Monthly Journal of Informa on Technology

Summer 2016 Update

 Winter 2017 Update

In this 

Issue: 

Pg.3 Regional 

Director 

Message 

 

 

Pg. 3 New 

Members 

 

Education: 

Pg. 5 Early 

Careerist 

Event (Save 

the Date)  

 

Articles: 

Pg.8 “The 

Top Three 

Factors Be‐

hind Success‐

ful partner‐

ship in Post 

Acute Care.” 

 

Pg. 12  “The 

Future of 

Rural health 

Care” 

 

 

 

Sponsorships: 

Pg. 16  Sup‐

porting spon‐

sors 

 

 

 

  

 

2016 —2017 Great Lakes Chapter Leadership

Mentoring

Chair:

Andrea Barnes

Members:

Carolyn Obrecht

Program

Co-Chairs:

Michelle Toups

Nicole Sulak

Members:

Gerald Artman

Amy Bilyea

Donald Dingman

Carolyn Obrecht

Sponsorship

Chair:

Patty Davis

Members:

Brent Smith

Networking

Chair:

Cinthia Brooks

Vice Chair:

Members:

Max Mendieta

Mike Cwik

Brent Smith

Tom Matonican

Audit & Finance

Carolyn Obrecht

Certification

Chair:

Mark Thompson

Vice Chair:

Elizabeth Hooper-Linn

Members:

Link Chapter Representa-

tive:

Sam P Niemi

Membership

Chair:

Ben Smyth

Members:

Steve Panoff

Brent Smith

Tom Matonican

Membership Directory

Chair:

Elizabeth Hooper-Linn

Newsletter

Chair:

Wieslaw Herdzik

Vice Chair:

Cheryl Kotenko

Members:

Alicia Kozak

Web Site

Chair:

Brent Smith

Great Lakes Chapter

Officers

President

Brent Smith

President Elect

Tom Matonican

Secretary

Michael Cwik

Treasurer

Kellie VanDeusen

Past President

Josh Wiggins

Board Members

Mark Kato

Tanya Hahn

Chad Gutzman

Sam Niemi

Directors

Northern Michigan

Gerald Artman

Upper Peninsula

Regina Bergh

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First Name Last Name Company

Angela Pinheiro CMH for Central Michigan

LeeAnn Sloan CMH for Central Michigan

Kaylyn Todd LJ Ross Associates, Inc.

Loi Chambers Grand Traverse Band of Ottawa

New Members 

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Regional Executive’s Message

We are well into 2017 at the point you are reading this, and my year as RE is quickly coming to a close. I am excited about the decisions your Region-al Executive Council made this past fall regarding benchmarks for the 2018-19 chapter year. I think they are in keeping with the strategic direction of National, and they make sense at the local level. If you are one of the chap-ter leaders, you will be hearing the full details at LTC. And after LTC, your

leaders will be bringing back plans and strategies to support and service all members.

The role of the Regional Executive is changing a bit and will continue to do so, as the definition of chapters and regions evolve. As such, the nomination process for the 19-20 RE is different. In the past, our region had a seven-year rotation plan. A chapter could nominate a person for the RE posi-tion only when it was their turn. That process has worked fairly well, but isn’t optimal. For in-stance, I would have preferred to have served as RE right after I finished the role of President for NW Ohio, not four years later when our chapter came up in the rotation.

To that end, there is no longer a rotation. There is a job description with requirements. If you feel you meet these requirements and would like to serve as a Regional Executive, please contact your chapter President and President-elect. They will send names on to Amy Bilyea, our RE2, and me for review. We will set up interviews and have discussions with all interested people. The Presidents and President-elects will vote and finalize the nomination at LTC.

I would encourage anyone who has been a chapter president in the past to consider serving as a Re-gional Executive. It has been a wonderful opportunity to understand more from a national perspec-tive and to network with other leaders from across the country. The ideas and sharing have been fantastic. If you are committed to HFMA and to professional growth, this may indeed be a great fit for you.

Take care,

Dawn Balduf

Region 6 Regional Executive

Take care,

Dawn Balduf Regional Executive, Region 6

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Annual Accoun ng Update & Winter Social

McLaren Bay’s Lincoln Center Lecture Hall

January 27, 2017

FASB and A&A Update by Plante Moran’s presented by Plante Moran’s Lindy Beldyga and Carolyn Obrecht What has FASB been up to? Learn about recent and upcoming accoun ng pronounce-ments and how they impact your organiza on. Key Compliance issues for Accoun ng presented by McLaren’s Heather McAllister What does Accoun ng need to know about Compliance? This session will discuss some key areas that all Accoun ng departments should know to keep their organiza ons Com-pliant. Fraud Happens by Plante Moran’s Michelle McHale and Amanda Fletcher The presenters will share ps for preven ng and detec ng fraud within organiza ons us-ing actual case study examples. Leader’s as Teachers presented by McLaren’s Patricia Hatcher Leaders wear several hats in our organiza ons and one of those hats is as teacher. This discussion will focus on the Leader as Teacher and the impact on culture, compliance, growth and learning. We will discuss the benefits of the leader as teacher for the leader, the learner and the organiza on. Employee Benefits by Plante Moran’s Laura Taylor and Zac Laumer What should your organiza on be concerned with related to employee benefits? Learn about DOL and IRS hot topics including DOL deposit requirements for employee deferrals and loan payments, 5500 filing requirements, fiduciary requirements, overall re rement plan compliance and 457 regula on changes.

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Annual Accoun ng Update & Winter Social

January 27, 2017

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The Top Three Factors Behind Successful partnership in Post Acute Care.

In a health care industry that is transi oning from a fee-for-service model to a value-based reimbursement system, hospitals are selling outcomes, not procedures. This shi has had a substan al impact on health care delivery and treatment, especially in regard to hospitals’ partnerships with post-acute care providers.

Although post-acute care providers include long-term care hospitals (LTCHs), inpa ent re-habilita on facili es (IRFs), skilled nursing facili es (SNFs), and home health agencies (HHAs), the majority of services are rendered by SNFs and HHAs (Figure 1). Devel-oping partnerships with these service providers is of crucial importance to reducing re- admi ances to the hospital and improving overall outcomes. Nearly 42% of Medicare pa-

ents are discharged to a post- acute care se ng and in order for improvements to be made, the process must first be measured and tracked. This becomes complicated as nearly 50% of hospitals refer pa ents to 18 or more post-acute care providers. The more post-acute care providers in the network of the hospital, the more resources will be required to manage the care process to ensure quality care is given a er discharge. Hospitals that iden -fy and select the correct strategic partners should achieve be er outcomes with their pa-

ents.

h p://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf

“Why Post-Acute Care Partners Are Cri cal to Hospitals’ Fu-ture,” h p://www.hhnmag.com/ar cles/7421-why-post-acute- care-partners-are-cri cal-to-hospitals-future

Figure 1: Post-Acute Care Providers

3%

40% 50%

HHA SNF IRF LTCH

7 %

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1. Iden fying and Selec ng Strategic Partners

There is a plethora of informa on out there to assist hospital management in screening for poten al strategic partners. Big data resources such as Medicare.gov is a good place to start. Here are some important measures of performance to focus on for SNFs and HHAs:

SNFs:

Three out of five quality ra ng minimum. A three-star quality ra ng is needed to waive the three-day-stay rule to allow for the transference of pa ents to a post-acute care se ng more quickly for comprehensive joint replacement (CJR) and certain managed care companies and ACO programs. Approximately 64% of SNFs have a ra ng of three or higher, leaving more than one-third of all SNFs below the requirement.

Below average re-hospitaliza on rates

Number of registered nurses

Pa ent and family sa sfac on survey informa on

 

HHAs:

Star scores at or above the state average

Recer fied rates at the state average

Pa ent survey results

Although the five star system started out as just a tool to measure SNF performance, it has developed into a highly sophis cated payment tool which is closely monitored by post-acute care providers. The ra ngs in the five star system are calculated on a state-by-state basis, with the top 10% of facili es receiving fi stars, the middle 70% receiving a ra ng of two, three or four, and the bo om 20% receiving one star. These ra ngs are based upon health inspec on scores, staffing case mix and quality. Those metrics may vary from year to year, thus it is important to look at the historical ra ngs of the facili es. Re-viewing re-hospitaliza on rates are also important and although the na onal average is currently 17.5%, special care should be given to analyze the acuity level of the facility (typically, the higher the acuity of the pa ent, the higher the chances of readmission are).

Addi onally, the appropriate number of registered nurses should be analyzed based on the acuity and number of pa ents at the facility, with careful dis nc on between regis-tered nurses and licensed prac cal nurses. Becoming a registered nurse requires addi-

onal training that allows for more accurate and mely assessments.

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For HHAs, the five star ra ng system is not as widely used as it is for SNFs. However, it s ll provides valuable informa on and will likely become more widely used as more pa ents u lize the Home Health Compare func on on Medicare.gov. Rec fica on rates are also useful, as they provide the propor on of non-ini al pa ent episodes to ini al episodes, giv-ing an indica on as to the incidence of chronic, mul - episode pa ents. Finally, because home health occurs in the pa ent’s home, pa ent surveys are a good source to review as well.

Considera on should be given to the proximity of the pa ents to the hospital if they are not returning home. Closer facili es present obvious benefit such as less travel me for a pa ent should a complica on occur and re-admi ance prove necessary. Closer facili es also allow for more networking between the post-acute care provider and the hospital. This could prove benefit in improving the lines of communica on, resul ng in reduced mis-takes and aligning both organiza ons to improving outcomes of pa ents. On-site reviews of the post-acute care facility and interviews of senior management are also key in determining the culture fit and quality of care.

2. Inves ng in People and Technology

To truly achieve an integrated health care delivery model, post-acute care must act as an extension of the care a pa ent receives at a hospital. Hospitals need to be able to monitor pa ents in the post-acute care se ng the same way they monitor pa ents in their own facility. This requires significant investment in technology that is able to communicate effec vely with the hospital’s own technology as many of these pa ents have co-occurring health condi ons. Although many hospitals may have sophis cated electronic health rec-ords systems, the same cannot always be said of post-acute care providers. Special a en-

on should be paid to the integra on of health informa on technology systems to ensure health informa on is able to be shared in a secure and mely manner. The best health man-agement systems are able to iden fy and issue alerts on a real- me data exchange to the hospital on pa ents discharged to post-acute care se ngs. Post-acute care providers that have implemented these systems may come at a higher price but a reduc on in re-admission rates may jus fy the increased cost.

Similar to inter-departmental mee ngs at the hospital, best prac ces denote regular mee ngs with management of the post-acute care facility to review trends in pa ent care, discuss readmission causes and iden fy any weaknesses in the provision of care a er discharge from the hospital. Assigning a hospital care coordinator with accountability in the pa ent outcomes and re-admission rates from a specific post-acute care facility could lead to be er results. Addi onally, aligning the incen ves of the hospital and post-acute care pro-vider by sharing savings if certain quality metrics are met may improve outcomes as well.

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3. Remaining Flexible

The implementa on of the Affordable Care Act (ACA) has disrupted the tradi onal health care delivery model and, no ma er what the ACA’s future, it is likely that there will be con nued change. Retaining fl is vital to hospital operators and post-acute care provid-ers alike. To deal with some of these changes, hospitals and accountable care organiza ons (ACOs) have been forming post-acute con nuing care networks comprised of select post-acute care providers. Although these care networks are s ll in the developmental phase, they are emerging as a means of ensuring there is a certain quality of care given to pa-

ents a er discharge from the hospital.

Some hospitals are forming joint ventures with post-acute care providers, building new facili es located on or near the hospital’s main campus. This allows for a streamlined pro-cess and uninterrupted care a er discharge from the hospital. The joint venture aligns the organiza ons and leverages experience from both acute care and post-acute care to im-prove pa ent outcomes. Other hospitals are choosing to instead lease space to post-acute care providers on their campuses in an effort to bring the organiza ons closer together.

Although there is no one-size-fit solu on to building successful partnerships with post-acute care providers, hospitals that allocate resources efficient and remain open to new care delivery models will be best posi oned to provide quality care to their pa ents.

Authors:

Conner  Girdley  is  a  vice  president  with  Lancaster  Pollard  in  Atlanta.  He may  be  reached at cgirdley@lancasterpollard.com.

 

 

 

Grant  Goodman    is  a  vice  president  with  Lancaster  Pollard  in  Newport Beach. He may be  reached at ggoodman@lancasterpollard.com.

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The Future of Rural health Care Few topics are as emo onal and personal as health care. Imagine your child breaking an arm playing football in the backyard, your mother calling to relay some bad news about your father’s health a er a visit to the doctor or your sibling telling you about an upcoming ba le with cancer. Fear, anger, sorrow, uncertainty and other emo ons flood over you in-stantly. It’s inevitable that everyone will face health care issues in one form or another.

But rural Americans are suffering unique health care challenges that urban residents typ-ically do not face. Simply accessing health care can be a significant hurdle for many. Even more challenging may be finding affordable care.

Defining Rural

The U.S. Census Bureau iden fies two categories of urban areas: the fi is an urbanized ar-ea of 50,000 or more people, including ci es and metropolitan areas; the second is an urban cluster of at least 2,500 and less than 50,000 people, including suburbs and large towns. Ru-ral encompasses all popula on, housing, and territory not included within either of the designated urban area defini ons. According to 2010 census data, approximately 20% to 25% of the U.S. popula on lives in rural areas.

Typical demographic trends of rural areas include lower median incomes, a high propor on of seniors, higher acuity levels and lower life-expectancies. Based on 2010 census data, per capita income is on average $7,417 lower in rural areas than in urban areas, and rural Americans have a higher likelihood of living below the poverty level. According to the Ru-ral Health Founda on, nearly 24% of children in rural areas live in poverty. And as younger residents leave home to a end colleges and universi es, or seek employment in urban cen-ters, the remaining popula on in the rural communi es they leave behind becomes old-er. The fastest growing age cohort in rural America are residents 85 years old and above.

Rural popula ons typically have high numbers of lower income and aged residents, and there are specific ailments that impact these communi es at a higher rate than urban communi es. Obesity, lung cancer, chronic obstruc ve pulmonary disease (COPD) and heart disease are sta s cally

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more common in rural areas. Finally, the gap between urban and rural life expectancies is growing. According to a 2014 study published in American Journal of Preven ve Medicine, consistent overall increases in U.S. life expectancy was noted during the past 40 years, from 70.8 years in 1970 to 78.7 years in 2010. However, the study reveals the rural-urban gap widening from 0.4 years in 1969 to 1971 to 2 years in 2005 to 2009.

To make ma ers worse, the providers of rural health care suffer alongside the popula ons they serve. From reimbursement cuts to a suffoca ng regulatory environment, smaller fa-cili es located outside urban and suburban popula on centers have a more different path to managing cash flow and scaling fixed costs. This ar cle will focus on two of the primary challenges that both residents and providers face in rural communi es.

Challenge One: Access to Health Care

In most U.S. ci es, access to physicians and hospitals is a quick drive, a cheap public transit fare, or a taxi ride away. However, people in rural se ngs are likely to live further away from health care providers, par cularly specialist services. Addi onally, the defi-ciency of dependable transporta on can be a barrier. Transporta on services that exist in urban areas are o en lacking or non-existent in rural areas.

Besides the geographical barriers to accessing health care, there are fewer providers. As not-ed earlier, about 20% to 25% of the popula on is rural; however, only about 10% of physi-cians prac ce in these communi es. Ask any rural hospital or skilled nursing CEO to list the top issues in the industry; most would likely tab finding qualified staff as a key con-cern. Per “Healthy People 2010: A Companion Document for Rural Areas,” a project fund-ed by the Office of Rural Health Policy, more than 33% of rural Americans live in “health pro-fessional shortage areas,” and nearly 82% of rural coun es are classified as “medically under-served areas.”

Compounding these issues is the rate at which rural health care facili es are shu ng down. The Na onal Rural Health Associa on recently teamed with the University of North Carolina and iVantage, a health analy cs firm to conduct a study that iden fying current and poten al rural hospital closures. The ul mate goal is to iden fy poten al closings before they occur. The research targeted approximately 2,000 rural hospitals across the country, and labeled 210 as “most vulnerable” with another 463 labeled as “at risk.” Those dubbed “most vulnerable” could close any day, while “at risk” ra ngs are reserved for hospitals that may only last another few years without adjustment. Ul mately, closing these sites will not only have a

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nega ve impact on the access to care in the service area, but also eliminate a top em-ployer in the community.

Challenge Two: Affordability

With a new presiden al administra on on the horizon, the future of the Affordable Care Act (ACA) is unclear. The general purpose of the ACA was to create more afforda-ble health insurance for the uninsured, thereby reducing the drain on the health care sys-tem created by caring for the uninsured. According to “The Affordable Care Act and Insur-ance Coverage in Rural Areas,” a 2014 report, rural popula ons have a larger propor on of low-income residents who could poten ally benefit from the ACA to receive health in-surance coverage.

However, approximately 66% of uninsured rural individuals live in states that chose not to expand Medicaid. In some states that chose to expand, the enrollment has far exceeded the projec ons, which has caused strain on the Medicaid funds from the state. Addi on-ally, several na onal insurers have pulled out of the ACA state exchanges as their losses piled up. In some cases, to offset losses, premiums on employer- provided insurance plans have increased, crea ng strains on small businesses subsidizing these plans to employees. Limited employment opportuni es combined with moun ng health care pre-miums con nue to drive costs higher. Ul mately, these factors equate to rural individu-als having fewer affordable health insurance choices.

Aside from the ACA complica ons, Medicare payment systems and reimbursement prac ces typically do not acknowledge the dis nc ve situa ons of small and rural hospitals. These hospitals are dispropor onately impacted by the con nual cuts to Medi-care reimbursements, including the bad-debt program and dispropor onate-share hos-pital payments. At some facili es, the average age of plant for health care and hospital facili es far exceeds acceptable levels. Improvements to the physical plant and the de-mand for new informa on systems climbs, yet access to capital financing can be limited. Reinves ng in the facility is difficult with dwindling revenues and limited financing op ons.

Solu ons and Paths Forward

Though the landscape seems bleak, not all hope is lost. Many rural health facili es are us-ing rural clinics, allowing them to open smaller yet impac ul health care facili es across their service areas. This model allows for easier access to general care, but s ll limits the ability to access specialty care, such as cancer treatment  

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centers or heart specialists. Accessibility is also being driven by new delivery methods, like telehealth, online prescrip on subscrip ons and delivery services and 24/7 on-call doc-tors via the internet. Supplemen ng hands-on care with technology should allow greater access as long as communi es become connected.

Health care organiza ons must also address affordability in expense reduc ons. Special-ized consul ng groups, such as Health Care Resource Group, focus on working with smaller rural facili es to navigate through difficult waters and improve opera ons.

A though ul capital structure is a good way for hospitals to address expense reduc ons through minimizing debt service payments. Several financing programs are available to rural hospitals that can address the need to reinvest in their facili es through expan-sion, acquisi on, rehabilita on, or even a modern replacement facility and meet the needs of the community. The USDA Community Facili es Program is reserved for rural nonprofit organiza ons, including hospitals and skilled nursing facili es, and provides below market fixed-rate, long-term, non-recourse financing for construc on and re-finance. Other non-recourse financing solu ons include Federal Housing Administra on (FHA) Sec. 242 mortgage insurance programs, which also provide agency-insured, long- term, fixed rate debt at rela vely high leverage points.

The aforemen oned challenges in rural communi es impact a significant por on of the U.S. on a daily basis. Simply accessing affordable health care is something the majority of the na on may take for granted. Without strategic financial ac on, our rural health care system will con nue to face obstacles that severely inhibit community members from receiving necessary care.

   Bre  Murphy is a vice president with Lancaster Pollard  in Chicago. He may be reached at bmurphy@lancasterpollard.com.

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We are always looking for ar cles, job openings or local Great Lakes content for the

newsle er. Please feel free to call or email your materials to myself , Cheryl or Alicia.

Wieslaw Herdzik Cheryl Kotenko Alicia Kozak

989‐839‐3304 989‐839‐3184 989‐839‐3732

Wieslaw.Herdzik@midmichigan.org Cheryl.Kotenko@midmichigan.org Alicia.Kozak@midmichigan.org

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