Estimated Change in Medicare Payments CY 2018 Final Rule Compared to CY 2019 Proposed Rule

Transcription

1 Oregon Impact Analysis Estimated CY 2018 Estimated CY 2019 Dollar Impact $581,687,400 $13,434,700 ($7,437,300) ($445,000) $3,448,000 ($4,431,200) $586,256, % -1.28% -0.08% 0.59% -0.76% Total Estimated Change CY 2018 to CY 2019 $4,569,200 Portion of CY 2016 OPPS Revenue for Off-Campus 0.79% The impact shown above does not include the impact of the 2.0% sequestration reduction to all lines of Medicare payment authorized by Congress through FFY It is estimated that the impact of sequestration on CY 2019 OPPS PPS-specific payments would be: -$11,725,100 Estimated Impact of CMS' Proposal to Pay Excepted Off- Campus Provider-Based Departments () at 40% of OPPS Rate 1.26% $7,391,900 $2,956,800 Estimated Impact/Change to CY 2019 OPPS Revenue ($4,435,100) -60.0% Estimated Impact of CMS' Proposal to Change Payment Rate for Biosimilars Purchased Through the 340B Drug Pricing Program (Currently only HCPCS Q5101) CY 2016 OPPS Revenue for Biosimilar Biological Products $23,600 $18,300 $28,300 Estimated Impact/Change to CY 2019 OPPS Revenue $10,000 Mid-Columbia Medical Center $260,900 Asante Three Rivers Medical Center $14,000 Providence St. Vincent Medical Center $740,400 Asante Ashland Community Hospital $171,000 Legacy Emanuel Medical Center $40,600 OHSU Hospital $109,500 Good Samaritan Regional Medical Center ($799,800) Legacy Good Samaritan Medical Center Asante Rogue Regional Medical Center McKenzie-Willamette Medical Center $281,000 ($307,400) $279,900 Tuality Healthcare $107,600 Samaritan Albany General Hospital ($669,600) Legacy Mount Hood Medical Center $202,300 Mercy Medical Center $653,700 Legacy Silverton Medical Center $53,400 PeaceHealth Sacred Heart MC - University ($172,800) Providence Newberg Medical Center $136,900 Providence Willamette Falls Med Center $117,500 St. Charles Redmond ($3,100) St. Charles Bend $91,500 Sky Lakes Medical Center ($376,700) 54.6% 2.03% 0.09% 1.99% 2.73% 0.37% 0.12% -3.49% 1.71% -0.79% 3.59% 1.05% -5.92% 2.88% 3.26% 1.78% -2.23% 2.30% 2.60% -0.06% 0.22% -1.58% August of 7 Apprise Health Insights

2 Salem Hospital Saint Alphonsus MedCenter - Ontario Santiam Hospital Adventist Medical Center Providence Portland Medical Center Willlamette Valley Medical Center Providence Medford Medical Center Providence Milwaukie Hospital Legacy Meridian Park Hospital Bay Area Hospital PeaceHealth Sacred Heart MC - RiverBend $718,700 ($81,500) $32,900 $383,400 $523,500 $156,400 $1,094,200 $124,100 ($809,400) $592,700 $903, % -1.09% 1.57% 3.31% 1.47% 1.91% 5.32% 2.54% -6.70% 2.12% 3.58% Notes: - This analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments may change from CY 2018 to CY 2019 based on the policies set forth in the CY 2019 OPPS proposed rule. - This analysis does not include payment estimates for services provided to Medicare Advantage patients or modifications in FFS payments as a result of hospital participation in new payment models being tested under Medicare demonstration/pilot programs. - Estimated CYs 2018 and 2019 OPPS payments are from CMS' CY 2019 OPPS proposed rule Impact File (based on CY 2017 outpatient claims data). OPPS conversion factors are from the CY 2018 final rule and CY 2019 proposed rule. Wage indexes are from the FFY 2018 Inpatient Perspective Payment System (IPPS) final rule October 2017 correction notice and the FFY 2019 IPPS proposed rule. - Dollar impacts in this analysis may differ from those provided by other organizations/associations due to differences in source data and analytic methods. Individual percentages and dollars shown in this analysis may not add to total due to compounding and rounding. Dollar amounts less than $50 and percentages less than 0.05% will appear as zeroes due to rounding. This analysis does not reflect changes due to volume or patient mix. CY 2019 OPPS Proposed Rule Changes Modeled in this Analysis: - : 2.8% marketbasket increase to the outpatient rate. - : Combined 0.8% productivity reduction and 0.75% pre-determined reduction to the marketbasket authorized by the Affordable Care Act (ACA) of : Reflects the impact of adjustments to the rate based on changes to the wage index (+0.04%), cancer hospital payments (+0.00%), as well as pass-through spending and outlier payments (-0.13%) in order to maintain program budget neutrality. - : d wage index values based on the proposed FFY 2019 hospital wage indexes, including the impact of new wage data, reclassifications, rural and legislated floors, and other adjustments to the wage indexes. - : This impact represents the changes to the APC assignments and weights proposed for CY It is inclusive of CMS policies regarding the creation of comprehensive APCs; the expansion of the categories of items/services that are packaged into APCs for payment as opposed to separately paid; and the anticipated change in outlier payments. This impact is derived by attributing all remaining payment changes to this category (after impact for wage index, marketbasket, etc.). Impacts resulting from changes to the off-campus PBD site neutral and biosimilar policies are included here and broken out below. - Estimated Impact of 60% to Excepted Off-Campus : CMS is proposing to expand the Medicare Physician Fee Schedule (MPFS) payment methodology to excepted off-campus (currently paid under the OPPS rates), for HCPCS code G0463 by reducing the current payment by 60% beginning FFY This reduction would be made in a non-budget neutral manner. Impacts provided are based on Medicare claims data from the CY 2016 Medicare 100% Standard Analytic File (SAF) using indicator "PO" to identify approriate claims with the assumption that all are excepted sites. The portion of CY 2016 OPPS revenue for off-campus is applied to CY 2019 OPPS estimated payments to determine impacts. - Estimated Impact of 340B Biosimilar Payment Rate Change: CMS is proposing to pay nonpass-through biosimilars acquired under the 340B Program at ASP minus 22.5% of the biosimilar s ASP, instead of the biosimilar s ASP minus 22.5% of the reference product s ASP beginning FFY Impacts provided are based on Medicare claims data from the CY 2016 Medicare 100% Standard Analytic File (SAF). Hospitals flagged as 340B entities are based on the list maintained by the Health Resources & Services Administration (HRSA) as of August 6, Currently, the impact of this policy is isolated to HCPCS code Q5101. August of 7 Apprise Health Insights

3 Summary Dollar Impact Other Impacts Estimated CY 2018 Total Estimated Value of Off-Campus Value of 340B Estimated CY 2019 Value of Change CY 2018 to Paid at 40% of Biosimilars Payment Sequestration CY 2019 OPPS Rate Rate Change $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Oregon $581,687,400 $586,256,600 $4,569, % $13,434,700 ($7,437,300) ($445,000) $3,448,000 ($4,431,200) ($11,725,100) ($4,435,100) $9, % -1.28% -0.08% 0.59% -0.76% Mid-Columbia Medical Center $12,841,000 $13,101,900 $260, % xx $264,000 ($146,100) ($8,800) $160,700 ($8,900) xx ($262,000) ($39,000) $0 xx 2.06% -1.14% -0.07% 1.25% -0.07% Asante Three Rivers Medical Center $15,133,400 $15,147,400 $14, % xx $377,000 ($208,700) ($12,500) ($218,500) $76,700 xx ($302,900) $0 $0 xx 2.49% -1.38% -0.08% -1.44% 0.51% Providence St. Vincent Medical Center $37,145,800 $37,886,200 $740, % xx $1,034,200 ($572,500) ($34,300) $367,300 ($54,300) xx ($757,700) $0 $0 xx 2.78% -1.54% -0.09% 0.99% -0.15% Asante Ashland Community Hospital $6,262,200 $6,433,200 $171, % xx $172,100 ($95,300) ($5,700) $7,500 $92,400 xx ($128,700) $0 $0 xx 2.75% -1.52% -0.09% 0.12% 1.48% Legacy Emanuel Medical Center $11,000,400 $11,041,000 $40, % xx $303,900 ($168,200) ($10,100) $107,900 ($192,900) xx ($220,800) ($70,200) $0 xx 2.76% -1.53% -0.09% 0.98% -1.75% OHSU Hospital $91,101,500 $91,211,000 $109, % xx $1,697,600 ($939,700) ($56,300) $603,000 ($1,195,100) xx ($1,824,200) ($678,300) $8,200 xx 1.86% -1.03% -0.06% 0.66% -1.31% Good Samaritan Regional Medical Center $22,908,700 $22,108,900 ($799,800) -3.49% xx $543,500 ($300,900) ($18,000) $54,800 ($1,079,200) xx ($442,200) ($824,800) $0 xx 2.37% -1.31% -0.08% 0.24% -4.71% Legacy Good Samaritan Medical Center $16,437,600 $16,718,600 $281, % xx $442,500 ($245,000) ($14,600) $157,100 ($59,000) xx ($334,400) ($65,300) $0 xx 2.69% -1.49% -0.09% 0.96% -0.36% Asante Rogue Regional Medical Center $38,805,400 $38,498,000 ($307,400) -0.79% xx $890,000 ($492,700) ($29,500) ($810,200) $135,000 xx ($770,000) $0 $0 xx 2.29% -1.27% -0.08% -2.09% 0.35% McKenzie-Willamette Medical Center $7,794,800 $8,074,700 $279, % xx $214,500 ($118,700) ($7,100) $182,400 $8,800 xx ($161,500) ($22,200) $0 xx 2.75% -1.52% -0.09% 2.34% 0.11% Tuality Healthcare $10,202,000 $10,309,600 $107, % xx $233,000 ($129,000) ($7,700) $82,700 ($71,400) xx ($206,200) ($294,000) $0 xx 2.28% -1.26% -0.08% 0.81% -0.70% Samaritan Albany General Hospital $11,312,300 $10,642,700 ($669,600) -5.92% xx $234,200 ($129,700) ($7,700) $11,600 ($778,000) xx ($212,900) ($689,400) $0 xx 2.07% -1.15% -0.07% 0.10% -6.88% Legacy Mount Hood Medical Center $7,017,600 $7,219,900 $202, % xx $195,100 ($108,000) ($6,500) $69,300 $52,400 xx ($144,400) ($29,600) $0 xx 2.78% -1.54% -0.09% 0.99% 0.75% Mercy Medical Center $20,028,000 $20,681,700 $653, % xx $523,100 ($289,600) ($17,300) $335,600 $101,900 xx ($413,600) $0 $0 xx 2.61% -1.45% -0.09% 1.68% 0.51% Legacy Silverton Medical Center $3,000,600 $3,054,000 $53, % xx $78,500 ($43,500) ($2,600) $2,100 $18,900 xx ($61,100) $0 $0 xx 2.62% -1.45% -0.09% 0.07% 0.63% PeaceHealth Sacred Heart MC - University $7,734,800 $7,562,000 ($172,800) -2.23% xx $91,400 ($50,600) ($3,000) $77,700 ($288,300) xx ($151,200) ($245,900) $0 xx 1.18% -0.65% -0.04% 1.00% -3.73% Providence Newberg Medical Center $5,953,400 $6,090,300 $136, % xx $151,000 ($83,600) ($5,000) $53,600 $20,900 xx ($121,800) $0 $0 xx 2.54% -1.40% -0.08% 0.90% 0.35% Providence Willamette Falls Med Center $4,514,300 $4,631,800 $117, % xx $118,700 ($65,700) ($3,900) $42,100 $26,300 xx ($92,600) $0 $0 xx 2.63% -1.46% -0.09% 0.93% 0.58% St. Charles Redmond $5,021,000 $5,017,900 ($3,100) -0.06% xx $134,900 ($74,700) ($4,500) ($94,200) $35,400 xx ($100,400) $0 $0 xx 2.69% -1.49% -0.09% -1.88% 0.71% St. Charles Bend $42,417,200 $42,508,700 $91, % xx $874,800 ($484,200) ($29,000) ($335,300) $65,200 xx ($850,200) $0 $0 xx 2.06% -1.14% -0.07% -0.79% 0.15% Sky Lakes Medical Center $23,909,200 $23,532,500 ($376,700) -1.58% xx $509,900 ($282,200) ($16,900) ($165,300) ($422,200) xx ($470,700) ($419,900) $0 xx 2.13% -1.18% -0.07% -0.69% -1.77% Salem Hospital $25,454,800 $26,173,500 $718, % xx $649,500 ($359,600) ($21,500) $395,300 $55,000 xx ($523,500) $0 $0 xx 2.55% -1.41% -0.08% 1.55% 0.22% Saint Alphonsus MedCenter - Ontario $7,472,800 $7,391,300 ($81,500) -1.09% xx $174,200 ($96,500) ($5,700) ($121,600) ($31,900) xx ($147,800) ($132,900) $0 xx 2.33% -1.29% -0.08% -1.63% -0.43% Santiam Hospital $2,090,700 $2,123,600 $32, % xx $58,200 ($32,300) ($1,900) $1,600 $7,300 xx ($42,500) $0 $0 xx 2.78% -1.54% -0.09% 0.08% 0.35% Adventist Medical Center $11,586,500 $11,969,900 $383, % xx $306,800 ($169,800) ($10,200) $109,000 $147,600 xx ($239,400) $0 $0 xx 2.65% -1.47% -0.09% 0.94% 1.27% Providence Portland Medical Center $35,585,700 $36,109,200 $523, % xx $694,600 ($384,500) ($23,000) $246,700 ($10,300) xx ($722,200) ($2,700) $1,500 xx 1.95% -1.08% -0.06% 0.69% -0.03% Willlamette Valley Medical Center $8,175,500 $8,331,900 $156, % xx $215,800 ($119,500) ($7,100) $76,700 ($9,500) xx ($166,600) ($18,700) $0 xx 2.64% -1.46% -0.09% 0.94% -0.12% Providence Medford Medical Center $20,578,100 $21,672,300 $1,094, % xx $542,700 ($300,400) ($18,000) $939,100 ($69,200) xx ($433,400) ($300) $200 xx 2.64% -1.46% -0.09% 4.56% -0.34% Providence Milwaukie Hospital $4,876,600 $5,000,700 $124, % xx $131,600 ($72,800) ($4,400) $46,700 $23,000 xx ($100,000) $0 $0 xx 2.70% -1.49% -0.09% 0.96% 0.47% Legacy Meridian Park Hospital $12,082,900 $11,273,500 ($809,400) -6.70% xx $337,500 ($186,800) ($11,200) $119,900 ($1,068,800) xx ($225,500) ($901,900) $0 xx 2.79% -1.55% -0.09% 0.99% -8.85% Bay Area Hospital $27,979,300 $28,572,000 $592, % xx $535,300 ($296,400) ($17,700) $343,400 $28,100 xx ($571,400) $0 $0 xx 1.91% -1.06% -0.06% 1.23% 0.10% PeaceHealth Sacred Heart MC - RiverBend $25,263,300 $26,166,700 $903, % xx $704,600 ($390,100) ($23,300) $599,300 $12,900 xx ($523,300) $0 $0 xx 2.79% -1.54% -0.09% 2.37% 0.05% Note: Individual totals may not foot due to rounding. August of 7 Apprise Health Insights

4 U.S. Impact Analysis Estimated CY 2018 Estimated CY 2019 Dollar Impact $55,561,345,300 $1,288,693,200 ($713,383,000) ($42,695,500) ($24,910,900) ($561,213,300) $55,507,835, % -1.28% -0.08% -0.04% -1.01% Total Estimated Change CY 2018 to CY 2019 Portion of CY 2016 OPPS Revenue for Off-Campus -0.10% The impact shown above does not include the impact of the 2.0% sequestration reduction to all lines of Medicare payment authorized by Congress through FFY It is estimated that the impact of sequestration on CY 2019 OPPS PPS-specific payments would be: -$1,110.2 million. Estimated Impact of CMS' Proposal to Pay Excepted Off- Campus Provider-Based Departments () at 40% of OPPS Rate ($53,509,500) 1.82% $1,008,832,900 $403,533,200 Estimated Impact/Change to CY 2019 OPPS Revenue ($605,299,700) -60.0% Estimated Impact of CMS' Proposal to Change Payment Rate for Biosimilars Purchased Through the 340B Drug Pricing Program (Currently only HCPCS Q5101) $3,310,900 $2,566,000 $3,964,000 CY 2016 OPPS Revenue for Biosimilar Biological Products Estimated Impact/Change to CY 2019 OPPS Revenue $1,398, % August of 7 Apprise Health Insights

5 U.S. Notes: - This analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments may change from CY 2018 to CY 2019 based on the policies set forth in the CY 2019 OPPS proposed rule. - This analysis does not include payment estimates for services provided to Medicare Advantage patients or modifications in FFS payments as a result of hospital participation in new payment models being tested under Medicare demonstration/pilot programs. - Estimated CYs 2018 and 2019 OPPS payments are from CMS' CY 2019 OPPS proposed rule Impact File (based on CY 2017 outpatient claims data). OPPS conversion factors are from the CY 2018 final rule and CY 2019 proposed rule. Wage indexes are from the FFY 2018 Inpatient Perspective Payment System (IPPS) final rule October 2017 correction notice and the FFY 2019 IPPS proposed rule. - Dollar impacts in this analysis may differ from those provided by other organizations/associations due to differences in source data and analytic methods. Individual percentages and dollars shown in this analysis may not add to total due to compounding and rounding. Dollar amounts less than $50 and percentages less than 0.05% will appear as zeroes due to rounding. This analysis does not reflect changes due to volume or patient mix. CY 2019 OPPS Proposed Rule Changes Modeled in this Analysis: - : 2.8% marketbasket increase to the outpatient rate. - : Combined 0.8% productivity reduction and 0.75% pre-determined reduction to the marketbasket authorized by the Affordable Care Act (ACA) of : Reflects the impact of adjustments to the rate based on changes to the wage index (+0.04%), cancer hospital payments (+0.00%), as well as pass-through spending and outlier payments (-0.13%) in order to maintain program budget neutrality. - : d wage index values based on the proposed FFY 2019 hospital wage indexes, including the impact of new wage data, reclassifications, rural and legislated floors, and other adjustments to the wage indexes. - : This impact represents the changes to the APC assignments and weights proposed for CY It is inclusive of CMS policies regarding the creation of comprehensive APCs; the expansion of the categories of items/services that are packaged into APCs for payment as opposed to separately paid; and the anticipated change in outlier payments. This impact is derived by attributing all remaining payment changes to this category (after impact for wage index, marketbasket, etc.). Impacts resulting from changes to the off-campus PBD site neutral and biosimilar policies are included here and broken out below. - Estimated Impact of 60% to Excepted Off-Campus : CMS is proposing to expand the Medicare Physician Fee Schedule (MPFS) payment methodology to excepted off-campus (currently paid under the OPPS rates), for HCPCS code G0463 by reducing the current payment by 60% beginning FFY This reduction would be made in a non-budget neutral manner. Impacts provided are based on Medicare claims data from the CY 2016 Medicare 100% Standard Analytic File (SAF) using indicator "PO" to identify approriate claims with the assumption that all are excepted sites. The portion of CY 2016 OPPS revenue for off-campus is applied to CY 2019 OPPS estimated payments to determine impacts. - Estimated Impact of 340B Biosimilar Payment Rate Change: CMS is proposing to pay nonpass-through biosimilars acquired under the 340B Program at ASP minus 22.5% of the biosimilar s ASP, instead of the biosimilar s ASP minus 22.5% of the reference product s ASP beginning FFY Impacts provided are based on Medicare claims data from the CY 2016 Medicare 100% Standard Analytic File (SAF). Hospitals flagged as 340B entities are based on the list maintained by the Health Resources & Services Administration (HRSA) as of August 6, Currently, the impact of this policy is isolated to HCPCS code Q5101. August of 7 Apprise Health Insights

6 Estimated CY 2018 Estimated CY 2019 Summary Dollar Impact Other Impacts Total Estimated Change CY 2018 to CY 2019 Value of Sequestration Value of Off-Campus Paid at 40% of OPPS Rate Value of 340B Biosimilars Payment Rate Change U.S. $55,561,345,300 $55,507,835,800 ($53,509,500) -0.10% $1,288,693,200 ($713,383,000) ($42,695,500) ($24,910,900) ($561,213,300) ($1,110,159,500) ($605,300,800) $1,398, % -1.28% -0.08% -0.04% -1.01% Alabama $849,056,100 $859,985,700 $10,929, % $20,065,300 ($11,108,400) ($663,900) $1,058,900 $1,577,700 ($17,199,900) ($799,900) $0 2.36% -1.31% -0.08% 0.12% 0.19% Alaska $86,933,300 $82,454,300 ($4,479,000) -5.15% $2,181,600 ($1,207,600) ($72,200) ($5,338,700) ($42,100) ($1,649,100) ($597,800) $1, % -1.39% -0.08% -6.14% -0.05% Arizona $971,787,100 $960,657,300 ($11,129,800) -1.15% $23,481,400 ($12,998,700) ($778,100) ($18,797,100) ($2,037,300) ($19,213,300) ($4,332,600) $4, % -1.34% -0.08% -1.93% -0.21% Arkansas $686,077,000 $679,143,400 ($6,933,600) -1.01% $16,895,300 ($9,352,600) ($559,900) ($8,652,000) ($5,264,400) ($13,582,900) ($5,261,000) $3, % -1.36% -0.08% -1.26% -0.77% California $4,746,181,800 $4,785,322,500 $39,140, % $112,941,900 ($62,521,200) ($3,742,200) $36,025,200 ($43,563,000) ($95,707,000) ($41,956,700) $217, % -1.32% -0.08% 0.76% -0.92% Colorado $759,548,100 $760,376,100 $828, % $16,785,600 ($9,292,600) ($555,900) ($932,200) ($5,176,900) ($15,207,900) ($5,897,000) $15, % -1.22% -0.07% -0.12% -0.68% Connecticut $863,517,400 $902,337,400 $38,820, % $19,074,800 ($10,559,200) ($632,400) $41,861,000 ($10,924,200) ($18,046,900) ($10,117,100) $29, % -1.22% -0.07% 4.85% -1.27% Delaware $254,563,000 $251,594,100 ($2,968,900) -1.17% $5,882,500 ($3,256,300) ($194,900) ($4,829,600) ($570,600) ($5,031,900) ($4,156,300) $0 2.31% -1.28% -0.08% -1.90% -0.22% D.C. $195,935,400 $195,714,300 ($221,100) -0.11% $4,482,200 ($2,481,200) ($148,700) ($1,843,400) ($230,000) ($3,914,400) ($267,000) $0 2.29% -1.27% -0.08% -0.94% -0.12% Florida $2,696,568,500 $2,703,489,200 $6,920, % $66,809,200 ($36,983,400) ($2,212,600) ($6,146,100) ($14,546,400) ($54,070,500) ($20,294,100) $33, % -1.37% -0.08% -0.23% -0.54% Georgia $1,538,553,500 $1,544,400,200 $5,846, % $33,964,300 ($18,801,800) ($1,125,100) ($2,247,800) ($5,942,900) ($30,887,700) ($6,496,400) $155, % -1.22% -0.07% -0.15% -0.39% Hawaii $142,552,300 $140,922,200 ($1,630,100) -1.14% $3,189,400 ($1,765,700) ($105,500) ($567,300) ($2,381,000) ($2,818,500) ($1,784,600) $4, % -1.24% -0.07% -0.40% -1.67% Idaho $323,026,000 $322,773,900 ($252,100) -0.08% $6,873,300 ($3,804,700) ($227,900) $6,824,300 ($9,917,100) ($6,455,400) ($9,625,800) $ % -1.18% -0.07% 2.11% -3.07% Illinois $2,564,632,300 $2,557,643,900 ($6,988,400) -0.27% $59,832,000 ($33,120,900) ($1,983,100) ($7,993,200) ($23,723,200) ($51,153,000) ($29,733,600) $9, % -1.29% -0.08% -0.31% -0.93% Indiana $1,485,828,900 $1,499,939,500 $14,110, % $33,613,900 ($18,607,700) ($1,113,400) $1,091,400 ($873,600) ($29,998,600) ($4,992,000) $6, % -1.25% -0.07% 0.07% -0.06% Iowa $623,956,500 $626,637,700 $2,681, % $14,603,600 ($8,083,900) ($484,200) $2,902,000 ($6,256,300) ($12,533,100) ($6,540,800) $34, % -1.30% -0.08% 0.47% -1.00% Kansas $623,528,800 $625,790,700 $2,261, % $13,850,500 ($7,666,900) ($458,900) ($787,700) ($2,675,100) ($12,515,900) ($3,958,100) $80, % -1.23% -0.07% -0.13% -0.43% Kentucky $1,031,062,300 $1,039,827,200 $8,764, % $22,817,400 ($12,630,700) ($756,300) $5,903,300 ($6,568,800) ($20,796,500) ($5,108,200) $27, % -1.23% -0.07% 0.57% -0.64% Louisiana $951,750,600 $960,385,100 $8,634, % $21,241,400 ($11,758,800) ($703,900) $6,333,200 ($6,477,400) ($19,208,200) ($7,848,000) $0 2.23% -1.24% -0.07% 0.67% -0.68% Maine $418,166,600 $396,663,300 ($21,503,300) -5.14% $9,469,400 ($5,242,100) ($313,700) $1,872,500 ($27,289,400) ($7,933,300) ($23,506,900) $3, % -1.25% -0.08% 0.45% -6.53% Maryland $0 $0 $0 0.00% $0 $0 $0 $0 $0 $0 $0 $0 0.00% 0.00% 0.00% 0.00% 0.00% Massachusetts $2,075,428,700 $2,054,710,800 ($20,717,900) -1.00% $48,369,800 ($26,775,900) ($1,602,500) ($19,958,900) ($20,750,400) ($41,094,400) ($25,110,500) $21, % -1.29% -0.08% -0.96% -1.00% Michigan $2,024,564,300 $2,007,652,400 ($16,911,900) -0.84% $47,276,800 ($26,171,300) ($1,566,200) $9,022,000 ($45,473,200) ($40,153,200) ($41,725,800) $38, % -1.29% -0.08% 0.45% -2.25% Minnesota $1,292,317,200 $1,277,021,100 ($15,296,100) -1.18% $29,835,300 ($16,516,300) ($988,300) ($7,226,000) ($20,400,800) ($25,540,700) ($18,383,600) $10, % -1.28% -0.08% -0.56% -1.58% Mississippi $741,830,200 $743,183,800 $1,353, % $16,510,600 ($9,139,800) ($546,700) ($1,144,100) ($4,326,400) ($14,863,400) ($4,485,100) $9, % -1.23% -0.07% -0.15% -0.58% Missouri $1,436,542,200 $1,433,996,300 ($2,545,900) -0.18% $32,060,300 ($17,747,500) ($1,061,900) ($3,230,200) ($12,566,600) ($28,679,900) ($13,751,400) $31, % -1.24% -0.07% -0.22% -0.87% Montana $302,245,100 $300,903,700 ($1,341,400) -0.44% $6,406,500 ($3,546,600) ($212,000) $0 ($3,989,300) ($6,018,200) ($6,689,100) $18, % -1.17% -0.07% 0.00% -1.32% Nebraska $395,828,200 $399,000,000 $3,171, % $9,220,300 ($5,103,900) ($305,600) $757,300 ($1,396,300) ($7,980,100) ($1,229,000) $0 2.33% -1.29% -0.08% 0.19% -0.35% Nevada $263,339,500 $263,154,900 ($184,600) -0.07% $6,791,600 ($3,759,500) ($225,100) ($3,116,600) $125,000 ($5,263,100) ($567,000) $0 2.58% -1.43% -0.09% -1.18% 0.05% New Hampshire $464,277,400 $443,110,200 ($21,167,200) -4.56% $10,341,700 ($5,724,900) ($342,500) ($10,990,300) ($14,451,200) ($8,862,300) ($13,814,100) $0 2.23% -1.23% -0.07% -2.37% -3.11% New Jersey $1,615,119,500 $1,626,813,800 $11,694, % $37,532,100 ($20,777,100) ($1,243,600) ($5,458,500) $1,641,400 ($32,536,000) ($2,917,300) $ % -1.29% -0.08% -0.34% 0.10% New Mexico $301,752,300 $298,612,700 ($3,139,600) -1.04% $6,928,700 ($3,835,300) ($229,500) $1,156,100 ($7,159,600) ($5,972,000) ($6,780,000) $16, % -1.27% -0.08% 0.38% -2.37% New York $2,823,706,600 $2,800,361,300 ($23,345,300) -0.83% $65,844,700 ($36,448,800) ($2,182,300) ($15,469,500) ($35,089,400) ($56,007,700) ($41,180,700) $131, % -1.29% -0.08% -0.55% -1.24% North Carolina $2,109,165,800 $2,116,914,700 $7,748, % $46,487,900 ($25,733,500) ($1,541,300) $13,503,000 ($24,967,200) ($42,337,900) ($24,923,200) $66, % -1.22% -0.07% 0.64% -1.18% North Dakota $331,687,700 $319,246,200 ($12,441,500) -3.75% $7,005,600 ($3,878,100) ($232,000) $0 ($15,337,000) ($6,385,000) ($12,038,200) $76, % -1.17% -0.07% 0.00% -4.62% Ohio $2,275,770,700 $2,243,202,300 ($32,568,400) -1.43% $53,476,200 ($29,602,900) ($1,772,100) ($17,297,200) ($37,372,400) ($44,864,000) ($35,501,500) $31, % -1.30% -0.08% -0.76% -1.64% Oklahoma $953,466,500 $961,741,000 $8,274, % $22,653,000 ($12,539,500) ($750,400) $1,686,500 ($2,775,100) ($19,234,400) ($5,593,500) $0 2.38% -1.32% -0.08% 0.18% -0.29% Oregon $581,687,400 $586,256,600 $4,569, % $13,434,700 ($7,437,300) ($445,000) $3,448,000 ($4,431,200) ($11,725,100) ($4,435,100) $9, % -1.28% -0.08% 0.59% -0.76% Puerto Rico $22,940,800 $22,806,300 ($134,500) -0.59% $591,600 ($327,500) ($19,500) ($240,400) ($138,700) ($456,100) $0 $0 2.58% -1.43% -0.09% -1.05% -0.60% Pennsylvania $2,507,404,600 $2,518,500,600 $11,096, % $55,882,100 ($30,934,800) ($1,851,500) $5,783,100 ($17,782,900) ($50,370,700) ($16,933,400) $32, % -1.23% -0.07% 0.23% -0.71% Rhode Island $169,651,100 $168,684,800 ($966,300) -0.57% $3,676,000 ($2,034,900) ($121,800) ($6,553,600) $4,068,000 ($3,373,600) ($2,192,000) $ % -1.20% -0.07% -3.86% 2.40% South Carolina $964,338,000 $968,559,800 $4,221, % $22,660,700 ($12,544,300) ($750,700) ($3,689,900) ($1,454,000) ($19,371,300) ($2,744,800) $10, % -1.30% -0.08% -0.38% -0.15% South Dakota $370,741,200 $366,150,400 ($4,590,800) -1.24% $8,062,000 ($4,462,700) ($267,100) $0 ($7,923,000) ($7,323,200) ($7,339,800) $17, % -1.20% -0.07% 0.00% -2.14% Tennessee $1,236,266,100 $1,242,534,900 $6,268, % $27,897,100 ($15,442,900) ($924,300) ($2,146,400) ($3,114,700) ($24,850,400) ($1,385,900) $55, % -1.25% -0.07% -0.17% -0.25% Texas $3,215,695,500 $3,230,379,100 $14,683, % $81,230,100 ($44,967,700) ($2,690,700) $7,901,200 ($26,789,300) ($64,607,400) ($28,665,200) $0 2.53% -1.40% -0.08% 0.25% -0.83% Utah $373,861,100 $373,029,200 ($831,900) -0.22% $8,610,200 ($4,766,600) ($285,100) ($759,400) ($3,631,000) ($7,460,400) ($3,894,500) $0 2.30% -1.27% -0.08% -0.20% -0.97% Vermont $187,982,300 $181,448,800 ($6,533,500) -3.48% $4,162,200 ($2,304,100) ($137,800) ($108,800) ($8,145,000) ($3,628,900) ($6,779,200) $8, % -1.23% -0.07% -0.06% -4.33% Virginia $1,611,688,300 $1,587,817,000 ($23,871,300) -1.48% $37,934,100 ($20,999,600) ($1,256,300) ($15,207,700) ($24,341,800) ($31,756,500) ($30,116,500) $0 2.35% -1.30% -0.08% -0.94% -1.51% Washington $1,307,532,400 $1,299,073,000 ($8,459,400) -0.65% $29,544,900 ($16,355,100) ($978,900) $2,760,700 ($23,431,000) ($25,981,600) ($25,285,100) $93, % -1.25% -0.07% 0.21% -1.79% West Virginia $478,731,300 $480,341,300 $1,610, % $11,059,100 ($6,121,900) ($366,600) ($504,100) ($2,456,500) ($9,606,900) ($3,866,800) $36, % -1.28% -0.08% -0.11% -0.51% Wisconsin $1,220,420,100 $1,203,489,300 ($16,930,800) -1.39% $27,164,000 ($15,037,800) ($899,400) ($3,282,100) ($24,875,500) ($24,069,500) ($23,698,600) $55, % -1.23% -0.07% -0.27% -2.04% August of 7 Apprise Health Insights

7 Estimated CY 2018 Estimated CY 2019 Summary Dollar Impact Other Impacts Total Estimated Change CY 2018 to CY 2019 Value of Sequestration Value of Off-Campus Paid at 40% of OPPS Rate Value of 340B Biosimilars Payment Rate Change U.S. $55,561,345,300 $55,507,835,800 ($53,509,500) -0.10% $1,288,693,200 ($713,383,000) ($42,695,500) ($24,910,900) ($561,213,300) ($1,110,159,500) ($605,300,800) $1,398, % -1.28% -0.08% -0.04% -1.01% Wyoming $92,137,700 $93,081,500 $943, % $1,988,300 ($1,100,500) ($66,000) ($281,800) $403,800 ($1,861,600) $0 $0 2.16% -1.19% -0.07% -0.31% 0.44% Note: Individual totals may not foot due to rounding. August of 7 Apprise Health Insights