Tackling Two CAH Financial Challenges HFMA Forum Networking
![Tackling Two CAH Financial Challenges HFMA Forum Networking Event July 17, 2014, 10 a. Tackling Two CAH Financial Challenges HFMA Forum Networking Event July 17, 2014, 10 a.](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-1.jpg)
![Course Agenda and Learning Objectives Agenda: 1. Emergency Department and Pharmacy Issues in the Course Agenda and Learning Objectives Agenda: 1. Emergency Department and Pharmacy Issues in the](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-2.jpg)
![Emergency Department And Pharmacy Issues In the CAH Setting Ralph J. Llewellyn, CPA, CHFP Emergency Department And Pharmacy Issues In the CAH Setting Ralph J. Llewellyn, CPA, CHFP](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-3.jpg)
![Polling Question #1 What is your greatest challenge with physician staffing in your emergency Polling Question #1 What is your greatest challenge with physician staffing in your emergency](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-4.jpg)
![ED Physician Availability • Operational history – Rural “old-time” physicians covered the ED in ED Physician Availability • Operational history – Rural “old-time” physicians covered the ED in](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-5.jpg)
![ED Physician Availability • Operational history – As time progresses § Demands for time ED Physician Availability • Operational history – As time progresses § Demands for time](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-6.jpg)
![ED Physician Availability • Reimbursement history – Part B component (cost for providing professional ED Physician Availability • Reimbursement history – Part B component (cost for providing professional](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-7.jpg)
![ED Physician Availability • Reimbursement history – Part A component (on-call or availability) § ED Physician Availability • Reimbursement history – Part A component (on-call or availability) §](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-8.jpg)
![ED Physician Availability • Challenge – How to structure contracts with providers to supply ED Physician Availability • Challenge – How to structure contracts with providers to supply](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-9.jpg)
![Polling Question #2 What is your greatest challenge with pharmacy services in your hospital? Polling Question #2 What is your greatest challenge with pharmacy services in your hospital?](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-10.jpg)
![Pharmacy • Historically, local retail pharmacies in rural America thrived – Independent – Stable Pharmacy • Historically, local retail pharmacies in rural America thrived – Independent – Stable](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-11.jpg)
![Pharmacy • Current – May be dependent–more corporate entities – Less stable professional workforce Pharmacy • Current – May be dependent–more corporate entities – Less stable professional workforce](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-12.jpg)
![Pharmacy • Current – Financial viability may be at risk § Reimbursements § Mobility Pharmacy • Current – Financial viability may be at risk § Reimbursements § Mobility](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-13.jpg)
![Pharmacy • Rural providers may find themselves in a bind – No retail pharmacy Pharmacy • Rural providers may find themselves in a bind – No retail pharmacy](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-14.jpg)
![Pharmacy • Addressing the issues – Purchasing – Managing – Competing 15 Pharmacy • Addressing the issues – Purchasing – Managing – Competing 15](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-15.jpg)
![Pharmacy • Challenge – Addressing the community concern – Preserving or improving overall financial Pharmacy • Challenge – Addressing the community concern – Preserving or improving overall financial](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-16.jpg)
![Polling Question #3 What solutions are you planning to implement to meet ED and Polling Question #3 What solutions are you planning to implement to meet ED and](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-17.jpg)
![A Provider Case Study: Emergency Department— Physician Availability Allowed in Cost Report Lenne Bonner A Provider Case Study: Emergency Department— Physician Availability Allowed in Cost Report Lenne Bonner](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-18.jpg)
![ED Physician Availability • What is allowed in cost report? – The time the ED Physician Availability • What is allowed in cost report? – The time the](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-19.jpg)
![ED Physician Case Study • Physicians requesting a pay increase • Medical Group Management ED Physician Case Study • Physicians requesting a pay increase • Medical Group Management](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-20.jpg)
![ED Physician Case Study • New pay model – $0 per hour Monday-Friday from ED Physician Case Study • New pay model – $0 per hour Monday-Friday from](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-21.jpg)
![Pharmacy Case Study • Scenario – Local retail pharmacy independent of hospital – Only Pharmacy Case Study • Scenario – Local retail pharmacy independent of hospital – Only](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-22.jpg)
![Pharmacy Case Study • What we did – Met with pharmacist (CEO, CFO, COO, Pharmacy Case Study • What we did – Met with pharmacist (CEO, CFO, COO,](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-23.jpg)
![Pharmacy Case Study • Ideas to Explore – Set up communication process for pharmacist Pharmacy Case Study • Ideas to Explore – Set up communication process for pharmacist](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-24.jpg)
![Questions & Answers Ask the speakers a question or share your CAH experiences. Just Questions & Answers Ask the speakers a question or share your CAH experiences. Just](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-25.jpg)
![Contact Information Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics lenne. bonner@smh-cvhc. org Contact Information Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics lenne. bonner@smh-cvhc. org](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-26.jpg)
- Slides: 26
![Tackling Two CAH Financial Challenges HFMA Forum Networking Event July 17 2014 10 a Tackling Two CAH Financial Challenges HFMA Forum Networking Event July 17, 2014, 10 a.](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-1.jpg)
Tackling Two CAH Financial Challenges HFMA Forum Networking Event July 17, 2014, 10 a. m. to 11 a. m. Central Standard Time Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics Ralph J. Llewellyn, CPA, CHFP Partner Eide Bailly, LLP Chad Mulvany Director, Healthcare Finance Policy, Strategy and Development HFMA
![Course Agenda and Learning Objectives Agenda 1 Emergency Department and Pharmacy Issues in the Course Agenda and Learning Objectives Agenda: 1. Emergency Department and Pharmacy Issues in the](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-2.jpg)
Course Agenda and Learning Objectives Agenda: 1. Emergency Department and Pharmacy Issues in the CAH Setting 2. A Provider Case Study: Emergency Department—Physician Availability Allowed in Cost Report 3. Q&A/Discussion Learning Objectives: • Understand how to restructure ED on-call physician contracts to address costs and physician availability. • Identify new strategies for ED physician compensation • Understand how CAHs can tackle pharmacy challenges, including improving customer service and handling pressure to enter the retail pharmacy market. • Identify methods to improve pharmacy accuracy, communication with physicians, and customer service. 2
![Emergency Department And Pharmacy Issues In the CAH Setting Ralph J Llewellyn CPA CHFP Emergency Department And Pharmacy Issues In the CAH Setting Ralph J. Llewellyn, CPA, CHFP](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-3.jpg)
Emergency Department And Pharmacy Issues In the CAH Setting Ralph J. Llewellyn, CPA, CHFP Eide Bailly LLP
![Polling Question 1 What is your greatest challenge with physician staffing in your emergency Polling Question #1 What is your greatest challenge with physician staffing in your emergency](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-4.jpg)
Polling Question #1 What is your greatest challenge with physician staffing in your emergency department (ED)? • Ability to staff the ED with physicians • Developing payment models for ED physicians services • Structuring contracts with ED physicians • All of the above 4
![ED Physician Availability Operational history Rural oldtime physicians covered the ED in ED Physician Availability • Operational history – Rural “old-time” physicians covered the ED in](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-5.jpg)
ED Physician Availability • Operational history – Rural “old-time” physicians covered the ED in addition to their daytime clinic/hospital obligations § Minimal cost § No Cost 5
![ED Physician Availability Operational history As time progresses Demands for time ED Physician Availability • Operational history – As time progresses § Demands for time](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-6.jpg)
ED Physician Availability • Operational history – As time progresses § Demands for time in ED increase § Societal norms change § Costs rise § Some providers opt out of covering ED 6
![ED Physician Availability Reimbursement history Part B component cost for providing professional ED Physician Availability • Reimbursement history – Part B component (cost for providing professional](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-7.jpg)
ED Physician Availability • Reimbursement history – Part B component (cost for providing professional services) § Unallowable cost on cost report § Patient specific § Reimbursed based on various fee schedules 7
![ED Physician Availability Reimbursement history Part A component oncall or availability ED Physician Availability • Reimbursement history – Part A component (on-call or availability) §](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-8.jpg)
ED Physician Availability • Reimbursement history – Part A component (on-call or availability) § Nonpatient specific § Greater good of all § Cost allowable on cost report • Not on-call elsewhere • Not providing professional services elsewhere • Originally had to be onsite 8
![ED Physician Availability Challenge How to structure contracts with providers to supply ED Physician Availability • Challenge – How to structure contracts with providers to supply](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-9.jpg)
ED Physician Availability • Challenge – How to structure contracts with providers to supply the best documentation that supports allowable costs – Strategies vary § Free-standing physicians § Provider-based physicians § Rural health clinic physicians 9
![Polling Question 2 What is your greatest challenge with pharmacy services in your hospital Polling Question #2 What is your greatest challenge with pharmacy services in your hospital?](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-10.jpg)
Polling Question #2 What is your greatest challenge with pharmacy services in your hospital? • Physician/pharmacy communication • Ability to staff pharmacy with qualified staff • Pharmacy/hospital management communication about processes for dispensing medication • All of the above 10
![Pharmacy Historically local retail pharmacies in rural America thrived Independent Stable Pharmacy • Historically, local retail pharmacies in rural America thrived – Independent – Stable](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-11.jpg)
Pharmacy • Historically, local retail pharmacies in rural America thrived – Independent – Stable professional workforce – Profitable – Multiple entities in the community 11
![Pharmacy Current May be dependentmore corporate entities Less stable professional workforce Pharmacy • Current – May be dependent–more corporate entities – Less stable professional workforce](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-12.jpg)
Pharmacy • Current – May be dependent–more corporate entities – Less stable professional workforce § Major competition for labor § Lifestyle changes 12
![Pharmacy Current Financial viability may be at risk Reimbursements Mobility Pharmacy • Current – Financial viability may be at risk § Reimbursements § Mobility](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-13.jpg)
Pharmacy • Current – Financial viability may be at risk § Reimbursements § Mobility of customer base § Mail order – 340 B may offer some financial benefits 13
![Pharmacy Rural providers may find themselves in a bind No retail pharmacy Pharmacy • Rural providers may find themselves in a bind – No retail pharmacy](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-14.jpg)
Pharmacy • Rural providers may find themselves in a bind – No retail pharmacy – Single retail pharmacy – Limited hours of service – Frustrated community looks to hospital to resolve the issue § They remember the past level of service 14
![Pharmacy Addressing the issues Purchasing Managing Competing 15 Pharmacy • Addressing the issues – Purchasing – Managing – Competing 15](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-15.jpg)
Pharmacy • Addressing the issues – Purchasing – Managing – Competing 15
![Pharmacy Challenge Addressing the community concern Preserving or improving overall financial Pharmacy • Challenge – Addressing the community concern – Preserving or improving overall financial](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-16.jpg)
Pharmacy • Challenge – Addressing the community concern – Preserving or improving overall financial performance of the organization § Retail pharmacy § Cost report 16
![Polling Question 3 What solutions are you planning to implement to meet ED and Polling Question #3 What solutions are you planning to implement to meet ED and](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-17.jpg)
Polling Question #3 What solutions are you planning to implement to meet ED and pharmacy challenges? • Developing a team of healthcare leaders to develop recommendations for solutions • Assigning one healthcare leader to reach out to stakeholders • Relying on senior leaders to make recommendations for solutions • Conducting surveys of stakeholder opinions to develop recommendations for solutions 17
![A Provider Case Study Emergency Department Physician Availability Allowed in Cost Report Lenne Bonner A Provider Case Study: Emergency Department— Physician Availability Allowed in Cost Report Lenne Bonner](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-18.jpg)
A Provider Case Study: Emergency Department— Physician Availability Allowed in Cost Report Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics
![ED Physician Availability What is allowed in cost report The time the ED Physician Availability • What is allowed in cost report? – The time the](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-19.jpg)
ED Physician Availability • What is allowed in cost report? – The time the physician is paid to be “available” • Time Studies – Required: Two separate two-week time studies per year – Allow for dictating, documenting, reviewing test results, etc. 19
![ED Physician Case Study Physicians requesting a pay increase Medical Group Management ED Physician Case Study • Physicians requesting a pay increase • Medical Group Management](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-20.jpg)
ED Physician Case Study • Physicians requesting a pay increase • Medical Group Management Association (MGMA) showed us at median with current compensation structure • Current ED physician pay model – $30 per hour Monday-Friday from 8 a. m. to 6 p. m. – $50 per hour Monday-Friday from 6 p. m. to 8 a. m. and weekends • Current availability percentage from ED time studies is 80 percent 20
![ED Physician Case Study New pay model 0 per hour MondayFriday from ED Physician Case Study • New pay model – $0 per hour Monday-Friday from](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-21.jpg)
ED Physician Case Study • New pay model – $0 per hour Monday-Friday from 8 a. m. to 6 p. m. (disallowed time) – $100 per hour Monday-Friday from 6 p. m. to 8 a. m. and weekends – Increased total call pay $234, 000 annually, which is $39, 000 per year per physician with six in the call rotation – Only cost facility $155, 000 – Puts us at 75 percent MGMA total compensation – Saved us 34 percent by changing ED call pay rather than base salary 21
![Pharmacy Case Study Scenario Local retail pharmacy independent of hospital Only Pharmacy Case Study • Scenario – Local retail pharmacy independent of hospital – Only](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-22.jpg)
Pharmacy Case Study • Scenario – Local retail pharmacy independent of hospital – Only pharmacy in town, no competition – Receiving many complaints § Delay in filling prescriptions § Out of medication, causing delays § Delays in filling bubble packs, causing us discharge problems § Wrong medications filled § Multiple medications in same bottle 22
![Pharmacy Case Study What we did Met with pharmacist CEO CFO COO Pharmacy Case Study • What we did – Met with pharmacist (CEO, CFO, COO,](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-23.jpg)
Pharmacy Case Study • What we did – Met with pharmacist (CEO, CFO, COO, physician) – Discussed concerns • What was discovered – Frustrations with some of our processes – Cash flow problems – Short staffed 23
![Pharmacy Case Study Ideas to Explore Set up communication process for pharmacist Pharmacy Case Study • Ideas to Explore – Set up communication process for pharmacist](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-24.jpg)
Pharmacy Case Study • Ideas to Explore – Set up communication process for pharmacist to direct problems to us (e. g. , discharge orders, questions on prescriptions, paper versus electronic prescriptions) – Rent pharmacy retail space in our hospital to minimize traffic in the pharmacy store and offer convenience to our patients – Research 340 B contract pharmacy agreement – Caution: Involve cost report preparers in all analysis 24
![Questions Answers Ask the speakers a question or share your CAH experiences Just Questions & Answers Ask the speakers a question or share your CAH experiences. Just](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-25.jpg)
Questions & Answers Ask the speakers a question or share your CAH experiences. Just type your question or comment into the Q&A box on your computer screen. 25
![Contact Information Lenne Bonner CFO St MarysClearwater Valley Hospital and Clinics lenne bonnersmhcvhc org Contact Information Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics lenne. bonner@smh-cvhc. org](https://slidetodoc.com/presentation_image_h2/b1cbf22f55334e45649f422c46a9420f/image-26.jpg)
Contact Information Lenne Bonner CFO St. Mary’s/Clearwater Valley Hospital and Clinics lenne. bonner@smh-cvhc. org Ralph J. Llewellyn, CPA, CHFP Partner Eide Bailly, LLP rllewellyn@eidebailly. com Chad Mulvany Director, Healthcare Finance Policy, Strategy and Development HFMA cmulvany@hfma. org 26
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