One of the most important organizations within the healthcare sector is CMS, and for obvious reasons. It is one of the largest healthcare payors in the world, and the federal agency dictates many of the rules that will directly and indirectly impact the finances of hospitals and health systems.
On Nov. 15, CMS posted its FY 2012 financial report (pdf). CMS CFO Deborah Taylor, a certified public accountant, prepared the 202-page document, which is required by law every year. Here are 10 of the biggest takeaways from the report.
1. What the nation's healthcare dollar looked like in 2012. Government health programs consume the largest parts of the U.S. healthcare system, and CMS' report broke down the different healthcare payors and how much money they represented in FY 2012. Here's how much each sector represented for every dollar spent on the U.S. healthcare last year:
• Private insurance: 31.6 cents
• Medicare: 21 cents
• Medicaid: 16.3 cents
• Other government programs: 13.3 cents
• Out-of-pocket: 11.1 cents
• Other private programs: 6.7 cents
Furthermore, Medicare and Medicaid, including state funding, represented 54 cents of every dollar spent on nursing homes, 49 cents of every dollar received by hospitals and 33 cents of every dollar spent on physician services.
2. CMS expenses and administrative costs. In FY 2012, CMS' total cost of operations equaled $802.9 billion. CMS' administrative costs — which cover salaries, facilities, equipment, rent and utilities — represented $3.7 billion, or 0.5 percent, of that total.
3. Medicare Part A benefit payments. Inpatient hospital spending accounted for 54 percent of Medicare Hospital Insurance, or Part A, benefit outlays in FY 2012. Managed care represented the next-highest total at 25 percent, while skilled nursing facilities received 12 percent of Part A payments.
4. Medicare Part B benefit payments. Medicare Part B, or Supplementary Medical Insurance, covers all physician, hospital outpatient, home health, lab test and other services not covered by Part A. Physicians services accounted for the largest slice of Part B at 24 percent. Prescription drugs accounted for 21 percent, while hospital outpatient services represented 11 percent.
5. Medicaid enrollees. Children represented the largest portion of Medicaid beneficiaries in FY 2012 at 50 percent. The remaining enrollees were adults (23 percent), disabled (18 percent) and elderly (9 percent).
6. Federal Medicaid costs. State and federal medical assistance payments and administrative costs totaled $452.5 billion last year. CMS' share of Medicaid outlays totaled $260.1 billion of that total.
7. Medicare and Medicaid Recovery Auditors. Medicare RACs recovered $2.3 billion in overpayments in FY 2012, as reported earlier. However, that figure does not include dollar amounts related to claims in the appeals process or claims that had been successfully appealed by providers.
Medicaid RACs were supposed to go live Jan. 1, 2012, although not all states have finalized their programs. According to the report, "states that have been unable to implement Medicaid RAC programs by Jan. 1, 2012, have been submitting [state plan amendments] to CMS requesting implementation delay exceptions." CMS released a Medicaid RAC final rule in September 2011, projecting savings of $2.1 billion over the next five years. Roughly $910 million of that total would be returned to states.
8. CMS' consolidated balance sheets. In FY 2012, CMS reported assets of $424.8 billion. A bulk of those assets, $302.9 billion, is in investments. Liabilities equaled $80.5 billion, making CMS' net worth $344.3 billion.
9. HI Trust Fund solvency. Medicare's HI Trust Fund is considered to be solvent as long as assets can sufficiently finance the program's obligations. The 2012 Trust Fund ratio — which is the assets of the program at the beginning of the fiscal year divided by expenditures for the year — was 94 percent, down significantly from 139 percent in 2008. CMS expects that by the end of 2021, assets will decline 50 percent. In 2024, the HI Trust Fund "will be exhausted," according to the latest projections by the CMS Office of the Actuary.
10. Miscellaneous statistics. CMS also broke down its financial statements page by page, and several statistics stood out for FY 2012:
• Total accounts receivable (net): $10.57 billion, compared with $10.53 billion in FY 2011.
• Gross amount of improper payments (overpayments and underpayments): $29.6 billion.
• Paid claims gross error rate: 8.5 percent.
• Between FY 2008 and FY 2011, the number of Medicare-certified hospitals decreased 5 percent, while the number of Medicare-certified critical access hospitals increased 3 percent.
On Nov. 15, CMS posted its FY 2012 financial report (pdf). CMS CFO Deborah Taylor, a certified public accountant, prepared the 202-page document, which is required by law every year. Here are 10 of the biggest takeaways from the report.1. What the nation's healthcare dollar looked like in 2012. Government health programs consume the largest parts of the U.S. healthcare system, and CMS' report broke down the different healthcare payors and how much money they represented in FY 2012. Here's how much each sector represented for every dollar spent on the U.S. healthcare last year:
• Private insurance: 31.6 cents
• Medicare: 21 cents
• Medicaid: 16.3 cents
• Other government programs: 13.3 cents
• Out-of-pocket: 11.1 cents
• Other private programs: 6.7 cents
Furthermore, Medicare and Medicaid, including state funding, represented 54 cents of every dollar spent on nursing homes, 49 cents of every dollar received by hospitals and 33 cents of every dollar spent on physician services.
2. CMS expenses and administrative costs. In FY 2012, CMS' total cost of operations equaled $802.9 billion. CMS' administrative costs — which cover salaries, facilities, equipment, rent and utilities — represented $3.7 billion, or 0.5 percent, of that total.
3. Medicare Part A benefit payments. Inpatient hospital spending accounted for 54 percent of Medicare Hospital Insurance, or Part A, benefit outlays in FY 2012. Managed care represented the next-highest total at 25 percent, while skilled nursing facilities received 12 percent of Part A payments.
4. Medicare Part B benefit payments. Medicare Part B, or Supplementary Medical Insurance, covers all physician, hospital outpatient, home health, lab test and other services not covered by Part A. Physicians services accounted for the largest slice of Part B at 24 percent. Prescription drugs accounted for 21 percent, while hospital outpatient services represented 11 percent.
5. Medicaid enrollees. Children represented the largest portion of Medicaid beneficiaries in FY 2012 at 50 percent. The remaining enrollees were adults (23 percent), disabled (18 percent) and elderly (9 percent).
6. Federal Medicaid costs. State and federal medical assistance payments and administrative costs totaled $452.5 billion last year. CMS' share of Medicaid outlays totaled $260.1 billion of that total.
7. Medicare and Medicaid Recovery Auditors. Medicare RACs recovered $2.3 billion in overpayments in FY 2012, as reported earlier. However, that figure does not include dollar amounts related to claims in the appeals process or claims that had been successfully appealed by providers.
Medicaid RACs were supposed to go live Jan. 1, 2012, although not all states have finalized their programs. According to the report, "states that have been unable to implement Medicaid RAC programs by Jan. 1, 2012, have been submitting [state plan amendments] to CMS requesting implementation delay exceptions." CMS released a Medicaid RAC final rule in September 2011, projecting savings of $2.1 billion over the next five years. Roughly $910 million of that total would be returned to states.
8. CMS' consolidated balance sheets. In FY 2012, CMS reported assets of $424.8 billion. A bulk of those assets, $302.9 billion, is in investments. Liabilities equaled $80.5 billion, making CMS' net worth $344.3 billion.
9. HI Trust Fund solvency. Medicare's HI Trust Fund is considered to be solvent as long as assets can sufficiently finance the program's obligations. The 2012 Trust Fund ratio — which is the assets of the program at the beginning of the fiscal year divided by expenditures for the year — was 94 percent, down significantly from 139 percent in 2008. CMS expects that by the end of 2021, assets will decline 50 percent. In 2024, the HI Trust Fund "will be exhausted," according to the latest projections by the CMS Office of the Actuary.
10. Miscellaneous statistics. CMS also broke down its financial statements page by page, and several statistics stood out for FY 2012:
• Total accounts receivable (net): $10.57 billion, compared with $10.53 billion in FY 2011.
• Gross amount of improper payments (overpayments and underpayments): $29.6 billion.
• Paid claims gross error rate: 8.5 percent.
• Between FY 2008 and FY 2011, the number of Medicare-certified hospitals decreased 5 percent, while the number of Medicare-certified critical access hospitals increased 3 percent.
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