O perational Transformation of St. Rose Hospital

1. Operational Transformation of St. Rose Hospital Edwin Hernandez Travis Young Natalie Eloskof ChintanSomaiya

2. The Debt

3. STRATEGY OVERVIEW • Improve operations • Physician integration and creating a favorable payer mix • Community outreach

4. Strategic Planning Process SWOT Analysis and Core Competencies Identify Objectives, Major Initiatives & Key Success Areas Implement Strategies & Set Measurable Goals Execute Plan & Assess the Success Rate Identify Effects of External Environment

5. Changing Payer Mix

6. Financial Impact on Hospitals

7. Insurance Profile * Approximately 30% of inpatients receive services out of the area

8. Primary Goal Increase the volume of Insured Patients

9. Financial Profile * Large change found in unaudited and audited numbers

10. Revenue Cycle Imperatives

11. Key Operation Initiatives • Nurse Navigator in the ED informs patients of financial resources • Provide automated pre-admission insurance verification, counseling, and price estimates at registration • Distinguish between charity care and bad debt accounts • Renegotiate contract with Alameda Alliance Health • Re-license suspended beds for pediatric services ( 7- beds) and medical surgical services (10 - beds)

12. Pediatric Services We cannot give Washington Hospital – Fremont the sole responsibility for caring for pediatric patients.

13. Operational Benefits * Source Healthcare Financial Management Association

14. Next Steps

15. Improving Physician Integration Create a sense of urgency Select physician champions to become advocates for the hospital to increase referrals Create and train a physician leadership team

16. Improving the continuum of care • ACA will not pay for readmission • Be proactive • Create bonuses off decreasing readmission rates • Telemedicine and discharge planning • Decreasing readmission rates

17. Readmission rates

18. Physician Leadership Team Goals

19. Creating A Favorable Payer Mix % of Payer Mix PLAN Determine service lines that attract third-party patients

20. Can we Increase utilization? • Analyze cardiology and obstetric departments system issues • Can we increase utilization? Is patient scheduling an efficient process? • Study the demographics • Hispanic -33%, Asian-29%, Caucasian-22% • According to Screenvision.com, 85% of Hispanics go to the movies • Average household income in Alameda County - $75,284

21. Steps to Increase utilization • Improve search engine marketing • Purchase Google ad words associated with cardiology and obstetrics • Create a user friendly website • Make it a 1-2-3 step process to scheduling a patient • Have a number to call for consultation • Create a general inquiry form • Purchase movie screen advertisements for $18/screen • Promote profitable service lines at health fairs • Blood pressure screenings, planned parenting classes, etc.

22. Obstetrics Services CardiacServices • SRH market share (28%) • 1 of 6 hospitals with a Percutaneous Coronary Intervention (PCI) contract in Alameda County • Kaiser-Hayward closing  increased occupancy • Current: 60% capacity • Target: 85% capacity • SRH market share (15%) • 85% of patient discharges are Medi-Cal • Current: 44% capacity • Target: 85% capacity

23. Revenue and Profit • Increasing the Cardiology department capacity from 60 - 85% will bring in $700,000 of revenue • Increasing the Obstetrics department capacity from 44 - 85% will bring in $1.8 million of revenue

24. Measure A Funds • Appeal to Alameda County Board of Supervisors for more Measure A Funds due to • St. Rose Hospital (SRH) • Medi-Cal- 60% (largest amount in county) • 7.6%- indigent care • 2.5%- Measure A funds • Alameda County Medical Center (ACMC) • 76.5%- indigent care • 75%- Measure A Funds

25. Results • Profit • Cardiology: $700,000 • Obstetrics: $1.8 million • Retention • Physician loyalty • Reimbursement • Measure A funds • $5 million

26. Improving Community Outreach services • Modify community benefit services • Proper access to primary care • Transform Silva Pediatric Clinic

27. Modifications to Community Benefit Services • Address key health concerns: • Hypertension and obesity • Educate with health monitoring and preventive care measures • Asthma • Utilize Care - A - Van services for early detection of the health issues

28. Proper Access to primary Care • Educate community on access to primary care • ED navigator • Triage patients to urgent care and outpatient services

29. Transformation

30. Transform Silva Pediatric Clinic • Retain the Silva Pediatric Clinic • Transform it into an outpatient clinic • Manage overcrowding at the ED • Currently, functioning at 103% of it capacity • Potential stress due to Kaiser’s relocation • Modify urgent care and outpatient clinic hours • Urgent care: 10:00 am to 12:00 am • Clinic hours: 7:00 am to 7:00 pm

31. STRATEGY BENEFITS • Improve operations • Collection process • Financial guidance • Renegotiating contracts • Physician integration • Cardiology: $700,000 • Obstetrics: $1.8 million • Measure A funds adjustment: $5 million • Community outreach • Improve patient access • Efficient utilization

32. TACKLING THE DEBT