Area Wage Index

September 17, 2003

Session I Overview Current Area Wage Index Facts & Calculations MSA Specifics and Profiles

Session II Sleeping Dogs and Edit Checks Hot Topics & Changes on the Horizon Geographic Reclassification Occupational Mix Survey S-3 Samples

Outline

OverviewHealthcare Affiliates, Inc is a national healthcarereimbursement consulting firm specializing ingovernmental reimbursement issues associated withMedicare/Medicaid , Blue Cross and other payors. Since 1992 we have performed close to 1,000 consultingengagements associated with wage index issues alone. 

Our primary services are: Area Wage Index (AWI) annual reviews Disproportionate Share Reviews and SSI appeals Cost Report IME, DGME and ESRD Reviews Healthcare Employee Benefit Reviews Specialized Billing Issues

CURRENT WAGE INDEX FACTS & CALCULATIONS

Presented byHealthcare Affiliates, Inc

Cost Reporting Data Used For the Wage Index By Year

Data for FFY 2001 (cost reporting periods beginning October 1, 2000 through September 30, 2001) will be used for FFY 2005 wage index computation.

For short periods beginning October 1, 2000 through September 30, 2001, CMS uses the longest period, or if two periods are the same length, the most recent period. CMS annualizes short period data.

Table of Hospitals with Various Fiscal Year EndsHospital FYE Inpatient Acute Care Acute Outpatient, Home

Rehab& Long Term Care Health, Hospice & SMF

Sept 30, 2000 FFY 2004 Calendar 2004

Dec 31, 2000 FFY 2004 Calendar 2004

April 30, 2001 FFY 2004 Calendar 2004

June 30, 2001 FFY 2004 Calendar 2004

Aug 31, 2001 FFY 2004 Calendar 2004

Sept 30, 2001 FFY 2005 Calendar 2005

Dec 31, 2001 FFY 2005 Calendar 2005

April 30, 2002 FFY 2005

June 30, 2002 FFY 2005

Aug 31, 2002 FFY 2005

For Medicare geographic reclassification purposes the wage index data is used to satisfy thecriteria for a wage index reclassification for the subsequent FFY to the payment year. Thismeans that the most recent wage index data available at the filing date is used forreclassification purposes.

AWI Facts

AWI factor is multiplied times the labor portion of the DRG base amount. This is 71% of the base DRG calculation. (Proposed to be higher)AWI will, in FFY 2005, impact DRG’s, Outpatient PPS, SNF, etc.In FFY 2005 the reduction for Medical Education cost will be at 100%. (Part of “Behind the Sheet Adjustment)Changes have been made in the overhead calculation (Part of “Behind the Sheet Adjustment)

AWI Facts

National average has been moving approximately 3% a year. It grew by 6.8% last year.

CMS has shortened time frames for Hospital corrections from May to March to February to November. Because of the reduced time frame, these months play havoc with a hospital’s responses.

Hospitals in their respective MSAs need to work together. Now!

AWI FactsFIs have edit checks that direct their attention to increases above a certain percentage, their edit checks do not direct them to decreases of any size. (For instance, in FFY 2000, there were 147 hospitals nationwide with $0 for fringes. Forty-seven (47) of those hospitals were in Texas. In FFY 2001,there were still 34 w/o Fringes. In FFY 2003 there were 3 hospitals with $1 in WRC. In FFY 2004, there is 1 hospital with $1 in WRC and 60 with under 10% WRC.The data supplied herein is from various data sources, most from CMS.Of 4,784 hospitals in the latest PUF, 333 were not adjusted1759 were adjusted after 1/1/03 with all but 124 after 2/2/03Florida had 94 after 1/1/03 – out of 182 hospitalsAdditional “errors”: there are 13 hospitals with over 40% WRC and 1 at 72%.There is a hospital in Texas with a $9.25 rate.

Sample Area Wage Index

Salaries/WRCs % Hours AHW Impact

Hosp A $40,000,000 40 2,000,000 $20.00 $8.00

Hosp B $20,000,000 20 1,100,000 $18.18 $3.62

Hosp C $30,000,000 30 1,600,000 $18.75 $5.61

Hosp D $10,000,000 10 505,000 $19.80 $1.98

Total $100,000,000 100 5,205,000 $19.21 $19.21

 

National Average $20.00

MSA’s AWI $19.21/$20.00 0.9605

If Hospital A increases by $1.00, this would equal a $0.40 increase (40% X $1) to MSA and an AWI change to .9805 ($19.61/$20.00). This is a positive increase of 2% to entire MSA.

 To get this same impact we would have to move Hospital D $4.00, or Hospital B $2.00, or Hospitals C + D $1.00 each.

Uses of Medicare Wage IndexINPATIENTStandardized Amount (eff) 10/1/03) – Applicable to DRG Payment pre Discharge 

Other Urban and Rural Large Urban (over 1 Million) (same as Large Urban 4/1/03 – 9/30/03)  71% 29% 71% 29% Labor Non-Labor 100% Labor Non-Labor 100%

Related Related Total Related Related Total$3,145 $1,279 $4,424 $3,095 $1,259 $4,354X .9807 X .9807$2,963.98 $1,226.48 $4,192.46 $2863.98 $1,228.48 $4,192.46

 Note: Congress is expected to legislate use of large urban standardized amount for all hospitals. 

“Geographic adjustment factor” (GAF) is computed from the wage index. Wage index to the power .6848. 

The wage index also affects Disproportionate Share Payments (DSH) and Indirect Medical Education (IME) and the adjustment factor for the labor related portion of outpatient prospective payment is 60% rather than 71%.

Uses of Medicare Wage Index

OTHER The wage index is also used for SNF, Home Health, Hospice, ambulatory surgical centers, and rehabilitation hospitals (or units). In SummaryThe wage index is a primary determinant of Medicare Payments. Wage Index Examples:  Wage IndexHighest: Oakland, CA 1.5058Average: 1.0000Lowest: Dothan, AL .7734

Wage Data Corrections

4 Year Old Data from Worksheet S-3 FFY 2004 Wage Index based on FFY 2000 data

Increased Volume of Corrections 1997 Wage Index: 13% of hospitals 2001 Wage Index: 32% of hospitals 2002 Wage Index: 30% of hospitals

Desk Audit Issues

Inconsistencies among auditors, FIs

Definition of self-insurance.

Calculations of costs under GAAP.

Allocation of wage costs to exclude units (salaries v. hours).

Reasonable, Sample, AWI vs. cost report, Refiling CR, overall documentation, etc.

Appeal Rights

CMS policy: no appeal to PRRP to challenge incorrect wage data if hospital failed to comply with all steps of data verification process.

Expedited Judicial Review

Midyear Corrections

Only if hospital can show FI or CMS error in tabulating data and hospital did not know or have opportunity to correct prior to start of FFY

Corrected WI applied prospectively only.

Hospitals can not seek correction of another hospitals wage data in this process.

Does not preclude hospitals from appealing to challenge WI based on erroneous data (if procedures followed).

Comparability of Wage Data

Statute requires comparison of area’s wage level to national average wage level.

Wage Index Appeals

Timing: 180 days from publication of final wage index.

Group Appeal?

Expedited Judicial Review?

Relief: Retrospective or Prospective.

Area Wage Index Calendar

Audit/desk review 10/1 to 11/15 Not Happening

Hospital review of adjustments 11/15 to 11/25 9/15 to 11/15

FI submits data to HCRIS file 11/26/02 Early Feb

Updated HCRIS file released 1/8/03 Adjustments to Adjustments 3/8

Last day for Hospital to update and document 2/8/03 Initial 11/15, A to A 3/8

Last day for FI to transmit final data 4/9/04

First “preliminary” release 6/5/04

Correction of transmission errors only 7/5/04

Final rate publication 8/1/04

Rates go into effect 10/1/04

Note: This schedule may be compressed because #’s 9 and 10 can not change

Area Wage Index Calendar

Our suggestions: Get your MSA organized1. Prioritize Hospitals and MSA’s

a.      Hospitals that dropped for FY 2004 or priorb.      Hospitals with apparent issuesc.       Hospitals with “hits” (teach, I/R, CRNA, other)

2. Prepare and perform field work now on #1’s.3. Handle all questions4. Review S-3’s as adjusted by FI for Hospitals not addressed in #1

above.Reasons:Data available now Not yetAvoid delays from FI’s side StillEnsures multiple levels of review NoStill allows for additional changes later No

AWI CalendarTimeframe Steps in Wage Index Development Process

Mid-September Preliminary and unaudited wage data file published as a public use file (PUF) on CMS website.

Mid-November Deadline for hospitals to send requests for revisions to fiscal intermediaries.

Early February Fiscal intermediaries review revisions and desk review wage data; notify hospitals of changes and resolution of revision requests; and submit preliminary revised data to CMS.

Early March Deadline for hospitals to request wage data reconsideration of desk review adjustments and provide adequate documentation to support the request.

Early April Deadline for the fiscal intermediaries to submit additional revisions resulting from the hospitals' reconsideration requests.This is also the deadline for hospitals to request CMS intervention in cases where the hospital disagrees with the fiscal intermediary's policy interpretations.

Early May* Release of final wage data PUF on CMS web site.

Early June* Deadline for hospitals to submit correction requests, to both CMS and their fiscal intermediary, for errors due to the mishandling of the final wage data by CMS or the fiscal intermediary.

National InformationFFY 04 FFY 03 FFY 04 C

MSA Location variance Variance 8/1/2003 8/1/2002 8/1/01 8/1/00 7/30/1999 7/31/1998 8/29/1997

8080-2 Steubenville-Weirton, OH-WV -0.8804 0.0167 0.8804 0.8637 .8548 0.8649 0.8537 0.8645

6020-2 Parkersburg-Marietta, WV -0.8613 -0.0055 0.8613 0.8668 .8670 0.8414 0.8537 0.8434

1900-2 Cumberland, MD-WV -0.7975 -0.0331 0.7975 0.8306 .8369 0.9096 0.8574 0.8822

4600 Lubbock, TX -0.1408 0.1183 0.8238 0.9646 0.8463 .8838 0.8411 0.8514 0.8400

6740 Richland-Kennewick-Pasco, WA -0.0925 0.0531 1.0566 1.1491 1.0960 1.1460 1.1224 1.0512 1.0221

6323 Pittsfield, MA -0.0898 -0.0166 1.0390 1.1288 1.1454 1.1204 1.1369 1.0857 1.0960

8003 Springfield, MA -0.0869 -0.0166 1.0419 1.1288 1.1454 1.1204 1.1369 1.0857 1.0718

1400 Champaign-Urbana, IL -0.0768 0.1329 0.9867 1.0635 0.9306 .9198 0.9163 0.8789 0.8824

2750 Fort Walton Beach, FL -0.0763 0.0691 0.8930 0.9693 0.9002 .9607 0.8986 0.8896 0.8838

7485 Santa Cruz-Watsonville, CA -0.0756 -0.0324 1.2890 1.3646 1.3970 1.4095 1.3927 1.4011 1.4187

0600 Augusta-Aiken, GA-SC -0.0677 0.0294 0.9587 1.0264 0.9970 .9160 0.9013 0.9253 0.9333

3350 Houma, LA -0.0645 0.0410 0.7740 0.8385 0.7975 .8086 0.7837 0.8215 0.7854

2985 Grand Forks, ND -0.0642 0.0124 0.8601 0.9243 0.9119 .8954 0.9097 0.8918 0.8815

9000-2 Wheeling, WV -0.0627 -0.0055 0.7986 0.8613 0.8668 .8670 0.8649 0.7892 0.7966

8750 Victoria, TX -0.0605 0.0428 0.8151 0.8756 0.8328 .8154 0.8378 0.8400 0.8474

3620 Janesville-Beloit, WI -0.0583 0.0110 0.9266 0.9849 0.9739 .9585 0.9656 0.9071 0.8824

3520 Jackson, MI -0.0582 0.0275 0.8950 0.9532 0.9257 .9134 0.8840 0.9244 0.9052

0860 Bellingham, WA -0.0572 0.0456 1.1710 1.2282 1.1826 1.1439 1.1394 1.1459 1.1221

3980 Lakeland-Winter Haven, FL -0.0534 0.0290 0.8823 0.9357 0.9067 .8928 0.8986 0.8896 0.8838

0875 Bergen-Passaic, NJ -0.0524 0.0399 1.1683 1.2207 1.1808 1.1605 1.1833 1.1774 1.1570

8920 Waterloo-Cedar Falls, IA -0.0520 0.0225 0.8382 0.8902 0.8677 .8802 0.8841 0.8350 0.8643

1350 Casper, WY -0.0519 0.0194 0.9171 0.9690 0.9496 .8817 0.9199 0.9170 0.9013

4900 Melbourne-Titusville-Palm Bay, FL -0.0517 0.0340 0.9736 1.0253 0.9913 .9688 0.9296 0.9236 0.8838

5600 New York, NY -0.0501 -0.0013 1.3913 1.4414 1.4427 1.4651 1.4517 1.4431 1.3982

6280 Pittsburgh, PA -0.0500 -0.0195 0.8865 0.9365 0.9560 .9741 0.9634 0.9809 0.9725

5280 Muncie, IN -0.0496 -0.0655 0.8788 0.9284 0.9939 1.0969 1.0834 0.9434 0.9173

3920 Lafayette, IN -0.0490 0.0157 0.8788 0.9278 0.9121 .8834 0.8809 0.8928 0.9174

6360 Ponce, PR -0.0480 -0.0049 0.4689 0.5169 0.5218 .5006 0.4971 0.4799 0.4589

6340 Pocatello, ID -0.0462 0.0226 0.9212 0.9674 0.9448 .9076 0.8973 0.8811 0.9586

1540 Charlottesville, VA -0.0453 -0.0128 0.9985 1.0438 1.0566 1.0789 1.0573 1.0294 0.9051

MSA’S SPECIFICS AND PROFILES

Presented byHealthcare Affiliates, Inc

Florida MSA's AWI ImpactMSA Location 8/29/1997 7/31/1998 7/30/1999 8/1/2000 8/1/2001 8/1/2002 8/1/2003 Var

2020 Daytona Beach, FL 0.8838 0.9153 0.8986 .9147 0.8972 0.9062 0.9024 -0.0038

2680 Ft. Lauderdale, FL 1.0487 0.9867 1.0172 1.0152 1.0784 1.0704 1.0436 -0.0268

2700 Fort Myers-Cape Coral, FL 0.8838 0.8936 0.8986 .9247 0.9374 0.9680 0.9776 0.0096

2710 Fort Pierce-Port St. Lucie, Fl 1.0257 1.0263 1.0109 .9622 1.0214 0.9931 1.0083 0.0152

2750 Fort Walton Beach, FL 0.8838 0.8896 0.8986 .9607 0.9002 0.9693 0.8930 -0.0763

2900 Gainesville, FL 0.9616 0.9482 1.0102 1.0074 0.9481 0.9871 0.9653 -0.0218

3600 Jacksonville, FL 0.8969 0.8919 0.8986 .9208 0.9223 0.9381 0.9490 0.0109

3980 Lakeland-Winter Haven, FL 0.8838 0.8896 0.8986 .8928 0.9067 0.9357 0.8823 -0.0534

4900 Melbourne-Titusville-Palm Bay, FL 0.8838 0.9236 0.9296 .9688 0.9913 1.0253 0.9736 -0.0517

5000 Miami, FL 0.9859 1.0038 1.0233 1.0059 0.9950 0.9815 0.9854 0.0039

5345 Naples, FL 1.0109 1.0199 0.9839 .9661 0.9699 0.9754 0.9750 -0.0004

5790 Ocala, FL 0.9032 0.9172 0.9615 .9243 0.9556 0.9402 0.9689 0.0287

5960 Orlando, FL 0.9397 0.9834 0.9806 .9610 0.9642 0.9640 0.9615 -0.0025

6015 Panama City, FL 0.8838 0.8896 0.9169 .9010 0.9061 0.8865 0.8819 -0.0046

6080 Pensacola, FL 0.8838 0.8896 0.8986 .8928 0.8794 0.8814 0.8819 0.0005

6580 Punta Gorda, FL 0.8838 0.9050 0.9508 .9613 0.9015 0.9218 0.9472 0.0254

7510 Sarasota-Bradenton, FL 0.9757 0.9553 0.9905 .9809 1.0090 0.9449 0.9931 0.0482

8240 Tallahassee, FL 0.8838 0.8896 0.8986 .8928 0.8794 0.8814 0.8819 0.0005

8280 Tampa-St. Petersburg-Clearwater, FL0.9196 0.9203 0.9119 .9099 0.8925 0.9171 0.9066 -0.0105

8960 West Palm Beach-Boca Raton, FL 1.0309 1.0203 0.9951 .9615 0.9777 0.9939 0.9759 -0.0180

-0.1269

10 Florida Rurals 0.8896 0.8986 .8928 0.8794 0.8814 0.8819 0.0005

Florida MSAsFlorida MSAs

0.8700

0.9200

0.9700

1.0200

1.0700

1998 1999 2000 2001 2002 2003 2004

Wag

e In

dex

Sarasota-Bradenton

Fort Pierce-Port St. Lucie

Panama City

Ocala

Miami

Ft. Lauderdale

Orlando

Pensacola

Tallahassee

Naples

Daytona Beach

Jacksonville

West Palm Beach-Boca Raton

Punta Gorda

Tampa-St. Petersburg-Clearwater

Lakeland-Winter Haven

Fort Myers-Cape Coral

Melbourne-Titusville-Palm Bay

Gainesville

Fort Walton Beach

Daytona Beach

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100014 BERT FISH MEDICAL CENTER2020 $19.84 $19.80 $19.58 $21.99 $21.75 0.0859 1.8685100017 HALIFAX MEDICAL CENTER 2020 $17.77 $19.06 $19.87 $20.14 $21.19 0.4289 9.0886100045 MEMORIAL HOSPITAL WEST VOLUSIA2020 $20.76 $20.92 $21.02 $22.81 $25.22 0.1025 2.5850100068 ATLANTIC MED CTR ORMOND2020 $18.65 $19.93 $19.83 $19.96 $23.78 0.0310 0.7379100072 FLORIDA HOSPITAL/FISH MEMORIAL2020 $19.22 $21.02 $20.60 $22.03 $23.53 0.0913 2.1485100118 MEMORIAL HOSPITAL FLAGLER2020 $19.76 $22.87 $20.73 $21.71 $24.11 0.0468 1.1294100169 MEMORIAL HOSPITAL ORMOND BEACH2020 $20.77 $20.95 $20.30 $21.64 $23.45 0.1613 3.7829100229 ATLANTIC MED. CENTER DAYTONA2020 $18.21 $19.69 $18.24 $19.73 $21.00 0.0522 1.0958

$21.25 $22.38 1.0000 22.44

MSA 2020 Wage Index 0.8986 0.9147 0.8972 0.9062 0.9024

Daytona Beach

0.8838

0.9153

0.8986

0.9147

0.8972

0.90620.9024

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Daytona Beach

Ft. LauderdaleFt. Lauderdale

1.0487

0.9867

1.0172 1.0152

1.07841.0704

1.0436

0.8700

0.9200

0.9700

1.0200

1.0700

1998 1999 2000 2001 2002 2003 2004

Wag

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nd

ex

Ft. Lauderdale

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100038 MEMORIAL REGIONAL HOSPITAL2680 $24.79 $23.36 $24.59 $24.95 $25.79 0.2135 5.5068100039 BROWARD GENERAL HOSPITAL2680 $20.25 $21.53 $21.79 $23.31 $23.80 0.1191 2.8343100056 CLEVELAND CLINIC HOSPITAL2680 $23.65 $25.79 $21.85 $23.17 $25.92 0.0277 0.7191100073 HOLY CROSS HOSPITAL 2680 $18.15 $21.19 $22.28 $22.24 $23.58 0.1362 3.2127100086 NORTH BROWARD MEDICAL CENTER2680 $21.16 $21.70 $23.37 $24.31 $25.23 0.0700 1.7651100167 Plantation General 2680 $21.81 $23.41 $23.30 $25.77 $26.45 0.0386 1.0211100189 NORTHWEST MEDICAL CENTER2680 $21.01 $21.31 $26.60 $27.13 $26.68 0.0318 0.8486100200 IMPERIAL POINT MEDICAL CENTER2680 $22.26 $22.46 $23.87 $24.89 $24.81 0.0332 0.8246100210 FLORIDA MEDICAL CENTER 2680 $19.18 $21.36 $21.85 $23.04 $26.09 0.0578 1.5085100224 UNIVERSITY HOSPITAL 2680 $24.70 $20.03 $21.86 $22.36 $23.08 0.0373 0.8615100225 HOLLYWOOD MEDICAL CENTER2680 $20.65 $20.68 $21.51 $22.46 $23.99 0.0216 0.5174100228 COLUMBIA WESTSIDE REGIONAL MED CTR2680 $23.70 $21.32 $20.88 $24.97 $26.25 0.0327 0.8584100230 MEMORIAL HOSPITAL PEMBROKE2680 $20.60 $20.51 $22.57 $23.42 $25.05 0.0261 0.6542100237 NORTH RIDGE MEDICAL CENTER2680 $22.93 $22.09 $23.24 $23.27 $26.76 0.0430 1.1513100276 CORAL SPRINGS MEDICAL CENTER2680 $21.98 $22.36 $24.10 $24.83 $25.45 0.0426 1.0847100281 MEMORIAL HOSPITAL WEST 2680 $22.02 $22.44 $23.01 $23.47 $25.33 0.0686 1.7382

$23.97 $25.11 1.0000 25.11

MSA 2680 Wage Index 1.0172 1.0152 1.0784 1.0704 1.0436

Ft. Myers – Cape CoralFort Myers-Cape Coral

0.8838

0.89360.8986

0.9247

0.9374

0.9680

0.9776

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

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dex

Fort Myers – Cape Coral

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100012 LEE MEMORIAL HOSPITAL 2700 $18.52 $19.62 $20.47 $22.02 $24.26 0.5290 12.8344100107 EAST POINTE HOSPITAL 2700 $18.01 $20.13 $20.07 $21.76 $23.37 0.0514 1.2018100220 REGIONAL MEDICAL CENTER SOUTHWEST FL2700 $19.91 $21.28 $21.82 $24.62 $24.97 0.2023 5.0507100244 CAPE CORAL HOSPITAL 2700 $17.41 $18.62 $20.54 $21.44 $23.48 0.1614 3.7894100279 GULF COAST HOSPITAL 2700 $23.02 $22.91 $22.59 $23.18 $24.84 0.0559 1.3881

$22.60 $24.25 1.0000 24.26

MSA 2700 Wage Index 0.8986 0.9247 0.9374 0.9680 0.9776

Fort Pierce-Port St. LucieFort Pierce-Port St. Lucie

1.0257 1.0263

1.0109

0.9622

1.0214

0.9931

1.0083

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Fort Pierce-Port St. Lucie

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100044 MARTIN MEMORIAL MEDICAL CENTER2710 $21.14 $21.48 $22.72 $22.95 $23.99 0.5537 13.2831100246 LAWNWOOD REGIONAL MEDICAL CENTER2710 $21.22 $19.64 $21.92 $23.56 $26.76 0.2914 7.7967100260 COLUMBIA MED. CTR. PORT ST. LUCIE2710 $21.22 $21.05 $24.92 $21.24 $23.51 0.1550 3.6429

$22.58 $24.72 1.0000 24.72

MSA 2710 Wage Index 1.0109 0.9622 1.0214 0.9931 1.0083

Fort Walton BeachFort Walton Beach

0.8838

0.8896

0.8986

0.9607

0.9002

0.9693

0.8930

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

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dex

Fort Walton Beach

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100054 TWIN CITIES HOSPITAL 2750 $18.19 $23.55 $21.15 $20.96 $22.03 0.1529 3.3677100122 NORTH OKALOOSA MEDICAL CENTER2750 $18.06 $19.88 $19.26 $24.98 $24.18 0.2885 6.9749100223 FT WALTON BEACH MEDICAL CENTER2750 $18.76 $20.63 $20.22 $21.90 $21.24 0.5587 11.8662

$22.61 $22.15 1.0000 22.21

MSA 2750 Wage Index 0.8986 0.9607 0.9002 0.9693 0.8930

GainesvilleGainesville

0.9616

0.9482

1.01021.0074

0.9481

0.9871

0.9653

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

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dex

Gainesville

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100113 SHANDS TEACHING HOSPITAL AND CLINICS2900 $22.26 $23.20 $21.35 $23.34 $24.36 0.8203 19.9818100204 NORTH FLORIDA REGIONAL MED CNTR2900 $20.20 $20.90 $20.22 $21.19 $22.26 0.1797 4.0007

$22.27 $23.94 1.0000 23.98

MSA 2900 Wage Index 1.0102 1.0074 0.9481 0.9871 0.9653

JacksonvilleJacksonville

0.89690.8919

0.8986

0.9208 0.9223

0.9381

0.9490

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

e In

dex

Jacksonville

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100001 UNIVERSITY MEDICAL CENTER, INC.3600 $17.69 $19.58 $20.22 $22.01 $22.61 0.1113 2.1400100040 ST. VINCENT'S MEDICAL CENTER3600 $18.64 $19.04 $18.63 $19.52 $22.46 0.2060 4.6274100088 BAPTIST MEDICAL CENTER 3600 $20.06 $20.37 $20.56 $20.67 $23.62 0.2256 5.3275100090 FLAGLER HOSPITAL, INC. 3600 $17.88 $19.15 $19.77 $21.04 $22.58 0.0884 1.9956100117 BAPTIST MEDICAL CTR. BEACHES3600 $18.86 $20.76 $20.70 $21.31 $23.91 0.0390 0.9328100140 BAPTIST MEDICAL CTR. NASSAU3600 $17.35 $17.14 $19.06 $20.23 $22.51 0.0203 0.4575100151 ST. LUKE'S HOSPITAL ASSOCIATION3600 $19.40 $21.61 $23.85 $26.61 $26.64 0.1401 3.7312100170 METHODIST MEDICAL CENTER3600 $15.12 $18.51 $19.30 $21.25 $0.00 0.0000 0.0000100179 MEMORIAL HOSPITAL OF J ACKSONVILLE3600 $20.91 $22.30 $23.08 $23.96 $24.18 0.1171 2.8307100226 ORANGE PARK MEDICAL CENTER3600 $24.86 $20.69 $21.88 $22.73 $23.87 0.0623 1.4865

$21.93 $23.54 1.0000 23.54

MSA 3600 Wage Index 0.8986 0.9208 0.9223 0.9381 0.9490

Lakeland-Winter HavenLakeland-Winter Haven

0.88380.8896

0.89860.8928

0.9067

0.9357

0.8823

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Lakeland-Winter Haven

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100052 WINTER HAVEN HOSPITAL 3980 $16.19 $17.95 $18.18 $19.66 $20.59 0.3687 7.5912100099 LAKE WALES MEDICAL CENTER3980 $15.30 $15.78 $15.76 $16.53 $18.52 0.0436 0.8080

100121 BARTOW 3980 $19.34 $18.58 $19.90 $23.11 0.0314 0.7263100137 HEART OF FLORIDA REG'L MEDICAL CTR.3980 $19.05 $18.70 $19.56 $20.90 $20.40 0.0641 1.3075100157 LAKELAND REGIONAL MEDICAL CENTER3980 $21.03 $22.67 $22.62 $24.22 $23.10 0.4922 11.3690

$20.24 $21.76 1.0000 21.80

MSA 3980 Wage Index 0.8986 0.8928 0.9067 0.9357 0.8823

Melbourne-Titusville Palm BayMelbourne-Titusville-Palm Bay

0.8838

0.92360.9296

0.9688

0.9913

1.0253

0.9736

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wa

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Ind

ex

Melbourne-Titusville Palm Bay

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100019 HOLMES REG'L MEDICAL CENTER4900 $19.81 $22.62 $23.55 $25.83 $24.28 0.4859 11.7978100028 PARRISH MEDICAL CENTER 4900 $19.75 $19.38 $19.34 $20.38 $21.88 0.1386 3.0327100092 WUESTHOFF MEMORIAL HOSPITAL4900 $18.20 $17.92 $20.18 $21.46 $25.46 0.2224 5.6633100177 CAPE CANAVERAL HOSPITAL, INC.4900 $22.00 $24.43 $24.43 $25.10 $24.50 0.1530 3.7497

$23.19 $24.15 1.0000 24.24

MSA 4900 Wage Index 0.9296 0.9688 0.9913 1.0253 0.9736

MiamiMiami

0.9859

1.0038

1.0233

1.0059

0.9950

0.98150.9854

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Miamiprov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100008 BAPTIST HOSPITAL 5000 $20.72 $20.50 $20.84 $21.64 $22.77 0.0883 2.0106100009 COLUMBIA CEDARS MEDICAL CENTER5000 $24.29 $22.64 $22.17 $22.64 $24.78 0.0469 1.1625100020 HEALTHSOUTH DOCTOR'S HOSPITAL5000 $26.17 $21.38 $20.78 $21.74 $23.53 0.0223 0.5236100022 JACKSON MEMORIAL 5000 $25.89 $24.41 $26.57 $27.42 $27.90 0.3173 8.8537100029 NORTH SHORE MEDICAL CENTER5000 $19.18 $20.87 $20.89 $22.26 $24.68 0.0287 0.7075100034 MOUNT SINAI MEDICAL CENTER5000 $18.23 $17.87 $19.53 $20.01 $23.11 0.1100 2.5422100050 PALMS SPRINGS GENERAL HOSPITAL5000 $16.61 $17.24 $17.90 $17.90 $20.04 0.0170 0.3403100053 HIALEAH HOSPITAL 5000 $18.71 $20.17 $19.68 $21.66 $23.78 0.0241 0.5740100061 MERCY HOSPITAL, INC. 5000 $21.79 $22.11 $22.92 $24.53 $26.12 0.0164 0.4296100076 PAN AMERICAN HOSPITAL 5000 $16.25 $17.87 $17.86 $18.48 $19.64 0.0286 0.5620100114 PARKWAY REGIONAL MEDICAL CENTER5000 $23.45 $21.63 $22.82 $22.53 $25.36 0.0356 0.9032100125 HOMESTEAD HOSPITAL 5000 $17.33 $18.95 $19.61 $20.32 $22.41 0.0128 0.2869100131 AVENTURA HOSPITAL AND MED. CENTER5000 $22.17 $23.44 $23.16 $24.62 $25.48 0.0262 0.6686100154 SOUTH MIAMI HOSPITAL 5000 $19.85 $20.00 $20.41 $21.67 $23.08 0.0550 1.2694100172 SOUTH SHORE HOSPITAL 5000 $15.18 $14.34 $14.88 $15.78 $17.60 0.0156 0.2751100181 LARKIN COMMUNITY HOSPITAL5000 $24.58 $23.08 $18.95 $17.90 $18.13 0.0095 0.1714100183 CORAL GABLES HOSPITAL 5000 $20.86 $24.61 $23.07 $22.21 $24.45 0.0147 0.3587100187 PALMETTO GENERAL HOSPITAL5000 $20.69 $20.25 $20.85 $21.50 $23.47 0.0389 0.9138100208 DEERING HOSPITAL 5000 $15.91 $21.21 $20.70 $20.47 $24.14 0.0205 0.4954100209 KENDALL MEDICAL CENTER 5000 $19.74 $22.46 $23.39 $22.82 $23.85 0.0293 0.6991100240 ANNE BATES LEACH EYE HOSPITAL5000 $17.94 $20.43 $21.06 $21.35 $23.06 0.0144 0.3316100277 MIAMI J EWISH HM & HOSPT./AGED, INC.5000 $16.14 $16.63 $19.72 $14.92 $25.29 0.0163 0.4115

100284 Westchester General 5000 $18.94 $18.57 $22.30 0.0115 0.2566

$21.00 $24.44 1.0000 24.75

MSA 5000 Wage Index 1.0233 1.0059 0.9950 0.9815 0.9854

NaplesNaples

1.0109

1.0199

0.9839

0.96610.9699

0.9754 0.9750

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Naples

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100018 NAPLES COMMUNITY HOSPITAL, INC.5345 $20.84 $21.03 $21.64 $22.66 $24.18 1.0000 24.18

MSA 5345 Wage Index 0.9839 0.9661 0.9699 0.9754 0.9750

OcalaOcala

0.9032

0.9172

0.9615

0.9243

0.9556

0.9402

0.9689

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Ocala

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100062 MUNROE REGIONAL MEDICAL CENTER5790 $17.95 $19.44 $21.44 $21.91 $24.98 0.6841 17.0900100212 MARION COMMUNITY HOSPITAL5790 $25.34 $21.12 $21.13 $21.72 $22.65 0.3159 7.1541

$21.81 $24.03 1.0000 24.24

MSA 5790 Wage Index 0.9615 0.9243 0.9556 0.9402 0.9689

OrlandoOrlando

0.9397

0.98340.9806

0.96100.9642 0.9640

0.9615

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

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Orlando

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact

100006 ORLANDO REGIONAL HEALTHCARE SYSTEM5960 $20.63 $20.11 $21.23 $21.69 $23.37 0.3047 7.1204100007 FLORIDA HOSPITAL MEDICAL CENTER5960 $21.72 $21.72 $22.16 $22.53 $24.33 0.4177 10.1618100030 HEALTH CENTRAL 5960 $18.82 $22.82 $20.60 $19.56 $21.85 0.0273 0.5956100051 SOUTH LAKE HOSPITAL 5960 $18.84 $23.13 $17.95 $19.33 $20.02 0.0129 0.2582100057 FLORIDA HOSPITAL WATERMAN5960 $18.75 $19.97 $19.53 $22.34 $24.64 0.0526 1.2971100084 LEESBURG REGIONAL MEDICAL CENTER5960 $20.40 $22.37 $22.70 $24.57 $24.11 0.0697 1.6815100110 COLUMBIA MED CTR OSCEOLA AS FILED CR5960 $19.64 $20.90 $20.19 $22.81 $24.45 0.0300 0.7332100161 CENTRAL FLORIDA REGIONAL HOSPITAL5960 $21.50 $22.30 $22.31 $23.36 $24.62 0.0329 0.8097100162 WINTER PARK MEMORIAL HOSPITAL5960 $19.87 $20.14 $20.31 $24.30 $23.80 0.0415 0.9882100221 LUCERNE MEDICAL CENTER 5960 $22.25 $17.40 $21.23 $23.23 $0.00 0.0107 0.0000

$22.37 $23.85 1.0000 23.65

MSA 5960 Wage Index 0.9806 0.9610 0.9642 0.9640 0.9615

Panama CityPanama City

0.88380.8896

0.9169

0.90100.9061

0.88650.8819

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

Wag

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Panama City

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100026 BAY MEDICAL CENTER 6015 $20.76 $20.56 $20.95 $21.37 $20.16 0.7244 14.6044100242 GULF COAST MEDICAL CENTER6015 $17.12 $17.93 $18.69 $19.11 $20.46 0.2756 5.6383

$20.24 $20.26 1.0000 20.24

MSA 6015 Wage Index 0.9169 0.9010 0.9061 0.8865 0.8819

PensacolaPensacola

0.88380.8896

0.89860.8928

0.8794 0.8814 0.8819

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Pensacola

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100025 SACRED HEART HOSPITAL 6080 $19.12 $18.78 $19.45 $20.14 $21.25 0.3436 7.3009100048 J AY HOSPITAL 6080 $13.50 $15.06 $15.78 $17.37 $17.55 0.0203 0.3569100093 BAPTIST HOSPITAL 6080 $16.63 $16.51 $16.84 $18.72 $20.29 0.2883 5.8495100124 SANTA ROSA MEDICAL CENTER6080 $19.05 $17.07 $20.40 $20.09 $24.30 0.0590 1.4332100231 WEST FLORIDA REGIONAL MEDICAL CENTER6080 $17.40 $17.92 $18.75 $21.57 $23.54 0.2458 5.7867100266 GULF BREEZE HOSPITAL 6080 $17.73 $18.30 $19.36 $20.28 $21.52 0.0430 0.9252

$19.69 $21.62 1.0000 21.65

MSA 6080 Wage Index 0.8986 0.8928 0.8794 0.8814 0.8819

Punta GordaPunta Gorda

0.8838

0.9050

0.9508

0.9613

0.9015

0.9218

0.9472

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Punta Gorda

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100047 CHARLOTTE REG'L MEDICAL CENTER6580 $18.87 $20.01 $20.61 $21.50 $24.35 0.2879 7.0101100236 FAWCETT MEMORIAL HOSPITAL6580 $21.81 $20.38 $20.69 $21.79 $23.97 0.2993 7.1745100077 St J oseph Port Char 6580 $19.62 $22.34 $19.06 $20.95 $22.37 0.4128 9.2344

$21.41 $23.49 1.0000 23.42

MSA 6580 Wage Index 0.9508 0.9613 0.9015 0.9218 0.9472

Sarasota BradentonSarasota-Bradenton

0.9757

0.9553

0.9809

1.0090

0.9449

0.9931

0.9905

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Sarasota Bradenton

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100035 MANATEE MEMORIAL HOSPITAL7510 $19.58 $20.15 $23.81 $21.35 $22.63 0.1729 3.9133100070 Bon Secours-Venice Hospital 7510 $20.34 $18.74 $20.04 $20.96 $23.55 0.1595 3.7557100087 SARASOTA MEMORIAL HOSPITAL7510 $23.11 $23.61 $23.66 $22.18 $26.59 0.3881 10.3187100166 DOCTORS HOSPITAL OF SARASOTA7510 $20.42 $20.03 $21.23 $22.24 $23.74 0.0963 2.2853100213 BLAKE MEDICAL CENTER 7510 $19.12 $20.66 $21.18 $22.02 $24.44 0.1405 3.4347100267 ENGLEWOOD COMMUNITY HOSPITAL7510 $17.10 $20.11 $21.74 $22.81 $23.37 0.0427 0.9985

$21.93 $24.61 1.0000 24.71

MSA 7510 Wage Index 0.9905 0.9809 1.0090 0.9449 0.9931

TallahasseeTallahassee

0.88380.8896

0.89860.8928

0.8794 0.8814 0.8819

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Tallahassee

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100135 TALLAHASSEE MEMORIAL HOSPITAL8240 $17.48 $18.83 $19.19 $19.77 $20.49 0.8571 17.5614100159 GADSDEN COMMUNITY HOSPITAL8240 $16.37 $10.28 $10.78 $15.06 $0.00 0.0094 0.0000100254 TALLAHASSEE COMMUNITY HOSPITAL8240 $20.91 $19.66 $19.55 $20.44 $23.27 0.1335 3.1064

$18.42 $21.04 1.0000 20.67

MSA 8240 Wage Index 0.8986 0.8928 0.8794 0.8814 0.8819

Tampa St. Petersburg ClearwaterTampa-St. Petersburg-Clearwater

0.9196 0.9203

0.9119 0.9099

0.8925

0.9171

0.9066

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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Tampa-St. Petersburg-Clearwaterprov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100015 SUN COAST HOSPITAL 8280 $18.24 $18.48 $18.07 $18.94 $22.12 0.0238 0.5273100032 BAYFRONT MEDICAL CENTER, INC.8280 $19.32 $19.81 $19.75 $20.65 $21.64 0.0272 0.5886100043 MEASE HOSPITAL & CLINIC 8280 $17.52 $18.80 $18.82 $20.77 $21.77 0.0285 0.6197100046 EAST PASCO MEDICAL CENTER8280 $21.21 $21.62 $21.30 $23.20 $24.27 0.0328 0.7962100055 HELEN ELLIS MEMORIAL HOSPITAL8280 $17.62 $18.05 $18.88 $19.13 $19.63 0.0273 0.5369100063 NORTH BAY MEDICAL CENTER8280 $16.23 $19.26 $18.46 $19.25 $21.56 0.0095 0.2038100067 ST. ANTHONY'S HOSPITAL 8280 $17.39 $18.09 $18.49 $19.22 $23.88 0.0338 0.8072100069 UCH - CARROLLWOOD 8280 $16.14 $16.83 $17.37 $18.88 $19.60 0.0149 0.2916100071 BROOKSVILLE REGIONAL HOSPITAL8280 $16.47 $17.55 $17.72 $20.75 $21.76 0.0113 0.2449100075 ST. J OSEPH'S HOSPITAL 8280 $18.05 $18.37 $19.45 $20.46 $22.38 0.1254 2.8064100126 PALMS OF PASADENA HOSPITAL8280 $18.09 $19.54 $19.31 $21.43 $21.79 0.0086 0.1871100127 MORTON PLANT HOSPITAL 8280 $19.87 $19.99 $19.21 $20.52 $21.01 0.0832 1.7486100128 TAMPA GENERAL HOSPITAL 8280 $21.36 $20.15 $22.88 $23.58 $24.41 0.1119 2.7313100132 SOUTH FLORIDA BAPTIST HOSPTIAL8280 $16.90 $18.12 $18.79 $19.53 $21.15 0.0203 0.4291100173 UNIVERSITY COMMUNITY HOSPITAL8280 $17.34 $18.57 $17.13 $18.38 $19.71 0.0806 1.5879100180 ST. PETERSBURG GENERAL 8280 $18.48 $20.21 $21.54 $22.78 $24.94 0.0181 0.4505100191 NEW PORT RICHEY COMMUNITY HOSPITAL8280 $18.47 $19.99 $21.06 $22.05 $24.19 0.0349 0.8447100206 MEMORIAL HOSPITAL OF TAMPA8280 $20.35 $19.57 $20.12 $20.34 $22.87 0.0144 0.3300100211 PASCO COMMUNITY HOSPITAL8280 $25.53 $20.64 $20.75 $21.64 $24.32 0.0106 0.2578100238 NORTHSIDE HOSPITAL & HEART INSTITUTE8280 $17.63 $19.64 $20.83 $23.37 $24.65 0.0235 0.5795100239 EDWARD WHITE HOSPITAL 8280 $19.76 $21.32 $19.45 $23.22 $25.05 0.0107 0.2674100243 COLUMBIA BRANDON REGIONAL MED CTR8280 $20.38 $21.26 $20.80 $22.45 $23.28 0.0429 0.9992100248 LARGO REGIONAL MEDICAL CENTER8280 $21.54 $20.70 $21.30 $22.16 $23.87 0.0287 0.6849100255 TOWN & COUNTRY HOSPITAL8280 $21.02 $25.21 $21.03 $20.72 $22.97 0.0112 0.2564100256 COLUMBIA REG MED CTR AT BAYONET PT8280 $23.56 $20.94 $21.28 $22.48 $24.19 0.0386 0.9337100259 SOUTH BAY HOSPITAL 8280 $19.86 $20.38 $21.12 $21.50 $24.11 0.0151 0.3648100264 OAK HILL HOSPITAL 8280 $17.61 $19.16 $19.95 $21.74 $22.48 0.0247 0.5543100265 MEASE HOSPITAL COUNTRYSIDE8280 $19.86 $18.83 $18.23 $20.27 $21.06 0.0237 0.4984100271 H. LEE MOFFITT CANCER CENTER8280 $19.92 $20.48 $20.87 $21.98 $0.00 0.0536 0.0000100280 SPRING HILL REGIONAL HOSPITAL8280 $16.59 $17.37 $18.20 $19.02 $0.00 0.0104 0.0000

$21.01 $22.49 1.0000 21.13

MSA 8280 Wage Index 0.9119 0.9099 0.8925 0.9171 0.9066

West Palm Beach-Boca RatonWest Palm Beach-Boca Raton

1.0309

1.0203

0.9951

0.9615

0.9777

0.9939

0.9759

0.8700

0.8900

0.9100

0.9300

0.9500

0.9700

0.9900

1.0100

1.0300

1998 1999 2000 2001 2002 2003 2004

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West Palm Beach-Boca Raton

prov num name msa 2000 2001 2002 2003 2004 % of MSA Impact100002 BETHESDA MEMORIAL HOSPITAL8960 $21.32 $20.71 $21.02 $21.58 $22.59 0.1033 2.3334100010 ST. MARY'S HOSPITAL 8960 $21.91 $21.91 $23.06 $23.96 $25.56 0.1228 3.1380100080 J FK MEDICAL CENTER 8960 $21.16 $22.20 $22.72 $22.97 $22.87 0.1255 2.8698100130 GLADES GENERAL HOSPITAL8960 $19.11 $18.68 $20.09 $21.00 $20.24 0.0204 0.4124100168 BOCA RATON COMMUNITY HOSPITAL, INC.8960 $20.13 $20.20 $20.32 $23.01 $24.62 0.1515 3.7293100176 PALM BEACH GARDENS 8960 $24.70 $22.86 $24.61 $24.66 $26.87 0.0635 1.7052100234 COLUMBIA HOSPITAL PALM BEACH AS FILE8960 $21.58 $20.91 $21.64 $24.34 $24.91 0.0464 1.1555100253 J UPITER MEDICAL CENTER 8960 $20.60 $21.32 $22.48 $22.65 $23.69 0.0766 1.8139100258 DELRAY MEDICAL CENTER 8960 $21.88 $21.35 $20.03 $22.08 $24.56 0.0986 2.4224100262 GOOD SAMARITAN HOSPT. 8960 $19.59 $20.04 $21.09 $22.71 $23.80 0.0646 1.5382100268 WEST BOCA MEDICAL CENTER8960 $23.59 $23.92 $24.05 $23.54 $26.02 0.0536 1.3958100269 PALMS WEST HOSPITAL 8960 $21.20 $21.67 $22.51 $26.03 $24.90 0.0431 1.0725100275 WELLINGTON REGIONAL MEDICAL CENTER8960 $21.33 $20.92 $21.49 $23.29 $23.14 0.0302 0.6992

$23.22 $24.20 1.0000 24.29

MSA 8960 Wage Index 0.9951 0.9615 0.9777 0.9939 0.9759

Tomorrow

Changes on the HorizonOccupational Mix SurveyMSA ChangesCongressional InterferenceInterns and Residents et al

Sample S-3 Review Exercises

Behind the Sheet Adjustments

Adjusted Paid Avg HrlyPart II - Wage Data Salaries Hours Wage

SALARIES1 Total Salary -$ - 2 Non-physician anesthetist Part A -$ - 3 Non-physician anesthetist Part B -$ - 4 Physician -Part A -$ -

4.01 Teaching Physicians -$ - 5 Physician-Part B -$ - 6 Interns & Residents (approved program) -$ - 7 Home office personnel -$ - 8 SNF -$ -

8.01 Excluded area salaries -$ -

OTHER WAGES & RELATED COSTS9 Contract labor: -$ -

9.01 Pharmacy Contract -$ - 9.02 Laboratory Contract -$ -

10 Contract labor: physician-Part A -$ - 10.01 Teaching Physicians Contract -$ -

11 Home office salaries & wage-related costs -$ - 12 Home Office Phys Pt A -$

12.01 Teaching Physicians -$

WAGE-RELATED COSTS 13 Wage-related costs (core) -$ 14 Wage-related costs (other) -$ 15 Excluded areas -$ 16 Non-physician anesthetist Part A -$ 17 Non-physician anesthetist Part B -$ 18 Physician Part A -$

18.01 Physician Part A -$ 19 Physician Part B -$ 20 Interns & Residents (approved program) -$

OVERHEAD COSTS21 Emp Benfits -$ - 22 Admin & Genl -$ - 23 Maint & Repairs -$ - 24 Operation of Plant -$ - 25 Laundry & Linen -$ - 26 Housekeeping -$ - 27 Dietary -$ - 28 Cafeteria -$ - 29 Maint of Personnel -$ - 30 Nursing Admin -$ - 31 Central Ser & Supply -$ - 32 Pharmacy -$ - 33 Medical Records -$ - 34 Social Serv -$ - 35 Other Genl Serv -$ -

Part III - Hospital Wage Index Summary1 Net Salaries -$ -$ 2 Excluded area salaries -$ - 3 Subtotal salaries (line 1 minus line 2) -$ - 4 Subtotal other wages & related costs -$ -$ 5 Subtotal wage-related costs -$ 6 Total (sum of lines 3 thru 5) -$ -

13 Total Overhead Costs 0 -

Average Hourly Wage Calculation for the Fiscal Year 2004 Wage Index (Using Cost Reporting Periods Beginning 10/1/99-9/30/00)*Fields in bold are calculated fields

Work Sheet S - 3, Part II Total Salariesline1/col. 3 0

Other Wages & Related Costs line2/col. 3 0line3/col. 3 0line4.01/col. 3 0line5/col. 3 0line5.01/col. 3 0line6/col. 3 0line7/col. 3 0line8/col. 3 0line8.01/col. 3 0sub-tot-a 0 sub-tot-a=line2+line3+line4.01+line5+line5.01+line6+line7+line8+line8.01line9/col. 3 0line9.01/col. 3 0line9.02/col. 3 0line10/col. 3 0line11/col. 3 0line12/col. 3 0line13/col. 3 0line14/col. 3 0line18/col. 3 0 sub-tot-b 0 sub-tot-b=line9+line9.01+line9.02+line10+line11+line12+line13+line14+line18 adjusted salaries 0 adjusted salaries=line1/col3 - sub-tot-a + sub-tot-b

Total Paid Hours

line1/col. 4 0

Other Paid Hours line2/col. 4 0line3/col. 4 0line4.01/col. 4 0line5/col. 4 0 line5.01/col.4 0line6/col. 4 0line7/col. 4 0line8/col. 4 0line8.01/col. 4 0sub-tot-c 0 sub-tot-c=line2+line3+line4.01+line5+line5.01+line6+line7+line8+line8.01line9/col. 4 0 Overhead Allocation line9.01/col. 4 0line9.02/col. 4 0line10/col. 4 0line11/col. 4 0line12/col. 4 0sub-tot-d 0 sub-tot-d=line9+line9.01+line9.02+line10+line11+line12

adjusted hours 0 adjusted hours=line1/col4 -sub-tot-c + sub-tot-d

Work Sheet S - 3, Part IIIOverhead Allocation

line13/col. 3 0 refers to work sheet S-3, Part III

line13/col. 4 0 refers to work sheet S-3, Part III

Occupational Mix Survey

Presented byHealthcare Affiliates, Inc

Occupational Mix Data

Benefit Improvement and Projection Act of 2000 (BIPA) states: CMS must collect data every three years CMS must make and OM adjustment to the wage index for FFY 2005 and

thereafter.CMS announced in the August 1 Federal Register that CMS plans (after an initial data collection scheduled for late Spring 2003) to include OM data in the cost report forms in future years. Apparently it will be collected annually.GOA computed impacts using data accumulation from California occupational mix data

Occupational Mix DataWhy use OM Data to adjust wage indexes? CMS adjusts resource consumption through the weighing factor of the DRG. Theoretically the difference in weighting reflects the relative occupational mix of various hospitals. Using a standard occupational mix eliminated the “double scoring” of occupational mix difference that are accounted for in the DRG weighting. This is expected to improve payment to rural hospital and reduced payment to large tertiary care MSAs.

Contrary argument – OM will reduce wage indexes to urban areas with sophisticated teaching hospitals. There is no corresponding higher DRG weighting for the sicker patients treated in the tertiary care hospitals, OM adjustments should be delayed.

Occupational Mix AdjustmentConceptual Overview

Assume two types of employees

National Average Percent OfProfessional 50%

Non Professional 50%

Total 100%

Occupational Mix Index 1.000

Occupational Mix AdjustmentMetropolis MSA

Tertiary Care and Teaching Hospitals Computed

Metropolis MSA (Tertiary Care and Teaching Hospitals) Wage Index

Professional 55%

Non-Professional 45%

Total 100%

Occupational Mix Index (56e50) 1.1000

Average Hourly Wage & Wage Index $25.00/Hour 1.0762

Occupational Mix Adjustment Factor + 1.10

Occupational Mix Adjustment AHW & Wage Index $22.72 .9780

.0982

Occupational Mix AdjustmentConceptual Overview

Statewide Rural Area

Professional Employee 45%Non-Professional 55%Total 100%

Occupational Mix Index (45e50) .90Average Hourly Wage $19.00Occupational Mix Adjustment Fact + .90Occupational Mix Adjusted AHW $21.11

Occupational Mix AdjustmentComputed Wage Indexes

Metropolis Statewide Rural

Current AHW $ 25.00 $ 19.00

National AHW + 22.3096 + 22.3096

Current Wage Index 1.1206 .8517

Occupational Mix AHW $ 22.72 $ 21.11

National AHW + 22.3096 + 22.3096

Occupational Mix Adj. WI 1.0184 .9457

Increase (Decrease) (.1022) +.0094

The above example is hypothetical