Mountain Views is the official newsletter of the
New Hampshire/Vermont Chapter of the
Healthcare Financial Management Association.
It’s Like Marriage Counseling
Winthrop Resources Corporation
How would mitigating these risks? Enter technology leasing.
you rate your
Most CIO's would agree that it is their One of the best financial tools that
primary responsibility to ensure the has gained broad acceptance within
in terms of its
organization's technology strategies stay healthcare organizations is technology
ability to adapt quickly to the fast paced
aligned with the business strategies. leasing. Leasing technology, as
changes and uncertainty in healthcare?
However, business strategies are changing opposed to using capital, affords today's
How are these changes impacting your
so quickly (for reasons beyond their healthcare organizations many benefits:
business strategies? How do these same
changes impact your technology strategies? control), that the underlying technology
that supports those business strategies are * Re-deploy capital for strategic and
What is your organization's strategy for
impacted. How does he or she keep up, growth oriented initiatives.
plan for the inevitable - obsolescence - and * Lower the financial and operational
risks of technology obsolescence.
Inside account for this risk?
* Improve ROI of technology projects
by matching the costs with the
Most CFO's would agree that it is their
Newsletter Committee & Policy 2 benefits.
primary responsibility to ensure the fiscal
Words From Your President 2 * Maintain alignment between the
resources of the organization are used
Financing Technology…Cont. 3 business strategies of the organization
Accounting Corner 4
wisely and in such a way to support the
business needs and future growth of the and the underlying technology
Hospitals Fight to Prevent More
organization. In today's world, that means needed to support it.
Medicare Cuts 4
(among other things) planning for the * Maximize the value of every dollar
Test Your Knowledge 5
ever-increasing line item(s) in their capital spent on technology.
NH-VT Chapter Sponsors 7
budget called technology. As technology * Address the strategic needs of the
Addressing Nurse Burnout 8
FREE Certification Webinars 9 spending goes up, so does the financial organization that often give way to
CFO Survey 10 risk of technology obsolescence to the the urgent: do more with less.
HFMA’s Virtual Conference 11 organization. When asked, almost every As many healthcare organizations move
HFMA Map Awards 12 CFO will tell you their organization has to the "cloud", leasing provides a similar
From Zero to 60, HFMA’s Career Center "an insatiable appetite for capital". Every benefit by allowing organizations to
Helps Drive Your Career 14 dollar spent on technology is a dollar not treat their technology as a utility. How
New Member Listing 14 available for other capital needs. many CFOs do you know that pay their
New CHFP Certification 15 phone bills or electric bills three years
How Mercy Health System Is Sizing This is the perfect storm to create a classic in advance?
Up Economies of Scale 16 marriage counseling session: the CIO
Saving Money by Reducing Blood needs to spend and the CFO needs to There are many other reasons healthcare
Product Use 17,19 conserve. Who is right? And how do we organizations elect to lease technology,
Chapter Officers 20 maintain strong alignment amidst these
competing interests? (Cont’d on page 3)
Words From Your President Jan/Feb 2013
& Policy Get Involved - 2013
Eric Walker, CPA The vast majority ter by volunteering. Whether you’re
The Jackson Laboratory of us are members interested in serving on a commit-
207-288-6756 of HFMA because tee, mentoring other HFMA mem-
Email: Eric.Walker@jax.org someone we work bers, participating on a task force, or
with asked or serving as an officer, you’ll find that
maybe even told the time and expertise you offer are
Diane Blaha - D Blaha Consultants LLC
us to join. They rewarded many times over through
Becky Bowen - Vermont Info. recognized the your:
value of HFMA to
Diane Church - Dartmouth Hitchcock o Personal and professional
their own careers and actively promoted
Judi Deavers - Dartmouth Hitchcock it. Do you remember who that person was growth
Robert Gilbert - Wentworth-Douglass o Influence on your chapter’s fu-
With the new year underway, we all have
Kristina Griffin - Well Sense Health Plan our own goals for 2013 and hopefully
Cory Gustafson - VAHHS yours are off to a solid start. As you tackle o Broadening of your professional
Jane Kapoian - Catholic Medical Center your professional goals, remember the network
Marie McGee, FHFMA value of HFMA that person shared with
Talk to any of your current chapter
Leslie Melby - NHHA you and get involved. There are many
leaders about your interest in volun-
Amy Beth Main - Alice Peck Day opportunities to get involved as an HFMA
Health Systems member and make the most of your
Connie Ouellette - BerryDunn membership: • Get certified – invest in your fu-
Sandra Pinette - Financial Health ture by becoming a Certified Health-
Strategies • Help the Association grow –
care Financial Professional (CHFP)
Gerri Provost - Baker Newman Noyes
share the same benefits with your
colleagues and peers by encouraging • Check out our website (www.
Amy Vaughan - Fletcher Allen Health Care
their membership nhvthfma.org) and National’s web-
Lisa Willis - Tyler, Simms & St. Sauveur
site (www.hfma.org) for the latest
• Write an article – consider au-
MOUNTAIN VIEWS is published five newsletters, publications and knowl-
thoring an article for the Chapter’s
times a year. Our objective is to provide edge center to further keep abreast of
newsletter, maybe something you
members with information regarding healthcare financial developments.
chapter activities as well as ideas to help have knowledge or passion for or
the individual in the performance of his/ something you’ve done for work or • Reach out to other members of
her duties. school. HFMA for their experience and ex-
EDITORIAL POLICY-The editor strongly pertise, whether by phone or at a net-
• Attend an education program or
encourages the submission of material working event.
for publication. Articles should be webinar. There are a large number
typewritten and doubled spaced. of programs available locally and HFMA can be a pretty powerful part
Letters should be neat and legible and nationally to help you keep up with
must be signed. The editor reserves the of your toolkit in the new year. Put it
the latest information and at afford- to work for you by getting involved.
right to edit material and accept or reject
contributions whether solicited or not. able prices. Take someone along with I am happy to help with any of the
Send all correspondence, or materials for you! above opportunities or questions
you may have and to hear the value
• Speak at an educational program
Eric Walker, CPA HFMA has for you.
– whether locally or nationally, this is
Controller - The Jackson Laboratory
610 Main Street a great way to share your expertise. Best wishes,
Bar Harbor, ME 04609
Phone: 207-288-6756 • Volunteer for the Chapter - Be- Connie
come a leader in your HFMA chap-
Opinions expressed in articles or features are those
of the author and do not necessarily reflect the views
of the Healthcare Financial Management Association,
New Hampshire/Vermont Chapter or the editor.
Mountain Views 2 www.nhvthfma.org
Financing Technology: It’s Like Marriage Counseling
(Continued from Cover) Cloud” allows end-users to pay for the
use of technology without giving up con-
trol or flexibility in customizing how and Visit Your
where technology and services are deliv-
* Strategic compliment to banking rela-
tionship. Growing healthcare organiza-
tions need multiple sources of capital to Former General Electric CEO Jack
meet increasing capital demands. Welch said, “Smart companies will use
any opportunity to take change and
* Reduce costs. Utilizing technology make it into a competitive advantage. A
beyond its useful life can lead to ineffi- company’s fundamental strength is its • Education Calendar
ciencies as well as increased support and ability to adapt to change, rather than
maintenance costs. predict it. Don’t hide from it, grab it and • Chapter Activities
do something with it!”
* Financial Diversification. Many organi- • Sponsorship
zations prefer to have technology assets As most would agree, change and Opportunities
off their balance sheets as that may help uncertainty is the "new normal" in today’s
with debt covenants, reimbursements or • Career Develop-
healthcare marketplace. To the extent
bond ratings and is more consistent with that you believe this will impact your ment
how the equipment behaves. organization's business strategies, and
thus your technology strategies, it might • Member Benefits
* Liquidity. Unlike bond deals or other be time to seek some marriage counseling.
cumbersome long-term debt instruments, • and more!!!
Leasing is a great option to consider.
leases can often be changed in a day and
without the additional time and cost of at- Contact Jake Schwamb, Winthrop
torneys and oversight committees. This Resources today at 617-999-4958 or
offers CFO's more liquidity in their over- email@example.com
all capital structure as well as more con- to learn more about how financing www.nhvthfma.org
trol over cash flows. technology can boost the bottom line of
* The “Financial Cloud.” The “Financial
Over 44 years of excellence in Healthcare
Bad Debt Collections
Best in Class Technology
Integrated Predictive Dialer
Budget Payment Plan Administration
Collections throughout US & Foreign Countries
Self-Pay Outsourcing Programs
Customized Receivable Management Programs
29 Winter Street Barbara Lynch
Pembroke, MA 02359 firstname.lastname@example.org
Mountain Views 3 www.nhvthfma.org
ASU 2012-05 - Not-for-Profit Entities:
Classification of the Sale Proceeds of Donated
Financial Assets in the Statement of Cash Flows
Eric Walker, CPA
Not-for-profit organizations that receive be used for long-term purposes, the sales if material, rather than netting them. This
donations of investment securities often proceeds would be classified as financing Technical Practice Aid contains various
immediately sell the securities, and then activities; otherwise, they would be Q&As related to this new requirement.
either use the cash proceeds for certain classified as operating activities.
purposes or reinvest them. ASU 2012-05 Eric is the Controller of the Jackson
provides that, if a not-for-profit receives Technical Practice Aid Laboratory in Bar Harbor, ME. Any
donated securities and immediately sells TIS 6400.49-.52 - Health Care Entities questions or comments regarding this or
them, the classification of the proceeds ASU 2010-24 requires health care entities other topics can be emailed to Eric at eric.
on sale in the statement of cash flows to present malpractice claim liabilities email@example.com.
should be the same as if the not-for-profit and any related insurance recoveries to
received the donation in cash. In other be presented on a gross basis (i.e., as a
words, if the donation was restricted to liability and an asset) in the balance sheet
Call EM 9
Pati ent Billing S s
Hospitals Fight to Prevent More Medicare Cuts
e MAN GEMENT A SSOCIATES, LLC
Revenue Cycle Strategies for a Healthy Bottom Line
Barry Lampke, VAHHS
In an effort to convince the U.S. Congress to physicians will drop by 26% and the our efforts to more efficiently deliver
not to target the Medicare and Medicaid across-the-board sequester will kick in high quality health care. This December
programs to avoid the “fiscal cliff” at the which includes a 2% cut to Medicare showdown will be just the first phase in
end of this year, the American Hospital payments. The potential negative impact a longer process to balance the federal
Association (AHA) has organized a series to Vermont hospitals would be significant. budget. Both Republicans and Democrats
of advocacy days during this “lame-duck” Even if some of the proposed deficit- recently agreed to a two-step process
session. Vermont Association of Hospitals driven Medicare cuts are enacted, any where a “down payment” would be made
and Health Systems (VAHHS) President additional Medicare and/or Medicaid cuts in December followed by a “bigger deal”
and CEO Bea Grause participated in this could easily exceed the $500 billion in next year. Hospitals nationwide will need
event to help send this message to our payment cuts already slated to take place to stay engaged throughout this process
delegation and Congress. Grause pointed as part of the Affordable Care Act. AHA to continue the fight against budget-
out that more Medicare and Medicaid and VAHHS are asking Congress to work driven Medicare and Medicaid cuts. Our
cuts will impede our reform progress with hospitals on ideas to constructively job is to stay focused on payment and
back home in Vermont. These high- reduce Medicare and Medicaid spending. delivery system reforms that will reduce
stakes negotiations will continue until Toward this end, AHA has advanced Medicare and Medicaid spending by
the end of this calendar year. If federal deficit reduction alternatives in health better coordinating and delivering patient
lawmakers don’t reach a deal, payroll care, such as modernizing the Medicaid care. For more information contact Bea@
taxes will increase, Medicare payments long-term care benefit that will enhance vahhs.org
Mountain Views 4 www.nhvthfma.org
Mountain Views 5 www.nhvthfma.org
HFMA is where healthcare finance be informed.
professionals need to be...
Pass it on.
Reform. Margin pressure. Revenue cycle. Value.
HFMA members are reshaping healthcare
finance at a critical time. Help build the
momentum. Invite your peers, your staff,
and others in your organization to join the
nation’s leading membership organization
for healthcare financial management
executives and leaders – HFMA.
Visit hfma.org/mgam for details on the program, and a listing of prizes. Earn valuable rewards when you
share your commitment to HFMA.
Recruit 1-2 members and choose between:
• HFMA apparel item (approximate retail value $25).
• $25 Visa debit card accepted worldwide.
Recruit 3-4 members and receive:
• $100 Visa debit card accepted worldwide.
• Entry into a drawing (of those recruiting 3-4 members)
“I turn to HFMA to keep up with the rapid change in the Recruit 5 or more members and receive:
profession, enhance my career and strengthen our chapter. • $150 Visa debit card accepted worldwide.
HFMA delivers the essential information that healthcare financial • Entry into a drawing (of those recruiting 5 or
more members) for $2,500.
management professionals require to stay on top of their game
and ahead of the curve.” For every member you recruit,
your name is entered in:
Mark A. Hartman, FHFMA, CPA, SVP Finance & Treasurer, Arkansas Heart Hospital
• Drawing for a brand new iPad (three drawings in all)
• Drawing for the Grand Prize worth $5,000 — $3,000
for you and a $2,000 donation in your name to the
charity of your choice.
The more members
you sponsor, the greater
your chances to win!
Mountain Views 6 www.nhvthfma.org
Because of the generosity of the
organizations listed below, we
are able to offer quality ser-
vices, such as this education-
al program, to our members.
To these organizations, we say
Baker Newman Noyes
Credit Bureau Collection Service
E-Management Associates, LLC
Gragil Associates, Inc./
Audit Billing Center, Inc.
Tyler, Simms & St. Sauveur, CPAs,
Bittel Financial Advisors, LLC
Hackett Valine & MacDonald
The Richards Group
The SSI Group, Inc.
healthcare Vecna Medical
throughout New England
Audit, Tax and Healthcare Consulting Services
with offices in Portland, Manchester, Portsmouth and Boston
Mountain Views 7 www.nhvthfma.org
Looking to network with someone?
Have you visited HFMA’s Online Membership Directory lately? Log in at http://www.hfma.org. When you
select “HFMA Directory,” not only can you search for members of your chapter, you can also search for all
your HFMA colleagues by name, company, and location—regardless of chapter! Using an online directory
instead of a printed directory ensures that you always have the most up-to-date contact information.
While accessing HFMA’s Online Membership Directory, you can view your current contact information and
make edits to your profile. You can also see products you have ordered, events you have registered for, your
CPE credits, your Founders points, and more!
It’s vital that HFMA has your correct information, so please take a moment to review your record now. By
doing so, you’ll ensure that HFMA continues to provide you with valuable information and insights that
further your success.
Addressing Nurse Burnout
Can Decrease Cost Related to Infections
Reducing burnout in registered The higher rate of infections in Researchers found that increasing a
nurses may lead to lower rates of hospitals in which nurses care for nurse’s workload by even one patient
healthcare-associated urinary tract and more patients seems to be related at resulted in increases in both types of
surgical site infections, according to least in part to the high levels of nurse infections. The average rate of urinary
a study published in the August issue burnout associated with heavier patient tract infection across hospitals was
of American Journal of Infection caseloads. seveninfections per 1,000 patients,
Control. and the average rate of surgical site
Hospitals in which burnout was infection was slightly less than five
Researchers studied urinary tract and reduced by 30 percent had a total of infections per 1,000 patients.
surgical site infection data at 161 6,239 fewer infections, for an annual
acute care Pennsylvania hospitals, cost savings of up to $68 million, Researchers hypothesize that the
along with survey data from 7,076 according to the study. The cost cognitive detachment associated with
registered nurses employed at these savings estimates are based on data high levels of burnout may result in
hospitals. They found a significant from a Centers for Disease Control inadequate hand hygiene practices
association between patient-to-nurse and Prevention report on the direct and lapses in other infection control
ratios and both types of infections medical costs of healthcare-associated procedures.
among patients. infections.
Mountain Views 8 www.nhvthfma.org
Free Certification webinars
Pre-Recorded for your convenience!
If you have missed the past two On-Line Certification Study Groups, here is your opportunity to participate!
Four chapters, WI, McMahon Illinois, NH/VT, and VA/DC have collaborated to find knowledgeable speakers
to present the certification material. A number of our On-line Certification Study Group members told us
that they would appreciate a high level review of the six certification modules. A one hour session has been
recorded for each module:
1. Revenue Cycle - presented by Randy Bledsoe (VA/DC)
2. Disbursements - presented by Kathleen Beriau (NH/VT)
3. Budgeting/Forecasting - presented by Jane Kapoian (NH/VT)
4. Internal Controls - presented by Connie Ouellette (NH/VT)
5. Financial Reporting - presented by Christina Bradbury (NH/VT)
6. Contract Management - presented by Mike Newby (VA/DC)
The sessions are available on our website. You’ll be asked to register, and when you submit the registration,
you’ll be directed into the recorded presentation. This educational time counts towards your CEUs and your
registration adds to our education hours for the NH/VT Chapter balanced scorecard.
To Access the Pre-Recorded Webinars (follow these steps):
2. Certification (on left hand side of page)
3. Certification Coaching Sessions (4th option listed under Certification)
The NH/VT Chapter maintains a high percentage of certified members (14% of our members), and
we would like to add your name to our list. Validate your skills and knowledge and support your
professional development….becoming certified distinguishes you as a leader and role model in the
healthcare finance field.
For more information about the certification material and information about the different exams,
contact Diane Blaha or Peter Smith our Co-Certification Chairs, at firstname.lastname@example.org
Mountain Views 9 www.nhvthfma.org
CFO at Cottage Hospital
1. Multiple forces are driving HFMA FHFMA – I have not reviewed 7. Do you currently support or would
members to become certified. How this certification in as much detail your organization consider financial
does your organization benefit from as others, but I feel this would support for these certification
an employee seeking certification ? only enhance the experience of programs subject to ability to fund
achieving CHFP certification such programs?
I see our organization benefitting
from HFMA members becoming d. Advanced Technical Study Our organization currently supports
certified because of the exposure to Certificate Programs members financially to take HFMA
a broader knowledge set. In a small certification programs as part of their
facility employees do not always From my perspective these professional development.
have the opportunity to explore programs allow individual
issues that are not directly related to members to concentrate on a
their work. Certification gives them specific area of interest. It would
the opportunity to discuss topics that also lead the member to think
they may not otherwise encounter. about additional certification
2. Did passing the exams increase
the confidence that the CFO had
in the employee(s) and whether 4. What impact would HFMA
the employees exhibited more certification have in a job hiring
confidence in their performance situation ?
overall ? Now that I have been through one of
Passing the exam increased my own the certification programs I would
confidence in my knowledge base. I have a higher regard for an applicant
believe that will translate to becoming that listed the HFMA certification on
a better leader in my organization. their resume because I understand the
depth and scope of the certification.
3. What is your professional
perspective of the value of HFMA’s
Certification Programs: 5. Do HFMAprofessional designations
a. CRCR - Certified Revenue such as CRCR, CHFP, and
Cycle Representative Program FHFMA, carry significant value in
I think this certification is valuable the healthcare profession ?
because there is not a true course I believe HFMA professional
of study available for Revenue designations do carry significant
Cycle Representatives that I feel value in the healthcare profession
as confident in as the HFMA because HFMA is a nationally
course. recognized organization with a direct
focus on healthcare.
b. CHFP – Certified Healthcare
As a recent recipient of this 6. How does the quality/perception
Whether we’re helping your
certification, I see where I of HFMA certification differ business do business or advising
would want to have Accounting from the quality of other you as an individual or family, our
Department members to work healthcare educational programs/ first priority at TSS is to develop
on achieving this certification certifications? solutions that work for you.
because it does help to round-out
healthcare experience. To build on my previous response I
believe HFMA is a well-respected
c. FHFMA – Fellow of the organization in the industry and is 19 Morgan Drive
recognized for high standards and Lebanon, NH 03766
Healthcare Financial 603-653-0044 (p)
Management is dedicated to providing quality
Mountain Views 10 www.nhvthfma.org
I T ’ S J U S T L I K E B E I N G T H E R E .
Mark your calendar for this live event – free to HFMA members. HFMA’s Virtual
Conference provides you with unique and cutting edge programming – all from
the convenience of your home or office! Each date offers new education content
including a keynote presentation, a session that presents the latest findings from
FOUR HFMA’s Value Project and a real-world case study that provides solutions to improve
L I V E D AT E S the quality of care and reduce costs.
AT T EN D A L L 4 LIVE EV ENTS TO RECEIVE 12 CPE CRED ITS
(1 C PE C RE DI T AWA RD ED FO R EACH LI VE PRESENTATI O N ATTENDED)
October 16 Non-member registration is only $155, which also includes membership
for those new to HFMA.
To learn more or register now, visit hfma.org/virtualconference
or call (800) 252-4362, extension 2.
F E BRUA RY LI VE ED UCATI ON SCHEDULE
5 top benefits K EYN OT E S ESS ION OT HER ED UCAT ION S ESS IONS
• Access 3 live education programs What’s Ahead for Healthcare HFMA Value Project: Managing Risk
plus on-demand educational content Delivery and Payment in 2013 Exposure in the Transition to Value
• Earn 12 CPE credits Joseph J. Fifer, Jim Landman,
for attending all 4 live dates FHFMA, CPA, HFMA President & CEO HFMA Director of Thought
• Learn new content on reform, Richard L. Gundling, Leadership Initiatives
quality, revenue cycle and value FHFMA, CMA, HFMA Vice President ICD-10 Lessons Learned:
of Healthcare Financial Practices What to Expect from Computer
• Gain insights from speakers
during Q & A sessions Assisted Coding Applications
• Download presentations, white Rose Dunn,
papers, tools, and other resources FHFMA, CPA, FACHE, RHIA, Chief Operating
Officer of First Class Solutions
11/7/2012 4:16:25 PM
HFMA’s MAP Award for High Performance in Revenue Cycle
recognizes healthcare organizations that achieve excellence in
revenue cycle performance. MAP Award for High Performance
winners excel in meeting the benchmarks and implementing patient-
friendly billing practices to achieve excellence in patient satisfaction.
As recognized industry leaders, winners share proven strategies for
extending revenue cycle excellence throughout the industry.
2013 MAP Award for High Performance deadline 02.28.13
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/m r fo
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a.o Pe ap
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MAP Award High
Mountain Performance 2013 hfm Ad.indd
11/8/2012 9:30:35 AM
Reform. Margin pressure. Revenue cycle. Value.
Reshaping healthcare finance together.
Online resources, educational programming,
and hfm — the number one publication
for hospital CFOs — keep you on top of
is where be engaged.
Network with colleagues, advance your career,
and join the conversation on issues like
reform, revenue cycle, and the drive for value.
With over 39,000 members, HFMA is
the leading organization for healthcare financial
management executives and leaders. At the
chapter, regional, and national level, HFMA
helps you meet the challenges of today’s
Join us. Member benefits include:
• hfm subscription plus e-newsletter
HFMA Weekly News
hfma.org/join or call (800) 252-4362, extension 2 • Members-only access to hfma.org
• Chapter membership
• Eligibility for CHFP and FHFMA
• Virtual Healthcare Finance Conference
• Member discounts for ANI: The HFMA
National Institute, MAP Event, seminars,
conferences, online courses and forums,
and many products and services
• Free CPE’s available
• And much more
Mountain Views 13 www.nhvthfma.org
From Zero to 60, HFMA’s Career Center
Helps Drive Your Career
Develop your business and personal skills drive to seek opportunity and take • Educational and career resources to
with tools created specifically for the control of your career by acquiring help you hone your core competency
healthcare finance professional. HFMA’s and maintaining skill sets, networking, skills.
new Career Center is organized into distinct and self-branding.
career levels to help you as you enhance • Advancing My Career teaches At some point in your career, it’s inevitable
and further your career path into healthcare how to accelerate your career by that you will also manazvelop their most
finance. improving your ability to anticipate valuable asset—their employees.
future opportunities and by actively
The Career Center is divided by levels, structuring and sequencing your work While you are on the page, check out
so whether you’re ready to begin your life. the Job Search Tools: Job Bank listings,
healthcare finance career or are actively resumes, and a job-posting site.
searching to identify the skill sets required Included in each career level are:
to advance and manage your career, HFMA • Assessments that provide a plan Learn more and further your career at hfma.
has the tools you need: to further develop your skills by org/careercenter.
• Starting My Career is for people who determining your level of knowledge,
are seeking their professional path into skills, and behavioral competencies
healthcare financial management. that are critical to current and future
• Managing My Career focuses the leadership needs in the industry.
Welcome Winter 2013 New Chapter Members
Name Title Organization
Christopher Gautreau Vice President Hackett Valine & MacDonald
Lisa J. Bachand Accountant
Michael Mast Senior Product Marketing Manager GE Healthcare
Kelly Foy MGP Finance Manager Central Vermont Medical Center
Jennifer White Director Patient Access Cottage Hospital
Steven W. Powell Chief Medical Officer - Physician New London Hospital
Andrew Guernsey Marketing Manager GE Healthcare
Tamara Klink Accountant Providence Strategic Management Svcs.
Ethan Abar Audit Manager Saslow Lufkin & Buggy, LLP
Iva Smejkal Vice President TD Bank
Is it still Winter?!
Mountain Views 14 www.nhvthfma.org
N e w C e rt i f i C at i o N
CHFP is designed for healthcare finance professionals who aspire to the executive
level or desire confirmation of financial management expertise. This certification
demonstrates qualifications to senior management, co-workers, and the industry
highlighting a person’s commitment to the profession and to maintain up-to-date skills
and knowledge. Congratulations to our newly certified member…
Peter LaNg, CHfP
Senior Manager, revenue ManageMent
DartMouth-hitchcock MeDical center
Please be sure to congratulate Peter when you see him!
What do YOU think?
Have you ever read an article in
Mountain Views and had a thought
you just HAD to share?
Join the NH-VT HFMA Linked In
Group and post your thoughts!
Go to http://www.linkedin.com/
groups?gid=2362148&goback=. BerryDunn’s team of seasoned professionals puts its audit,
gna_2362148 to join now! tax, and consulting know-how to work for you in a way that ﬁts
your operational style. Our hospital and health care system
professionals stay on the leading edge of health care ﬁnancial
issues and strategies, combining our industry knowledge with
an understanding of your organization’s strategic goals to
help you make better-informed decisions. We help you capitalize
on opportunities that drive value—all with more control!
Billing & Accounts Receivable
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396 High Street • Somersworth, NH 03878 Learn more. Visit us at berrydunn.com or call 800.432.7202.
Mountain Views 15 www.nhvthfma.org
How Mercy Health System Is Sizing Up Economies of Scale
One fast-growing health system is success,” says Michael McCurry, Mercy’s fosters system change and leads to business
using economies of scale to standardize executive vice president and COO. “When success.
operations across dozens of hospitals while you have a concentration of facilities in a
introducing an innovative model of care, given geographic area, it’s much easier to More Strategies for Achieving Economies
according to a recent article from HFMA’s leverage your administrative and back-office of Scale
Leadership magazine, excerpted below. functions, such as billing and purchasing, Reassessing ways to achieve economies of
for scale to serve those facilities.” scale is one of the most common strategies
This past June, Mercy Hospital El Reno, a that hospitals interviewed by HFMA’s
48-bed hospital in central Oklahoma, went Examples of ways in which Mercy Hospital Value Project are considering as they focus
live with an electronic health record (EHR) El Reno is benefitting from the economies on ways to reduce costs while providing
system, an achievement that at one time of scale that come with being part of a large quality care. “For many, the question of
seemed impossible.Until three years ago, system include the following: possible mergers, alliances, and other
the facility was called Parkview Hospital forms of linkages between systems is a
and it was staring at a $1.4 million estimated • El Reno’s business office, formerly
staffed with about 20 FTEs, now has central determinant of future strategy and
bill to meet the federal government’s EHR/ structure,” the Value Project states in its
meaningful use mandate. “We had no idea one staff member on campus because
most back-office functions are handled most recent report, The Value Journey:
where we were going to get that money,” Organizational Road Maps for Value-
says Doug Danker, RN, the hospital’s at a central business office in Missouri.
Driven Health Care. Read the report: http://
• El Reno has no local CFO; one Mercy
In fact, the hospital was struggling on finance leader is responsible for the
system’s rural facilities in Oklahoma. One method by which organizations
many fronts. Sometimes the nursing staff achieve scale is consolidation. Learn about
worked short-handed because it could the new wave of hospital consolidation
• Transcription is outsourced, eliminating
not fill positions. It was hard to succeed from an article by Moody’s Lisa Goldstein
two FTEs, and El Reno shares medical
financially, in part because supplies were in hfm magazine. Read the article: http://
coding services with other Mercy
so expensive. Staff morale was low. www.hfma.org/templates/interiormaster.
In 2010, the public hospital, owned by aspx?id=31501
Because of economies of scale, the benefits
the city of El Reno, entered into a lease Get more information from two archived
that Mercy El Reno Hospital gets from
agreement with Mercy Health System, the HFMA webinars:
being part of a large organization do not
sixth-largest Catholic health system in the
translate into commensurately big costs for
country. That makes Mercy Hospital El • Current Trends in Healthcare Mergers,
Mercy. According to an economic impact
Reno one of 31 hospitals and more than Acquisitions, Consolidations, and
study that Mercy commissioned, the
200 clinics in Mercy’s four-state service Affiliations
system invested $252,000 in direct capital
expenditures in El Reno in FY11 and • Creating Sustainability Through New
Danker now has 38,000 Mercy coworkers, projected capital spending of $300,000 for Business Models for Mergers and
90 of whom came to help when Mercy FY12 and FY13, which includes the EHR Acquisitions
extended its EHR system to El Reno. “I had implementation.
no idea resources existed like this until we Not an HFMA member? Get exclusive
Read the complete article in the Fall/ access to practical strategies and thought
became part of a large system,” he says. “I
Winter issue of HFMA’s Leadership leadership from HFMA and other industry
truly believe that had we not been leased by
magazine, which features case examples
Mercy that El Reno would no longer have experts. Join today.
of cross-disciplinary collaboration that
Mercy’s View of the Future
Since June 2011, Mercy has acquired Visit Your
three hospitals, added more than 70
clinic locations, and grown by nearly 300 Chapter Website
integrated physicians. Last year, the St. • Education Calendar
Louis-based system announced a plan for
expansion over the next eight years that • Chapter Activities
could amount to more than $4 billion. The • Sponsorship Opportunities
money will be spent to advance Mercy’s
central strategy: success via economies of • Career Development
scale. • Member Benefits and more!!!
“Managing the cost of care is vital to future
Mountain Views 16 www.nhvthfma.org
Saving Money by Reducing Blood Product Use—Without
Adversely Affecting Outcomes
Blood transfusions represent the most In the analysis, blood use was examined quartile of the top performing hospitals,
commonly coded patient procedure, with across 7.4 million deidentified patient or those with lowest blood product usage
15 million performed each year inU.S. discharges from 464 hospitals to determine and better-than-expected patient outcomes.
hospitals at an annual cost of up to $15 potential opportunities for improvement The top-performing hospitals used fewer
billion (Saving Blood, Saving Money, and cost savings. Results demonstrated units of all blood products, with the
Saving Lives, University of Florida significant variation. If all hospitals largest difference in the use of red blood
Health Science Center, October 2010). analyzed used blood at the level of the cells—358,617 fewer units, at a total
Although many clinical practice guidelines top performing quartile of hospitals, savings of $75.7 million.
for blood product usage exist, scientific $165 million could be saved per year on
evidence supporting specific practice purchasing costs alone by reducing use by The analysis also found usage variations
recommendations is not robust. 802,000 units, while maintaining positive across inpatient service areas. The largest
patient outcomes. The opportunity does not volume of potential opportunity identified
According to an October 2012 analysis include costs associated with blood testing, was in internal medicine (196,600 units),
of blood utilization by Premier, lack of storage, transportation or administration, or followed by cardiac surgery (167,490 units)
standards related to blood utilization, harm to patients due to the administration and general surgery (156,326 units).
practice variation, and inability to easily of unnecessary blood products. These
compare the effectiveness of one practice Findings also indicate that the treatment
expenses can add hundreds of dollars to
with another has led to overuse of of sepsis presents the highest individual
blood products (Best Practices in Blood opportunity (35,650 units) for reducing
Utilization: A Premier Healthcare Alliance Taking a Closer Look variation for the top 10 inpatient diagnoses
Analysis, Premier, October 2012). As a (by Medicare Severity DRGs). Five of the
Taking into account patient diagnosis and remaining diagnoses involve major cardiac
result, care providers demonstrate sizable severity, the analysts benchmarked blood
variations in their use of blood products. surgeries.
usage at individual hospitals against a
(Cont’d on page 19)
Mountain Views 17 www.nhvthfma.org
ANI 2013 ORLANDO JUNE 16-19
Pick up sound business intelligence. Learn about strategies for
managing risk, aligning leadership, improving care delivery. Talk to
colleagues. Get the best ideas out there. hfma.org/ani
Register by May 16 and take $100 off the full conference rate.
Mountain Views 18 www.nhvthfma.org
Saving Money … (Cont.)
(Continued from page 17)
Negative Outcomes of Overuse Hospitals of Acquiring and Processing wants to be at the bottom of performance
Blood in the US: A Survey of Hospital- levels quarter after quarter. Reporting
Drug transfusions are risky. Recent Based Blood Banks and Transfusion also identifies the biggest potential areas
research indicates that overuse of blood Services,” Applied Health Economics and of improvement so that clinicians can
and transfusions can lead to a number of Health Policy Journal, January 2011). understand where they most need to
complications requiring therapeutic or improve.
diagnostic intervention.The estimated Critical Factors for Successful Blood
annual number of these adverse reactions Management The Need to Benchmark
from blood transfusions is 1 in 394
transfusions, a number believed to be Based on experiences in working with Blood utilization is a very complex issue.
even higher because of underreporting, member hospitals and national experts, Some variation in blood usage among
according to the most recent data from the the Premier health alliance analysis providers is both expected and appropriate
National Blood Collection and Utilization recommends the following critical factors and can be attributed to factors such as
Survey (Marik, P.E., “The Hazards of for successful blood management. differences in patient diagnosis and severity
Blood Transfusion,” British Journal of of illness. Variation also can be attributed
Create a blood stewardship team to the lack of strong scientific evidence
Hospital Medicine, January 2009). These with representatives from across their
reported complications include circulatory supporting specific recommendations on
organizations who are willing to work the utilization of blood products (Carson,
overload, acute lung injury and respiratory collaboratively. A good example is
failure, severe allergic reactions, sepsis, and J.L., et al.,“Red Blood Cell Transfusion:
clinicians collaborating with supply chain A Clinical Practice Guideline from the
hemolytic transfusion reactions (The 2009 executives to explore alternative products
National Blood Collection and Utilization AABB,” Annals of Internal Medicine, July
and procedures to reduce costs while 2012).
Survey Report, U.S. Department of Health maintaining care quality.
and Human Services, August 2011). The opportunity to achieve significant
Implement evidence-based transfusion savings in healthcare is well recognized,
Multiple observational studies also have guidelines. Clearly, this is an area that
demonstrated that blood transfusions are but benchmarks and metrics are needed to
requires increased focus. Once guidelines identify specific actionable opportunities.
associated with increased postoperative are implemented, providing education
infections, multisystem organ failure, and Without the ability to benchmark usage
and clinical decision support tools to rates and outcomes, providers cannot define
increased length ofstay, and multivariate inform clinicians of guidelines is critical.
analysis consistently demonstrates that and apply practice, including optimal blood
This information should be presented in product utilization.
transfusions are independent predictors of realtime.
mortality.Overuse also can substantially Given the variation of blood product use
increase the cost of care. For example, the Develop ways to monitor adherence to presented by this analysis, hospital leaders
average cost of a single unit of red blood guidelines and utilization, as well as need to review their organization’s practices
cells is about $210 (The 2009 National measure the impact of improvement and and protocols to identify potential waste
Blood Collection and Utilization Survey provide feedback to clinicians. Regular while maintaining care quality.
Report, U.S. Department of Health and and transparent reporting provides a sense
Human Services, August 2011). However, of urgency for change. In some case, Gina Pugliese, RN, MS, is vice president,
when administration and supply costs clinicians who thought their performance Premier Healthcare Alliance Safety
are included, the total averages as much was acceptable may find that they are not Institute, Charlotte, N.C. (gina_pugliese@
as $1,100 (Toner, R.W., et al., “Costs to doing as well as they believed. And no one PremierInc.com).
Mountain Views 19 www.nhvthfma.org
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