In this Issue Chapter News − President’s Letter − Editorial Policy, Deadlines… − Editor’s Note − Committee Update − Member Spotlight − Challenges, Optimism Persist for Rural Healthcare − Region 7 Conference Update − Do You Remember When? − Save the Dates Articles − HIP 2.0 − Cyberattacks − Waves of Compliance − Harmonizing Hospital and Physician Financial Assistance Sponsors − Listings and Logos Hoosier Times: Summer Issue Upcoming Events National Webinars August 26, 2016 Baseball and Picnic Outing (Community Service Project at Event) September 15, 2016 HFMA Virtual Conference: Health Care 2020 -The Ongoing Transition to Value October 5-7, 2016 Fall Institute and Golf Outing January 26-27, 2017 Winter Institute Please check website for updated information and events: www.hfma-indiana.org Hoosier Times - Indiana Pressler Memorial Summer - 2016 Page 1
Transcript
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In this Issue
Chapter News − President’s Letter
− Editorial Policy, Deadlines…
− Editor’s Note
− Committee Update
− Member Spotlight
− Challenges, Optimism Persist for Rural Healthcare
− Region 7 Conference Update
− Do You Remember When?
− Save the Dates
Articles − HIP 2.0
− Cyberattacks
− Waves of Compliance
− Harmonizing Hospital and Physician Financial Assistance
Sponsors − Listings and Logos
Hoosier Times: Summer Issue
Upcoming Events National Webinars
August 26, 2016 Baseball and Picnic Outing (Community Service Project at Event)
September 15, 2016 HFMA Virtual Conference: Health Care 2020 -The Ongoing Transition to Value
October 5-7, 2016 Fall Institute and Golf Outing January 26-27, 2017 Winter Institute
Please check website for updated information and events: www.hfma-indiana.org
Hoosier Times - Indiana Pressler Memorial Summer - 2016
Welcome to the 2016-2017 Chapter year! In preparing to write this letter, I took a minute to think back on the years in which I have been involved with the Indiana Pressler Memorial Chapter of HFMA. I remember being approached from Chapter leaders saying “join a committee, get involved.” They made a promise to me saying that the more you put into HFMA the more you will get out of it. Boy were they right! I started as a committee member, then the chair of several committees, a Director on the Board and, eventually, an Officer and now President. It has been a fantastic experience each step along the way. HFMA has afforded me the chance to learn, grow professionally and foster lifelong relationships. It is truly an honor to be President of this well respected Chapter.
First, I would like to congratulate our immediate Past President, Randy Russell, on a great 2015-2016 year for our Chapter. Under Randy’s leadership, we obtained 80 out of the possible 100 points under the Chapter Balance Scorecard and was awarded a Yerger Award for Improvement at this year’s Annual Chapter Awards Dinner held during ANI. I am excited about this Chapter year and looking forward to following Randy’s example. My primary focus will be to sustain the excellence we have achieved in education, networking, and leveraging the knowledge gained amongst those who face the same challenges. With this year’s education planning and coordinating in full swing, our Committees are already off to a great start. We had a very successful mini LTC with over 40 Chapter Leaders and Volunteers on hand. What a great experience that was to have that many people taking time out of their busy schedule to help make our Chapter one of the best in the nation! Mary Mirabelli, our National Chair for the 2016-2017 year, has chosen the theme of “Thrive.” Our Chapter will use “thrive” in our approach to traditional educational programs. For example, something new for us this year was the Region 7 “WI be chIL IN by the lake” summer event. While similar to the Tri-State event, this program brought Chapters from Indiana, Illinois and Wisconsin together for a large education and networking event. Furthering our approach to doing things a little differently, the Chapter was able to obtain a bus to transport members to and from the event using HFMA Innovation dollars so there was no cost to our members to use the bus. Please do not forget about our Indianapolis Indians baseball game scheduled for Friday, August 26, 2016! If you have not done so, go to http://www.hfma-indiana.org/events and sign up now. In closing, I would like to thank you, our members, for making this Chapter what it is today. I can say, in all honesty, we have one of the strongest chapters in HFMA and let’s keep it going! Jack L. Bishop II
President’s Letter by Jack L. Bishop II
Hoosier Times - Indiana Pressler Memorial Summer - 2016
Welcome to the 2016 Summer Edition of the Hoosier Times. We hope you will enjoy the many updates about Chapter activities as well as the informative articles on current industry issues. Our goal is to make this publication better and of value to you. If you have not already done so, please consider completing our on-line Newsletter survey so we will know what to include and how to improve this Newsletter. The survey will take you only a few minutes to finish, as it asks for your opinion on topics to include, the readability of the updates and articles, and the Newsletter’s length. The survey can be accessed at: 2016 Indiana Pressler Newsletter Member Survey
I would like to take this opportunity to echo our President’s message of getting involved in HFMA and our Chapter by joining one of our Chapter Committees. Inside this newsletter you will find overviews for each committee (visit our Chapter’s Website http://www.hfma-indiana.org/ to sign-up). There is still plenty of time to get involved in the current year’s Committee and Chapter events. If there is anything I can do answer to any questions or help you get connected with specific activities in our Chapter, please do not hesitate to reach out to me.
I would like to say a big “thank you” to everyone on our Communications Committee, as well as the many other Chapter members who did a great job of gathering and preparing the materials for our 2016 Summer Newsletter. Also, please take a few moments to look at the “Save the Date” section of the Newsletter and plan on attending the Summer Networking and Fall Institutes/Networking events - hope to see you there!
General Policy The statements and opinions expressed in articles or features are those of the author(s) and do not necessarily reflect the view of the Indiana Pressler Memorial Chapter, the Healthcare Financial Management Association, or the Editor. The Editorial Board reserves the right to edit material and to accept or reject contributions whether solicited or not. All correspondence is assumed to be released for publication unless otherwise indicated. All rights reserved.
Questions regarding articles or features should be addressed directly to the author(s). All article submissions must be typed and sent via email or provided on a disc.
Deadlines All submissions must be received by the following dates. Materials received after an Edition’s deadline are not guaranteed to be published: October 20, 2016 Fall Edition January 19, 2017 Winter Edition April 13, 2017 Spring Edition July 13, 2017 Summer Edition All submissions, correspondence, advertising, and comments should be sent to David Parry, Editor – Hoosier Times
With the exception of business cards, discounts are available for advertising in consecutive issues. Ads should be in high res .tif, or .jpg files at least 300 dpi – submit via email to [email protected]
Editorial Policy, Publication Deadlines and Advertising Rates
Editor’s Note by David Parry
Hoosier Times - Indiana Pressler Memorial Summer - 2016
Following the Mini LTC, Chapter committee goals and membership were set for the current year (2016-17) year and are listed below: Awards and Recognition Committee
Goal: Seek out opportunities for membership recognition and awards from Chapter/HFMA services
Members: Randall Russell (Chairperson) Communication Committee
Goal: Provide communication and education for members through the Chapter’s Newsletter o Evaluate the Newsletter and other media options to best meet Chapter member needs
Members: Eric Day, Dustin McKinley, Jim Miller, David Parry (Chairperson), Kimberly Pendzinski, Rick Rhew, Jerry Smith, Nick Wolf
Education Committee
Goal: Design and provide all educational programs for Chapter members. For event topics, the Team strives to stay current on National and Local healthcare related topics; this year, National HFMA has challenged us to include topics that are related to Providers, Physicians, and Payers, as well as early-careerists and women in healthcare. Targeted event activities include:
o Fall, Winter, Spring Institutes; Region 7 and Tri-State conferences o Lunch and learns throughout the state o Exploring opportunities with other organizations such as IMGMA and IRHA
Members: Trae Christian, Lindy Beldyga, Phil Ellis, Sally Hargrove, John Kraft, Amber LaRue, Farrah Mahoney (Chairperson), Karen Meyer, Andrea Mott, Meghan Linvill McNab, Pat Rocap, Sheila Thomas, Jean Young
LINK Committee
Goal: The continuance of these Chapter Committees is being evaluated by National HFMA, and will likely be decided with the REC (Regional Executive Committee) meetings in November
In May, Chapter members convened for a Mini LTC at Fort Harrison State Park in Indianapolis. In addition to social and networking opportunities that included golf, horseback rides, a bean bag toss tournament and euchre, Chapter Board and Committee members discussed plans and goals for the upcoming year…
Committee Update
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o The goal of the LINK committee has been to provide a coordinated mechanism for HFMA Chapters to give feedback to National HFMA on proposed regulations/legislation that could affect our industry, by getting feedback from a cross section of our provider membership. Feeding that information back to National in this coordinated fashion enables National HFMA to present a collective voice to those legislators responsible for creating and passing those laws or regulations.
The original structure was to send out one topic every quarter to the Chapter Link Committees and ask for feedback within 3 weeks or so. Our Chapter was well represented from 2012-2015. But across the nation it was not getting much traction. Only 10% of the Chapters were proving feedback. Over 1/2 the Chapters of HFMA didn’t even have active committees.
In 2015 National decided to stop sending the emails. In March of 2016 a small focus group (comprised of several LINK committee chairs and representatives from National) met to discuss either revitalizing the LINK efforts or stop it completely; the focus group’s decision was that the LINK committees and structure still had value and should be continued. However, National wanted to reach back out to the Chapter leadership teams and make sure they wanted to support what the focus group suggested; as noted above this decision will likely be made at the upcoming REC meeting
Members: Brad Willkie (Chairperson), Randy Russell , Virginia Martinez, Jack Bishop, Dave Cholger, Barbara Clayton
Membership Committee
Goal: Provide better coordination and awareness of member needs, through: o Achieving Balance Scorecard requirements o Contacting members who have not been attending recent events or need to renew their
membership o Attracting other groups (e.g., long–term care); increasing the number of student
members o Maintaining the membership directory; new member orientation activities and events
Members: Emily Boster, Steve Cooper, Brian Cox, Lisa Earl, J. Hopkins (Chairperson), Tony Taylor, Mark Weber
Networking Committee Goal: Focus on social and networking needs of members; opportunities to include:
o Events at upcoming Institute and educational programs o Networking only events; baseball game(s); lunch and learns at organizations around the
state o Outreach/charity programs
Members: Grant Brackin, Andrew Davis, Sara Falconer, Angie Flora, Lisa Gensigner (Co-Chairperson), Megan Iemma, Jacqueline Kerwin, John Masini, Thelma Retz, Michelle Trowell, (Co-Chairperson), Joshua White
Committee Update - (continued)
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Professional Development Committee Goal: Facilitate Chapter members’ professional growth by providing certification information
and working with National HFMA to promote professional development through on-line tools Members: Laura Adams, Shannon Ebenkamp (Chairperson), Lisa Earl, Andrea Mott, Jon
Townsend Sponsorship Committee
Goal: Securing Chapter sponsors and administering the various financial opportunities for sponsors
o Increase the number of Chapter sponsors o Keep the cost of Chapter sponsorship at current levels
Members: Richard Altman, AJ Beck, Darren Cook (Co-Chairperson), Beck Funk, Kathi Geiger, Brian Gordon, Alicia Henson, Dan Hartnett (Co-Chairperson), Bob Kemp, Bill Logan, Rosalyn Ryan, Shawn Williams, Rick Zimmerman
SUBC – Adhoc Committee
Goal: Review, comment and act on initiatives impacting healthcare institutional billing at the national and state levels; meets quarterly
Members: Healthcare providers, payers, software vendors, consultants; Jim Miller (Chairperson)
Website Committee Goal: Design and maintain the Chapter’s website with fresh and current information
o Evaluate other potential electronic media options to work with the website o Update all Chapter Leadership/Committee information by end of June, 2016 o Work with third-party vendor to assist with the provision of new web content as well as
hosting tools to reduce costs, centralize operations, and improve web management Members: Bill Carmichael (Chairperson)
Additional photos from the Mini LTC…
Committee Update - (continued)
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HFMA Member in the Spotlight – Eric Day By Jerry Smith
Eric Day has a story to share, and he’s not shy about telling it. After coming through much difficulty and tragedy in his life, including several personal health challenges, Eric not only manages to stay positive, he uses his experiences to inspire others to do the same. We asked him to share a bit of that story with others in the chapter. Q. Can you tell us where you grew up and where you live now? A: I grew up in Plymouth, Indiana, which is roughly 30 minutes south of South Bend. I currently live on the North side of Indianapolis.
Q: What about your education? Where did you go to school? A: After graduating high school, I attended Indiana State University for a brief time before transferring to Butler University. In 2015, I graduated from Butler with a degree in Organizational Communications and Leadership. Q. What about your family? A: My family has always been close, with my parents being very supportive of my sister and me. In addition to my immediate family, my sister is married and I am the proud uncle of my adorable nephew who we affectionately call “Worm.”
Q: How did you get started in the healthcare field? A: That’s a funny story. I was actually doing an event at a Butler basketball game and Mark Schabel, RMP’s CEO, was in attendance. After the game we talked, and to make a long story short, he ended up offering me a job at RMP’s Indianapolis office, IMC Credit Services. I didn’t know very much at the time about healthcare, but growing up my parents encouraged me to pick a job where I would be able to surround myself with people I like. Mark made such an impact in that brief conversation that I knew IMC Credit Services would be a good place for me.
Q: Can you talk about your current position? What do you like most about it? A: My current position is Business Development for IMC Credit Services. I love my job because I have the opportunity to talk to and learn about others. Additionally, I love being able to use my skill set to be a problem solver and help people, all on a daily basis.
Q: Tell us about your non-profit organization, Stay Positive. What is it and why did you start it? A: I am a survivor of brain cancer and have undergone two surgeries, a relapse, and radiation to fight this cancer, and I strive to be a positive figure in people’s lives. For someone who is such a positive light for so many others, I have my own personal positive light in my young friend, Allison. Little Allison is a girl suffering from perimenigeal aveolar rhabdomyosarcoma cancer, whom I met while at Jill’s House, a temporary housing facility for patients being treated at the Indiana University Health
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Proton Therapy Center in Bloomington, IN. Together at Jill’s House, Allison and I became close friends and developed an emotional bond to one another.
After fighting a remarkable fight with cancer, I was able to leave Jill’s House and return home. Before leaving, Allison wrote me a letter with the message “Stay Positive” signed at the bottom in her best handwriting; both Allison and I enjoy spreading this new motto together. We realize that in life, you can’t control most things, but you CAN control one thing … your attitude.
Now I spread this message to various groups through speaking opportunities and my website – which share the seemingly simple message of “Stay Positive.” Life is a lot better with a positive attitude and this message serves as a daily reminder of that to all I come in contact with.
Q: How do you think you overcame your difficulties and retained that positive attitude? A: I believe I was able to overcome so many obstacles because of my parents. They never allowed me to quit. In life when you quit you aren’t just quitting on yourself—you’re quitting on everyone that believes in you. And after meeting Allison, my life was put into perspective. If someone so young going through so much can maintain such a positive attitude, I knew I could remain positive. Q: You do motivational speaking. Who are your audiences and what do you talk about? A: I have done hundreds of speaking engagements at churches, hospitals, schools and everything in between. I basically tell my life story with audiences from 10 to 15,000 people, sharing that it’s never too late to accomplish what you want to accomplish. I’m a firm believer that in life, the only thing we can control is our attitude. I try and put that in perspective for others by showing that there will always be someone with a seemingly easier life than you, but there is also someone that is struggling more than you. In the end, I love sharing the impact of the Stay Positive movement.
Q: What are your career aspirations? A: Honestly, I’m just thankful I have a great job in Business Development at IMC Credit Services – my current goals are to develop skills that will not only benefit me as I continue down this career path, but ones that will also help IMC.
Q: Why did you join HFMA and what are you looking to get from your membership? A: After joining the team at IMC, I discovered that so many of my co-workers believe in HFMA and its mission. After joining HFMA and attending a few conferences, I now see the importance of making Indiana the best state when it comes to healthcare and I want to be a part of that.
Q: Do you serve on any HFMA committees? If so, which one did you select and why? A: I currently serve on the Communications Committee. I selected this group as I felt that the skills I gained in earning my degree Organizational Communications and Leadership would best be utilized on this team. Q: Who are the people who have had the biggest impact on your life and why? A: I have always looked to my parents and appreciate the way they treat others. In addition to my parents, there are two people I really look up to in different ways. The first is my sister Katie. Katie is
Member Spotlight of Eric Day - (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
a year older than me, but has paved the way for the both of us. Growing up, and even today, I want to be like my sister—not only because of her achievements, but because of her attitude towards everyone. And I also admire Allison. When she was six, she and I were going through radiation together during the day, but she was also going through chemotherapy at night by herself. Allison put my life in perspective. Even though Allison is nine now and I’m 25, she has played possibly the largest role in who I am today.
Q: What do you do to relax? A: I enjoy attending Butler basketball games, hanging out with my two-year-old nephew and playing golf. Thanks to Eric and his inspiring story. Eric, the entire Indiana chapter wishes the absolute best to you and your young friend Allison.
Member Spotlight of Eric Day - (continued)
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Rural healthcare will continue to face daunting challenges for the foreseeable future, but emerging positive signs point to optimism as the nation continues moving toward healthcare delivery reform.
That was the message earlier this summer from Tom Morris, the chief rural health policymaker for the Healthcare Resource Services Administration -- the federal agency charged with providing health resources for the nation’s medically underserved populations.
Speaking before a packed audience at the opening session of the Indiana Rural Health Association’s Annual Conference in French Lick on June 21, Morris stated rural healthcare’s primary challenge will be to join the U.S. healthcare system in its migration toward reimbursement models based on quality, not quantity, of care rendered.
“Rural healthcare is on the wrong end of the healthcare paradigm,” said Morris, HRSA’s Associate Administrator for Rural Health Policy. “We should be paying on the quality of care delivered and continue the move to alternative payment models. The rural challenge is how to align with the rest of that healthcare system.”
Morris cited four principal variables that significantly impact rural healthcare: poor access to care which results in low volumes of care delivered, a growing divergence of healthcare payers and providers, ongoing difficult economic conditions in rural communities, and the prevalence of chronic diseases, such as diabetes, heart disease, and tobacco dependency, in rural settings.
Acknowledging a growing disparity in the healthcare system between rural and urban settings, Morris attributed declining rural life expectancy, the rampant opioid/heroin epidemic, and threatened access to healthcare services as the principal challenges to rural healthcare delivery.
Morris pointed out that findings from the 2016 Robert Wood Johnson County Health Rankings showed that premature death continues to trend far worse in rural counties compared to metropolitan and suburban sites. Over the next seven years, life expectancy in rural America is expected to decline at twice the rate of metro areas.
Though opioid abuse and opioid-related death have been on the rise nationally, Morris noted that rural communities are disproportionately affected by the opioid epidemic -- a 45% higher percentage of drug-related deaths in rural areas due largely to rural residents more likely to be prescribed with opioid painkillers.
Lastly, Morris remarked, the economic plight of rural hospitals will continue to threaten access to care in rural areas as 75 rural hospitals have closed since 2010, with many more vulnerable to shut their doors in the next few years. Recent statistics from the National Rural Health Association and iVantage confirm Morris’ concerns. A recent study by iVantage, a health analytics firm, reported that 673 more rural hospitals are vulnerable to closing, 210 or 31.2% of which are considered the most vulnerable to close.
Challenges, Optimism Persist for Rural Healthcare by Jim Miller
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But amidst those ominous trends, Morris embraces optimism for rural America, thanks to increased federal funding and numerous grant opportunities combined with, what he termed “rural steadfastness” – particularly found in state rural associations, like IRHA.
In 2016, Morris’ agency earmarked $149.5 million for, among other items, policy development and outreach efforts, rural hospital flexibility grants, radiation exposure screening services, Black Lung clinics and telehealth. Moreover, the Administration’s 2017 budget proposal included nearly $7 billion for rural health programs, community health centers, health workforce development, Healthy Start and home visits.
“I’m optimistic with what I’m seeing here today,” Morris said, overlooking an audience of nearly 600 conferees that included 80 students in medical school, allied health and other healthcare disciplines. “IRHA is the model for the other 49 states. Some state associations would be pleased to have 100 attendees at its annual conference.”
Morris praised IRHA members and their advocacy efforts, which have yielded approximately $12 million in federal grant funding, used for a variety of vital public health policy initiatives.
Meanwhile, Morris added, the White House Rural Council, established in 2011 by the Obama Administration, continues its work on a number of critical rural issues, and that improved collaboration among several other federal agencies has facilitated that effort.
Morris’ remarks came during the keynote address at IRHA’s 19th Annual Conference – annually the largest healthcare conference in Indiana. The three-day event featured plenary sessions on population health and value-based purchasing, managing the HIV outbreak and prescription drug abuse epidemic, and the psycho-social awareness of the rural experience, as well as 38 concurrent sessions on a variety of healthcare-related topics, a two-day vendor show with 101 exhibitors, and a series of networking opportunities. Nearly 600 conferees attended this year’s annual event. IRHA will host its 20th Annual Conference on June 13-14, 2017 at the French Lick Resort.
Dr. Jennifer Whitehall, Deputy State Health Commissioner, addresses a plenary session on managing the HIV outbreak and prescription drug abuse epidemic at the IRHA Annual Conference
Over 100 exhibitors, including Eskenazi Health, participated in this year’s Vendor Show at the IRHA Annual Event
Several Indiana HFMA members attended, including past and current HFMA Board Members Richard Altman and Darren Cook
Rural Healthcare Challenges and Optimism – (continued)
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The 2016 HFMA Region 7 Conference was held at the Grand Geneva Resort in Lake Geneva, Wisconsin from July 17-20, 2016. With about 300 attendees and 100 vendors represented, the Conference featured a vendor exhibition hall, and general and break-out educational sessions in the areas of revenue cycle, leadership, critical access hospitals, and finance and accounting.
The Indiana Pressler Chapter had many members in attendance; with several of us travelling to and from the conference on a chartered bus that was funded through an HFMA Innovation award.
Hospitals in the Internet Economy Kenneth Kaufman (Chair of Kaufman Hall) delivered the Conference’s Keynote Address on “Hospitals in the Internet Economy”. Mr. Kaufman began by asking the following question: In today’s Internet Economy, what distinguishes your services from the increasingly many other choices being offered by your competitors; that is, why should a patient go to you for their health care needs?
Mr. Kaufman said the $3 trillion health care industry will not be immune from the disruptions and impacts of today’s Internet Economy; and, those inroads for changes have already begun. Two examples cited by Mr. Kaufman were flu vaccines at Walgreens and the convenient, discounted MRIs being provided in strip malls by SmartChoice MRI. In a short period of time, Walgreen’s has grown to become the second largest provider of patient flu shots; SmartChoice MRI is an expanding new company that offers MRIs to patients with easier accessibility and at significantly lower prices than those provided at outpatient hospital sites.
The significance of those two, small examples? They show how patients are becoming more engaged and thinking differently about how and at what cost they access health care services: no longer does the patient believe he/she has to go to a physician office or hospital for all of their healthcare needs.
As hospitals rethink their business models to survive, Mr. Kaufman said hospitals will need to consider and incorporate the lessons other industries have learned from operating in the Internet Economy. Successful Internet Economy companies:
Work to increase traffic/connections through their portal or sites - the more the better. The key is to keep your services constantly on the mind of a consumer so when they have needs they think of you.
Make it easy to do business with them – examples are Amazon and Uber Know what their customers want (e.g., by accessing and analyzing available information
they can modify their products and services to align with consumer preferences) Constantly strive to innovate and improve their products/services (e.g., Amazon)
Bus travelers from left to right: Jesse Ford, Brad Willke, Lisa Willke, Jennifer Swindle, John Kraft, Tiffany Walls, David Parry
2016 HFMA Region 7 Conference Update by David Parry
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Understand that once a customer leaves them for a new delivery model that customer will not return to them (e.g., Blockbuster and Netflix)
Mr. Kaufman talked about recent successful initiatives by MD Anderson and Mount Sinai. In those cases, they provided services that patients “wanted” instead of what physicians had decided their patients “needed”; and, these health care services were also targeted for all patients instead of just acutely-ill patients.
To survive in the world of the Internet Economy, health care providers need to move away from their traditional, paternalistic delivery model where physicians solely determine access for acutely ill-patients, and move towards a model that actively engages patients to choose and control how and where they receive their health care services. In order to do this successfully, Mr. Kaufman said hospitals will need to develop strategies for significant organizational changes, achieve rigorous cost reductions, utilize improved software and technology tools, and develop new relationships with their patients that emphasize an ongoing and relentless need to improve every patient’s healthcare experience with them.
In closing, Mr. Kaufman said hospitals need to already be rethinking and moving away from their old revenue and business models, or they will be left behind as patients move to other providers who will be better positioned to meet their health care needs in this dynamic and opportunistic Internet Economy.
Life in the Espresso Lane At Monday afternoon’s General Session, Laurie Guest spoke about “7 Ways to Thrive in a Fast-Paced World (or Life in the Espresso Lane)”
Ms. Guest said today’s fast-paced environment can create a stressful environment in which our only thoughts are how to get all of the daily tasks completed on time – and then the cycle repeats the next day, and so on. We can’t seem to get enough done, or go fast enough. However, by making a few small changes (organized in 7 steps) in how we think, speak, and look at situations, we may be able to significantly reduce that stress and achieve higher levels of energy, motivation and contentment. Ms. Guest walked through and provided examples for each of these 7 steps:
Practice a “Pick-Me” philosophy (Seek opportunities; avoid the “Pick-On-Me” syndrome) Forsake the mistake (keep mistakes in proportion; be approachable to hear mistakes) Word tweaks make a difference (“I’d be happy to – IBHT”; replace “no” with “actually”) Know when to say “sorry” (and more importantly, when not to say “sorry”) GUTSY (“Dale Carnegie’s how to Win Friends and Influence People”) Incorporate time to “reset” or “recharge” yourself; personal retreats Ask for what you want (clearly communicate; stop hoping someone guesses)
HFMA Region 7 Conference Update - (continued)
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Brave New World of Patient and Family Engagement: 2016 Policy and Practice Update At the Tuesday morning General Session, Susan Frampton (President, Planetree) talked about the current movement of patients being more actively engaged in their patient care services. Ms. Frampton said patients are “wanting to take the reins” and be active partners in determining their health care needs and services - and not simply following a physician’s directives. Ms. Frampton gave examples of change: Arizona patients are now able to order and receive their own lab results, the increased amount of direct-to-consumer (DTC) advertising in the today’s media (e.g., Television), and the growth of “Ubercare” (e.g., Heal, MedZed, TrueNorth, etc.)
As the old model of a single Primary Care doctor directing all of a patient’s care continues to erode, Ms. Hampton suggested the Primary Care model of the future may be “self-administered” by patients’ own goals and health care decisions. Guidelines and definitions from agencies and programs are changing to give patients more active roles in setting goals and determining how and what patient care they will receive (e.g., ACA, National Academy of Health, HHS, CMS, NCQA, PCMH)
Ms. Hampton said health care entities that establish a foundation of transparency and support for patients to set goals and be actively engaged in determining their care are showing positive results of increased patient satisfaction, lower length of stays, decreased costs, and better patient treatment outcomes. Specific steps hospitals and health care organizations can take include having well-defined discharge planning checklists in place, hourly bedside rounding, shift-change reports in patient rooms, and a patient representative on the Governing Board.
Healthcare, Remixed The Conference’s Closing Keynote Session was given by Zubin Damania (Internist and Founder of Turntable Health). Dr. Damania entertained us with song and humor as he addressed the problems and needed changes with our current health care delivery model. As an Internist at Stanford, Dr. Damania had become increasingly disillusioned with the amount of computer documentation he and other providers were required to perform on a daily basis and the lack of time and focus given to more hands-on communication and care for patients. Those frustrations led Dr. Damania to create many successful videos (under the name of ZDogg) that educated patients about health care while satirizing the currently dysfunctional health care delivery model. Dr. Damania gained national recognition from those videos, which ultimately provided him the opportunity to establish a new health care service model in Las Vegas called Turntable Health.
Dr. Damania said the health care of the 1990’s and earlier – Healthcare 1.0 – which stressed the strong Physician and patient relationship has now been displaced by Heathcare 2.0. Under Healthcare 2.0, there is so much emphasis on documenting in the EHR it is more like treating the computer instead of the patient.
HFMA Region 7 Conference Update - (continued)
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Dr. Damania’s Turntable Health is being designed to move the delivery model to Healthcare 3.0, restoring the patient relationship and requiring active involvement of the patient in their healthcare decisions and delivery options. Results from Turntable Heath have been positive with lower costs, reduced ED visits and Hospital re-admissions, and modified documentation methods that have increased patient and provider communication and satisfaction.
------------------------------------------------------------------------------------------------------------------------------ Indiana Pressler members at the Conference:
HFMA Region 7 Conference Update - (continued)
J.Hopkins with wife Charity and son Max take a break in the Exhibitor Hall
Pulaski Memorial Hospital CFO John Kraft speaks about Capital budgeting and funding during a session at the Region 7 Conference
Farrah and Rob Mahoney, and Nick McLaughlin at Monday night’s dinner
Lisa Willke (front left) sings with CFO Brian Daeger (front right) and his band at Monday night’s dinner
Marwan Hanania (right) with Keith Bull (McMahon-Illini Chapter)
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Again this chapter year, with each issue of Hoosier Times, we’ll look back a few moments from yesteryear that we can remember and take pride in.
The chapter has an extensive collection of old photos. Chances are we have a picture of some fond memory or event that you might have. Let us know if you have a suggestion or special memory of chapter years gone by. We’d love to hear from you . . .
Yours in HFMA,
JIM MILLER
Former chapter officers (from left) Al White, Pam Burns and Bill Lammers enjoy some cocktails and camaraderie during a Fall Institute in Nashville. Both Pam Burns (2005-06) and Bill Lammers (1999-2000) served as chapter president, while Al White was a former officer and longtime chapter volunteer.
The Andrews Sisters – Patti, LaVerne and Maxine – better known as (left to right) Clara Hiatt, Sharon Muncie and Debbe Winkle, entertain the masses at a chapter function from yesteryear. All three “Andrews” sisters frequently participated and presented at chapter educational events.
Longtime chapter supporters Ken Bush (left) and Craig Williams chuckle it up at an HFMA vendor show on Indianapolis’ eastside – before likely heading out to a local golf course to hone their skills on the links. Both Ken Bush and Craig Williams were frequent exhibitors at chapter functions for many years.
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DO YOU REMEMBER WHEN . . .
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2016 Summer Baseball Outing at Victory Field On Friday, August 26, 2016 Indiana HFMA members, and their families, will have the opportunity to attend an Indian’s baseball game at Victory Field in Indianapolis. In addition to enjoying the baseball game, HFMA will be giving prizes to the children who attend this event.
When you are completing the registration form for the event, you will find space on the form to include your child’s/children’s sex and age(s). It will be a great time to see some of you fellow HFMA members and to enjoy a great summer pastime – baseball – with your family.
The picnic start at 5:30PM; the game begins at 7:15PM.
So, make sure and save the date – August 26 – and plan on attending this event!
Summer Baseball Game August 26 2016
Community Service Project at the Summer Baseball Outing At the Summer Baseball Outing on August 26, we will be collecting school supplies for the Indianapolis Public Schools and schools throughout Central Indiana. This project is called “Indy Backpack Attack”. Please bring your school supply donations to the baseball game and picnic: We will have bins available at the registration table at Victory Field for dropping off any items you are planning on donating for this very worthwhile service project.
For your convenience in selecting items you would like to donate, a list of the “Items Most Needed” is below:
We appreciate the members of HFMA participating in this important service project, and we look forward to assisting the public schools with some of the needed items.
Save the Dates… for these upcoming Events and Programs
Hoosier Times - Indiana Pressler Memorial Summer - 2016
Bloomington Convention Center, Bloomington, Indiana https://www.hfma-indiana.org
Preview of the Fall Institute Educational Sessions From October 5-7, our HFMA Indiana Pressler Chapter will hold their annual Fall Institute at the Convention Center in Bloomington, Indiana. This year’s Institute will include a dual focus of two areas; Evolving Trends in Healthcare Finance and the other focusing on MACRA.
The first track, Evolving Trends in Healthcare, will include sessions on Consumerism in Healthcare, Cost Management and Cost Accounting models, Financial Impact of the Triple Aim, Population Health, Performance and Productivity in medical practices, Reimbursement trends with ACOs and Medical Homes, and Revenue Recognition issues. This track will address some of the growing trends in healthcare reimbursement issues.
The second track will be focused on MACRA. This massive legislation will start impacting future reimbursement in January – yes, just 6 short months from now. We will break the sessions into the various elements of MACRA: MIPS and APM, addressing what is required under each model. MIPS is a budget neutral program which will payout $830 million, but that money will not come from CMS, it will come out of the pockets of practices who do not meet MACRA expectations relative to their counterparts. Every HFMA member with physician practices in their hospital needs to be very familiar with MACRA and begin making plans quickly to prepare for January 2017 – that is when your performance will begin to determine if you will receive the incentive adjustments for a successful implementation…. or pay those who did.
Don’t miss this event! Plan on spending a couple of Fall days in the hospitality of one of the best cities in the state. Enjoy some of Bloomington’s many landmark restaurants with your colleagues. Relax, learn, and have some fun! (Including golf and other activities – see below)
Golf Anyone? Tee-up your Fall Institute with a round of golf at the beautiful Martinsville Golf Course!
Start time is 10AM on Wednesday, October 5 at the Martinsville Golf Course - 1510 S.R. 37 North, Martinsville, IN 46151. Cost $48.50, includes lunch and 2 drink tickets
Sign-up for golf on your Fall Institute registration form
Additional Networking Events at the Fall Institute in Bloomington Wine and Canvas For those not interested in golfing, you can join us for a Wine & Canvas (http://www.wineandcanvas.com/bloomington-in.html) event in Bloomington from 2-5PM on Wednesday, October 5, 2016. The first 10 people will be sponsored by IMC Credit Services, so reserve your space early! After that, the cost will be $35, which will include your wine and hors d’oeuvres for the event. Their talented instructors will guide you step by step so even the inexperienced will end up
Save the Dates for these Upcoming Events and Programs – (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
with a fantastic picture! We will also be giving away prizes for the best painting, so come out and show off your artistic abilities!
Sign-up for Wine and Canvas on your Fall Institute registration form
Welcome Reception After a relaxing afternoon of golfing or painting, join us back at the hotel for our Welcome Reception from 6-7:30PM (Wednesday evening). Oliver Winery will be joining us for a special Wine Tasting Event. Enjoy an evening of refreshments and stimulating conversations while learning about one of Bloomington’s most popular wines. If you find a flavor you especially enjoy, bottles will be available for purchase. (http://www.oliverwinery.com/)
Meet and Greet Event Need more networking opportunities? Well, on Thursday, October 6, 2016, there will be a “Meet & Greet” following the day’s last education session. Please join old friends and meet new friends for drinks and appetizers before your dinner plans.
“Night Owl” Networking Are you a “Night Owl”? Join us for more networking fun at Nick’s (423 E Kirkwood Ave, Bloomington, IN 47408) on Thursday October 6, 2016 from 9:00PM until they kick us out! This is a BYOB event… “Buy Your Own Booze.” We look forward to seeing you there!
Thank you to Michelle Trowell of the Networking Committee, Phil Ellis of the Education Committee, and Nick McLaughlin for your teams’ work to organize these events and programs, and for providing us with these updates.
Save the Dates for these Upcoming Events and Programs – (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
If you are reading this article you are most likely familiar with Indiana’s alternate version of Medicaid expansion, the Healthy Indiana Plan (HIP 2.0). With the HIP 2.0 agreement, Indiana became the ninth state with a GOP governor to reach a deal with the federal administration to expand health coverage to low income families. But HIP 2.0 was quite different from other expansions: Unlike most Medicaid entitlement programs, both coverage and eligibility in HIP 2.0 required principles of “personal responsibility.”
There is scrutiny of this approach on both sides of the political aisle: Republicans dislike accepting federal dollars created by the Affordable Care Act and Democrats question the conservative approach by citing potential barriers to healthcare. Indiana’s expansion model, under the waiver agreement with the federal Centers for Medicare & Medicaid (CMS), is unique in that it relies on new successes in patient engagement in their health care. Members of HIP 2.0 are required to make a small contribution to their Personal Wellness and Responsibility (POWER) account (similar to a health savings account) in exchange for enhanced coverage. The cost can be as low as $1.00 a month and is limited to no more than 2% of the family unit’s income. Those who make the contribution are enrolled in the “HIP Plus” plan and are considered to receive the “best value” as it eliminates nearly all co-pays and includes vision and dental coverage.
For some, there are stiff penalties for failing to make the POWER account contribution: If two consecutive payments are missed and the enrollee’s income is between 100%-138% of the federal poverty level (FPL), the member will lose coverage and may be locked out of the plan for 6 months. Members who are pregnant, determined medically frail, a Native American living in a domestic violence shelter, receiving transitional assistance or in a state-declared disaster area are exempt from this penalty. Those with income at 100% of the FPL and below who do not contribute to their POWER account, default to “HIP Basic” and become subject to co-pays and the loss of their dental and vision coverage.
So how is HIP 2.0 playing out after the first year? By most accounts, it appears to be a success as an expansion of coverage for the low-income uninsured. In the Healthy Indiana Plan Annual Report submitted to CMS in April for the first demonstration year of February 2015 through January 2016, the state reported a total enrollment of 343,647 HIP members. That appears to be right on target for the 350,000 projected goal released upon waiver approval in January, 2015. The report further provided that nearly 70% of members enrolled in HIP 2.0 elected to make contributions to their POWER account. More than 80% of the HIP Plus members have income below the poverty level, meaning that they could refuse the payment and still have basic coverage.
Of these members who started making contributions and earn less than the poverty level, approximately 93% continued to make them. There is also another positive indicator: Stipulations provided by CMS for Indiana’s HIP 2.0 waiver permitted third parties to assist the member with POWER account contributions subject to published restrictions (405 IAC 10-10-4). However data released in the state’s Annual Report revealed that less than 1% of HIP participants were aided by not-for-profit organizations, employers or providers in the first year.
Indiana’s Annual Report, along with the results of research conducted by the Lewin Group (contracted by Indiana), provides data that demonstrate neither affordability nor lack of medical
HIP 2.0 Scorecard: Year Two by Beth Overmyer
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transportation coverage by HIP members have been a barrier to completing medical appointments. When CMS approved Indiana’s waiver request to expand Medicaid, it gave the state permission to waive non-emergency transportation services (NEMT) until December 2016. CMS has responded with claims that the research conducted by the Lewin Group was too limited in the percent surveyed and thus will have an additional survey performed by another third party. This review, by The Urban Institute, is to study the waiver (including the NEMT waiver) to determine if HIP 2.0 will be extended beyond the initial three year approval.
Organizations that work directly with enrolled HIP 2.0 members do not appear to mirror the concerns that CMS has of the NEMT waiver at this juncture of the program. Social Service groups have shared that transportation for medical care has not been a significant barrier. One reason is that the issue was addressed before HIP 2.0 was passed. Many regions throughout the state began to provide transport to appointments via vouchers funded by medical providers, community foundations, volunteers or community social service agencies. These transportation services are often provided to patients despite the type of coverage plan in which the patient is enrolled.
More good news for HIP 2.0 supporters came from a recently published white paper by Anthem, Inc.’s Public Policy Institute. Released on July 13th, the paper stated that HIP 2.0 members are accessing more preventative services, following up on care more, and using the ER for non-emergency treatment less than members in traditional Medicaid plans. Additionally, nearly 90% of HIP members are satisfied with their overall health care, according to a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Anthem, one of three managed care entities (MCEs) contracted by the HIP 2.0 plan, covers approximately 40% of enrolled HIP 2.0 members as of June 2016.
Though improvements are being made, the loudest complaints from those assisting individuals with coverage are similar to problems experienced the first year with enrollment for the ACA Marketplace plans. Technical issues with file transfers between the state and the Managed Care Entities (MCEs), Anthem, MDwise, and MHS has created delays in authorizing a member’s eligibility appropriately. “Fast Track” payments and “Presumptive Eligibility” for temporary coverage both of which can expedite coverage and can be a great benefit to both the member and medical provider, have had some issues as well with correct payment recognition, processing consistency and timing. To address these issues, the Indiana Family and Social Services Administration (FSSA) has responded with a dedicated special customer service unit and conducts weekly meetings with the MCEs to address these issues for rapid response and improvement.
With FSSA’s recent announcement of the 2017 HIP 2.0 MCEs (which added CareSource as a fourth option), providers and members will be expecting assurance that there will be improvement in both eligibility and claims processing. In a June FSSA News Release, Indiana Medicaid Director Joe Moser stated: “We used this opportunity to really take a fresh look at what we expect the health plan to deliver and the value Hoosier taxpayers are getting from these contracts considering the more than $3 billion a year we are spending on them. We have made key changes to ensure Indiana Medicaid members are getting better coordinated health care and customer service from the Medicaid plan. We are confident we have selected the best managed care entities to meet or exceed these expectations.”
HIP 2.0 Update - (continued)
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The complexity of health coverage programs, and especially a new, untested model that has many entities and individuals touching each application, has required expanded assistance of Indiana certified “Navigators.” Indiana Navigators are subject to certification and registration requirements, pre-certification education, examinations, continuing education, and other requirements pursuant to the newly released final rule (Indiana Administrative Code (IAC) Title 760 Article 4). These individuals focus on assisting and advocating for Indiana residents throughout the application process for health coverage, including education and enrollment outreach. FSSA acknowledges that Navigators and other stakeholders bring much needed resources to reach HIP 2.0 goals and have worked together in community events and marketing.
Continuing education of both members and providers is a mutual goal for the state and Navigators. Jessica Ellis, Director of Outreach and Enrollment for the Indiana Primary Health Care Association (IPHCA), recently shared that the one-on-one assistance to consumers from Navigators, providers, and community members has had a direct result of improved understanding of coverage and respective benefits. A positive and successful experience has lead consumers to spread the word and that has greatly helped with enrollment efforts.
Despite the challenges in the first year of the HIP 2.0 implementation, the enrollment of Hoosiers has now grown to over 395,000 as of June 2016 and been a positive impact on individuals, families, employers, communities and providers. Most of these HIP 2.0 enrollees had no previous options for coverage. In the forty years that I have been an advocate for the uninsured and underinsured, I have not previously witnessed the extended scope of cooperation, dialogue, and active participation to understand a new health care plan and educate those who can receive the benefits. These partners include health care providers, religious organizations, social service agencies, non-profit coalitions, communities, and correctional systems - to name just a few. All of these groups are sincerely working together to reach potential members. While much work needs to be done, the energy has not stalled. As for the long term future of the program, we will need to wait for leadership at the federal and state levels to debate whether or not to extend the waiver beyond 2017. We must also wait to see how the upcoming Fall elections might impact the Affordable Care Act altogether.
_____________________________________________ About the Author Beth Overmyer is Executive Vice President for ClaimAid, Indianapolis, Indiana She is a member of the HFMA Indiana Pressler Memorial Chapter, and may be reached at: [email protected] (P) 800.842.4052 x102 (C) 317.695.7705
HIP 2.0 Update - (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
For years, the healthcare world has been fairly immune from the barrage of cyberattacks directed at the financial and retail industries. Instead, data breaches tended to involve lost or stolen devices, often with unencrypted data.
No more.
Today, healthcare entities are top targets of cyberattackers, who are drawn to rich repositories of personal data that can fetch prices 20-30 times higher on the black market than a stolen credit card. Last year, an estimated 66% of healthcare organizations experienced a cybersecurity incident affecting
an estimated 109 million patients.1 Overall, cyberattacks cost the US healthcare system about $6 billion a year.2
These are not your typical hackers. Instead, the attacks come from sophisticated networks of cybercriminals, often located overseas.
The potential for damage to an institution’s financial stability as well as reputation from one of these breaches is huge, which is why every executive up to the CEO and members of the board of directors should be concerned. Yet, a 2015 survey of nearly 300 healthcare organizations found that just a quarter allocated more than 6% of their annual budgets to IT security. About half allocated less than 3%. In addition, few had
committed any significant percentage of IT employees to the issue, either.1
Understanding the Breaches While there are numerous types of attacks, including distributed denial of service, phishing, and advanced persistent threat attacks, healthcare executives should be aware of two newer types of cyberattacks:
o Business email compromise. Also known as “CEO fraud,” this attack begins with an email to the CFO, ostensibly from the company’s controller, asking for an electronic funds transfer. The email appears legitimate because it includes information gleaned from social media. The FBI issued an alert on this type of attack last year, calling it an “emerging global threat.”
o Ransomware. Hospitals are the perfect target for ransomware, in which cyberattackers insert malware into the IT system to take control of the system and/or its data, then demand payment to return control to the hospital. In February, Hollywood Presbyterian Medical Center in California experienced a ransomware attack that locked the staff out of the electronic health record. The hospital eventually paid the hackers $17,000 in ransom to regain access. A similar attack at MedStar Health in Maryland required the system to shut down its entire computer networks for several days and providers to revert to paper processes.
Connected Devices a Threat Hackers have a unique entry point into hospital systems that doesn’t exist in the retail or banking sectors: interconnected medical devices. Nearly every device in a healthcare setting, from infusion pumps to MRIs, has a computer chip that allows it to communicate with the EHR and other systems. Most run legacy software that hasn’t been updated in years and have hard-wired passwords that
Cyberattacks in Health Care: A Growing, Dangerous Concern… Are YOU ready? by William Ahrens
Hoosier Times - Indiana Pressler Memorial Summer - 2016
haven’t been changed. Not only can hackers then move into the organization’s main IT systems from the device, but they could reprogram them to cause patient harm.
Taking an Offensive Approach It is nearly impossible to completely protect your IT systems against cyberattacks. However, there are numerous steps healthcare organizations can take to take to minimize the number and severity of such attacks:
o Employ a strong security posture, including multi-layered endpoint and network security, encryption, strong authentication and monitoring capabilities; first-and-foremost, ensure all software and plug-ins are up-to-date.
o Regularly conduct risk assessments and mock exercises; analyse the results, develop lessons learned, and quickly address any identified vulnerabilities.
o Provide mandatory ongoing education and training for all employees; enforce the use of strong passwords; in addition, make sure users understand and practice good security hygiene.
o Hire and maintain an appropriately sized and skilled IT security team. Also consider pre-contracting with top-tier managed security service providers and third-party experts to assist in the event of a breach.
It isn’t a question of whether or not your facility will be attacked; it will, and probably already has. The question is: “Can I contain the damage and defeat the attackers?”
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References 1 HIMSS. 2015 HIMSS Cybersecurity Survey. 2016. http://cynergistek.com/cynergistek-resources/himss-cybersecurity-survey-results/. 2 Pettypiece S. Rising Cyber Attacks Costing Health System $6 Billion Annually. Bloomberg Technology. May 7, 2015. http://www.bloomberg.com/news/articles/2015-05-07/rising-cyber-attacks-costing-health-system-6-billion-annually. Accessed April 21, 2016.
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About the Author William (Bill) Ahrens is a Senior Manager in the Health Care Group at WeiserMazars, LLP Bill may be reached at [email protected] (P) 212.375.6662 (C) 201.315.9586
Cyberattacks - (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
HFMA Waves of Compliance by Ken Blickenstaff, Blickenstaff LLC Email: [email protected]
Here at BlickenStaff LLC, we watch the healthcare horizon for changes that are “making waves” in the area of compliance. We want to write about what you want to know about, so please feel free to reach out! Below I highlight a number of headlines featured recently that I hope you will find useful. Please refer to the original source for the full story.
"National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing"1 On June 22nd, The Department of Justice announced the “most defendants charged and largest alleged loss amount in strike force history.” The Medicare Fraud Strike Force in 36 federal districts, as well as 23 state Medicaid Fraud Control Units, charged 301 people for
alleged participation in health care fraud schemes involving approximately $900 million in false billings. Defendants were charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The alleged fraud schemes involved home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and prescription drugs. The defendants allegedly submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. Since January 2009, the Justice Department’s Civil Division, along with U.S. Attorney’s Offices around the country, has recovered a total of more than $29.9 billion through False Claims Act cases, with more than $18.3 billion of that amount recovered in cases involving fraud against federal health care programs.
“First Business Associate HIPAA Penalty Announced”2 The U.S. Department of Health and Human Services Office for Civil Rights (OCR) began investigating a report in April of 2014 that an employee iPhone issued by the Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS) was stolen. CHCS was a business associate to six skilled nursing facilities, providing management and information technology services. The phone was unencrypted and had no password protection. Information was potentially exposed regarding 412 patients at six Philadelphia-area nursing homes. At the time of the incident, CHCS did not have policies in place for mobile devices containing PHI being removed from its facility, nor was there a plan of what to do in the event of a security breach. Additionally, there was no risk analysis or risk management plan, per the OCR. The stolen iPhone included Social Security numbers, diagnosis and treatment information, medical procedures, names of family members and legal guardians, and medication information. The incident marks OCR’s first enforcement action against a business associate since the HIPAA Omnibus Rule (making business associates directly liable for HIPAA compliance) went into effect in 2013.
“Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process”3 The Government Accountability Office (GAO) released a report in June regarding the appeals process for Medicare fee-for-service (FFS) claims. There are four administrative levels of review within the Department of Health and Human Services (HHS), and a fifth level for appeals reviewed by federal courts. From fiscal years 2010 and 2014, the third level of appeals experienced a 936% increase in appeals. The growth in appeals is attributed to increased program integrity efforts by HHS, and a greater number of providers appealing claims. The GAO recommends that HHS improves the completeness and consistency of the data used by HHS to monitor appeals, as well as implementing a more efficient method of handling appeals associated with repetitious claims. ________________________________________ 1 Source: https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-301-individuals-approximately-900 (accessed 7/15/16) 2 Source: http://www.healthcareinfosecurity.com/first-business-associate-hipaa-penalty-announced-a-9238?rf (accessed 7/15/16) 3 Source: http://gao.gov/products/GAO-16-366 (accessed 7/15/16)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
The Importance of Harmonizing Hospital and Physician Financial Assistance By Mark Rukavina
Non-Profit Hospitals Under the Microscope The level of scrutiny over billing and collection practices of non-profit hospitals continues. Investigative news stories have focused on hospitals in Florida, Illinois, New Jersey, Ohio, and Oregon, questioning whether these nonprofits deserve a tax break.
Hospitals in Illinois and New Jersey have had their state tax exemption challenged in court.
A recent report in California entitled Insufficient Data: Do Central Valley Not-For-Profit Hospitals Meet Their Community Benefit Obligations? alleges that non-profit hospitals fail to provide information that is needed to understand whether they earn the tax breaks.
Some of the strongest criticism of non-profit hospital collection practices centers on hospitals filing lawsuits against former patients. A St. Louis Post-Dispatch analysis from earlier this year found that more than 1,000 lawsuits were filed against patients over a 15 month period, and 99 percent of the cases involved debt that originated from treatment provided at hospital emergency rooms. Uncharitable Acts Some consider collections just part of doing business, even for non-profit hospitals. Others, like one local tax assessor in Illinois believe strongly that lawsuits are wrong and if you sue people you are not charitable.
In fact, non-profit hospitals receive huge tax breaks from federal, state and local governments in exchange for their charitable acts. U.S. Senator Charles Grassley has been investigating the practices of non-profit hospitals for more than a decade, questioning whether they truly deserve their federal tax-exemption. Federal Requirements As a means of clarifying what is expected in return for that tax-exemption, Sen. Grassley fought to include a provision in the Affordable Care Act that put new requirements on non-profit hospitals. It directed the IRS to establish Section 501r of the tax code requiring hospitals to have written financial assistance, billing, and collection policies that adhere to certain specifications.
In order to maintain their federal tax exemptions, hospitals must have written financial assistance policies that are widely distributed to patients and the community. They must also refrain from pursuing extraordinary collection actions (including lawsuits and credit reporting) against patients prior to making reasonable efforts to determine whether they qualify for assistance. The intent is to make sure that low income patients are provided assistance according to the hospital’s policy. Physicians Providing Services in Non-Profit Hospitals Hospitals and health systems are complicated organizations. Often the services received within the walls of a hospital are provided by entities that are separate and independent from the hospital itself. This is understandably confusing to patients. As a result, the federal regulations call for hospitals to maintain a list of the providers delivering emergency or medically necessary care in the hospital and specify which are covered under the financial assistance policy. This was done to improve transparency
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for patients and eliminate surprise medical bills. It is similar to the laws in certain states requiring hospitals to list whether providers of services in a hospital are in-network, or out-of-network, for purposes of insurance. For example, a New York state law requires hospitals to disclose which health plans they accept, as well as list standard charges for services. They must also inform patients that physicians working at an in-network facility may not participate in the insurance network.
Back to the St. Louis Dispatch story; it focused on a health system that outsourced the staffing of its emergency services. This is a fairly common practice in the industry. However, it involves risk, especially when emergency room providers do not follow the hospital’s financial assistance policy. While physicians not employed by a hospital are not technically required to follow the hospital’s assistance policy, it is a leading practice for physicians to do so.
Furthermore, IRS Section 501r regulations note that if a hospital outsources the operation of its emergency room to a third party and care provided by that third party is not covered under the hospital facility’s financial assistance policy, the hospital may not be considered to operate an emergency room for purposes of the factors considered in Rev. Rul. 69-545 (1969-2 CB 117) which previously set community benefit standards. Included among them is operating an emergency room open to everyone is one of the factors required by the IRS to qualify for an exemption from federal taxes. Sen Grassley Flexes Congressional Oversight This past May, Sen Grassley addressed the US Senate to announce the results of his office’s investigation launched against a non-profit hospital that he felt was engaging in aggressive collection actions without adequately informing patients of their rights.
Sen Grassley announcement
Sen Grassley gave credit to the hospital for making changes. What he then went on to say is cautionary for all non-profit hospitals, “but it should not take Congressional and press attention to ensure that tax-exempt, charitable organizations are focused on their mission of helping those in need. Congress, via its oversight powers, can help ensure that non-profit hospitals appropriately manage their responsibilities to low-income communities. That is, after all, one of the reasons why we created the tax-exempt status for charitable institutions in the first place.”
In June, Sen Grassley asked the IRS to report on its implementation and enforcement actions related to the financial assistance, billing and collection requirements of Section 501r. In this letter Sen Grassley said, “It is important that Congress, via its oversight role, and the IRS, ensure that charitable hospitals are functioning as intended.” Federal Tax Exemption and Reputation At Risk Given the scrutiny of Sen Grassley, the media, consumer groups, and other elected officials, non-profit hospitals must be vigilant in their efforts to ensure they are assisting their most vulnerable patients.
If a physician is providing care in a hospital, the patient might expect that the hospital and physician are in alignment concerning financial assistance. Most patients would think of them as one in the same. Mirroring hospital policy is beneficial for physicians, since it reduces the cost associated with account processing for low-income patients who qualify for hospital assistance. Low income patients unlikely to have the resources to pay their hospital bills are also unlikely to have the resources to pay their physician bills.
The Importance of Harmonizing Hospital and Physician… - (continued)
Hoosier Times - Indiana Pressler Memorial Summer - 2016
Recent press attention shows that the collection practices of outsourced providers and third party vendors can jeopardize the reputation of a non-profit hospital. The practices of these third parties may also threaten a non-profit hospital’s tax-exempt status. Steps should be taken by hospitals to avoid unnecessary compliance risk. Hospitals outsourcing the staffing of emergency departments should particularly be mindful of the billing and collection practices associated with these services since it is a factor in determining federal tax exemption. What Should Be Done?
1. Require physicians not employed by the hospital to harmonize with the hospital’s financial assistance policy. o This is a leading practice. It will eliminate surprise bills for patients. It will also allow these
providers to focus their collection efforts on patients that likely have the financial resources to pay their accounts. They may be pleasantly surprised to see their recovery rates rise once they remove accounts of patients with little or no resources to pay their bills.
2. Screen all patients prior to pursuing collection actions. o The federal regulations require hospitals to make reasonable efforts to determine whether a
patient qualifies for financial assistance. Many hospitals go further. They meet the minimum requirement and then provide further screening of all accounts prior to pursuing any extraordinary collection action. One leading practice is the use of a predictive screening model to grant presumptive eligibility for financial assistance. If an account meets the hospital’s criteria for assistance, it is classified to a community benefit and no further collection action is taken. This information could be shared with physicians not employed by the hospital so that they, too, could grant assistance on their mutual patient encounters.
3. If neither of the above, confer with your legal and compliance teams. o If outsourced physicians are not following your policy and you are not taking extra precautions
to screen patients before going to collection, be sure to inform legal. Contact your legal and tax compliance teams to fully inform them of practices related to financial assistance for emergency care. Conduct an analysis to determine whether your federal tax exemption is at risk. Contact your marketing and/or public relations department, too. They should be prepared to describe your policies and practices and defend your reputation.
4. Reach out to members of the community. o Finally, the federal requirements also call on hospitals to affirmatively reach out to members of
the community that they serve to notify them of the financial assistance policy. If you have not already done this, do so today. Hospitals with community goodwill and transparent policies are far less likely to be scrutinized and criticized than those who have not built a strong culture of community collaboration.
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About the Author Mark Rukavina, Principal at Community Health Advisors, LLC, Boston, is a member of HFMA’s Massachusetts-Rhode Island Chapter (P) 617.833.9829 [email protected]
The Importance of Harmonizing Hospital and Physician… - (continued)
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Chapter Sponsors
President Level BKD, LLP
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We apologize if we have missed your advertisement or if it is blurry. We are asking all sponsors to resubmit your ad (.jpg, .gif, .tif) to [email protected] with the subject line: (Sponsor name) 2016 Ad. In addition, if we did not receive a sponsorship ad, we made every effort to obtain and include all logos/ads to the best of our ability. Thank you for being patient with us during this transition.
Hoosier Times - Indiana Pressler Memorial Summer - 2016
