Mountain Views - Winthrop Resources Corporation

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					Mountain Views
Jan/Feb 2013




                                                                             Mountain Views is the official newsletter of the
                                                                             New Hampshire/Vermont Chapter of the
                                                                             Healthcare Financial Management Association.


                           Financing Technology:
                           It’s Like Marriage Counseling
                           Jake Schwamb
                           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
                           organization
                                              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
 Newsletter Committee
 & Policy                                                Get Involved - 2013
Newsletter Editor:
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
Newsletter Committee:
                                                                              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:
Technology Leaders
                                                                              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
Medical Center
                                                         for you?
Robert Gilbert - Wentworth-Douglass                                                                        o Influence on your chapter’s fu-
Hospital                                                                                                   ture
                                                         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
                                                                                                         teering.
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
publication, to:
                                                                                                         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

among them:
                                              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-
                                              ered.                                              Chapter
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
                                                                                                 Website
* 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-    jschwamb@winthropresources.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
                                              your organization.
* The “Financial Cloud.” The “Financial




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                                                                                                                                   (617) 549-9498




Mountain Views                                                      3                                              www.nhvthfma.org
                              Accounting Corner

                              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       walker@jax.org.
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

                                                                                                 Important!
words, if the donation was restricted to      liability and an asset) in the balance sheet



                                                                                                         A@
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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...
                                                                                       be engaged.

     Pass it on.
                                                                                       belong.
                                                                                       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.
                    Member-Get-A-Member
                      Program 2012-2013

           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)
                                                                                        for $1,000.

      “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
                                                                        New Hampshire/Vermont
                                                                        Chapter Sponsors

                                                                        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
                                                                        “thank you”.

                                                                        PLATINUM PATRONS
                                                                        Baker Newman Noyes
                                                                        BerryDunn
                                                                        BKD, LLP

                                                                        GOLD PATRONS
                                                                        Credit Bureau Collection Service
                                                                        E-Management Associates, LLC
                                                                        Gragil Associates, Inc./
                                                                        Audit Billing Center, Inc.
                                                                        Marcam Associates
                                                                        Tyler, Simms & St. Sauveur, CPAs,
                                                                        P.C.
                                                                        Winthrop Resources

                                                                        SILVER PATRONS
                                                                        AMTEC
                                                                        Bittel Financial Advisors, LLC
                                                                        Emdeon
                                                                        EOS CCA


    Serving
                                                                        Hackett Valine & MacDonald
                                                                        The Richards Group
                                                                        The SSI Group, Inc.

        healthcare                                                      Vecna Medical



            organizations
            throughout New England

          Audit, Tax and Healthcare Consulting Services
          with offices in Portland, Manchester, Portsmouth and Boston

                    www.bnncpa.com         800.244.7444


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):


  1. www.NHVTHFMA.org
  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 diane.blaha@gmail.com
  or peter.smith@wdhospital.com



Mountain Views                                          9                                      www.nhvthfma.org
CFO Survey
Steven Plant,
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
                                                         options.
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
        Financial Professional

        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
                                                                                                     603-653-0209 (f)
                                                      programs.
                                                                                                     www.tss-cpa.com



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 .




                                               HFMA’S
                                               VIRTUAL
                                               CONFERENCE
                                               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.
                      February 6
                                               AT T EN D A L L 4 LIVE EV ENTS TO RECEIVE 12 CPE CRED ITS
                       April 11
                                               (1 C PE C RE DI T AWA RD ED FO R EACH LI VE PRESENTATI O N ATTENDED)
                        July 17
                      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




Mountain Views
 VirtualConferenceAd.indd 1
                                                                        11                                             www.nhvthfma.org
                                                                                                                            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
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                                                   winners excel in meeting the benchmarks and implementing patient-
                           no




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Mountain Performance 2013 hfm Ad.indd
                Views                   1
                                                             12
                                                                                                               11/8/2012 9:30:35 AM
                                                                                                          www.nhvthfma.org
      Reform. Margin pressure. Revenue cycle. Value.
      Reshaping healthcare finance together.




      HFMA
                                                                       be informed.
                                                                       Online resources, educational programming,
                                                                       and hfm — the number one publication
                                                                       for hospital CFOs — keep you on top of
                                                                       healthcare finance.




      is where                                                         be engaged.
                                                                       Network with colleagues, advance your career,




      you need
                                                                       and join the conversation on issues like
                                                                       reform, revenue cycle, and the drive for value.




                                                                       belong.

      to be...
                                                                       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
                                                                       healthcare environment.




                               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
                                                                        Certification Programs
                                                                      • Virtual Healthcare Finance Conference
                                                                        and Webinars
                                                                      • 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
                             JaNuary 2013!
   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

                                                ROLL WITH
 Professionalism • Integrity • Results
     www.marcamassociates.com
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         to discuss the many exciting
         outsourcing opportunities for
               your organization!




   Paul: PFinnegan@MarcamAssociates.com
    Mark: MNiska@MarcamAssociates.com
    Tim: TMoore@MarcamAssociates.com
   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://
administrator.                                                                                   www.hfma.org/valurjourney/.
                                                 •   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.
                                                     hospitals.
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
area.
                                                 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
a hospital.”

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!!!
                                                                                                     www.nhvthfma.org
“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
Gina Pugliese

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
                                              unit costs.
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
           The way
           we’ve always
           done things.

            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).




                             Think Spring…
 Mountain Views                                                       19                                            www.nhvthfma.org
 the newsletter committee! Commitment is flexible


                   If you can read this…
olved you want to become! We are always looking for
d for people to reach out and contact prospective


                                            Then Walker at
 Griffin at kgriffin0509@gmail.com or Eric you should consider
h.org if you’re interested in learning more!
                                        joining	the	newsletter	committee!

                                                                                             Do you enjoy reading
                                                                                              Mountain Views?

                                                                                          Are you looking to network
                                                                                         and get more involved in the
                                                                                            NH/VT HFMA chapter?

                                                                                               Consider joining
                                                                                         the	newsletter	committee!	
                                                                                       Commitment is flexible around
                                                                                     how	involved	you	want	to	become!	
                                                                                       We are always looking for new
                                                                                           writers, and for people
                                                                                          to reach out and contact
                                                                                          prospective contributors.

                                                                                            Contact Eric Walker at:
                                                                                      eric.walker@jax.org if you’re inter-
                                                                                            ested	in	learning	more!




                                             Chapter Officers
                 President                                             Secretary
                 Connie J. Ouellette, FHFMA, CPA                       Amy Vaughan
                 (207) 541-2201                                        (802) 847-7809
                 Email: couellette@berrydunn.com                       Email: amy.vaughan@vtmednet.org
                 President-Elect                                       Treasurer
                 Sandra Pinette                                        Diane L. Blaha, FHFMA
                 (603) 379-2095                                        (603) 305-5486
                 Email: spinette@finrx.com                             Email: diane.blaha@gmail.com
                 Past President
                 Evalie Crosby
                 (603) 448-7453
                 Email: crosbye@apdmh.org
                             The New Hampshire/Vermont Chapter of the Healthcare Financial
                              Management Association (HFMA) is a professional membership
                             organization for individuals in financial management of healthcare
                                       institutions and related patient organizations.


     Mountain Views                                         20                                         www.nhvthfma.org

				
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