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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
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
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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
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Geisinger Health System An Integrated Health Service Organization
Provider
Facilities
$1,760M
Physician
Practice Group
$825M
Managed Care
Companies
$2,093M
•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
•Multispecialty group
•~ 1,020 Physician FTEs, ~ 700
advanced practitioner FTEs
•78 primary and specialty clinics
•2 outpatient surgery centers
•~ 2.4 million clinic visits
•~463,000 members (including
~77,000 Medicare Advantage and
112,000 Medicaid members)
• Diversified products
• ~37,000 contracted
providers/facilities
• 43 PA counties
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•Last updated 11/12/09
Geisinger Health System
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Hospital for Advanced Medicine Janet Weis Children’s Hospital
Geisinger Wyoming Valley (GWV)
Geisinger Community Medical Center
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Geisinger Bloomsburg Hospital
Marworth (Drug/Alcohol Treatment)
Geisinger Grays Woods
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Creating a Revenue Cycle Strategy for Mergers and Acquisitions
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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.”
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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
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Geisinger Revenue Management
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End-to-End Revenue Cycle
ADMINISTRATIVE
SERVICES
PROFESSIONAL
OPERATIONS
CODING & REVENUE
CAPTURE
HOSPITAL
OPERATIONS
THIRD-PARTY
BILLING
CLINICAL TRIALS
COLLECTIONS
THIRD-PARTY
BILLING
COLLECTIONS
CASH
MANAGEMENT
CREDENTIALING
PATIENT CALL
CENTER
HOSP-PROF
SYSTEMS
SUPPORT
PHYSICIAN
EDUCATION
PHYSICIAN CODING
REVENUE CAPTURE
CONCURRENT
CODING - CDIP
REVENUE
ENHANCEMENT
PROFESSIONAL
REIMBURSEMENT
HOSPITAL CODING
CHARITY
PROCESSING
MA PENDING
ELIGIBILITY
INTEGRITY
ACCESS
SCHEDULING CALL
CENTER
QUALITY
ASSURANCE
PATIENT
REGISTRATION
SELF PAY
COLLECTIONS
HOSP-PROF
REVENUE
ENHANCEMENT
CREDIT BALANCES
PRE-VISIT
CLEARANCE
FINANCIAL
COUNSELING
CORPORATE
IMAGING
CHARGE MASTER
BUDGET &
PLANNING
INTERNAL
CONTROLS
BUSINESS
ANALYSIS
CHARGE CAPTURE
AUDIT
POINT OF SERVICE
COLLECTIONS
TRAINING
COMPLIANCE
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Integration Challenges
Culture
Technology
People
Performance Preservation
Geography
Policies
Patients
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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
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How was this accomplished?
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It started with a “Check List”
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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!
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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 Due Diligence
o Process and Decision documentation
o Communication of project status, challenges, barriers
• Identifying resource needs prior to project kick-off assists in
maintaining emphasis on core business during integration
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Selecting team members for M & A
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End-to-End Revenue Cycle
ADMINISTRATIVE
SERVICES
PROFESSIONAL
OPERATIONS
CODING & REVENUE
CAPTURE
HOSPITAL
OPERATIONS
THIRD-PARTY
BILLING
CLINICAL TRIALS
COLLECTIONS
THIRD-PARTY
BILLING
COLLECTIONS
CASH
MANAGEMENT
CREDENTIALING
PATIENT CALL
CENTER
HOSP-PROF
SYSTEMS
SUPPORT
PHYSICIAN
EDUCATION
PHYSICIAN CODING
REVENUE CAPTURE
CONCURRENT
CODING - CDIP
REVENUE
ENHANCEMENT
PROFESSIONAL
REIMBURSEMENT
HOSPITAL CODING
CHARITY
PROCESSING
MA PENDING
ELIGIBILITY
INTEGRITY
ACCESS
SCHEDULING CALL
CENTER
QUALITY
ASSURANCE
PATIENT
REGISTRATION
SELF PAY
COLLECTIONS
HOSP-PROF
REVENUE
ENHANCEMENT
CREDIT BALANCES
PRE-VISIT
CLEARANCE
FINANCIAL
COUNSELING
CORPORATE
IMAGING
CHARGE MASTER
BUDGET &
PLANNING
INTERNAL
CONTROLS
BUSINESS
ANALYSIS
CHARGE CAPTURE
AUDIT
POINT OF SERVICE
COLLECTIONS
TRAINING
COMPLIANCE
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Skills & Experience
M & A
Project Management
Information Technology Experience
Documentation
Training Skills
Revenue Management
Workflows
Communication Skills
Relationship Builders
Clinical Workflows
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Continuously Expanding Roles
Each member of this team must be:
Flexible
Quick Study Adaptable
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Team Objectives • Ensure due diligence and all aspects of
integration are addressed and on schedule.
• Facilitate communication among stakeholders
• Communicate project status to management and to various workgroups
Communication
• Assess current state of operations with key stakeholders
• Propose future state of operations; develop plan
Analysis and Development
• Document RM project questions, decisions, tasks, issues, changes to policies or standard operating procedures
Documentation
• Enforce RM project plan execution to achieve milestone dates Enforcement
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Integration Strategies
Project Plan Tools
Establish Milestones
Due Diligence Documentation
Document Storage
Communication
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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
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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
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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
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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
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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
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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
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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
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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
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M & A Workgroup Meeting Schedule • Meetings held through the course of the project are agenda-
driven; attendees can decide if topic is applicable to their role
• Example schedule:
o Meeting 1 – Enterprise Scheduling
o Meeting 2 – Pre-service Financial Clearance
o Meeting 3 – Patient Access – ADT
o Meeting 4 – Financial Counseling
o Meeting 5 – Charge Description Master
o Meeting 6 – Charge Capture
o Meeting 7 – Coding
o Meeting 8 – Patient Accounting
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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.
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RM Structure and Workgroup participation
Coding
• Charge Capture
• Coding
• CDI
• PRC
Hospital RM
• Billing & Collections
• Cash Application
• Contract
Management
Professional RM
• Billing & Collections
• Self-Pay and PSCC
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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
Access
• Scheduling
• Pre-Reg
• Admissions
• Financial Counseling
Integrity
• Internal Controls
• Charge Master
• Credit Balances
Information
Technology
• Financial Systems
• E.H.R.
Other Mergers and Acquisition Considerations
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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
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Helping Managers through Change
• Engage new managers and employees in decision-
making
• 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
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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
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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
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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
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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
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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
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Contact information
Barbara M Tapscott, CHFP, CPAM
VP Revenue Management
Geisinger Health System
100 N. Academy Avenue
Danville, PA 17822-4944
Phone: 570-271-6432
e-mail: [email protected]
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Appendix
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Project Plan Example
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Major Milestone List Example
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Due Diligence Documentation Example
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