July 2013 Newsletter - Wvhfma.org by pengxuezhuyes


									             Mountain Talk
July 2013 Issue—West Virginia Chapter

   Patterson Earns CHFP Certification
                               Congratulations to Whitney Patterson as the first WV HFMA
                               member to pass the New Certification Exam! Whitney is the
                               Controller at Fairmont General Hospital, Inc. Whitney gradu-
                               ated from WVU in 2007 with a BS in Business Administration,
                               Accounting, and a graduate certificate in Forensic Accounting
                               and Fraud Investigation. She started her career with Dixon
                               Hughes Goodman in Morgantown before coming to FGH in
                               early 2011. Whitney currently resides in Clarksburg with her
                               husband, David. They are expecting a little girl, Audrey, in
                               the fall.

                               Mountain Talk (MT) recently had the opportunity to talk with
                               Whitney about this amazing accomplishment:

   MT: Congratulations Whitney on achieving this certification and also on being the first
   member of the WV chapter to pass the new certification exam. There are only 2400
   CHFP members nationwide. How did you feel when you found out you had passed the             Inside this Edition:
   Whitney: Relieved! I said a little prayer before I hit the submit button. I was expecting
   the exam to be challenging, but it was much more difficult than I had expected. I              President’s Message      2
   thought after passing the CPA exam, this one would be easy - I was wrong!
   MT: There must have been other people giving you advice on how to prepare for this             Value of Certification   3
   exam. What was the best advice that you didn't take?
   Whitney: One thing a lot of people were telling me was that I didn't need to study too         Common Strategies for    4
   hard for the areas that relate directly to my job - budgeting, financial statements, etc.      Achieving Value
   However, I'm glad I studied just as hard for those areas because the exam questions
   and real world applications are sometimes very different.                                      Health Insurance         6
   MT: This accomplishment validates your expertise. What keeps you enthused about                Marketplace
   your career?
   Whitney: I feel like my job and our industry in general are constantly changing and cre-       Hospital-Physician       8
   ating new hurdles and challenges. I don't think I've ever been bored or lacked some-
   thing to do!                                                                                                            10
   MT: What would you tell someone who is thinking about taking this exam?                        ANI Recap
   Whitney: I would tell them to jump on the opportunity, but to make sure you give your-         Managing Avoidable       11
   self plenty of time for preparation. It's not something to be underestimated.                  Inpatient Days

   Interview by Laura Adkins                                                                      Calendar of Events       13

                                                                                                  New Members              15

                                                                                                  Webinars                 20

                                                                                                  Directory                23

President’s Message

President’s Letter: Belinda Bennett
 As I look at the last years of being a member of WV HFMA, I would
 like to recognize and thank those Chapter Presidents who came be-
 fore me for paving the road to a successful chapter. This is a posi-
 tion that comes with tremendous responsibility and commitment. I
 would also like to recognize every person who has participated on a
 committee to ensure that this chapter offers the best education pos-
 sible. Without leadership and volunteers we would no doubt fail in
 our mission.

 This is going to be a very exciting year for our Chapter. In January
 2014 we will be celebrating 60 years of Success. This is a monu-
 mental achievement in today’s healthcare times. With the ever loom-
 ing healthcare reform in sight ,what does the future hold for hospi-
 tals? I am a firm believer that through HFMA we as a group can
 overcome and prosper thru the uncertain changes that are about to
 affect each one of us. On a lighter note, we are planning a major celebration and would love to
 see all of our members attend the Winter Meeting in Charleston. Please watch your email for fu-
 ture information.

 I was recently asked what my goals are for our Chapter for the next year. I would have to say to
 get more of our members involved within our chapter’s committees. So, we are concentrating on
 our efforts and getting more members on board and getting their ideas to help us be successful.
 So don’t be surprised if Susan Cunningham asks you to join a committee. GO SUSAN!!!

 The next goal is our membership satisfaction score. Last year we scored a 75%, which is awe-
 some!!! We rank in the top 15% in satisfied members throughout all of the chapters. To sustain
 this goal we need our members to complete the speaker and meeting forms. These forms are cru-
 cial in planning our next meeting. We want to give our members what they are wanting in educa-
 tion and networking.

 If you have any questions or would like to volunteer please see the Board of Directors listing along
 with committees located in this newsletter. Please do not hesitate to contact any of us.

 Have a great summer!!

The Value of Certification

Many healthcare organizations in today’s challenging economy recognize their workforce as their
most valuable asset. As such, these organizations tend to hold workforce development as a pri-
mary business strategy.

Investment in developing the talents, knowledge and skill sets of staffs are critical to the organiza-
tion’s success. HFMA’s Healthcare Financial Pulse research identified this dynamic and noted that
successful organizations today commit to the “bread and butter” of financial management, i.e. tech-
nically strong and comprehensive financial management.

Likewise, many individual financial managers today recognize the importance of assuming person-
al responsibility for their careers’ success. More than ever before, individuals understand the im-
portance of acquiring and maintaining comprehensive skill sets to ensure their ability to provide the
financial management demanded today. These individuals frequently seek out relevant profession-
al development opportunities.

The larger business environment resulting from these forces is a heightened interest in workforce
development initiatives including certifications and credentialing. Credentialing programs have ex-
ploded across the past couple of decades and include:
 professional associations offering certifications
 community colleges offering curriculum-based certificates
 corporate sponsored in-house credentials for employees
 technology companies providing proprietary credentials to customers

HFMA certification provides a fundamental business service to our industry, namely HFMA certifi-
cation offers:
 Assessment of job-related competency
 The opportunity for an individual to demonstrate skills and knowledge
 Independent verification of the skills and knowledge
 Confirmation that an individual is current in the practice field

The value of HFMA certification can be seen in several reported “value-adds”:
 Increased departmental cooperation 
 Heightened self-confidence among participants 
 Increased performance against selected metrics 
 Verification of staff knowledge and skills 
   Assistance in structuring career paths 

HFMA is committed to being the indispensable resource that defines, realizes and advances
healthcare financial management practice. As such, HFMA provides professional certifications to
achieve this purpose in today’s business environment. This makes HFMA Certification a smart
workforce investment strategy.

For more information on HFMA Certification, visit http://www.hfma.org/certification/.

Report Identifies Common Strategies for Achieving Value

 Virtually all hospitals and health systems are negotiating the transition to value-based business
 models—and there are common strategies and initiatives that each should consider, regardless of
 the size of their organizations, their location, or the populations they serve, according to the new
 HFMA Value Project Report The Value Journey . The report is based on research involving 35
 hospitals and health systems to better understand their road maps to value.

 HFMA’s research has identified a number of common approaches that will help all types of provid-
 ers close the value gap, wherein rising costs outpace improvements in quality of care. Strategies
 that hospitals and health systems should consider include the following.

 Reassess ways to achieve economies of scale. Standalone and rural hospitals will face particular
 challenges in pursuing a value strategy without some form of linkage with other organizations,
 whether through mergers, alliances, or other forms of partnership. For academic medical centers,
 such linkages are a way of tying the referral base closer. Meanwhile, for multihospital systems, do-
 ing so provides a unique opportunity to add still more scale.

 Evaluate the types of staffing and skills that will be necessary in the future. Develop transition
 plans that take these assessments into account. Many organizations, such as Franklin Memorial
 Hospital, a rural hospital in Farmington, Maine, and Billings Clinic, an aligned integrated system in
 Billings, Mont., have developed plans related to staff attrition, using retirements as opportunities to
 redeploy available positions in more strategic ways. Providers across the country also are planning
 to add staff strategically, with an emphasis on analysts, care coordinators, and physician extend-

 Review strategies for cross-subsidizing services, business units, and other components of the or-
 ganization. Take a careful look at strategies for cross-subsidizing services for key population seg-
 ments, evaluating the needs and values of each segment relative to the organization’s ability to de-
 liver on them. For example, what is the organization’s strategy for chronic care patients; for those
 whose visits to the emergency department could be curtailed if they were given lower-cost options
 for care; or even for those who are well much of the time? Refining strategic and tactical plans spe-
 cific to each population segment the organization serves can accomplish longer-term, segment-
 specific financial performance.

 Consider organizational goals related to episode-of-care management, chronic disease care, pop-
 ulation health management, and research when investing in IT. Organizations that are dealing with
 more than one electronic health record system or costing system are actively moving toward com-
 mon (or, in some cases, integrated) information systems and data definitions. The goal is for care
 teams and finance teams to have access to patient-specific data over time, across all care set-
 tings, and integrated across clinical and financial domains.

 Determine what process engineering methodologies to utilize. Methodologies such as Lean and
 Plan-Do-Check-Act can be used in optimizing care delivery, reducing variation, achieving adminis-
 trative simplification, improving the patient experience, and allocating resources appropriately.
 Hospitals and health systems should establish a cross-functional forum to identify and select which
 process improvement initiatives will be undertaken. Dean Health, an aligned integrated system
 based in Madison, Wis., and Bon Secours Health System, a multihospital system based Rich-
 mond, Va., have developed proven approaches that involve clinical, financial, and administrative

Report Identifies Common Strategies for Achieving Value


 Develop multiyear cost-containment plans. Dean Health is in the process of establishing a rolling
 calendar of initiatives that are built into budgets planning processes. New York-Presbyterian Hospi-
 tal, an academic medical center, has established a similar approach. Partners HealthCare in Bos-
 ton also is planning value-based initiatives over multiple years.

 Prepare for a second generation of value-based payment approaches. As noted in the HFMA Val-
 ue Project report Defining and Delivering Value, the emerging payment environment has been de-
 scribed by stakeholders as a period of experimentation and learning. Providers should expect in-
 dustry learning to further shape new payment experiments in the future.

 Read the complete report from HFMA’s Value Project, The Value Journey: Organizational Road
 Maps for Value-Driven Health Care. You’ll find strategies that are common across all organizations
 as well as strategies specific to rural hospitals, academic medical centers, aligned integrated sys-
 tems, multihospital systems, and integrated delivery systems.

 More Insights on the Journey Toward Value

 Through HFMA’s Value Project, healthcare finance leaders are joining their clinical partners to
 shape this transformation. Launched in 2010, the Value Project is now in its second phase. Learn
 more about the Value Project and gain resources for improving value, including reports and a web

 Want to See Your Name in Print?

                                   Gas prices too high?
                          Back to School Shopping got you down?
                          We can help. How does $250.00 sound?

                                   What do you need to do?

            Write an article for the WVHFMA Newsletter. During 2013, we will
                     be accepting articles from WVHFMA members.

  If you are the winner of the best article you can win $250 for first prize and $150 for
                                      second prize.

        Submit to via email to Laura Adkins: Laura.Adkins@HCAhealthcare.com

Report on Health Insurance Marketplace

New report finds competition lowers premiums by nearly 20 percent in the Health Insurance

Affordable Care Act gives consumers access to better coverage at a greater value in 2014
HHS Secretary Kathleen Sebelius today released a new report that finds premiums in the Health
Insurance Marketplace will be nearly 20 percent lower in 2014 than previously expected.
The Affordable Care Act requires health insurers in every state to publicly justify any premium rate
increases of 10 percent or more. Health insurance companies now generally have to spend at
least 80 cents of every premium dollar on health care or improvements to care, or provide a rebate
to their policy holders. In addition, when the Health Insurance Marketplace opens for enrollment
on October 1, 2013 consumers will be able to make apples to apples comparisons of quality health
insurance plans.

“Today’s report shows that the Affordable Care Act is working to increase transparency and com-
petition among health insurance plans and drive premiums down,” said Secretary Sebelius. “The
reforms in the health care law ensure consumers will have access to better coverage at a lower
cost in 2014.”

Specifically the report finds that:

•In the 11 states (including the District of Columbia) that have made information available for the
individual market, proposed premiums for 2014 are on average 18 percent lower than HHS’ esti-
mate of 2014 individual market premiums derived from CBO publications.

•In the six states that have made information available in the small group market, proposed premi-
ums are estimated to be on average 18 percent lower than the premium a small employer would
pay for similar coverage without the Affordable Care Act.

•Both estimates are based on premium proposals for the lowest cost silver plan in the individual
and small group markets. Actual premiums in 2014 may be even lower when health plans are of-
fered in the Marketplace this fall. Already, in a number of states (DC, OR, RI, VT), the rate review
process and competition are resulting in final rates that are significantly below what was proposed
earlier this spring.

•Preliminary premiums appear to be affordable even for young men. For example, in Los Angeles -
the county with the largest number of uninsured Americans in the nation - the lowest cost silver
plan in 2014 for a 25-year-old individual costs $174 per month without a tax credit, $34 per month
for an individual whose income is $17,235, and a catastrophic plan can be purchased for $117 per
month for an individual.

Further, data from the Medical Expenditure Panel Survey Insurance Component shows that the
average premiums for employer sponsored insurance increased by only 3 percent from 2011 to
2012, the lowest rate of increase observed since the data series started in 1996.

 Report on Health Insurance Marketplace

  Already the 80/20 rule, or medical loss ratio, has saved 77.8 million consumers $3.4 billion up front
  on their premiums as insurance companies operated more efficiently and spent more on health
  care than administrative expenses, and 8.5 million consumers can expect an average rebate of ap-
  proximately $100 per family. Since the health law’s rate review provisions were implemented, the
  number of requests for insurance premium increases of 10 percent or more has dropped dramati-
  cally, from 75 percent to 14 percent. To date, the rate review program has helped save Americans
  an estimated $1 billion.

  The report is available at: http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/

  Visit HealthCare.gov to learn more about the Health Insurance Marketplace. Open enrollment be-
  gins on October 1, 2013 for coverage starting as early as January 2014.

Don’t Forget about the WV HFMA Store

WV HFMA members can now purchase clothing and other merchandise with the organization’s logo!!

                           Below are the URLs for you to start shopping.

               You can set up an individual account and purchase whatever you like.

                 There are two logos available—a white logo and a blue/gold logo.

  If there is something you would like but don’t see it on the website please contact Lisa Simmons.

    Lands’ End - http://ocs.landsend.com/cd/frontdoor?store_name=WV_HFMA&store_type=3
From the Members Area on the WV HFMA site - http://www.wvhfma.org/site/epage/125032_455.htm

Hospital-Physician Alignment: Is It Different This Time?

 By Michael Ehlen

 Background: The current move towards Hospital-Physician alignment feels like something we’ve done be-
 fore – networks, joint ventures, and practice acquisitions. Provider integration has been a cyclical strategy
 for hospitals dating back to the early 1980’s. As in the past, physicians are currently looking for deals, but
 will falling physician reimbursement mean that hospitals end up getting burned again?

 Previous hospital-physician alignments were the result of hospitals buying primary care physician practices
 to protect market share and gain the upper hand with managed care contracting. Once employed by the
 hospital, physician productivity tended to nose dive and many hospitals experienced large annual losses on
 their practice investment. To add insult to injury, hospitals ended up selling their practices back to the origi-
 nal employed physicians, at a discount, once the perceived threat from managed care went unfulfilled. What
 is different this time is that the strategic implication from not aligning with physicians is a larger financial
 threat to hospitals than just market share. The shift from inpatient procedures to outpatient procedures and
 the loss of those patient encounters is stressing many hospitals’ financial performance.

 Current Environment: Complicating matters today is the fact that market data on outpatient and physician
 office services although better than previous years is still lacking or limited. Without reliable data, many or-
 ganizations seek advice from outside consultants, who may not possess the unique financial physician skills
 to understand the risks and true value of a practice acquisition or joint venture. Not understanding values
 can be misconstrued as overpaying in exchange for patient referrals as some hospitals have learned the
 hard way.

 It is crucial for today’s financial manger to take a more active role in the due diligence process of any cur-
 rent or future hospital-physician integration. As the pressure to migrate to a consumer driven model gains
 traction, many physicians do not have a clear understanding of the economics of their current practice and
 the business pressures they are exposed to. This is where the financial manager can address potential
 problems during due diligence and improve the hospital-physician negotiation process.

 This article will look at four key physician practice performance areas to gain a proper financial per-
 spective before any alignment takes place:

 1. Denial Management: The most common way practices lose money is through inadequate or inaccurate
    ICD-9 and CPT coding. Unlike a hospital charge master, with thousands of procedures, the physician
    fee schedule may contain less than 100 procedures and is much easier to manage. For example, CPT
    coding denials can be reported to the specific carrier levels for payment timeliness, cash flow turna-
    round, under payments, and claims edit sources/frequencies. From these detailed reporting metrics, a
    true measure of the practice’s coding risk can be obtained and also be used as a source for compara-
    tive analysis.
 2. Electronic Medical Records (EMR): The pros of EMR outweigh the cons; however there is one finan-
    cial aspect that needs to be addressed. With an EMR system, there is a tendency for the physician to
    simply check a series of boxes or clicks, on a computer, to complete a patient chart. This can cause
    physician charting to deviate from “medically necessity” and building the chart documentation from the
    proper diagnostic codes. Before practice EMR systems, it was common for a physician to under code
    their documentation below the actual level of resources consumed. This is due to the overwhelming task
    of back-tracking the decision sequence for all the patients seen at the end of the day by dictation or
    chart notes. If the practice is seeing a significant increase in the number of medical necessity denials,
    (post EMR implementation), a whole new category of compliance reviews may need to be addressed as
    the chart documentation is not being supported by the diagnostic coding.

Hospital-Physician Alignment: Is It Different This Time?

 3. Medicare Resource Based Relative Value Scale (RBRVS): There is a wealth of research on the
    use of RBRVS as a means to both physician productivity and/or physician compensation. All physi-
    cians establish fee schedules based on the costs incurred by their practice and the value furnished
    in delivering quality medical care. Policy adopted by the American Medical Association (AMA) vigor-
    ously recommends the use of RBRVS as a basis for setting physician fee schedules.1 The issue
    with using a RBRVS to set fees is that both age and sex have a great deal to do with utilization and
    the intensity of services provided to the practice’s patients. The Medicare population is older than
    the general population and consists of a higher percent of females. Unless the practice is 100%
    Medicare, the value of RBRVS is diminished to the degree that the payor mix is other than Medi-
    care. In order for financial managers to make sense of any practice specific RBRVS data and per-
    form a physician productivity analysis, an acuity factor, (AF) or intensity of service factor, must be
    applied to the practice’s data. This is the only way to generate meaningful results applicable to eve-
    ry physician, regardless of payer mix. A by-product of calculating an AF and applying it to the phy-
    sician’s RBRVS frequency distribution, is the elimination of the “my patients are sicker than others,”
    defense as the physician’s true level of service can be quantified either by provider to peer group or
    provider to national average.
 4. Point of Service Collections: With the sharp spike in patient co-pays and deductibles, a shift to
    collecting as much of the guarantor balance at the time of service has become a necessity for phy-
    sician practices. To upstream the practice’s collections, many practices offer discounts of up to
    20% to patients, who pay their portion of the bill at the time of service. If the practice offers dis-
    counts to all patients, without categorizing them by work effort, loss of income will occur as a large
    group of patients, who previously paid 100% of their balance from their first statement mailed, will
    now be paying less than they would have. This can be significant. For example, a family practice
    with a typical 62-percent overhead and 38-percent profit margin that loses an additional 5 percent
    of collections actually loses approximately 13 percent of net income, since the losses come directly
    from the "last-dollar" profits that remain after overhead has been paid. That 13 percent represents
    approximately $20,000 for a practice with a profit of approximately $145,000, the median for a fami-
    ly practice without obstetrics. 2

 Summary: The above four physician practice performance areas highlight a few of the opportunities where
 financial managers can make a difference. Physician practice valuation is an increasingly critical compo-
 nent of the various transactions among health care entities and referring providers. Although not touched on
 here, regulatory considerations also require that any findings used to determine value are not based on
 “tainted” market data. The result of a bad valuation method can be a liability under Anti-Kickback Statues,
 False Claims Act, or Administrative Sanctions such as exclusion from the Medicare Program.

 Whether one is doing a current physician portfolio review, a potential joint venture or a physician practice
 acquisition, and regardless of whether one is relying on internal data or an external consultancy’s report,
 today’s healthcare financial manger must take an integral role in the process to ensure that all findings are
 consistently applied and the appropriate documentation is created to support any hospital-physician align-
 ment going forward.

 Michael Ehlen is the PFS Business Analyst with Beaufort Memorial Hospital located in the “Low Country”
 area of South Carolina. He is a current member of the South Carolina HFMA chapter. If you have any
 questions regarding this article, Michael can be reached at mehlen@bmhsc.org

  Joint Statistics: Medical and Dental Income and Expense Averages, 2011 Report Based on 2010 Data.
 National Association of Healthcare Consultants, September, 2011

WV HFMA Rocks the House at ANI

By Belinda Bennett

This past June I had the pleasure of attend-
ing the Annual National Institute (ANI) held in
Orlando Florida. I have now come to the
conclusion that Orlando is the hottest place
on earth, however one of the most exciting. It
was an honor to sit with Lisa Simmons, Past
President and Okey Silman, II, President
Elect and listen to the accomplishments
HFMA has had in the last year. Our highlight
was when Lisa walked up on the stage and
accepted the awards for our chapter.

To achieve these awards each chapter must
meet minimum standards each year as measured by the Chapter Balanced Score Card (CBSC).
We achieved 90 points out of 100. The CBSC measures the chapter on education hours, member-
ship growth/retention, overall member satisfaction, certification, days cash on hand, on-time report-
ing and Board Composition.

Based on last year’s results our chapter received the John M. Stagl Award for Excellence for Edu-
cation. Our goal was 15.9% and we had 18.5%. This is achieved by offering better education at
our meetings throughout the year. We also received the Award of Excellence for Membership
growth and retention. Our goal was 244; we closed at 246. Again, this is achieved by members
staying active and obtaining new members. And last but not least, for the first time in many years
the chapter received the Excellence for Certification Silver Award. Our goal was to have the test
taken by two members and this was achieved. Hats off to Whitney Patterson for becoming certi-

Managing Avoidable Inpatient Days

by Daniel Honerbrink, FHFMA, FACHE, Sonja Raddish, MBA & Diana Arnold, BSN, RN

Many of us, as hospital team members, spend a great deal of time looking for ways to generate additional
revenue or reduce operating costs. Managing avoidable inpatient days, in my opinion, presents a huge op-
portunity to better manage hospital costs. Regardless of the reasons for the avoidable inpatient days, the
fact remains, avoidable days cost the hospital quite a lot and, to the extent possible, should be minimized.

Your Utilization Management / Case Management team will undoubtedly already be managing each pa-
tient’s episode of care to ensure the care plan is being executed and resource inputs are being applied in
a timely and efficient manner. However, you can enhance those efforts by evaluating each and every inpa-
tient stay against the Medicare (or insurance company) Expected Length of Stay for the Admitting Diagno-
sis and the associated admission DRG, to start gaining an understanding of the occurrence of avoidable
days at your hospital.

Often times, the Expected Length of Stay is based on an initial DRG assignment that is faulty or incom-
plete due to missed co-morbidities at initial DRG assignment (often based on lack of a complete assess-
ment and/or incomplete documentation of the patient’s condition). Other times, the communication and
hand-off processes within the hospital break down and patients sometimes “fall through the cracks” and
receive little service or attention extended period of time. Additionally, but somewhat less frequently, pa-
tients sometimes remain in the hospital for additional periods of time due to social reasons (i.e. there’s no-
body at home to take care of the patient, support is lacking, etc.). Lastly, patients sometimes “sit” for peri-
ods of time due to internal or external system issues, either in the hospital or at supporting organizations
(e.g. transfers delayed, DME not available, etc.). Regardless of the reasons for avoidable days, they are
costly, routinely rob the hospital of needed resources and need to be understood and addressed.

To understand avoidable days at your hospital, first, make sure your Information Technology system can
produce summaries that list the admitting diagnosis, assigned DRG and the associated expected Geomet-
ric Mean Length-of-Stay (GM-LOS) for each patient admitted. Second, make sure this information availa-
ble to, and in use by, your Case Managers. Third, have your IT and/or Decision Support folks create a
spreadsheet listing all discharges for a period of time (e.g. 30 days) showing the actual LOS, the GM-LOS,
Admitting Diagnoses, attending physician and any other attributes that may prove useful (e.g. medical rec-
ord number, dates of service, admitting and/or attending physician, etc.). When constructed and complete,
you now have a dataset that can be easily manipulated. Moreover, by assigning a base cost rate of “X”
dollars (e.g. from the Medicare Cost Report), you can easily extrapolate out the overall impact of the
avoidable days for that period. Please note that not all avoidable days can be eliminated. However, know-
ing the overall impact elevates the issue and elicits more focused attention.

 Use this dataset (spreadsheet) to evaluate variances by admitting diagnosis, assigned DRG and admitting
and/or attending physician (or, even, assigned Case Manager). The avoidable days by type will become
obvious. And, while you’ll know “WHAT” occurred with regard to avoidable days, you’ll now have to deter-
mine “WHY.” Drilling down into the patient chart to identify the various delays is more art than science. It
requires a non-defensive attitude by the folks doing the reviews to ensure an appropriate level of data in-
tegrity….after all, you’re going to use this information to isolate root causes and take action to remedy
those performance gaps. With this, classifying the avoidable days is essential. Please note, here, that
there may be multiple reasons/causes for delays for each patient episode of care. Each reason should be
captured and an estimate of the delay (in days or hours) needs to be listed.

Managing Avoidable Inpatient Days


Here’s a summary of the reasons and reason codes that one hospital uses for avoidable days:

 Code          Reason / Issue
 Criteria      Service Criteria Issues:
 IC-1          Inpatient/admission criteria not met.
 IC-2          Inpatient/admission criteria not met based on documentation.
 IC-3          ICU/CCU inpatient criteria not met.
 IC-4          Other (document in common field).
 Social        Social / Support Issues:
 SO-1          Nobody at home to care for patient upon discharge.
 SO-2          Transportation lacking.
 SO-3          Unable to contact guardian/care giver.
 SO-4          Patient/family delay in selecting extended care or rehab facility.
 SO-5          Patient/family requested more days or refused to leave.
 SO-6          Patient/family indecisive about care, intervention or disposition.
 SO-7          Awaiting placement: Legal/financial issues.
 SO-8          Awaiting placement: Guardianship issues.
 SO-9          Awaiting placement: No bed available in community/SNF.
 SO-10         Other (document in common field).
 Physician     Physician Issues:
 MD-1          Patient does not meet Inpatient Status for stay/continued.
 MD-2          Delay in attending physician review/response.
 MD-3          Delay in consulting physician review/response.
 MD-4          Other (document in common field).
 Internal      Internal System Issues
 SI-1          Procedure/surgery delayed or postponed: Supply/Equipment availability/
 SI-2          Procedure/surgery delayed or postponed: Scheduling issues.
 SI-3          Delay: Timely test results or reports.
 SI-4          Delay: Lack of nursing oversight or follow-through
 SI-5          Other (document in common field).
 External      External System Issues
 SE-1          Receiving Facility Delay: Refusal of weekend transfers or staffing issues.
 SE-2          Medical equipment / home medical equipment (DME) support delays.
 SE-3          Home Health service / support delays.
 SE-4          Insurance Company Delays.
 SE-5          Other (document in common field).

Managing Avoidable Inpatient Days


As with any initiative such as this, it is important to utilize appropriate process improvement tools and tech-
niques. Additionally, as we all know and have come to appreciate, involving those team members closest
to the process, assures the issues are clearly identified and, ultimately, the improved process is accepted
by all stakeholders.

 In summary, your objective is to determine what avoidable days your hospital has and the associated
cost of those avoidable days. Your goal, however, is to evaluate the reasons and, ultimately, fix the relat-
ed processes to minimize costly avoidable patient days.

Calendar of Events

Region IV Mid-Atlantic Meeting              Virginia Beach               September 25-27, 2013

Fall Education Program                      Oglebay Resort               October 9-11, 2013

Fall Revenue Cycle Meeting                  Flatwoods                    October 23, 2013

Winter Education Program                    Charleston                   January 22-24, 2014

Spring Revenue Cycle Meeting                Flatwoods                    March 26, 2014

Spring Education Conference                 Stonewall Resort             May 14-16, 2014

  HFMA is
 where you
  need to
Celebrate the WV Chapter ‘s
     60th Anniversary

 Save the date: January 22-24

More details coming soon!

New Members

Jennifer Hosey                              Lisa Stanley
Patient Accounts Manager                    Charleston Area Medical Center
Cabell Huntington Hospital                  Work Phone: (304) 348-5432
Work Phone: (304) 526-6397                  Email: lisa.stanley@camc.org
Email: jennifer.hosey@chhi.org
                                            Shannen White
Ryan Thompson                               Supervisor
Senior                                      Charleston Area Medical Center
Ernst & Young                               Work Phone: (304) 388-7245
Work Phone: (304) 634-7785                  Email: shannen.white@camc.org
Email: ryan.thompson1@ey.com
                                            Nancy Willuhn
Pam Muncy                                   Patient Account Analyst
PFS Director                                Charleston Area Medical Center
Pleasant Valley Hospital                    Work Phone: (304) 388-7584
Work Phone: (304) 675-4340                  Email: nancy.willuhn@camc.org
Email: pmuncy@pvalley.org
                                            Susan McDonald
Steven Perry                                Account Executive
Corporate Director—Supply Chain Mgmt        CBCS
Charleston Area Medical Center              Work Phone: (800) 537-6881
Work Phone: (304) 388-4173                  Email: susan.mcdonald@cbcsnational.com
Email: steve.perry@camc.org
                                            Diann Wentz
Ruth Hopkins                                Director
Contract Management Analyst                 Highmark Blue Cross Blue Shield WV
Monongalia General Hospital                 Work Phone: (304) 424-9817
Work Phone: (304) 598-1568                  Email: diann.wentz@highmark.com
Email: hopkinsr@monhealthsys.org
                                            Traci Lopez
Cheri Godbey                                Vice President
Customer Service Supervisor                 ProBill Medical Billing Services
Charleston Area Medical Center              Work Phone: (304) 523-0746
Work Phone: (304) 388-7413                  Email: TJLOP2012@yahoo.com
Email: cheri.godbey@camc.org
                                            Do you know someone who is interested in be-
Jame Moore                                  ing a HFMA member? Please visit our website
Patient Revenue Manager                     or contact any board member for assistance.        
Jackson General Hospital                    For all of those who sponsored a new member        
Work Phone: (304) 373-1572                  in the 2011-2012 year, a SPECIAL THANKS            
Email: jmoore@jacksongeneral.com            goes out to you.                                   
Eva Hundley                                 If you would like to volunteer or assist in any    
Pre-Reg Supervisor                          way see a committee chair. (listed on the last
Charleston Area Medical Center
                                            page of the newsletter)
Work Phone: (304) 348-5432
Email: eva.hundley@camc.org

Karen Martin
Charleston Area Medical Center
Work Phone: (304) 348-5432
Email: karen.martin@camc.org           15
HFMA Webinars Offered
HFMA is hosting the following Live webinars in the following months. Please visit hfma.org for
more information.

July 31st Metro Health Case Study: Using Patient Financing to Develop Positive Outcomes for Your Pa-
tients, Community, and Bottom Line

Aug 8th High-Impact Service Contracts: Balancing Risks and Savings to Lower Costs

Aug 15th Leveraging the Latest RFID Technology to Support Your Supply Chain, Manage Costs, and
Improve Clinician Workflow

Aug 22nd Managing the Transition from Volume to Value

Aug 27th Strategies to Increase and Accelerate Patient Payment at the Point of Care

Aug 28th Transform Budgeting, Capital Planning, and Performance Reporting to Support Strategic Busi-
ness Decisions

Sep 10th Leveraging Your Organization’s Enterprise Resource Planning (ERP) System Investment

Sep 11th Understanding the Impact of Consumable Costs that Exceed Their Capital Investments

Sep 12th Predicting the Unpredictable: Using Analysis to Match Staffing-to-Patient Demand

Oct 17th Control High-Cost Supplies From Value Analysis to Point-of-Use

Please see the ON DEMAND WEBINARS on the HFMA website. Most are free to members. (This is a
good place to get CPE hours)

       2013 – 2014 CORPORATE SPONSORS

                          EMERALD LEVEL

                     HealthCare Financial Services

                            RUBY LEVEL

                      Arnett Foster Toothman PLLC
                        Helvey & Associates, Inc.

                          SAPPHIRE LEVEL

                    Advanced Patient Advocacy, LLC
                        Highmark West Virginia
                          The Mash Program
                             Quadax, Inc.
                     United Collection Bureau, Inc.

                            PEARL LEVEL

                      Collection Service Center, Inc.
                     HealthNet Aeromedical Services

  ***Please note that this is a tentative list of sponsors based upon
information received at the time of publication. The sponsorship list
        will be revised as additional information is received.***

Dear HFMA Chapter Member,

As your Chapter President, I would like to share with you a unique HFMA educational opportuni-
ty that has been brought back by popular demand. HFMA’s Virtual Conference includes live
sessions, offers all new content, and is FREE to Members. Earn up to 12 CPEs for attending
the live presentations. Live dates include February 6, April 11, July 17, and October 16, 2013.
Your participation in this event also presents our Chapter with an outstanding
opportunity to increase our DCMS educational program hours.

When?        October 16, 2013

What?        Access your choice of 12 CPE-eligible live education programs presented by in-
             dustry leaders – 3 on each day – from the convenience of your home or office.
             View the live conference agenda.

Why?         If you attend the live event presentations, you can earn up to 12 NASBA-certified
             CPE credits over the course of the four days (1 CPE credit awarded for each live
             presentation attended). Each date offers new education content including a key-
             note session, a session that presents the latest findings from HFMA’s Value Pro-
             ject, and a real-world case study that provides solutions to improve the quality of
             care and reduce costs.

How Much? It’s FREE for HFMA members!

             Free online content and no associated travel expenses are a great combina-
             tion when all organizational budgets are tight.

             Non-member registration is only $155, which also includes membership for those
             new to HFMA. Help them take advantage of this educational opportunity.

Where?       Visit hfma.org/virtualconference for more information – and to REGISTER for
             this FREE educational event.

Please forward this e-mail to colleagues and/or staff in your organization today! For more infor-
mation, visit hfma.org/virtualconference.

If you have questions, HFMA’s Member Services Center will be happy to assist you at (800) 252
-4362, ext. 2 or send an email to virtualhcfc@hfma.org.

Belinda Bennett, WVHFMA President

                            WVHFMA Board
  President                                                    Board Members
  Belinda Bennett             304-469-8620                     Marcia Metz        304-551-3988
                                                               Ryan Lindsay       304-206-3323
  Vice President                                               Joe Barnes         304-257-5802
  Okey Silman II              304-473-2127                     Dan Honerbrink     304-367-7154

  Becky Hammer                304-637-3156

  Jan Strope                  304-989-7370

                2013-2014 Committees
Committee Name Chairs                                 Members
Advisory                    Past Presidents           Lisa Simmons              Keith Morgan
                                                      Jan Strope                Jim Holden

Awards                      Jill Epstein              Belinda Bennett           Diana Cesa
                                                      Okey Silman II            Sonja Raddish
                                                      Lisa Simmons              Linda Dugan

Sponsorship                 Joan Namey                Sonja Raddish

Financial Review            Outgoing President        Whitney Patterson

Web Master                  Lisa Simmons

Mid Atlantic                Lisa Simmons              Sonja Raddish             Belinda Bennett

Newsletter                  Laura Adkins              Wes Vanscoy
                            Corey Slider

Program and Entertainment   Nikia Carper              John May                  Tommy Spurlock
                            Lisa Simmons              Keith Morgan              Laura Adkins
                                                      Joan Namey                Marcia Metz
                                                      Sonja Raddish             Dodie Arbogast
                                                      Tony Rumsberg             Joe Barnes
                                                      Okey Silman II            Dianna Cesa
                                                      Corey Slider              Jill Epstein
                                                      Jamie Demuth              Angie Frame
                                                      Becky Hammer              Dan Honerbrink
                                                      Ryan Lindsay

Certification               Belinda Bennett

Membership                  Linda Dugan               Belinda Bennett           Okey Silman II


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