Principles of Healthcare Management HCM401 Kemal Erkan FACHE

Principles of Healthcare Management HCM-401 Kemal Erkan, FACHE

HCM-401 Week I • Syllabus Overview • Group Project • Case Study • Midterm and Final • Pre-test • Group Project Outline • Kyle Bain • EMR Incentive Presentation • Meaningful Use Core Measure • Week I presentation by Kemal Erkan Changing the Behavior

Changing The Behavior of Responsible Parties • No Copay • No Deductible • Medicare • Medicaid • Fee For Service • Length of Stay Patients Physicians And Hospitals Government Insurance Companies • Cost • Profit Changing the Behavior

Changing the Behavior

Changing the Behavior

United Medical Community Model ONE United Medical Network • Advanced Surgery • Optometrist • Cardiology • Pediatrics • Dermatology • Psychiatry • Family Practice • Gastroenterology • Physical Pain & Rehab • Podiatry • Hospitalists • Internal Medicine • Pulmonary Disease • Radiology • Nephrology • Rheumatology • OB/GYN • Sports Medicine • Ophthalmology • Urology PATIENT CHART DHIN • Patient Demographics • Medication History • Allergies • Progress Notes • Flow Charts • Immunizations • All Other Patient Related Records Changing the Behavior Hospitals CCHS Bayhealth AI Du. Pont Beebe Labs Other DHIN Organizations

United Medical ACO Qualifications based on CMS ACO Guidelines • • ACOs must have a formal legal structure to receive and distribute shared savings to participating providers. Each ACO must employ enough primary care professionals to treat their beneficiary population (minimum of 5, 000 beneficiaries) as deemed sufficient by CMS. Each ACO must agree to at least three years of participation in the program. Each ACO will have to develop sufficient information about their participating health care professionals to support beneficiary assignment and for the determination of payments for shared savings. ACOs will be expected to include a leadership and management structure that includes clinical and administrative systems. Each ACO will be expected to have defined processes to promote evidence-based medicine, report on quality and cost measures, and coordinate care. ACOs will also be required to produce reports demonstrating the adoption of patient-centered care. Changing the Behavior

30 DAY READMISSION COST STUDY Estimated # of Total Readmissions in 12 months Average Length of stay (4 days: 5437*4) # of Total Discharges Total Encounters-Days Average payment per encounter Total Payment for professional Services 5, 437 21, 748 5, 437 32, 622 $ 80. 00 $ 2, 609, 760. 00 (=32, 622*80. 00) Total Payment for Hospital Stay $ 150, 789, 758. 00 (=5, 437*27, 734. 00) This Estimate study does not take the reduction on the initial admissions in consideration but only focuses on 30 day Readmissions. Changing the Behavior

Organizational Structure Board of Partners Executive Committee (EC) Doctors & Directors Executive Director Accounting Operations Legal

Changing the Behavior

Old Method Of Reporting Sample Changing the Behavior

United Medical ACO EHR Screen Shot for Patient Health Maintenance Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Balance Sheet 2011 Changing the Behavior