Our facilities are located in 20 states and England. Through our predecessors, we commenced operations in 1968. 8226; Our performance depends on our ability to recruit and retain quality physicians. 8226; Our operations could be impaired by a failure of our information systems. &# See Item 1, "Business — Competition." These payments are financed by offsetting reductions in the inpatient PPS rates. For federal fiscal year 2020, CMS increased the MS-DRG rate by approximately 3.1%. In this situation, the case is paid as though the secondary diagnosis was not present. Payments to hospitals may also be reduced based on readmission rates. In addition, CMS reduces the inpatient PPS payment amount for all discharges by 2.0%. Previously, this rate did not apply to "excepted" provider-based departments. CMS has established the IPF PPS payment rate in a manner intended to be budget neutral. f) Represents the average number of days admitted patients stay in our hospitals. ( Pain management and endoscopy procedures are not included in inpatient surgeries. ( Our strategies are designed to ensure our hospitals are competitive. These penalties are updated annually based on changes to the consumer price index. Like the Anti-kickback Statute, these provisions are very broad. EMTALA All of our hospitals in the United States are subject to EMTALA. However, there is uncertainty regarding the future of the Affordable Care Act. The law has been subject to legislative and regulatory changes and court challenges. We are dedicated to being an employer of choice. As a result, our labor costs could increase. Charles J. Hall was appointed President — National Group in February 2011. From 2000 to 2010, Mr. Wyatt served in various capacities with Ernst & Young LLP. As of December 31, 2020, our total indebtedness was $31.004 billion. We are unable to predict what, if any, and when such changes will be made in the future. CMS administrators have also signaled interest in changing Medicaid payment models. We are exposed to market risk related to changes in market values of securities.
