hoosier times: 2017 fall issue - hfma-indiana.org times... · 11/16/2017 · welcome to your 2017...

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In this Issue

− President’s Letter

− Editorial Policy, Deadlines…

− Editor’s Note

− Membership

− Spotlights

o New Chapter Member

o Eskenazi Health

− Programs and Events

o Tri-State Conference

− Do You Remember When…

− Save the Dates

− Articles

o Adult Day Health Care…

o Diagnosing Payments…

o Succession Planning

Sponsors − Listings

− Logos

Hoosier Times: 2017 Fall Issue

`Upcoming Events National Webinars

January 25-26, 2018: 2018 HFMA IN Winter Institute

Revenue Cycle Conferences: February 1 - March 8, 2018 (Sponsored by Indiana HFMA and MGMA)

April 12-13, 2018: 2018 HFMA IN Spring Institute

Please check website for updated information on upcoming Institutes (including hotel reservations)

and other events: www.hfma-indiana.org

Use the HFMA Weblink for easy access to HFMA National leadership activities and membership tools!

Indiana Pressler Memorial Hoosier Times - Fall 2017

http://www.hfma-indiana.org/

https://www.hfma.org/webinars/

https://www.hfma.org/webinars/

http://www.hfma-indiana.org/event-2543686

http://www.imgma.net/





http://www.hfma.org/content.aspx?id=46025

Greetings Indiana Pressler Memorial Members,

I don’t know about you, but Fall is my favorite time of the year! The crisp air, the vivid colors of the changing leaves, enjoying friends and s’mores around the fire pit – it doesn’t get much better!!

Fall also means our bi-annual Tri-State Institute. Again this year we partnered up with the Southwest Ohio, Central Ohio, and Kentucky Chapters in Cincinnati for some quality education and fun networking. We had just over 300 attendees with the Indiana Chapter well represented. Thank you to all who attended! Check out the event photos on page 8. The planning committee met after the event and felt the Reds game at the Handlebar is a good draw and Cincinnati is a good central location for all four chapters, so we will likely be returning to Cincinnati in two years.

The Chapter Board and Committee Chairs met on October 6th for a Planning Retreat. This was the first time in several years that we’ve gathered in this fashion and it was very productive! Michael Garczynski, a member of National’s Chapter Advancement Team (CAT) and member of the Western Pennsylvania Chapter, facilitated the discussion. He shared demographic information on our Chapter and led us through discussions on our chapter’s Strengths,

Weaknesses, Opportunities, and Threats (SWOT). We know that one our biggest strengths is our amazing members! Getting our members engaged and active in our Chapter is an opportunity and something we spent a lot of time discussing, as well as what, where, and how we deliver our educational events, and balancing the value proposition with our valued sponsors. It’s never too late to get involved with the Chapter and we invite your participation and feedback. Look for some new exciting changes to our upcoming Institutes as we tie in what we learned from the retreat.

Collaboration is also one of our strengths. Mark your calendars for the IRHA Fall Forum to be held November 16th in Kokomo and the IMGMA/HFMA Revenue Cycle Conferences (formerly the Third Party Payor Days) to be held across the state in February (see pages 11-12 for more information). We have five days planned with stops in South Bend, Ft. Wayne, Indianapolis, Bedford, and Evansville. Stay tuned for more details.

As our Chapter events slow down in November and December, I hope you all find time to enjoy the Holidays with family and friends. I look forward to seeing you January 25-26 at the Winter Institute at the Indianapolis Marriott North!

Sincerely,

Amy Herron

President’s Letter by Amy Herron


Welcome to your 2017 Fall Hoosier Times Newsletter!

This edition of the Hoosier Times Newsletter contains updates on recent and upcoming HFMA events, Chapter member and organizational spotlights, and timely articles on healthcare industry topics, including:

• The innovative nutritional solution at Eskenazi Health • An opportunity to get to know one of our new Chapter members, Michael Chromy • Photos from the recent Tri-State event • Easy-to-read and informative articles on Value-based reimbursement, Adult Day Heatlh Care, and

Succession Planning (Thank you to the authors for allowing us to publish their articles in our Newsletter) • Information on the MGMA and HMFA jointly-sponsored revenue cycle conferences coming in February

and March, 2018.

We hope you will find the Newsletter useful, and we would love to hear from you on how to improve the Newsletter and better meet your needs. Please do not hesitate to reach out to us with your suggestions. Our Committee would like to extend a special thank you to other Chapter members who have contributed to this edition – Amy Herron, Jim Miller and Brad Willkie.

A big ‘Thank you’ also goes to all of our Sponsors, whose ongoing support is essential in order for us to be able to provide programs and events that meet the needs of our Chapter members.

General Policy The statements and opinions expressed in articles or features are those of the author(s) and do not necessarily reflect the view of the Indiana Pressler Memorial Chapter, the Healthcare Financial Management Association, or the Editor. The Editorial Board reserves the right to edit material and to accept or reject contributions whether solicited or not. All correspondence is assumed to be released for publication unless otherwise indicated. All rights reserved.

Questions regarding articles or features should be addressed directly to the author(s). All article `submissions must be typed and sent via email or provided on a disc.

Deadlines All submissions must be received by the following dates. Materials received after an Edition’s deadline are not guaranteed to be published: January 19, 2018 Winter Edition April 12, 2018 Spring Edition July 15, 2018 Summer Edition October 12, 2018 Fall Edition All submissions, correspondence, advertising, and comments should be sent to David Parry, Editor – Hoosier Times

Email: [email protected]

Hoosier Times Non-Sponsor Advertising Rates

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Full Page $390.00

With the exception of business cards, discounts are available for advertising in consecutive issues. Ads should be in high res .tif, or .jpeg files at least 300 dpi – submit via email to [email protected]

Editorial Policy, Publication Deadlines and Advertising Rates

Editor’s Note by David Parry


mailto:[email protected]


Pass on the value of HFMA membership and be rewarded!

It’s easy to get started. After you establish a connection with a potential member, simply complete HFMA’s Member-Get-A-Member Online Referral Form.

You’ll be rewarded. For every new member you recruit who joins HFMA, you’ll receive points to redeem for great prizes any time using HFMA’s new online Member-Get-A-Member Rewards Center (site coming soon).

If you’re the top recruiter, you’ll receive The ANI 2018 Experience Package. This package includes:

• Complimentary conference registration • Hotel accommodations during the conference • A gift card for travel and incidentals

All recruiters also receive:

• Recognition on HFMA’s Member-Get-A-Member leaderboard webpage (coming soon) • An HFMA Member-Get-A-Member lapel pin

Additional Member-Get-A-Member Resources:

• View the complete rules of HFMA’s Member-Get-A-Member Program • Access HFMA’s Member-Get-A-Member Resource Center • See the 2016-2017 Member-Get-A-Member Winner’s Circle

Questions? Contact HFMA’s Membership Manager at 800/252-4362, ext. 339, or [email protected].

Membership Committee News: HFMA’s Member-Get-A-Member Program


https://hfma.realmagnet.land/mgam


http://www.hfma.org/ani/

http://www.hfma.org/Content.aspx?id=55341




https://hfma.realmagnet.land/my-hfma-story


Michael Chromy is our Member in the Spotlight this issue! An auditor by trade, Mike enjoys life with his girlfriend and dogs, and is a big lover of the outdoors. He has been in Indiana a little over a year, so if you see him please give him a warm Hoosier welcome! Q. What is your career/current position? Mike: I’m currently an audit senior with the RSM healthcare team. I have been auditing five years and have had a healthcare focus for three years. I started with RSM three years ago in Minneapolis and transferred to Indianapolis in November of 2016. Q: Tell us about your family. Mike: I have a girlfriend of three years. I moved out to Indiana for her as she is pursuing a career in radio with WAZY 96.5 in Lafayette. Q: Any pets? Mike: I have two dogs. Both are three-year-old rescues. Baila is a three-year-old min-pin mix, and Arabella is a three-year-old Finnish Spitz mix. Both have a lot of energy and are extremely spoiled. Q: What are your hobbies or what you like to do for fun? Mike: When I am not working, I really enjoy taking the dogs hiking on different trails I haven’t been to. In addition, I am a foodie and like trying different restaurants. Q: What about vacation spots? Mike: I really enjoy places with an outdoor element and a fun, large town culture feel (similar to a Bloomington). I have really enjoyed Fort Collins (Colorado), Anchorage (Alaska), and Portland (Maine). Vegas is fun too, but for no more than two nights.

HFMA Indiana Pressler Member in the Spotlight: Michael Chromy


Q: How did you get involved with HFMA? Mike: I became involved with HFMA because it is a great resource for connecting with other professionals in the industry. In addition, it is a resource for learning about industry updates and challenges. Q: Do you serve on any committees? Mike: I am not currently involved with any committees at this time. Q: What is the last good book you read? Mike: Bare Bones – I’m Not Lonely If You’re Reading This Book; the story of country radio personality Bobby Bones progressing through life and developing into what he is today. Q: Favorite TV show or movie, if any? Mike: I am a nerd, and I like action. My favorite shows depending on how I feel are Doctor Who, Hawaii-Five-0, or a documentary that I haven’t seen yet. Q: What is something that would surprise people about you? Mike: I’ve run two marathons. I have personally witnessed two 109-yard plays in NFL games: 1. Antonio Cromartie – 109-yard missed field goal return in 2007 against the Vikings.

2. Cordarrelle Patterson – 109-yard kickoff return against the Packers in 2013.

Q: If there was a movie produced about your life, who would play you and why? Mike: Unfortunately, probably Seth Rogen. My life story would be some type of awkward comedy! Q: What historical character would you most like to have lunch with? Mike: Winston Churchill. Both of my grandfathers fought in WWII and I really enjoy watching WWII documentaries. I am fascinated by that period of time. I think it would be interesting to pick the brain of arguably the world’s most important man during that period. Thanks to Mike for indulging us in a few “deep” and humorous questions to get to know him better!

Thank you to Jerry Smith, member of the Communications Committee, for this update

Michael Chromy Spotlight… (continued)


Eskenazi Health recently opened a new mini-grocery story on its main campus allowing staff, patients and community members a convenient option for fresh ingredients along with education on how to make them into nutritious meals. The ‘Fresh for You Market’ is located within the Ingram Micro Mobility Marketplace at Eskenazi Health and is open 6 a.m. – 2 a.m. seven days a week. It not only offers a variety of grocery and produce items but also incentives and education, such as cooking demonstrations, nutrition education, recipe samplings and ideas for easy meals.

In addition to providing employees, patients and visitors access to fresh ingredients and foods, the ‘Fresh for You Market’ encourages the creation of healthy meals at home. Offerings found in the market are nutrient-dense, budget friendly and organic and sourced locally when available, and include fruits and vegetables, convenience ingredients, pre-prepped foods, pantry staples and healthy snacks.

"We've been working on this concept for several months," said Seth Grant, associate director of culinary services at Eskenazi Health. "We've partnered with vendors and figured out the logistics of running a grocery store. This fits in with a big passion of ours to work to combat the food insecurity and food desert issues in Indianapolis. Many of our patients live in food deserts. Our big goal is to encourage people to cook at home and discourage shopping at c-stores. We want to give them access to healthy foods at reasonable prices and teach them how to use the food."

The ‘Fresh For You Market’ contains a large open-air cooler offering produce, a glass door reach-in cooler for milk, eggs and cheese and designer-style shelving displaying kitchen utensils and recipes to help guide customers in home meal planning. "Many people who just start to cook may not have utensils such as measuring cups and strainers," said Amy Carter, MA, RD, CD, CDE, director of outpatient nutrition at Eskenazi Health.

Carter and the Eskenazi Health dietitian team host educational events in the market at a large worktable. “The outpatient nutrition team at Eskenazi Health has been providing cooking classes to patients for years and we are finally able to make that last connection for them of having access to the proper ingredients," Carter said. Eskenazi Health Outpatient Nutrition encourages patients, staff and visitors to practice healthful eating. Twice a month, staff members sample farm-fresh veggies during the weekly Fresh Veggie Friday event. Participants then take samples home. Much of the produce used for educational programming comes from The Sky Farm at Eskenazi Health. Sitting on the rooftop of the Sandra Eskenazi Outpatient Care Center and featuring 5,000 square feet of growing space, the farm raises more than 3,000 pounds of produce. This produce also filters into retail operations and patient room service meals. While attempting to be budget neutral with this endeavor, the hospital does end up with some degree of subsidizing of this community program, but considers it critical to its community service mission. _________________________________________ About the Author

William (Bill) is Vice-Chairperson of the HFMA Indiana Chapter’s Communication Committee, and an IS Director for Eskenazi Health in Indianapolis, Indiana. Bill can be at: [email protected] (P) 317.880.4560

Organizational Spotlight: Eskenazi Health’s Innovative ‘Fresh For You Market’

By William Carmichael



`

2017 Tri-State Conference

Indiana Chapter Members at the Registration Desk

The 2017 HFMA Tri-State Conference was held at the Hyatt Regency in Cincinnati, Ohio from September 21 -22, 2017. The Conference was presented by the HFMA Chapters of Indiana, Kentucky, Central Ohio and Southwest Ohio…

Event Sponsors

In addition to great educational sessions, there were many opportunities to catch-up with friends and colleagues…


Let’s look back to a few moments from yesteryear that we can remember and take pride in.

The chapter has an extensive collection of old photos, and chances are we have a picture of some fond memory or event that you might have. We’d love to hear from you . . .

Yours in HFMA,

JIM MILLER

The "Three Musketeers" (left to right) Leah Aikman, Linda Reynolds and Peggy Elder-Nelson pause for a candid shot at a chapter education institute. The trio of friends were long-time HFMA volunteers and fixtures at chapter events in the early 2000s.

Former chapter presidents Nancy Winkle and Trudy Struck (front row) joined fellow chapter members Sam Dudley, Kelly Lee-Lackey, Terry May, Connie Bishop and Brad Willkie in soaking up fun, sun and the roar of engines at the Indianapolis Motor Speedway. Chapter members attended the Indy 500 practice session following a Finance Forum in May 2003.

DO YOU REMEMBER WHEN . . .

Former Marion General Controller and CFO Robyn Powell relaxes prior a memorable round of golf at a chapter golf outing at Salt Lick Golf Course. The chapter hosted its Fall Institute for many years at the nearby Seasons Lodge in Nashville.


Event Date: January 25-26, 2018 Location: Indianapolis Marriott North 3645 River Crossing Pkwy, Indianapolis, IN 46240 Registration and Hotel Link: 2018 HFMA Indiana Winter Institute

Event Date: April 12-13, 2018 Location: Indianapolis Marriott North 3645 River Crossing Pkwy, Indianapolis, IN 46240 Registration and Hotel Link: 2018 HFMA Indiana Spring Institute

Event Date: June 24-27, 2018 Location: Venetian –Palazzo Sands Expo Center

Las Vegas, Nevada Link for more information: 2018 HFMA ANI

Save the Dates… for these upcoming Programs and Events

2018 HFMA Indiana Winter Institute

2018 HFMA Indiana Spring Institute

2018 HFMA ANI




http://www.hfma.org/ANI/Home/

Intended Audience Practice managers, business office managers, administrators, front office, billing, insurance and coding staff.

Exhibits The invited payers will have display tables with additional information and representatives will be available to answer questions and discuss problems you may be experiencing at your practice.

Credit Hours ACMPE—7 hours HFMA —7 CPE

Registration Fees

IMGMA & HFMA MEMBERS $119 - first person $79 - each additional person from the same practice.

Non-Member $179—first person (Fee includes membership in IMGMA—$125 value)

$129 - each additional person from same practice.

Fee includes continental breakfast, breaks, lunch.

You can register and pay on-line at www.imgma.net.

Thursday, Feb 1, 2018

Evansville Surgical Associates

Deaconess Midtown

Evansville, Indiana

Friday, Feb 2, 2018

Downtown Depot

Bedford, Indiana

Tuesday, Feb 20, 2018

Pfeil Innovation Center

South Bend, Indiana

Wednesday, Feb 21, 2018

Grand Wayne Convention Center

Ft. Wayne, Indiana

Thursday, March 8, 2018

Ritz Charles

Carmel, Indiana

Revenue Cycle Conference

Sponsored

by

General Information

Need More Information?

Contact the office at 317-371-4354 or

[email protected] or On-line at www.imgma.net

Location Information

Feb 1, 2018 Evansville Surgical Associates Deaconess Midtown location 520 Mary Street, Suite 440 Evansville, IN 47710

Feb 2, 2018 Downtown Depot 1401 J Street Bedford, Indiana 47421

Feb 20, 2018 Pfeil Innovation Center 420 N. Niles Avenue South Bend, IN 46617

Feb 21, 2018 Grand Wayne Convention Center 120 West Jefferson Blvd Fort Wayne IN 46802

March 8, 2018 Ritz Charles 12156 N. Meridian St Carmel IN 46032

Hotel Accommodations

Hampton Inn, Airport Courtyard by Marriott, East

Quality Inn & Suites 911 Constitution Ave Phone: (812) 279-8111

Holiday Inn Express & Suites 2800 Express Ln Phone: (812) 279-1206

Residence Inn 716 N Niles Ave Phone: (574) 289-5555

The Double Tree Hotel 123 N. Dr. Martin Luther King Jr. Phone 574-234-2000

Hilton Ft. Wayne at Grand Wayne 1020 South Calhoun St. 260-422-4002

Marriott Courtyard 317-571-1100 Doubletree Hotel 317-844-7994

Save the Dates.... (continued)




Check Enclosed (payable to IMGMA) - $

Credit Card—$

Card #

Expiration

Name

Billing Address

Sec Code_

Name

Title

Organization

Address

City, State, Zip

CHECK Location:

___ Carmel ___ Fort Wayne

___ Evansville ___ Bedford

___ South Bend

M EM BER: __ __ IMGMA

Phone _Email

There will be no refunds for cancellations made less than

four days before meeting. Substitutions are permitted.

____ HFMA _____ Non

Complete a separate form for each person registering.

Please keep copy of this form for your records.

Send registration and payment to: IMGMA 10014 Deering St Fishers, IN 46037 Email: indianamgma @gmail.com

Take advantage of reduced rate for additional persons from the same member practice and send several! Member, First Person—$119; Additional—$79 Non-Member, First—$179; Additional—$129

Check Enclosed (payable to IMGMA) $____________________ Credit Card Amount $______________________ Credit Card # __________________________________ Expiration ______________________Sec Code______________ Name________________________________________________

Billing Address_________________________________________

_____________________________________________________

Save the dates.... (continued)



When I was 30 and a young auditor for the California Department of Health Services, one of the projects assigned to me was the audit of the Adult Day Health Care (ADHC) program. At the time, the ADHC program was new – operational for only a year or two, and in preparing for the engagement I wondered why the state was spending money on day care for older, sicker people? Because the focus of the audit was largely financial and a prelude to the state’s rate setting process, I did not dwell on the human side of the ADHC program or really think about all the services provided and how important they were to the safety and well-being of the daily recipients.

Today, I'm 40 years older and, as fate would have it, I'm once again involved in Adult Day Health Care. This time, however, I'm much more involved in how centers operate, their mission and vision, how they get paid, and in understanding the vital role a center plays each day in ensuring its recipients remain safe while the associated costs are mitigated as much as possible. As the population continues to age, it is critical for the well-being of the recipients involved, their families, the health plans that arrange and pay for ADHC services, and the economy as a whole, that Adult Day programs succeed in carrying out their mission.

For those who think ADHC is just day care, think again! Yes, it's a place for family members to drop-off their aging parents while they head off to work, run errands or simply use the time to get a little (and often much needed) respite from their 24/7 caregiving duties. But, ADHCs are so much more than a place to drop off Mom and Dad for part of a day. Consider for just a moment all the vital services that a typical ADHC provides on a typical day, and for those involved in managing full-risk Medi-Cal or Medicare Advantage contracts, note what unbelievable partners ADHCs can be when it comes to revenue enhancement and cost containment. Following are just a few of the most immediate benefits of partnering with ADHC's:

• ADHCs are physically in touch with your members several days a week. Where else within a typical managed care structure would it be possible to directly contact your high risk population this often? Nowhere else other than a nursing home, SNF, or acute care hospital setting.

• ADHCs provide food, shelter, safety, socialization, and a wide array of health care services in one central location. These services are essential to sustain life, preserve a person’s dignity and sense of well- being and it allows the highest risk patients to continue living in their homes or with help from family and friends, which is by far the least costly and most efficient way to preserve a high quality of living for elderly patients.

• ADHCs are more than day care centers; they’re actually Wellness Centers, which can attract interested Plan members for all sorts of reasons. They can serve as a vehicle to complete Initial Health Assessments (IHAs), identify and report new Hierarchical Condition

ADULT DAY HEALTH CARE: AN UNBELIEVABLE COST CONTAINMENT RESOURCE THAT IS

UNDERFUNDED AND UNDERUTILIZED by Russell D. Foster


Category (HCC) information, feed updated information to case managers or the patient’s PCP. They can also assist members in locating a new PCP or reconnecting members to their existing PCPs, provide a host of wellness literature and communicate other information that health plans want to provide to their members on a regular basis.

• ADHCs provide dementia care, physical therapy, nutrition counseling, skilled nursing, medication reconciliation, home monitoring, transportation and other vital services that reduce the frequency of ER visits, and hospital admissions and re-admissions.

• ADHCs can serve health plans and other risk bearing organizations (RBO's) through the provision of high cost case management services, an area in which many health plans and RBOs are constantly short- handed and in need of help.

• ADHCs are ethnically diverse and their staff has the ability to relate to the range of cultures that exist within the populations they serve. Being able to understand and relate to patients is often half the battle in serving their needs and achieving compliance.

It is rare to find a health plan or risk bearing organization these days that is not committed to achieving the Triple Aim - improving the health of populations, improving the individual experience of healthcare and reducing its cost. With so much emphasis on keeping members healthy and out of the emergency room and hospital, I find it truly amazing that ADHCs are constantly struggling for market share, and have difficulty receiving compensation sufficient to cover their costs.

For those health plans and risk-bearing organizations who do understand the valuable services ADHCs provide, think again about the rates you're paying, the absence of acuity adjustment and quality incentive sharing. Where else can you get the high touch services ADHCs provide for less than $100 per day? A single unnecessary test, referral or procedure will pay for a full day of adult day health care. One ER visit saved will often cover a month of ADHC services, and one hospital admission or readmission saved will offset as much as a year's service at most ADHCs. Talk about an ROI! There is nothing like it anywhere else in the health care system.

As I said at the beginning of this story, regrettably, I was once counted amongst the group that thought ADHCs were unnecessary and a waste of money. But, after years in the trenches working with ADHCs and the California Association for Adult Day Services (CAADS) I have come to see ADHC in a much different light, and I'm convinced that my health plan and RBO colleagues will also come to realize that ADHCs are valuable resources and partners in the fight to achieve the Triple Aim.

If your organization is at-risk, consider adding one or more local ADHCs to your provider panel and solicit their involvement and expertise in the management of your high risk patients. They are incredibly savvy folks and likely know a lot about keeping high risk patients safe which can lead to significant cost savings for your organization if you work as a team! ________________________________

About the Author

Russell (Russ) is a Senior Advisor in the Health Care Practice at Mazars USA. Russ is based out of Mazars’ Sacramento, California office and can be reached at: [email protected] (P) 916.813.4070

Adult Day Health Care… (continued)



Presentations and discussions centered on the payment shift from fee-for-service (FFS) to value-based reimbursement (VBR) are ubiquitous. Hospitals have significant experience dealing with a variety of alphabet soup VBR programs imposed by the Centers for Medicare & Medicaid Services (CMS) and gradually adopted by the commercial payor markets (e.g., Hospital Value-Based Purchasing, Hospital Readmission Reduction, Hospital-Acquired Condition Reduction, etc.). New payment models whereby health care providers share in the cost savings or losses for managing quality outcomes and patient care utilization such as Accountable Care Organizations (ACO), bundled payments, etc., also are on the rise. It’s no surprise the CMS may reach its goal of linking 90 percent of FFS payments to quality and alternative payment models1 in 2018.

Clinical documentation and diagnosis coding are playing increasingly important roles in the success of hospital participants under these VBR models, and health care finance professionals should be well aware of their effect on payments. Diagnosis coding is critical to properly identify patients with chronic conditions due to the potential for higher use of services and effects on hospital quality and cost performance in an Alternative Payment Model (APM) if not managed correctly. Accurate clinical documentation and coding are important for patients in an APM given their roles in calculating a risk adjustment factor (RAF). The overall RAF of a population under a VBR model could determine whether you incur savings or pay for a loss to the CMS.

What’s the HCC RAF? Implemented in 2004, Hierarchical Condition Category (HCC) coding is the Medicare risk adjustment methodology developed for Medicare Advantage Plans and now used in various VBR models. The methodology uses patient demographics and hierarchical disease conditions (diagnoses containing a risk factor) to calculate an overall RAF score to reflect the expected complexity of treating patients with chronic conditions. While the methodology also takes into consideration other factors, the important point is the higher a patient’s RAF score, the higher assumed complexity (and associated cost) of treating that patient.

Exhibit 1 below is an illustrative example of an HCC’s presence or omission on a patient’s overall RAF score. In this scenario, the differential codes result in the patient RAF score falling from 2.12 to 0.65, a fairly significant drop. Read on to see how this can significantly affect your payments.

Exhibit 1 All Conditions Coded Some Conditions Coded

76-year-old female 0.468 76-year-old female 0.468

Diabetes with vascular complications 0.608 Diabetes without vascular complications 0.181

Vascular disease with complications 0.645 Vascular disease without complications Not coded

Congestive heart failure 0.395 Congestive heart failure Not coded

Total RAF 2.12 Total RAF 0.65

DIAGNOSING YOUR PAYMENTS: What’s Driving Your Value-Based Reimbursement?

by Zach Remmich, Sarah Bixby, and Marla Dumm


(b) (c) (d) = (b) x (c)*12 (e) (f) = (b) x (e)*12 (g)Beneficiary Scenario 1 Scenario 2 Scenarioper month Assigned Scenario 1 Assigned Scenario 2 Yearly

CMF Beneficiaries Annual Beneficiaries Annual PaymentRisk Tier Revenue (n) = 1,000 PMPM (n) = 1,000 PMPM VarianceLow 9.00$ 325 35,100$ 225$ 24,300$ (10,800)$ Med-Low 11.00$ 300 39,600$ 250$ 33,000$ (6,600)$ Med-High 19.00$ 225 51,300$ 275$ 62,700$ 11,400$ High 33.00$ 100 39,600$ 150$ 59,400$ 19,800$ Complex 100.00$ 50 60,000$ 100$ 120,000$ 60,000$ Total: 225,600$ 299,400$ 73,800$

HCC RAF Effect on Payments Care Management Fee Effects Risk adjustment methodologies in VBR models can help keep providers that treat complex patients from being unfairly penalized for the additional treatment costs. The Comprehensive Primary Care Plus (CPC+) program is a great example of demonstrating how an HCC score can alter payment levels. In CPC+, the CMS pays a monthly care management fee (CMF) for each beneficiary attributed to a participating primary care provider. The payment amount for each beneficiary is based on the expected care complexity, as reflected in the HCC score, which is assigned to a risk tier defined by Medicare. The higher the HCC score, the higher the risk tier and corresponding payment (per attributed beneficiary per month in this model). Columns (d) and (f) in Exhibit 2 (illustrative), which aggregate CMF payments by risk tier, demonstrate the potential effect on a CPC+ practice’s overall CMF revenue by assignment into higher-risk tiers.

Exhibit 2

Accountable Care Organization Effect The CMS also uses the HCC RAF to adjust ACO expenditure benchmarks under the Medicare Shared Savings Program. For program participants, a higher RAF translates to a higher-expenditure benchmark. Exhibit 3 demonstrates how the change in risk adjustment to the ACO benchmark can affect an ACO’s savings or losses. Keeping the baseline versus actual cost outcomes constant across the three scenarios, we can see how a slight shift of the RAF score up or down—column (c)—can have million-dollar implications—column (e)—and determine whether the ACO experiences a savings or loss.

Exhibit 3

(a) (b) (c) (d) = (a) * (c) (e) = (d) - (b)(in mill ions) (in mill ions) (in mill ions)

ACO ACO RAF Adj. ACOScenario Baseline Cost Actual Cost RAF Baseline Cost Savings/(Loss)

1 400$ 402$ 0.98 392$ (10,000,000)$ 2 400$ 402$ 1.00 400$ (2,000,000)$ 3 400$ 402$ 1.02 408$ 6,000,000$

Diagnosing Your Payments… (continued)


Quick Note on MACRA The CMS has proposed HCCs will become a bigger factor in calculating a physician’s overall Merit-based Incentive Payment System (MIPS) score in 2018. Essentially, the CMS will compare the severity of physicians’ attributed patient populations and award additional points to those who treat patients with a higher severity of illness. This could potentially mean the difference between a positive or negative payment adjustment on Medicare Part B FFS revenue under MIPS.

Next Steps Evaluate Current State Health care financial professionals should begin evaluating the current state of their HCC coding capture processes and identifying gaps in capturing accurate diagnoses for patients seen in the hospital (inpatient and outpatient) or physician practices. An assessment can help develop an understanding of where the organization needs to improve and what process improvements may be necessary to accurately capture HCC coding information.

Engage Providers on HCCs Physicians and mid-level providers may be interested in understanding how risk adjustment works under these new payment models. HCC stratification provides physicians with the opportunity to demonstrate the severity burden of their patient panels and can help inform pre-visit planning for those patients with multiple chronic conditions. In many cases, opportunities to improve diagnosis coding in physician practices exist, whether by helping providers understand the importance of diagnosis coding or assessing if the appropriate level of clinical documentation exists to justify an HCC diagnosis code.

References 1 U.S. Department of Health and Human Services, 2015 _____________________________________________ About the Authors

Zach Remmich is a member of HFMA’s Indiana Pressler Memorial Chapter. Zach is a Managing Consultant at BKD, and a member of the Physician Services Center of Excellence, where he assists hospitals and practices in strategic and operational consulting. He can be reached at [email protected] (P) 317.383.4021.

Sarah Bixby is a Consultant, and is also a member of BKD’s Physician Services Center of Excellence, where she provides consulting services for health care organizations. She can be reached at [email protected] (P) 317.383.4000. Marla Dumm is a Manager in BKD’s National Health Care Group, and has over 20 years of experience in the health care industry, both in Industry and as a Consultant. She specializes in physician documentation, coding and billing, and is a frequent speaker and has authored numerous health care articles. Marla can be reached at [email protected] (P) 417.865.8701.

Diagnosing Your Payments… (continued)





A Strategic Tool for Success

Succession planning can be a very taboo topic, but with planning and communication it can be a very influential tool in your long-term strategic planning for your organization. We do five year financial plans and budgets all the time, but how are we doing with our people plan?

It's Critical

Succession planning is critical for healthcare organizations, departments, and for you personally.

Seeing firsthand where without a good plan, individuals in the department may not know you are planning to move on or retire or have different aspirations, and they make their own plan, which is different than you expected.

That all is very frustrating when you are thinking and planning that they will be promoted to your position longer-term but have not yet directly communicated it. In your mind, you are doing the planning and ensuring that you mitigate risk for the organization and the department, but the lack of communication is also really critical.

Communication is Essential

We see this over and over again as there a couple reasons why this happens. First, as a manager, do I really want to communicate what my plans are?

Well the easy answer is no, right? However, you find that without communication, there is no way to appropriately plan. Communicating your plans can be scary and sometimes risky, but it is definitely the right step forward for your department longer-term. When everyone has transparency and open lines of communication, the fear subsides. Why is this important?

Don't Lose Your Key People

Well without planning, we lose great people. Turnover is higher, productivity is lower, and quite simply, we lose people we never expected to lose. Those folks in your organization that are critical and high performers expect communication on succession planning. It's quite simple, and without communication on the plan, those individuals will make changes long-term that certainly do not include your department.

Why is Succession Planning so Important? by Stacey McCreery


They will not do it quickly or abruptly, but high performers want to be communicated with; they want to know the plan. They want to contribute to the organization and the department, and if they cannot see a vision for their future in a promotion longer-term then they will start making their own career plan. Unfortunately, hiring managers all the time are disappointed when they receive that resignation. It is heartbreaking when you have a high performer you lose, and you had no idea they were looking for that next step in their career. However, one way you can mitigate that risk of losing a high performer is having a succession plan.

Getting Started is Hard

So where do you start? First, it starts with you. Sitting down in a room looking at your organization chart and drawing it out. It should include your employees’ names, titles, years of experience, and top three attributes, rather than only a name. When was the last time you did that? Then taking a look and identifying in the organization chart and determining who is ready for the next level, who will be ready for the next level in a couple years, and who do I need to have conversations with that may not be performing as strong as you would like. All of those individuals are critical to communicate with so there is no misunderstanding where they are in their career path.

You often learn things when you really give it thought, and sometimes you forget things. For example, in my own career it was several years back, I had a conversation that I was looking for something different than the next step and that was a surprise in the first conversation. After it sink in, the hiring manager thought about our conversation and my background, my skills, my desires, and it made perfect sense. She was then able to think about how her organization would look longer-term without me.

Necessary Tools and Training

Succession planning gives hiring managers the tools to be successful in their own department. It also gives you the okay longer-term to want to do something else. Then you can best plan and put that plan into action.

Second by having these conversations and identifying all the individuals in the department and where they are in their career path, it mitigates risk for the organization. The reason why is you can easily identify gaps in the organization of where successors or skill sets may not be fully developed or are missing.

Third, it helps you think about your own career action plan. It helps you think about when you are ready to make that next step. And that might not be for 10 years depending on your level. Or in some cases, it might be one or two years. What we know is one or two years goes by quickly and even faster without planning.

Succession Planning… (continued)


Crucial Conversations

I know when I was developing my own succession plan, I wanted to ensure the organization was left in the best possible transition. I had a very long-term plan in my mind of how to do that. Most people though do not have those conversations at a risk, but as hiring managers and leaders, if we open ourselves up to the succession planning and communication, we can not only reduce turnover but we can long-term increase productivity. We no longer lose the valuable time an employee is thinking about the next level, what they should do, how they should communicate it, how they go about this, how to keep it confidential, and all the while productivity is decreasing. With an open line of communication, not only are hiring managers and leaders better positioned longer-term, but also our employees.

Employees will have a clear understanding of how the organization and the leader sees them, and they can communicate where they see themselves. They can also work on further development, too.

Planning is Critical

With these tools, increasing communication, and openness to the discussion of succession planning, both companies and leaders as well as current employees can be better positioned for the long-term. This is particularly important in healthcare as we are going through rapid changes, and really no one wants to lose their best person on the team unexpectedly. Take a moment, think about what you are doing today. Do you review your succession planning monthly? If the answer is no or very minimal, start with step one which would be rolling out your organization plan with key information such as title, years of experience, and top three skills. During the process, identify the high performers with a star, who are defined as those who you want to succeed and be promoted in the next one or two years or certainly would not want to lose to another organization. Starting Today

Start identifying folks with a longer-term plan for promotion. That will really help you position your department in the best way. See succession planning is a year-round activity while performance management although I would agree should be an ongoing activity and discussion, the actual act of it is once a year. Succession planning and performance management can go hand-in-hand. When it does, it leads for a successful department, an organization that is well-positioned, and also leaders and employees who are very happy because when you know and communicate the plan, you can achieve the plan. ___________________________________________

About the Author Stacey is President of the ROI Search Group, and a member of HFMA’s Indiana Pressler Memorial Chapter. Stacey is also a member of the Chapter’s Professional Development Committee. For more information please visit ROISG’s website at www.roisearchgroup.com , or contact Stacey at: [email protected] (P) 317.727.9768

Succession Planning… (continued)


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