strategies for healthy finances don pursley, col ret. usafa, bse, ms, dba the speaker does not have...
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Strategies for Healthy FinancesStrategies for Healthy FinancesDon Pursley, Don Pursley, Col Ret. USAFA, BSE, MS, Col Ret. USAFA, BSE, MS,
DBADBAThe speaker does not have any relevant financial relationships with any commercial interests
Blantyre Adventist HospitalBlantyre Adventist Hospital
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
2006 2008 2010 2012 2014
BAH Profit
How They Did ItHow They Did It
Right sizing the staff.Right sizing the staff.
Recognition of where the business comes Recognition of where the business comes from.from.
Adjusting the tariffs.Adjusting the tariffs.
Watch surgeries and occupancies.Watch surgeries and occupancies.
StrategiesStrategiesDifferent Laws.Different Laws.
Different Cultures.Different Cultures.
Different Situations.Different Situations.
All have been used in hospitals.All have been used in hospitals.
10 WAYS TO10 WAYS TOIMPROVE YOUR FINANCESIMPROVE YOUR FINANCES
Contract ComplianceContract Compliance
Special Service LinesSpecial Service Lines
Lure The PhysicianLure The Physician
DonationsDonations
Watch InflationWatch Inflation
10 WAYS TO10 WAYS TOIMPROVE YOUR FINANCESIMPROVE YOUR FINANCES
Right Size The OrganizationRight Size The Organization
Use Flex StaffingUse Flex Staffing
Control OvertimeControl Overtime
Manage Supplies/MedicinesManage Supplies/Medicines
Fewer Might Be BetterFewer Might Be Better
Strategy #1Strategy #1Contract ComplianceContract Compliance
Contract ComplianceContract Compliance““The provider may bill against this contract for the The provider may bill against this contract for the
following: (See appendix A for rates)following: (See appendix A for rates)
1: Physician services1: Physician services
2: Hospital bed usage2: Hospital bed usage
3: Medicines given3: Medicines given
4: Meals given to the patient4: Meals given to the patient
5: Supplies used in treatment5: Supplies used in treatment
6: Auxiliary services”6: Auxiliary services”
Contract ComplianceContract Compliance
THE BILLTHE BILLPhysician Services-----------------------500Physician Services-----------------------500Hospital Bed (5 nights)------------------250Hospital Bed (5 nights)------------------250Medicines given to the Patient--------100Medicines given to the Patient--------100Meals------------------------------------------25Meals------------------------------------------25Laboratory -----------------------------------50Laboratory -----------------------------------50
Total------------------------925Total------------------------925
Medical Supplies???Medical Supplies???
Contract ComplianceContract Compliance““The provider may bill against this contract for the The provider may bill against this contract for the
following: (See appendix A for rates)following: (See appendix A for rates)
1: Physician services1: Physician services
2: Hospital bed usage2: Hospital bed usage
3: Medicines given3: Medicines given
4: Meals given to the patient4: Meals given to the patient
5: Supplies used in treatment5: Supplies used in treatment
6: Auxiliary services”6: Auxiliary services”
Contract ComplianceContract Compliance
THE BILLTHE BILLPhysician Services-----------------------500Physician Services-----------------------500Hospital Bed (5 nights)------------------250Hospital Bed (5 nights)------------------250Medicines given to the Patient--------100Medicines given to the Patient--------100Meals------------------------------------------25Meals------------------------------------------25Laboratory -----------------------------------50Laboratory -----------------------------------50
Total------------------------925Total------------------------925
Contract ComplianceContract Compliance
Must list the type and quantity of medicines Must list the type and quantity of medicines given.given.Must List the specific laboratory test given.Must List the specific laboratory test given.The physician must submit with the bill the The physician must submit with the bill the medical summaries.medical summaries.Bills must be submitted within 90 days of the Bills must be submitted within 90 days of the dismissal.dismissal.Readmission for the same medical problem Readmission for the same medical problem within 30 days of dismissal is not covered by this within 30 days of dismissal is not covered by this contract.contract.
Strategy #2Strategy #2Special Service LinesSpecial Service Lines
Special Service LinesSpecial Service Lines
ChinaChinaManufacturing Assembly WorkerManufacturing Assembly Worker
$11,500$11,500
ArchitectArchitect$28,470$28,470
General ManagerGeneral Manager$132,801$132,801
ZambiaZambiaAccountantAccountant
$11,700$11,700
Finance ManagerFinance Manager$48,000$48,000
Country ManagerCountry Manager$54,000$54,000
BotswanaBotswanaPhysicianPhysician$33,600$33,600
AccountantAccountant$4,372-$88,769$4,372-$88,769
Civil EngineerCivil Engineer$142,031$142,031
NigeriaNigeriaAccountantAccountant
$16,000$16,000
Mechanical EngineerMechanical Engineer$32,522$32,522
CEOCEO$165,000$165,000
Executive PhysicalsExecutive Physicals
Blood WorkBlood WorkStress TestStress TestColonoscopyColonoscopyGeneral PhysicalGeneral PhysicalLife Style CounselingLife Style CounselingDiet CounselingDiet Counseling
Strategy # 3Strategy # 3Lure The PhysicianLure The Physician
Who decides which hospital a Who decides which hospital a patient will go to for a patient will go to for a
procedure?procedure?
Strategy # 4Strategy # 4DonationsDonations
Donations To Nonprofit OrganizationsDonations To Nonprofit Organizations
In 2013In 2013
$335.17 Billion$335.17 Billion
72% Is Given By Individuals72% Is Given By Individuals
DonationsDonations
““We are a Hospital in We are a Hospital in need please send need please send
money”money”
DonationsDonations
Information About The HospitalInformation About The Hospital
A Case StatementA Case Statement
Thank YouThank You
Constant CommunicationConstant Communication
Strategy # 5Strategy # 5Watch InflationWatch Inflation
Chad----------------------------------3.7%Chad----------------------------------3.7%
Nigeria--------------------------------8.2%Nigeria--------------------------------8.2%
Cameroon----------------------------2.6%Cameroon----------------------------2.6%
Ghana--------------------------------16.5%Ghana--------------------------------16.5%
Gabon----------------------------------5.2%Gabon----------------------------------5.2%
Cote D’ivore--------------------------1.3%Cote D’ivore--------------------------1.3%
Strategy # 5Strategy # 5Watch InflationWatch Inflation
Angola---------------------------------8.8%Angola---------------------------------8.8%Malawi---------------------------------21.2%Malawi---------------------------------21.2%Mozambique-------------------------3.5%Mozambique-------------------------3.5%Zambabwe----------------------------5.4%Zambabwe----------------------------5.4%Madagascar--------------------------6.2%Madagascar--------------------------6.2%South Africa--------------------------6.3%South Africa--------------------------6.3%Tanzania------------------------------6.5%Tanzania------------------------------6.5%Zambia--------------------------------8.0%Zambia--------------------------------8.0%Kenya----------------------------------5.6%Kenya----------------------------------5.6%Namibia-------------------------------4.4%Namibia-------------------------------4.4%
Effects Of Inflation Over TimeEffects Of Inflation Over Time
20092009 20102010 20112011 20122012 20132013
InflationInflation 3%3% 3%3% 3%3% 3%3%
IncomeIncome 105105 105105 105105 105105 105105
ExpensesExpenses 100100 103103 106.09106.09 109.27109.27 112.55112.55
Profit/(loss)Profit/(loss) 55 22 -1.09-1.09 -4.27-4.27 -7.55-7.55
Profit MarginProfit Margin 4.76%4.76% 1.9%1.9% -1.04%-1.04% -4.07%-4.07% -7.19%-7.19%
Strategy # 6Strategy # 6Right Size The OrganizationRight Size The Organization
How many staff do you How many staff do you need in each need in each department?department?
WHERE ARE THE WHERE ARE THE EXPENSES?EXPENSES?
63%
22%7%
8%
PERSONNELCOSTS
FOOD, DRUG &SUPPLIES
PURCHASEDSERVICES
OTHER
WHAT ARE THESE CHARTS WHAT ARE THESE CHARTS TELLING US?TELLING US?
0
500
1000
1500
2000
2500
3000
2002 2003 2004 2005
YEARLY ADMISSIONS YEARLY SURGICALS
0
5
10
15
20
25
30
35
40
2002 2003 2004 2005
STAFF
RIGHT SIZE THE RIGHT SIZE THE ORGANIZATIONORGANIZATION
1. EXTERNAL BENCHMARKS1. EXTERNAL BENCHMARKS a. COMMERCIAL DATAa. COMMERCIAL DATA
b. STATE GUIDELINESb. STATE GUIDELINES
c. FEDEREAL GUIDELINESc. FEDEREAL GUIDELINES
2. INTERNAL BENCHMARKS2. INTERNAL BENCHMARKS
Cost/Saving of Right SizingCost/Saving of Right Sizing
Hospital is over staffed by 20 employees.Hospital is over staffed by 20 employees.
Average annual salary and benefits of the Average annual salary and benefits of the 20 employees is $9,000. ( $180,000)20 employees is $9,000. ( $180,000)
The cost to terminate by law is 3 months The cost to terminate by law is 3 months salary and benefits. ($45,000) Payable salary and benefits. ($45,000) Payable upon termination.upon termination.
Savings From Right SizingSavings From Right Sizing
Spend $45,000 save $180,000 per year.Spend $45,000 save $180,000 per year.
Where do we get the $45,000?Where do we get the $45,000?
Do the math and borrow the money.Do the math and borrow the money.
Strategy # 7Strategy # 7Flex StaffingFlex Staffing
What Nursing Staff Do You Need?What Nursing Staff Do You Need?
PatientsPatients 55 1010 1515 2020 2525 3030 3535 4040 4545 5050 5555
NumberNumber
Of Of NursesNurses
22 22 33 44 55 66 77 88 99 1010 1111
How Do You Deal With This?How Do You Deal With This?
0
5
10
15
20
25
30
35
40
45
Mon Tue Wed Thu Fri Sat Sun
Use Flex StaffingUse Flex Staffing
Send employees home.Send employees home.
Use an on-call system.Use an on-call system.
Use an employee contracting agency.Use an employee contracting agency.
Have part-time employees who can be Have part-time employees who can be called.called.
Strategy # 8Strategy # 8Control OvertimeControl Overtime
About 10% of a provider’s labor budgetAbout 10% of a provider’s labor budget
Labor 63% of your costsLabor 63% of your costs
No overtime would save about 6%No overtime would save about 6%
Labor $500,000 per year-save $30,000Labor $500,000 per year-save $30,000
Control OvertimeControl OvertimeHave clear policies and proceduresHave clear policies and procedures
Who can approve overtimeWho can approve overtime
Set goals Set goals
Track overtime and compare with goalsTrack overtime and compare with goals
Strategy # 9 Strategy # 9 Manage Supplies/MedicinesManage Supplies/Medicines
22% of expenses22% of expenses
Who is making the decisions Who is making the decisions on supply and medicine on supply and medicine
usage?usage?
Manage Supplies/MedicinesManage Supplies/Medicines
Inventory controlInventory control– StealingStealing– OutdatedOutdated– Too Much and Too LittleToo Much and Too Little
Gain sharingGain sharing– Who is making the decision on usage?Who is making the decision on usage?– Give an incentive for efficienciesGive an incentive for efficiencies
Strategy # 10Strategy # 10Fewer Might Be BetterFewer Might Be Better
1. Is your hospital’s quality down because of 1. Is your hospital’s quality down because of unmotivated and unresponsive staff?unmotivated and unresponsive staff?
2. Are the staff in the hospital rude to the patients?2. Are the staff in the hospital rude to the patients?
3. Is the morale in the hospital down because of some 3. Is the morale in the hospital down because of some disgruntled staff?disgruntled staff?
4. Are you losing money because patients and doctors 4. Are you losing money because patients and doctors do not want to use the hospital because of 1, 2, and 3 do not want to use the hospital because of 1, 2, and 3 above?above?
Fewer Might Be BetterFewer Might Be Better
““It is far easier to allow matters in our important It is far easier to allow matters in our important institutions to go in a lax, loose way than to institutions to go in a lax, loose way than to weed out that which is offensive, which will weed out that which is offensive, which will corrupt and destroy confidence and faith. But it corrupt and destroy confidence and faith. But it would be far better to have a smaller number of would be far better to have a smaller number of workers, to accomplish less, and as far as workers, to accomplish less, and as far as possible to have these who are engaged in the possible to have these who are engaged in the work truehearted, firm as rock in principle, loving work truehearted, firm as rock in principle, loving the whole truth, obedient to all the the whole truth, obedient to all the commandments of God”commandments of God”
Counsels On Health Page 264Counsels On Health Page 264
10 WAYS TO10 WAYS TOIMPROVE YOUR FINANCESIMPROVE YOUR FINANCES
Contract ComplianceContract Compliance
Special Service LinesSpecial Service Lines
Lure The PhysicianLure The Physician
DonationsDonations
Watch InflationWatch Inflation
10 WAYS TO10 WAYS TOIMPROVE YOUR FINANCESIMPROVE YOUR FINANCES
Right Size The OrganizationRight Size The Organization
Use Flex StaffingUse Flex Staffing
Control OvertimeControl Overtime
Manage Supplies/MedicinesManage Supplies/Medicines
Fewer Might Be BetterFewer Might Be Better
