Geisinger Health System

Transcription

1 Geisinger Health System Creating a Revenue Cycle Strategy for Mergers and Acquisitions (B08) October 29, 2013 Presented by Barbara M Tapscott, CHFP, CPAM VP Revenue Management, Geisinger Health System

2 Session Objectives Overview of GHS Revenue Management mergers and acquisition strategies for integration Why create an M & A team? Mergers and Acquisitions key considerations Review project tools and documentation Lessons learned 2

3 About Geisinger Mission Enhancing quality of life through an integrated health service organization based on a balanced program of patient care, education, research and community service 3

4 Geisinger Health System An Integrated Health Service Organization Physician Practice Group $825M Provider Facilities $1,760M Managed Care Companies $2,093M Multispecialty group ~ 1,020 Physician FTEs, ~ 700 advanced practitioner FTEs 78 primary and specialty clinics 2 outpatient surgery centers ~ 2.4 million clinic visits 4 Geisinger Medical Center including Hospital for Advanced Medicine (HfAM), Janet Weis Children s Hospital, Geisinger Shamokin Community Hospital Geisinger Wyoming Valley Medical Center including Geisinger South Wilkes-Barre, the Henry Cancer Center, and Pearsall Heart Hospital Geisinger Community Medical Center Geisinger Bloomsburg Hospital Marworth Alcohol & Chemical Dependency Treatment Center MountainView Care Center Bloomsburg Health Care Center 1,623 licensed inpatient beds > 79K admissions/obs & SORU 4 ~463,000 members (including ~77,000 Medicare Advantage and 112,000 Medicaid members) Diversified products ~37,000 contracted providers/facilities 43 PA counties

5 Geisinger Health System Last updated 11/12/09 5 5

6 Hospital for Advanced Medicine Janet Weis Children s Hospital Geisinger Wyoming Valley (GWV) Geisinger Community Medical Center 6

7 Marworth (Drug/Alcohol Treatment) Geisinger Bloomsburg Hospital Geisinger Grays Woods 7

8 Creating a Revenue Cycle Strategy for Mergers and Acquisitions 8

9 A Changing Industry During the past decade the healthcare industry has experienced extensive consolidation through mergers and acquisitions A major theme of this growth has been hospital campuses transitioning to larger systems, and consolidation of physician practices HFMA: Hospital mergers and acquisitions have been the primary means to consolidate, with goals to increase market share and negotiate leverage with commercial payers. Gaining size and scale remains a key reason to consolidate. 9

10 Life Cycle of an Acquisition Agreement signed by Entities, Regulatory Approvals Communication to Employees, Patients & Public Operational Analysis People, Process, Technology Integration Project Plan Development Project Plan Execution & Communication PROCESS IMPROVEMENT 10

11 Geisinger Revenue Management 11

12 End-to-End Revenue Cycle ACCESS CODING & REVENUE CAPTURE HOSPITAL OPERATIONS PROFESSIONAL OPERATIONS ADMINISTRATIVE SERVICES INTEGRITY SCHEDULING CALL CENTER PHYSICIAN CODING THIRD-PARTY BILLING THIRD-PARTY BILLING CREDENTIALING CHARGE MASTER PRE-VISIT CLEARANCE REVENUE CAPTURE CLINICAL TRIALS COLLECTIONS SYSTEMS SUPPORT BUDGET & PLANNING PATIENT REGISTRATION HOSPITAL CODING COLLECTIONS MA PENDING ELIGIBILITY QUALITY ASSURANCE INTERNAL CONTROLS FINANCIAL COUNSELING POINT OF SERVICE COLLECTIONS CONCURRENT CODING - CDIP PROFESSIONAL REIMBURSEMENT PHYSICIAN EDUCATION CASH MANAGEMENT REVENUE ENHANCEMENT CHARITY PROCESSING SELF PAY COLLECTIONS HOSP-PROF REVENUE ENHANCEMENT PATIENT CALL CENTER HOSP-PROF CORPORATE IMAGING BUSINESS ANALYSIS CREDIT BALANCES CHARGE CAPTURE AUDIT TRAINING COMPLIANCE 12

13 Integration Challenges Culture Patients Technology Policies People Geography Performance Preservation 13

14 Geisinger Growth January 2012 February 2012 July 2012 January 2012 Geisinger Shamokin Area Community Hospital February 2012 Geisinger Community Medical Center. Geisinger Community Medical Care, Inc., Geisinger MountainView Care Center July 2012 Geisinger Bloomsburg Hospital 14

15 How was this accomplished? 15

16 It started with a Check List 16

17 The Project Plan Having a check list quickly proved inefficient There was a need to retain decisions to model and deploy future growth Project planning was fragmented. Departments worked in silos, setting their own priorities unintentionally disregarding co-dependencies There was risk in diluting resources with multiple priorities, and ultimately impacting results The Mergers and Acquisition team was born! 17

18 M & A Team Responsible to manage the integration from a revenue cycle perspective: People, Process & Technology Empowered to seek and engage subject-matter experts to collaborate on issues that cross departmental lines or require external input (Human Resources, Information Technology, etc.) Charged with Project Management including: o o o Due Diligence Process and Decision documentation Communication of project status, challenges, barriers Identifying resource needs prior to project kick-off assists in maintaining emphasis on core business during integration 18

19 Selecting team members for M & A 19

20 End-to-End Revenue Cycle ACCESS CODING & REVENUE CAPTURE HOSPITAL OPERATIONS PROFESSIONAL OPERATIONS ADMINISTRATIVE SERVICES INTEGRITY SCHEDULING CALL CENTER PHYSICIAN CODING THIRD-PARTY BILLING THIRD-PARTY BILLING CREDENTIALING CHARGE MASTER PRE-VISIT CLEARANCE REVENUE CAPTURE CLINICAL TRIALS COLLECTIONS SYSTEMS SUPPORT BUDGET & PLANNING PATIENT REGISTRATION HOSPITAL CODING COLLECTIONS MA PENDING ELIGIBILITY QUALITY ASSURANCE INTERNAL CONTROLS FINANCIAL COUNSELING POINT OF SERVICE COLLECTIONS CONCURRENT CODING - CDIP PROFESSIONAL REIMBURSEMENT PHYSICIAN EDUCATION CASH MANAGEMENT REVENUE ENHANCEMENT CHARITY PROCESSING SELF PAY COLLECTIONS HOSP-PROF REVENUE ENHANCEMENT PATIENT CALL CENTER HOSP-PROF CORPORATE IMAGING BUSINESS ANALYSIS CREDIT BALANCES CHARGE CAPTURE AUDIT TRAINING COMPLIANCE 20

21 Skills & Experience Project Management Clinical Workflows Information Technology Experience Relationship Builders M & A Documentation Communication Skills Revenue Management Workflows Training Skills 21

22 Continuously Expanding Roles Each member of this team must be: Flexible Quick Study Adaptable 22

23 Team Objectives Ensure due diligence and all aspects of integration are addressed and on schedule. Communication Analysis and Development Facilitate communication among stakeholders Communicate project status to management and to various workgroups Assess current state of operations with key stakeholders Propose future state of operations; develop plan Documentation Document RM project questions, decisions, tasks, issues, changes to policies or standard operating procedures Enforcement Enforce RM project plan execution to achieve milestone dates 23

24 Integration Strategies Project Plan Tools Establish Milestones Due Diligence Documentation Document Storage Communication 24

25 Project Plan Tools Select a Project Manager Agree on a single platform or software for Project Management Assign security and rights to key project stakeholders Establish central location for all files 25

26 Establish Milestones Many revenue management components are inter-related Agree on co-dependencies Establish desired milestones with desired project end-date Milestones set the pace of the project Understand there will be mini-projects within the larger context 26

27 Due Diligence Documentation Ensures tasks are completed and decisions documented Promotes efficiency many revenue management areas have co-dependencies Documentation is stored centrally and is accessible to all stakeholders 27

28 Document Storage Agree on a centralized location for all documents Agree on nomenclature: Workgroup Workgroup Task Workgroup Deliverable(s) Product Assign rights to edit or view Ensure your software retains versions Easily navigable 28

29 Communication Over-communicate Establish frequency, day and time for Integration meetings. A set date and time ensures participation of most team members Assign resources to capture meeting minutes Disseminate minutes timely Publish meeting and milestones calendars Communicate progress and challenges, seek solutions to barriers, communicate results 29

30 Communication Clear definitions of acronyms and terminology is essential Communication does not stop with management. Line staff whose everyday work assignments and roles may change, must understand how they are affected Clinical or other operational staff may not be aware of their impact on revenue management processes. These individuals require training also 30

31 Communication Never assume decisions or changes have no effect on other areas. Information gathered and changes may impact more employees than anticipated Ensure your message is heard: Meeting minutes Centrally share documents, decisions, project status Provide contact for questions 31

32 Project Planning, Tracking and Documentation Workgroup meetings, topics and agenda are managed by M & A team Required collaboration between M & A, revenue management and other departments Collaboration with Information Technology and Human Resources is essential Budget planning Managing expenses vs. plan 32

33 M & A Workgroup Meeting Schedule Meetings held through the course of the project are agendadriven; attendees can decide if topic is applicable to their role Example schedule: o Meeting 1 Enterprise Scheduling o o o o o o o Meeting 2 Pre-service Financial Clearance Meeting 3 Patient Access ADT Meeting 4 Financial Counseling Meeting 5 Charge Description Master Meeting 6 Charge Capture Meeting 7 Coding Meeting 8 Patient Accounting 33

34 Management Plan Identify key characteristics of the project Define key components that may impact people Changing roles and job descriptions Compensation considerations Technology Process change Reporting relationships Each integration is different. Accept this. 34

35 RM Structure and Workgroup participation Access Scheduling Pre-Reg Admissions Financial Counseling Integrity Internal Controls Charge Master Credit Balances Information Technology Financial Systems E.H.R. Coding Charge Capture Coding CDI PRC Hospital RM Billing & Collections Cash Application Contract Management Professional RM Billing & Collections Self-Pay and PSCC Administrative Services Provider credentialing and enrollment Training and Quality Assurance Testing and Security Technology platform support E-systems support Human Resources Compensation Job description development Employee orientation 35

36 Other Mergers and Acquisition Considerations 36

37 Helping Managers through Change Recognize that new roles, operational changes and new technology can become overwhelming very quickly Take additional steps to help managers and line employees through change: Communicate what to expect and how to prepare for the project Review existing and proposed workflows, roles, etc. Provide shadowing opportunities in addition to initial training 37

38 Helping Managers through Change Engage new managers and employees in decisionmaking Present options and recommendations, review decision and obtain agreement Show empathy to project team and new employees Be sensitive to how messages are relayed; messages are not always heard or accepted as originally intended 38

39 Helping Managers through Change Accept that change management will demand additional time Address the fear of new technology, losing jobs, etc. Encourage staff to self-test for skills assessment to understand training opportunities and appropriate role assignments Encourage staff to be open to transition to better-suited roles 39

40 Geographic challenges When facilities are geographically distant from the central business office challenges faced include: Employee travel time Long work days and employee burn out Potential accommodation needs In some instances these can be overcome by the use of technology Conference calls WebEx Video conferencing Visibility is important 40

41 Project Management Options Depending on the size and scope of the project, there are multiple options to consider: Outsource project management Take on the project internally Use a blend of internal and external resources In our experience, each acquisition had its unique idiosyncrasies; we had to understand and accept their differences, and adapt our approach Regardless of size, roles and timelines, project management strategies and disciplines remain the same 41

42 Adaptable M & A Strategy Concepts and strategies are scalable for any size project At Geisinger, the M & A team is responsible for integration of hospital and other providers Projects of all sizes are managed using this approach New Group Practices New Clinic Locations New Services New Departments New Providers 42

43 Conclusion As a health network expands it is critical internal analysis is conducted to ensure resources are assigned to accomplish integration A dedicated team who can direct such an endeavor will prove to be a valuable resource allocation Collaboration among all project participants is essential to the success of the project. This includes revenue management, human resources, information technology and clinical operations 43

44 Contact information Barbara M Tapscott, CHFP, CPAM VP Revenue Management Geisinger Health System 100 N. Academy Avenue Danville, PA Phone: bmtapscott@geisinger.edu 44

45 Appendix 45

46 Project Plan Example 46

47 Major Milestone List Example 47

48 Due Diligence Documentation Example 48