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A Storm Approaches

A Storm Approaches. Peggy and Hugh Greeley HG Healthcare Consultants LLC. Multiple Storm Fronts. Hospital financial position Federal proposals to reform system Physician practice patterns changing Regulatory activism (TJC) Legal climate Economic situation MS leadership burnout.

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A Storm Approaches

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  1. A Storm Approaches Peggy and Hugh Greeley HG Healthcare Consultants LLC

  2. Multiple Storm Fronts • Hospital financial position • Federal proposals to reform system • Physician practice patterns changing • Regulatory activism (TJC) • Legal climate • Economic situation • MS leadership burnout

  3. Hospital Financial PositionFalling • Total Median Margin at Zero: an unprecedented low. • 50% of all hospitals are in the Red: Read that to mean “unprofitable.” • Growth in Reimbursement Rates Shrinking: Payments from all insures growing at a declining rate through the end of 2008. • Credit Crunch, hospitals running out of cash: Hospitals' median cash-on-hand reached an historic low. • Stable Operations: Potential recessionary impacts that are not yet seen in the data include bed closures, layoffs, declines in patient volumes and elective procedures.

  4. Reform Proposals • Creation of public insurance plan option • Bundling of payments to hospitals • Incentivizing physicians to pursue Continuous competency certification programs • Toughening procedures for participating in Medicare if a provider. • Linking payment to quality

  5. Reform Proposals • Moving from Fee for service to payment for accountable care • Transparency and modification of rules for physician ownership of healthcare facilities. • Enhanced public integrity program components. (Qualifier.net) • Evidence based medicine • http://www.finance.senate.gov/sitepages/leg/LEG%202009/042809%20Health%20Care%20Description%20of%20Policy%20Option.pdf

  6. Additional reform activitiesThe Congressional Budget Office • http://www.cbo.gov/doc.cfm?index=9925 • CBO projects that, without any changes in federal law, total spending on health care will rise from 16 percent of GDP in 2007 to 25 percent in 2025 and close to 50% in 2082; net federal spending on Medicare and Medicaid will rise from 4 percent of GDP to almost 20 percent over the same period.

  7. Physician Practice Patterns • Shift to ambulatory practice. • Shift to hospital employment. • Movement away from volunteerism. • Decline in % of MS members involved in hospital care. • Rise in entrepreneurial interest.

  8. Regulatory ActivismTJC, HFAP, DNV • Requirements without resources • FPPE • OPPE • Competency verification • Credentialing • MS role and responsibility

  9. Legal Climate • Poliner http://www.jpands.org/vol13no4/poliner.pdf • Frigo V. Silver Cross Hospital IL. Ap.ct.2007 • Hamrick http://www.wvjusticewatch.org/news/display_news.cfm?ID=247 • UMC SN

  10. Economic Situation • Banks in distress. • Chrysler Bankrupt. • GM owned by US government. • Foreclosures at all time high. • Unemployment nearing 10%. • 50+ million with no insurance. • Credit card debt soaring.

  11. MS Leader Burnout • Been there done that. • Not me, I have important things to do. • No way. • Don’t have time to attend. • Don’t come to hospital anymore. • It’s far too complicated.

  12. The Storm Is Here. Questions? Tools!

  13. Blueprint For Success • Your Aspired Development • Your Professional Cornerstone • Your Tools • Barriers

  14. Choosing Accreditation Options • There are options • Selecting none is an option. • TJC • HFAP • DNV

  15. Preparing a Compelling Cost Benefit Analysis • Diminishing resources • No profit • Increased scrutiny of all expenditures • Projects put on hold • No travel • Etc.

  16. A CBA • Calculates and compares benefits and cost of a project • To determine if a project is a sound investment • To compare alternatives

  17. Cost Benefit Analysis • Time consuming • Expensive (time = money) • May not need justification if… • Project is required • Priorities already established • Deficiencies have been identified • Expenditure is below a threshold

  18. Consider a CBA When • The cost of a project is large enough to warrant spending the time and money to forecast, measure and evaluate the benefits and impacts • The purpose of the expenditure is to improve the ability/efficiency of the Medical Staff Office to carry out responsibilities (or to add additional services) • The project has articulated benefits but previously hasn’t been measured or there has been some intangible benefit

  19. Examples of When to Complete a CBA • Software that improves the speed of the credentialing process or the accuracy of practitioner data • Teleconferencing capabilities • Reduce physician time in meetings • Obtain more input from physicians • Equipment that will reduce the need for filing cabinets, space, etc. • Add an employee for a new function in the Medical Staff Office • Something that is not in the budget • When your boss requires you to do one

  20. Include in a CBA • Purpose and effort • Goal or problem to be addressed • Benefits • Project information • Who will benefit • Who will be impacted • Who will incur direct and indirect costs • Alternatives, including doing nothing • Project schedule • When will costs be incurred • When will benefits be realized

  21. Include in a CBA, cont. • How will the project be evaluated • Cost benefit ratio • Internal rate of return • How will the analysis be used? • To determine if a project should be undertaken • To establish priorities • To determine how a project should be done

  22. Project Costs • Include • Assessment costs • Acquisition costs • Installation costs • Orientation and training • Ongoing maintenance • Space • Utilities

  23. Your Assignments • Selecting your accreditation option. Rely upon State Licensure only Continue to seek accreditation Chose from among various vendors What are the various ROIs (Licensure, TJC, HFAP, DNV)

  24. Your Assignments… • Privileging Project • Privileges haven’t been updated since 1992 • Laundry lists • No criteria • No FPPE • The Joint Commission is expected in 2010 • The MSO is aware of privileging deficiencies, but the organization has never been cited for poor privileging or competency systems

  25. Your Assignments… • Establish a CVO for a 10 hospital system that spans 4 states • Currently hospitals use five different types of software • All hospitals doing credentialing on their own • Significant overlap of practitioners across 3 of the hospitals (these hospitals are in close geographic proximity)

  26. Cost Benefit Analysis • Questions, discussion, ultimate use • What is the ROI for the Medical Staff Office?

  27. Medical Staff Models, Options and Alternatives • Regulatory issues: CMS TJC FPPE OPPE Core Privileging issues

  28. Medical Staff Models, Options and Alternatives • Staffing Levels and Time Management Time management Staying Focused Organization Inadequate staffing

  29. Medical Staff Models, Options and Alternatives • Odds and ends Incomplete applications Incorrect info on application Verifying info Lack of applicant response Slow state licensing process Upset applicants. Answer to the above, the Guiding Principles of Appointment. See materials.

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