NW Outlook Q1 2015 - HFMA WA

Transcription

Northwest
✵
Tips for Success
Ensure Project Partnership
Editor Comment: While healthcare is one of the most
vital markets for vendors, successful relationships
between providers and vendor-partners can be
challenging. Regardless the healthcare client depends
on that relationship to progress in achieving their
operational goals. Technology projects have been
center stage but with mixed results, often making
providers question if the vendor is a partner or
predator.
With providers and other aligned stakeholders in the
Electronic Medical Record (EMR) and ICD10 transitions
putting more and more money into the technology
market (see related story: Page 23) the opportunity for
success or failed relationships is even higher.
A Cautionary Tale
Recent headlines offer
examples of relationships
and failed projects being
litigated rather than
celebrated. The story
behind the failure of the
Care Oregon project and
subsequent lawsuits
provides lessons learned
common in many vendorclient technology projects.
When I read the details of
the contentious lawsuit
between the State of
Oregon and Oracle (over
the failure of Cover Oregon project) I get the image the
Oracle owner winning the World Cup as his clients fell
overboard on every turn. The State of Oregon stated
their case in plain terms Oracle lied to the state of
Oregon.
IJ 3K=HJAH
#
✵
As I review the accusations and legal filings on
both sides, I also get a glimpse of a client who
failed to prepare for the risks inherent in the
venture they took on. There are a lot of parallels
between the outcome of this technology project
and the litigation in headlines about hospitals
taking technology vendors to court over failed
EMR projects.
Buyer Beware
Technology problems had beset Cover Oregons
continued on page 20...
Inside this Issue:
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Tips For Success - Project Partnership
Editor’s Corner
President’s Message
Proper Physician Documentation: More than Just a
Bottom Line
Alaska Healthcare Watch: Alaska Chapter News
Patient-Friendly Billing: Creating a Positive
Feedback Loop that Benefits Patients & Provider
Connect With Us: New Website Coming Soon!
How Do I Change My HFMA Information?
Win $100 for writing an article
Regulatory Watch: Excerpts from Day Egusquiza Blog
HFMA Reg. 11 Executive Interview: Chuck Acquisto
Corporate Sponsors
Washington Insurance Commissioner Fines MODA
Register for a Live Webinar
Job Opportunities
Welcome New Members
Excerpts from Modern Healthcare
Upcoming Chapter Meetings & Educational Events
Contributing Writers
Chuck Acquisto
Randy Blue
Chris Brazil
Charlie Brown
Day Egusquiza
Lori Forbess
Jeff Johnson
Scott Owens
Mindy Scher
Bret Stuter
Judy Veazie
John Zelem
THANK YOU!!!
Editors Corner
by Judy I. Veazie | CRCE
O
ur page one article references the very
public legal battle between the State of
Oregon and Oracle over a computer
project voyage turned into shipwreck (shameless
nautical reference). About the same time
Oracles Mega Billionaire Larry Ellison won
headlines for his big World Cup win, things
had gone terribly wrong according to
Or
ac
headlines in the press about Cover
le
Oregon (the Oregon version of the ACA
enrollment website). I was working in
San Francisco at the time and as I flew
back and forth over that prior year between PDX
and SFO, I met a number of tech guys working on
the project (directly or indirectly). Oddly my family
was visiting and on the shore for the big win and
they became big fans of Mr. Ellison and all things
Oracle. At the same time, I was getting a very
different view of the seamy side of the tech industry.
According to Oracle, the only reason people got
that view was due to deliberate slandering in the
press by Oregon at the same time they were
seeking more assistance from Oracle. I began to
see many collieries between the plight and failures
of the State of Oregon and the typical healthcare
client. Regardless, the customer for technology
services is seldom equipped to adequately protect
themselves if the things go wrong and the vendor is
not able to offset the inherent risks in big dollar
large scope projects.
There are many similar stories in the press about
hospitals who launched projects to participate in
the EMR incentive programs, only to bog down in
the details and costs of the venture beyond their
internal resources.
These are familiar stories. Even when I worked on
Officers 2014-2015
Charlie Brown, President
Peggi Ann Amstutz, President-Elect
Rik Lewis, Secretary
Gary Bartlett, Treasurer
Janet Walthew, Program Chair/VP
Carla DewBerry, Immediate Past President
Editorial
Policy
Publication
Objective
Page 2
an Epic project with a huge contingent of vendor
and consultants (over 170 external team members
were on the floor at midnight of the go-live) the
number of people assigned to the conversion that
had solid operations knowledge as well as strong
technical skills can be counted on one hand. Read
any of these project recaps and you get the same
picture. The number of people billed on these
projects has been padded with very new techie
analysts in training. This seems to be a common
practice.
The more you read these horror stories
the more you realize how the client is
not blameless in these failures.
These EMR project tales illustrate
the inherent risk as health-care
providers of all sizes move towards implementing
electronic medical records. While hospitals are
eager to meet higher technology/ E.H.R standards,
they often lack the in-house expertise to contract
with and supervise vendors on the complex
implementation of records systems.
A 25-bed rural health-care provider in Kansas
claims in a lawsuit that despite paying Cerner
more than $1.2 million in fees, it still has no
electronic medical record system and still doesnt
qualify for federal monies to pay for one. We just
kept running into things that werent included, in
the original $2.9 million price tag the hospital
initially agreed to pay according to the hospitals
chief financial officer. But hospital officials also
acknowledge that neither they nor the board had
a complete understanding of the contract on which
they signed off. It was incredibly complex and
difficult to understand, the CFO said. We relied
on them to explain to us what the contract
represented.
In the final analysis, many clients including the
State of Oregon share that same predicament (but
too often they realize this in hindsight). C
Board Members 2014-2015
Anthony Dorsch
Bruce Houlihan
Jennifer House
Patty Jorgensen
Becky Littke
Jennifer Mitchell
Patti Peterson
Gail Sarchet
Michael Smith
Dean Taplett
Opinions expressed in articles or features are those of the author and do not necessarily reflect the view of the Washington/Alaska Chapter, the
Healthcare Financial Management Association, or the Editor. The Editor reserves the right to edit material and accept or reject contributions
whether solicited or not. All correspondence is assumed to be a release for publication unless otherwise indicated.
The NW Outlook is the official publication of the Washington/Alaska Chapter Healthcare Financial Management Association. Our objective is to
provide members with information regarding Chapter and national activities, with current and useful news of both national and local significance to
healthcare finance professionals and to serve as a forum for the exchange of ideas and information.
Washington-Alaska HFMA Chapter
1st Quarter 2015
Presidents Message
reach levels of even stronger performance. Well
this has been a record setting year for our HFMA
WA/AK chapter! I mentioned that our February
meeting had one of the highest attendance rates in
our history, and we also achieved the following
new records during the last year:
From

Charlie Brown
Chapter President

RECORD SETTING YEAR!!
I
ts been an amazing year that has flown by at
lightning speed! I have truly appreciated the
opportunity to serve as your President during the
last year. Being able to serve half of my term after
relocating to Chicago has really helped me to stay
connected with my WA/AK friends and colleagues
and I appreciate being able to finish my term. I
hope that you all had the opportunity to attend our
February meeting, which was one of the highest
attended meetings in our history. The education
content was excellent and Joe Theismann did an
outstanding job of kicking-off the meeting and
inspiring us.
In my career I have always been focused on
achieving new records. I feel strongly that if you
measure something, it will improve. I constantly
encourage my team to achieve new records and
The highest member satisfaction rate at
65% very or extremely satisfied.
The highest number of new members
joined our chapter than any other year.
We raised more money in corporate
sponsorship than any previous year.
Record fundraising event that
generated over $15,000 to support
Camp Patriot.
The volunteerism and commitment from our
Chapter leadership and our members allowed us
to achieve these record levels of performance. It
was truly a team effort, and I have thoroughly
enjoyed working with the team to set aggressive
goals and surpass them. The Chapters Strategic
plan is in great hands with the new leadership
team and I am confident that we will take the
Chapter to even greatly heights!
Im sad to say that this will be my last chance to
publish a Presidents Message for our WA/AK HFMA
Chapter. My term will come to an end when we
pass the gavel to Peggi Ann Amstutz in May. It was
been an amazing journey and I truly appreciate the
opportunity to serve our members. C
HFMA Scholarships
One of the objectives of our social networking programs is to raise money for
scholarships to fund membership fees. Thanks to all the generosity of our sponsors,
we are able to raise funds which we will use to increase HFMA membership by
funding the first-year membership fees of 10 new members! If you would like to
nominate someone you would like to see join our chapter please contact Charlie
Brown ([email protected])
1st Quarter 2015
Page 3
Proper Physician
Documentation: More
than Just Your Botton Line
by John D. Zelem | Executive Health Services
P
hysician documentation in the medical
record helps provide the cornerstone of
medical necessity that not only can help
validate the level of patient care provided, but
also help to ensure proper reimbursement to the
hospital.
An increase in denials by Recovery Auditors (RAs),
Medicare Administrative Contractors (MACs),
Commercial Payers and others have propelled
documentation into the spotlight as a critical part
of the equation.
The Benefits
I highly doubt that anyone would argue that
accurate and complete physician documentation
is essential, but there are definitely a number of
clear cut benefits beyond helping to ensure
proper reimbursement is received from cases
submitted.
Quality of Care. Increased quality tops
the list of benefits that comes to mind. A
2008 Archives of Internal Medicine1
article indicated that medical records
for patients with NSTEMI often lack key
elements of the history and physical
examination. Patients treated at hospitals
with better medical records quality have
significantly lower mortality (and) the
relationship between better medical
charting and better medical care could
lead to new ways to monitor and
improve the quality of medical care.
The article also points out that patients
cared for at hospitals that had better medical
recordkeeping experienced lower in-hospital
mortality compared to patients who did not have
this experience.
Increased Patient Safety. Although not as
noticeable a benefit at first, patient safety and the
quality of physician documentation within the
medical record can run hand in hand. According
Page 4
to a recent study published in the September 2013
issue of the Journal of Patient Safety2, between
210,000 and 440,000 patients each year who go
to the hospital for care suffer some type of
preventable harm that contributes to their death.
Staggering numbers, such as these, can help stress
the need for better documentation to provide a
clear picture of the care provided.
Increased Accuracy and Specificity.A third
notable benefit as the result of proper physician
documentation is the increase in accuracy and
specificity within the medical record. In addition to
this, timeliness of the information recorded tends
to lead to higher accuracy within documentation.
With increased proficiency in accuracy and
specificity from better documentation comes a
better description of services provided to the
patient. This outcome can also lead to an increase
in quality scores the higher the quality scores, the
more of a reflection of patient acuity. This can
have collateral benefit to 30 day risk adjusted
mortality and readmission rates amongst some
other metrics being measured.
Potential Roadblocks
Although improvements to the physician
documentation process have evolved
over the years, the road traveled has
been a rocky one, to say the least
with some even claiming that
documentation has even deteriorated
the more it progresses.
Among these factors, two stand out as
the prime culprits impacting physician
documentation: the emergence of the
electronic medical record (EMR) and
the uneasy transition from a sourceoriented record to a problem-oriented
record.
Electronic Medical Record.The future of EMR
holds so much promise that, according to The New
York Times3, the federal government is spending
more than $22 billion to encourage hospitals and
physicians to adopt electronic health records. But
the problems can start basically from the planning
stage, as EMRs are typically designed by nonclinicians i.e., programmers who are not as
familiar with how hospitals and clinicians actually
continued on next page...
1st Quarter 2015
...continued from previous page
function.
As reported in the Times article, cutting and
pasting (C&P), commonly referred to as copy
forward, may allow for information to be quickly
copied from one portion of a document to another,
as well as reduce the time that a doctor spends
inputting recurring patient data, but it also leaves
the window open to potential fraud. In an effort to
cut down on C&P abuse by physicians who are
performing less work than they actually bill, the
Office of the Inspector General (OIG) has named
the issue of cloning in the medical record as a
priority in 2015, the Times reported.
To further muddy the concerns on documentation,
the EMR is limited in providing the opportunity for
physicians to include their own thoughts and
comments. So much within the record is a
template, a checkbox, etc., which prevents
physicians from documenting their impressions,
assessments and courses of action for the patient.
Problem-Oriented Record. The creation of the
problem-oriented medical record (POMR) by Dr.
Lawrence Weed in the late 1960s provided a
disciplined approach for physicians to include
proper documentation in the medical record.
Through POMR, Weed created the SOAP note (an
acronym for Subjective, Objective, Assessment,
Plan), which gave physicians a structured
approach to gathering and evaluating the
volumes of information contained in the medical
record and provided them with an avenue to better
communicate with each other.
Over the years, physicians have essentially
abandoned the fundamentals of the SOAP
approach to the more straight-forward, but not
necessarily well-rounded Problem List approach.
But in order for this transition to be effective,
physicians must be able to successfully address all
of the following factors:
The problem list was actually designed to help
with treatment progress. Many times, the initial
problem list is copied and pasted, unchanged,
from one day to the next with no original
thought or comment. This practice can present
challenges for Utilization Management, coding,
discharge planning, as well as others.
1st Quarter 2015
The problem list may not adequately express
the physicians concerns for what is actually
going on with the patient.
The problem list may not connect the risks and
acuity with which the patient presents.
The Importance of Quality
Physicians need to lead the charge in
documentation improvements in the medical
record. As budgets get tighter and resources
become fewer, one misconception rears its ugly
head that hospitals are forcing improvements in
this area solely to benefit coding and help
increase revenue. As a matter a fact, its just the
opposite. Medicare actually encourages hospitals
to improve their coding to support proper
reimbursement, which may be higher or lower
based on the documentation, but also for better
reflection of the patient acuity. This improved
accuracy can only increase cost measures, such as
the case mix index (CMI), over time, as well as the
previously mentioned quality scores. Accurate and
specific documentation may also favorably impact
audit findings and prevent reimbursement delays
or take backs, due to incorrectly denied hospital
and physician claims.
Better documentation can benefit both hospitals
and physicians through quality scores that are now
readily available in publicly recorded data, such
as Healthgrades. The road to improved physician
documentation has not been without its bumps
and curves over the years, but physicians remain
on the front line of this issue, and need to take an
active part in ensuring that the quality and
thoroughness of their documentation stands as a
true record of the care provided.
References:
1
Dunlay, Shannon M.; Alexander, Karen P.; Melloni, Chiara;
Kraschnewski, Jennifer L.; Liang, Li; Gibler, W. Brian; Roe, Matthew
T.; Ohman, E. Magnus; Peterson, Eric D. (2008). Medical Records
and Quality of Care in Acute Coronary Syndromes: Results from
CRUSADE. Archives of Internal Medicine, 168(15), 1692-1698.
2
James, John T. (2013). A New, Evidence-based Estimate of Patient
Harms Associated with Hospital Care. Journal of Patient Safety,
9(3), 122-128.
3
Abelson, Reed, and Creswell, Julie. The New York Times. Report
Finds More Flaws in Digitizing Patient Files, January 8, 2014.
John D. Zelem, MD, FACS, is Executive Medical Director, Client
Relations & Education at Executive Health Resources, Newtown
Square, Pa. He can be reached at [email protected].
Page 5
Alaska
Healthcare Watch
Alaska Healthcare Commission
This column is intended to update and inform the
Chapter Members about Alaska healthcare financial news
Alaska Medicaid Expansion
by Bret Stuter | Providence Strategic &
Management Services
L
ate to the party, Gov. Bill Walker was elected
based, in part, on his commitment to expand
the Alaska Medicaid program. The Alaska
legislature is nearing its final two week of the 90day
legislative
session and
no consensus
has yet been
reached. The
House
Finance
Committee
had
scheduled
Juneau, located in a temperate rainforest
twice daily
in Southeast Alaska, enjoys unsurmeetings
passed natural beauty, a small town
atmosphere with the spphistication of a
from Tuesday
capital city.
April 7
through Thursday April 9 in an attempt to break
the deadlock by focusing exclusively on Medicaid
in the morning sessions.
While there had been much optimism that
some solution could be reached, that was
tempered recently by comments of House
Speak Mike Chenault R-Nikiski when he
shared with reported that the current
system is broken and there are concerns
with adding more people to the program.
We think that there are things that need to
be addressed before expansion happens, he said.
Does that mean that the governor doesnt get an
photo by Jennifer Mitchell
Written by Bret Stuter
of Providence
Strategic & Management Services
expansion bill by end of session? I cant say
because its the legislative process.
The committees co-chair, Rep. Steve Thompson, RFairbanks,
said the
committee
will try to get
a better
handle on
the issues
involved.
The Senate
Health and Social Services Committee is also
working on the legislation, and there is a warmer
feel there. Sen. Bert Stedman, R-Sitka, said he has
become more comfortable with the idea of
expansion as he has researched the issue. The
issue is not a set-it-and-forget-it one, however, and
he indicated that the reforms will need ongoing
conversation.
One of the reasons for the slow progress on the
Medicaid reform package is the address the
massive deficits projected.
Alaska state budget is
linked with the price and
production of oil in the
state. With both at record
lows, the states coffers are
relatively lean and requires
the utmost attention from
the legislators. Senate
President Kevin Meyer, RAnchorage, said a bill
could be on the Senate floor by Friday, April 10.
Alaska news continued on next page...
Page 6
1st Quarter 2015
...Alaska news continued from previous page
Alaska Hosting 2015
Second Roadshow
by Bret Stuter | Regional Senior
Reimbursement Analyst
I
n healthcare, the challenge of producing more
with less is the topic of discussion in nearly every
planning and budgetary session since the
1970s. But there is help on its way, and its coming
in the form of Brian Douglas, who will giving two
half day session scheduled for dates in May/June
(watch for your booking information) for Alaska
Healthcare providers.
The Washington Alaska Chapter of HFMA has
prioritized getting educational resources to
members of not just HFMA, but to the healthcare
community at large. Having enjoyed success in the
state of Washington, the chapter has turned its
attention northwards to replicate those results.
Alaska is a unique forum for healthcare
professionals. Separated by distance, and access,
healthcare providers often find themselves limited
in finding out whats happening? Providers have
the same number of tasks, but with fewer staff to
accomplish those tasks. Wearing hats of many
disciplines gives Alaskan healthcare unique
perspectives of broad peripheral understanding of
the complex regulatory and issues that confront the
industry. But that same generalization works
against specialization. That, in turn, can limit the
number of new issues providers become aware of
on an ongoing basis.
HFMA wants to change that. By providing no-cost
presentations, the hope is that professionals can
become versed in the latest information and
anticipate changes coming around the bend.
1st Quarter 2015
Watch for the Date: May/June Meeting
The Morning Session begins from
9 AM Noon, and includes:
(1)
(2)
(3)
(4)
(5)
RAC Audits
OIG workplan Effect on AK
DSH Medicare
Midnight Rule
Quality Initiatives
a. Physician Quality Reporting System
b. Accountable Care Organizations
c. Other topics
The Afternoon Session runs from
1pm 4pm and includes:
1.
2.
3.
2552-10 cost report. Transmittal changes after
inception.
a. Bundled Model 1 discounts
b. HVBP incentive payments
c. Hospital readmissions reductions
d. Recovery of accelerated depreciation
e. Low volume adjustments
f. Sequestration
Electronic Health Records
DSH Medicaid
The agenda is fairly aggressive, and will cover a fairly
wide range of topics. However, the informal nature of
these sessions encourages questions and open
discussions. These interactive qualities allow
participants to translate regulations into real world
experiences.
And if you wanted to know a little bit about the
presenter:
Brian Douglas is a Member of Douglas, Sheets &
Stremcha, CPAs, LLC and specializes in the healthcare
industry, specifically Federal and State reimbursement.
Cumulated over the past 30 years, Mr. Douglas has a
unique blend of healthcare experience having worked
as a Manager of Reimbursement at Samaritan Health
Services (now Banner Health), Senior Manager for the
Fiscal Intermediary, Blue Cross Blue Shield of Arizona,
and now providing healthcare consulting services over
the past 10 years.
We absolutely look forward to seeing you there. Look
for events date and times through our regular HFMA
emails, and look for the follow up in next quarters
newsletter. C
Page 7
Patient-Friendly Billing:
Creating a Positive
Feedback Loop that
Benefits Patient & Provider
by Randy Blue | McKesson
P
atient billing traditionally hasnt been a focal
point for customer service efforts in
healthcare. But thats changing today as
organizations pursue the benefits of a more
patient-friendly billing experience.
Improving the patient side of revenue cycle
management can strengthen customer satisfaction,
contribute to performance bonuses, increase
loyalty and generate new referrals. It can also
reduce bad debt by improving the odds that selfpay balances will be collected in a timely fashion.
Strategies for developing patient-focused billing
involve improved communications, simplified
statements and providing a single point of contact
for billing issues. Even seemingly minor tweaks like
reducing customer hold time can have a dramatic
impact on customer perceptions, studies show.
Customer satisfaction takes center stage
Customer satisfaction has emerged as a key
component in the Patient Protection and
Affordable Care Acts (ACA) overall push to
improve healthcare quality. Today, customer
satisfaction data collected through the Hospital
Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) survey is used to help calculate
performance bonuses and penalties developed
under the Center for Medicare & Medicaids (CMS)
Hospital Value-based Purchasing Program.1
Patient satisfaction scores also figure prominently
in CMS Accountable Care Organization quality
measurement efforts, as well as the physician
performance bonuses and penalties implemented
through the Physician Quality Reporting System
(PQRS).2
Beyond supporting these reform-driven programs,
positive customer experience scores generate
dividends in their own right. The continued growth
of high-deductible health plans means that
Page 8
consumers
increasingly are
shopping for care
based on both cost
and perceived
value.
As a result, the
ability to promote
customer
satisfaction
represents another
way for providers to
differentiate
themselves in a
competitive
Randy Blue
environment. A
positive billing experience can generate word-ofmouth referrals and positive customer feedback on
social media sites. Significantly, a 2013 survey
conducted by Connace found that 88% of patients
with highly positive billing experiences would
recommend a hospital to friends.3
And as patient financial responsibilities increase
due to high-deductible plans, strengthening
effective patient communications also can
translate into accelerated cash flow. That means
reduced days in A/R, reduced collection expense
and less bad debt. According to a 2014 survey by
TransUnion, 75% of responding patients stated that
pre-treatment estimates of out-of-pocket costs
would improve their ability to pay for healthcare.4
Communication key to patient-friendly billing
Effective communications about a patients
financial obligations provided both before and
after the episode of care are at the heart of a
customer-friendly billing process.
Organizations should make every effort to develop
a system that can give patients an accurate
estimate of their total out-of-pocket expense at the
time of registration or procedure check-in. Patients
who may have difficulty immediately paying their
entire balance should be given the opportunity to
make installment payments over time.
Additionally, statements submitted after care
should be clearly written and concise. Whenever
possible, the balances due from all providers
1st Quarter 2015
involved in a care event should be consolidated
into a single, easily understood statement.
While many organizations may not yet be
sufficiently integrated to offer this service, they
should nonetheless work with their care partners to
determine how such a statement could be
produced. A consolidated statement is critical,
since multiple bills for what the patient rightly
views as a single episode of care can confuse and
frustrate customers and lead to slow or no pay.
Patient-friendly billing can be further enhanced by
providing a dedicated customer service contact for
patient questions about billing issues. The ability
for patients to connect with a specific individual
conversant in all financial aspects of their care
should help reduce consumer frustration and illwill. This level of service can be taken a step further
if the billing representative offers to contact
insurance providers, healthcare providers,
healthcare facilities or government agencies on
the patients behalf.5
Best practices from remote call centers
Since telephone conversations are the primary
method for communicating with patients about
financial matters, setting the groundwork for a
positive phone experience from the consumers
perspective is critical. In fact, a study by Frost &
Sullivan Research suggests that being on hold for
an extended period of time is one of the primary
causes of customer dissatisfaction. Moreover, it can
take only two negative phone experiences for a
consumer to develop a diminished opinion of the
service provider.6
To meet the challenge of prompt, personable and
knowledgeable communications, organizations
may wish to contract with a dedicated outsourced
call center. Call centers focused specifically on
revenue cycle issues can provide detailed
information regarding co-pays, dates of service
and amounts due, and also work with patients to
develop workable plans for paying down
balances. Additionally, qualified centers offer a
scalable solution that can be ramped up as
patient volume increases.
Fostering loyalty and goodwill to boost
referrals
1st Quarter 2015
As a patients healthcare financial obligations
increase, their interactions with billing personnel
carry an ever-greater weight. For many,
perceptions formed during these encounters can
have a major, if not decisive, impact on the way
the overall organization is viewed.
For that reason, it is critical that providers work to
develop truly customer-friendly billing services. By
reducing wait times, empowering dedicated,
knowledgeable personnel, offering payment
flexibility and creating easy-to-understand
statements, providers will foster loyalty and
goodwill.
These positive feelings not only improve the
likelihood of return business, but also boost the
prospect of referrals and beneficial social media
reviews. Affirmative patient feedback, in turn,
supports quality scores that can produce
performance bonuses.
Finally, reasonable billing procedures and
accessible, respectful billing personnel can help
strengthen cash flow, reduce collection costs and
cut bad debt. All told, patient-friendly billing is a
positive feedback loop that once in place can
continue to generate key benefits for both
consumers and healthcare organizations for years
to come.
Randy Blue M.Ed, CRCR, is an Executive Director with
McKesson’s Business Performance Services division. Randy is
located in Seattle, WA and has over 25 years experience in
sales and marketing, specifically in the healthcare space. Randy
is committed to helping health systems and physician organizations manage the rapidly evolving healthcare landscape to
improve business performance.
[email protected]
www.mckesson.com/BPS
Twitter: @McKesson_BPS
1
HCAHPS: Patients Perspectives of Care Survey, Centers for Medicare &
Medicaid Services, Sept. 25, 2014, http://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/HospitalQualityInits/
HospitalHCAHPS.html
2
Quality Measures and Performance Standards, Centers for Medicare &
Medicaid Services, Dec. 31, 2014, http://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/sharedsavingsprogram/
Quality_Measures_Standards.html
3
Dustin Whisenhut, Making the Revenue Cycle an Ambassador for Your
Organization, hfma.org/rcs, November 2014, http://bit.ly/1yrWIYF
4
TransUnion Survey Finds Patients Willing to Pay More of Their Bills With
Improve Billing Information at the Time of Service, TransUnion, April 7,
2014, http://transunion.mwnewsroom.com/press-releases/transunionsurvey-finds-patients-willing-to-pay-mo-1104086?feed=abde9b49-87164c7b-b7a3-bff44ca35beb#.VLkjrSvF_h4
5
Whisenhut, Making the Revenue Cycle an Ambassador for Your
Organization, hfma.org/rcs, November 2014, http://bit.ly/1yrWIYF
6
This is Your Wake-Up Call: Ten Ways to Improve the Patient Experience,
McKesson Business Performance Services, January 2015, http://bit.ly/
1wggkth
Page 9
Connect with WA-AK on Social Media
Page 10
1st Quarter 2015
HOW DO I CHANGE MY
HFMA
INFORMATION?
All of our chapter
directory
information
including e-mail
and addresses for
the newsletter are
received from the
National HFMA
database.
$100
Best
le
Artic
The easiest way to make changes
is via the internet. Simply follow
these steps to change any of your
personal information.
Please note: you must make your
own information changes. The
Chapter cannnot make these for
you.
1. Log on to http://
www.hfma.org
2. Go to the membership
section
3. Log in using the
username and password
prompts
4. Follow instructions to
access your Profile
5. Edit information.
1st Quarter 2015
You could win $100 by
writing an article for
N.W. Outlook! Share
your knowledge &
experiences with
other HFMA
Members. You
can help make
a difference!
.
Please send
information &
articles for upcoming
newsletters to:
Judy Veazie
E-mail: [email protected]
Share the
Wealth
Share your wealth
of knowledge by
submitting an article or
experience for the Northwest
Outlook newsletter ....that way, we
are all enriched!
Page 11
Excerpts from Day Egusquiza Blog.....
Regulatory Watch
by Day Egusquiza | AR Systems, Inc
NEW website:
http:// arsystemsdayegusquiza.com
ICD -10 is alive and well
Yes, as of today, ICD -10 is still going live in Oct
15. There are lots of readiness efforts in all
organizations but here are a few pointers - beyond
HIM.
1. Physician office partners. To be able to do
medical necessity screening, it is imperative
that dx are received at the time of ordering. We
all know ICD 9, but who in the hospital/
provider is going to receive the a) narrative or
b) old ICD 9 code and translate into the ICD
10 PRIOR to the service? Be prepared to do the
ABN for the patient or call the provider and ask
for additional new ICD 10 dx? OR if the
provider is doing dx thru CPOE, who is going
to get the rejected dx against CPT codes/
Medical necessity and ask Are there any
other dx codes associated with this test that you
may have omitted when selecting the codes?
Note: Huge potential for new denials/
rejections/lost revenue and/or inappropriate
ABNs with patients. CANNOT write off CPT tests
because the screening was not done PRIOR to
the testing. Has been and always will be
against Medicare rules...
2. Physician office partners. Give something back
to the practices! We need a strong partnership
with all the employed and community
providersand most of that comes by
providing support and FREE education to their
office staff/nursing. Idea: Host lunch and
learns - HIM coding team help the office code
a record with ICD 10.
3. Payer readiness. Be sure to get your letter to
ALL payers ask:
who is their contact to test, when will they
start?
how long can you submit ICD 9 claims
after go live/ask for one year?
can you test all patient types (ER separate
from inpatient separate from inpatient
surgeries separate from oncology, etc.) ?
Not just one big batch as only loops and
segments/837 will be tested. Run the
individual patient types through the edits
and receive the return to provider rejections
and watch the 835/electronic payment too
- be on the lookout for unique/new denials.
Note: Going from 15,000 dx to over
70,000 = could result in new rejections. BE
READY!
4. Remote coding support to keep the UR down
thru coder practice times and beyond. Keep a
resource list. (Yes, we are offering remote
coding - with no minimum # of claims and we
are NOT raising our rates for ICD -10... Let me
know if you would like more info).
New Modifiers - X
CMS provided great information regarding the
implementation of the new X modifiers. The CMO
for the Integrity Unit did the clarification.
Highlights:
CMS Integrity Initiative - when deciding to
attach a 59 - can still use the 59 modifier
with the same rules as has always been
present.
Using of the X - a full rollout will occur over
the year(s) as they identify procedures
where the X will be required instead of the
59.For now, can use either and CMS will
treat same.
Also there is a MedLearn, CR 8863, Effective 1-115. https://www.coms.gov/Outreach-andeducation/medicare-learning-network-MLN/
MLNmattersarticles/downloads/SE1503.pdf
RAC Program Improvements
There are some excellent expected improvements
that will be in place with the new RAC contractswhich are on hold for now. Still definitely worth
reviewing:
Go to: http://www.cms.gov/research-statisticsdata-and-systems/monitoring-programs/
medicare-FFS-compliance-programs/recoveryaudit-program/downloads/RAC-programimprovements.pdf
Tidbits
Settlements at 68%- time to stay in close contact
with your MAC on round two of the settlement
process. If questions use email:
Page 12
1st Quarter 2015
[email protected]. Get
your money!
Check out :(http://
www.healthcarefinancenews.com/news/twomidnight-rule-delayed-until-sepatientember-sgrrepeal-bill)
Short Stay DRG !
HUGE
It is a HUGE potential change that both
MedPac and AHA are appearing to recommend.
Please take the time to carefully study AHAs letter
to CMS Feb 13th letter: Two-Midnight Policy and
Potential Short Stay Payment Solutions.
Days Thoughts: MedPAC recommended moving
to a new DRG for any inpatient stays that had less
than 2 MNs. Although AHA has done extensive
financial analysis along with detailed outlined
ideas/multiple analysis using the most current
financial info/PRIOR to 2 MN rules unfortunately, a
few major concernsa) Currently 1 Outpatient MN and 1 inpatient MN
= 2 MN benchmark. This is paid at 100% of
the full DRG. This is the gift from CMS that
gives us our new inpatients. These are definitely
within the target zone of the new short stay
DRG. HUGE loss of cash as the 100% DRG/
current will be reduced to a lower payment.
b) For any inpatient that has less than 2 MN - take
a look at your historical analysis. What kind of
financial hit will occur if this happens?
admitted but has to be transferred out = all
will be impacted if the SS DRG is implemented.
Anything under 2 MN)
AHA indicates they dont know how CMS will
address the 2 MN benchmark -but hopefully they
will LOBBY HARD to keep the full 100% DRG for
these 2 MN combinations..
I am afraid that we are creating a major level of
complexity while losing significant payments for
the majority of the Inpatients - those under 2 MN
but with 1 MN Outpatient/1 MN Inpatient being
the highest at risk. Please contact: Priya Bathija,
[email protected]. They want to hear from you...
April 2015 Update of the Hospital Outpatient
Prospective Payment System/OPPS
Take a look at the Inpatient Only and the 72 hr.
combine. Change request 9097, March 13, 2015.
Day Egusquiza, President
NEW website: http:// arsystemsdayegusquiza.com
AR Systems, Inc
PO Box 2521
Twin Falls, Id 83303
[email protected]
208 423 9036
FAX 208 423 9036
”Leading with Energy and Excellence”
You don’t get reimbursed for what you do,
you get paid for what you document.
on
the
run?
c) Observation- originally there was
consideration to count the 1st MN as an
outpatient toward the 3 MN SNF - OR - -if OBS
was involved, consider paying as an inpatient in the SS DRG formula. Does not appear to
clarify these very problematic areas.
d) How many inpatients occur that REALLY need
to be an inpatient and yet not cross the 2 MN
benchmark? Does the volume of new SS
DRGs equal the HUGE Loss of Inpatients under
the 2 MN benchmark? (1 MN Inpatient without
the preceding 1 MN Outpatient; 1 MN
Inpatient and discharged with no declaration
of needing a 2nd MN; patient admitted and
recovers sooner than expected; patient
1st Quarter 2015
stay
connected
at
www.waakhfma.org
Page 13
HFMA Region 11
Executive Interview
with Chuck Acquisto | Stephenson, Acquisto &
Coleman
How will you approach this year? My 2014-15 year as
Regional Executive-elect
allowed me a wonderful
opportunity to engage
each chapters Presidentelects who will serve as
President during the
2015-16 HFMA year in
which I will be serving my
term as the Regional
Executive. I am blessed to
Chuck Acquisto
be working with an
amazing group of strong chapter leaders. In
addition, I am extremely excited to be working with
the Nevada Chapters Jason Meyer, who will be
serving as the Regional Executive-elect.
What are your key initiatives for the year? My goals this 2015-16 year is to focus each
chapter on connecting with membership,
especially with social media. My initiative is to
push each chapter into the 21st Century with active
Twitter accounts as well as exploring the possibility
of a Region 11 app and/or chapter apps. As for
representing Region 11 at the Regional 11
Council, I will continue to push initiatives to have
corporate memberships as well as pushing for
more tweaks to the Chapter Balance Scorecard
where many if not all of the categories will no
longer be a pass or fail grade. Given the fact
HFMA is a volunteer organization, I am a strong
believer that hard work should be rewarded with
proper evaluation.
When you look back on this year - what will
you have hoped to accomplish? What are the
obligations you feel you will need to meet and
what will be your legacy? If all the chapters meet their goals, whether it is
Chapter Balance Scorecard or objectives set at the
chapters mini-Leadership Training Conference/
National LTC, then I will be satisfied with the year. I
hope to continue to have the Regional chapters
CORPORATE
••••••••
SPONSORS
The Chapter would like to thank
the following companies
for 2013 - 2014 sponsorships:
PLATINUM LEVEL
Audit and Adjustment Company Inc.
Cardon Outreach
Dingus, Zarecor and Associates PLLC
Evergreen Professional Recoveries
Foster Pepper PLLC
Healthcare Resource Group
Healthfirst Financial, LLC
Key Bank
Merchants Credit Association
Moss Adams LLP
Professional Credit Service
Resource Corporation of America
Wipfli, LLP
GOLD LEVEL
Clark Nuber PS
Emdeon
KPMG LLP
MedAssist Solutions
Ogden Murphy Wallace PLLC
Passport Health Communications
Triage Consulting Group
Xtend Healthcare
SILVER LEVEL
Capio Partners
Cymetrix Corporation
ECG Management Consultants
Evergreen Financial Services, Inc.
First Choice Health
LaPlant Consulting Group
Tom and Jean Muller
Parker Smith & Feek
Ricoh Healthcare
The SSI Group, Inc.
Value Healthcare Services
BRONZE LEVEL
C
Craneware Inc.
Hawes Financial Group
Legend ID
MedFi
Page 14
1st Quarter 2015
move even closer to working together throughout
the year with the sharing of information and
volunteer talent.
What do you foresee your biggest challenge
to be in the upcoming year? The seismic shift in the healthcare industry from
consolidation continues to pose concerns as
hospitals either move into health systems or close.
The goal is to make sure our chapters are not in
the end stages of maturity. I use the example of a
50-something person going to the doctor and
hearing that their days are numbered unless they
change their ways. Like a person changing their
diet and adding more exercise to their lifestyle, the
positive is HFMA Region 11 chapters can reverse
the aging process with proactive measures to
engage not only the current membership, but also
the millennials that have been entering the
healthcare work force.
Do you have specific ideas for how you will
expend your energy toward any specific
project and/or committee? My energy this year will be focused on making sure
to visit each Region 11 chapter for a conference
and/or Board meeting to make a personal
connection with the Regions leaders and
members. It is critical to listen to what hurdles and
successes each chapter has experienced or is
facing. This is important to effectively serve on the
Regional Council throughout the 2015-16 year.
Discuss your thoughts on planning for the
future and how you will address that during
your year? Do you have ideas for how to
attract younger volunteer leaders? It is not only critical to continue to bring in younger
membership, but to integrate and mentor the
millennial members into important leadership
roles. To do this successfully requires current
leadership to open strong dialogue with this
generation of volunteers/leaders to understand
what works for them. Many younger volunteers
prefer to work on one project and be done as well
as to be considered part of a team rather than a
committee. Other young leaders are more old
school and do not mind the current structure. The
Regions Chapters have to make sure they are
SAVE THE DATE!
Spring Conference
Spokane, Washington
May 6-8, 2014
Join us at the
NORTHERN QUEST CASINO
Leading the Change!
2015 is hereLeading the
Change continues to be the
theme as Healthcare Reform,
consolidation, ICD-10, tax and
regulatory changes, reimbursement changes, rising costs,
resource constraints, risk management, Electronic Health
Records, Insurance Exchanges,
and many other significant
issues continue to
influence our path in 2015.
SEE
YOU
THERE
!
1st Quarter 2015
Page 15
willing to change and adapt. In addition, it is
important for each Chapter to not wait for HFMA
National to take the lead all the time. It is up to the
Chapters and/or Region to lead the way.
What do you feel are the top three most
pressing National concerns that will need to
be addressed this year? What are some of the
changes that will be addressed that will affect
all the chapters? The new certification exam is the obvious answer to
the concern question, but HFMA Nationals
willingness to address the issues chapters had with
the old exam is a strong positive sign that changes
are being made. It appears this new exam is a big
step in the right direction. As Region Executive, I
will continue to press for a HFMA app that will help
the local chapters continue to thrive with education
and awareness for its members. In addition, my
goal to make adjustments to the Chapter Balance
Scorecard will hopefully make stepping into
leadership roles more attractive. I have always
stated the greatest recruiting pitch for HFMA is that
at little cost the Chapters afford the opportunity for
members to gain leadership and management
skills. Finally, without a corporate membership being
offered in the near future, the ability for chapters to
grow both with youth as well as total membership
will be extremely challenging.
I heard the big meeting this year was in
Chicago - any specific fun plans for your visit
to the Windy City? Our Regions Presidents will return to Chicago this
September for the Fall Presidents Meeting (FPM),
this time with the President-elects making their first
trip. This FPM change from Hawaii in 2014 was a
positive experience as outgoing Regional Executive
Greg Labow and I worked hard to provide a few
bonding experiences beyond our boardroom
meeting time. Last year, we might have been the
only Region that did not attend a Cubs game at
Wrigley Field. I am working with Jason to make
sure will add that to our agenda at this FPM. There
will also be one free evening to allow for the
Presidents and President-elects a chance to get a
taste of Chicago, whether it is Italian beef, hot
dogs with no Ketchup, deep-dish pizza, a classic
steak, a trip to the Billy Goat Tavern, Harry Carays
or a frosty libation at the world famous Three Dots
and A Dash tiki bar. C
Page 16
Washington Insurance
Commissioner Kreidler
Fines Moda
Moda Health Plan,
Portland, Oregon;
Fined $17,500
A
consumer filed a complaint with the
Insurance Commissioner on behalf of
her husband because Moda processed
an oral medication to treat cancer as a
prescription benefit, which has a higher cost,
rather than a medical
benefit. Washingtons
Oral Chemotherapy
Parity Law requires that
insurers cover oral
chemotherapy drugs as a medical benefit
rather than a prescription benefit because the
cost is lower for consumers.
Moda reviewed the case and agreed to cover
the treatment as a medical benefit. The
Insurance Commissioner then asked Moda to
review all such cases dating back to January
2012; Moda identified 78 consumers with
278 claims that were processed as more
expensive pharmacy claims. Moda is in the
process of reprocessing those claims for the
affected consumers and will notify the
Insurance Commissioner of the results.
The Insurance Commissioner also advised
Moda on updates to its claims processing
procedures to avoid this happening in the
future. Washington-Alaska HFMA Chapter
1st Quarter 2015
REGISTER FOR A LIVE WEBINAR
Learn about timely healthcare finance topics and earn CPEs.
Most live webinars are free for HFMA members and $99 for
non-members, unless otherwise noted. Become a member
today. The Webinars are a great opportunity to listen and learn
about interworking’s of HFMA as well as leadership skills.
DATE HFMA LIVE WEBINAR TITLE
Apr 22
Clinical Documentation Improvement (CDI): Remedies to Improve Quality and Financial Results
Apr 23
Transforming Capital Management and Planning Outcomes into Operational Budgets and Forecasts
Apr 29
Moody’s Not-for-Profit Healthcare Industry Outlook and Credit Perspective
Apr 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 Mgt in Accountable Care Organizations
May 19
Creating Revenue Integrity Strategies for the Future
May 20
Strategies to Ensure Compliance with IRS-501(r) and Its Impact on Patient Responsibility Workflows
May 21
How Memorial Hermann Health Sys Improved Patient Satisfaction & Collection Rates while Reducing Costs
May 26
Reducing Value-Based Purchasing Penalties by Improving Clinical Documentation
May 27
A Cross-Organizational Approach to Costing, Performance Measurement, Decision Support, and Analytics
Jun 3
A 360-Degree Perspective on Best Practices for ICD-10 Readiness
Jun 4
Minimizing ICD-10’s Impact on a Physician Practice’s Revenue Cycle
Jun 11
Managing Perioperative Operations to Improve Margins
Jun 16
How Overtime May Be Harming Your Business and Patients
NOTE: In addition to the scheduled webinars, HFMA provides webinars available one calendar year
following the live webinar date and year. On-demand webinars are not eligible for CPE credit. Most
on-demand webinars are free for HFMA members (M) and $99 for non-members (NM), unless
otherwise noted.
1st Quarter 2015
Page 17
washington / alaska chapter
Job Opportunities
healthcare financial management association
TITLE
ORGANIZATION
LOCATION
CONTACT
Manager of Patient Access
Chief Financial Officer
Senior Decision Support Analyst
Reg. Financial Support Svcs. Mgr.
Senior Accountant
Medicare Cost Report Specialist
Controller_Accounting Mgr
Manager of Compensation
VP of Finance
Health Economist
Cash Management Supervisor
Accountant
Director of Business Intelligence
Accounting Application Analyst II
Financial Analyst
Budget Analyst
Reimbursement Nurse Reviewer
Director of Revenue Cycle
Chief Financial Officer
Director of Patient Receivables
Director of Access Services
Senior Financial Analyst
Assistant Controller
Corporate Controller
Revenue Cycle Analyst
Dir of Financial Services
VP Operational Finance
Staff Accountant
Sr Reimbursement Analyst
Financial Analyst
Sr Payor Contracting Specialist
Evergreen Health
Forks Community Hospital
Providence Health & Services
Franciscan Health System
Qualis Health
Southcentral Foundation
Legacy Health
Anthem, Inc
Confluence Health
Confluence Health
Confluence Health
Confluence Health
Confluence Health
Confluence Health
Confluence Health
Cascade Medical
MultiCare Health Systems
MultiCare Health Systems
Ecova
Ecova
Compass Health
Franciscan Health Group
St Anthony Hospital, CHI
Columbia Memorial Hospital
Legacy Health
Peace Health
Legacy Health
Kirkland, WA
Forks, WA
Renton, WA
Anchorage, AK
Tacoma, WA
Tacoma, WA
Seattle, WA
Anchorage, AK
Portland, OR
Seattle, WA
Tacoma, WA
Wenatchee, WA
Wenatchee, WA
Wenatchee, WA
Wenatchee, WA
Wenatchee, WA
Wenatchee, WA
Wenatchee, WA
Leavenworth, WA
Tacoma, WA
Tacoma, WA
Renton, WA
Spokane, WA
Spokane, WA
Everett, WA
Tacoma, WA
Pendleton, OR
Astoria, OR
Portland, OR
Vancouver, WA
Portland, OR
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
&
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&
&
&
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&
click
click
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for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
more
more
more
more
more
more
more
more
more
more
more
more
more
more
more
more
more
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more
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more
more
more
more
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
information
NATIONAL OPPORTUNITIES
Whether youre climbing the ladder or youve reached the top, you must stay
continuously focused on your career. HFMA gives you a distinct advantage every
step of the way. Professional certification programs, career self-assessments,
employment opportunity updates, resume referral services, mentoring
opportunities, and national and local leadership opportunities let you have a hand
in shaping the future of the industry and the profession.
To access HFMA Nationals Job Bank please click here! &
For more information on these listings or to include a listing, please contact
Don Burke at (425) 814-2537 or email at: [email protected]
See also National HFMAs website (www.hfma.org) for additional job listings.
[Last Update: April 18th, 2015]
Page 18
1st Quarter 2015
New
Members
The Washington/Alaska Chapter is pleased to
announce the following new members:
Ariel Aisen
The Advisory Board Company
Albert Froling
University of Washington
Elham Morshedzadeh
Anna Anderson
Providence Health and Services
Paul George
Cory Pace
Alaska Heart & Vascular Institute
Jasmin Anderson
Valley Medical Center
Sukhwinder Gill
Group Health
Andrea Pederson
Navigant Consulting, Inc.
Rachel Aronovich
Michelle Hager
Confluence Health
Edward Piecek
Julia Jones
Norton Sound Health Corp.
Karen Plaister
EvergreenHealth
Jacqueline Jordan
Kadlec
Kelly Rancourt
Clark Nuber
F. Kellegrew
COMPASS Health
Deanna Ravet
Samaritan Hospital
Rosalinda Kibby
Columbia Basin Hospital
Michele Robertson
Centene Corp
Tyler Killpack
Ethan Rosenberg
Elyse Brokaw
Katherine Carlton
Southcentral Foundation
Danea King
YVMH - Memorial Physicians
Chris Cerman
Overlake Hospital Med Center
Michael Lang
Southeast Alaska
Regional Health Consortium
Alon Asefovitz
Cedar Financial
Evan Auerbach
University of Washington - MHA
Daniel Baron
Multicare Health System
Holly Barrett
Key Bank
John Blaine
Hilary Clark
Lee Colburn
Brenda Davis
The Polyclinic
Edward Day
Kittitas Valley Healthcare
Patrick Donka
Tatum Consulting
Rasheed El-Moslimany
Virginia Mason Medical Center
Tim Fitzpatrick
Asante Alliance
1st Quarter 2015
Dinh Lieu
Virginia Mason Medical Center
Dawn Loeliger
Group Health Cooperative
M. Thomas Lukehart
UW Medicine
Rebecca Maki
Jefferson Healthcare
William McDermott
United HealthCare
Brian Miner
U.S. Bank
Rachel Stauffer
Southeast Alaska Regional
Health Consortium
Mathew Stopa
Karen Tarver
Elgee Rehfeld Mertz LLC
Darren Thomas
Yakima Valley Farm
Workers Clinic
Andrea Tobon
Seattle Cancer Care Alliance
Bob Waskom
Dell
Pamela White
YKHC
Linda Wilcoxson
Dina Yunker
Page 19
...continued from page 1
online healthcare exchange with the web portal
never going live after open enrolment began on
October 1, 2013. In March 2014, Oregon State
dismissed Oracle, the lead website developer for
Cover Oregon, followed in April by the axing of
the exchange, despite spending $248 million on it.
Oracle has taken the fight to the client, landing the
first punch by filing a lawsuit against the State of
Oregon. Oracle contends in a 21-page complaint
(interesting reading) that it is still owed $23 million
by Cover Oregon under its contract.
The State of Oregon was pointed in their direct
claim against Oracle: Oracle lied. Theres been
a flurry of legal activity between Oracle America
and the state of Oregon over the Cover Oregon
fiasco. As of today, the parties have four lawsuits
against one another, with more likely to come.
Failed Deliverables or Failed
Definitions
Oregons claim that Oracle lied is rooted in the
original communications on deliverables and
when Oracle responded to the RFP and responded
to the RFP implying products would work out-ofthe-box.
Industry experts have quickly jumped in with
observations against both Oregon and Oracle:
Anybody that knows enterprise software knows
that these are not absolute terms, if in fact the state
was expecting an automatic out-of-the-box
solution I believe that expectation was
unreasonable, and may suggest significant
inexperience on the part of the state.
More lessons learned for healthcare
technology clients
A major contributor to the failure of the project,
according to Oracle, was Oregons decision not to
appoint a systems integrator.
That decision was akin to an individual with no
construction experience undertaking to manage the
processes of designing and building a massive
multi-use downtown skyscraper without an
architect or general contractor.
In this issue of HFMA Outlook I wanted to
feature the vendor perspective providing
tips they have to offer for successful project/
product integration. I asked representatives
from some of our vendor membership:
What have you seen as a common success
or failure on the part of providers when
they try to integrate a product (consulting,
software, cash acceleration, outsourcing,
etc.)
Judy Veazie
Oregon vs. Oracle: Yes, no doubt, clients bear
some responsibility with project management
failings, but time after time I hear/read/see sales
promises of this is easy, yes the product does X,
only to find out months later that in fact, no, the
product doesnt do X - that they meant was once
you sign an 8 figure contract, well assign some
junior developers to make it almost do that.
More experts weigh in. loads of promises, under
delivered, and as an IT consultant, it was pretty
obvious what they were promising was not possible
on the time schedule provided. Having techknowledgeable external resources to review and
looking for clarification on muddied points would
have helped.
Tip: Providers need a vendor partner that
can work with them to clearly define their
needs.
Lori Forbess: The first question I ask what is it
the client is trying to achieve.
There are so many articles and information
about best practices of project management but I
like to start from the beginning. The first question I
ask is Why? Why do you need this solution or
product? What are you trying to solve or achieve?
If you do not understand the problem you are not
likely to have the right solution. You cannot expect
the customer to understand your product. Once the
Why? is clearly understood, and then you can
document a solution, defined deliverables and
timelines with the expected outcome for the client.
This helps both parties to be on the same page.
(Lori Forbess)
Tip: Seek buy-in for the changes from
stakeholders.
Page 20
1st Quarter 2015
A vendor can promise the moon, but without the
full focus of the business units that are involved in
the day to day operations the overall success will
be limited.
Of course, the opposite applies to the vendor. They
need to insure there is a clear roadmap,
understand who the key owners are for the
provider, and maintain a clear and concise project
plan. Any deviation from that plan needs to be
clearly communicated and agreed upon by all
parties. (Scott Owens)
Tip: Successful projects depend on good
communication. Take a page from "project
marketing" and keep the visiblity of progress
to goals very visible during the process.
" I believe that one of the biggest failing points
from a project management side is not having the
right people involved on both sides. Marketing the
project (internally and externally) also is a big
downfall of many organizations. I know that not
many people think about marketing a project, but
I've seen projects really take off when marketing
becomes a part of the overall desired outcome."
(Jeff Johnson)
Oracle vs. Oregon: Blog comments: The problem
is the need for expert management of the project,
very much the issue in Oregon: relying on Oracle
to manage the project turned out to be an
expensive mistake. I still cannot bend my head
around the idea that a State of the most powerful
country on earth should somehow be allowed to
reclaim what is to all intents and purposes their
mismanagement.
Tip: An experienced Implementation
Coordinator is essential to success
Even in the contracting phase it is important for
both vendors and providers to have a clear
understanding of what the implementation process
is going to look like. Once hospitals recognize that
they want to move forward with a cash
acceleration project or are implementing a new
system and need legacy system work, they want to
get started as soon as possible. With our AR
outsourcing projects, we provide an
implementation coordinator who provides our
clients with a detailed implementation spreadsheet
noting the various implementation components
1st Quarter 2015
(connectivity, files needed hospital required
paperwork, logons, Statement of Practice etc.).
(Mindy Scher)
Tip: Define essential team members and skill
requirements for each team role, particularly
IT.
Both sides will identify and appoint responsible
parties to complete these deliverables. IT is
stretched so thinly, that its important theyre
informed well in advance of what is required and
that appropriate introductions are made with the
vendor and provider IT representatives. This helps
to ensure that time spent is optimized; not wasted.
Instances have occurred (especially in the IT realm)
where the incorrect individual is appointed or it
was never communicated to them that it was
assumed they would complete needed
deliverables.
When expectations are not clearly defined and
confirmed with each person on the team, the
project can become compromised. In some cases
the individual appointed as an IT does not
communicate or in some cases seems unaware
that they have been appointed as the key resource
to a project team, thus resulting in unplanned
delays of the overall implementation.
(Mindy Scher)
Tip: Set expectations of the staff that will be
utilizing the new tools.
Too many times a provider purchases a tool and
expects things to go seamless but fails to
appropriately set expectations of staff for their
involvement. A very unfortunate trend is to see that
IT resources have not been fully allocated or
included in the project plan so they can insure a
smooth implementation and transition (if changing
tools) from the previous vendor.
In addition, setting expectations of the staff that will
be utilizing the tools is critical; including the
overall selection process of the product so there is
full buy-in from everybody. Insuring that full focus
is dedicated to learning the new tool and not
trying to implement too many changes at one time
can be key to success. Changing the scope of the
project during implementation can also provide
devastating results and should only occur after a
thorough discussion and review of the
Page 21
ramifications of the changes mid implementation.
(Scott Owens)
Tip: Establish weekly or bi-weekly
implementation work out sessions.
Communication between departments is crucial
to a successful implementation. Weekly or biweekly implementation calls keep everyone on
track and critical items or delays are identified.
With so many different security requirements,
having a security questionnaire before contracting,
helps the vendor know what is required, and if
there are additional personnel medical screening
or background check requirements. PHI
compliance is key, so it is also important to take
note if your vendor partner, as well as their
software partners adhere to onshore/offshore
hospital requirements.
An implementation can be relatively smooth if
both parties enter with a firm understanding of
what is required upfront; appoint the correct
individuals to complete deliverables; and work to
establish a transparent partnership that allows
clear visibility into the implementation process thus
ensuring both parties the opportunity to aid each
other through future needs and changes.
(Mindy Scher)
Tips: Cautionary Tale: Train the Trainer
Blog Quote: Oregon vs. Oracle observations: So
this is a consulting services lawsuit, not a product
lawsuit. Interesting. When I graduated, some
people I knew went to work for a major vendor who
billed them out at $350/hour immediately. So
youd have a few dozen consultants with little to
no experience and one or two people who had
been on projects before. I assume all the big
consulting companies operate that way.
Im sure the state of Oregon screwed up, but I
have little doubt Oracle was bilking them for every
dollar they could get. Whether Oregon can prove
this in court will be interesting to see, I assume
Oracle will settle at some point, since they wouldnt
want everyone to wake up and smell the $$$.
Many vendors utilize the concept of train the
trainer. We all use this concept to maximize our
resources by selecting some super users from our
staff that the vendor will establish as the key
training resource to train the other provider staff. A
common scenario with conversion projects and
software installation is what could be called bait
and switch when the client is introduced to a
seasoned installation team, only later to be
handed over with a very green newly hired team
from the vendor for the actual install. Now the
concept of Train the Trainer takes on a new
meaning when you find yourself training the
vendor staff on the basics of healthcare
operations. My favorite story is when one hospital
director actually sent a bill to the vendor for the
training hours devoted to training their project
lead. But the costs of lost momentum and staff
confidence in the project are too harmful to fix with
compensation.
Tip: Make sure to establish the credentials/
biographies of the team you buy for your
install. Place more value on operations
experience and skills than the GPA and
pedigree of a recent graduate. And,
remember, generic project management and
audit experience cannot fix a critical gap in
an operations crisis.
Tip: Develop job assignments and support
roles of each project team member on both
the vendor and provider side.
Our companys successful implementations are the
result of a well-orchestrated combination of
internal and external team development. As early
as the initial proposal, we begin to determine the
internal cross-functional support that will be
necessary to meet the needs of the particular client
and project, said Chris Brazil, Chief Revenue
Officer for Cardon Outreach.
We suggest that hospital providers go through a
similar exercise once they have selected their
partner, so that the fundamental links of
communication are established and maintained
from the earliest possible point. This ensures a
strong foundation of stakeholders who can
effectively communicate with each other
Page 22
1st Quarter 2015
during each and every stage of the
implementation - not just in the first few weeks or
months after go-live. (Chris Brazil)
Contributors:
Chris Brazil
Chief Revenue Officer
CardonOutreach
206.880.6281
[email protected]
Lori Forbess
Chief Operating Officer
Prevision
503-313-5928
Jeff Johnson
Chief Sales & Marketing Officer
Hawes Financial Group
Toll Free: 888-422-6557
Direct: 541-335-2207
Mindy Scher
Director, Business Development SW Region
Xtend Healthcare
Advanced Revenue Solutions
Cell: 760-505-3535
[email protected]
Scott Owens
Director of Sales
Experian Health / DSG
Office: 800.568.7553
[email protected]
Excerpts from Modern Healthcare
New Wave of IT Spending Opportunity to Fail or Succeed.
Lessons to learn:
Rather than EHRs dominating health IT spending,
the next round of investment is likely to address
other IT needs. New payment models and pay-forperformance plans in the Patient Protection and
Affordable Care Act will require healthcare
organizations to revamp or replace a lot of aging
financial management systems. Demand for those
systems in recent years has been artificially
depressed by providers need to focus on adopting
clinical support systems that would qualify them for
federal EHR subsidies.
This years switch to the ICD-10 family of
diagnostic and procedural codes will also be
giving a major boost to IT firms that offer
computerized coding and documentation support
tools. ICD-10 should also generate lots of
consulting contracts for firms offering advice,
training and implementation support.
Ambulatory EMR/EHR software spending by all
types of providers was $633.5 million in 2009 and
is expected to grow to $1.4 billion in 2015. The
CAGR for ambulatory EMR spending between
2009 and 2015 is expected to be 14.2%.
Inpatient EMR/EHR software spending by all
types of providers was approximately $1.3 billion
in 2009 and is expected to grow to $2.4 billion in
2015. The CAGR for inpatient EMR/EHR spending
between 2009 and 2015 is expected to be 10%.
As the $22.5 billion federal EHR incentive
ebbs, some analysts are now predicting that
a new wave of health IT spending on other IT
systems will rush in to take its place.
1st Quarter 2015
Page 23
UPCOMING CHAPTER MEETINGS & EDUCATIONAL EVENTS
DATE
EVENT
LOCATION
Apr 26 - 28, 2015
HFMA LTC
San Antonio, TX
Apr 29, 2015
Certification Webinar
May 6 - 8, 2015
WA AK HFMA Spring Conference
TBA
Alaska May/June Meeting
June 22 - 25, 2015
HFMA’s 2015 National Institute
www.waakhfma.org
NW Outlook
1st Quarter 2015
Published Quarterly by the Washington/Alaska Chapter of HFMA
Editor: Judy Veazie
e-mail: [email protected]
Northern Quest Resort & Casino
Spokane, WA
Orange County Convention Center
Orlando, FL