINN CO.
DEKALB COMMUNITY HOSPITAL
UNITED REGIONAL MEDICAL CENTER
MCNAIRY REGIONAL HOSPITAL
WHITE COUNTY COMMUNITY HOSPITAL
BAPTIST MEM HOSPITAL HUNTINGDON
MCKENZIE REGIONAL HOSPITAL
HENDERSON COUNTY HOSPITAL
HAYWOOD PARK COMMUNITY HOSPITAL
HUMBOLDT GENERAL HOSPITAL
DECATUR COUNTY GENERAL HOSPITAL
MILAN GENERAL HOSPITAL
GIBSON GENERAL HOSPITAL
BOLIVAR GENERAL HOSPITAL
WAYNE MEDICAL CENTER
CUMBERLAND RIVER HOSPITAL
PERRY COMMUNITY HOSPITAL
Col A
Col B
Provider
Provider
unadjusted unadjusted
wages
AH W
$ 11,981,163 $
26.62
$ 11,448,442 $
26.78
$ 10,870,309 $
26.41
$ 10,511,022 $
23.69
$ 10,491,100 $
23.47
$ 10,235,106 $
32.33
$ 10,131,733 $
26.53
$ 9,658,368 $
25.88
$ 8,676,873 $
29.06
$ 8,348,784 $
25.25
$ 7,646,631 $
27.08
$ 7,575,881 $
30.81
$ 7,412,298 $
27.78
$ 7,061,781 $
27.46
$ 6,923,945 $
30.20
$ 5,418,089 $
30.85
$ 5,034,500 $
27.98
$ 4,742,531 $
23.32
$ 4,537,434 $
28.76
$ 4,362,980 $
28.61
$ 4,082,030 $
27.52
$ 3,905,022 $
21.87
$ 3,653,343 $
24.77
$ 2,660,229 $
19.36
CBSA
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
Col C
Col D
Provider
CBSA
nurse occ nurse occ
mix factor mix factor
0.956
1.02
1.025
1.02
0.945
1.02
1.022
1.02
1.070
1.02
1.027
1.02
1.113
1.02
1.021
1.02
1.022
1.02
1.022
1.02
1.008
1.02
1.122
1.02
1.075
1.02
1.007
1.02
0.947
1.02
1.110
1.02
1.005
1.02
1.128
1.02
1.019
1.02
0.985
1.02
1.081
1.02
1.129
1.02
1.323
1.02
1.022
1.02
Col E
Prov occ
mix adjusted
AHW
$
26.13
$
27.10
$
25.92
$
23.90
$
23.96
$
32.66
$
27.77
$
26.08
$
29.32
$
25.49
$
27.18
$
32.27
$
28.41
$
27.54
$
29.52
$
32.09
$
28.02
$
24.18
$
28.95
$
28.47
$
28.22
$
22.98
$
27.43
$
19.54
SRG
TENNESSEE PROVIDERS
OCC MIX ADJUSTMENT FACTOR
FY 2014
CBSA
16860
16860
16860
16860
16860
Col A
Provider
unadjusted
wages
$ 225,281,532
$ 194,098,072
$ 96,164,267
$ 10,860,956
$ 3,347,090
440035 GATEWAY HEALTH SYSTEM
17300
$ 60,018,106 $
30.29
0.986
1.00 $
440185 SKYRIDGE MEDICAL CENTER
17420
$ 55,032,379 $
28.78
1.020
1.02 $
29.05
440002 JACKSON-MADISON COUNTY GENERAL HOSP27180
440189 REGIONAL HOSPITAL OF JACKSON
27180
$ 197,232,377 $
$ 29,856,383 $
29.38
31.77
0.953
1.016
0.96 $
0.96 $
28.83
32.05
440063
440184
440018
440001
JOHNSON CITY MEDICAL CENTER
FRANKLIN WOODS COMMUNITY HOSPITAL
SYCAMORE SHOALS HOSPITAL
UNICOI COUNTY MEMORIAL HOSPITAL,INC
27740
27740
27740
27740
$ 172,368,057 $
$ 24,675,320 $
$ 19,248,071 $
$ 7,460,495 $
28.15
29.17
26.19
20.77
1.017
0.980
0.972
1.032
1.01
1.01
1.01
1.01
$
$
$
$
28.38
28.94
25.87
21.01
440017
440012
440176
440032
HOLSTON VALLEY HOSP & MED CTR
BRISTOL REGIONAL MEDICAL CENTER
INDIAN PATH MEDICAL CENTER
HAWKINS COUNTY MEMORIAL HOSPITAL
28700
28700
28700
28700
$ 111,142,579 $
$ 83,699,359 $
$ 39,996,786 $
$ 9,130,973 $
27.45
28.36
27.75
26.99
1.051
1.005
1.000
1.050
1.03
1.03
1.03
1.03
$
$
$
$
28.13
28.42
27.74
27.53
PROV
440104
440091
440156
440064
440162
PROV NAME
ERLANGER MEDICAL CENTER
MEMORIAL HEALTH CARE SYSTEM INC.
PARKRIDGE MEDICAL CENTER
GRANDVIEW MEDICAL CENTER
HEALTHSOUTH CHATTANOOGA HOSPITAL
Col B
Col C
Col D
Col E
Prov occ
CBSA
Provider
Provider
unadjusted nurse occ nurse occ mix adjusted
AHW
mix factor mix factor
AH W
$
34.01
0.989
1.00 $
33.85
$
34.66
1.007
1.00 $
34.76
$
34.07
1.012
1.00 $
34.29
$
30.51
1.040
1.00 $
30.96
$
40.45
0.999
1.00 $
40.43
30.11
SRG
T EN N ESSE E P R OVID ER S
OCC MIX AD JU ST ME N T FACT OR
FY 2014
Col A
Col B
P ro vide r
una djuste
d AH W
$
29.61
$
30.73
$
26.79
$
27.73
$
28.58
$
29.50
$
22.52
$
26.19
Col C
Col D
Col E
Prov occ
mix
a djuste d
AH W
$
29.75
$
30.90
$
27.60
$
28.09
$
28.73
$
30.04
$
22.78
$
25.93
PR OV
440015
440120
440173
440125
440011
440034
440226
440110
PR OV N AME
CBSA
UNIV OF T N MEMORIAL HOSPITAL
28940
MERCY HEALTH SYST EM INC
28940
PARKWEST MEDICAL CENTER
28940
FORT SANDERS REGIONAL MEDICAL CENTER28940
BLOUNT MEMORIAL HOSPITAL
28940
METHODIST MEDICAL CENTER
28940
BAPTIST HOSPITAL WEST
28940
FORT LOUDOUN MEDICAL CENT ER
28940
Provid e r
una djuste d
wa g e s
$ 168,646,082
$ 151,997,068
$ 115,831,109
$ 103,928,012
$ 80,337,907
$ 77,325,054
$ 29,004,932
$ 13,899,012
440049
440048
440152
440183
440228
440159
440131
440147
440168
METHODIST HC MEMPHIS HOSPITALS
BAPTIST MEM HOSPIT AL MEMPHIS
REGIONAL MEDICAL CENT ER AT MEMPHIS
ST. FRANCIS HOSPITAL
ST. FRANCIS BARTLETT MED CT R
DELTA MEDICAL CENT ER MEMPHIS
BAPTIST MEM HOSPIT AL T IPTON COUNTY
BMH GERMANTOWN
METHODIST HC FAYETT E HOSPITAL
32820
32820
32820
32820
32820
32820
32820
32820
32820
$ 555,945,965 $
$ 271,902,807 $
$ 129,558,601 $
$ 98,036,944 $
$ 35,419,297 $
$ 20,099,083 $
$ 14,013,915 $
$ 11,174,969 $
$ 6,023,373 $
36.18
34.50
33.71
34.78
35.08
32.11
30.07
37.92
32.63
1.017
1.002
0.977
1.002
0.979
1.006
0.940
0.850
1.038
1.01
1.01
1.01
1.01
1.01
1.01
1.01
1.01
1.01
$
$
$
$
$
$
$
$
$
36.49
34.52
33.34
34.81
34.71
32.19
29.36
37.78
33.16
34100
34100
34100
$
$
$
25.01
27.81
28.54
0.999
0.980
1.054
1.01 $
1.01 $
1.01 $
25.00
27.57
29.16
440030 MORRISTOWN-HAMBLEN HOSPITAL
440056 ST MARY'S JEFFERSON MEMORIAL
440067 LAKEWAY REGIONAL HOSPITAL
37,180,618 $
15,703,856 $
15,130,140 $
Provid e r
CBSA
nurse o cc nurse o cc
mix fa ctor mix fa cto r
1.010
1.03
1.013
1.03
1.065
1.03
1.030
1.03
1.006
1.03
1.047
1.03
1.026
1.03
0.970
1.03
SRG
7
TENNESSEE PROVIDERS
OCC MIX ADJUSTMENT FACTOR
FY 2014
PROV
440039
440082
440161
440133
440053
440006
440029
440150
440003
440111
440193
440194
440197
440065
440046
440227
440186
440218
440200
PROV NAME
VANDERBILT UNIVERSITY HOSPITALS & CL
SAINT THOMAS HOSPITAL
CENTENNIAL MEDICAL CENTER
BAPTIST HOSPITAL
MIDDLE TENNESSEE MEDICAL CENTER
SKYLINE MEDICAL CENTER
WILLIAMSON MEDICAL CENTER
SUMMIT MEDICAL CENTER
SUMNER REGIONAL MEDICAL CENTER
METRO NASHVILLE GENERAL HOSPITAL
UNIVERSITY MEDICAL CENTER
HENDERSONVILLE MEDICAL CENTER
SOUTHERN HILLS MEDICAL CENTER
NORTHCREST MEDICAL CENTER
HORIZON MEDICAL CENTER
STONECREST MEDICAL CENTER
RIVERVIEW REG MED CNTR NORTH
THE CENTER FOR SPINAL SURGERY
STONES RIVER HOSPITAL
CBSA
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
34980
Col A
Provider
unadjusted
wages
$ 689,503,772
$ 182,157,545
$ 180,756,157
$ 176,375,084
$ 100,150,770
$ 76,607,518
$ 61,799,737
$ 59,777,266
$ 47,914,595
$ 47,234,475
$ 37,395,481
$ 35,294,483
$ 34,522,102
$ 34,092,205
$ 32,295,943
$ 32,243,855
$ 9,219,563
$ 7,275,723
$ 5,233,392
Col B
Col C
Col D
Col E
Provider
CBSA
Prov occ
Provider
unadjusted nurse occ nurse occ mix adjusted
AHW
mix factor mix factor
AHW
$
35.27
1.040
1.00 $
35.81
$
37.65
0.965
1.00 $
37.10
$
37.03
0.933
1.00 $
35.78
$
34.76
0.992
1.00 $
34.63
$
33.56
0.998
1.00 $
33.53
$
35.58
0.974
1.00 $
35.20
$
31.96
0.969
1.00 $
31.48
$
35.21
0.979
1.00 $
34.85
$
33.98
0.981
1.00 $
33.72
$
35.12
0.938
1.00 $
34.01
$
28.75
1.039
1.00 $
29.26
$
36.56
0.967
1.00 $
35.99
$
36.49
0.935
1.00 $
35.34
$
30.06
1.037
1.00 $
30.24
$
35.75
1.015
1.00 $
36.02
$
35.97
0.953
1.00 $
35.17
$
29.97
1.070
1.00 $
30.56
$
38.12
0.996
1.00 $
38.06
$
27.52
1.134
1.00 $
29.12
SRG
Spreadsheet for Proposed FY 2010 Calculation of Provider Occupational Mix AHW
Fields in PINK are filled in by the provider from the provider's occupational mix spreadsheet
Fields in GREEN are filled in from IPPS wage index Web Site or Federal Registers
Fields in BOLD and/or Blue are calculated fields--DO NOT ENTER any information here
Provider Information
Provider Number
FI #
Occ Mix Begin Date
Occ Mix End Date
123456
MY MAC
7/1/2007
6/30/2008
step 1
Provider Occ
Mix Hours
1,671,346
RN
210,946
LPN and Surgical Technicians
349,727
National Nurse Aides, Orderlies, and Attendants
14,778
Medical Assistants
Total Nurse Hours and Salaries
2,246,797
$
Nurse Occ Mix Wages
All Other Unadjusted Occ Mix Wages
Total Occ Mix Wages
Final Occ Mix Adjusted AHW
Provider
Occ Mix Provider % by
Salaries
Subcategory
40,366,170
74.39%
3,587,381
9.39%
4,227,499
15.57%
243,499
0.66%
48,424,549
step
2
FY
2011
Proposed
National
AHWs by
Subcategory
$
36.07
$
20.87
$
14.62
$
16.48
step 3
step 5
Proposed FY
Provider
2010 National
Adjusted Adjusted Nurse
AHW
AHW
$ 26.83
$
1.96
$
2.28
$
0.11
$ 31.18 $
30.47
step 6
in step 7
Nurse Occ
Mix
Adjustment
Factor
Provider
% by
Total
2,696,283 59,914,846
4,943,080 108,339,395
ALL OTHER
TOTAL
Wages (From S-3, Parts II and III)
Hours (From S-3, Parts II and III)
Unadjusted AHW
Step 6= Step
5/ Step 3
Step 3 = Step
1 x Step 2
Step 1 is based
on Hours
44.70%
55.30%
Wage Data from Cost Report
$135,225,691
4,258,859
31.75
$59,078,434
$74,783,752
$133,862,186
$
0.9774
31.43
step 7
step 7
step 8
(Wages x Nurse %) x OM Factor
(Wages x All Other %) x OM Factor
Total of Above
step 8
Total Occ Mix Wages/Hours
Final Summary
If a hospital’s OM AHW is less than the national average,
the OM factor will be greater than 1.0 and will result in an
increased final occ mix adjusted AHW.
If a hospital’s OM AHW is greater than the national
average, the OM factor will be less than 1.0 and will result
in a decreased final occ mix adjusted AHW.
SRG
8
How long does it take to prepare the OMS?
CMS states the time required to complete this information
collection is estimated to average 480 hours per response.
SRG
Questions ?
Call us at 770-928-3352
or send us an email at:
[email protected]
SRG
9

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