1 / 45

Managing in a Hybrid System

Presented by Health Management Consultants, LLC Columbia, Maryland 2009. Managing in a Hybrid System. From Treatment Systems with Fee-For-Service Reimbursement. Lessons Learned. Requirements. Leadership Commitment Team Approach Vigilance Flexibility Adaptability Champions

fuller-mccormick
Download Presentation

Managing in a Hybrid System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Presented by Health Management Consultants, LLC Columbia, Maryland 2009 Managing in a Hybrid System

  2. From Treatment Systems with Fee-For-Service Reimbursement Lessons Learned

  3. Requirements Leadership Commitment Team Approach Vigilance Flexibility Adaptability Champions Accountability

  4. Impact on Organization Roles & Responsibilities Service Offerings Service Delivery Documentation Communication Scheduling Staffing Reporting

  5. Roles & Responsibilities Affects everyone’s job duties from receptionist to director Requires clear expectations Requires clear performance expectations Requires support & guidance Tip: Organize “change teams” to promote & monitor implementation

  6. Service Offerings Assess current offerings Review reimbursable services Analyze service needs of consumers Plan continuum of services Expand services to meet demand Tip: Opportunity to add Intensive Outpatient Program

  7. Service Delivery Review client & information flow Incorporate billing & collecting processes into existing operations Assess common service delivery approaches for compatibility with reimbursement requirements Tip: Add elements to screening/intake process to capture needed MA/PAC information

  8. Documentation • Capture service information needed for claim • Utilize existing documentation procedures whenever possible • Individual client records should support/document services delivered Tip: Add data elements required for CMS 1500 in checklist format

  9. Communication • Two – way & circular • Front desk to clinician • Clinician to back office • Back office to front desk • Shared data/file access Tip: Establish regular opportunities for front desk, clinicians, & back office to review processes & performance

  10. Scheduling Track no-shows by service & by clinician Person responsible for scheduling must be knowledgeable of authorizations In order to reach billable service targets, appointments need to be over-booked to compensate for no-shows Tip: Use centralized scheduling

  11. Staffing Against initial instincts, may need to hire clinicians (who can generate billings) Against initial instincts, may need to hire administrative staff (who can prepare & submit bills) Examine need & capacity for licensed clinicians Tip: Consider adding part-time staff

  12. Reporting Establish & communicate targets– verbally & visually Track & communicate progress– verbally & visually Analyze & learn from own experience - CQI Establish regular reporting mechanisms & share with staff Tip: Involve management team in determining reporting requirements

  13. Summary Plan Evaluate Revise Evaluate Acknowledge Achievements Correct/Improve Inefficiencies Apply Continuous Process Improvements Engage Others in Planning & Evaluation Consider Expansion to Private Insurance

  14. REMEMBER Requirements • Leadership • Commitment • Team Approach • Vigilance • Flexibility • Adaptability • Champions • Accountability

  15. An Overview of an Substance Abuse Treatment Agency Financial Management

  16. Typical SA TX Agency Revenue & Expense Statement

  17. Question 1 Why is this clinic losing money? ANSWER Because revenues are less than expenses.

  18. Question 2 Does the Agency need to increase revenues, decrease expenses, or both? How do you decide?

  19. Three primary reasons why Agencies lose money • Difficulties in billing & collecting for services. • Productivity problems. • Current service capacity is too low to support the current infrastructure.

  20. Financial Management Helps to: • Identify what is causing financial difficulty. • Isolate the specific issues that require management attention.

  21. Substance Abuse Treatment Agency Financial Management

  22. Substance Abuse Treatment Agency Financial Management

  23. Key Performance Indicators Collection Rate = Fee-For-Service Collections Fee-for-Service Billings $717,992 $875,600 82.00% =

  24. Substance Abuse Treatment Agency Financial Management

  25. Gross Billings Clinicians Cost (Salary & Fringe) $875,600 $547,250 Key Performance Indicators Multiplier = 1.60 =

  26. Substance Abuse Treatment Agency Financial Management

  27. Total Admin. Salary & Fringe Total Personnel Salary & Fringe $182,417 547,250 + 182,417 = $729,667 Key Performance Indicators Administrative Rate = 25.00% =

  28. Substance Abuse Treatment Agency Financial Management

  29. Total Overhead Costs Total Clinic Costs $128,765 547,250+182,417+128,765 = $858,432 Key Performance Indicators Overhead Rate = 15.00% =

  30. Substance Abuse Treatment Agency Financial Management

  31. Substance Abuse Treatment AgencyFinancial Management REVENUES Gross billings Write-downs/-offs Net Collections Collection rate EXPENSES Clinical personnel costs Multiplier Admin. Personnel costs Administrative rate Overhead costs Overhead rate Net income (loss) % of Gross Billings Actual $875,600 (157,608) 717,992 82.00% 547,250 1.60 182,417 25.00% 128,765 15.00% $(140,439) -16.04% “WHAT IF?” ANALYSIS Break - even $1,017,885 547,250 1.86

  32. Substance Abuse Treatment Agency Financial Management “WHAT IF?” ANALYSIS REVENUES • Gross billings • Write-downs/-offs • Net Collections • Collection rate EXPENSES • Clinical personnel costs • Multiplier • Admin. Personnel costs • Administrative rate • Overhead costs • Overhead rate • Net income (loss) • % of Gross Billings Actual $875,600 (157,608) 717,992 82.00% 547,250 1.60 182,417 25.00% 128,765 15.00% $(140,439) -16.04% Break - even $1,017,885 (122,146) 895,739 88.00% 547,250 1.86

  33. Substance Abuse Treatment Agency Financial Management “WHAT IF?” ANALYSIS REVENUES • Gross billings • Write-downs/-offs • Net Collections • Collection rate EXPENSES • Clinical personnel costs • Multiplier • Admin. Personnel costs • Administrative rate • Overhead costs • Overhead rate • Net income (loss) • % of Gross Billings Actual $875,600 (157,608) 717,992 82.00% 547,250 1.60 182,417 25.00% 128,765 15.00% $(140,439) -16.04% Break - even $1,017,885 (122,146) 895,739 88.00% 547,250 1.86 212,819 28.00%

  34. Substance Abuse Treatment Agency Financial Management “WHAT IF?” ANALYSIS REVENUES • Gross billings • Write-downs/-offs • Net Collections • Collection rate EXPENSES • Clinical personnel costs • Multiplier • Admin. Personnel costs • Administrative rate • Overhead costs • Overhead rate • Net income (loss) • % of Gross Billings Actual $875,600 (157,608) 717,992 82.00% 547,250 1.60 182,417 25.00% 128,765 15.00% $(140,439) -16.04% Break - even $1,017,885 (122,146) 895,739 88.00% 547,250 1.86 212,819 28.00% 134,130 15.00%

  35. Substance Abuse Treatment Agency Financial Management “WHAT IF?” ANALYSIS REVENUES • Gross billings • Write-downs/-offs • Net Collections • Collection rate EXPENSES • Clinical personnel costs • Multiplier • Admin. Personnel costs • Administrative rate • Overhead costs • Overhead rate • Net income (loss) • % of Gross Billings Actual $875,600 (157,608) 717,992 82.00% 547,250 1.60 182,417 25.00% 128,765 15.00% $(140,439) -16.04% Break - even $1,017,885 (122,146) 895,739 88.00% 547,250 1.86 212,819 28.00% 134,130 15.00% $1,539 0.15%

  36. Financial Health

  37. Summary Build an Annual Financial Plan (Budget) Monthly and/or Quarterly Reporting with Variance Track Key Performance Indicators Collection Rate Multiplier Administrative Rate Overhead Rate Produce Regular Management Reports Monitor Key Performance Indicators Weekly reporting of Key Performance issues Monthly reporting against plan

  38. Performance Management To Align Individual Performance with Organizational Goals

  39. Objectives • To Define and Support Organizational Goals • To Plan and Facilitate Change • To Manage and Measure Progress • To Reward Good Performance • Challenge: Assist Staff with Transition from Grants to FFS (Time = Money)

  40. Approaches • Engage Staff – Setting Targets & Measurements • Communicate Objectives – Don’t Forget Quality • Publicize Targets • Measure & Report Progress • Share Strategies of Effective Performance • Celebrate Successes!!!

  41. Substance Abuse Treatment AgencyPerformance Management

  42. Substance Abuse Treatment AgencyPerformance Management

  43. Substance Abuse Treatment AgencyPerformance Management

  44. Strategies • Maximize Group Services • Centralized Scheduling • Track No-Shows by Service & Clinician • Overbook Appointments • Assess Un-billable Time • Share Successful Approaches & Interventions

  45. ???

More Related