Preparing & Positioning for

the Hospice Medicare

Advantage Carve-In!

Presented by

Andrew Reed, System Analyst, CPA

CEO &Chief Teaching Officer

Multi-View Incorporated

Evolution or De-Evolution?

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Professional Perspective

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828-698-5885

828-698-5885

The Value of HumilityA spirit and attitude of Humility and

Openness allows a person to consider

alternative views and beliefs. Pride

and fear shut a person off from new

learning. We have to “let go,” at least

temporarily, of what we perceive we

know to make “space” for alternative

ways to look at things! This comes from

the domain of Integrity. moves!!!

Normally Distributed Bell Curve

1) Use unique/powerful methods of People Development.

2) Are highly “spiritual” organizations.

3) Have unique and different compensation practices.

Elevated

Consciousness

of Integrity

100% of the

organizations in

the 90th

percentile

long-term:

Focus on the 90th PercentileWe are NOT very interested in what the

majority (the huddled masses) are doing.

You can call up the Hospice next door and

find this type of practice information. To

become highly profitable based on

extraordinary quality, you will have to

become an “Outlier” and do things that

typical Hospices are ignorant of or are afraid

to do. It is a lonely but highly satisfying road.

NEVER focus on the mediocre majority!

The Bell-Curve…

is always with

us…

If we have Humility…

we will recognize that virtually all of the

major frustrations involved with creating and

running a Hospice have been either solved

or greatly alleviated by someone in the field.

Within all industries (Movement in the case

of Hospice), there is usually a small group,

or even a single organization, that has

discovered ways that greatly alleviate or

even solve such frustrations. This brings

great relief…… It is ok to imitate them!

To WIN with Medicare Advantage Providers It’s About…

1 … low costs… #1, #1, #1!

2 … quality…

3 … coverage…

4 … reality…your present numbers…

5 … making it a “No Brainer” to contract with you…

6 … their plan to get you addicted to patient-volume…

7 ... “out-managing” managed care…and THRIVING!

The best and soundest

strategy in uncertain times,

especially with the unknowns

of the Hospice MA Carve-In, is

to run a tight, highly-

profitable business…828-698-5885

It’s about low costs…

Slide 13

Your Hospice must be highly profitable

and in a position of strength as money is

the language of Managed Care. You must

be able to provide a SUPERIOR service

or experience for LESS cost than the

Hospice Medicare Benefit…and be

profitable at the same time or you can’t

survive… You must help the MA providers

make money and manage their MLRs.

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It’s about low costs…

Slide 14

14% or Higher Profitability to have

options A Hospice can do this if it operates all areas a little better

than average or the median, so this is no big stretch. Top

Hospices are doing 20-30% margins. This gives you options!

Expert knowledge of cost or you will get

“played” Diagnosis

Referral Source – Nursing Home/ALF, Hospital, Physician,

Physician Practice, etc.

Payor

Clinician and Physician

Patient or Beneficiary

Clinical Team or Patient-Class

Age, Sex or other Important Demographic of a Healthcare

Population

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It’s about quality…

Slide 15

MA providers (and perhaps you,

depending upon your deal) receive Bonus

Payments based on quality. Your Hospice

must contribute to these bonuses. High-

quality will only come from the quality of

your People as a direct result of the

quality of your People Systems. Perfect

Visits with Perfect Documentation is

key…

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It’s about quality…

Slide 16

There is a constant stream of “quality

measures” being introduced as healthcare

in general grasps at this subjective

property. These will come and go.

The best strategy is to “be” high-quality

already! Usually your quality will translate

automatically to whatever measures are

instituted.

If a Hospice will FOCUS on Perfect Visits

with Perfect Documentation, it will cure

most Financial & Quality woes.

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Perfect = To the

Standards of the

Organization

828-698-5885

How Perfect Visits Cure Most

Quality & Financial Woes! 1. Patients/Families are Happy! Complaints are RARE.

2. Team sizes of Clinical Managers easily increase.

3. Billing goes out on time with little effort.

4. Less Compliance Staff are needed.

5. Marketers don’t have to Lie…Quality is easy to sell in a

broken healthcare world.

6. Census increases as a direct result of radically increased

QUALITY!

7. Financials surge.

8. CAHPS scores surge.

9. Less Staff are needed and organizations can flatten.

10. You don’t have to worry about a ZPIC (or similar) KILLING

you off! You’re tight!

It’s about coverage…

Slide 19

MA providers prefer to contract with larger

Hospices. Historically, MA providers are

required to contract with a percentage of

providers (sometimes 30-50%). As a result,

there are many alliances, affiliations, mergers

and various business combinations happening.

The key is to try to only do deals with

organizations that have Indirects below 31%

and profits at or above 14%. Have “escape”

clauses in your contracts AND make sure the

“hooks” aren’t so deep you can’t get free from a

bad alliance.

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It’s about coverage…

Slide 20

It’s just easier to contract with fewer

Hospices.

There are good relationships & affiliations and

there are BAD ones… What to look for: Look at their numbers via benchmarking.

Profits of 14% or greater for Hospice Homecare, 2% profit

for IPUs.

Indirects less than 31% If these numbers are NOT there, then the organization does not know

how to do them yet…and YOU may be their plan to do “economies of

scale.” The ones that know how to do this are already doing it!

Have “escape clauses” where you can quickly get out of bad

deals.

Do deals where it is month-to-month and not annual. Month-to-Month demonstrates CONFIDENCE. Annual or longer deals

reveal an entity that is NOT confident in their offerings.

Watch out for “hooks” in the deal which make it extremely

difficult to extract yourself from. Yes, we’ve done this a long time! Ha!

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It’s about your present

numbers…

Slide 21

Your current numbers are your truth… MA

providers will want to see them…and you

will be judged by these numbers. You

must demonstrate expert knowledge of

costs and professional perspective via

Benchmarking. These can be improved

dramatically in 5-8 months with effort.

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It’s about your present

numbers…

Slide 22

Your current numbers are the BEST you can

do… If you really could do better you would

be… This is Humility…

These numbers are national benchmarking (as

financially-oriented as possible). Limited use of

local, regional or state-wide benchmarks or you

will be less impressive.

Where do you stack up against the Herd? Financials

Quality

Cost Avoidance

Knowledge of cost

Coverage – Patient-Volume

Your numbers must be IMPRESSIVE via the

convention of COMPARISION!

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It’s about making it a “No Brainer”

to contract with you…

Slide 23

You must make the decision to contract

with you a “No Brainer” with

UNDENIABLE value. Often this translates

to “cost avoidance” for MA providers. In

our many years of experience with

Managed Care, providers love to “dump”

their high-cost patients into Hospice. This

will force a Hospice to develop expertise

in CAP management.

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It’s about making it a “No Brainer”

to contract with you…

Slide 24

This is easier to do that most think because most Hospices are

SLOW and are AVERAGE… This makes it easy to stand out

from the Herd!

Your Financials need to be in the 70-80th percentile compared to

all Hospices in the US.

Show quality scores (CAHPS, etc) as high as they can be. This

will come from the quality of your People Systems.

Show them exactly the populations you will help them gain profit

through cost avoidance/savings.

Let them see your Clinical Synthetic lab & methods.

Have them pick any clinician at random to see if he or she can

explain a Perfect Visit according to your proprietary method

where you go days and sometimes weeks without a single

complaint or documentation error.

Show the use of Advanced Bereavement Technologies rather

than cognitive approaches with quantified results.

Show them your method of SCALE.

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It’s about their plan to get you

addicted to patient-volume…

Slide 25

And then decrease your reimbursement… Most

Hospices will innocently and ignorantly

increase Indirect costs and not structure costs

to fluctuate with patient-volume, especially their

compensation systems. Then they will be

reactive, facing a merger or other form of

unplanned end due to economic pressures.

The point is to anticipate this and be totally

prepared! The best strategy is to be highly-

profitable with large reserves.

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It’s about their plan to get you

addicted to patient-volume…

Slide 26

This is unavoidable and is a human condition…so

we are not demonizing anyone here…

Many MA providers have quarterly calls with

shareholders that expect increasing profits.

In an effort to meet these expectations, there is

constant economic pressure to perform.

Ruthless deals will be offered… Eventually the

Hospice Benefit will be unbundled, at least by

some…

The strategy is to anticipate these moves and

intelligently structure your costs so they flex

automatically with patient-volume… Most of this will

be the result of how to structure your compensation

systems.

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It’s about “out-managing”

managed care…and THRIVING!

Slide 27

Using the latest Best Known Practices (BKPs)

is your only option to stay ahead of slow

moving MA providers and other Hospices.

BKPs are your competitive advantage. There

are always new practices used by

organizations that live in the extremities of the

Bell-Curve to imitate! MVI benchmarks 769

Hospices monthly to discover & systemize

BKPs for our clients! Such BKPs will put your

Hospice in the 90th percentile statistically. The

world is not over! You can do this!

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It’s about “out-managing”

managed care…and THRIVING!

Slide 28

Use this “crisis” as an opportunity!

It is our experience that with FOCUS, a

Hospice can be prepared in 5-8 months

as the practices to do this are already

known and don’t have to be invented.

Position your Hospice to be able take a 25%

decrease in reimbursement and still be

highly profitable.

Use entrenching strategies with Managed

Care.

Remaining tougher and more nimble!

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Of course there is more to the

topic, but this will get you

heading in a great direction!

And you will find yourself here on

the Bell Curve!Users of

Best Known

Practices

Recognize that your view of the world will change and Best Practices WILL

put you in a much smaller group, the 90th percentile.

And will people applaud and tell you how great your are?

NO! You will be ridiculed and held with contempt! BUT its OK!!!

Our Movement needs Heroes!

Lead by

ExampleBe rather than to Seem…

All Quality comes from the Quality of your

People

Questions/Contact Information:

Andrew Reed, areed@multiviewinc.com

Bill Taylor bill.taylor@multiviewinc.com

Michelle Ellsworth michelle@multviewinc.com

JT Lapp JT@multiviewinc.com

Rahma Brown rahma@multiviewinc.com

Justin Wall justin@multiviewinc.com

828-698-5885

www.multiviewinc.comPresented by

Andrew Reed, CPA/Chief Teaching Officer

Multi-View Incorporated