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  • Kadlec Health System's Four-Step Approach to Physician Integration
    leaders have actually helped the health system reduce friction between physicians and executives which can stall integration efforts While Wortman concedes that it s more challenging for executives to have physicians as partners in governance at the board level and operational level the result is a better organization and fewer operational silos Physicians can be your best ally when you re in a tough spot and at the same time they keep you honest Today most Kadlec physicians realize that their success depends on the success of the healthcare system Wortman said In a functionally integrated system it becomes more and more difficult to tell whether you re in a medical executive committee meeting or whether you re in a system business meeting because many of the issues begin to overlap Wortman said The physicians aren t just practicing at the hospital they are the hospital You can t tell where the hospital starts and stops and where the practice starts and stops Employing Specialists of Choice In addition to putting more physician leaders in place Kadlec executives have added more physicians to the payroll About eight or 10 years ago it became obvious certainly here at Kadlec that if we didn t have an employment model or an employment option for physicians who were looking for a position that we weren t going to be able to recruit and we couldn t compete Wortman said Over the past five years the system has acquired five existing practices and recruited new physicians into the community Today primary care providers represent about 56 percent of employed physicians in the Kadlec Clinic which has 15 sites in the region As a result specialty dollars are staying in the system Wortman said Having a strong primary care network has allowed Kadlec Clinic to attract top notch specialists who want to be busy and to attract that market share he said We have also made a conscious capital investment in the specialty practices themselves allowing subspecialty physicians to enhance their service offerings This summer the health system will open a new 19 2 million three story building dedicated to outpatient specialty care It will offer neurosurgery and neurology endocrinology gastroenterology cardiothoracic surgery and other specialty services Hospital leaders expect the new building will lead to more collaboration and coordination between providers In addition Kadlec leaders plan to recruit more specialists in cardiology pulmonology and urology Through these efforts leaders at Kadlec are helping manage the referral path that runs from the primary care physician to the subspecialist to the hospital Managing that referral path becomes absolutely critical whether a system is in a discounted fee for service model or more importantly in some type of global capitation or risk model said Marc D Halley president and CEO of The Halley Consulting Group In fact measuring referrals in and out of the system can indicate whether or not a system is actually working as it should he added PCPs primary care providers will become increasingly directive as we share additional financial risk Referral patterns will change based on things like cost and utilization as well as service quality Improving Care Coordination Accountable care organizations ACOs and other risk based systems tie payment to measurable outcomes To succeed in a future dominated by these evolving payment structures Kadlec leaders are improving care coordination which requires better communication among providers The organizations that learn to integrate properly and pull all the pieces together the organizations that have single medical records to allow all the system pieces to see as much of the patient care as possible the systems that learn how to relate to the patient and make the patient experience better the systems that become more efficient those systems are the ones that are going to be the most competitive and lead in their markets Wortman said To improve care coordination in the Kadlec Health System executives have implemented a central medical record In addition physician network leaders have been working with the hospital s service line managers to improve care coordination across the continuum particularly for heart lung vascular and other surgical patients We have hospitalists intensivists and pediatric hospitalists who meet with the leadership of Kadlec Clinic frequently Wortman said Communication between these hospital based specialists and our ambulatory specialists is critical to our continued process improvement Kadlec executives are also looking to improve communication and care coordination with physicians outside of the system Last year the system entered into a strategic alliance with a public hospital PMH Medical Center Prosser Wash The agreement included a plan to bring PMH physicians and PMH Medical Center online with Kadlec s new electronic health record so that it would be easier for them to coordinate care with specialists in the Kadlec system Measuring the Results In addition to measuring revenue and quality metrics leaders at Kadlec are developing numerous performance measures to track their progress toward functional integration Wortman said These include Viability of primary care practices in key markets Ensuring the success of certain physician practices can help sustain the system over time Time to access care In a functionally integrated system patients should not have to wait weeks to be seen by a specialist Wortman said Physician engagement While difficult to quantify having an engaged medical staff helps support integration efforts Lower cost per unit of service Like an HMO Kadlec is exploring how to track how much they spend per patient per month so they are ready for risk based payments Wortman said Laura Ramos Hegwer is a freelance writer and editor based north of Chicago laurahegwer comcast net Access Halley s and Wortman s slides from their November 2012 webinar From Structural to Functional Integration organized by The Halley Consulting Group Interviewed for this article Marc D Halley is president and CEO The Halley Consulting Group Westerville Ohio mhalley halleyconsulting com Rand Wortman is president and CEO Kadlec Health System Richland Wash rand wortman kadlecmed org Discussion Starters Forum members Please add your insights questions and comments about this article on the CFO Forum s LinkedIn discussion board What are the biggest challenges for CFOs helping their organizations manage the referral path What suggestions do you have for hospitals looking to overcome operational silos that can stall functional integration Or perhaps you have another discussion starter BACK TO PAGINATION Kadlec Health System is getting ready for risk based payments by forging stronger connections between its primary care physicians specialists and hospital service lines Kadlec Health System a locally owned locally governed not for profit health system serving southeast Washington state has a lot going for it It is home to a growing open heart surgery and interventional cardiology program it has a strong neuroscience center and it boasts the region s only neonatal intensive care unit In addition the system s hospital Kadlec Regional Medical Center has earned the coveted Planetree designation for patient centered care and was rated No 5 in the country for patient safety by Consumer Reports in 2012 This is a sample article from HFMA s CFO Forum a discussion and networking community for senior finance leaders in hospitals and health systems Learn more about the CFO Forum and subscribe But as an independent health system Kadlec faces some significant challenges according to Rand Wortman the system s president and CEO As a stand alone entity Kadlec probably doesn t obtain the highest reimbursement from the insurers We lack the negotiating leverage of a larger network Wortman said during a November 2012 teleseminar Another challenge is that Kadlec continues to compete with larger health networks for referrals As payments across the country become more risk based the system will face even greater pressure to coordinate care among providers for better quality and cost control To meet these problems head on leaders at Kadlec have taken steps to better attract referrals into the system and keep revenue from leaving the network At the same time they have started to move from a structurally integrated system to a functionally integrated system This involves several strategies including building better bridges between primary care physicians specialists service lines and the hospital Here are four actions they have taken along the way Engaging Physician Leaders as Partners According to Wortman physician leadership is critical to promoting functional integration which relies on a common vision and shared trust between the medical staff and administration Currently Kadlec s system board includes five physicians who help guide the organization s vision In addition Kadlec s employed physician network Kadlec Clinic is governed by a partnership of nine members six of whom are physicians Over the past several years Kadlec has actively recruited and developed physician leaders by specialty Those employed clinical leaders have become champions on our medical staff Wortman said in a follow up interview via email In addition to defining clinical quality metrics throughout the organization these physician leaders have actually helped the health system reduce friction between physicians and executives which can stall integration efforts While Wortman concedes that it s more challenging for executives to have physicians as partners in governance at the board level and operational level the result is a better organization and fewer operational silos Physicians can be your best ally when you re in a tough spot and at the same time they keep you honest Today most Kadlec physicians realize that their success depends on the success of the healthcare system Wortman said In a functionally integrated system it becomes more and more difficult to tell whether you re in a medical executive committee meeting or whether you re in a system business meeting because many of the issues begin to overlap Wortman said The physicians aren t just practicing at the hospital they are the hospital You can t tell where the hospital starts and stops and where the practice starts and stops Employing Specialists of Choice In addition to putting more physician leaders in place Kadlec executives have added more physicians to the payroll About eight or 10 years ago it became obvious certainly here at Kadlec that if we didn t have an employment model or an employment option for physicians who were looking for a position that we weren t going to be able to recruit and we couldn t compete Wortman said Over the past five years the system has acquired five existing practices and recruited new physicians into the community Today primary care providers represent about 56 percent of employed physicians in the Kadlec Clinic which has 15 sites in the region As a result specialty dollars are staying in the system Wortman said Having a strong primary care network has allowed Kadlec Clinic to attract top notch specialists who want to be busy and to attract that market share he said We have also made a conscious capital investment in the specialty practices themselves allowing subspecialty physicians to enhance their service offerings This summer the health system will open a new 19 2 million three story building dedicated to outpatient specialty care It will offer neurosurgery and neurology endocrinology gastroenterology cardiothoracic surgery and other specialty services Hospital leaders expect the new building will lead to more collaboration and coordination between providers In addition Kadlec leaders plan to recruit more specialists in cardiology pulmonology and urology Through these efforts leaders at Kadlec are helping manage the referral path that runs from the primary care physician to the subspecialist to the hospital Managing that referral path becomes absolutely critical whether a system is in a discounted fee for service model or more importantly in some type of global capitation or risk model said Marc D Halley president and CEO of The Halley Consulting Group In fact measuring referrals in and out of the system can indicate whether or not a system is actually working as it should he added PCPs primary care providers will become increasingly directive as we share additional financial risk Referral patterns will change based on things like cost and utilization as well as service quality Improving Care Coordination Accountable care organizations ACOs and other risk based systems tie payment to measurable outcomes To succeed in a future dominated by these evolving payment structures Kadlec leaders are improving care coordination which requires better communication among providers The organizations that learn to integrate properly and pull all the pieces together the organizations that have single medical records to allow all the system pieces to see as much of the patient care as possible the systems that learn how to relate to the patient and make the patient experience better the systems that become more efficient those systems are the ones that are going to be the most competitive and lead in their markets Wortman said To improve care coordination in the Kadlec Health System executives have implemented a central medical record In addition physician network leaders have been working with the hospital s service line managers to improve care coordination across the continuum particularly for heart lung vascular and other surgical patients We have hospitalists intensivists and pediatric hospitalists who meet with the leadership of Kadlec Clinic frequently Wortman said Communication between these hospital based specialists and our ambulatory specialists is critical to our continued process improvement Kadlec executives are also looking to improve communication and care coordination with physicians outside of the system Last year the system entered into a strategic alliance with a public hospital PMH Medical Center Prosser Wash The agreement included a plan to bring PMH physicians and PMH Medical Center online with Kadlec s new electronic health record so that it would be easier for them to coordinate care with specialists in the Kadlec system Measuring the Results In addition to measuring revenue and quality metrics leaders at Kadlec are developing numerous performance measures to track their progress toward functional integration Wortman said These include Viability of primary care practices in key markets Ensuring the success of certain physician practices can help sustain the system over time Time to access care In a functionally integrated system patients should not have to wait weeks to be seen by a specialist Wortman said Physician engagement While difficult to quantify having an engaged medical staff helps support integration efforts Lower cost per unit of service Like an HMO Kadlec is exploring how to track how much they spend per patient per month so they are ready for risk based payments Wortman said Laura Ramos Hegwer is a freelance writer and editor based north of Chicago laurahegwer comcast net Access Halley s and Wortman s slides from their November 2012 webinar From Structural to Functional Integration organized by The Halley Consulting Group Interviewed for this article Marc D Halley is president and CEO The Halley Consulting Group Westerville Ohio mhalley halleyconsulting com Rand Wortman is president and CEO Kadlec Health System Richland Wash rand wortman kadlecmed org Discussion Starters Forum members Please add your insights questions and comments about this article on the CFO Forum s LinkedIn discussion board What are the biggest challenges for CFOs helping their organizations manage the referral path What suggestions do you have for hospitals looking to overcome operational silos that can stall functional integration Or perhaps you have another discussion starter Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta

    Original URL path: http://www.hfma.org/Content.aspx?id=15784 (2016-02-10)
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  • Zeroing in on Patients with a High Risk for Potentially Preventable Admissions
    and Hospitals INTERACT to Reduce Readmissions Discussion Starters Forum members Please add your insights questions and comments about this article on the CFO Forum s LinkedIn discussion board What is your health system s strategy for reducing potentially avoidable admissions and readmissions In your health system what percentage of admissions start in the ED BACK TO PAGINATION An authority on long term care offers a targeted approach that could help hospitals get the most bang out of their efforts to reduce unnecessary hospitalizations and readmissions Nursing home residents who visit the emergency department ED represent a prime target for hospital admission reduction efforts says Joseph G Ouslander MD senior associate dean for geriatric programs Charles E Schmidt College of Medicine Florida Atlantic University Boca Raton Fla Ouslander s recommendation is based on three facts More than half of all hospital admissions and readmissions begin in the ED according to a February 2006 statistical brief Nursing home residents who have an ED visit are highly likely to be hospitalized according to an October 2011 study in the Journal of the American Geriatrics Society In 2008 48 percent of the 9 1 million ED visits by nursing home residents resulted in hospitalization compared to only 13 percent of ED visits by non nursing home residents More than 70 percent of potentially preventable hospitalizations start in the ED according to the 2006 statistical brief cited above A Two Step Framework Given these facts Ouslander suggests that hospitals work collaboratively with their local nursing homes to develop and track a set of quality measures for all nursing home patients who are transferred to the ED He offers this framework to get started Track all unplanned hospital admissions Track admissions or readmissions for specific diagnoses and conditions that are associated with potentially preventable hospitalizations Altered mental status or delirium Cellulitis Congestive heart failure Chronic obstructive pulmonary disease Dehydration electrolyte imbalance Gastrointestinal conditions including nausea vomiting and diarrhea Pneumonia respiratory infection Sepsis Urinary tract infection More Improvement Opportunities Ouslander also suggests establishing joint quality improvement initiatives and interdisciplinary teams to review Clinical information from nursing home discharge transfer forms to determine whether the transfer was preventable Data about adherence to clinical practice guidelines for medical conditions associated with potentially preventable hospitalizations in nursing homes as well as in the ED and the hospital Analysis of these data should help hospital leaders identify opportunities for reducing unnecessary hospitalizations for nursing home residents says Ouslander who is also past president and board chair of the American Geriatrics Association This may involve collaborating with nursing home staff or changing ED processes For example the pressure on ED physicians to move patients quickly through the ED may lead to unnecessary admissions Emergency room physicians and nurses are tasked with doing things quickly They are there to see a problem and make a judgment about it so if they are under a lot of time pressure they have no choice but to take complicated patients and just admit them he says An Important Target Avoiding unnecessary hospitalizations for frail elderly patients is not just good for the hospital s bottom line it is also best for patients health status Ouslander says The majority of admissions of older people are appropriate and necessary for safe care But there s a certain proportion of them that are not and they lead to a whole variety of complications that affect peoples ability to function and quality of life he says That s what we need to target I truly believe that by working together to reduce these unnecessary hospitalizations we can improve care reduce complications and reduce costs Lola Butcher is a freelance writer and editor based in Missouri Interviewed for this article Joseph G Ouslander MD is project director INTERACT and senior associate dean for geriatric programs Charles E Schmidt College of Medicine Florida Atlantic University Boca Raton Fla Joseph Ouslander fau edu Learn more about nursing home readmissions in the HFMA Leadership article Nursing Homes and Hospitals INTERACT to Reduce Readmissions Discussion Starters Forum members Please add your insights questions and comments about this article on the CFO Forum s LinkedIn discussion board What is your health system s strategy for reducing potentially avoidable admissions and readmissions In your health system what percentage of admissions start in the ED Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a

    Original URL path: http://www.hfma.org/Content.aspx?id=15498 (2016-02-10)
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  • The Changing Basis of Competition in Health Care
    Kaufman Hall Associates LLC Skokie Ill Sidebar Questions for Provider Leadership Teams to Ask Themselves What is the basis of competition in our market today How is the basis of competition changing and how quickly How are we adapting our business model What are the likely triggers or catalysts that will signal full scale market conversion to value based care delivery and payment On what bases of competition would we have an advantage in a value based care environment How might we leverage those advantages What would be our biggest gaps or deficiencies in a value based environment How can we address those gaps Publication Date Wednesday July 15 2015 BACK TO PAGINATION From forum sponsor Kaufman Hall Associates LLC The potential for hospitals and health systems to differentiate themselves from their competitors in the shifting healthcare environment depends on their ability to coordinate care increase efficiency and adopt a consumer oriented focus Numerous forces are converging to move health care to a value based business model including increased consumer skin in the game through enrollment in plans with high deductibles the proliferation of retail health clinics and the emergence of services offered via mobile applications Such forces are driving a fundamental transformation in U S health care changing the ways in which hospitals health systems physician groups and other industry stakeholders compete in their respective service areas Looking at the big picture an industry s basis of competition is the collection of benefits that most influence a customer s choice between competing products or services Basis of competition is not static It is customer segment specific and variable changing over time as circumstances and customer needs shift at different speeds in different markets As the basis of competition rapidly evolves in today s healthcare industry organizations are compelled to compete based on new criteria Shifting Focus Areas In the recent past patients played largely passive roles relying heavily on their providers to direct their care choices Hospitals gained patients primarily via physician referrals Competition among hospitals health systems and other industry participants focused largely on factors such as physician relationships driven by the hospital s role as the physician s workshop location payer mix and reputation As patients become more engaged in their health and health care they increasingly compare their options and seek companies capable of organizing care for them in ways that ensure high quality services low costs and convenient access These organizers of care i e healthcare companies may be health systems health plans independent practice associations or other entities Whereas the focus in recent decades was on building new facilities and expanding services to increase revenue the new healthcare era emphasizes improving quality while also reducing costs by optimizing efficiencies and eliminating redundancies For providers these changes require new emphasis on criteria such as customer engagement and transparency of cost and quality measures Cost likely will be a top determinant in patient choice moving forward as patients bear more out of pocket expenses through participation in healthcare exchanges and high deductible health plans Other competitive criteria are an organization s level of clinician physician alignment network configuration and rationality and care management capabilities In particular hospitals and health systems wishing to fulfill the healthcare company role will have to demonstrate their ability to manage care across the care continuum and right size their care delivery system They must be able to create a product that will be price competitive in the evolving market As health care becomes more consumer oriented organizations also will need to build substantial clinical and business intelligence to track patient needs and preferences Factors such as ensuring quality and safety while critical are increasingly assumed and less significant as competitive differentiators Four Dimensions of Competition At a core level an industry s basis of competition typically involves four distinct dimensions Functionality Does the product or service actually work Reliability Is the product or service consistent and replicable Convenience Is the product or service readily accessible Price Is the product or service worth the cost The speed and level of change within and across these dimensions can vary by market segment and service and the dimensions often overlap In some markets for example two health systems may be competing to make emergency services more accessible to rural residents through freestanding sites extension of transport capabilities or telehealth connections with specialists in a metropolitan area In a more evolved urban market residents may have multiple options for accessible emergency services and ready substitutes for non emergent care These health systems must compete at a higher level based on price consumer engagement and care coordination History is full of examples of organizations that either succeeded or failed in reshaping their business models to adapt to basis of competition changes Apple for example has remained a leader in its industry over the years by successfully transitioning from offering hardware to offering software and now an array of mobile and cloud based products and services For hospitals and health systems success in navigating new bases of competition will hinge on their ability to significantly streamline internal operations and to partner with other providers to maximize efficiencies and coordinate care within a delivery network Brian Fuller is a senior vice president in the Strategy Practice at Kaufman Hall Associates LLC Skokie Ill Sidebar Questions for Provider Leadership Teams to Ask Themselves What is the basis of competition in our market today How is the basis of competition changing and how quickly How are we adapting our business model What are the likely triggers or catalysts that will signal full scale market conversion to value based care delivery and payment On what bases of competition would we have an advantage in a value based care environment How might we leverage those advantages What would be our biggest gaps or deficiencies in a value based environment How can we address those gaps Publication Date Wednesday July 15 2015 Comments Please login to add your comments Add Comment Text Only

    Original URL path: http://www.hfma.org/Content.aspx?id=32150 (2016-02-10)
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  • CFO Thinks Out-of-the-Box to Add Millions to the Balance Sheet
    Interviewed for this article Jeffrey Costello is CFO Beacon Health System South Bend Ind Matthew Krathwohl is executive director of innovation Beacon Health System South Bend Ind Discussion Starters How does your health system encourage innovation Please share an example of financial innovation from your hospital or health system Publication Date Tuesday May 14 2013 BACK TO PAGINATION Trained to look for innovation opportunities the finance team at Memorial Hospital of South Bend Ind acted boldly during the 2008 financial crisis and strengthened its balance sheet by 22 million in just six days When the Wall Street crisis hit in 2008 Memorial Hospital of South Bend was just as vulnerable to the frozen credit markets and the plummeting stock market as any other organization But vice president and CFO Jeff Costello did what he was trained to do In our view every crisis creates opportunities he says As the financial catastrophe was unfolding on Oct 2 2008 Costello called Memorial s financial advisors to find what opportunity might present itself One of the advisors mentioned that floating rate notes FRNs tax exempt bonds with variable interest rates were trading at deep discounts and Costello saw his opening Memorial had 80 million outstanding in FRNs In the next six days Memorial used its cash on hand to buy 52 million of the bond issue from a panicked mutual fund at 57 percent of face value That created a 22 million gain for the hospital s balance sheet Several months later the owner of the remaining FRNs needed to sell Memorial repurchased those bonds at a 51 percent discount The total win for Memorial s balance sheet was 35 4 million at a time when many hospitals were hunkered down waiting for the financial storm to pass We knew this was going to have a very short term negative implication to the balance sheet from a liquidity perspective because we were going to use cash to buy back our debt but we knew it had huge upside potential from a long term perspective Costello says This is a sample article from HFMA s CFO Forum a job specific networking community Learn more about the Forums Innovative Thinking Memorial Hospital now part of the Beacon Health System was positioned to act boldly in a time of crisis because its organizationwide culture supports and rewards innovation Staff members throughout the organization are trained in the Innovation WOW Projects methodology developed by management consultant Tom Peters author of In Search of Excellence Through that training Costello and his colleagues have learned how to create and implement projects with the goal of always taking Memorial to the next level of performance excellence The value of innovation is instilled in the hospital s culture spurring leaders to act rather than to be paralyzed during times of adversity I knew that we didn t have a lot of time to evaluate this opportunity Costello says So I literally dropped what we were doing and said Let s focus on this and see if we can make this happen Although the project lasted only a few days it included four distinct phases of the WOW methodology Create the project The create phase is when an idea coalesces to make an organization stronger in a new way says Matthew Krathwohl executive director of innovation for the Beacon Health System By analyzing how the financial crisis affected the world outside Memorial Costello was able to see an opportunity that was mutually beneficial to the hospital and its bondholder Sell the project To pursue the idea Costello needed the support of his hospital colleagues outside experts including legal counsel bond counsel and investment bankers and the hospital s board of directors An essential tool for the sell phase is an elevator speech that quickly communicates the idea In a concise way he had to present this compelling vision that would be mutually beneficial to all parties involved Krathwohl says Execute the project With the necessary support in place the bond buyback program became a series of steps e g negotiating the terms preparing the contract implemented on a fast track Move on The last phase of the Tom Peters methodology is to celebrate and move on whether that means having a department pizza party or as we have done here making sure that certain projects receive recognition during a board meeting Krathwohl says Part of the move on phase is to capture lessons learned from the successful project that could be used in future endeavors Indeed Costello used those lessons six months later when the holder of the rest of Memorial s FRNs wanted to sell The project team was reassembled to replicate the process leading to another 13 4 million improvement in Memorial s balance sheet Out of the Box Approaches Costello believes the WOW methodology is one of many approaches to project management that can be successful But he credits staffwide training that fosters out of the box thinking with creating an organizational culture that encourages innovation I think it is about being proactive being creative thinking opportunistically and executing on whatever it is you re working on he says Those are the keys to success Lola Butcher is a freelance writer and editor based in Missouri Interviewed for this article Jeffrey Costello is CFO Beacon Health System South Bend Ind Matthew Krathwohl is executive director of innovation Beacon Health System South Bend Ind Discussion Starters How does your health system encourage innovation Please share an example of financial innovation from your hospital or health system Publication Date Tuesday May 14 2013 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging

    Original URL path: http://www.hfma.org/Content.aspx?id=16885 (2016-02-10)
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  • Patient Financial Engagement Starts with Communication
    managed care contract pricing as well as additional training for patient access staff Access our whitepaper for the entire 10 step workflow The steps are grouped into the progressive sequences of communicate navigate and capture Together they offer a roadmap for discussing what patients need and want to know about their medical costs and payment options and helps providers help patients make financial decisions As a result of providing the right information at the right time and a better financial experience for patients providers then earn their loyalty and increase their satisfaction Nicole Miller is vice president product management Careayment Lake Oswego Ore Publication Date Wednesday April 15 2015 BACK TO PAGINATION Insights from Forum sponsor CarePayment Engaging new healthcare consumers financially is an important first step to engaging them clinically which is central to providers efforts to lower costs and improve outcomes through population health management and related initiatives Relatively few providers are currently equipped to discuss and arrange financial services and payment options upfront with every patient They also must overcome the hurdle of long standing payment behavior Conditioned to wait to find out their financial obligation when medical bills arrive months after treatment and insurance pays its share patients are often caught off guard if asked to make financial arrangements beyond meeting their copays especially as many feel ill or stressed about their health In a recent whitepaper we offer a 10 step workflow to enable healthcare organizations of all sizes to successfully update their revenue cycle to financially engage patients in compassionate and practical ways The first three steps in this workflow revolve around improved communication with patients Step 1 Promote financial programs pre service When it comes to healthcare marketing providers generally focus on promoting clinical expertise rankings on best lists and amenities They should add financial services to their outreach efforts As consumers increasingly shop for medical care they are choosing hospitals physician groups and other healthcare providers at least in part on how they handle patient financial matters From prominent website placement media coverage and advertising to facility banners posters brochures and other marketing materials promoting patient financial services is a highly visible declaration that a provider cares about patients physical and financial health It clarifies for both parties the expectations surrounding payment offering patients peace of mind about how they are going to pay and reducing the providers time and effort spent trying to collect unpaid patient balances Step 2 Connect in multiple ways Consumers like to communicate in different ways from in person and text to email and phone Reaching out in a variety of ways gives patients convenient choices for interacting with providers eliminating missed opportunities to provide the financial help they need to receive treatment Once a consumer makes clear their favored method or methods of communication providers can build stronger ties to patients by personalizing their communications to cater to those preferences Some of the steps revenue cycle and patient access staff can take to facilitate alternative communication options for patients is to evaluate and update intake documents to include requests for email addresses communication preferences and consent By capturing this information up front providers can offer more convenience to patients and can employ more cost effective means to conduct outreach For example autodialing or texting cell phones would be compliant with the Telephone Consumer Protection Act regulations throughout the revenue cycle if a patient s express consent for these practices can be gathered during the admission process Step 3 Estimate patient balances Not knowing how much care is going to cost can add more tension and uncertainty to an already stressful situation for many patients Giving patients a reasonably accurate idea of their obligation allows them to make informed confident decisions about their care and payment options Accurate balance estimation entails integration of real time verification of benefits and managed care contract pricing as well as additional training for patient access staff Access our whitepaper for the entire 10 step workflow The steps are grouped into the progressive sequences of communicate navigate and capture Together they offer a roadmap for discussing what patients need and want to know about their medical costs and payment options and helps providers help patients make financial decisions As a result of providing the right information at the right time and a better financial experience for patients providers then earn their loyalty and increase their satisfaction Nicole Miller is vice president product management Careayment Lake Oswego Ore Publication Date Wednesday April 15 2015 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques

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  • Using Social Media to Accelerate Your Healthcare Finance Career
    and president Come Recommended LLC Derwood Md heather comerecommended com Steve Marshall is director of patient financial services Margaret R Pardee Memorial Hospital Hendersonville N C and a member of HFMA s North Carolina Chapter steve marshall pardeehospital com Publication Date Wednesday June 13 2012 BACK TO PAGINATION By Jason Bramwell As Steve Marshall director of patient financial services at Margaret R Pardee Memorial Hospital can attest using social media sites like LinkedIn can provide opportunities for career advancement and for maintaining relationships with other finance leaders and colleagues If it were not for LinkedIn Steve Marshall may have never known about the job he currently holds as director of patient financial services at Margaret R Pardee Memorial Hospital Hendersonville N C This is a sample article from HFMA Forums which are online job specific discussion communities for healthcare finance leaders Learn more about HFMA Forums and subscribe In spring 2011 while working as director of patient financial services and physician billing at Methodist Medical Center of Illinois in Peoria Marshall was contacted by a recruiter who saw his LinkedIn profile which includes several career accomplishments such as Led significant reductions in accounts receivable for hospital and physician services Led revenue capture projects that resulted in eight figure enhancement to emergency department revenue Participated in managed care and compliance committees resulting in improved compliance and contractual performance which impacted the bottom line I m here because a recruiter identified me through LinkedIn as a potential candidate for this organization says Marshall By listing accomplishments in your LinkedIn profile it makes it easier for recruiters to look and say This is the candidate who we need Whether it s Facebook LinkedIn Twitter or even the HFMA Forums listserv healthcare finance leaders can use social media in a variety of ways to advance their careers Creating an Eye Catching Profile The three main social media sites Facebook LinkedIn and Twitter are valuable for different reasons and healthcare finance leaders should create online profiles for each platform recommends Heather Huhman president Come Recommended LLC a Derwood Md based content agency specializing in careers recruiting and human resources LinkedIn is great for keeping in touch with former supervisors colleagues and professional acquaintances whereas Facebook is a better place for connecting with your personal network of friends and family she says Twitter is a great tool for connecting with people who you already know and people who you have never met such as other thought leaders or people you admire By including the following three elements Huhman says healthcare finance leaders can elevate their social media profiles from good to great Profile photo The user s photo is often the first thing people see when they access an online profile she says It should be a professional headshot not a group picture or something that could be deemed inappropriate by other healthcare finance professionals adds Huhman On sites like Twitter profiles without photos are often thought of as spam Professional headline In a LinkedIn profile the text under the user s name is called a professional headline It defaults to the person s most current job title but can easily be changed and made more eye catching says Huhman She recommends including skills that set you apart from other healthcare finance leaders or notable achievements that define you For example if you ve written a book about healthcare finance include notable author or healthcare finance author in your headline says Huhman Career accomplishments Huhman says it is important to detail career accomplishments in your profile along with your job history What did you do to add value to the hospital or health system Use dollar amounts and figures when possible she says Shaping Your Personal Brand Huhman says social media is all about shaping your personal brand Do you want to be a go to source for healthcare finance information Think about what you want to be known for to determine how to best go about accomplishing your goals she says Huhman shares the following advice on how healthcare finance leaders can build and create relationships with other key finance professionals through social media Share valuable content It s best to share content like links to valuable and interesting articles or blogs on a daily basis she says By sharing content that is interesting and thought provoking you can often spark a conversation with your connections and gain new connections based on what you re sharing Engage with your networks Successful networking is all about building a two way mutually beneficial relationship she says Regularly engaging with your connections such as commenting on status updates sharing content with them and liking the content they post is important for building relationships and strengthening existing ones Show your passion as a thought leader Healthcare finance leaders are passionate about their industry Make that apparent by positioning yourself as a thought leader she says Create a blog if you re interested in writing about topics related to healthcare finance Provide insight on current events or share advice on breaking into the industry Passion is something that is apparent to others and will make you admirable as a thought leader Staying in Touch with Peers Although he doesn t often initiate discussions on LinkedIn Marshall says he checks the networking site daily to read articles his connections have posted and to see what his colleagues are up to LinkedIn has been helpful because I can build and maintain networks in the different regions I ve worked in he says I ll send short messages through LinkedIn to folks I used to work with just to see how they re doing Marshall is also an active contributor to HFMA s Forums listserv which uses email and specialized service software to enable communication exclusively among Forums members Only Forum subscribers can access the listserv Learn more about HFMA Forums and subscribe The listserv is a great resource of people in the profession You can use it as a sounding board to

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  • Management Services Agreements Offer Path to Efficiency, Growth
    and productive partnership Ryan S Gish is a managing director Kaufman Hall Associates LLC Skokie Ill and a member of the firm s Strategy practice David M Cyganowski is a managing director Kaufman Hall Associates LLC and is based in New York City Discussion Starters Forum members What do you think Please share your thoughts in the comments section below In which operational areas or service lines are management services agreement especially beneficial What are some reasons to be cautious about entering into a management services agreement What advice would you give a hospital or health system that is considering entering into a management services agreement Publication Date Monday August 17 2015 BACK TO PAGINATION Insights from forum sponsor Kaufman Hall Associates LLC An increasing number of hospitals and health systems are pursuing management services agreements as a means to grow leverage their fixed cost base and gain access to expertise and other benefits of scale Management services agreements MSAs typically involve a contractual arrangement for a larger healthcare system to provide partial or full management services for a smaller organization In some cases organizations enter into service or expertise specific MSAs such as for purchasing or clinical best practices The larger system commonly provides services in exchange for a negotiated fee For example the smaller entity may pay management fees equal to a percentage of annual operating revenue plus incentives when it meets mutually agreed upon performance goals These agreements do not involve a change in ownership or governance and thus do not require state or federal regulatory approval In an environment of increasing cost pressure with significant work already having gone into harvesting traditional cost reduction opportunities MSAs offer an alternative means to maintain a strong financial position and or address specific competency requirements Numerous health systems have pursued MSAs to garner some of the financial and operational benefits of a partnership without having to engage in a more integrated arrangement Realizing the Benefits of MSAs Both partners can benefit from an MSA For the health system providing management services such agreements offer a new revenue source and the chance to expand share in an existing market or to establish share in a new market The economic risk is minimal because the health system does not assume debt or other liabilities of the managed organization Typically the managing entity does not supply a cash infusion or a commitment to major capital projects For managed entities MSAs may provide hitherto strong but smaller organizations the support of a larger more sophisticated system while allowing them to maintain governance autonomy and independence Such agreements also may offer an opportunity for distressed hospitals to rebuild financial strength while ensuring the community asset remains under local control In either case the managed entity benefits from access to the larger system s operational expertise and other advantages of scale For example smaller organizations often are unable to support the level of specific management expertise that their MSA partner brings An executive at a small hospital often must be a jack of all trades with a wide range of responsibilities while the revenue base of larger systems allows for more specialization Both organizations in fact benefit from increased scale which allows for improved efficiencies and savings in areas such as supply chain sourcing and procurement Increased scale enables both entities to allocate costs across shared service areas thereby achieving a lower cost per unit Other potential joint benefits include the ability to Align key performance and operational incentives Achieve back office and support function synergies Integrate IT platforms Share intellectual capital by linking quality programs and best practices Health systems that are looking to rapidly expand into neighboring markets may use MSAs as a growth vehicle through longer term agreements with multiple smaller providers Several large health systems and integrated delivery systems across the country have established management services as a separate and distinct business line for this purpose Many of these MSAs have been around for decades while in other cases systems are moving quickly to meet market demand for this form of affiliation Some organizations enter into MSAs as a way to test the waters for a defined period of time e g five years as a prelude to a full asset merger or other more integrated partnership MSAs allow both entities a chance to work together and to assess operational and cultural compatibilities before pursuing a more binding arrangement Quantifying the Savings The leaders of a community health system with an A rating and approximately 1 billion in net revenue sought a partnership that could provide the benefits of scale while allowing the organization to remain independent The system was approached by a 4 billion multistate integrated delivery system with centralized shared services and a hospital in the same market as the community based system The larger system presented the community system with a tailored value proposition including the provision of shared services in the areas of supply chain biomedical engineering insurance and risk The savings for the community based system were estimated at more than 35 million over five years The community health system entered into the MSA and started building a relationship with the more advanced integrated delivery system The agreement has the potential to expand to other areas such as clinical affiliations and population health management initiatives Balancing Benefits and Risks Before pursuing an MSA organizations should consider both the benefits and potential challenges MSAs often require complex negotiations to establish the management system and contract structure including defining the duration of the agreement performance targets and metrics service commitments and exit provisions It is essential to ensure that incentives are aligned relative to the goals of each party and that a shared vision for the partnership exists Smaller organizations may be concerned about being a low priority for the larger organization Larger organizations meanwhile may be concerned about extending too much expertise and thereby discouraging the managed entity from future interest in a more integrated partnership Overall

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  • Evaluation of MTIs Critical in Efforts to Maximize Partnership Synergies
    partnership be it an acquisition merger long term lease or other type of arrangement yet the benefits can be significant To address these challenges executives in finance and other areas must be thorough and consider all available avenues Finding customized solutions likely will involve significant investments of time and resources but will be vital to many organizations success Matt Robbins is a vice president financial advisory practice Kaufman Hall Associates Inc Skokie Ill and a member of HFMA s Massachusetts Rhode Island Chapter Kate Guelich is a managing director Kaufman Hall Associates Inc and a member of the strategic financial and capital planning and financial advisory practices Publication Date Wednesday September 10 2014 BACK TO PAGINATION Insights from Forum Sponsor Kaufman Hall Associates Hospital and health system leaders seeking to realize synergies as part of a merger or acquisition should consider four key factors in combining the documents that govern organizations borrowing provisions Hospitals and health systems nationwide are working to determine how best to achieve the efficiencies and scale needed to succeed in the new healthcare era The high level of merger and acquisition activity continues among not for profit hospitals as organizations seek financial operational and clinical synergies Chief among those desired synergies is the ability to consolidate capital structures to lower the overall cost of capital and maximize operational flexibility and efficiency Yet the growing complexity of partnerships and the diversity of entities involved make the process increasingly complicated Identifying capital structure synergies requires a thorough review and comparison of each organization s master trust indenture MTI which governs the current and future borrowing provisions for most not for profit hospitals and health systems It is the agreement between the entity or group of entities formally obligated to repay the debt i e the credit group and a master trustee typically a bank that assumes certain fiduciary responsibilities on behalf of lenders The specific terms of these documents are unique to each entity and define the legal conduct on which synergies may be realized They may have significant implications in optimizing the ability of combining organizations to fully integrate their operations With separate MTIs each credit group may have to maintain a separate balance sheet which may limit the ability to commingle cash and investments or to transfer funds or other assets Considering whether multiple MTIs can be combined into one governing document is one crucial consideration for effective partnerships Consolidating MTIs There is no single solution set for organizations seeking to consolidate MTIs A plan that works for one newly merged entity may not be appropriate for another Others will be unable to find any viable plan due to prohibitive provisions and or high costs Organizations may consider a range of tactics to improve the chances of a successful outcome such as refinancing the bonds offering to tender the bonds or seeking note holder consent to amend certain provisions Many successful MTI consolidations have used some combination of tactics Here are four factors healthcare leaders should consider as they evaluate their options Realizing the full capital structure benefits of the combined organization Management should determine how consolidating MTIs will affect the credit position of the combined health system Consolidating MTIs may offer opportunities to improve borrowing costs and terms potentially increasing overall debt capacity It also may provide for lower borrowing costs and lower investment management fees Ensuring the MTI and capital structure don t impede anticipated operational benefits The merger integration process requires considerable coordination to ensure anticipated operational synergies It is essential that the legacy MTIs and credit groups while they remain outstanding do not impede this process Any potential issues or restrictions imposed on the organization such as an inability to transfer funds between entities must be quickly addressed Reducing or eliminating security and financial covenants In consolidating MTIs healthcare leaders should take advantage of the opportunity to reduce or eliminate security provisions restrictive financial covenants and other requirements as practicable Examples might be the ability to release a mortgage security on real assets like the main hospital or hospitals or the removal of a restrictive financial test such as days cash on hand or debt to capitalization Lowering capital costs and maximizing operational flexibility By leveraging the scale of the combined organization health systems may be able to negotiate lower borrowing costs and more favorable terms in issuing new debt Management should evaluate in advance how and where they can reduce capital costs and weigh any short term losses associated with refinancing debt against the long term costs and or benefits Consolidating MTIs also can provide the merged health system more flexibility in how it uses capital and operating funds To determine the best MTI solution for a particular partnership organizations should ensure a thorough analysis of related bond and swap documents and an in depth analysis of the financial impact of proposed solutions Garnering input from various experts and stakeholders including lawyers advisors auditors and if necessary note holders and other credit providers will help ensure a viable and comprehensive solution Finding Solutions May Require Significant Resources Consolidations continue among hospitals and health systems nationwide as organizations work to position themselves for long term sustainability under a very different business model How to consolidate capital structures and credit groups are critical considerations The challenges surrounding efforts to consolidate MTIs are unique to each organization and each partnership be it an acquisition merger long term lease or other type of arrangement yet the benefits can be significant To address these challenges executives in finance and other areas must be thorough and consider all available avenues Finding customized solutions likely will involve significant investments of time and resources but will be vital to many organizations success Matt Robbins is a vice president financial advisory practice Kaufman Hall Associates Inc Skokie Ill and a member of HFMA s Massachusetts Rhode Island Chapter Kate Guelich is a managing director Kaufman Hall Associates Inc and a member of the strategic financial and capital planning and financial

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