Three Critical Gaps Hospital CFOs Must Address Today
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- Maude Harper
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1 Three Critical Gaps Hospital CFOs Must Address Today PRESENTERS Name PRESENTER: Title Tim Welling Name Vice President BI Title 12/1/
2 Webinar Agenda Introductions and Housekeeping Webinar Objectives Hospital Finance Perspective Instituting a True Cost Accounting System Setting up Financial Systems and Operational Processes Capturing All Costs Associated with an Episode of Care Q & A
3 Webinar Objectives
4 Webinar Objectives To share insights regarding the three critical gaps that Hospital CFOs must address to adapt to the current healthcare transformation: 1. Instituting a true cost accounting system and the challenges associated with hospital cost accounting 2. Setting up financial systems and operational processes to manage and reduce costs by service line 3. Understanding and reporting the true nature of an episode of care within an organization from a financial perspective for both hospital HIM and physician practices
5 Hospital Finance Perspective
6 Title Challenges Hospital CFOs Face Today Lack Main of Bullet transparency Point about the cost and profit/loss of all service lines Subpoint 1 Difficult to drill down into variances to understand them Subpoint 2 Lack of transparency into payer reimbursement trends and inability Main Bullet to identify Point variances Lack of Physician profiling/comparisons Subpoint 1 Inability to view real time patient costs Subpoint 2 Difficult to report on simple tasks and requests
7 Demands for Financial Visibility are Increasing CFO Controller CIO Dept. Head Hospital President Financial Analyst Which service lines are the most profitable? The least? Why? Why does it take so long to get this information? Why isn t this information real time? I have to make real time decisions. Cardio was profitable last month, why not this month? I should be in IT half my life is spent finding the right financial data and smashing it into an Excel spreadsheet to answer questions for the CFO. Every month/ week I get a call from the CFO asking for detailed financial information. Every time I have to pull two of my people off other critical projects to get this done. I can never catch up. The CFO just called and asked why I was off of my staffing budget by 20%, and I had NO idea. I THINK my department is profitable but I m really not sure. We are running on a 3% margin that appears to be trending toward 2%. What areas can we improve profitability? What areas can we cut costs? I am combining 20 spreadsheets into one in an attempt to provide meaningful information to my CFO. How can I provide accurate data when I m relying on manual and sometimes inaccurate inputs..
8 Instituting a True Cost Accounting System
9 TIME & ATTENDANCE PRACTICE MANAGEMENT PATIENT ACCOUNTING GENERAL LEDGER How CFOs Receive Financial Data Today Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 MEDITECH FINANCIAL ANALYSIS
10 TIME & ATTENDANCE PRACTICE MANAGEMENT PATIENT ACCOUNTING GENERAL LEDGER How a CFO Should Receive Financial Data MEDITECH One common platform/data warehouse FINANCIAL ANALYSIS Service Line Cost & Profit Productivity Revenue Cycle Ad-Hoc
11 Overall Cost Allocation Goal Cost Allocation Goal 2013 GL Costs 2014 GL Costs 2015 GL Costs 2013 Patients 2014 Patients 2015 Patients
12 How Cost Accounting Can Work Indirect Administration HR HIM Housekeeping Cost Buckets Salaries Supplies Contract Capital Rev Days FTE s Sq. Ft Cost Drivers Direct Surgery Radiology Nursing Pharmacy Salaries Supplies Contract Capital Activity Drivers Patient Activities Time/Std. Cost Or Price Or Hybrid REQUIRED REPORTING DIRECT/INDIRECT SALARIES/SUPPLIES BY SERVICE LINE BY INSURANCE BY PHYSICIAN BY PATIENT
13 Current Reporting Challenges Common reporting challenges: Large amounts of complex patient data often require more than Excel or Access Extracting information from multiple transactional systems is complex and time consuming Reporting is often an iterative process, with Excel/Access based models, adjustments are often lengthy or require additional data elements With manual reporting processes there is an increased probability of human errors
14 Common Platform Reporting Data is fully integrated and automated into a data warehouse HIM, Practice Management, GL, Time & Attendance Cost Accounting becomes nearly automated with a single source of truth for all data elements Reporting/Dashboarding Standard sets of reports/dashboard for industry standard analysis Ad-Hoc availability for customized, hospital specific reporting needs
15 Common Platform Reporting Example Reports can be drilled into for additional analysis
16 Setting up Financial Systems and Operational Processes
17 Managing Costs by Service Line Laboratory Pharmacy Radiology Anesthesiology Dialysis Surgery Orthopedics Obstetrics Cardiology Emergency Department Pediatrics
18 Managing Charge Master Detail ACL Reconstruction Cost Variance In a Regional Healthcare System $3, Lowest Cost $2, $2, $2, $1, $2, Highest Cost Mean Cost $1, $1, $1, $ $ $0.00 $1.19 $46.00 $18.26 $40.10 Graft Cost Suture Cost Tools & Disposable Supplies Cost Source: American Journal of Sports Medicine; June, 2015
19 Complete Cost Methodology Initial Configuration RCC Method GO LIVE RVU Development and Maintenance 6 weeks to several years to implement depending on resources allocated to project Full ABC Costing is rarely found in healthcare organizations Phase 0 Phase I Phase II Phase III Phase IV Phase V Phase VI Phase VII No cost model or manual cost model in Excel or Access Initial configurations of accounts and departments Add Reclassifications Add manual overhead statistics Run and Reconcile several cycles of Cost Model Develop RVUs for initial department(s) Develop RVUS for additional Departments Refine RVUs with Micro Costing, ABC methodology, and automation
20 Ongoing Maintenance/Continuous Improvements CONTINUOUS CYCLE Maintenance includes accounts and departments, reclassifications, RVU s, mark-up factors, overhead statistics, and GL to Patient Accounting department mappings. Cost Model cannot be properly maintained without the support of Accounting, Operations, and Decision Support departments. Run Cost Model Maintain Charge Activity Relative Weights Review Results Maintain Overhead Statistics Maintain Accounts and Departments Maintain Cost Reclassifications Maintain Cost Buckets
21 Use Service-Line Planning and Costing Information to Create a Volume Matrix for Strategic Planning
22 Managing Costs by Service Line Determine service line costing and profitability
23 Managing Costs by Service Line Physician Profiling Determine service line costing and profitability
24 Capturing all Costs in an Episode of Care
25 Measuring Episode of Care Costs Pre-Admission Patient presents to his PCP with complaints of worsening knee pain. PCP refers patient to an orthopedic surgeon for a consult. In-Patient Patient has surgery. Discharge Patient is discharged and follows up with the orthopedic surgeon in his office. Post Discharge Patient undergoes 6 weeks of rehabilitation at the hospital s outpatient therapy department. Costs Span the Entire Continuum of Care
26 Recap 1. Instituting a true cost accounting system and the challenges associated with hospital cost accounting 2. Setting up financial systems and operational processes to manage and reduce costs by service line 3. Understanding and reporting the true nature of an episode of care within an organization from a financial perspective for both hospital HIM and physician practices
27 Questions If you have any specific questions for your organization, please contact: Shawn Frazier (303)
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