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TRANSYLVANIA REGIONAL HOSPITAL

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									Transylvania Regional Hospital
TRH Overview
   Founded in 1933
   Not-for-profit, governed by a volunteer board
   Critical Access Hospital
   630 employees, 450 FTEs
   58 active medical staff members and 80+ courtesy/consulting
    physicians
   $65+ million in net revenue/year
   1,969 acute admissions/year
   14,799 emergency visits/year
   35,862 diagnostic & ancillary visits/year
   Surgeries per year: 1,768 outpatient, 422 inpatient
   18,094 home health visits/year
   23 employed providers covering primary care and 7 specialties
   Contracted physicians for ED, adult and pediatric hospitalist
    services
   Affiliate of Mission Health System, January 1, 2011
Medical Specialties
   Family Practice                  Urology
   Internal Medicine                Pediatrics
   General Surgery                  Radiology
   Orthopedic Surgery               Anesthesiology
   OB/GYN Services                  Sports Medicine
   Pulmonology                      Pathology
   Sleep Medicine                   Hospitalist Medicine
   Cardiology                       Emergency Medicine
   Gastroenterology                 Nephrology
   Hematology                       Ophthalmology
   Oncology                         Otolaryngology

Post-Acute Services
   Transitional Care Unit
   Home Health Services
   KOALA Adult Day Services
   AgeWell Fresh Start Behavioral Health
   Hospice
 Eric K. Shell, CPA, MBA
 Stroudwater Associates
50 Sewell Street, Suite 102
   Portland, ME 04102
 Phone: (207)221-8257 or
      (201)650-2702
Attributes of Success Critical Access Hospitals
   Presentation for New Hampshire Hospital
                   Association
                  June, 2010




   Operational Assessment with Education
             Specifically for TRH
   TRH provided the following in advance of the
    site visit:
     Most  recently filed cost report
     Interim cost report
     Internal cost report model with cost report dashboard
     Most recent financial statement
     Statistical report
     FY 2011 budget
     Days in AR & other key dashboard measurements
     Projection for Home Care joint venture
     Provider based clinic analysis for Cancer Center
Educational Session Agenda
   7:30 – 8:00 Tour of Hospital
   8:00 – 8:30 Set up for Meeting
   8:30 – 11:00 Overview of Presentation
   11:00 – 12:00 Cost Report Issues for TRH
   12:00 – 1:00 Lunch
   1:00 – 3:00 Continue Discussion of Cost Report Issues
   3:00 – 5:00 Development of Go-Forward Strategies
Presentation Overview
   Attributes of Successful Critical Access Hospitals
       Understand Rural Hospital Economics
       The “Right” Medical Staff
       Focus on Both Inpatient and Outpatient Volume
       Effective Organizational Design
       Strong Revenue Cycle Practices
       Understand Physician Practice Management
       Facility Design that Supports Patient Care Model
       Developing Information Technology Systems
       Current Third Party Contracts and Charge Master
       Accurate Medicare Cost Report
       Know their Market Service Area
   Summary/Discussion
Action Items/”Take-A-Ways”/Next Steps
   Reduce Expenses
        Goal: organizational accountability and ownership
             Develop required variance analysis reporting system on monthly “budget to actual”
              reports and system to correct variances
             Incentive program to be considered for management team
        Evaluate PT contract
        More active review of nurse staffing ratios
        Hard review of profitability of SNF
        Evaluate physician contracts for appropriate matching of RVUs to benchmarks
   Increase Volume (Medicare or non-Medicare)
        Grow outpatient lab volume by 20% by March 31, 2011
        Target inpatient census of 20 by December 31, 2010
             Increased census management techniques
                   ERA admission rates per physician
                   More capacity/throughput systems
        Clinical integration model to be developed in partnership with physicians
        Customer service plan “might could” be developed and rolled out to physician
         practices
Action Items/”Take-A-Ways”/Next Steps

   Increase “Slope” of Revenue Line
       Cost Report Opportunities
            ROIs on all non-reimbursable cost centers taking into effect Foundation
                  SNF
                  Hospice/Home Health
                  CAP
                  Lifeline
                  Koala Care
            Evaluate use of hospice patient days
            Time study for Labor and Delivery
            Time studies for ER standby – target 15 minutes/visit
            Subscripting A&G
            Consolidating Radiology and CT
            Time studies for Medical Records
            Square footage for sleep lab
            TRH Home office allocation review and better understanding
            Home health square footage
            Review housekeeping allocation
            Review interest offset calculation with DH
Action Items/”Take-A-Ways”/Next Steps

   Increase “Slope” of Revenue Line (continued)
       Tie into Mission Health third party contracts ASAP after affiliation
       Analyze charge structure and third party payment amounts for
        physician practices and make recommendations for
        improvement
       Mission and TRH to develop home office cost report strategy
       Review Cancer Center Billing – call John Behn to discuss
       Revenue cycle team to meet more frequently and move to
        operations from reporting
       Share bell curve of individual physician practices with practice
        managers
       Prioritize insurance verification prior to patient visit in physician
        offices
       Point of service collection incentive for physician practices
Accountability Tool – Where Are We



            Handout
  Contact Information:
     Bob Bednarek
bbednarek@trhospital.org
    (828)883-5302

								
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