Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
As pressure mounts on hospitals to improve quality and reduce costs, they have turned to medicine's fastest growing physician specialty—hospital medicine---to improve clinical performance and operational efficiency. How this new role for hospitalists plays out varies according to the type, location and creativity of individual healthcare organizations and the resources available to them. This editorial webinar will explore the steps health care organizations should take to prepare and position their hospitalists for quality-improvement responsibilities. Our panel of experts will share their insights, experiences and proven strategies for success.
Regional Anesthesia and Bundled Payments – Opioid-sparing Pain Management for...Wellbe
Speaker: Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia
This webinar will:
-Discuss Enhanced Recovery After Surgery (ERAS) protocols for joint replacement
-Review the positive impact of regional anesthesia throughout the episode of care
-Spotlight the key components of successful value-based orthopedic care – length of stay, discharge to home, patient and surgeon satisfaction
About the Speaker:
Sonia Szlyk, MD, is the Director of Regional Anesthesia for North American Partners in Anesthesia’s Mid-Atlantic division. Dr. Szlyk orchestrates an outcomes-based regional anesthesia service focused on patient and surgeon satisfaction, safety, and efficiency. She oversees regional anesthesia quality metrics, billing compliance, strategic growth, and education. Dr. Szlyk specializes in opioid-sparing ERAS protocols for joint replacement, sports medicine, colorectal, general, and cosmetic surgery. Her initiatives highlight the value of regional anesthesia in the evolving era of bundled payments.
Dr. Szlyk served as the Director of Regional Anesthesia at the Ambulatory Surgery Center of Bethesda, MD where she oversaw the design and implementation of anesthesia services as well as AAAHC accreditation. The center’s comprehensive pain management program included ultrasound-guided peripheral nerve blocks and catheters for outpatient knee and hip replacements, and sports medicine procedures.
Dr. Szlyk is a board-certified anesthesiologist. She completed medical school and anesthesia residency at the George Washington University School of Medicine and was a Clinical Instructor in regional anesthesia at Stanford University Hospital.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
As pressure mounts on hospitals to improve quality and reduce costs, they have turned to medicine's fastest growing physician specialty—hospital medicine---to improve clinical performance and operational efficiency. How this new role for hospitalists plays out varies according to the type, location and creativity of individual healthcare organizations and the resources available to them. This editorial webinar will explore the steps health care organizations should take to prepare and position their hospitalists for quality-improvement responsibilities. Our panel of experts will share their insights, experiences and proven strategies for success.
Regional Anesthesia and Bundled Payments – Opioid-sparing Pain Management for...Wellbe
Speaker: Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia
This webinar will:
-Discuss Enhanced Recovery After Surgery (ERAS) protocols for joint replacement
-Review the positive impact of regional anesthesia throughout the episode of care
-Spotlight the key components of successful value-based orthopedic care – length of stay, discharge to home, patient and surgeon satisfaction
About the Speaker:
Sonia Szlyk, MD, is the Director of Regional Anesthesia for North American Partners in Anesthesia’s Mid-Atlantic division. Dr. Szlyk orchestrates an outcomes-based regional anesthesia service focused on patient and surgeon satisfaction, safety, and efficiency. She oversees regional anesthesia quality metrics, billing compliance, strategic growth, and education. Dr. Szlyk specializes in opioid-sparing ERAS protocols for joint replacement, sports medicine, colorectal, general, and cosmetic surgery. Her initiatives highlight the value of regional anesthesia in the evolving era of bundled payments.
Dr. Szlyk served as the Director of Regional Anesthesia at the Ambulatory Surgery Center of Bethesda, MD where she oversaw the design and implementation of anesthesia services as well as AAAHC accreditation. The center’s comprehensive pain management program included ultrasound-guided peripheral nerve blocks and catheters for outpatient knee and hip replacements, and sports medicine procedures.
Dr. Szlyk is a board-certified anesthesiologist. She completed medical school and anesthesia residency at the George Washington University School of Medicine and was a Clinical Instructor in regional anesthesia at Stanford University Hospital.
*Learn how to find lost patients in your current practice management program
*Tips on how to fill your schedules
*Successes other practices have had from our program
*Polls with live data from call participants
Speakers:
Bill Mercier - President of OptiCall, Inc.
www.opticall.com
Steve Gottfredson - Vice President of Sales & Marketing at Brevium
www.brevium.com
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
Medicines Management Pharmacist (NHS Hampshire)
Independent Prescriber (Victoria Practice, Aldershot)
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
*Learn how to find lost patients in your current practice management program
*Tips on how to fill your schedules
*Successes other practices have had from our program
*Polls with live data from call participants
Speakers:
Bill Mercier - President of OptiCall, Inc.
www.opticall.com
Steve Gottfredson - Vice President of Sales & Marketing at Brevium
www.brevium.com
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
Medicines Management Pharmacist (NHS Hampshire)
Independent Prescriber (Victoria Practice, Aldershot)
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Similar to Demystifying the Anesthesia Stipend: Achieving More Coverage and Better Quality for Less Cost (20)
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
3. Effects of the Rising Subsidy
75% 66%
75% of hospitals 66% of hospitals
are experiencing are limiting
an increase in access to
surgery wait operating rooms
times
2º anesthesia staffing issues
--American Society of Anesthesiologists
October 27, 2009 2:15 p.m. EST
4. Effects of the Rising Subsidy
47% of hospital
administrators are reducing
or re-directing operating
room procedures due to
anesthesia staffing issues.
- ASA Hospital Study
October 27, 2009 2:15 p.m. EST
5. Why? Cost of Current Staffing Model
October 27, 2009 2:15 p.m. EST
7. Why Are Salaries Rising? Supply & Demand
October 27, 2009 2:15 p.m. EST
8. Why Are Salaries Rising? Supply & Demand
October 27, 2009 2:15 p.m. EST
9. The Anesthesia Supply/Demand Gap
Retirees Outnumber Graduates
Residents entering anesthesiology practice
between 1990 and 2002 declined by 15%. – AMA
Practicing anesthesiologists
AMA study of 30,000 Anesthesiologists:
Approx. 60% are age 45 or older
More than 25% are 55 or older
Only 12% are residents
Practicing CRNA
Shortage is more than 5000 – US Dept. of Health
October 27, 2009 2:15 p.m. EST
10. Common Stipend Solutions
Scenario 1 – Pay more for same coverage
Pay doctors more
Provide more robust perquisites
Scenario 2 – Cut-back on coverage
Sacrifice efficiency, surgeon, nurse and patient satisfaction
Reducing or re-directing operating room procedures due to anesthesia
staffing issues
Scenario 3 – Demand Anesthesia Cover its Costs
Attract less qualified anesthetists
Sacrifice efficiency, surgeon, nurse and patient satisfaction
Scenario 4 – Make your problem someone else's problem
Anesthesia is #1 outsourced service – Waller Landsen
October 27, 2009 2:15 p.m. EST
11. Anesthesia Subsidy Trends
de-mys-ti-fy : Expected to Continue Growing
-(verb) to rid of Resulting In:
mystery or
obscurity; Decreasing OR Coverage
clarify
Decreasing OR Revenue
Increasing Stipend
Dissatisfied:
Surgeons
Patients
www.somniainc.com Hospital Leaders
October 27, 2009 2:15 p.m. EST
12. Anesthesia Subsidy
Solutions
de-mys-ti-fy :
-(verb) to rid of Today’s Agenda:
mystery or Lower Anesthesia Expenses
obscurity;
clarify Increase Anesthesia Revenue
Increase OR Coverage
Increase Surgeons, Patient &
Leadership Satisfaction
Text Questions to be
Answered at End of
Presentation
www.somniainc.com
October 27, 2009 2:15 p.m. EST
13. Presenters
Dr. Marc E. Koch Dr. Larry Schecter
Co-Founder & CEO Somnia CMO Providence Regional
Anesthesia Medical Center Everett
National Provider of Medical Degree from
Anesthesia Services Hahnemann Medical College
Including Leadership, in Philadelphia and surgical
Recruiting, Revenue Cycle training at UCLA and West
Mgmt., Payor Contracting & Los Angeles Veterans Hospital
QA Former Medical Director of
Yale University School of Santa Monica-UCLA Medical
Medicine: Anesthesia Center
Fordham University: MBA 30 year career as a General
Surgeon in Santa Monica, CA
October 27, 2009 2:15 p.m. EST
14. Presenters
Dr. Marc E. Koch Dr. Larry Schecter
Strategies to Managing the
Reduce Your Subsidy/Service
Subsidy & Balance
Increase
Coverage
October 27, 2009 2:15 p.m. EST
15. Presented By:
Dr. Larry
Schecter
Managing the
CMO
Anesthesia Subsidy
Providence
Regional & Service Balance
Medical Center
Everett, WA
Achieving Quality, Cost
www.providence.org
& Satisfaction
October 27, 2009 2:15 p.m. EST
16. Providence Regional Medical
Background Center Everett
Everett, Washington
372 Bed Acute Care Hospital
14 ORs
Approx 12,000 surgical cases/yr.
#1 in Approx 4000 OB deliveries
Washington for Cardiac, Thoracic, Vascular, Neurology,
cardiac and Ortho, Urology, General, ENT
critical care, Top 100 Hospital (Thomson/Reuters)
stroke, and Distinguished Hospital for Clinical
general surgery. Excellence (4 yrs. Running)
www.providence.org
October 27, 2009 2:15 p.m. EST
18. Achieving the Right Balance
Subsidy Expectations Service Expectations
In Synch with Hospital Coverage at or Near 100%
Goals On-Time Starts
Formal QA Program to Quick Turnover
Prove Results Avoidance of Pre & Post-
Professional Behavior Op Bottlenecks
Active Citizens of Larger Thorough Pre-Op
Organization Evaluation
October 27, 2009 2:15 p.m. EST
20. The Balanced Scorecard
Quality
Importance of Quality Management Data
Anesthesia Company Should Provide
Also Do it Yourself (the Anesthesia Scorecard)
Compatibility
Focused on Same Goals as Hospital
Citizens of Larger Hospital Community
Same Professionalism as Hospital Leadership
Other
Collective data for group
Individual data by provider
Should drive process improvement
October 27, 2009 2:15 p.m. EST
21. The Balanced Scorecard
Cost (Stipend)
Compensation Competitive with Region based on FMV
Based on Performance Objectives
Not Based on Physician Salaries
October 27, 2009 2:15 p.m. EST
22. The Balanced Scorecard
Satisfaction
100% Coverage
On-Time Starts
Pre-Op Interviews
Post-Op Examinations
Avoidance of Post-Op PONV
Meeting Attendance
Patient and Surgeon perception
October 27, 2009 2:15 p.m. EST
23. The Challenge: Replace the
Incumbent Group
ADVICE: GET IT RIGHT THE
FIRST TIME – YOU DON’T
WANT TO DO THIS TWICE.
October 27, 2009 2:15 p.m. EST
24. The Needs
More Robust Level of Service
The Challenge: Ability to Demonstrate Superior
Quality Outcomes
Replace the Group Compatibility with Hospital
Incumbent Work Collaboratively to Reduce the
Anesthesia Subsidy
Group
October 27, 2009 2:15 p.m. EST
25. Timeline & Tasks
Less than 90 days to get a new
The Challenge: solution in place
Understand & Define our Needs
Replace the Solicit RFPs
Incumbent Interview Top Prospects
Anesthesia Negotiate Contract
Group Attract 30 clinicians in 30 days!!
October 27, 2009 2:15 p.m. EST
26. The Early Results
Clinicians Successfully Recruited
The Challenge: Starting to See Competencies of Each
Provider
Replace the Noticeable Dedication, Attitude,
Incumbent Behavior
Anesthesia Anesthesia Leadership both Local &
National are Major Components of
Group Successful Transition
Implementing MD/CRNA Mix
Challenging but Rewarding
October 27, 2009 2:15 p.m. EST
27. PRMCE’s Anesthesia Scorecard:
OR Efficiency
The Challenge: Available ORs
Turn-Around Time
Prove On-Time Starts
Anesthesia Obstetrics
Results C-Section Delays
Epidural Timeliness
Epidural Success
Quality & Citizenship
SCIP Standards
Meeting Attendance
Med Staff Participation
And Many More…
October 27, 2009 2:15 p.m. EST
28. Lessons Learned
Get as much information as possible prior to
transition-Don’t hesitate to visit the OR!
Do It Right the First Time – Transitions are Tough
on the Facility and Tough on Staff
Anticipate credentialing challenges
Expect attrition and turnover
Be Totally Honest With Your Customers
There is No Substitute for Being in the Trenches
“Hard Times Flush Out the Chumps”
October 27, 2009 2:15 p.m. EST
29. Presented by :
Dr. Marc E. Koch
Co-Founder and CEO of
Somnia Anesthesia
Strategies to Reduce
Your Subsidy &
Increase Coverage
www.somniainc.com
October 27, 2009 2:15 p.m. EST
30. Before Reducing Your Subsidy You Must
First Understand It
October 27, 2009 2:15 p.m. EST
32. Intervention possible but goals must be
realistic. Deriving maximal value is
realistic. Low cost and high quality is
magical.
October 27, 2009 2:15 p.m. EST
34. Patient
• Unrushed /thorough Pre-Op
• Attentive Post-Op
• Avoidance of PONV
• Limited Pain
• Physical
• Financial
October 27, 2009 2:15 p.m. EST
35. Surgical
Leadership
Surgeon-Centric Schedule ≠ “Efficient” Schedule
On-time Starts = Abundance of anesthesia staff
Quick Turnover = Abundance of anesthesia staff
Good working chemistry/trust
Additional Anesthesia Services
October 27, 2009 2:15 p.m. EST
36. Nursing
Leadership
Surgeon-Centric Schedule
Support and assistance with challenging issues
Solve more headaches than they create
On-time Starts = Abundance of anesthesia staff
Quick Turnover = Abundance of anesthesia staff
Good working chemistry/trust
Additional Anesthesia Services
October 27, 2009 2:15 p.m. EST
37. Administrative
Leadership
“Efficient” Schedule (Note: ≠ Surgeon-Centric Schedule)
Exploration of cost efficient staffing models
No Subsidy or Subsidy supports
FMV Compensation
FMV Benefits
Savvy contracting with payors, to a point
Stellar revenue management
Pro-growth mindset
October 27, 2009 2:15 p.m. EST
38. “Revenue”= Funds to Support Anesthesia Department
There are only 3 Sources of Funds
1. Patients
2. Insurance Companies
3. Facility (Stipends)
October 27, 2009 2:15 p.m. EST
39. Anesthesia “Revenue” from Patients
1. Patient mindset makes it a difficult line to walk
2. Surgeon alienation limits utility
3. Hard to count on
October 27, 2009 2:15 p.m. EST
40. Anesthesia “Revenue” from Payors
1. Out-of-network, a pyrrhic victory, since it interferes with
Hospital contract
Surgeon
Surgeon referral sources
2. In-network, battles can be won
Mindful of co-insurance/deductible = from Patient
Guile of payors: holdbacks, abrupt policy shifts
Optimal rates requires out-of-network intermediate step
Stomach of hospital CFO predicates success
October 27, 2009 2:15 p.m. EST
41. Indigenous Anesthesia “Revenue”
Nuts and Bolts
• Compliantly obtain unit rates
• Define sources of revenue (OP, IP, OB, GI, Lines, Etc.)
• Define units by revenue source
• Define reimbursement by unit
• Calculate revenue by payor
• Calculate net collections from gross revenue
October 27, 2009 2:15 p.m. EST
42. Identification and Quantification of Revenue Sources
Inpatient assumes 13-15 Units per Case OB assumes 15-20 Units per Case
Outpatient assumes 9-11 Units per Case Acute Pain and Lines are $ per case
GI Endo assumes 7-9 Units per Case
INPATIENT CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR ACUTE PAIN REVENUE CASES % PATIENTS UNITS CASE RATE REV/PAYOR
AETNA 18 0.83% 229 $89.21 $20,428
BLUE CROSS 297 13.67% 4,746 $65.30 $309,910 AETNA 6 0.94% $357.67 $2,146
CDPHP 552 25.40% 8,392 $36.32 $304,760 BLUE CROSS 91 14.33% $145.47 $13,238
CIGNA 9 0.41% 142 $89.67 $12,733 CDPHP 164 25.83% $100.15 $16,425
COMMERCIAL 65 2.99% 1,032 $54.84 $56,599 CIGNA 6 0.94% $326.83 $1,961
MEDICARE 756 34.79% 11,580 $19.00 $105,746 COMMERCIAL 21 3.31% $279.19 $5,863
MEDICAID 129 5.94% 1,606 $14.13 $22,685 MEDICARE 264 41.57% $32.59 $8,603
MVP 102 4.69% 1,668 $73.12 $121,962 MEDICAID 8 1.26% $35.38 $283
SELF PAY 9 0.41% 162 $32.53 $5,270 MVP 22 3.46% $330.32 $7,267
UH 101 4.65% 1,597 $96.96 $154,850 UH 27 4.25% $220.85 $5,963
WC/NF 135 6.21% 2,499 $25.07 $62,647 WC/NF 26 4.09% $127.77 $3,322
TOTAL 2,173 100.00% 33,653 $34.99 $1,177,590 TOTAL 635 100.00% $102.47 $65,071
OUTPATIENT CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR Lines CASES % OF PATIENTS UNITS CASE RATE REV/PAYOR
AETNA 34 1.03% 342 $87.35 $29,875
BLUE CROSS 694 21.09% 6,980 $54.38 $379,589 AETNA 1 1.19% $106.00 $106
CDPHP 1,001 30.43% 9,761 $36.56 $356,854 BLUE CROSS 11 13.10% $96.36 $1,060
CIGNA 15 0.46% 159 $97.31 $15,473 CDPHP 34 40.48% $76.85 $2,613
COMMERCIAL 141 4.29% 1,396 $49.73 $69,420 CIGNA - 0.00% $0
MEDICARE 694 21.09% 7,446 $19.00 $68,221 COMMERCIAL 3 3.57% $56.33 $169
MEDICAID 182 5.53% 1,681 $30.20 $50,768 MEDICARE 24 28.57% $29.04 $697
MVP 193 5.87% 1,916 $104.78 $200,759 MEDICAID 4 4.76% $25.00 $100
SELF PAY 29 0.88% 232 $47.62 $11,047 MVP 3 3.57% $241.67 $725
UH 226 6.87% 2,236 $84.62 $189,217 UH 2 2.38% $61.00 $122
WC/NF 81 2.46% 904 $23.61 $21,340 WC/NF 2 2.38% $54.00 $108
TOTAL 3,290 100.00% 33,053 $42.13 $1,392,563 TOTAL 84 100.00% $67.86 $5,700
10.0
OB REVENUE CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR GASTRO REVENUE CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR
AETNA 5 1.12% 136 $99.40 $13,518
BLUE CROSS 92 20.67% 2,060 $62.43 $128,598 AETNA 1 1.12% 7 $102.86 $720
CDPHP 209 46.97% 4,717 $42.88 $202,281 BLUE CROSS 16 17.98% 124 $65.00 $6,383
CIGNA 2 0.45% 44 $74.80 $3,291 CDPHP 26 29.21% 208 $32.98 $6,860
COMMERCIAL 20 4.49% 406 $72.65 $29,495 CIGNA 1 1.12% 8 $18.25 $146
MEDICARE 6 1.35% 221 $19.00 $4,199 COMMERCIAL 2 2.25% 16 $28.88 $462
MEDICAID 69 15.51% 1,229 $16.70 $20,528 MEDICARE 31 34.83% 258 $19.00 $4,602
MVP 24 5.39% 463 $71.75 $33,219 MEDICAID 3 3.37% 23 $10.00 $230
UH 18 4.04% 401 $78.29 $31,393 MVP 4 4.49% 38 $59.74 $2,270
WC/NF - 0.00% - $0.00 $0 UH 5 5.62% 40 $87.63 $3,505
TOTAL 445 100.00% 9,677 $48.21 $466,522 TOTAL 89 100.00% 722 $25,178
Total projected revenue $3,132,624
Net Collections (95% of gross) $2,975,993
October 27, 2009 2:15 p.m. EST
43. Revenue Augmentation Intervention
1. Sources of Revenue
Conversion of local cases to sedation
Cover GI
Cover pediatric radiology
2. Calculate net collections from gross revenue
Confirm historical figures benchmark to MGMA
Days AR
0-30 Days AR Bucket
30-60 Days AR Bucket
60-90 Days AR Bucket
90-120 Days AR Bucket
>120 Days AR Bucket
Ensure actual verses contracted payments sync
Scanning, rapid charge entry, rapid coding, e-submissions, robust billing
system, audits
October 27, 2009 2:15 p.m. EST
44. “Expenses”= Costs to Run an Anesthesia Department
There are 2 Buckets of Expenses
1. Direct Expenses
Clinical Staff, Equipment, Supplies
2. Indirect Expenses = Management Costs
Technology: Telephony, computers, servers, software (i.e. Billing System)
Credentialing with Payors and Hospital
Payroll & Benefits Administration
Scheduling
Revenue Management and Collections
Quality Assurance Program
Risk Management
Legal
Accounting
October 27, 2009 2:15 p.m. EST
45. Anesthesia Staffing (Direct) Expense: Nuts and Bolts
Total Coverage Cost
Management Fee 25%
Total Direct & Indirect Expense
$ 1,316,214
$ 10,090,973
1. Define rooms
Revenue
Shortfall/Surplus
$ 6,612,163
$ (3,478,809)
& hours of coverage
Shortfall per month $ (289,901)
Coverage by hours General Hospital‐ In Patients and OB
2. Define staffing model & MD‐CRNA
Monday ‐ MD
OR 1
24
OR 2 OR 3 OR 4 Float MD
8
OB
24 including ratios, break folks, etc
Monday ‐ CRNA 12 12 10 8 24
Tuesday ‐ MD 24 8 24
Tuesday ‐ CRNA 12 12 10 8 24
Wednesday ‐ MD 24 8 24
Wednesday ‐ CRNA 12 12 10 8 24
Thursday ‐ MD 24 8 24
Thursday ‐ CRNA 12 12 10 8 24
Friday ‐ MD 24 8 24
Friday ‐ CRNA 12 12 10 8 24
Saturday ‐ MD 24 24
Sunday ‐ MD 24 24
Total Hours ‐ MD 168 40 168
Total Hours ‐ CRNA 60 60 50 40 120
Number of MD hours per week 376
Number of MD hours per year
Number of CRNA hours per week
19,552
330 3. Sum hours of work for MD and CRNA
Number of OB hours per year 17,160
Model with Expenses
MD CRNA
OR, Endo & OB Coverage
Total Hours (week) 526 630
Total Hours (year)
Per FTE Hours/Week
27,352
54
32,760
40 4. Based on # of hours work per FTE calculate headcount
Per FTE Hours/Year 2808 2080
Required to cover OR 9.7 15.8
Required to cover vacations 2.0 2.0
Chief MD (incl as float)
Site Director (incl as float)
Total MD and CRNA on Staff
Compensation
12 18
$ 421,801 $ 190,000 5. Calculate compensation per clinician
Cost of OR Coverage $ 4,952,259 $ 3,372,500
Subspecialty Stipend $ ‐
Chief of Anesthesia Stipend
Vice Chief
$ 100,000
$ 50,000 6. Add‐in premiums (Chief, directors, subspecialists,
OB/Cardiac/Peds Stipends $ 50,000
Administrative Costs
Coverage Cost
$ 250,000
$ 5,402,259 $ 3,372,500
beeper call, etc.)
Total staffing expenses $
8,774,759
October 27, 2009 2:15 p.m. EST
46. “Direct Expense” = Mostly Science …
Survey Title: Midwest (US)
Market - Northeast US (NY) BASE SALARY INCENTIVE COMPENSATION
Data Effective Date Surveyed Data Adjustments
25%ile 50%ile 75%ile Age Data Geograph Total 50% Median 25% 50% 75%
Base $ Base $ Base $ Jul-09 Adjust. Base Comp. Incentive Total comp Total Comp. Total Comp.
Economic Research Institute Data 07/09 $223,386 $250,447 $285,571 100.00% 100.00% $250,447 $17,426 $248,785 $267,873 $415,421
Anesthesiologist: DesMoines
Sullivan Cotter Physician Survey Data 03/08 $220,000 $259,000 $302,306 106.67% 101.00% $279,029 $65,357 $262,412 $344,386 $455,534
Anesthesiology Staff Physician MidWest US
Sullivan Cotter Physician Survey 03/08 $234,662 $296,341 $349,100 106.67% 103.00% $325,580 $61,990 $284,691 $387,570 $501,545
Anesthesiology Staff MD US Group Practice
Medical Group Mgt Assoc (MGMA) 01/08 $295,912 $364,758 $436,505 107.50% 103.00% $403,878 $327,649 $403,878 $483,320
Anesthesiology: All Orgsm US Group Practice
Hospital & Healthcare Comp Svc (HHCS) Data 04/08 $269,000 $306,407 $390,000 106.25% 103.00% $335,324 $294,387 $335,324 $426,806
Physician Survey: Anesthesiologist : Group Practice
Hospital & Healthcare Comp Svc (HHCS) Data 04/08 $237,844 $265,160 $313,425 104.58% 101.00% $280,086 $251,233 $280,086 $331,068
Physician Survey: Anesthesiologist : All Groups
AAMC Data 06/07 $250,000 $296,250 $341,250 110.42% 103.00% $336,923 $284,323 $336,923 $388,101
Clinical Science: Anesthesiology All Orgs
Averaged Results $247,258 $291,195 $345,451 106% 102% $315,895 $48,258 $315,623 $364,153 $421,801
October 27, 2009 2:15 p.m. EST
47. “Direct Expense” = Some Art…
Aging Data
Large escalations
Local supply and demand idiosyncrasies
Regional COL variations run counter to
compensation
Accounting for job stress, case volume, call
stress, etc.
October 27, 2009 2:15 p.m. EST
48. “Direct Expense”: Interventions to Lower
• Sophisticated determination of fair market
value salary
• Sophisticated determination of fair market
value benefits
• Explore alternative staffing models
October 27, 2009 2:15 p.m. EST
51. Direct Expense Management
Various Models to Cover 4 ORs
Model MD CRNA Rooms Covered Hands on Deck Gross $ Cost/Room
MD Only 4 0 4 4 people 1,600,000 400,000
CRNA Only 0 4 4 4 people 800,000 200,000
MD/CRNA 1 4 4 5 people 1,200,000 300,000
The CRNA Only model provides lowest cost per room.
• Liability and Revenue Management Issues
The MD/CRNA model provides second lowest cost per room.
• Avoids Liability or Revenue Management Issues
October 27, 2009 2:15 p.m. EST
52. “Indirect Expenses”= Costs to Run an Anesthesia
Department
Technology: Telephony, computers, servers, software (i.e. Billing System)
Credentialing with Payors and Hospital
Payroll & Benefits Administration
Scheduling
Revenue Management and Collections
Quality Assurance Program
Risk Management
Legal
Accounting
Insurances
October 27, 2009 2:15 p.m. EST
53. “Indirect Expenses”=Costs to Run an Anesthesia
Department
Percent of Revenue Allocated to Administration Functions
35.0%
30.0% 26.7%
25.0%
20.0%
13.9%
Percent of Revenue
15.0%
10.0%
5.0%
0.0%
Total Administrative Costs Billing and Insurance Related Costs
Source: American Hospital Association, 2005
Physician Groups
October 27, 2009 2:15 p.m. EST
54. Indirect Expense Intervention
The average medical practice spends
between 14 and 25% on administrative costs.
Working with larger entities permits
economies of scale and economies of scope
and can drive down costs. Larger entities
have access to the most effective technology
and highly sophisticated human resources.
October 27, 2009 2:15 p.m. EST
55. Review: The Anatomy of a Subsidy
Revenue - Expenses = Subsidy
• Patients • Clinicians • Fixed Amount
• Payors • Management • Revenue Threshold
• Case/Payor Mix Guarantee
• Cost Plus
October 27, 2009 2:15 p.m. EST
56. Subsidy Forms
Fixed Amount
Hospital defers revenue/expense risk and reward
If sum proves insufficient, is insolvency an option?
Revenue Threshold
Hospital on the hook for group’s billing
Due diligence on revenue management and contracting required
Contemplate bonus schedule to align interests
Case/Payor Mix Guarantee
Hard to quantify impact of payor mix drift
Case guarantee relatively easy to quantify
Hospital avoids revenue management risk
Cost Plus
Hospital retains all revenue/expense risk and reward
Bonus schedule critical to align interests
October 27, 2009 2:15 p.m. EST
57. Review: Interventions to Reduce Subsidy
Revenue - Expenses
-Savvy Payor Contracting -Sophisticated compensation analysis
-Pristine Revenue Management -Ensuring FMV salary and benefits
-Leveraging technology -Deploying cost-efficient staffing models
-Leveraging technology
SOUND ADMINISTRATION
October 27, 2009 2:15 p.m. EST
58. Is There Relief on the Horizon?
2,000 70%
Growth in Number of New Anesthesia Graduates 60%
1,800
50%
1,600
40%
1,400
30%
1,200
YoY % Growth
# of Graduates
20%
1,000
10%
800
0%
600
-10%
400
-20%
200 -30%
0 -40%
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
October 27, 2009 2:15 p.m. EST
59. The Data is Not Encouraging…
Note the unfilled demand
100%
18% 20% 21% 23% 25%
80%
60%
49%
49% 50%
50%
50%
40%
20%
33% 31% 29% 27% 25%
0%
2001 2002 2003 2004 2005
CRNA's Anesthesiologists Unfilled Demand
October 27, 2009 2:15 p.m. EST
60. Closing Remarks: Defining Victory
Deriving the most value per dollar spent
Clinicians are paid a fair day’s wage for fair day’s work
Fair benefits
Obtaining a robust quality management program
Making sure that all potential revenue is captured
All revenue streams explored
Contracts with payors are optimized
Revenue management is smooth, efficient and error-free
October 27, 2009 2:15 p.m. EST
61. Questions
Marc E. Koch, MD MBA
Somnia President and Chief Executive Officer
877-476-6642
www.somniainc.com
October 27, 2009 2:15 p.m. EST