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Creating Savings in Anticipation of Reform
by Donald Tapella

February 28, 2012 - Since the inception of the Patient Protection and Affordable Care Act (PPACA), hospitals have become a scapegoat of sorts in the national “debate”, getting caught squarely in the crossfire between those demanding Cadillac healthcare for Yugo prices and simply making enough margin to continue the mission, as the old saying goes.

The drumbeat continues for increased quality, better outcomes, transparent prices and balanced budgets. Meanwhile, hospitals bear the weight of being chastised from every side for uncontrolled costs. Interesting, because the CFOs I know are extremely conscious of every dime earned, spent, saved or lost.

Conspicuously missing from public display is the extreme pressure on hospitals to continually accept less payment for more services, evident in such ways as the continued consolidation of services (bundling), multiple procedure payment reductions and other payment-reducing mechanisms as well as abated increases; Even hospitals with resources allowing for spectacular systems and talent to support, manage and optimize their utilization are heeding the call for increased cost-consciousness. The age of reduced reimbursement is firmly upon us so as a matter of survival, the hospital industry must counter-adapt to Medicare and Medicaid mandates and commercial payers’ self-preservation initiatives.

Real savings has been documented in a various ways: through superior medical management programs (meaning those focused on care efficiencies as opposed to simple cost-containment), improved business processes and reduced materials and personnel cost. The focus here will be on savings through outsourcing. Today’s environment is hostile to the international brand of outsourcing popular with health insurance companies for the past decade - those intended primarily to decrease cost with little or no benefit to the customer; in fact, frequently increasing customer burden under this system. However, outsourcing for the right reasons with the right company can be highly beneficial. Simply stated, outsourcing can significantly raise the bar and decrease cost.

Outsourcing offers many benefits and cost-saving opportunities, such as the instilment of confidence through the efficient and effective implementation and execution of services. Additionally, it will help ensure those services are optimized to achieve maximum benefit for your facility.

Outsource companies bring significant experience and tools to the table. They provide necessary services many providers can ill-afford to perform in-house due to limited resources and the ongoing problem of attracting exceptional talent. A reputable outsource company provides highly experienced industry personnel and cutting-edge tools. And due to inherent economies of scale, outsource companies can make available these services and tools at a fraction of the in-house cost and simultaneously provide outstanding service.

Quote Various outsource companies can even offer an entire department of experienced and talented individuals, sometimes for the price of approximately one full-time-equivalent employee (or less). The resource-strapped hospital benefits by gaining vital services at a decreased cost. Larger, more financially-secure facilities can decrease existing back office personnel costs and other associated overhead. Further, depending upon the degree of outsourcing and the facility’s physical design, outsourcing may even free-up square footage that can be re-purposed for clinical use, thereby turning previous cost-center space into a revenue-generating zone. Savings would then be achieved through reduced overhead and more efficient business process while revenues are increased through higher levels of performance and better space-utilization. These cost-saving and potential revenue-generating efforts can increase the bottom line and create savings that can eventually be passed on to the customer in the form of decreased reimbursement requirements and possibly even result in lower charges. Now that’s real reform.

About Don Tapella
Mr. Tapella has been in healthcare for nearly 20 years and a professional negotiator for over 13 years. He has held positions in account management, marketing and sales, contract negotiation on behalf of payers and providers and hospital business office. Currently he is CEO of Medical Recovery Services, a Revenue Cycle Firm specializing in small community and Critical Access hospitals.

Donald Tapella will present "Negotiating from a Position of Strength" at the 2012 NCHN Conference in Denver, Colorado.

Contact
Donald Tapella
CEO, Medical Recovery Services
Phone: 816-229-4887 ext 111
Email: dtapella@mrsa1.net
Website: www.mrsa1.net

MEMBER BLURBS

Member News

RWHC's Eye on Health - March 2012 issue is available online
The Health Care Collaborative of Rural Missouri (formerly the Health Care Coalition of Lafayette County) is hosting a series of focus groups/community meetings to assist in planning for improved access to health care services in the region.

Maintaining Medicare’s Investment in Rural Health Care
by Tim Size, Rural Wisconsin Health Cooperative

February 24, 2012 (The Rural Health Advocate) - My red, white and blue Medicare card just arrived. The colors are nice but it would be fine with me to not yet be old enough. In any event, I am now officially an advocate for a rapidly growing number of aging geezers as well as rural providers and rural communities. This is a comfortable role as Medicare depends on us melding all three of these perspectives.

We know that rural health care is vitally important to both the physical and economic health of rural America. We know that business decisions to start, grow or relocate are influenced by the availability of local health care. Rural health care means rural jobs.

But we less often think about the economic impact of rural health care as a major export commodity. I don’t mean doctors flying to exotic locations to provide health care. I mean that local health care drives a rural community’s economy just like its export of milk, corn, soybeans or manufactured goods.

Coastal Carolinas Health Alliance Announces 2012 Alliance Day

February 21, 2012 (Coastal Carolinas Health Alliance) - Coastal Carolinas Health Alliance is excited to announce the date and location for our 2012 Alliance Day celebration! This year’s event will take place on Friday, November 2, 2012 at the Hilton Wilmington Riverside hotel in Downtown Wilmington, North Carolina. CCHA is a non-profit organization working together with our member hospitals to promote stellar member performance and mutual success, while focusing on local and regional healthcare issues. For more information, contact Ashley Bell at 910-332-8017 or abell@coastalalliance.org

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UPCOMING EVENTS

HIT Standards Committee Advisory Meeting; Notice of Meeting

February 29, 2012
9:00 AM - 3:00 PM EST
U.S. Department of Health and Human Services
Omni Shoreham Hotel
2500 Calvert Street NW.
Washington, US, 20008

Procedure: Interested persons may present data, information, or views, orally or in writing, on issues pending before the committee. Written submissions may be made to the contact person. Oral comments from the public will be scheduled between approximately 11:30 a.m. and 12:30 p.m./Eastern Time. Time allotted for each presentation will be limited to three minutes each. If the number of speakers requesting to comment is greater than can be reasonably accommodated during the scheduled open public hearing session, ONC will take written comments after the meeting until close of business.

RCA: The Path to 4G for Rural and Regional Carriers: The Need for Interoperability
Rural Cellular Association

Webinar: March 1, 2012
1:00 - 2:00 PM Central

iGR Partners With RCA to Deliver Educational Webinar Series to Discuss Key Issues Facing U.S. Rural Operators

Skilled Nursing Facility (SNF)/Long Term Care (LTC) Open Door Forum
CMS

Conference Call: March 1 @ 2:00 PM ET
Dial: 1.800.837.1935
Conference ID: 27269788

NQF Webinar: Community Tool to Align Measurement
National Quality Forum

Webinar: March 7, 2012
1:30 - 3:00 PM ET

A new tool developed by the National Quality Forum (NQF) can help you align, expand, or start your measurement and public reporting efforts in ways that fit with key national programs. Reap the benefit of learning from others engaged in similar work across the country.

Step by Step: Starting A Telehealth Program
Telehealth Resource Centers

Webinar: March 15, 2012

The TRC Webinar Series provides timely information and demonstrations to support and guide the development of your telehealth program by experienced telehealth professionals from the HRSA-designated Telehealth Resource Centers (TRCs).

The Benchmark for Excellence in Patient Safety™ Program
Clarity

Webinar: March 22, 2012
10:00 - 11:00 AM CDT

Join Clarity and your fellow small and rural providers for this free webinar to learn more about the National Benchmark for Excellence in Patient Safety™ Program specifically designed for critical access, small and rural healthcare organizations. The webinar also introduces the Healthcare SafetyZone® Portal, the web-based patient safety event management system that your colleagues are currently using at their facilities.

HRSA Health IT & Quality Webinar

Using Health IT for Patient Safety

March 23, 2012 @ 2:00 PM EST

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NATIONAL NEWS

Secretary Sebelius Announces Next Stage for Providers Adopting Electronic Health Records

February 27, 2012 (RAConline.org) - Health and Human Services Secretary Kathleen Sebelius has announced the next steps for providers who are using electronic health record (EHR) technology and receiving incentive payments from Medicare and Medicaid. These proposed rules, from the Centers for Medicaid & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), will govern stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs.

States, Governors Have Different Views On Exchanges, Impact Of Health Law
News compiled by Kaiser Health News

February 27, 2012 (kaiserhealthnews.org) - This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations.

The New York Times: Many States Take A Wait-And-See Approach On New Insurance Exchanges
The Washington Post: Governors Split Over Effects Of Obama's Health-Care Law
KQED's State of Health blog: High-Risk Insurance Pool Helps … But What About Cost?
Related, earlier KHN story: 9 States Seek Help For High-Risk Pools
Kaiser Health News: Capsules: By The Numbers: Wisconsin's High Risk Pool

» VIEW ONLINE

CMS releases Stage 2 proposed rule on Meaningful Use of EHR

February 27, 2012 (HealthReformGPS) - The Centers for Medicare & Medicaid Services (CMS) released a proposed rule for Stage 2 requirements for the Medicare and Medicaid electronic health record (EHR) incentive programs. The proposed rule outlines the “meaningful use” criteria for eligible providers and hospitals. If executed, the proposed rule would increase requirements for the recording of electronic health information in a structured format, as well as increase the requirements for information exchange between providers at care transitions. ...Eligible hospitals and critical access hospitals (CAHs) would have to meet, or qualify for an exclusion to, 16 core objectives and two of four menu objectives.

Why Primary Care is Often Not a Consideration for Medical Students
by John Corker

February 27, 2012 (nextgen Journal) - The Association of American Medical Colleges’ Office of Workforce Studies projects by 2015 — the year after the Patient Protection and Affordable Care Act is scheduled to add approximately 32 million patients to the ranks of the insured — we will have 63,000 fewer physicians than we need in the United States.

If nothing is done to address this critical shortage, then that number is projected to reach an astounding 130,600 by 2025. Unfortunately, as of this time one year ago, these “projections” had already become reality for 22 states and 17 medical societies across the country.

Related
Americans facing a shortage of primary care doctors (Feb. 22, 2012, KFVS12.com)

National Advisory Council on the National Health Service Corps; Request for Nominations

February 24, 2012 (Federal Register) - The Health Resources and Services Administration (HRSA) is requesting nominations to fill five vacancies on the National Advisory Council (NAC) on the National Health Service Corps (NHSC). The NAC on the NHSC was established in 1978.

...HRSA is requesting nominations for individuals with a background in primary care, dental health, and mental health, representing the following areas of expertise: Working with underserved populations, health care policy, recruitment and retention, site administration, customer service, marketing, organizational partnerships, research, and clinical practice. We are looking for nominees that either currently or have previously filled a role as site administrators, physicians, dentists, mid-level professionals (i.e., nurses, physician assistants), mental or behavioral health professionals, and NHSC scholars or loan repayors. Nominees will be invited to serve a 3-year term beginning after July 2012.

The agency must receive nominations on or before March 28, 2012.

HHS Announces New Assistance to States: More Resources, Transparency, and Flexibility

February 22, 2012 (CMS.gov) - Today, HHS Secretary Kathleen Sebelius announced more assistance to states as it implements three new provisions of the Affordable Care Act. Today’s announcement gives states help by:

Providing a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces;
Promoting transparency and meaningful public input into the Medicaid demonstration process, and streamlining the federal-state consideration process as states test new models of care;
Supporting innovation and implement the health care solutions that work best for them.

Best places to be a nurse: Rural vs. urban hospitals
by Sean Dent

February 23, 2012 (scrubsmag.com) - Over the years I’ve learned a few things. While working as a nurse in a particular unit is fairly straight forward across hospital systems, the type of hospital can make quite the impact on your job.

When job seeking, whether a new nurse landing their first job, or the seasoned nurse looking for a change, it helps to be aware of some important distinctions and differences between the small rural hospitals and the large, sometimes massive, urban hospitals.

Beacon Grants Boost HIT, Patient-Centered Care
by Greg Freeman

February 27, 2012 (HealthLeaders Media) - Millions of dollars continue to flow from Washington, DC, to communities across the country in the form of grants to so-called Beacon Communities, intended to serve as pilots and role models for how health information technology can be used to improve quality and care coordination. The federal government announced recently the award of $220 million to another 15 communities, and earlier recipients are reporting that the money can make a difference.

House OKs bills luring health workers to rural SD
Associated Press

February 23, 2012 (WFAA.com) - South Dakota's House has passed two bills in an effort to help end the shortage of medical professionals in rural counties.

One bill allows doctors or dentists who work at a rural facility for three years to get reimbursed for double the cost of attending the University of South Dakota School of Medicine for four years.

Related
South Dakota WINS will improve health care (Feb. 27, Rapid City Journal)

Are meaningful use bonuses enough to drive EMR adoption?
by Pamela Lewis Dolan

February 22, 2012 (amednews.com) - A policy report says no, and explains what needs to happen to ensure that health information technology nears its potential.

If a health system made up of accountable, coordinated, patient-centered care is to be achieved in the U.S., the existing information technology infrastructure is not enough to get the country there, according to a report by the Bipartisan Policy Center.

Health Affairs Policy Brief on the Prevention and Public Health Fund

February 27, 2012 (Robert Wood Johnson Foundation blog) - A new policy brief from Health Affairs and the Robert Wood Johnson Foundation looks at the Prevention and Public Health Fund created under the Affordable Care Act of 2010. The fund was originally authorized to spend $15 billion over its first ten years, but will be cut by a third under an agreement between the White House and Congress to finance an extension of payroll tax cuts and to forestall Medicare payment cuts for physicians. Some members of Congress think the Fund should be eliminated.

FUNDING

Telehealth Network Grant Program
HRSA

Purpose: This announcement solicits applications for the Telehealth Network Grant Program (TNGP). The primary objective of the TNGP is to demonstrate how telehealth programs and networks can improve access to quality health care services in rural and underserved communities.

Grants made under this authority will demonstrate how telehealth networks improve healthcare services for medically underserved populations in urban, rural, and frontier communities. TNGP networks are used to: (a) expand access to, coordinate, and improve the quality of health care services; (b) improve and expand the training of health care providers; and/or (c) expand and improve the quality of health information available to health care providers, and patients and their families, for decisionmaking. However, as noted below, because of legislative restrictions, grants will be limited to programs that serve rural communities, although grantees may be located in urban or rural areas.

Applications are due by April 13, 2012.

Related
Telehealth Resource Center Grant Program (posted 2/24/12; due 4/20/12)