Visions 2016-2017 Issue 2 THRIVE! When I sit back and reflect on the past few months I am amazed how we are already half way through this chapter year. We have had a very successful first few months. Education hours are on track to exceed the current 12 hours per member, we are tracking to hit our certification goals and membership goals and to no surprise I am sure we have already exceeded the 4 networking event required by every chapter! Ted and I attended our President’s meeting this past September in Memphis and we were able to spend some time with our friends in Region 6. We always appreciate the time to share common issues our chapters are facing. We brainstorm solutions and share best practices. We also learned more about HFMA National’s Strategic plan for the future of our organization, which I hope to share more in future newsletters. Programming has been on the forefront for our VP of programming and her committees. We already had two very successful joint programs one with ACHE at the Global Center for Health Innovation on Improving Community Health. Most recently we partnered with our colleagues at Baldwin Wallace and co-hosted an event for approximately 125 attendees. The program focused around the topics of Breaking down the Silos. Our chapter was fortunate enough to be awarded innovation dollars toward our program November 18 th at the Embassy Suites in Independence. This program is geared to bringing together all avenues of healthcare from finance, practice managers, administrators, IT etc. to bridge the gap between the silos within our own health systems. We are looking forward to the program and have speakers from the Advisory Board, Premier, Brennan, Manna and Diamond, as well as the Cleveland Clinic and University Hospitals. We will finish our year with a fun Holiday and Award Ceremony at the Rocksino on December 8 th and start the year with our second annual Women in Leadership event January 27 th at Mapleside Farms. February 16 th will host our PFS event along with AHHAM at the Wellness Center in Montrose followed by our March Madness Event on March 30 th at Shula’s. Anyone who has served on a committee or has done the leadership track knows how dedicated our chapter is to service of not only our members but all the community. We will be hosting our first 2016-2017 Chapter Sponsors Presidential Sponsors Ernst & Young First Credit Inc., HRSI/RevCare HW&Co. JP Recovery Services, Inc. RSM Platinum Sponsors Brennan, Manna & Diamond, LLC. Commerce Bank Fifth Third Plante Moran Gold Sponsors CompMed Analysis Fidelity National Collections Net Revenue Associates PNC Healthcare Silver Sponsors CliftonLarsonAllen Crowe Horwath LLP Fenner KPMG ProAssurance The Wellington Group, LLC Bronze Sponsors BKD, LLP BlueMark Cardon Outreach Emrhein & Associates Helvey & Associates HumanArc Parallon Quadax, Inc. SAKAL/CAI UCB, Inc.
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Visions 2016-2017 Issue 2
THRIVE! When I sit back and reflect on the past few months I am amazed how we are already half way through this chapter year. We have had a very successful first few months. Education hours are on track to exceed the current 12 hours per member, we are tracking to hit our certification goals and membership goals and to no surprise I am sure we have already exceeded the 4 networking event required by every chapter! Ted and I attended our President’s meeting this past September in Memphis and we were
able to spend some time with our friends in Region 6. We always appreciate the time to share common issues our chapters are facing. We brainstorm solutions and share best practices. We also learned more about HFMA National’s Strategic plan for the future of our organization, which I hope to share more in future newsletters. Programming has been on the forefront for our VP of programming and her committees. We already had two very successful joint programs one with ACHE at the Global Center for Health Innovation on Improving Community Health. Most recently we partnered with our colleagues at Baldwin Wallace and co-hosted an event for approximately 125 attendees. The program focused around the topics of Breaking down the Silos. Our chapter was fortunate enough to be awarded innovation dollars toward our program November 18th at the Embassy Suites in Independence. This program is geared to bringing together all avenues of healthcare from finance, practice managers, administrators, IT etc. to bridge the gap between the silos within our own health systems. We are looking forward to the program and have speakers from the Advisory Board, Premier, Brennan, Manna and Diamond, as well as the Cleveland Clinic and University Hospitals. We will finish our year with a fun Holiday and Award Ceremony at the Rocksino on December 8th and start the year with our second annual Women in Leadership event January 27th at Mapleside Farms. February 16th will host our PFS event along with AHHAM at the Wellness Center in Montrose followed by our March Madness Event on March 30th at Shula’s. Anyone who has served on a committee or has done the leadership track knows how dedicated our chapter is to service of not only our members but all the community. We will be hosting our first
2016-2017 Chapter Sponsors
Presidential Sponsors Ernst & Young First Credit Inc., HRSI/RevCare HW&Co. JP Recovery Services, Inc. RSM
Platinum Sponsors
Brennan, Manna & Diamond, LLC. Commerce Bank
Fifth Third
Plante Moran
Gold Sponsors CompMed Analysis Fidelity National Collections Net Revenue Associates PNC Healthcare
Bronze Sponsors BKD, LLP BlueMark Cardon Outreach Emrhein & Associates Helvey & Associates HumanArc Parallon Quadax, Inc. SAKAL/CAI UCB, Inc.
VISIONS NEWSLETTER ISSUE 2: 2016-2017
community event this upcoming year. So stay tuned for more information in the upcoming month. By now you should have received and were asked to fill out your National membership satisfaction survey. Myself and the leadership team find the comments very valuable and hope to improve with every year. I look forward to sharing the results in the upcoming months. In closing, NEO HFMA is continuing to THRIVE with the help of leadership team, committees and members. If you have any new programming ideas for our chapter, networking ideas or want to get involved please contact me directly. Warmest Regards, Nadia Vincenti President Northeast Ohio Chapter of HFMA
Regional Update
This trimester I am taking a class in systematic theology…not an easy subject for this action-oriented, application-minded girl who struggles with theoretical models. One of the things we discussed was the image of God and how we are created in it. The perspective that most resonated with me was a relational view. As the name suggests, this viewpoint is one of relationships. It has social and moral components. To put it simply, we are exhibiting the image of God when we work in harmony, in community. That’s how we are wired as humankind; we thrive when we work together. The implications for our work in healthcare is clear. We cannot be successful when we work in silos. The best ideas, the best care plans, the most successful teams, and the healthiest bottom lines are born out of collaboration and interdisciplinary work. The long-term viability of our organizations depends on relationships with our
community, our patients, our employees, our boards—all the stakeholders. These relationships are shifting, and changes and information are coming at us fast and furiously. We spend our days performing a juggling act. HFMA National is looking at these very issues in the strategic direction and planning for future relevancy. On a local level, our chapters continue to measure KPIs for the balanced scorecards while incorporating innovation and new kinds of collaboration to see what works for our members. All of this can be exhausting, but it can also be invigorating if we focus on relationships—our common building block. Find and foster those relationships which renew and energize you. HFMA is certainly an avenue to achieve this goal. We will lighten our loads together and truly thrive in this chaotic world of healthcare finance. Take care, Dawn Balduf Regional Executive, Region 6
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Welcome Back!
HFMA Members that have reinstated their membership during this past quarter.
Emily Miller, Mercy Health Paige K. Leininger, Ernst & Young
Hilary J. Fichter, Ernst & Young Charlene A. Steiner, Cleveland Clinic
Valarie Green, Cleveland Clinic Cynthia A. Terrano, Moffitt Cancer Center
Suzanne Marie Tschetter, Cleveland Clinic Rodney H. Finch, University Hospitals
Jessica Korman, Cleveland Clinic Robert C. Jay, Menorah Park
Don J. Barrett, Jr., Convergent Revenue Cycle Management
Charles R. Alderson, Direction Home, Akron Canton Area Agency on Aging
Brian L. Palmer, Cleveland Clinic Melissa Cox, Accretive Health
Shana L. Earle, Akron Children’s Hospital Lisa Hagee, First Credit (FCi)/RevCare
Richard L. Marrapese, Shamrock Companies Cynthia R. Nixon, American Healthcare Solutions
New Members - Welcome to NEOHFMA!
Please welcome our newest members to the Northeast Ohio Chapter of HFMA. Look for them at
our next meeting and welcome them to our organization.
Beth Conklin, State Collection Service Keith T. Coleman, Transfer In
Tracy Marie Vargo, Anthem, Transfer In Carolyn Castrovince, Oracle
Amie Fox, Plante Moran Ellen Ourednik, RGP
David Johnson, US Acute Care Solutions Benjamin Truax, University Hospitals
VISIONS NEWSLETTER ISSUE 2: 2016-2017
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Program Recaps Payor & Provider Relations July 28, 2016 Chapter members received an afternoon of education revolving around leadership at Market Garden Brewery in Cleveland. Craig Richmond, CFO of the MetroHealth System, started the session with an overview of the healthcare landscape and the future risks, delivery models and information needs that will impact both payors and providers. Market forces are acting as a catalyst for change as more risk is shifting to providers and payment reductions have become more commonplace. It is expected that at least 50% of Medicare reimbursement will be tied to risk-based models by 2018. Consumerism has created demand for more price and quality transparency, resulting in more narrow networks and growing popularity of high-deductible plans. Across the country, private payor ACO’s are emerging as health plans partner with provider organizations to reduce costs while providing appropriate access to care. As providers enter these new agreements, it is crucial to have timely and accurate data to track the costs and outcomes of care. Both the payor and provider have a responsibility to share data to identify care gaps and maintain coordinated care for the contracted population. Aaron Murski and Lisa Hahn from VMG Health shared a presentation entitled “Payer Provider Convergence: Understanding Trends and Transaction Structures”. An interesting fact was that United Healthcare is the largest provider of physicians and nurses in the country. Four major payor mergers have been announced within the past year though the Department of Justice has filed lawsuits to block two of the pending mergers. There has also been vast provider consolidation across the country as compressed reimbursement rates have forced smaller systems to pursue mergers to survive. There are four primary transaction structures: They continued to discuss valuation methodologies including determining value based on cost, income and market share. Early adopters have faced significant challenges with new delivery models as three Pioneer ACO members have exited the program. Mergers and acquisitions have also proved to be difficult as partners must integrate different cultures, IT systems and care models.
Partner Lease -Two models: Equity JV & Contractual JV (intermediary or plan controlled risk pool) -New products / market / population
Separate but inter-dependent on plan / provider functions
-Allocation of power based upon seats on the Board and reporting relationship of key management -Payor responsible for back office functions
-Provider “rents” or “leases” license to offer products. -Payor bears the ultimate risk and will provide health plan functions. -No capital contribution by provider, but provider may pay a fronting fee and make other financial commitments.
-Contract with experts / vendors on health plan capabilities must be developed (e.g., insurer, TPA, PBM, etc., may provide back-office functions) -Board of Director and key management capabilities
-Minimum capital and surplus, risk based capital and hazardous financial condition standards
-Separation of provider from health plan (e.g., tal
Acquisition Build
-Acquire an existing plan / shell license transaction
-Stock or asset purchase
-Utilize plan’s existing capabilities
-Assignment of provider network
-Health plan operational capabilities
-Regulatory approvals
-Insurance & other state regulatory agencies
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Adam Vincz, Director of Business Development at Free Choice Healthcare Foundation, discussed Leadership in Action. His organization is a not-for-profit created to assist the self-pay patient population pay their healthcare insurance policy premiums. They are one of several foundations making premium payments to qualified health plans on behalf of enrollees. The group currently works with fifty hospitals and maintains around 3,000 covered lives. Patients are nominated for coverage by provider organizations based on financial need and a history of non-compliance or inappropriate utilization. The group ensures that patients have continuous coverage for twelve months so that issues can be addressed and resolved during the coverage period. Patients in these programs are covered by a commercial policy, which is often beneficial for providers as this population would likely otherwise be Medicaid beneficiaries. The final speaker was John Blakeney, Principal, Idea Firm, LLC., who shared his views on business leadership. One of the biggest problems in both life and business is people who have not found an appropriate role based on their strengths and weaknesses. Having engaged employees and minimizing mistakes will lead to success and a winning culture. Everyone has unique talents and is a genius but must find their place and be on the appropriate path to achieve satisfaction and fulfill their potential. We must take time every week for both personal and professional development. We can build strength by studying those we admire and identifying the characteristics that give us strength. We can all be game changers if we recognize our strengths and able to overcome doubt and adversity.
Improving the Health Status of Your Community September 29, 2016 On behalf of ACHE and NEO HFMA I would like to thank all of those that attended the partnered event on Thursday, September 29, 2016. This event was held at The Global Center for Health Innovation in Cleveland Ohio. The evening began with dinner and cocktails during registration. The event began with our moderator Craig Richmond who is the Senior Vice President & Chief Financial Officer for The MetroHealth System. Craig began by explaining how MetroHealth is assisting with urban development issues and the challenges that are facing the hospitals in our communities. Several questions on hospital involvement and future steps were asked of Craig as well.
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Serving on the panel for the evening were Aparna Bole, MD who is the Assistant Professor Pediatrics at University Hospitals and Sagree Sharma, who is the Principal, Urban Designer, DPI (Design for Public Interest). Each panelist presented to the attendees on their role and challenges of the future in urban development and produced some staggering statistics. One of the most interesting to me was the report done by Aparna Bole, MD on how children in certain demographics are being tested for lead in their systems. Based on where these children live in the Cleveland area determines the amount of lead found. Another interesting fact was presented by Sagree Sharma on how some communities have a high number of Senior Citizens that don’t have cars or transportation and are miles from grocery stores or healthcare facilities. Future plans are being developed in these areas to allow for better locations for these two important factors.
This program was an entirely different approach to health care in the community. Attendees gained a lot of insight on how our communities are affected by different dynamics of urban development.
Breaking Down the Silos of Healthcare October 17, 2016 Chapter members received an evening of education through presentations and discussion at Baldwin Wallace University in Berea sponsored by JP Recovery Services. Thomas Campanella, Associate Professor, Health Economics Director, Health Care MBA Baldwin Wallace University, gave an overview of the topics covered before introducing the panel. The interrelated impact of self-interest, asymmetric information, moral hazard, passive purchasers of health care services transitioning to active purchasers of health care services, and social circumstances have contributed to high healthcare costs. Creating a culture based on value, innovation, and the customer are critical for the success of an organization.
VISIONS NEWSLETTER ISSUE 2: 2016-2017
The first to present from the panel was Teresa Koenig, Senior Medical Officer, Medical Mutual of Ohio, sharing her views on changing from volume to value as a basis for payment. Teresa discussed how medical spending is outpacing salaries. She outlined the Provider Value Equation: Value = Quality + Service/Cost. A paradigm shift is necessary for all levels of healthcare in order to lower the breakeven point for providers and increase value for the consumer. The next to present was Michael Hughes, Senior VP Hospital Operations, Summa Health Barberton Campus discussing the
Accountable Care Organization (ACO) that Summa has created. In moving from a Fee For Service to the new shared risk models Summa found that a team approach worked best, they improved processes and developed best practices which lead to less variation in care. The ACO works on a Triple AIM model – the right care, at the right time and for the right price. They are also using nontraditional means to deliver patient care such as tele health and relying more heavily on mid-level providers for routine care. Patients want easy access to competitive services at a reasonable price. At the Summa Health campus in Barberton they are changing the role of the community hospital. They are involving community leaders, members of staff and volunteers to create the type of facility that is needed. Loren Anthes, Public Policy Fellow, Medicaid Policy Center, The Center for Community Solutions, presented next. Loren was able to bring a governmental view to the program. Privatizing managed care plans can incentivize health care providers to negotiate payments from insurance companies. Ohio Department of Medicaid covers 86% of all beneficiaries, which is expanding the reach of Managed Care Plans. Stephanie Morley, Administrator, The Gardens of McGregor and Amasa Stone, discussed the challenges facing post-acute care facilities in today’s changing regulatory and financial markets. The role of post-acute care facilities has changed from short stay rehab to all-encompassing care. This is a move from short stay rehab to palliative and hospice care. The final speaker was Kyle Yoder, VP of Contracts & Billing, Cardinal Health, discussing durable medical equipment and how Cardinal Health is adapting to the changing utilization landscape of today’s healthcare. As testing moves from brick and mortar hospital stays to outpatient clinics to home testing these providers are keeping pace. For example, sleep apnea testing can be performed in the comfort of one’s own home and can cost 90% less than an in-lab study. The durable medical equipment industry has needed and will continue to need to be proactive in meeting ever-changing consumer needs. Historical silos can hinder organizational value and should be broken down to maximize success. The extent of recognition and acceptance of future value-based operations can either make or break the organization. There are opportunities for organization’s to add value should they decide to break away from the past.
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Save the Date Upcoming NEOHFMA Programs
Log on to the HFMA Website (http://neohfma.org/upcoming-programs/) for more information on upcoming programs.
Healthcare Huddle
November 18, 2016: 5800 Rockside Woods Blvd. Independence, OH 44131
8:00 AM to 5:30 PM
This is a free event for members and non-members! Total HFMA Hours: 6.75 Total Ohio CPA CPE’s: 6.75
Upcoming National Programs HFMA Seminars provide in-depth education on key topics critical to achieving effective financial results and creating strategic initiatives consistent with today’s environment. New to the industry? Seminars also provide the tools and information to enhance your job performance. Seminar size is limited to allow for maximum peer-to-peer interaction, and faculty are carefully chosen for their depth of knowledge and industry experience. Whether you need more healthcare finance fundamentals (Essentials Programs) or need to focus on issues related to new care delivery models (Master Sessions), HFMA’s highly rated programs continue to deliver in-depth, high-quality information that enables you to achieve immediate job results and organizational improvement.
Visit https://www.hfma.org/seminars/ to learn more and register
UPCOMING LIVE WEBINARS Take a look at the upcoming Webinars offered by HFMA and consider sitting in on one as
an easy way to get the information you need on pressing healthcare finance topics. From
the comfort of your office, you can participate in a Webinar and find the strategies and
tools you need to help your organization achieve success. Log onto the HFMA Website
(www.hfma.org) to sign up or get more information about the topic. The following
Webinars are free to HFMA members.
Transparency: Exploring the Merits and Challenges facing Patients and their Providers
3:00 - 4:00 pm, Eastern Time Understanding the Critical Role of Decision Support in the Capital Management Process Hosted by: HFMA
Wednesday, November 9th 2016
3:00 - 4:00 pm, Eastern Time Latest Updates on Legislative and Regulatory Issues and the Impact of the 2016 Presidential Election on Health Care Hosted by: HFMA
Monday, November 14th 2016
3:00 - 4:00 pm, Eastern Time Making Sense of the Final CMS MACRA Rule Hosted by: HFMA
Wednesday, November 16th 2016
3:00 - 4:00 pm, Eastern Time Strategies for Physician Groups to Prepare for MACRA Implementation Hosted by: HFMA
Tuesday, November 29th 2016
3:00 - 4:00 pm, Eastern Time 2017 Final Rule Changes to Outpatient Prospective Payment Systems and Ambulatory Surgical Centers Hosted by: HFMA
Wednesday, November 30th 2016
3:00 - 4:30 pm, Eastern Time Using Big Data and Analytics to Drive Sustainable Denials Management Workflows that Improve the Bottom Line Hosted by: HFMA
Thursday, December 1st 2016
3:00 - 4:00 pm, Eastern Time
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Strategies for Taking the Pain Out of the Pre-Authorization Process Hosted by: HFMA
Tuesday, December 6th 2016
3:00 - 4:00 pm, Eastern Time Increasing the Value of Care through Integrated Diagnostic Image Analysis Services Hosted by: HFMA
Wednesday, December 7th 2016
3:00 - 4:30 pm, Eastern Time HFMA’s MAP Awards for Physician Practices: Strategies for High Performance and Application Overview Hosted by: HFMA
Monday, December 12th 2016
3:00 - 4:00 pm, Eastern Time The Patient Status Battle: A Case Study on a Programmatic Approach to Retain Revenue while Maintaining Compliance Hosted by: HFMA
Wednesday, December 13th 2016
3:00 - 4:30 pm, Eastern Time Understanding the Final Rule Changes of the 2017 Medicare Physician Fee Schedule Hosted by: HFMA
Thursday, December 15th 2016
3:00 - 4:00 pm, Eastern Time Patient Payment Behaviors: Turn Collection Costs and Bad Debt Into Revenue Hosted by: HFMA
Tuesday, January 10th 2017
3:00 - 4:00 pm, Eastern Time
VISIONS NEWSLETTER ISSUE 2: 2016-2017
Chapter Updates
The planning for our 2017 GHALI conference is currently underway! The event will be held at The Lodge at Geneva on the Lake May 21st – 23rd, 2017. This interactive conference will be educational and provide great networking opportunities. We hope you will be able to join us! Save the Dates and Registration info will be coming in the next few months. If you would like to join the planning committee please contact Lori Koenig at [email protected].
The Membership committee will be hosting the annual March Madness Leadership Educational
Event in March 2017. Place and date are not yet decided. However, the committee is looking for
volunteers to assist with planning the event. Anyone interested in helping can contact Christina
