Palmetto State News · 2019. 1. 25. · Winter 2013 Palmetto State News south carolina chapter...

www.schfma.org Winter 2013

Palmetto State News

south carolina chapter Serving healthcare financial

management professionals statewide since 1953

Table of Contents

Officers, Board & Committee Chairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2012-2013 Sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

A Message from the Chapter President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

“The 7 Components of a Clinical Integration Network” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10

Regional Perspective from the HFMA Region 5 Executive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

"It's Time to Panic" - an article from the SCHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Pictures from the Fall Presidents Cruise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pictures from the Fall Conference in Charleston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Pictures from the Revenue Cycle Boot Camp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19

"Hospital - Physician Alignment: Tailoring Patient Panel Size to Improve Profitability" . . . . . . . . . . . . . 21-22

HFMA Dixie Conference Announcement and Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

HFMA, South Carolina Chapter

Our Vision: The South Carolina Chapter of the Healthcare Financial Management Association

will continue to be the leading professional resource for individuals seeking excellence in the

area of financial management of integrated health systems and other healthcare

organizations.

Advertising Prices!

1/4 page 3 7/8 x 5 3/8 $250 per issue

Half page 7 1/2 x 5 $450 per issue

Whole 7 1/2 x 10 $800 per issue

Include links to company websites ande-mail addresses

[email protected]

Palmetto State NewsEditor: Estelle Welte

2001 9th Avenue, Suite 312 • Vero Beach, FL 32960 • 772-559-8782Email: [email protected]

Please contact Estelle with any updates to data contained within this publication.

Palmetto State News is the official publication of the South Carolina Chapter of theHealthcare Financial Management Association.

Opinions expressed here are those of the author and do not reflect the views of theHFMA or the South Carolina chapter.

© 2012-2013 South Carolina Chapter, Healthcare Financial Management Association.All rights reserved.

For a copy of the publications policy and guidelines, send a letter or email to the Editorat the address above.

2

PresidentDiane StoryRoper St. [email protected]

President-ElectJude CrowellWashington and [email protected]

SecretaryGreg TaylorDixon Hughes, [email protected]

TreasurerWoody TurnerLexington Medical [email protected]

Immediate Past PresidentRonnie HyattBon Secours St. Francis Hlth [email protected]

Chapter Board of DirectorsDavid SudduthBon Secours St. FrancisHealth [email protected]

Michael JebailyPrice Waterhouse [email protected]

Julianne DreonAnMed [email protected]

Ray HighVerisma [email protected]

Barney OsborneSC Hospital [email protected]

James EllingtonMed A/[email protected]

Christy PowersCB&[email protected]

Jackie YoungClarendon Memorial

Estelle [email protected]

Tommy CockrellSC Hospital [email protected]

Committee ChairsAdvisory CommitteeRonnie Hyatt, ChairBudget/Finance

Barney Osborne, ChairCommunicationsEstelle Welte, Chair

Corporate SponsorshipJames Ellington, Chair

CRCAMichael Jebaily, Chair

Dixie 2015Greg Taylor, Chair

Education/ProgramsKen Scheller, ChairFounders ContactGreg Taylor, Chair

Information SystemsMichael Bowe, Chair

MembershipChristy Powers, Chair

NominatingRay High, Chair

Professional Excellence/CertificationSteve Lutfy, ChairSpecial Awards

Michael Jebaily, ChairStrategic PlanningRonnie Hyatt, Chair

3

Officers, Board & Committee Chairs 2012-2013

4

Presidents ClubBlueCross BlueShield of South Carolina • www.southcarolinablues.com

GoldCB & T, a division of Synovus Bank • www.apsolutions-cbt.com Medicol, Inc.DECO, LLC • www.decorm.com MED A/Rx • www.medarx.comDraffin & Tucker, LLP • www.draffin-tucker.com PricewaterhouseCoopers, LLP • www.us.pwc.comHollis Cobb Associates • www.holliscobb.com

SilverBank of America Merrill Lynch • www.bankofamerica.com Avectus Healthcare Solutions • www.avectushealth.comBottom Line Systems, Inc. • www.onlinebls.com The SSI Group • www.thessigoup.comCompuGroup Medical, Inc.

BronzeAdvanced Patient Advocacy LLC • www.apallc.com MDS • www.meddatsys.comAMCOL SYSTEMS • www.amcolsystems.com Receivables Management Corporation • www.reccollect.comAvadyne Health • www.avadynehealth.com Receivable Solutions, Inc. • www.receivables-solutions.comCAB Collection Agency • www.cabrmc.com Security Collection Agency • www.abs-sca.comCliftonLarsonAllen LLP • www.cliftonlarsonallen.com South Carolina Hospital Association • www.scha.orgConvergent Revenue Cycle Mgmt, Inc. • www.convergentusa.com/solutions/healthcare The MASH Program • www.mashinc.comDataTrac Receivables Recovery The Outsource Group • www.theoutsourcegroup.comDixon Hughes Goodman LLP • www.dhgllp.com The ROI Companies • www.theroi.comEnvision Telecommunications Consulting • www.envisiontele.com Verisma Systems, Incl. • www.verismasystems.comLaddaga-Garrett, P.A. • www.sehealthlaw.com Webster Rogers LLP • www.websterrogers.comLetter Logic, Inc. • www.letterlogic.com West Corporation • www.westassetmanagement.com

2012/2013 Corporate Sponsors

The 2012-2013 South Carolina HFMA Corporate SponsorshipApplications are now open!

The chapter truly appreciates the generous support from all of ourcorporate sponsors.

Contact James Ellington at [email protected] for more information onbecoming a SC HFMA Corporate Sponsor

Happy Fall – my favorite time of the year (especially in New England)! It has been a busylast few weeks for many of us. First and foremost, we are still concerned about thoseimpacted by Hurricane Sandy. Living in the Southeast, we all understand the devastationMother Nature can inflict upon us. I am thankful that my family and friends in theNortheast weathered the storm with minimal consequence. Please keep those who wereimpacted by this devastating storm in your thoughts and prayers.

Our Fall Institute in October here in Charleston was a resounding success. Julianne Dreonand her team organized a terrific event, including great educational sessions, delicious

food, and plentiful networking opportunities. Thank you Julianne for all your hard work. I received verypositive feedback from everyone who attended. We had great attendance to the Institute as well as theindividual sessions. For the first time, we conducted a “Speed Networking” event, where providers andvendors were able to meet one-on-one in 5 minute intervals. I participated in the event representing myhospital and really enjoyed it! I think this is an event we should do annually.

We will continue to offer relevant, economical, and convenient education sessions for our members. We havethe “Finance and Reimbursement Forum” on Tuesday, November 13 at the Embassy Suites in Columbia. TheSC Chapter is also responsible for the next Region V webinar to be scheduled at the end of November – detailsto follow. For those of you in need of CPE Credits, the SCHFMA is going to co-sponsor with Dixon HughesGoodman LLP a one-day session in Charleston on December 3. The details are still being worked out. Wewill let you know as soon as everything is confirmed.

This past week, National emailed to our membership the Annual Member Satisfaction Survey. Thank you toeveryone who took the time to complete this survey. This is the most important data we use in managing ourchapter to ensure we meet the needs of our membership. I used it in establishing my goals for this year andJude will do the same with the results from this most recent survey. Thank you again!

I look forward to the second half of my Presidency serving the SC Chapter. It is a pleasure and honor to workwith such a great group of professionals and friends.

Leadership matters!

Diane Story

5

A Message from the Chapter President…..

Diane Story

“Do not go wherethe path may

lead; go insteadwhere there is nopath and leave

a trail”Ralph Waldo Emerson

6

Make your chapterwork by workingfor your chapter

Become aVolunteer!www.schfma.org

TRUST.VALUE.CHOICES.SouthCarolinaBlues.com

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

Have something tocontribute to the

Palmetto State News? An article, a story about

a fellow member, pictures?

Your submission is encouraged.Send your article to the

Palmetto State News Editor [email protected]

7

The 7 Components of a Clinical IntegrationNetwork

Dennis Butts, MBA – Manager, Dixon Hughes GoodmanMichael Strilesky, Manager, Dixon Hughes Goodman

Matthew Fadel, MBA, MSM – Senior Associate, Dixon Hughes Goodman

Healthcare providers are preparing for the reality of thepost-reform environment that will require hospitals andphysicians to be more accountable for the delivery ofhigher quality and more efficient care delivered at a lowercost. As hospitals and physicians navigate through thechallenges of planning for this future, they also have toremain focused on current operations that are threatenedby thinning margins due to an increased cost structureand reimbursement declines in the current fee-for-serviceenvironment.

To effectively position for the future realities of healthcarewhile maintaining focus on current operations, manyhospitals and physicians are turning to Clinical Integration(CI) as a viable option to 1) increase quality, 2) reducecost and waste in the current system to maintain margins,3) sustain independence for physicians not ready forhospital employment and 4) position providers to take onhigher levels of accountability to effectively manageutilization and the health of populations in the future.

CI is commonly defined as a health network workingtogether, using proven protocols and measures, to improvepatient care, decrease cost and demonstrate value to themarket. Once the CI network can demonstrate a valueproposition, payers and large employers are approached tosupport the network and other incentives that are basedon achieving defined results. In most cases, CI networksand the initial conversations with payers are initiated byhealth systems. However, to be successful, CI networksmust become physician-led, professionally managedorganizations.

Organizations should keep the FTC definition andrequirements in mind during CI program developmentand implementation. In 1996, the Department of Justiceand the FTC defined CI as an active and ongoing programto evaluate and modify practice patterns by the CInetwork’s physician participants and create a high degreeof interdependence and cooperation among the physiciansto control costs and ensure quality. Generally, the FTCconsiders a program to be clinically integrated if itperforms the following:

1. Establishes mechanisms to monitor and controlutilization of healthcare services that are designed to

control costs and ensure quality of care.2. Selectively chooses CI network physicians who are

likely to further these efficiency objectives. 3. Utilizes investment of significant capital, both

monetary and human, in the necessary infrastructureand capability to realize the claimed efficiencies.

To effectively implement CI, the network shouldunderstand the relevance and the possible options foreach component provided below:

Legal Options:

To legally implement CI, the health system and physiciansare required to organize in a structure that supportsprogram objectives. With the exception of anemployment-only model, a CI network can primarily becreated within a (an):

• Physician-Hospital Organization (PHO) – A jointventure between a health system and its medical staffs.

• Independent Practice Association (IPA) – Owned andoperated by only physician partners.

• Subsidiary of the Health System – The health systemis the sole corporate member of the subsidiary entityand member physicians sign separate legal agreementsto participate.

Traditionally these structures have been used to negotiateand handle managed care contracts (HMO, Fee-for-Service, etc.) for a defined network of providers and theyare now being utilized as the vehicle to implement CInetworks by achieving the following objectives:

• Establishing a network of providers that enables

Clinical Integration

Legal Options

Physician Leadership

Participation Criteria

Performance Improvement

Information Technology

Contracting Options

Flow of Funds

Contracting


Contracting Options

Flow of Funds


Legal Options



Information

hnologyceTTe

Options


Criteria


8

enhanced coordination of care.• Creating a new partnership model with employed and

independent physicians that includes defined roles forphysician leadership.

• Defining performance improvement initiatives toprovide demonstrated value to the market

• Providing a platform for joint contracting to supportcare redesign and performance improvementinitiatives.

• Negotiating with potential partners for risk-basedcontracts.

Each legal option is capable of achieving these CIobjectives and they differ in ownership structure andcapitalization requirements. Some hospitals and physiciansalready have a PHO or IPA in place and are using thoseentities as the foundation for their CI programs. Forexample, a four-hospital system in the Midwest chose toutilize a PHO as their vehicle for CI because the businessentity was already created. Although the infrastructure wasnot entirely created to support a fully-functioning CInetwork, the PHO created an opportunity for ownership,access to resources, strong public perception and theanalytics staff to support quality programs. However, tolimit physician costs while still allowing physicians tohave a significant leadership role in the network; a four-hospital system in the southeast created a subsidiary of thehealth system to launch its program.


Integration in the post-reform era requires a high degreeof physician-hospital alignment that is based on trust andtransparency. Health systems willing to pursue CI mustempower physician leaders to have an influence on thefuture direction of the CI network. This will help tointegrate the physician’s clinical expertise into hospitaloperations and also increase cooperation and credibility ofthe CI network. Furthermore, dedicated physicians andadministrative leadership will be required to successfullyimplement a major change project of this magnitude.

A vital step to physician engagement and leadership is arobust communication strategy across the network and itspartners. Clear goals and objectives by both employed andindependent physicians will encourage dialogue andpartnership formation as the strategy is implemented.

Once the CI network is created, a governance structureshould be developed. Physician leaders should participateon the CI Board and provide leadership to committeesformed to achieve program objectives. Other participatingphysicians may lead and/or participate on sub-committeessupported by the CI network or health system. CI

committees may merge with existing committees in placewithin the health system (i.e. executive committee, qualitycommittee and contracting committee).


Member physicians or groups in the CI network must signa participation agreement. This agreement outlines theexpectations and requirements for participation in the CIprogram. In the initial stages of the network, it is verycritical that member physicians adhere to programguidelines to help ensure that stated objectives are metand the network’s value proposition is able to bedemonstrated to the market.

Recognizing this, one large CI network in the Southeastincluded Information Technology (IT) adoption in theparticipation criteria to ensure that the network was ableto demonstrate the value of enhanced coordinationbetween providers following evidence-based guidelines. Toingrain IT utilization into the culture, not only did the CInetwork initially include IT adoption and utilization in theparticipation criteria; but the network also designated aportion of the performance incentive dollars to this area toincrease compliance.

As the network matures and the participation criteria issolidified into the culture, incentive payments are nottypically awarded for compliance. However, to keepphysicians focused on program requirements, physicianeligibility in the incentive program may be tied to meetingthe participation.

Sample participation criteria include:

• Maintaining the appropriate IT infrastructure.• Logging into the CI Network website to view network

and individual performance.• Compliance with clinical protocols and care pathways

developed by the network.• Participation in all network contracts.


Clinical quality and operational improvement projects arenecessary components of a CI program. CI provides avehicle that engages physicians in determining howquality is defined and measured. CI also allows physiciansto take an active role in care redesign and protocoldevelopment to increase quality, more effectively managecosts, reduce variation and eliminate unnecessary wastewithin the delivery system. The performance initiativesspan across specialties and sites of care.

To achieve performance improvement, the CI networkworks to define baseline performance and identify areaswhere the network can demonstrate quality andoperational efficiencies to the market. It is critical thatphysicians play an active role in selecting metrics for theperformance improvement initiatives. CI networks shouldselect performance improvement initiatives based on the1) feasibility of capturing sufficient data to monitorperformance, 2) improvement opportunity, 3) payer,employer, and/or hospital interest in the program and 4)the ability of participating physicians to impact thetargeted metrics.

Performance improvement initiatives can be complex anddifficult to monitor effectively based on the sophisticationof the network’s IT system and the capacity of the networkto manage multiple initiatives effectively. Recognizingthis, one large multi-hospital system in the Midwestimplemented their initiatives in a phased approach overtime and ensured that all metrics were consistent acrosscontracts. Individual metrics were then reevaluated andupdated on an annual basis to help ensure that theinitiatives continued to demonstrate the value of thenetwork. Performance improvement initiatives aretypically developed in the following categories:

• Variance and Cost Reduction: Improving operationalefficiencies

• Clinical Efficiency: Reducing avoidable, unproductiveand duplicative services

• Care Redesign: Ensuring treatment in the mostoptimal setting and by the right provider

• System Optimization: Shifting focus to preventivecare and population health

• Patient Experience: Objective and meaningfulcomparisons between providers of care

Information Technology

If you do not measure it, you cannot improve it. IT is thebackbone of the CI network’s value proposition and iscritical to improving coordination and connectivitybetween providers of care. Early adopters of CI wouldmanually input data and transfer information by exceltemplate report cards. Today the industry is inundatedwith tools to assist with monitoring and reporting the careprovided to a patient. Since providers will be affectedmost by a change in technology, they must be heavilyinvolved in choosing the correct vendor. Two types of datasharing sources being used most by hospitals areElectronic Health Records (EHRs) and Patient Registries.However, Health Information Exchanges are becomingmore popular and could eventually become robust enoughto support clinically integrated initiatives.

An EHR is a medical record for a patient in a physicianoffice, hospital, ancillary care facility or ambulatory carefacility. The EHR is intended to replace paper-basedpatient records for recording encounter-based informationon each patient who receives care from the provider entityand includes electronic: data entry, order entry, prescribingand transcription.

A patient registry is a repository that holds clinicalinformation specific to a disease, disease process, implant,drug, etc. A cancer registry is an example of a disease-specific database. The registry is intended to track 1)patients and their compliance with specific chronic disease(or wellness) based guidelines across populations, 2)physician compliance with those guidelines and 3)outcomes for specific interventions. A data registrydifferentiates itself by interfaces with multiple data sourcesto provide sufficient data at the point of care provided to apatient, which is why many CI networks are utilizing dataregistries as opposed to the Electronic Medical Records(EMR) approach.

Contracting Options

The purpose of CI is to provide higher quality care.Creating a CI network for the sole purpose of negotiatingbetter rates is not the purpose of CI. However, CInetworks are rewarded for demonstrated value, which isdefined as the highest quality care at the lowest cost.

The CI network can contract with payers, employers orhealth systems. These contracts can range from a specificprocedure to a population of patients. Many hospitalsystems have reported that payers are not requiring thatCI contracts include downside risk for the network. Asix-hospital system in the Southeast reported that a majorpayer has approached them with a contracting model thatwould reward their network for demonstratedperformance in the following ways:

• Premium Base Rates: Increased fee-for-service ratesbased on expected performance

• Performance Incentives: Incentive payments made forperformance improvement initiatives

• Shared Savings: Savings shared based on a reductionin the cost of care

Some hospitals have also contracted with their own CInetwork to realize cost saving opportunities and to moreeffectively manage cost within their own health plan. Ahospital system in the Southwest has implemented thisstrategy. The savings that are generated by the network areshared to fund the CI program and to make distributionsto member physicians.

9

10

Flow of Funds

Calculation and distribution of CI incentives to physiciansand to the health system occur after performance isachieved. A distribution of funds will typically be realizedthrough cost savings, quality and efficiency programsnegotiated by the CI network and its partners. Funds aredistributed based on meeting performance objectives andperformance can be defined in a variety of ways. Forexample, some CI networks reward simply for globalnetwork compliance of the CI agreement while other CInetworks reward based on site (multiple hospital systems),specialty and individual performance.

Regardless of how the funds flow to the members of theCI network, the methodology should be transparent andeasy to understand. Key considerations for CI networkdistribution methodologies include:

• Distribute rewards based on measurable performance.• Reduce complexity of distribution methodology.• Increase transparency across the network.

Conclusion

Health systems and physicians are implementing CInetworks across the nation to respond to changinghealthcare dynamics that are holding providers moreaccountable for quality and outcomes. Each CI networkneeds to create a disciplined approach to assessing anddeveloping the key components of their network to createa sufficient value proposition for the health system,physicians, payers and employers. As CI becomes astrategic imperative in most markets, organizations shouldkeep the following critical success factors in mind toaccelerate the implementation of a successful andsustainable CI network:1. Align your health system objectives with the CI vision

and strategy to avoid conflicting messages in yourmarket.

2. Involve physician leaders in the CI developmentprocess to gain physician buy-in for programobjectives.

3. Express a willingness to create a new partnershipmodel with employed and independent physiciansthat includes defined roles for physician leadership.

4. Maintain systems that can track and monitor clinicaldata across the continuum of ambulatory, acute andpost-acute services.

5. Utilize a scaled approach to develop a comprehensivelist of metrics that provide value to multiplestakeholders and positions the CI network for greaterlevels of accountability.

6. Create an effective communication strategy across allstakeholders to increase understanding of the keyissues of CI.

7. Commit to approach payers in the market as acombined network.

For more information to accelerate the development ofyour CI network, the authors can be reached at thecontact information below:

Dennis Butts is a Manager with Dixon Hughes Goodman, where hedesigns and implements strategic business solutions for hospitals andlarge physician practices. Mr. Butts can be reached [email protected].

Michael Strilesky is a Manager with Dixon Hughes Goodman, wherehe develops strategic and operational solutions for healthcare clients.Mr. Strilesky can be reached at [email protected]

Matthew Fadel is a Senior Associate with Dixon Hughes Goodman,where he assists hospitals and physicians with alignment strategiesand strategic planning initiatives. Mr. Fadel can be reached [email protected]

11

MUSCLE + efficiency

CPAs and Advisors throughout the Southern U.S. 877.424.6324 | dhgllp.com/healthcare

1700+11

Top 201

PeopleStates Healthcare Management Consulting FirmGo-To Relationship Partner

Experience our relationship focused service model backed by

Dixon Hughes Goodman is proud to serve South Carolina hospitals, physician groups, senior housing, long term care,

12

Regional Perspective By Jay Rickman, Jr.

Region 5 at the Fall President’s Meeting

From 30,000 feet above the Gulf of Mexico - What agreat week it has been. Region 5 Chapter Presidents andPresident-elects conducted the regional Fall President’sMeeting while on board the cruise ship Oasis of the Seas.HFMA regions across the country meet each Fall betweenAugust 15 and September 30 to learn, discuss chapterperformance, share ideas and best practices and generallyhow to improve service to their chapter members. Themeeting also provides fellowship and creates a relationshipthat lasts for years.

FPM is not restricted to chapter presidents and president-elects, however. Any member and/or guest of a membercan also plan to attend a FPM as they are not a closedevent. This year members joined us from the Georgia andFlorida chapters as did their spouses and relatives.

This year’s meeting was probably one of better FPM. Froman absolute beautiful venue, to engaging colleagues andfriends with more personal time than they probably wouldhave been able to get at any other chapter or regionalevent. This FPM was awesome.

What a few of the attendees had to say about the 2012FPM meeting.What a great time. Thank you for welcoming Tracy and mewith open arms.

Region 5 does rock, as someone noted!! Of course I must saythat I think all of HFMA does too!!

Again, thank you for a wonderful time. Thank you for all youdo for HFMA!!

-Steve Rose, HFMA National Chair-elect

Rick and I had a blast – totally awesome week – one we willnever forget.

-Mimi Taylor, Florida Chatper President

Had an amazing time! Really enjoyed spending time andgetting to know everyone. Looking forward to working withyou and seeing you again at Dixie. I feel better prepared formy role as president next year after sharing so muchinformation and knowing that I have such a strong supportgroup. You all are awesome!

Region 5 rocks!!-Renee Jordon, Florida Chapter President-elect

What a great week and looking forward to seeing everyone thenext time our paths cross. Carpe diem.

-Marc Carter, Tennessee Chapter President

Just made it home…. But it was a such a great week…Thankyou for a wonderful week and for making this a trip I willnever forget.

See you at the Dixie! -Billie Jean Mounts. Florida Chapter Board member

Bob and I really enjoyed this trip with you great people. Verydedicated HFMA leaders who work hard and play hard. A goodbalance!

-Cathy Daugherty, Region 5 Regional Executive-elect

But more so than building better relationships, attendeesrecognized that member education is the main focus ofHFMA. A member armed with the latest trends infinancial performance has a greater opportunity tocontribute more to the mission of his/her organization.And at the end of the day for providers that, of course,means great patient care and outcomes.

As healthcare financial administrators, our role is moredemanding than ever. We have to know what will makeour organization perform at the very best possible leveland help relieve the ever-increasing financial strain foundtoday at most healthcare organizations.

As I stated, the basic mission of the chapter is to provideeducation to members. Chapters try diligently to give youknowledge about the best tools to help you optimally runyour department or perhaps your organization.

HFMA needs you, however. It needs members who aresuccessful under today’s challenges and who are alsowilling to work for the chapters and not only share ideasbut working to develop best practices. It also needsmembers who just want to learn more while networkingwith colleagues who share similar missions with theirorganizations.

I recommend connecting with your chapter president tosee where the most help is needed. Start today.

Oh, and about the Fall President’s Meeting for 2013, it’son a cruise to Alaska. Be sure to check out your chapterwebsite for details and considering make plans to attend.You’ll be glad you did.

Onward!JayRegion V Regional Executive

13

UPCOMING SCHFMA EVENTSUPCOMING SCHFMA EVENTSReimbursement Update – November 13, 2012 – Embassy Suites, Columbia, SC

Region V Webinar, Hosted by the SC Chapter, “Protecting Your Revenues from ICD10:Applying a Revenue-Focused Approach to the ICD10 Challenge”, November 29, 2012

“Hospital Accounting Forum”, Roper Hospital, Charleston, SC, December 3, 2012

SCHFMA Webinar, “Implications of 501(r): An Overview of Proposed Regulations Affecting FinancialAssistance Policies and Billing in Collection Practices”, December 13, 2012

Chapter Awards & CRCA Graduation – January 11, 2013 – Embassy Suites, Columbia, SC

Region 5 Dixie Conference - February 24 - 27, 2013 - Naples, Florida

Payor Summit – March 19, 2013 – Embassy Suites, Columbia, SC

www.schfma.org/events.htm

14

It’s Time to PanicBy Barney Osborne, SC Hospital Association

South Carolina hospitals are facing nearly $15 billion inlost revenue between now and 2020.

Do you have any idea what portion of that burden yourhospital or system will bear? I do. And I can tell you thatit is time to take action to blunt the impact of this attackon our hospitals’ bottom lines.

When the Affordable Care Act (ACA or Obamacare) waspassed, it included significant federal payment cuts underMedicare and the DSH program to hospitals. Medicare ACAreductions for South Carolina total over $2 billion duringits implementation from 2014 to 2020. The logic was thatrequiring individuals to buy coverage, providing subsidiesto help cover the premiums, and expanding Medicaid tothose living at or below 138 percent of poverty woulddrastically reduce hospital unreimbursed care. Mosthospitals supported the reimbursement cuts as a way tohelp pay for the ACA without adding to the deficit.

Following its passage, a number of states, including SouthCarolina, sued the federal government, claiming the newlaw was unconstitutional. The case went all the way to theU.S. Supreme Court. Would the Court uphold or overturnthe entire law, or just the individual mandate? If themandate was overturned and the number of uninsuredremained high, how would hospitals absorb the cuts?

Well, by now you know the Court did neither. Instead,the law – including cuts to hospital reimbursement – wasdeclared constitutional, but the requirement that everystate expand its Medicaid program was not. The Medicaidexpansion became an option, not a requirement for states.

The Congressional Budget Office estimates six to tenmillion fewer Americans will gain insurance as a result ofthe Supreme Court decision. If our state does notparticipate in the expansion, an estimated 355,565 SouthCarolinians who would have had their bills paid byMedicaid will remain uninsured. When they come to yourhospital, much of the uncovered costs will be passed on tothose with private health insurance. Hospitals with a lowpercentage of privately insured may struggle to survive.Some may not survive at all.

Other than the Medicaid expansion requirement, the ACAremains intact. The Federal Government will still pay 100percent of the costs of expansion between 2014 and 2016.The match will gradually decrease to a minimum of 90%in 2020 and beyond. The Secretary of the U.S.Department of Health and Human Services will considerexpansions below 138 percent of poverty, and states canopt in and out at any time.

Refusing to accept the expansion as directed by the ACAwill cost our state $11 billion in federal funds. Regardlessof whether or not we accept Medicaid expansion, SouthCarolina hospitals will suffer an estimated $735 millionreduction in our current federal Disproportionate Share(DSH) funds. In the past, these funds have helpedreimburse hospitals for care for the individuals who couldbecome covered under an expanded Medicaid program.

State planners also predict that many South Carolina

citizens who could already qualify for our currentMedicaid program will learn of their eligibility from eitherthe state's enhanced eligibility program, through all of themedia attention, or even from their employers. Thisamount of new Medicaid cost to the state, referred to as"woodwork", will not be matched at the new higher ACArates, but at the current 70/30 federal Medicaid match.Unless the state finds a new means to fund this additional$3.5 billion cost over seven years, this growth couldreduce Medicaid reimbursement rates for all SouthCarolina hospitals.

Governor Haley and SC Medicaid Director Tony Keckhave consistently expressed strong opposition to anyexpansion of Medicaid in South Carolina. In a July 4,2012, guest editorial published in The State newspaper,the Governor and Keck wrote:

We simply can’t support this. We are not going to jammore South Carolinians into a broken program, a programthat stifles innovation, discourages personal responsibilityand encourages fraud, abuse and over use of services —and that, by the way, costs us billions of dollars.

The new federal funds provided by the ACA for Medicaidexpansion could strengthen our state’s ability to convert toa new payment system if that is truly what our stateneeds. Refusing the federal ACA funds will take away thesafety net that hospitals need to survive the conversion.Also, even if our state does not accept these new federalfunds, South Carolina tax payers will help fund thenational ACA with our tax dollars.

During the upcoming legislative session, this issue mustbe a priority for HFMA and our hospitals. It is criticalthat your financial staff work with hospital leadership tosound the alarm and explain to business leaders andelected officials about the devastating impact the loomingcuts will have on your hospital and community.

Is there anything that you can do to help? The first step isto make sure that all hospital chief financial officers andchief executive officers are aware of the cuts their hospitalsface. Those numbers are being shared with them in ahospital-specific impact report. But we shouldn’t assumethat they have given them the attention they deserve.Please ask your CFO or CEO if he or she has had time toreview those numbers and what you can do to helphospital leaders advocate for an expanded Medicaidprogram.

You can also advocate for healthcare in the communitiesyou serve. By joining SCHA’s grassroots advocacy program,Leadership for Education and Advocacy or LEAD, youcan help influence policy decisions that affect health andhealthcare in our state and nation. Visit SCHA’s website orcontact Elizabeth Burt at (803) 744-3541 to learn how tojoin this effort.

Now, more than ever, the decisions of our state legislatorswill impact all aspects of healthcare in our state. Thisincludes jobs like yours and mine. I encourage you to getinvolved.

15

Contact solutions that won’t leave you or your patients

hanging.At Firstsource, our strategic approach combined with an advanced interactive voice response (IVR) technology help clients achieve a 34% live connect rate, up from 14-18% with traditional dialers.

Patient-friendly interaction24/7 patient eligibility screening and payment servicesMultiple voice talents and languagesUnlimited call scriptingUnlimited call volumes 100% calls recorded

For a better, faster way to connect with your patients, contact Firstsource toll free at 877-926-7370.

www.firstsource.com

Copyright © 2011 Firstsource Solutions USA, LLC. All rights reserved.

MedAssist®

G e n e r a t e R e v e n u e* w i t h C B & T ’ s

[email protected]

www.apsolutions-cbt.com

Generate revenue by automating your accounts payablesystem and replacing checks with electronic payments –all at no cost to you!

*Revenue share based on volume

APSolutions is a web-based state-of-the-art payables processing system that allows you to pay invoices more efficiently, have better control of your cash flow,and provide your vendors with reporting that enhances their posting process. Best of all, your day-to-day accounts payable operations remain the same.

Improve your accounts payable process with APSolutions. Contact us today.

Subject to credit approval.CB&T is a division of Synovus Bank. Synovus Bank, Member FDIC, is chartered in the state of Georgia and operates under multiple trade names across the Southeast. Divisions of Synovus Bank are notseparately FDIC-insured banks. The FDIC coverage extended to deposit customers is that of one insured bank.

16

Fall Presidents Cruise

17

SC-HFMA Fall ConferenceHeld October 17-19 in Charleston, SC

Pictures below are from the Fall Conference . . .

Current and Past SC Chapter Presidents Region 5 Past Presidents

18

Revenue Cycle Boot CampHeld September 18, 2012

19

Revenue Cycle Boot CampHeld September 18, 2012

21

Hospital-Physician Alignment: TailoringPatient Panel Size to Improve Profitability

By Michael Ehlen

Background: Establishing and monitoring patient panelscan be a powerful tool for increasing practice revenue,promoting customer service and reducing practiceexpenses. Provider based primary care practices candefine patient panels for all of their employed physicians,physician assistants, (PA) and/or nurse practitioners, (NP).Panel size can be defined as the number of individualpatients seen by a provider, or the entire practice, over adetermined time period. Most practices utilize 12 monthsof data for their panel size calculations. However, 18months is more ideal to capture any established patients,who do not visit the practice within a 12 month timeframe.

Patient panel size needs to be carefully considered. If aprovider’s panel is too large, the excess demand will spillover to other providers in the practice. Patient satisfactionwill suffer. Quality of care and practice revenue will trenddownward. If a provider’s panel is too small, the demandfor services may not be enough to cover the practice’sexpenses and large losses can occur. Either one of theabove situations puts the practice in a position where itcannot be successful.

Current Patient Panel Size Determination: In order toperform meaningful financial analysis, each patient on thepractice’s active patient roster should be assigned to oneprovider. Because there are going to be some patients,who have been treated by more than one provider in thepractice, a set of rules should be used to designate whichpatients are assigned to each provider. Some of the morecommon rules for patient panel designations are:

• Patients treated by only one provider areautomatically assigned to that provider.

• Patients treated by multiple providers are assignedto the provider with the highest visit count for thatpatient.

• Patients treated by multiple providers, where thereis a tie between two or more providers for thehighest visit count, are assigned to the provider,who treated the patient on their most recent visit.

Keep in mind that current patient panel size can beinfluenced by many factors, including weekly hoursavailable for appointments, a physician’s “bedside

manner,” and the age or gender of the patient panelpopulation. As more physicians align with hospitals,consolidating information systems will allow for betteranalysis of patient panel levels, i.e. making an adjustmentto one provider’s panel based on acuity to account formore return visits than another provider in the samepractice.

Improving the Bottom Line with Appropriate PatientPanel Size: Patient access can make or break a practice.If daily patient demand for appointments is greater thandaily provider capacity, backlogs and bottlenecks willoccur. Patients may have to wait days for their nextappointment. If one of the practice’s providers has apatient panel size, which is too big, leakage will occur aspatients “lose their patience” and leave the practice. Staffwill also be flooded with increased phone calls andcancellations. Many patients will experience poorerclinical outcomes, which increases return visit lengths,and puts more stress on the practice’s capacity andproductivity.

A simple, but effective method to evaluate each provider’spanel size is to perform an “Effort versus Reward”calculation as follows:

• 1. Select a time frame to measure, at least 12months, preferably 18 months.

• 2. Total all the net revenue received by the practiceover the time frame selected. Total and divideeach provider’s patient panel net revenue by thetotal net revenue to compute the percentagerendered by that provider’s panel.

• 3. Total all the visits or treatments performed bythe practice over the time frame selected. Totaland divide each provider’s patient panel’snumber of visits by the total number of visits tocompute the percentage of “effort” rendered bythat provider’s panel.

• 4. Compare the percentage of revenues for eachprovider panel to its corresponding percentage of“effort.” The higher the percentage of revenuecompared to the percentage of effort, the better.An equal ratio indicates a provider is onlygetting out what they put in and margins aresuffering. In those cases, where the revenue ratiois less than the effort ratio, further analysis is

22

PricewaterhouseCoopers’ on shore Virtual Business Office, located in Columbia, SC manages third party accounts receivable and provides detailed analysis and recommendations to enhance cash recovery.

Our Virtual Testing Center (VTC) assists Providers with Testing, during system conversions and ICD-10 transition. Both VBO and VTC will turn complex issues surrounding the revenue cycle into opportunities, specifically in the areas of:

•!Third Party Account Remediation •!Legacy A/R Sunset Services •!Testing •!Denials Management •!Insurance Verification and Eligibility •!Unbilled Claims Recovery

Contact Steve Lutfy, FHFMA Managing Director [email protected] (803) 753-5209

PwC’s Virtual Business Office

www.PwC.com/us/VBO Voted #1 in KLAS's April 2011 Survey of Extended Business Office Services

required as there are significant problems.Looking at patient panels, by this method, canidentify scheduling issues quickly. The next stepwill be to analysis specific provider workflowissues, such as shorter patient revisit intervals orthe number of days a provider is booked forpatient visits.

Summary: Besides the brief panel size analysis above,there are many other physician practice performancedrivers, where panel size financial analysis can be appliedby today’s healthcare financial manager. Some of the moreestablished uses are:

• Adjusting for physician productivity: If aphysician, whose bed-side manner creates longeroffice visits, resulting in a patient panel size that is90 percent of the practice’s benchmark patientpanel size, their compensation might be adjusted toreflect this.

• Predicting practice overhead: Patient panels can beused to budget or analysis demand for tests,procedures and even some hospital stays based onage, sex and payor considerations.

• Improving patient outcomes: Providers, whoidentify with their own patients, take ownership ofthem through their patient panels, are able to makethe commitment to continuous quality care. Thiswill lead to reduced costs and/or increased revenue.

The ability to extract and monitor key performancemeasures from a practice’s patient panel size by physician,based on their individual scope of practice, patient mixand office hours will improve Hospital/Physicianrelationships. Customer service goals and financial goalswill be aligned.

Michael Ehlen is the PFS Business Analyst with BeaufortMemorial Hospital located in the “Low Country” area of SouthCarolina. He is a current member of the South CarolinaHFMA chapter. If you have any questions regarding thisarticle, Michael can be reached at [email protected]

23

Crisis Ministries Service Project at theFall Conference

Palmetto State News · 2019. 1. 25. · Winter 2013 Palmetto State News south carolina chapter...

Documents

Transcript of Palmetto State News · 2019. 1. 25. · Winter 2013 Palmetto State News south carolina chapter...