Lone Star Express

HFMA

Healthcare Financial Management Association

Q1 Issue 1 2016-2017

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President’s Corner Gree ngs Lone Star chapter, We begin the year of 2016 -2017 with a new theme of “Thrive” from Mary Mirabelli our HFMA Na onal Chair. This theme sends an important message to healthcare leaders seeking to find their foo ng in the face of the financial and societal shi s in the na on’s healthcare system. The changes require the industry to con-

nuously innovate to bring together a fragmented delivery framework that is rapidly shi ing from volume- to value-based care and payment models that will support a far more consumer-focused healthcare delivery system. The aim is to empower consumers, medical providers, and healthcare leaders with state-of-the-art technology, thereby promo ng improved outcomes and reduced costs. Healthcare professionals must do much more than simply respond to this change; they must find a way to thrive in the face of it. For Mirabelli, this message is part inspira on, part determina on, and part for tude.

In the spirit of con nuing forward with the HFMA 2.0 ini a ve from HFMA Na onal, the chapters have been asked to grow membership in several new direc ons including, Physician, Payors, Emerging Leaders, and Women’s Leadership. The Lone Star chapter board has implemented a five-year-plan to support the inclu-sion and partnering with these groups. Lone Star chapter had ini ated a Women’s Leadership Conference and a Mentoring program, a networking pipeline for graduate students, and an Organiza onal based confer-ence at Christus Health Systems. We will con nue to move forward with all of these ini a ves in 2016- 2017. We will also be including the addi on of an Academic pillar that will help us direct graduate students, and bring academic speakers into our educa onal events. HFMA Na onal is calling this expansion the Inno-va on ini a ve, and has offered the poten al for the chapters wiling to move into collabora on with these new groups poten al for some minimal addi onal funding. This year we are excited to offer a new educa onal event suppor ng Cost Repor ng. This is the first me that Cost Repor ng educa on has been provided by the Lone Star chapter. The Summer Ins tute will be held at Las Colinas Country Club in Dallas on 8/19, and the Key Note Speakers will be three- mes Superbowl

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President’s Corner Champion Chad Hennings. We are also scheduling a Member Ac va on Day (MAD CAT) mee ng on 9/2, to bring in volunteers and educate them on volunteer opportuni es within the Lone Star chapter. The Red River showdown conference co-hosted by both the Lone Star and OK chapters is moving to a new loca on, and will be held at the Tanglewood Resort in Po sboro, TX. Addi onally, we have a Women’s Leadership conference scheduled for 10/28. The Women’s Leadership conference will host actress Janine Turner. Fi-nally in November we will be holding a dinner at the new Parkland building. For those that cannot make it to a formal educa onal event we have ongoing webinars scheduled every month. Please look at the calen-dar of events on the Lone Star chapter website for details to these upcoming educa onal opportuni es. This year’s networking events include a golf driving range event in October, a networking event at the Perot Museum in December, student networking events for both semesters in coordina on with UNT and TCU. And a crawfish boil in March next year. These events provide an opportunity for socializing with other Healthcare Finance leaders, and are fun in addi on to being well a ended. I also want to point out that Cer fica on for the CHFP has been modified and now is comprised of two on-line computer based training courses. We are working to provide cer fica on training in combina on with the other two Texas chapters and the CO chapter. We look forward to the opportunity to support the new cer fica on tes ng format for our chapter members this year. I am looking forward to a great new year for the chapter, as well as looking forward to seeing you at the conferences and networking events.

Chris Joiner President HFMA Lone Star Chapter 817-988-1757 / cell Cjoiner@Accordias.com

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LLone Star Express

FEATURES

DEPARTMENTS

We are always looking for articles, pictures, and content for every issue. Due date for arti-cle submissions for consideration for the next issue is September 9, 2016. Please feel free to contact me or any of our committee members. Sherry Witzman, Chair switzman@bkd.com

MEMBERSHIP METER

2016-2017 Goal: 1,254

1,100

950

800

650

500

350

200

Membership Benefits Publications and Resources * Hfm Magazine * HFMA Weekly News * Buyer’s Resource Guide

* Industry Incentives * Premium Web Content * HFMA Forums * Local Chapter Membership Education and Professional Development * Events * Webinars * Professional Designations * Career Development Resources

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Members Strong

The publications Committee reserves the right to accept or refuse contributions whether solicited or not. All correspondence is assumed to be released for publication unless otherwise indicated. All article submissions are requested to be types and provided in elec-tronic format, if possible. Send all correspondence to Sherry Witzman, BKD, switz-man@bkd.com IDENTIFICATION STATEMENT The Lone Star Chapter “The Lone Star Express” is published quarterly by the Lone Star Chapter of Healthcare Financial Management Association EDITORIAL POLICY Opinions expressed in articles or features are those of the author(s) and do not reflect the view of the Lone Star Chapter, Gulf Coast Chapter, or South Texas Chapter of the Healthcare Financial Management Association, or the Publications Committee. Questions regarding articles or features should be addressed to the author(s). The Healthcare Financial Management Association and Publications Committee assume no responsibility for the accuracy or content of any articles or features published in the newsmagazine. The Publications Committee reserves the right to accept or refuse contributions whether solicited or not. All correspondence is assumed to be a release for publication unless indicated. All article submissions are requested to be typed and provided in electronic for-mat, if possible. REPRINT POLICY The Lone Star Chapter, Gulf Coast Chapter, or South Texas Chapter of HFMA will not reprint articles published in the “Texas Voice” newsmagazine. Individuals wishing to obtain reprint authorization must obtain it directly from the author(s) of the article. The reprint may not imply endorsement from HFMA, directly or indirectly.

President’s Letter ……………………………...….……2 CHFP Certification ……….......……………………......5 Meet Your 2016-2016 Officers..……………………......8 Committee Blocks……………………………………....9 New Members…..……………………………………...11 Upcoming Events………..……...………..……………18 Sponsors………………………………………………..23

Agency Options for Hospital Finance ...…………….…5 By Kyle Hemminger & Ritchie Dickey The Twitter Asthma Pulse………………………….…..8 By PCCI Staff The Uncertain Nature of Current Cost Report Instruc-tions & S-10 Compliance.……………………………..12 By Michael Thomas Career Strategies: Effective Communication—Avoiding the Apocalypse…………………………………………14 By Joseph Abel, CPCC, ACC, PHD Cardiac Arrest– Early Detection Could Save Your Hos-pital’s Bundle…………………………………………..16 By Eric Rodgers

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HFMA's Certified Healthcare Financial Professional (CHFP) The CHFP program has been updated to provide the broad range of business and financial skills essen al for succeeding in today's high-value healthcare environment:

Business acumen Collabora on Financial strategy Understanding future trends

The new CHFP is geared toward financial professionals, clinical and nonclinical leaders, and payers – all those whose jobs require a deep understanding of the new financial reali es of health care. The new CHFP program includes two modules (both modules must be successfully completed to earn the CHFP):

Register now for Module I of the CHFP program: HFMA's Business of Health Care online program. HFMA's Business of Health Care - Healthcare finance overview, risk mi ga on, evolving payment models, healthcare accoun ng and cost analysis, strategic finance, and managing financial resources.

Register now for Module II of the CHFP Program: HFMA's Opera onal Excellence exam. HFMA's Opera onal Excellence exam - Exercises and case studies on the applica on of business acumen in health care. Earning the CHFP

The CHFP creden al is awarded upon successful comple on of module 1 end of course assessment and suc-cessful comple on of module II exam (case study exercises). HFMA membership is required.

Frequently Asked Ques ons - Addi onal CHFP program informa on can be found in the CHFP FAQ docu-ment.

HFMA Na onal Webinar Recording

Why HFMA’s Cer fied Healthcare Financial Professional (CHFP) Cer fica on is Right for You - The webinar discussion examines the specific knowledge areas and professional skills that are hallmarks of the profession - learn how earning HFMA’s CHFP cer fica on is one of the savviest business moves you’ll ever make. (Recorded Webinar Pricing for HFMA members and non-members: Free)

Please contact Jim Foster at James.Foster@BSWHealth.org if you are interested in seeking your certifica-tion. The CHFP program has become a desirable certification for all those who are in Health Care Fi-nance. It will certainly be a benefit to your career as you seek opportunities in Health Care Finance. We are in the process of looking at a certification training and review program and if you are interested please contact me so I can get you on the mailing list.

Lone Star is please to announce our new CHFPs!! Marie Becan &

Amanda McHatton

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Meet Your 2016-2017 Officers

John Dragovits, CPA President Elect Allscripts Healthcare

Chris Joiner President Accordias Healthcare Services, LLC

Jonathan Phillips Immediate Past President GE Healthcare Financial Services

Chris Clark, CPA Vice President BKD LLP

Natalie Erchinger, BSW Secretary Baylor Scott & White Health

Rick Humphrey FHFHA, CPA, THA Tresesurer Texas Health Resources

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COMMITTEE BLOCKS

Looking to become more actively involved in the Lone Star chapter? Member Activation Day (MADCAT) is coming September 2

2016-2011 Committee Chairs

Newsletter If you would like to contribute articles for consideration in

the upcoming newsletters please submit by September 9, 2016 November 11, 2016 February 10, 2017

April 7, 2017

PROGRAM Tim Nese MEMBERSHIP Jeanna Adler NEWSLETTER Sherry Witzman SPONSORSHIP Natalie Erchinger SOCIAL MEDIA Tammy Ormuz DCMS Contact Chris Joiner

FOUNDERS CONTACT Rick Humphrey CERTIFICATION James Foster LINK Elizabeth Pulliam

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The Twitter-Asthma Pulse Researchers in Dallas use Social Media to Predict Increases in ED visits.

By: PCCI Staff A recent study shows that tweets on social media can be a useful tool to predict – and prevent – in-creases in asthma emergencies. For the study, researchers in Dallas collected tweets posted between October 2013 and June 2014 and narrowed them down to those that originated in the DFW area and also mentioned asthma at-tacks. During the same time period, incidences of asthma-related emergency department visits and hospitalizations across the region were recorded. Researchers found that when the number of asthma-related tweets increased in a given week, the number of asthma emergency department visits or hospitalizations increased significantly during the following week, “If the number of asthma related tweets increased by 20 in a give week, for example, we would ex-pect asthma-related emergency department visits or hospitalizations to increase by 12 the next week,” said lead researcher Yolande Pengetnze, MD of PCCI. “These finding can change the way health departments and other healthcare stakeholders monitor asthma activity in a community.” Currently, asthma activity in a community is usually measured after emergency department visits or hospitalizations have already occurred. “Using real time Twitter activity,” she said, “health depart-ments could actually anticipate asthma ED visits or hospitalizations in the following days and possi-bly intervene before some of them occur.” “Our research is innovative and unique because it harnesses the power of Big Data from social media and other sources to address the problem of anticipating emergency department visits for a chronic condition, in this case Asthma, in close to real-time conditions.” Said study co-author Sudha Ram, PhD, “We believe this work paves the way to address signal extraction and prediction for other chronic conditions.” The work at PCCI was supported in parts by the National Center for Advancing Translational Sci-ences, National Institutes of Health, and the W.W. Caruth, Jr. Foundation at Communities Founda-tion of Texas. About PCCI PCCI is a non-profit research center in Dallas, Texas on a mission to reimagine and expand the knowledge-base of healthcare delivery in the age of machines. PCCI uses scientific research and ap-plied analytics to improve the quality, efficiency and experience of healthcare, at Parkland Health & Hospital Sytsem, and beyond. For more information, visit pccipieces.org or follow @pccipieces.

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NEW MEMBERS AS OF JUNE 2016

Sherry Ost

Lindsey Burris Corporate Healthcare Banker-AVP Legacy Texas Bank

Shawnalee Olmeda Auditor Baylor Sco & White Health

Wendy L Dunlap Director, Compliance and Privacy Texas Health Resources

John Denton Manager of Business Development MediGain

Adam Lowe Manager of Business Development MediGain

Lakshmi N. Koteeswaran Associate Director ZeOmega, Inc.

Colby Corbe Accountant Cook Children's Health Care System

Aaron B. Peterson Director of Finance

Gary Anthony Managing Director, Popula on Health Huron Consul ng Group

Omar Jenkins Chief Finance Officer HCP

Leo Smith Commercial Ban king Officer Commerce Bank

Teresa Nash Hampton, CRCR Senior Director Revenue Cycle Fresenius Medical Care

Richard P. Harvey Health System Execu ve CHRISTUS Health Transferred from 038

Brian Clubb Vice President,, Product Management MedAssets Transferred from 008

Jon D. Alford, FHFMA, CPA, CSAF Chief Finance Officer Denton Regional Medical Center (HCA) Transferred from 008

Vicki A. Pascasio, FACHE President/CEO TMSI/Texas Organiza on of Rural Community Hospital Transferred from 069

Jus n Toson Vice President-Financial Services Account Man-ager Clinical Analy cs Transferred from 069

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The Uncertain Nature of Current Cost Report Instructions & S-10 Compliance

In its fiscal year (FY) 2014 Final Rule, the Centers for Medicare & Medicaid Services (CMS) acknowl-edged that information reported on Worksheet S-10 (S-10) is inaccurate throughout the industry. Howev-er, the FY 2017 Proposed Rule stated that S-10 information correlates to IRS Form 990 and is more con-sistent between years than Medicaid and Supplemental Security Income data. While this may be true, it’s important to highlight that information reported between hospitals can be inconsistent.

The inconsistency partly stems from the current cost report instructions, which are confusing or don’t align with practical reimbursement principles. Hospitals are challenged to interpret cost report instructions while remaining compliant with the intentions of reporting accurate uncompensated care costs.

The example chart below examines cost report instructions in relation to charity, bad debt, patient pay-ments and uncompensated care and calculates portions of the S-10 according to current cost report in-structions for a non-Medicare patient with the following criteria:

$20,000 total charges $2,000 deductible $800 charity write-off $750 patient payment $450 bad debt write-off

The chart illustrates multiple ways in which cost report instructions can lead to potential issues:

Charities, bad debt and patient payments not reconciling to the patient responsibility Incorrect reporting of uncompensated care cost (red)

Noncompliance with Medicare requirements (orange)

Chart Option One

Current cost report instructions lead many professionals to record amounts represented in this scenario; however, two critical issues arise:

Cost of charity care is negative Cost of uncompensated care is understated

Hospitals with a sliding scale charity policy where patients often pay on an outstanding balance are the most susceptible to understating cost of charity.

Chart Option Two

Cost report instructions for line 20 state that for patients with insurance, the amounts to report are “the

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deductible and coinsurance payments required by the payer.” However, the patient's initial payment obliga-tion could be interpreted to be only the portion approved for charity. The potential problem with this op-tion is that the cost of charity and uncompensated care is negative.

Chart Option Three

This approach is similar to option two; however, in an attempt to resolve the noted potential problem of understating uncompensated care costs, it records patient payment amounts on Line 22 in violation of cost report instructions. In theory, the patient didn’t make a payment on an amount qualified for charity. The potential problem with this option is that CMS requires providers to record amounts using literal interpre-tation of instructions.

While this option doesn’t appear to comply with current cost report instructions, the goal of accurately re-porting uncompensated care cost for the patient might be best represented under this methodology.

Conclusion

This example highlights the importance of CMS clarifying S-10 instructions or revising the form entirely. In the meantime, hospitals are tasked with completing the worksheet to the best of their ability. BKD’s ap-proach to completing S-10 includes analyzing patient-level detail and categorizing amounts, which would allow hospitals to adapt to the likely upcoming revisions in the CMS Final Rule. Quantifying amounts using various interpretations would allow hospitals to meet CMS requirements and document potential appeal op-portunities or re-openings as necessary. The July 15, 2016, Centers for Medicare & Medicaid Services Transmittal 1681 attempted to solidify the time frame for updating federal fiscal year (FFY) 2014 cost report information that can impact proposed FFY 2018–2020 Medicare Disproportionate Share Hospital reimbursement. The transmittal states that hospitals must submit revised Worksheet S-10 (S-10) information on amended cost reports by September 30, 2016, to

be included in the FFY 2018 calculation.. BKD National Health Care Group regularly collaborates concerning uncom-pensated care reporting and will continue to do so as CMS directives evolve. We’re actively working with numerous organizations on uncompensated care reporting. CMS has been clear for many years it intends to eventually use S-10 information for uncompensated care payments, and that certainly seems close to becoming a reality.

Contact your BKD advisor for information regard-ing the revision’s potential impact on your reim-bursement and how you can prepare .

The Uncertain Nature of Current Cost Report Instructions & S-10 Compliance

Author: Michael Thomas Director BKD

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Career Strategies: Effective Communication— Avoiding the Apocalypse NfN Jul2016

JOSEPH ABEL, CPCC, ACC, PHD DIRECTOR, CAREER SERVICES, HFMA

Success in the workplace requires teamwork and effective collaboration. The foundation of effective team-work and cooperation is the ability to handle disagreement and conflict.

Disagreement and conflict may be expected in any relationship. Conflict is actually normal. Ideally it can serve people with different needs and interests who work together. It is how conflict is handled that deter-mines a relationship’s success.

There are clear signals of distress in relationships. University of Washington researcher John Gottman uncov-ered four clear indicators of relationship failure that he’s dubbed the “Four Horsemen of the Apocalypse.” The presence of any of the four Horsemen indicates the conflict is not being dealt with constructively or pro-ductively. Below is a brief summary of each of the horseman.

The First Horsemen: Criticism

Criticism is not the same as providing constructive feedback. Criticism in its most troubling form focuses on the individual's personality, character, style, and interests rather than specific actions or behaviors that may need to be changed. This is, in effect, simply going after someone.

In offering feedback it is helpful to plan ahead. Make sure that what you are going to say is constructive. It’s best to focus feedback on a single specific behavior. Feedback is never given on a person’s personality or character. Criticism is appropriately directed to processes and outcomes not “flesh and blood.”

The Second Horsemen: Contempt

Contempt is open disrespect of others. Contempt often involves comments designed to take another down, embarrassing them. Contempt can embrace indirect forms such as rolling the eyes or attempting to wrap in-sults in humor.

The root of contempt is lack of interest in others. If this lack of interest is unavoidable in the relationship, the relationship may be in peril. There then needs to be focus on managing the relationship itself. People who manage relationships well understand the benefits of connecting with many different people. Common ground is a commodity to be sought and cherished.

The Third Horsemen: Defensiveness

Denying responsibility, making excuses, deflecting negative feedback to another, is problematic because the defensiveness prevents reaching any resolution to problems. Defensiveness accelerates anxiety and tension. The focus here needs to be on understanding the other person's perspective so you can work towards mutual ground. Yes, you must be calm and open-minded.

The Fourth Horsemen: Stonewalling

Stonewalling is shutting the discussion down by refusing to respond. Examples of stonewalling include feigned certainty, emotional distancing, and physically walking away from conversations with others. It is problematic in that it aggravates the person being stonewalled and is NOT a solution to conflict.

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Career Strategies: Effective Communication— Avoiding the Apocalypse NfN Jul2016

The key to overcoming stonewalling is to participate in the discussion. If need be, ask the other person for the time you need to reflect and utilize that time. Maintain eye contact and a forward position. Bring the other person into the discussion and listen. Remember, participating in discussion and working together to resolve the conflict are the only ways to keep the relationship from crumbling.

Keep Horsemen from Taking Control

There is a very simple technique for effectively addressing conflict. Gottman states that the technique is natu-ral and is present in all conversations. It is known as a "repair bid."

A repair bid is any pause or break that allows refocusing the conversation. It is an attempt to restore equilibri-um. A repair bid can be anything from a pause and down-cast eyes to silence to suggesting a compromise to using humor to break the tension to voicing respect for the other party. Conversations can get off-track. When it’s off-track it is time to refocus and fix the situation. The power of the repair bid is that it can be a deliber-ate, conscious choice to step back, assess the situation and begin the repair work.

In choosing to employ strong communication skills, you send the signal that you believe other people are im-portant to you, you respect what they can do, and you put relationships ahead of self-interest.

Relationships can become strained with discord. The solution however is simple and a matter of choice—communicate.

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Cardiac Arrest– Early Detection Could Save Your Hospital’s Bundle

Providers waiting for the right time to transition to value-based care got the sign they were waiting for: The Centers for Medicare & Medicaid Services (CMS) has proposed a mandatory Cardiac Rehabilitation (CR) Incentive Payment Model. Under the model, hospitals will be held financially accountable for an anchor hospitalization and 90 days of post-acute care. The announcement comes on the heels of the Comprehensive Care for Joint Replacement (CJR) model and requires a similar system of data-driven risk management. The impact of CR will be larger than the bundle for hips and knees, affecting 98 randomly selected metropolitan statistical areas (MSA). The CR bundles are set to begin on July 1, 2017.

Heart disease is a leading cause of death in the U.S.; the American Heart Association estimates more than $316 billion in direct and indirect costs for treating cardiovascular disease and stroke in 2014. The CR In-centive Payment Model proposal underscored the need for improved clinical and financial outcomes by stat-ing that “the cost of treating patients for bypass surgery, hospitalization, and recovery varied by 50 percent across hospitals, and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50 percent.”

Hospitals looking to succeed in tomorrow's reimbursement model will need to enhance their data analytics ca-pabilities, develop stronger post-acute networks and align physicians to achieve desired results. BKD’s dedi-cated team of advanced payment model leaders understands the challenge of changing reimbursement and is prepared to assist you. Visit our Health Care Payment Reform Resource Center to learn more about our Out-comes Compass™ services.

Proposed Rule FAQs

Which hospitals will participate in coronary artery bypass grafting (CABG)?

Hospitals in 98 MSAs will be mandated to participate in the cardiac bundle—rural counties will be exclud-ed, and rural hospitals will have additional protections to limit the financial risk.

What patients are eligible for the new bundle?

The new bundle will apply to Medicare patients admitted for heart attacks and bypass surgeries. The CR bundle will include acute myocardial infraction (AMI) (Diagnosis-Related Groups (DRG) 280–282), percu-taneous coronary intervention (PCI) (DRGs 246–251)*, CABG (DRG 231–236) and surgical hip/femur frac-ture treatment episodes.

* PCI DRGs only will be included when the claim has an AMI diagnosis code in the principal or secondary position on the inpatient prospective payment system claim.

How is the cardiac bundle set up?

The cardiac bundle is similar to CJR—it will hold the hospital accountable for cost and quality of care for the entire 90-day episode. Hospitals will receive a fixed target price for each episode and have the opportuni-ty for gainshare savings if they are under the target price at the end of the performance year.

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Cardiac Arrest– Early Detection Could Save Your Hospital’s Bundle

How does this proposed mandate impact the Medicare Access and CHIP Reauthorization Act of 2015’s (MACRA) proposed rule?

Both CJR and the cardiac bundle allow physicians to potentially qualify under the Quality Payment Program for Advanced Alternative Payment Models (APM). This is positive news for physicians and hospitals look-ing to engage physicians in the quality redesign process, because it allows physicians to earn additional lump-sum bonuses during the first two years and bypass the sustainable growth rate formula.

What is the future of bundled payment models?

CMS indicated it plans to launch a voluntary bundled payment program in 2018 that also could potentially qualify as an APM under MACRA. Bundles are attractive to CMS because risk (target prices) easily can be measured and modulated based on performance. Providers should begin preparing for commercial bundles that adopt Medicare definitions and pricing mechanics.

Contact your BKD advisor for more information on successfully navigating bundles.

Author: Eric Rogers Managing Consultant BKD

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Upcoming Calendar of Events

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CHAPTER CHATTER

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Sponsorship

The Lone Star HFMA Chapter offers chapter level and statewide level sponsorship opportunities. Sponsorship dollars and participation en-able our Chapter to meet our charter objective of providing quali-ty education to the healthcare business community. Sponsorship opportunities are provided at Gold, Silver and Bronze levels. Sponsors gain visibility at chapter educational and networking events, brand recognition on collateral materials and online, and have the opportunity to provide input into chapter programming. The three Texas HFMA chapters, with more than 2,200 members collectively, have teamed to offer statewide sponsorship opportunities that provide spon-sors discounted rates and the ability to ex-hibit at the annual Texas state meeting. For more details on becoming a sponsor, please contact the Lone Star sponsorship chairs listed below. Sponsorship Committee Chair Natalie Erchinger nerchinger@BSWHealth.org

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GGOLD

SPONSORS

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BBRONZE

BESLER Consulting HCFS, Inc.

MDSave Medical Data Systems

Protiviti Resources Corporation of America

Triage Consulting Group

Apex Revenue Technologies Apogee Consulting Group

Cardon Outreach Connance, Inc. Getix Health

Healthcare Payment Specialists, LLC Healthcare Resources Group, Inc.

Litmos Healthcare MedA/Rx

Organizational Intelligence ProAssurance SCI Solutions

SPONSORS

SILVER