Florida Office of Rural Health

1. Florida Office of Rural Health Weathering the Storm: Survival Education & Resources Florida SHIP & FLEX Programs 2012-2013

2. Florida Office of Rural Health • Weathering the Storm Take-aways: • Appreciation for what CAH & small PPS hospitals are facing in the near future • Know where to find HTH/HTHU resources • Know which tools/resources* will assist in identifying & prioritizing the issues that your organization must be pro-active in preparing for • Meet the business partners in attendance* • Hospital Strength Index report • ICD-10 is a big deal (Oct. 1, 2014) • Are you an attractive partner?

3. Todays Forecast • Todays Forecast: • Stormy • Value Based Purchasing (PPS) • Decreasing market share • Low days-cash-on-hand* • High patient deductions* • High salaries to net patient revenue* • Low outpatient cost to charge* • RACs/medical necessity

4. Tomorrows Forecast • Tomorrows Forecast: • Stormy (possibly severe) • Value Based Purchasing (CAH) • ICD-10 • DSH payment reductions • Readmission rates & penalties • EHR mandates • ACOs ? • Medical staff recruitment • Unintended consequences of PP&ACA

5. What You Will Need for Today • Resources for Todays Storm: • Value Based Purchasing • Quality of Care • Clinical domain (ED and surgery) • Adding outcomes in FFY2014 • Implementing best practices/pathways • Thrombolytic on arrival for heart attacks • D/C instructions for CHF patients • Blood cultures for PN patients • On small sample sizes, adherence is KSF • HCAHPS • EVERY PATIENT ENCOUNTER MATTERS

6. What You Will Need for Today • Resources for Todays Storm: • Value Based Purchasing • Quality of Care • VBP calculator (HTH website) • Useful with Board & Med Staff • Clinical dashboard (HTH website) • Useful with Board* and Med Staff* • HTHU

7. What You Will Need for Today • Resources for Todays Storm: • Value Based Purchasing • HCAHPS • VBP calculator • Press-Ganey agreement • Flexible and offers many more tools • HTHU HCAHPS & VBP courses • SHIP gets 10 seats

8. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • Hospital Strength Index • Financial & Operational Assessment Tool • SWOT Analysis • Improvement Scenarios

9. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • Hospital Strength Index • Market, VBP & financial strengths • Webinars (2nd Tuesday of month at 10 EST) • Data in folder (tomorrow) • Do not let this collect dust.

10. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • Financial & Operational Assessment Tool • 6 section assessment that concludes with strategic recommendations. Includes SWOT • HTH website/clinical services tab • Different than HSI. This is the how & why & what to do to improve competitiveness • SWOT analysis*

11. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • Financial & Operational Assessment Tool • To survive and thrive, you must be willing to ask and answer: • how will you defendyour market position, how will you improveyour market position*, how will you respond to a changing healthcare industry and competitive conditions/forces and do you have a distinctive competence?

12. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • Improvement Scenarios • HTH website/clinical tab • Pick and choose model providing a framework for asking questions that lead to change • Very delegatable • Designed to actually be used • Planned P&P repository

13. What You Will Need for Today • Resources for Todays Storm: • Financial Strength and Market Position • RACS & medical necessity • What tool do your case management coordinators/staff use to determine medical necessity criteria? Is it out of date? • McKesson agreement for InterQual • Do you use PEPPER Resources? • Program for Evaluating Payment Patterns Report • Medicare discharge stats for vulnerable to improper payments. • CAH section

14. Todays Forecast QUESTIONS ?

15. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • Value Based Purchasing • Carrot, probably no stick • Likely to be grouped by peer ADC number • Likely no AMI • Likely to keep achievement vs improvement • 2015?

16. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • ICD-10 (HTHU website) • Webinars (1/7/13) • ICD-10 implementation program • $750/month (if signed up by Jan 31) • Track 1 starts April 2013 • Sept 18-20, ICD-10 bootcamp in Macon • SHIP grant $ can be used in 2013-14

17. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • Readmission rates & penalties • Do you know your readmission rates for: • PN & CHF • Be proactive • Quality dashboard • Does your medical staff know their readmission rates • Based on data from the Federal Register, vol. 77, no. 170: • 22% of the 3,393 participating PPS hospitals received a negative adjustment of >/= .70 percent

18. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • DSH payment reductions • Have you calculated you liability? • For some, this could be the end, if a plan to improve (make-up the DSH shortfall) net revenue is not successfully implemented.

19. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • EHR mandates • Previous speaker

20. What You Will Need for Tomorrow • Resources for Tomorrows Storm: • (Un)intended consequences of PP&ACA • Some 20 million people that will be uninsured • Exacerbation of healthcare worker shortage • Unionization of healthcare workers • ? ? ?

21. Resource Central • www.hometownhealthonline.com • Clinical services tab & enter password • www.hthu.net • 10 seats as part of SHIP grant

22. Resource Central Contact Info: Lou Semrad, Clinical Services 706-474-0434 Lsemrad@gmail.com Kathy Whitmire, Managing Director kfw@windstream.net Jimmy Lewis, CEO theleadershipgrp@mindspring.com

23. Resource Central • There are 24 hours in a day. Add the night and you should have enough time to finish your work.

24. Tomorrows Forecast QUESTIONS ?