Volume 67 | Issue 4 Spring 2015
heartbeat H E A LT H C A R E F I N A N C I A L M A N A G E M E N T A S S O C I AT I O N S E R V I N G T H E K A N S A S C I T Y C H A P T E R Programming .............................2 Webinars ....................................2 President’s Corner ......................3 New Board Members..................7 ANI Conference...........................8
Officers and Directors.................9 Corporate Sponsors ....................9 Managed Care Forum ...............10 Healthcare 101.........................11
Region 8...................................12 Sponsor Spotlight .....................12 CHFP Ad ...................................13 MHA Update .............................14
Healthcare Trends 2015 Every year B. E. Smith analyzes its surveys of more than 300 healthcare executives, partners with AHA on a thorough environmental scan and reflects upon the most crucial trends expected to impact healthcare leaders throughout 2015 and beyond. Some trends are prevailing from recent years, showing their long-run persistence. Others are emerging and gaining momentum. The following nine trends deserve top-of-mind attention in executive decision-making and strategic leadership throughout 2015.
Cost Savings vs. Quality Care Debate continues about whether, after years of attention to cost-cutting in all aspects of healthcare, a pivot to heavy concentration on quality is needed. Are the two demands at odds? There is little abatement in aggressive cost cutbacks. As the AHA Environmental Scan notes: “Providers will be under tremendous pressure due to lowered reimbursement rates and increased patient volumes from health insurance exchanges and expanding Medicaid rolls. Some health systems are approaching the challenge by trying to
High Deductible Plans...............15 New Members ..........................16 Women in Healthcare ...............17 CHFP Certification.....................18 HFMA Anniversaries..................19
By Doug Smith, MBA, MHA Christine Ricci, MBA, RN
reduce costs by 20-30% overall.”1 The fundamental alteration of the healthcare business model will continue to drive such reductions. Yet care quality is equally demanded, and healthcare leaders recognize they must focus rigorously on both cost and quality, with the only way to bridge the two being devotion to value. This term is being defined as “delivering the best possible outcomes at a given level of cost. We call this competing on outcomes.” 2 Such competition moves away from simply seeking the lowest cost or market pricing power.
Increasing Volume, Variety and Complexity of Affiliations Organizations pursue the value equation within a changing and often unclear healthcare environment. The uncertainty is borne out by a recent B. E. Smith executive survey that revealed a split between the 44% Confident or Very Confident in outlook for the year and the 47% who hold an Uncertain or Very Uncertain outlook. 3 Article continues on page 4
mark your calendars National Webinars
Heart of America Programming
Live Webinars April 29 Moody's Not-for-Profit Healthcare Industry Outlook and Credit Perspective April 30 Current Trends in Healthcare Consumer Payments and Their Impact on Providers May 11 Understanding HFMA's Newly Redesigned Certified Healthcare Financial Professional (CHFP) Program May 12 Balancing Clinical and Financial Concerns: Insights on CMO-CFO Collaboration May 13 Reigning in Labor Costs Using Predictive Analytics and Data Transparency May 14 Fostering Provider-Payer Collaboration to Improve Chronic Care Management in Accountable Care Organizations
ATTENTION: OFFICERS, BOARD OF DIRECTORS, AND CHAIRS/CO-CHAIRS
View all upcoming live webinars If you are interested in presenting a webinar, please contact Kurt Belisle at
[email protected].
Available until December 9, 2015 Personalizing the Patient Experience: The Ultimate Objective of Population Health
JUNE 12, 2015 Heart of America Leadership Training Mark Your Calendars!!!
National Webinars Webinars available for one year... HFMA provides webinars available one calendar year following the live webinar date and year. Most on-demand webinars are free for HFMA members and $99 for non-members, unless otherwise noted. Available until October 13, 2015 Six Strategies to Keep Your Hospital Out of the Pricing Headlines Available until December 2, 2015 CFO Action Steps: Leading Practices for Revenue and Outcomes Reporting Improvement – Panel Discussion
Available until December 24, 2015 Building the Right Infrastructure to Succeed in Higher-Risk Value-Based Contracts View all on-demand webinars
View all upcoming on-demand webinars HFMA provides webinars available one calendar year following the live webinar date and year. Most on-demand webinars are free for HFMA members and $99 for non-members, unless otherwise noted. Go to http://www.hfma.org/Templates/OnDemandWebinars.aspx?id=6730 to view all available on-demand webinars with topics that include: - Accounting & Financial Reporting - Finance & Business Strategy - Payment, Reimbursement, & Managed Care - Revenue Cycle - Technology - And others – page 2 –
Jim Mozena, President
Dear Heart of America HFMA Members Wow, that was a quick four years as an HFMA officer! Capping off the experience over this past year as president has been great, and I would encourage others to take on the challenge. I will miss the opportunity to network with people from all over the US and share the success stories of the Heart of America Chapter. With minimal ongoing HFMA responsibilities, I’ve started to figure out how I will be spending some of my new found free time. For starters, I’ve joined a softball team again… after a 20-year hiatus. It will be an interesting summer! I’m happy to be able to report some successes and positive changes to the chapter over the past year. First, the programs were modified during the year to feature different types of offerings, including a political update and the “Women in Healthcare Luncheon”. The website redesign received an overwhelmingly positive response. The payment process was modified by utilizing PayPal to offer members and sponsors more flexibility in making payments. Modifications were also made to the registration and e-mail communication process. The chapter now uses Constant Contact, which gives us greater flexibility in registering and communicating with members. These improvements impacted the chapter’s performance with a 66% overall high satisfaction rating, an increase of 3% from the prior year. The rating is based on program topics, coverage of issues, the newsletter, networking opportunities, the website, and an overall rating. I would like to recognize the continued support of our corporate sponsors. Their engagement through sponsorships and volunteering allows us to provide quality educational and networking opportunities for our membership. Paul Knutson has been working diligently in planning the 20152016 year. He has a great team in place to lead our chapter through the next year. The team includes Michelle Narayan, President-Elect, Todd Kenney, Vice-President, Matt Robertson, Secretary, and Damara Harper, Treasurer. We have implemented many changes to the chapter’s operations in the past year, and these leaders will continue to make improvements over the coming years.
Thank you to our membership, board members, officers, and committee chairs who all contributed to making this a successful year for the Heart of America Chapter. Your continued support is appreciated and is crucial to the ongoing success of the chapter.
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Healthcare Trends 2015, cont. Healthcare leaders are responding with stepped-up pursuit of a wide range of alignments that include horizontal scale increases via hospital mergers and acquisitions (M&A) and vertical integration of physician practices, ambulatory centers, post-acute providers and others. Some are undertaking even more transformative moves that may be harbingers of the future: Embracing risk-shifting by becoming payers as well as providers. PricewaterhouseCoopers estimates that 50% of health systems have applied or intend to apply for an insurance license. 4 All of this realignment can create ever more complex organizations, which leaders must work to simplify. Noted management consultant Adrian Slywotzky has called healthcare delivery “hassle map heaven,” warning the industry to adapt and be truly customer-centric.
Migration of Care Outside the Hospital is Accelerating
Driven by the emerging population health movement, telemedicine is also booming. Video consultations are projected to grow from 5.7 million in 2014 to 130 million by 2018.7 Geisinger has found that telemonitoring of patients “improved the efficiency of care managers and delivered a 3.3 times return on Geisinger’s investment.” 8 This migration does not represent simply tinkering with the care delivery model. It is a response to far more disruptive forces. Non-traditional healthcare clinics are growing due to accessibility and convenience. Urgent care centers have become a $13 billion market9 and the rise of retail clinics in drugstores and other locations has been dramatic, doubling between 2012 and 2015. The recent rebranding of CVS to CVS Health sends a clear directional message from this self-described “new entrant.”
Healthcare Consumerism has Arrived
A parallel movement to value and realignment is a shift to caregiving outside the four walls of the hospital into various ambulatory entities such as urgent care centers and stand-alone EDs, as well as greater reliance on post- acute settings such as home care and long-term acute care providers. More surgeries are now performed outpatient than inpatient, and hospital ownership of free- standing ambulatory care centers has grown 27%.5 Brian Silverstein, M.D., of research firm Sg2, observes that the hospital profit base 10 years ago was 64% inpatient and 35% outpatient. “Today, that’s flipped,” he says. 6
Most of the trends described are fueled by - and require - far more active consumer participation in the process than has traditionally been the case. While the rise of consumer power has been predicted for many years, it now appears to be here in force. Newly insured individuals and the spread of high-deductible plans are driving more customer awareness of healthcare delivery options, further fueled by greater market price transparency. 10 Additionally, aging “baby boomers” are healthier, better educated and more accountable for their well-being. This important population will insist on being involved in their own care and their patient rights. Altarum confirms the trend: “Similar to prior years, this survey finds strong evidence that consumers want a seat at the table in decisions about their health. Nine out of 10 consumers prefer to be in control of medical decisions, while 64% take steps to learn about their health condition instead of relying solely on the doctor for information.” 11
Population Health Driving Communities of Service Beyond the move to outpatient care, alignments and partnerships are extending to very non-traditional delivery settings such as soup kitchens, Red Cross facilities and non-governmental organizations.
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These innovative approaches are being driven by the substantial interest in population health. They are motivated by the recognition that stronger preventative medicine and wellness programs are needed and will succeed if they meet individuals at their locations and states of readiness.
Experience the power. Go to www.mcgladrey.com/healthcare
This emergent trend is creating true “communities of service” designed to keep patients out of the hospital and leverage post© 2014 McGladrey LLP. All Rights Reserved. MCG-1214KV
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article continues on next page...
Healthcare Trends 2015, cont. acute care management. It is a model that optimizes what an observer described as the essence of population health: “Customized coordinated care.” 12
Changing Environment Creating New Leadership Competencies and Compensation Leadership is being heavily impacted by the altering landscape, creating new success requirements. A particularly notable trend is that CEO turnover is on the rise, reaching its highest level in 2013: 20%.13 Retirements, hospital M&A and the pressures of change are all contributing factors. B. E. Smith’s research suggests the consequences of CEO turnover can be far-reaching in many organizations. When asked which executives are likely to leave after a CEO departure and which initiatives are most affected, respondents indicated below.14 Executive compensation is adapting to the new leadership realities as well, albeit somewhat slowly. B. E. Smith continuously monitors the compensation landscape. Over the past year, pay raises in the executive suite ranged between 2% to 3%, with CEO increases slightly higher. Consensus forecasts average 2% for 2015.15
There is clear movement to alignment of compensation with the performance-based care model. Despite progress, though, 43% of surveyed executives say their organization has yet to match incentives to key values such as cost containment, patient engagement and clinical outcomes.16 Such changes will accelerate in 2015 and beyond. Experimentation with compensation typical in other industries is also occurring. Examples include stay bonuses to promote project completion or complete merger transitions and flexible, metrics-based bonuses to motivate individual goals.
Organizations Focusing on Succession Planning and Emerging Leaders Given the C-level turnover and the urgency to promote the skills necessary to thrive, healthcare organizations are increasingly training their sights on two interrelated initiatives: Succession planning and development of emerging leaders. The former is overdue, as 64% of executives still report no succession program in place.17 With at least 40% of CEO hires resulting from internal promotion,18 the need for a more formal succession approach is desirable. Some hospitals are turning to outside advisors to help build customized programs. Leadership development is about more than identifying the next-inline. Strategic organizations are devoting attention to younger and emerging leaders, realizing the need to build a strong bench in the
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Healthcare Trends 2015, cont. face of an aging workforce and a younger generation that may need new incentives to seek leadership roles. Recommended education and emerging-talent development efforts include: • Executive coaching and one-on-one real-time mentoring • Leadership development programs tailored to an organization’s specific needs • Regular competency assessment
Physician Leadership a Clear Priority Two data points are compelling when it comes to the role of physicians in the leadership equation. First, physicians continue at a rapid pace to become employees rather than independent practitioners. Forecasts suggest over 75% of physicians could be employed in hospitals and systems by 2020.19 Second, physicians are underrepresented in senior leadership, representing just 14% of C-suite hires in a recent study. 20
Recommendations include: • Foster a truly collaborative culture that sees individuals as partners who can bring ideas to the table. • Promote the right competitive environment that motivates rather than stifles change. • Gain leadership exposure to people outside healthcare for fresh perspectives. • Be attentive and work hard to overcome cultural and social norms that inhibit engagement. For example, women comprise 80% of the healthcare workforce but only 18% of leadership. The trends discussed here span a range of factors impacting institutional structures, competitive forces, patient demands, population health and workforce development and engagement. Clearly 2015 presents many challenges, but healthcare leaders should recognize that successfully navigating the changes presents exceptional opportunities to make significant progress towards transforming not only their organizations, but the industry as a whole. Doug Smith, MBA, MHA, has served as president and chief executive officer at B. E. Smith since 1996. A seasoned professional with more than 30 years of experience in healthcare search and recruitment, Smith provided leadership to B. E. Smith during a period in which the firm grew from two consultants to a staff of over 200.
This situation is changing rapidly as organizations seek closer integration of the clinical and administrative. Doctors are being recruited for new positions such as Vice President of Clinical Transformation or Informatics as well lending their voice as part of management dyads or triads with other leaders.21 Roles span the operational, strategic and even cultural. As the AHA Environmental Scan observes, the physician leader must drive a culture of accountability, commitment to care excellence and continuous performance improvement. Determining the right skill sets, identifying physicians with the best cultural fit and providing strong training are all becoming paramount.
Christine Ricci, MBA, RN, is chief communications officer at B. E. Smith. Ricci is recognized for assessing market conditions, building strategy and brands and delivering with executional excellence.
Workforce Engagement Remains a Key Ingredient in Achieving Quality The shift to value-based care is increasing the emphasis on patient satisfaction and employee engagement at every level of the organization. Yet achieving such engagement continues to be very challenging. A recent B. E. Smith survey found executives completely divided:22
For more information visit BESmith.com or call 855.254.8261 1 2 3 4 5
6 7 8 9 10 11 12 13 14 15
Given the attention to this topic over the years, one would expect greater progress toward positive engagement, suggesting further prioritization needed. B. E. Smith frequently advises organizations on enhancing workforce engagement.
16 17 18 19 20 21 22
“American Hospital Association Environmental Scan 2015,” Hospitals & Health Networks, September 2014. Boston Consulting Group, quoted in AHA Environmental Scan. B. E. Smith Executive Survey, September 2014. Gary Ahlquist, Minoo Javanmardian, Phil Lathrop, and Amika Porwal, “Several hundred health networks will become payors,” Strategy&, June 20, 2014. Modern Healthcare, June 23, 2014. See also a study by Kaufman Hall finding that “inpatient utilization rates per 1,000 declined across all age groups, averaging a 5 percent across-the-board drop.” R. York, K. Kaufman, M. Grube, “Where have all the inpatients gone?” Health Blog, January 6th, 2014. Kara Olson, “Outpatient Outlook,” HealthLeaders online magazine, 2014. Parks Associates forecast quoted in mHealthNews, August 26, 2014. Christine Kern, “Telemonitoring Provides 3 to 1 ROI,” HealthIT Outcomes, Oct. 14, 2014. IBIS World Urgent Care Centers report, 2012. AHA Environmental Scan cites growth in percentage of workers with HDPs from 4% in 2006 to 20% in 2013. Altarum Institute, 2014 Survey of Consumer Health Care Opinions Jenkins and Neuwirth, Carolinas Health System, presentation at American Society for Healthcare Human Resource Administrators (ASHRAA) convention, 2014. ACHE data quoted in AHA Environmental Scan. B. E. Smith executive surveys, 2014 Charles Kim, quoted in Karen Wagner, “Core Competencies for a Changing Healthcare Environment,” HFM Web August 01, 2014. B. E. Smith survey, 2014 B. E. Smith survey, 2014 “Who are you hiring for your C-suite?” Becker’s Hospital Review, August 25, 2014. AHA Environmental Scan “Who are you hiring for your C-suite?” Becker’s Hospital Review, August 25, 2014. Health Research & Educational Trust, Building a leadership team for the health care organization of the future, April 2014. B. E. Smith survey, 2014
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To our newly elected board members:
Insurance Re l Claim cov a c i d ery e M
Sue Brammer Michelle Decker Donna Findley Kalinda Marfisi Tammy Shepard
Officers for the 2015-16 term are as follows: President President-Elect Vice President Secretary Founders/DCMS Contact Treasurer
Paul Knudtson Michelle Narayan Todd Kenney Matt Robertson Matt Robertson Damara Harper
Stay tuned! In the next issue, learn more about our new board members and officers, and how they plan to impact the 2015-16 HFMA year.
2015-16 Officers from L to R: Damara Harper, Matt Robertson, Todd Kenney, Michelle Narayan, and Paul Knudtson
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2015-17 Board Members from L to R: Donna Findley, Sue Brammer, Tammy Shepard, and Michelle Decker
Connecting industry expertise with customized solutions is how healthcare systems and patients grow stronger. Matthew Michalak 816.292.4258
[email protected] baml.com/healthcare
The power of global connections
TM
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Officers and Directors 2015 HEART OF AMERICA CHAPTER OFFICERS
BOARD OF DIRECTORS 2013-2015
President President-Elect Vice President Secretary Founders/DCMS Treasurer
Mea Austin Heath Leuck Cathy Kindle Karrie Pence Mary Knollmeyer
Jim Mozena Paul Knudtson Michelle Narayan Todd Kenney Todd Kenney Matt Robertson
2015 PUBLICATION COMMITTEE Jessica Baird, Co Chair Cathy Kindle, Co Chair Tammy Shepherd Pablo Marquez
2014-2016 Jessica Baird Damara Harper
Esteban Ponce Keely Roach
816-407-2041 816-691-2010 913-945-5596 816-218-1699
Deadline for submission of articles for the next newsletter is June 15, 2015.
2015 Corporate Sponsorship PLATINUM
GOLD
BKD, LLP Bank of America Merrill Lynch Haase & Long Human Arc McGladrey LLP Parrish Shaw
Bank of Kansas City Commerce Bank
Sincere appreciation is extended to our corporate sponsors for 2014. Your support of our Chapter significantly improves our ability to offer quality programs to our members. Please consider joining our fantastic group of sponsoring organizations.
SILVER Cardon Outreach Country Club Bank Mercer
If you are a service provider, please contact: Mea Austin 785-842-0726 Mary Knollmeyer 913-791-3500 x 4018
Come join us! HFMA volunteers receive opportunities for professional development, information, networking, and advocacy and earn Founders points when they participate in a chapter committee. The 2014-15 committee chairs and co-chairs are as follows: Audit Committee Keeley Roach 816-474-4253 x21507
Fall Workshop Committee Paul Knudtson, Chair 816-932-0336
Programs Committee Michelle Narayan, Co-Chair 913-791-4260
By-Laws Committee Mary Knollmeyer, Chair 913-791-3500 x4018
Social Media/Networking Committee Heath Leuck, Co-Chair 816-347-2859 Kalinda Tenborg, Co-Chair 913-234-6654
Nominating Committee Andrea Lindsay, Chair 816-502-7033
Sponsorship Committee Mea Austin, Co-Chair 785-842-0726 Mary Knollmeyer, Co-Chair 913-791-3500 x4018 Membership Committee Todd Kenney, Chair 816-701-0266 Website Matt Michalak, Chair 817-308-7338
Directory Robert Fowle, Chair 913-319-6209 Certification Damara Harper, Chair 816-781-7200 Publications Committee Cathy Kindle, Co-Chair 816-691-2010 Jessica Baird, Co-Chair 816-407-2041
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Link Committee Frankie Forbes, Chair 913-341-8600
Managed Care Forum & Updates The program held at North Kansas City Hospital on January 21st focused on the current state of Managed Care, as well as updates from local payors. The half-day session included presentations by Mark Whiting, Principal of Employee Health and Benefits at Mercer and Bob Finuf, Vice President of Payor Relations and PCN Executive Director at Children’s Mercy and Children’s Mercy Pediatric Care Network. Representatives from Blue Cross and Blue Shield of Kansas City and Coventry Health Care of Kansas were also on hand to discuss payor updates.
2
1 3
4 1 2 3 4
Mark Whiting presents “How We Got Here and Where We Are Going”.
Brenda Cook, Manager of Provider Services, Coventry Health Care of Kansas
Jason Spacek, Department Vice President, Channel Marketing, Blue Cross and Blue Shield of Kansas City
Bob Finuf discusses Children’s Mercy’s transition from volume to value.
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Healthcare 101 2
1 The Healthcare 101 program was again a big success! Hosted by St. Joseph Medical Center in Kansas City, the all-day event was held on February 19 and included over 70 attendees. Topics of discussion were comprised of ACA impacts, patient financial engagement, management of the EHR, productivity and labor management, Stark/Anti-Kickback concerns, and more. Local experts presenting at the event included: Cari Benshoof and Sean Callahan, HRS Erase Dan Kutchel, CarePayment Mea Austin, Haase & Long Mark Whiting, Mercer Mary Mirabelli, 2014-2015 HFMA National Secretary/Treasurer Mark Hakim, ProAssurance David Pursell and David Solberg, Husch Blackwell Stephanie Dorwart, Altius Healthcare Consulting Group
1 2
Mea Austin defined next steps related to the 501(r) IRS Final Regulation David Pursell and David Solberg presented Stark law and Anti-Kickback Hot Topics for 2015
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Tracy Packingham, Region 8 Executive
Wow, it’s hard to believe this is my final Regional Executive message and another HFMA year is almost complete. I would like to take this opportunity to say “Thank You” to all of the Region 8 Presidents – Darren, Amy, Troy, Rita, Tim, Sarah, Jon, Becky and Jim. It has been a privilege to work with and get to know all of you. It has been a phenomenal year to say the least. All the chapters in the region have met or exceeded goals and will be presented with National Awards at ANI this year in Orlando. It takes a TEAM to make this happen and we have an amazing group of dedicated individuals. CONGRATULATIONS to each of you! Stephanie Hultman and her TEAM have been working hard to bring yet another fantastic year in 2015/2016. Thank you Steph for all your support through this year; the region is in very good hands with you and Bill Fenske. Thank you for the continued support of all of our officers, directors, volunteers and members. Our chapters are truly exceptional. Region 8 ROCKS!!! Get involved and make this next chapter year even better. Thanks for the opportunity to serve as your Region 8 Regional Executive. This was truly a fabulous experience and look forward to working with the new leadership. Lastly, I would like to thank all of the chapter leaders who have made the Region 8 Mid America Summer Institutes a success. Don’t miss the conference this year, August 26-28 in Minneapolis, MN. Hope to see everyone there. My telephone number is 314-570-3580 and my email address is
[email protected]. I welcome your questions and comments at anytime!!!
Spring Sponsor Spotlight: Human Arc Your complete self-pay reimbursement solution, right here in Kansas City. In 2014, we celebrated our 30th year of providing comprehensive solutions to address self-pay reimbursement challenges. Experience: An extensive range of solutions including Medicaid and disability program eligibility enrollment, screening and enrollment for subsidized Marketplace insurance, out-of-state Medicaid billing and follow-up, and denial management and appeals. Compassion: A patient-first approach achieved through genuine caring, concern and respect for everyone we serve, optimizing their health care experiences while improving your fiscal health. Results: Improved access to health care and quality-of-life benefits delivered to over a million people each year, and billions in incremental revenue secured for clients nationwide. Through a combination of technology and innovation, we can provide the solution you need to secure more revenue—from complete outsourcing of self-pay patient account management to leading-edge software that makes in-sourcing more accurate and efficient. 800.828.6453 or 816.363.8989 Fax: 816.363.3535 | www.humanarc.com
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Andrew B. Wheeler, Vice President of Federal Finance, Missouri Hospital Association
Why is the King v. Burwell Case Important to Missouri? Since the passage of the Affordable Care Act, opponents have worked to repeal and question its constitutionality. While the Supreme Court of the United States previously ruled that the ACA may require nearly all Americans to secure insurance, it ruled that states cannot be forced to expand Medicaid eligibility standards to 138 percent of federal poverty level. Since that time, 28 states and the District of Columbia have increased the eligibility standards to meet the ACA requirement. To date, Missouri has yet to expand Medicaid eligibility, leaving more population without insurance than those states who have expanded coverage. The ACA contains provisions to assist individuals without affordable coverage through Medicaid eligibility expansion and through the health insurance marketplace. Since Medicaid eligibility has not been expanded in Missouri, the only other ACA option is to purchase insurance through the health insurance marketplace.
The Supreme Court is once again hearing a case which could have negative implications for those in Missouri who are now covered under the marketplace. The challengers are arguing that the text of the ACA only allows tax credits to be provided in state facilitated marketplaces. If the challengers are successful, this will leave those who have enrolled in a federally facilitated marketplace without tax credits, allowing them to purchase affordable insurance. Since Missouri is a federally facilitated marketplace state, the loss of tax credits could result in many individuals forfeiting coverage. What is known is that more than 253,000 individuals in Missouri have enrolled in the marketplace. Of the enrollees, 88 percent are a receiving tax credits averaging $3,408 per year. Without these tax credits, Missouri’s marketplace enrollees would see their average monthly premium payment increase by 4.3 times their current payment. The loss of these tax credits would force Missouri’s marketplace enrollees to collectively incur a $761 million increase in premiums for 2015. If the challengers succeed, all providers in the state of Missouri will see an increase in the patients who are uninsured.
All FFM States
MO
AR
IL
IA
KS
NE
OK
TN
87%
88%
88%
78%
85%
80%
88%
79%
82%
Average Yearly Premium
$4,488
$4,440
$4,764
$4,116
$4,560
$3,684
$4,260
$3,624 $3,852
Average Yearly Tax Credit
$3,216
$3,408
$3,444
$2,520
$3,156
$2,568
$2,940
$2,496 $2,532
Average Premium after Tax Credit
$1,260
$1,032
$1,320
$1,596
$1,404
$1,128
$1,320
$1,140 $1,320
Percent Premium Reduction due to Tax Credit
71.7%
76.8%
72.3%
61.2%
69.2%
69.7%
69.0%
68.9%
Percent Enrollee’s with Premium Assistance
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65.7%
High-Deductible Plans: Consumer Education for Successful Reimbursement By Emily Anne Nolte and Stacey Lee
As more consumers enroll in high-deductible health plans (HDHP), they must quickly become reasonably fluent in the language of health insurance and benefits. Patients who were previously covered under HMO, PPO, and POS plans were able to get by with a basic understanding of a referral and primary care doctor. Now, these same consumers struggle to understand the difference between a copay, coinsurance, and deductible, let alone a basic idea of what their treatment will actually cost them. Hospitals can leverage this consumer education gap to their advantage through patient and physician educational outreach. According to a PwC survey1, 67% of employers offered their employees HDHPs in 2014, up from 62% in 2013. Additionally, 56% of employers are considering increasing employee contributions, and 26% of employers selected HDHP as the plan with the largest enrollment, compared to 21% in 2013. Under these HDHPs, sometimes referred to as consumer-directed plans, patients typically must pay at least the first $1,000 before their insurance company covers any treatment. Oftentimes, patients do not fully grasp the importance of selecting a plan fit for their lifestyle until they are faced with a large healthcare bill. By proactively educating consumers about HDHPs, health savings accounts, and price transparency, hospitals can help patients make better informed decisions, build goodwill with the community, and provide entry to their organization for potential patients. These goals can be reached through consumer outreach at events such as health fairs, community gatherings, local non-profit organizations, and company meetings. Most hospitals already support community outreach for wellness checks, cancer screenings, and vaccination drives at community events. Adding basic education about health insurance information to these events can bolster success around the goal of overall wellness. For example, instead of encouraging patients to sign up for traditional screenings such as colonoscopies at these events, also provide them with information on how to pay for such services. Send Patient Financial Services specialists to meet with local religious groups or civic organizations such as Rotary International and the Junior League. Offer to speak about the changing dynamic of health insurance and provide educational material to members that they can, in turn, share with others. As providers work to educate consumers, they should be prepared to address patient concerns about the reality of having a HDHP and paying higher out-of-pocket amounts for coinsurances and copayments, particularly with respect to middle-to-low income consumers. According to a report published by The Commonwealth Fund in November 2014, consumers are increasingly concerned about affording their deductibles.2 Forty-three percent (43%) of privately insured adults surveyed reported that their deductible was somewhat, very difficult, or impossible to afford. Of the group surveyed, 40%
even reported delaying/avoiding a doctor visit due to the unaffordability of their deductible.2 In allaying these concerns while providing education around basic health insurance information, these consumer outreach events can be an excellent venue to spotlight any price transparency efforts your hospital has put into place. Encourage and empower your patients to manage their healthcare costs and direct them to your financial counselors. By helping consumers understand their health benefits before they need them, your hospital will see many benefits. For one, these discussions are a key marketing opportunity for your organization. Insurance education outreach differentiates your hospital from the standard community outreach, while still supporting the local community. Outreach also provides an opportunity to exhibit quality and favorable price metrics. Armed with basic knowledge of their health plan, a consumer is more likely to not only understand, but to pay his/her bill in a timely fashion, or seek financial counseling prior to service. As consumers adjust to the most recent major changes in health insurance, you and your patients can benefit by being ahead of the curve on revenue cycle patient education.
Take Advantage of Regular Enrollment Periods Scheduling meetings during regular enrollment time could be particularly helpful to consumers who are making decisions about their future healthcare needs. If a large local employer has recently started offering a HDHP as an option, or has moved all employees to a HDHP, reach out to their Human Resources office and arrange a lunch-andlearn on how the plan impacts its consumers. Make sure that all representatives from your hospital have a solid understanding of insurance terms and are prepared to answer consumer questions. In addition, coaching patients and addressing their concerns with higher deductibles, copayments and coinsurances will help them through this transition.
© 2014 PricewaterhouseCoopers LLP, a Delaware limited liability partnership. All rights reserved. PwC refers to the U.S. member firm, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details. This content is for general information purposes only, and should not be used as a substitute for consultation with professional advisors. 1 http://www.pwc.com/en_US/us/hr-management/publications/assets/pwctouchstone-survey-results-june-2014.pdf 2 Collins, S.R.; Rasmussen, P.W.; Doty, M.M.; Beutel, S. “Too High a Price: Out-of-Pocket Health Care Costs in the United States”. Tracking Trends in Health System Performance. Commonwealth Fund pub. 1784 Vol. 29. November 2014. < http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/nov/1784_collins_too_ high_a_price_out_of_pocket_tb_v2.pdf>
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Welcome New Members! Adrian Calderon, Sr Account Manager Sagacious Consultants Work Phone: (816) 914-7572 Email: adriancalderon@ sagaciousconsultants.com
Venkata Rao, Dir of Staff Development & Training Osawatomie State Hospital Work Phone: (913) 755-7173 Email:
[email protected]
Lesley Delaney, Accounting Manager Hedrick Medical Center Work Phone: (660) 214-8124 Email:
[email protected]
Chris Sandoval Kansas City Pulmonology Practice Work Phone: (816) 333-1919 Email: chris.sandoval@ hcahealthcare.com
Nevin Folino Cerner Corporation Work Phone: (816) 645-4714 Email:
[email protected] Jean Garten, Principal JG Consulting Work Phone: (913) 884-6789 Email:
[email protected] Sarah Howard, Sr Financial Analyst Saint Luke's Hospital of Kansas City Work: (816) 932-1522 Email:
[email protected] Tim Lambing, Senior Associate Mercer Work Phone: (816) 556-4808 Email:
[email protected]
Debora Summers DLS Consulting Work Phone: (816) 305-4308 Email:
[email protected] Augustin Sylvester, Associate Administrator Truman Medical Centers Work Phone: (816) 404-6351 Email:
[email protected] Matthew Toyne, Operations Revenue Cycle Mgr Optum RX Work Phone: (913) 217-3537 Email:
[email protected]
Sharum Newberry, Treasury Sales Analyst Bank of America Merrill Lynch Work Phone: (816) 292-4233 Email:
[email protected]
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Women in Healthcare 2
1 4
3
Women in Healthcare Luncheon The Women in Healthcare Luncheon was held on March 26 at North Kansas City Hospital. Speakers included Sandy Brown with The Employer’s Resource, Becky Fisk, Vice President, Revenue and Business Development at North Kansas City Hospital, and Joanne Burns, Senior Vice President and Chief Strategy Officer at Cerner.
1
Sandy Brown discusses the importance of having fun at work.
2
Joanne Burns talks about her personal journey to becoming the Senior Vice President and Chief Strategy Officer for Cerner.
3
Attendees enjoy the lunch and learn program.
4
Women in Healthcare speakers Joanne Burns and Becky Fisk.
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Changes to HFMA’s CHFP Certification Program HFMA’s strategic vision characterizes the current healthcare business environment as the transformation of care to achieve value. Providers, physicians, and payers are all confronted with new business challenges. The nature of the business environment and its impact on industry stakeholders supply both the demand for and elements of a new approach to the CHFP.
New CHFP program features - A learning program designed to build comprehensive industry understanding and sharpen business skills; - Two-module structure: 1) Achieving Strategy: the Business of Healthcare 2) Operational Excellence: Healthcare Industry S takeholder’s Business Challenges; - CHFP designation earned by successful completion of both modules; - Online study materials created specifically to assist in mastering the business content.
Why is the certification program changing? The healthcare reform environment has caused the industry’s key stakeholders—providers, payers and physicians—to fundamentally rethink existing business models. Care transformation is business transformation. The necessary success factor for finance professionals today: Change-oriented business acumen. The existing certification program focuses narrowly on applied finance and financial reporting and does not address the business environment.
pursue the revised certification. These options are open to those who have: - Purchased the self-study course since January 2014, whether they have completed it or not. - Registered and paid for the CHFP exam via Castle since February 2014 (but not yet scheduled). - Registered, paid for, and scheduled the CHFP exam via Castle since February 2014 (but not yet taken). Note: Members who may have been unsuccessful and are waiting to retake the current CHFP examination are not eligible. Candidates must choose one of these options by April 30, 2015 and notify Career Services at
[email protected]. HFMA will provide the complete revised CHFP program (Modules 1 and 2) at no cost to all those who have purchased the CHFP self-study course and/or registered for the exam, as outlined above. For members interested in certification who have not yet begun preparing, HFMA encourages that they wait and use the new materials available in summer 2015 to prepare for the new CHFP. Questions? Please contact
[email protected] or call (800) 252-4362 and ask for career services.
CHFP Program Important Dates: - April 30, 2015 - Current CHFP exam registration ends You may register for the current CHFP exam prior to April 30. You have one year from the date of registration to schedule your exam. For example; if you register in March 2015 you will have until March 2016 to schedule your exam. Also, if you need to retake the exam, the current exam will be available to you for as long as you need (based on current registration, scheduling, and retake policy). - May 1, 2015 - New CHFP program pre-registration available Pre-registration allows interested members to email HFMA. HFMA will email members as soon as the link to purchase and more information about the new program is available. - June, 2015 - New CHFP program registration available.
CHFP Program - Transition Groups For members who are currently pursuing certification and have begun actively preparing for the exam, or have been through a chapter certification webinar series or practicum study group, HFMA encourages continuing with the current process. Current CHFP candidates can choose, at no additional cost, either to continue the traditional CHFP program or to wait until June 2015 to – page 18 –
5 YEARS
25 YEARS
Jamie Ackerman - Wisconsin Physician Services Jessica Baird - Liberty Hospital Cathy Berube - Western Missouri Medical Center Dwight Carvell - Heartland Regional Medical Ctr Kari Casady - St Francis Hospital And Health Services Mitchell Clark - Cerner Corporation Michelle Frederick - Esolutions, Inc. Rhonda Harrelson - Enterprise Bank & Trust Scott Hendrickson - Allscripts Cynthia Hicks - Clinical Reference Laboratory, Inc. Steven Hunt - Love Funding Linda Lemons - North Kansas City Hospital Kristine Marsh - Davita Healthcare Partners Karrie Pence - Mcgladrey LLP Brooke Runnion - Lockton Companies Shanda Spire - Lafayette Regional Health Center Michael Viazzoli - Bank of America
Terri Bradley - Western Missouri Medical Center Allen Clark Janet Gordon - Saint Luke's Surgicenter/Nueterra Hlthcare Cathy Kindle - North Kansas City Hospital Terry Weathers - Sunflower State Health Plan
10 YEARS Jason Keibler - Coventry Health Care Of Kansas Janet Mueller - Olathe Medical Center Kelli Schroeder - North Kansas City Hospital James Wilson - Health Outcomes Sciences
15 YEARS Cathryn Carter - Wyandot Inc. Jennifer Chrostowski - North Kansas City Hospital Katie Guhr - Aetna Natalie Lee - Centura Health
30 PLUS YEARS Larry Todd - Netsmart Technologies Mary Knollmeyer - Olathe Medical Center Jocelyn Skidmore - St. Francis Hospital & Health Services Linda Cole - Country Club Bank Michael Herrick - Catholic Health Initiatives Kathy Janvrin - Carondelet Health Joyce Keck - Carondelet Health Carol Meyer - Saint Luke's Health System Steve Doherty Jerry Rutherford - Child Health Corp Of America Dan Williams - Liberty Hospital Darrell Bieberly - Saint Luke's Health System Ron Bremer - Bremer & Co., CPA Larry Fogel - Fogel Consulting, LLC Gordon Glass - Golden Valley Memorial Hospital Marie Nicholson Frank Devocelle - Olathe Medical Center Larry Crozier Kenneth Gross - Retired Tom Kennedy - Retired Jim Franklin Conrad Maygers
20 Years Connie Cargin - Kingswood Ben Ernst - Northwest Health Services, Inc. Teri James - Lafayette Regional Health Center David Makkers - North Kansas City Hospital Tammy Shepherd - University of Kansas Health System Sandra Soerries - Medical Revenue Solutions, LLC Joe Stasi - Saint Lukes East Hospital
It’s time someone took care of you. You need a financial specialist who understands the healthcare industry. The Commerce Bank Healthcare Team can help you use innovative financial solutions and best practices to overcome challenges and bring results to your bottom line. Interested in learning more? Call us!
ccommercebank.com ommercebank.com / 816.234.1895 816.234 .1895
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