NFPHC Confidential

UMC Status Update

May Status Meeting to the OCFO & DHCF

7/27/17

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NFPHC Confidential

Agenda

Review of Budget Gap Initiatives Hospital-wide initiatives Revenue Cycle initiatives

APPENDIX A: Budget Gap Initiatives Detail

APPENDIX B: Review FY18 Capital Plans

APPENDIX C: May Financial and Performance Data

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NFPHC Confidential

Budget Gap Summary

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Hospital Operations Expected Amount Realized Not RealizedMedical Necessity 5,000,000$ 462,000$ 4,538,000$ Supply Chain 1,000,000$ -$ 1,000,000$ Managed Care Contracts 2,500,000$ 456,000$ 2,044,000$ Contract Management & Review 500,000$ 154,000$ 346,000$

9,000,000$ 1,072,000$ 7,928,000$

Expected Amount Realized Not RealizedRevenue Cycle 2,000,000$ 6,000,000$ -$ Patient Access/ Patient AccountsHIM/CDIRevenue IntegrityUtilization Review

2,000,000$ 6,000,000$ -$

Hosp-Rates Workplan

Not-For-Profit Hospital CorporationUpdated 5-18-2017

Budget Shortfall Initiatives & Actions Required

Action/InitiativeExpected DateCompletion DateAction OwnerStatus

Hospital Operations:

1Implement InterQual Guidelines4/30/17CEO/ITInternet Explorer 11.0 will be installed onto identified workstations this week 5/15

2Physician training on InterQual, Observation, Admission Certification, two midnight rule & medical necessity5/12/17Case Mngt HIMAdam to schedule a meeting to discuss level of care & changes in status with Hospitalists, mid levels, Evelyn, Vivien, Finance

3Hire scribe for immediate need for physician documentation4/17/17CEO/Dr. CraigContract finalized with Legal 5/17/17

4Implement voice recognition for physician documentation9/30/17IT/Dr. CraigAs of 5/18/17 - on track to meet deadline

5Accountability and monitoring of physician contractsContinuousDavid/Dr. Craig

6Purchase and Implement phone system to increase Outpatient appointments4/30/17David/ITDavid to work with PAS per Alan

7Purchase and implement HIM 3M revenue cycle software6/30/17CEO/HIM/CFO/ITWith Legal for review; Alan requested an implementation timeline once contract is signed so he can plan IT resources

8Collaborate to implement hospital clinic visit billing7/31/17BillyInitial stakeholder meeting held 5/16

9Implement hospital based clinic visit billing7/31/17BillySee #8 comment

10Develop/revise charge ticket & define charge capture process for Clinic Visits7/31/17Dr. Dennis/BillySee #8 comment

11Implement Case Management in the Emergency Room 24/7ImmediateDavidNarrowed vendors down to RSI (staffing agency); Contract waiting for financial sufficiency (to be signed 5/18/17) & then needs to go to Finance Committee for presentation to Board

12Institute disposition nurse in Emergency Room5/15/17MaribelWaiting for CEO sign off

13Training of Case Managers and Social Workers5/12/17AdamAdam to follow up with Evelyn regarding InterQual trainer training

14Placing patients in the correct level of careImmediateCase Mngt/AdamRe-enforce 7am meeting & include Case Management; Permanent fix to be in place once Case Mngt staffing agency is finalized (July 1st)

15Training of RN/Providers on Observation Criteria5/12/17MaribelMaribel to provide a listing of Nurses to be trained to Vivien/Evelyn starting with ED nurses

16Create Emergency Room triage and workflow process4/18/17Need DateDavidComplete

17Case Management assigned to direct admission and surgery department4/17/17Adam

18Initiate communication with Payors to re-negotiate all Master Agreements4/17/17David B & David TDavid Thompson working with David Boucree to develop a listing of payors & priority for contracting

19Provide Payor Master Agreement(s) to Legal for review & red line5/31/17CEO/DavidAmeriHealth red line complete

20Make business decision to enter into new and/or revised Payor Master Agreement(s)4/30/17CEOSee #18 comment

21Identify and document CEO's strategy to increase/maintain sustainable volumes6/30/17CEOLuis meeting with stakeholder departments

22Reduce Length of StayContinuousAdam/Dr. Craig

23Improve skill mix in SNF7/31/17MaribelCurrently 17 Medicare patients; 116 census

24Service Line growth plan(s)Need DateDr. Craig/Dr. Morrow/Adam/David

25Evaluate all outsourced vendor contracts to quantify savings8/31/17DavidIn process, on target

26Evaluate physical therapy contract4/24/17David

27Evaluate the need for all physical therapy orders4/24/17Dr. Craig

28Evaluate the need for Gastroenterology orders4/17/17Dr. CraigWalt is running a report to quantify how many patients are receiving within 1-2 days of discharge

29Prepare Service Line Proforma (OCFO) by 4/30/2017 & Develop corrective strategies for underperforming programs5/31/17CEO/David

30Evaluate supply chain department and develop hospital-wide supply monitoring program5/31/17DavidWorking with vendor to transition; Will need information from Finance-request forthcoming

Revenue Cycle

1Implement Relay Health Clearance/AhiQa6/30/17Crystal/IT

2Hire Coding Manager and 5 additional coders6/30/17JeremiahWorking with Agency until FT staff can be employed

3Transition outsourced coding vendor to in-house coding6/30/17JeremiahWorking with Agency until FT staff can be employed

4Accomplish coding review to identify areas of opportunity6/30/17Jeremiah/CFO

5Implement Quality Assurance Team between coding and clinical documentation (CDI)6/30/17Jeremiah/Anna

6Hire Documentation and Quality Assurance Audit Manager and 1 additional Clinical Documentation Liaison6/30/17Anna

7Full assessment of CDI needs6/30/17Anna

8Accomplish 100% CDI review of Medicare and DC Medicaid records6/30/17Anna

9Expand CDI review to include DC Medicaid Managed Care6/30/17Anna

10Establish quality assurance billing audit process team6/30/17Jeremiah/ Veronica

11Recruit Revenue Integrity Team (charge capture)6/30/17Amy

12Implement charge capture process for all revenue generating departments6/30/17AmyTo include review of ED Point system used for leveling

13Develop workplan to implement hospital clinic visit billing4/30/174/26/17AmyDraft completed & circulated to stakeholders for comment

14Set-up Clinic Visit charge in CDM ensuring coding & pricing is accurate7/31/17Amy/Veronica

15Ensure necessary information is captured on bill for hospital-based clinic billing7/31/17Veronica/Amy

16Ensure proper language exists in Managed Care contracts for reimbursable services provided by hospital4/30/17On-goingAmyInformation provided to AmeriHealth

17Provide/review reimbursement rates to Payors & Hospital Administration for Managed Care contracting4/30/17On-goingAmyInformation provided to AmeriHealth

&Z&F

Hosp-Rates Workplan (2)

Not-For-Profit Hospital CorporationUpdated 5-18-2017

Budget Shortfall Initiatives & Actions Required

Action/InitiativeOriginal DateTarget DateCompletion DateAction OwnerStatus

Hospital Operations:

11Implement InterQual Guidelines4/30/17CEO/ITInternet Explorer 11.0 will be installed onto identified workstations this week 5/15

22Physician training on InterQual, Observation, Admission Certification, two midnight rule & medical necessity5/12/17Case Mngt HIMAdam to schedule a meeting to discuss level of care & changes in status with Hospitalists, mid levels, Evelyn, Vivien, Finance

33Hire scribe for immediate need for physician documentation4/17/17CEO/Dr. CraigContract finalized with Legal 5/17/17

44Implement voice recognition for physician documentation9/30/17IT/Dr. CraigAs of 5/18/17 - on track to meet deadline

55Accountability and monitoring of physician contractsContinuousDavid/Dr. Craig

614Placing patients in the correct level of careImmediateCase Mgmt/AdamRe-enforce 7am meeting & include Case Management; Permanent fix to be in place once Case Mngt staffing agency is finalized (July 1st)

715Training of RN/Providers on Observation Criteria5/12/17MaribelMaribel to provide a listing of Nurses to be trained to Vivien/Evelyn starting with ED nurses

811Implement Case Management in the Emergency Room 24/7ImmediateDavidNarrowed vendors down to RSI (staffing agency); Contract waiting for financial sufficiency (to be signed 5/18/17) & then needs to go to Finance Committee for presentation to Board

913Training of Case Managers and Social Workers5/12/17AdamAdam to follow up with Evelyn regarding InterQual trainer training

1017Case Management assigned to direct admission and surgery department4/17/17Adam

1122Reduce Length of StayContinuousAdam/Dr. Craig

1223Improve skill mix in SNF7/31/17MaribelCurrently 17 Medicare patients; 116 census

138Collaborate to implement hospital clinic visit billing7/31/17BillyInitial stakeholder meeting held 5/16

149Implement hospital based clinic visit billing7/31/17BillySee #8 comment

1510Develop/revise charge ticket & define charge capture process for Clinic Visits7/31/17Dr. Dennis/BillySee #8 comment

1616Create Emergency Room triage and workflow process4/18/17Need DateDavidComplete

1712Institute disposition nurse in Emergency Room5/15/17MaribelWaiting for CEO sign off

1818Initiate communication with Payors to re-negotiate all Master Agreements4/17/17David B & David TDavid Thompson working with David Boucree to develop a listing of payors & priority for contracting

1919Provide Payor Master Agreement(s) to Legal for review & red line5/31/17CEO/DavidAmeriHealth red line complete

2020Make