The document provides an overview of the long term lease of CMC-Union hospital in Union County. It discusses the healthcare industry environment facing increasing pressures. The current 25-year lease between the county and CHS is set to expire in 2020, with an option to renew for 9 additional years. Over the lease term, CMC-Union has invested in new service lines and facilities. Its medical staff has grown from 75 to 475 physicians. The county receives annual lease payments based on a percentage of the hospital's operating cash flow and investment income.
Management services organizations (MSOs) are emerging as partnerships that offer business support services to independent physician and ancillary groups. MSOs help providers with functions like purchasing, billing, and regulatory compliance. They also implement electronic health records that improve care coordination. Hospitals often anchor MSOs to better align with local providers and improve quality. MSOs allow physician groups to access resources and expertise through shared services that individual practices cannot afford alone.
Emerging Business Models for Hospital and Physician Integration: Clinical In...chriskalkhof
The document discusses emerging business models for hospital and physician integration, focusing on clinical integration as a business strategy. It provides an overview of the evolving regulatory landscape under the Affordable Care Act and its impact on provider revenues. It then discusses emerging provider business models and financing options, highlighting clinical integration organization (CIO) models. The presentation outlines steps to develop a clinical integration and business plan, including assessing readiness, defining the organizational model, and planning initial clinical integration initiatives. The goal is to create a fully integrated network capable of managing patient populations and risks.
Final Kalkhof Tri State Hfma 09 15 11 Integrated Service Lines And Managed Carechriskalkhof
This document summarizes a presentation on building a value-driven integrated service line and care continuum. The presentation discusses transitioning from traditional fee-for-service models to population management models, defining service line capabilities across care continuums, aligning clinical and capital resources, physician alignment strategies, and establishing networks to support core service lines. It also covers service line pricing, lessons learned, and taking questions.
This document summarizes a presentation on managed care contracting strategies for physician practices. The presentation covers: 1) Payer goals and how physician network participation impacts practices, 2) How patient steering works between payers, hospitals, and practices, and 3) Strategies practices can use to negotiate contracts and align with other providers. It discusses factors that influence referrals and revenues and challenges practices currently face in contracting with payers.
This is the summary of a webinar I delivered in November 2012 on Health Outcomes Liaisons and their roles in supporting managed care busines and ACO business.
Mark Zezza: Moving towards accountable care in the USNuffield Trust
The document discusses how accountable care organizations (ACOs) help achieve the vision of health care reform under the Affordable Care Act. ACOs aim to clarify health care goals, foster care coordination and accountability, and align payment incentives with quality care. Early evidence shows ACOs in Medicare programs and private sector initiatives have improved quality measures and reduced costs. The document notes ACOs are one part of broader reform efforts through the Center for Medicare and Medicaid Innovation to test new payment and delivery models beyond ACOs alone.
The document provides tips for contracting with managed care organizations (MCOs). It discusses the four knows: 1) Know the rules of the program and MCO requirements, 2) Know what the MCOs need and want, 3) Know your own organization, and 4) Know your contracting strategy options. It emphasizes understanding state and MCO requirements, determining MCO needs, promoting your organization's value, considering alternative payment models, and being prepared to negotiate. The tips aim to help providers effectively contract with MCOs participating in state managed care programs.
This document is the fourth edition of the American Medical Association's model managed care contract. It aims to provide physicians with a balanced contract that protects both physician and patient rights in dealings with managed care organizations. The introduction notes revisions made to address new unfair contracting practices. Physicians are advised to carefully review any managed care contract and all related policies before signing.
Management services organizations (MSOs) are emerging as partnerships that offer business support services to independent physician and ancillary groups. MSOs help providers with functions like purchasing, billing, and regulatory compliance. They also implement electronic health records that improve care coordination. Hospitals often anchor MSOs to better align with local providers and improve quality. MSOs allow physician groups to access resources and expertise through shared services that individual practices cannot afford alone.
Emerging Business Models for Hospital and Physician Integration: Clinical In...chriskalkhof
The document discusses emerging business models for hospital and physician integration, focusing on clinical integration as a business strategy. It provides an overview of the evolving regulatory landscape under the Affordable Care Act and its impact on provider revenues. It then discusses emerging provider business models and financing options, highlighting clinical integration organization (CIO) models. The presentation outlines steps to develop a clinical integration and business plan, including assessing readiness, defining the organizational model, and planning initial clinical integration initiatives. The goal is to create a fully integrated network capable of managing patient populations and risks.
Final Kalkhof Tri State Hfma 09 15 11 Integrated Service Lines And Managed Carechriskalkhof
This document summarizes a presentation on building a value-driven integrated service line and care continuum. The presentation discusses transitioning from traditional fee-for-service models to population management models, defining service line capabilities across care continuums, aligning clinical and capital resources, physician alignment strategies, and establishing networks to support core service lines. It also covers service line pricing, lessons learned, and taking questions.
This document summarizes a presentation on managed care contracting strategies for physician practices. The presentation covers: 1) Payer goals and how physician network participation impacts practices, 2) How patient steering works between payers, hospitals, and practices, and 3) Strategies practices can use to negotiate contracts and align with other providers. It discusses factors that influence referrals and revenues and challenges practices currently face in contracting with payers.
This is the summary of a webinar I delivered in November 2012 on Health Outcomes Liaisons and their roles in supporting managed care busines and ACO business.
Mark Zezza: Moving towards accountable care in the USNuffield Trust
The document discusses how accountable care organizations (ACOs) help achieve the vision of health care reform under the Affordable Care Act. ACOs aim to clarify health care goals, foster care coordination and accountability, and align payment incentives with quality care. Early evidence shows ACOs in Medicare programs and private sector initiatives have improved quality measures and reduced costs. The document notes ACOs are one part of broader reform efforts through the Center for Medicare and Medicaid Innovation to test new payment and delivery models beyond ACOs alone.
The document provides tips for contracting with managed care organizations (MCOs). It discusses the four knows: 1) Know the rules of the program and MCO requirements, 2) Know what the MCOs need and want, 3) Know your own organization, and 4) Know your contracting strategy options. It emphasizes understanding state and MCO requirements, determining MCO needs, promoting your organization's value, considering alternative payment models, and being prepared to negotiate. The tips aim to help providers effectively contract with MCOs participating in state managed care programs.
This document is the fourth edition of the American Medical Association's model managed care contract. It aims to provide physicians with a balanced contract that protects both physician and patient rights in dealings with managed care organizations. The introduction notes revisions made to address new unfair contracting practices. Physicians are advised to carefully review any managed care contract and all related policies before signing.
Managed Care Contracting and Network Development ConsultantsHeather Burke
The document provides information about the services offered by Healthcare Provider Connections (HCPC), a consulting firm that specializes in network development for managed care organizations. HCPC utilizes experienced consultants with years of experience in managed care contracting to negotiate rates and contracts with various provider types across the country. HCPC prides itself on its proven contracting process that can develop strong provider networks within tight timeframes and its customized CRM tools to track contracting progress. A variety of network development services are listed, including market research, provider outreach and education, contract negotiations, and reporting.
InfosysPublicServices - Accountable Care Organization Solution | ACO RegulationsInfosys
Accountable Care Organization Solution for payors Combines Comprehensive platform by providing Operational & Analytical Services. White Paper highlights Functional Landscape & key Features of the Platform.
An ageing population and significant public funding pressures means that the private sector is becoming more involved in delivering healthcare services. Catalyst\’s Autumn 2012 Healthcare Services industry sector note outlines key issues and pressures within the healthcare services supply chain and analyses the impact on M&A.
Delivering Telehealth At Scale In Northern Ireland - Jim O'Donghuehealthcareisi
The document discusses delivering telehealth at scale in Northern Ireland from a service provider perspective. It notes that chronic diseases account for a large portion of health spending and issues in NI. It raises questions for NI authorities about whether telehealth should be provided publicly or outsourced, and what a potential outsourced model might look like. It then discusses options for procuring telehealth including managed service models and responsibilities of commissioners and providers in such models.
Revenue Cycle Risk Mitigation White Paper December 1 2010 Ver 1 2Phil C. Solomon
This document discusses strategies for healthcare providers to mitigate revenue risk and improve their revenue cycle performance. It recommends leveraging operational business intelligence tools to gain real-time insights into revenue cycle metrics and key performance indicators. This allows providers to identify negative trends early and make timely decisions. The document also stresses the importance of continuous benchmarking against performance metrics and communicating goals to all staff involved in the revenue cycle process. The overall aim is for providers to optimize revenue capture and cash collection in the complex healthcare environment.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
Lenox Advisors provides comprehensive corporate benefits services and financial planning solutions to help employers and individuals achieve financial security and success. Their partnership with NFP Benefits allows them to offer an expansive portfolio of benefits products and services, technology resources, and personalized attention. Key offerings include group medical, dental and vision plans, life and disability insurance, retirement plans, and compliance guidance.
Disruptive Data Science - How Data Science and Big Data are Transforming Busi...EMC
The document discusses how CareCore National evolved to utilize data-driven transformations, highlighting EMC's analytics platforms, tools, and services that can assist organizations in building their data science capabilities and teams to leverage big data and drive business value through predictive analytics and data mining. It also outlines the key components needed for a successful analytics transformation, including establishing a clear vision, understanding platform dependencies, embracing unified analytics platforms, building data science skills, and delivering initial wins to socialize analytics.
Iason is a consulting company created by financial professionals to provide services related to asset valuation, derivatives pricing, risk measurement, and quantitative finance. It offers flexible consulting services using practitioners' expertise in financial markets and state-of-the-art quantitative models. Iason's services include portfolio revaluation, risk assessment, model development, and regulatory compliance support.
A Regional Coastal Modelling System for the North West from Wales to Scotland...Stephen Flood
2015 DHI UK & Ireland Symposium
A Regional Coastal Modelling System for the North West – from Wales to Scotland
Samantha Mullan (Intertek),
Tuesday 21 April 2015 at 12:20 - 12:40
Intertek has developed a regional coastal modelling system for United Utilities. This modelling system covers UU’s entire area of interest and stretches from the north Wales coast to the southeast coast of Scotland, including complex and dynamic environments such as the Ribble Estuary, Morecambe Bay and the Solway Firth. To develop an efficient and practical system that provides the client with an assessment and management tool that meets their requirements, with sufficient resolution in all areas of interest over such a large and varied region, has been challenging. The presentation will provide an overview of the modelling system, including the techniques employed, and some of the difficulties experienced.
1. Video, and video on demand (VOD) specifically, has become an effective tool for churches to communicate with and reach more people, including those at multiple campuses and worldwide.
2. An IPTV system is well-suited to distributing stored video files like sermons for VOD in houses of worship, as it allows delivery over an IP network without a separate AV network.
3. Key benefits of VOD for houses of worship include reaching audiences anytime anywhere on any device, and supporting satellite campuses by streaming content in real-time to multiple locations.
New microsoft office power point presentationYogesh Garg
The document summarizes a large marketing research company. It has its headquarters in New York and operates in over 100 countries, employing 32,000 people. It tracks retail chains, online users, and has 500,000 panelists worldwide. It measures marketing information, TV ratings, online intelligence, and consumer behavior. It provides services in areas like growth strategies, advertising effectiveness, marketing performance, brand management, pricing, cross-platform behavior analysis, and serves industries like media, CPG, retail, telecom, travel and sports. It uses technologies like people meters, book/music/video scans, and neurometrics to gather insights.
Ringkasan dokumen tersebut adalah:
1. Menguraikan 10 indikator kinerja utama Pengadilan Negeri Selong untuk meningkatkan kualitas pelayanan peradilan
2. Mencakup indikator seperti penyelesaian perkara, pengawasan, kualitas SDM, transparansi dan aksesibilitas masyarakat
3. Data yang digunakan berasal dari berkas perkara, laporan bulanan, dan survei kepuasan masyarakat
Recent HPC trial of MIKE 21 Flexible Mesh Series in the UK gives impressive results (DHI).
MIKE by DHI 15th UK User Group Meeting - Tuesday 19 March 2013
Update on launch of the Digital & Creative Career College, one of the first three Career Colleges to launch in the UK in September 2014.
Based within the campus of Oldham College in Greater Manchester, the DCCC works with industry to help students develop skills for success in digitally driven industries.
Este documento presenta un mapa conceptual sobre las características de la gerencia de proyectos y su ciclo de vida, incluyendo las fases, responsables y tiempos de desarrollo. Resalta la importancia de planificar y administrar adecuadamente los recursos para lograr el éxito del proyecto. Concluye que el éxito depende de la planificación y administración de recursos, es responsabilidad del director definir objetivos, acciones y tiempos, y que cuando se desarrolla adecuadamente el proyecto cumple las fases y
Moving Beyond Access: University Institutional Repositories, Copyright and Di...Harrison Inefuku
This document summarizes a research project on university institutional repositories (UIRs), copyright, and digital preservation. The research aims to identify how digital preservation may conflict with copyright law, establish long-term preservation strategies allowed under current law, and determine needed copyright reforms. The research in progress includes developing policies and guidelines. An overview of relevant copyright legislation and exemptions for libraries is provided. Weaknesses of current law for digital environments are discussed, such as restrictions on the number of copies and digitization. The relationship between digital preservation activities and copyright, and suggestions for reform, are also reviewed.
The document discusses learning about various writing principles, including sentence fluency, punctuation, and response techniques. It mentions the 7 Principles of Writing, learning to read aloud to hear rhythm, making punctuation memorable, using response starters instead of just retelling, and using icons like ! and ? in responses. It also notes getting into peer response groups and keeping a response journal.
The document discusses various writing and reading response techniques that were learned, including the 7 Principles of Writing, sentence fluency, making punctuation memorable, sharing language skills, writing music not just words, getting into peer response groups, using response journals, anticipation responses, assessments, stopping to jot down notes, turning to talk to others, using marginal notes, avoiding simply retelling and using response starters, and using icons like ! and ? to engage with texts.
- PhD in Physics
- Over 30 years of experience in research and management in the field of nanotechnologies
- Author of over 150 scientific publications
- Coordinator of EU research projects worth over EUR 20 million
Dr. Eng.
- PhD in Materials Engineering
- Specialist in rare earth metals and their applications
- Author of over 30 scientific publications
- Experienced manager of research infrastructure
- Responsible for cooperation with industry within the Department
M.Sc.
- Master's degree in Materials Engineering
- Over 5 years of experience in project management
- Excellent organizational skills and knowledge of EU funds regulations
- Responsible for execution and reporting of the NanoMat project
Managed Care Contracting and Network Development ConsultantsHeather Burke
The document provides information about the services offered by Healthcare Provider Connections (HCPC), a consulting firm that specializes in network development for managed care organizations. HCPC utilizes experienced consultants with years of experience in managed care contracting to negotiate rates and contracts with various provider types across the country. HCPC prides itself on its proven contracting process that can develop strong provider networks within tight timeframes and its customized CRM tools to track contracting progress. A variety of network development services are listed, including market research, provider outreach and education, contract negotiations, and reporting.
InfosysPublicServices - Accountable Care Organization Solution | ACO RegulationsInfosys
Accountable Care Organization Solution for payors Combines Comprehensive platform by providing Operational & Analytical Services. White Paper highlights Functional Landscape & key Features of the Platform.
An ageing population and significant public funding pressures means that the private sector is becoming more involved in delivering healthcare services. Catalyst\’s Autumn 2012 Healthcare Services industry sector note outlines key issues and pressures within the healthcare services supply chain and analyses the impact on M&A.
Delivering Telehealth At Scale In Northern Ireland - Jim O'Donghuehealthcareisi
The document discusses delivering telehealth at scale in Northern Ireland from a service provider perspective. It notes that chronic diseases account for a large portion of health spending and issues in NI. It raises questions for NI authorities about whether telehealth should be provided publicly or outsourced, and what a potential outsourced model might look like. It then discusses options for procuring telehealth including managed service models and responsibilities of commissioners and providers in such models.
Revenue Cycle Risk Mitigation White Paper December 1 2010 Ver 1 2Phil C. Solomon
This document discusses strategies for healthcare providers to mitigate revenue risk and improve their revenue cycle performance. It recommends leveraging operational business intelligence tools to gain real-time insights into revenue cycle metrics and key performance indicators. This allows providers to identify negative trends early and make timely decisions. The document also stresses the importance of continuous benchmarking against performance metrics and communicating goals to all staff involved in the revenue cycle process. The overall aim is for providers to optimize revenue capture and cash collection in the complex healthcare environment.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
Lenox Advisors provides comprehensive corporate benefits services and financial planning solutions to help employers and individuals achieve financial security and success. Their partnership with NFP Benefits allows them to offer an expansive portfolio of benefits products and services, technology resources, and personalized attention. Key offerings include group medical, dental and vision plans, life and disability insurance, retirement plans, and compliance guidance.
Disruptive Data Science - How Data Science and Big Data are Transforming Busi...EMC
The document discusses how CareCore National evolved to utilize data-driven transformations, highlighting EMC's analytics platforms, tools, and services that can assist organizations in building their data science capabilities and teams to leverage big data and drive business value through predictive analytics and data mining. It also outlines the key components needed for a successful analytics transformation, including establishing a clear vision, understanding platform dependencies, embracing unified analytics platforms, building data science skills, and delivering initial wins to socialize analytics.
Iason is a consulting company created by financial professionals to provide services related to asset valuation, derivatives pricing, risk measurement, and quantitative finance. It offers flexible consulting services using practitioners' expertise in financial markets and state-of-the-art quantitative models. Iason's services include portfolio revaluation, risk assessment, model development, and regulatory compliance support.
A Regional Coastal Modelling System for the North West from Wales to Scotland...Stephen Flood
2015 DHI UK & Ireland Symposium
A Regional Coastal Modelling System for the North West – from Wales to Scotland
Samantha Mullan (Intertek),
Tuesday 21 April 2015 at 12:20 - 12:40
Intertek has developed a regional coastal modelling system for United Utilities. This modelling system covers UU’s entire area of interest and stretches from the north Wales coast to the southeast coast of Scotland, including complex and dynamic environments such as the Ribble Estuary, Morecambe Bay and the Solway Firth. To develop an efficient and practical system that provides the client with an assessment and management tool that meets their requirements, with sufficient resolution in all areas of interest over such a large and varied region, has been challenging. The presentation will provide an overview of the modelling system, including the techniques employed, and some of the difficulties experienced.
1. Video, and video on demand (VOD) specifically, has become an effective tool for churches to communicate with and reach more people, including those at multiple campuses and worldwide.
2. An IPTV system is well-suited to distributing stored video files like sermons for VOD in houses of worship, as it allows delivery over an IP network without a separate AV network.
3. Key benefits of VOD for houses of worship include reaching audiences anytime anywhere on any device, and supporting satellite campuses by streaming content in real-time to multiple locations.
New microsoft office power point presentationYogesh Garg
The document summarizes a large marketing research company. It has its headquarters in New York and operates in over 100 countries, employing 32,000 people. It tracks retail chains, online users, and has 500,000 panelists worldwide. It measures marketing information, TV ratings, online intelligence, and consumer behavior. It provides services in areas like growth strategies, advertising effectiveness, marketing performance, brand management, pricing, cross-platform behavior analysis, and serves industries like media, CPG, retail, telecom, travel and sports. It uses technologies like people meters, book/music/video scans, and neurometrics to gather insights.
Ringkasan dokumen tersebut adalah:
1. Menguraikan 10 indikator kinerja utama Pengadilan Negeri Selong untuk meningkatkan kualitas pelayanan peradilan
2. Mencakup indikator seperti penyelesaian perkara, pengawasan, kualitas SDM, transparansi dan aksesibilitas masyarakat
3. Data yang digunakan berasal dari berkas perkara, laporan bulanan, dan survei kepuasan masyarakat
Recent HPC trial of MIKE 21 Flexible Mesh Series in the UK gives impressive results (DHI).
MIKE by DHI 15th UK User Group Meeting - Tuesday 19 March 2013
Update on launch of the Digital & Creative Career College, one of the first three Career Colleges to launch in the UK in September 2014.
Based within the campus of Oldham College in Greater Manchester, the DCCC works with industry to help students develop skills for success in digitally driven industries.
Este documento presenta un mapa conceptual sobre las características de la gerencia de proyectos y su ciclo de vida, incluyendo las fases, responsables y tiempos de desarrollo. Resalta la importancia de planificar y administrar adecuadamente los recursos para lograr el éxito del proyecto. Concluye que el éxito depende de la planificación y administración de recursos, es responsabilidad del director definir objetivos, acciones y tiempos, y que cuando se desarrolla adecuadamente el proyecto cumple las fases y
Moving Beyond Access: University Institutional Repositories, Copyright and Di...Harrison Inefuku
This document summarizes a research project on university institutional repositories (UIRs), copyright, and digital preservation. The research aims to identify how digital preservation may conflict with copyright law, establish long-term preservation strategies allowed under current law, and determine needed copyright reforms. The research in progress includes developing policies and guidelines. An overview of relevant copyright legislation and exemptions for libraries is provided. Weaknesses of current law for digital environments are discussed, such as restrictions on the number of copies and digitization. The relationship between digital preservation activities and copyright, and suggestions for reform, are also reviewed.
The document discusses learning about various writing principles, including sentence fluency, punctuation, and response techniques. It mentions the 7 Principles of Writing, learning to read aloud to hear rhythm, making punctuation memorable, using response starters instead of just retelling, and using icons like ! and ? in responses. It also notes getting into peer response groups and keeping a response journal.
The document discusses various writing and reading response techniques that were learned, including the 7 Principles of Writing, sentence fluency, making punctuation memorable, sharing language skills, writing music not just words, getting into peer response groups, using response journals, anticipation responses, assessments, stopping to jot down notes, turning to talk to others, using marginal notes, avoiding simply retelling and using response starters, and using icons like ! and ? to engage with texts.
- PhD in Physics
- Over 30 years of experience in research and management in the field of nanotechnologies
- Author of over 150 scientific publications
- Coordinator of EU research projects worth over EUR 20 million
Dr. Eng.
- PhD in Materials Engineering
- Specialist in rare earth metals and their applications
- Author of over 30 scientific publications
- Experienced manager of research infrastructure
- Responsible for cooperation with industry within the Department
M.Sc.
- Master's degree in Materials Engineering
- Over 5 years of experience in project management
- Excellent organizational skills and knowledge of EU funds regulations
- Responsible for execution and reporting of the NanoMat project
The document summarizes the daily activities and lessons from a writing class. It describes:
- A morning free write activity quoting Paul Laurence Dunbar.
- Presentations from students on various informative topics like newspapers, governments, butterflies and more.
- A lecture on opinion and argument writing focusing on using evidence to support claims.
- Book club meetings and a portfolio reflection activity where students reviewed their narrative, informative pieces and free writes.
CIWEM Urban Drainage Group Autumn Conference & Exhibition 2015Stephen Flood
Building upon our successful participation in last years 30th Anniversary Conference, we are very pleased to again sponsor the CIWEM Urban Drainage Group Autumn Conference & Exhibition 2015 to be held over 4th - 6th November 2015 in Chester.
IPTV for Schools - 21st Century SolutionsAndrew Lemert
Many educational institutions need to upgrade the systems used to deliver video content to classrooms, either to replace aging technologies or to support a greater range of content and viewing devices. IPTV networks, particularly those based on newly available technologies, offer significant video quality improvements and provide a unified user interface for live, pre-recorded, on-demand, and Internet-sourced video. IPTV systems can be installed incrementally as an overlay to an existing network, or can be deployed as complete replacements of an existing system. Recent cost reductions, particularly in key software and server components, have now made IPTV technology affordable for virtually any school system.
The document summarizes the daily activities and lessons from a writing class. It describes presentations by students on various informative topics like newspapers, brochures, and governments. It also mentions an upcoming lesson on opinion and argument writing, asking students to make a claim and support it with evidence. Book clubs then meet before students work on portfolio reflections, bringing samples of their narrative, informative, and free write work.
Driving Decisions From Predictive ModelingAnand Rao
This document discusses strategic applications of predictive modeling in healthcare. It provides examples of using system dynamics modeling to create patient flow models and examine the impact of healthcare policies. It also describes a case study where Diamond used system dynamics modeling to prototype a diabetes management intervention in South Africa. The prototype aimed to use multi-channel communication and social networking to increase prevention, self-care, and primary care of diabetes patients while gathering data to evaluate the intervention's efficiency and efficacy.
I want to sell my practice webinar presentationPYA, P.C.
This document discusses considerations for valuing and compensating physicians when selling a medical practice. It covers the hospital/physician alignment environment, regulatory issues, valuation methods, and physician compensation models. Valuation methods discussed include the asset, income, and market approaches. Key factors in physician compensation include base salary, incentives for quality measures, leadership, and productivity based on work RVUs.
A Look Under the Hood: 5 Critical Questions You Should be Asking about ACOsSheri Litchford
The document discusses 5 critical questions about Accountable Care Organizations (ACOs): 1) what an ACO is, 2) whether ACOs are failing, 3) if there is money to be made through ACOs, 4) examples of successful ACOs, and 5) the information technology costs of ACOs. It provides details on these topics, including definitions of ACOs, perspectives on their viability, examples of ACOs that have generated savings, and the types of IT systems needed to support ACO operations and goals such as quality reporting, cost control and care management.
Accretive Health - Revenue Cycle - Revenue Cycle Management AccretiveHealth
This document provides an overview and summary of Accretive Health's business for investors attending the Credit Suisse 2012 Healthcare Conference. It includes a safe harbor statement, descriptions of Accretive Health's three main offerings (revenue cycle management, quality and total cost of care management, and physician advisory services), highlights of the company's mission and value proposition. It also provides financial performance summaries and outlook, growth priorities, and defines how the company uses non-GAAP measures like adjusted EBITDA in evaluating performance.
Optimizing Revenue Cycle Management: Centricity Business at Saint Francis Hea...GE Healthcare - IT
For large hospitals and small provider practices alike, healthcare
reform and changing reimbursement models have introduced
significant new challenges to the business. It is now more important
than ever for organizations to have a well-designed revenue cycle
management (RCM) strategy in order to optimize their revenue cycle,
prepare for change, and maximize revenue. At the same time, mergers
and acquisitions among U.S. hospitals and physician practices add to
operational complexity, and with most hospitals employing a wide
vendor portfolio of HCIT solutions, these challenges further the
importance of running a tight financial enterprise. The inability to
effectively monitor and proactively manage the revenue cycle can
destroy profitability and make it difficult to focus on what matters
most — delivering outstanding care to patients.
Forces confronting health care CIOs include accelerating changes in health care IT driven by government incentives and mandates. This squeezes budgets and requires further cost reductions. CIOs are looking for real business value from IT. Federal incentive programs only offset 15-20% of total EHR costs. There is a predicted shortage of 50,000 health IT workers. Most CIOs are concerned about meeting meaningful use deadlines. Significant federal penalties exist for non-compliance. A transformational approach is needed to effectively leverage health care IT.
Today’s Reality for Hospitals: Brand is the New Must Have
Authored by: Gwane Levey
The paper addresses healthcare trends and the multifaceted and complex transformations hospitals are undergoing and the ways in which hospital administrators, marketers, boards and management can use brand to overcome the turbulence, harness flux and transform it into stable momentum and long-term success.
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
Healthcare in the US is undergoing rapid reform that will change how insurance is provided and how healthcare is delivered. Major drivers of this change include the actions of large employers and the government to reduce costs, the rise of new care delivery models like retail clinics, and increased consumer accountability. To survive, healthcare organizations must improve their ability to innovate in response to the shifting market by focusing on strategic agility, organizational innovation, and strengthening core competencies in product development. Payors that can manage innovation, align products with strategy, and adjust quickly will be best positioned to address the need for reform.
Five forces that will change healthcare marketingKaren Corrigan
In the healthcare industry, powerful demographic, economic, societal, technology and legislative forces are converging to change the underlying basis for competition. For health systems, new economic models, disruptive technologies and transformation of care delivery systems are front and center – challenging marketing executives to better understand and anticipate the impact of this change.
Using employed physicians as a competitive weapon involves developing strategic plans to leverage employed physician groups to increase hospital revenue and market share. Key strategies include managing referrals within the employed group, developing primary care and specialty care networks, improving care processes, pursuing clinical integration and risk-based contracting opportunities, and focusing groups on quality and cost metrics. Success requires investing in physician leadership development, marketing the physician brand, and ensuring cultural and operational alignment between the hospital and employed physicians.
The document discusses performance management systems and how they can help health care organizations navigate challenges. Specifically, it discusses:
1) How Kurt Salmon Associates provides management consulting services including strategy, facility planning, and IT to various health care providers.
2) How performance management systems like the Balanced Scorecard can help organizations link strategic objectives to operations by monitoring key performance indicators.
3) An example of how a performance scorecard could be designed for a cardiology center of excellence, identifying objectives, metrics, and the relationships between metrics in each of the four Balanced Scorecard perspectives: financial, internal processes, learning and growth, and customers.
The document discusses performance management systems and how they can help health care organizations navigate challenges. Specifically, it discusses:
1) Kurt Salmon Associates provides management consulting services including facility planning, strategy, and IT to various health care providers.
2) Performance management systems like the Balanced Scorecard can help organizations translate strategies into action by focusing employees on key performance measures.
3) These systems balance financial and non-financial metrics across perspectives like customers, internal processes, learning and growth, and finances. Leading and lagging indicators are connected to show how improving processes leads to better outcomes.
This document discusses developing enterprise-wide electronic medical records (EMRs) and summarizes as follows:
1) Healthcare providers are under pressure to ensure critical patient information is available across their growing networks of facilities. Traditional stand-alone systems are evolving into enterprise solutions that can integrate multiple facilities.
2) Enterprise EMRs promise benefits like enhanced care, reduced costs, and improved performance by providing a holistic view of patient information. However, a one-size-fits-all approach does not work given facilities have different needs.
3) A tailored analysis of each facility's requirements is needed to identify the right EMR solution. Options range from basic to partial to full enterprise systems. This ensures the solution
Developing Employment Agreement for Quality, Operational Efficiency and Patie...Curtis Bernstein
This document discusses developing employment agreements for physicians that comply with regulations while improving quality and efficiency. It recommends tying physician compensation to productivity, quality metrics, and operational goals. Specific incentives are suggested around quality measures, operational improvements, and medical directorships. Fair market value benchmarks are important to consider to comply with Stark and anti-kickback laws.
Healthcare real estate optimization involves assessing opportunities within a healthcare system's real estate portfolio to generate cost savings and create value. This includes analyzing a healthcare system's portfolio inventory, utilization, leasing strategies, capital strategies, development strategies, and facilities management effectiveness. Conducting these assessments requires collecting and analyzing appropriate real estate data to make strategic portfolio decisions that contain costs and increase value. Common opportunities identified include utilizing vacant owned space to reduce leasing costs, negotiating lower lease rates, improving operating efficiencies, and pursuing capital strategies such as monetization or credit tenant lease financing.
Decosimo's Shannon Farr and Anderson Busby's Amanda Busby co-presented this PowerPoint at the 2012 Tennessee Bar Association's Health Law Primer on October 3, 2012 in Brentwood, TN.
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Kh 110815 union county work session v7
1. Union County
Union County Work Session
Overview of Long Term Lease of CMC-Union
Monroe, North Carolina / August 15, 2011
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 1
2. Union County
Topics for Discussion
• Healthcare Industry Update
• Overview of Current Lease
• Development of CMC-Union During Current Lease
• Review of County’s Stated Goals and Objectives
• Summary of Proposed Lease Terms
• Observations
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 2
4. Union County
We Are in a Period of Tremendous Challenge
for Healthcare Providers
• Declining volumes
• Deteriorating payor mix
• Compromised financial performance and position
• Increased competitive pressures
• A physician market “free for all”
• A large capital appetite, but more limited/ difficult capital access
• Uncertain impact of reform
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 4
5. Union County
Feeling Squeezed Even Before the Impact of Healthcare Reform
Reimbursement Bond covenants
Pressures and RAC/ Investment losses
Short Stay Issues
Physician shortages/
recruitment/ retention/ Capital access/ cost
employment and the need to fund
growth strategies
Increasingly
competitive markets Pension funding
Specialty hospital/ Payor mix
ambulatory niche Impact on operating cash
flow and balance sheet stability? deterioration with rising
competition bad debt and charity
Equipment
Aging Infrastructure replacement/ new
Information technology needs technology
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 5
6. Union County
National Healthcare Point of View
1. Healthcare is rapidly moving from a post-Medicare business
model to a post-reform business model
2. Reimbursement will decline over time either on a “relative”
or a “real” basis
3. Reimbursement mechanisms will migrate away from
activity-based approaches towards those that reward quality
and cost effectiveness
4. The hospital sector will consolidate significantly and size
and scale matter
5. The basic relationships and care model between hospitals,
doctors, and patients will change dramatically
6. Technology will become a major disruptive change agent in
healthcare as it has been in other industries
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 6
7. Union County
New Core Competencies Will Be Required
Integration Attributes Key Characteristics of the Best Prepared
A highly aligned medical staff characterized by shared goals, outcomes-based
Physician/ Hospital Integration contractual arrangements, significant planning input, and adequately represented in
organizational governance
Care Coordination/ Management Use of care coordination tools and processes by an empowered and integrated
Capability workforce to meet performance goals that are regularly measured and reported
An IT platform that supports clinical decision making, information management, facile
Information Systems
communications, and access by all stakeholders (physicians, patients, administration)
Sophistication
to proper treatment and strategic decision making
A right-sized organization-wide cost structure, highlighted by appropriate levels of
Cost Management staffing, capital spending, overhead support, and supply chain costs; constantly
reviewed based on comparative peer group studies and benchmarks
A rational service distribution system that has accessible primary care and easy access
Service Distribution System
(both physically and through referrals) across the care continuum, delivered in
Effectiveness
contemporary facilities with contemporary equipment
Sufficient scale to attract competitive clinical and administrative talent, realize
Scale and Market Essentiality economies, drive marketplace innovation, and be an essential provider to health plans
and patients
Brand Identification Well recognized and respected, associated with high-quality and service excellence.
Maintaining strong relationships with payors and the ability to negotiate support for
Payor Relationships/ Contracts
“new era” business practices
Financial Strength/ Capital Strong appeal to capital markets through sustained operations, revenue growth, and
Capacity balance sheet strength
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 7
8. Union County
The Emerging Success Model in the New Era Will Likely Require…
• Compelling, market-based and physician driven strategy
• Scale and size to leverage fixed costs
• A strong position in the geographies served
• A solid, highly aligned physician platform
• A care, cost, and quality management culture
• Sophisticated IT and care management infrastructures
• Acute attention to operations, cost structure and business
portfolio management
• A well-managed balance sheet to weather volatility
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 8
9. Union County
The Expected Consolidation Trajectory: The Outlook Is for Increased
Consolidation Activity in the Hospital Industry
• Community hospitals that are unable to compete (financial
distress or lack of access to capital) are consolidating with
regional and national not-for-profit systems and for-profit entities
• Strong stand-alone community hospitals are partnering with
regional not-for-profit health systems
• Strong community hospitals are forming new not-for-profit health
systems with other strong community hospitals
• Regional not-for-profit systems are consolidating with other
regional not-for-profit systems
• National not-for-profit systems are consolidating with regional
and other national not-for-profit systems
• Large for-profit hospital management companies have
repositioned their portfolios and are poised for further acquisitions
• New private equity financing is entering the market
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 9
10. Union County
Industry Pressures Have Led to Hospital Consolidation Trends
Number of M&A transactions, 1995-2010 System hospitals – percentage
60%
58%
58%
56%
54%
52%
52%
50%
2000 2010
Primary drivers of • Financially distressed community hospitals
hospital consolidation in • Community hospitals requiring significant capital for
the past decade investments, but unable to access the capital necessary
to fund those projects
Sources: The Health Care M&A Deal Search, Irving Levin Associates, Inc., 1995-11 and American Hospital Association 2011.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 10
11. Union County
Recent Consolidation Activity Supportive of Expected Trajectory
Quarterly Number of M&A Transactions, 2009 to Date
30 120 105
25 24 24 24
100
74
20 18 18 80
16 50
15 60
12
10 8 40
5 4
20
0
0
2009 2009 2009 2009 2010 2010 2010 2010 2011 2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Annualized*
Note: 2011 annualized data based on 46 total deals as of June 9, 2011.
Source: The Health Care M&A Deal Search Online, Irving Levin Associates, Inc.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 11
12. Union County
Why Are Many Stand-Alone Community Hospitals Considering
Partners in Today’s Market?
1. Preservation of Access to Capital – The market is rewarding large
providers through access to low cost capital under flexible terms to
those that deliver on the promise of size and scale.
2. Insufficient Balance Sheets – Many independent hospital’s
balance sheets have been impaired due to the economic crisis –
and in tandem with limited capital access – these organizations are
no longer able to maintain their credit rating and fund competitive
capital needs.
3. Mitigation of Risk – Leaders of stand-alone community hospitals
are becoming increasingly concerned with industry risks, including
those related to healthcare reform, and their hospital’s ability to
maintain consistently high operating cash flow.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 12
13. Union County
Why Are Strong Stand-Alone Community Hospitals Considering
Partners in Today’s Market? (continued)
4. Opportunity to Improve Quality – Larger organizations can afford
the significant investment of time, manpower, infrastructure, and
capital to truly drive improvement in the delivery of healthcare.
5. Expansion of the Platform for Physician Integration – Larger
organizations established successful physician employment models,
advanced information technology systems, and competitive physical
plants are generally better positioned realize the full potential of highly
integrated physician strategies.
6. Counter Payer Consolidation – The very strong position of major
insurers has, in some markets, aversely impacted independent
hospitals relative to larger systems which typically are in a better
position to negotiate fair compensation by virtue of their size and
market leverage.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 13
14. Union County
Why Are Strong Stand-Alone Community Hospitals Considering
Partners in Today’s Market? (continued)
7. More Expansive Market Presence and Competitive Position –
Increasing access points and service area availability typically
leads to better branding and reputation within a service area
8. Service/ Program Development – The sharing of best practices
among multiple delivery sites enables organizations to learn quickly
from others successes
9. Information Technology – Larger organizations are better
positioned to leverage the fixed costs and infrastructure required for
sophisticated information technology platforms
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 14
15. Union County
The Outlook Is for Increased Consolidation Activity in the
Hospital Industry
• Community hospitals that are unable to compete (financial
distress or lack of access to capital) are consolidating with
regional and national not-for-profit systems and for-profit entities
• Strong stand-alone community hospitals are partnering with
regional not-for-profit health systems
• Strong community hospitals are forming new not-for-profit health
systems with other strong community hospitals
• Regional not-for-profit systems are consolidating with other
regional not-for-profit systems
• National not-for-profit systems are consolidating with regional and
other national not-for-profit systems
• Large for-profit hospital management companies have
repositioned their portfolios and are poised for further acquisitions
• New private equity financing is entering the market
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 15
16. Union County
Overview of Current Lease
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 16
17. Union County
Lease Term and Financial Considerations to Union County
• The current hospital lease began on August 27, 1995 and is set to
expire on August 26, 2020 (25 years from commencement date)
• Union Memorial Regional Medical Center, Inc. (currently doing
business as “CMC-Union”), a subsidiary of the Charlotte-
Mecklenburg Hospital Authority (d.b.a. “Carolinas HealthCare
System” or “CHS”) and Union County may renew for up to 9 years
upon mutual written agreement 180 days prior to lease expiration
• Union County receives an annual lease payment equal to the
greater of:
– $1.4 million; or
– 10% of operating cash flow plus 7.5% of investment income
• The annual rent payment is paid to the County in January of each
year and any additional funds due are paid after the close of that
fiscal year’s books
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 17
18. Union County
Recent Historical Lease Payments to Union County
Union County
Historical Lease Payments
2006 2007 2008 2009 2010
Minimum Payment - - $ 1,400,000 - -
10% of Operating Cash Flow $ 2,341,518 $ 2,134,777 - $2,809,175 $ 2,677,166
7.5% of Investment Income $ 490,954 $ 294,955 - $ 486,514 $ 479,164
Total $ 2,832,472 $ 2,429,732 $ 1,400,000 $ 3,295,689 $ 3,156,330
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 18
19. Union County
Financial Considerations to CHS
• CHS receives an annual Network Development Fee equal
to the greater of:
– $1.2 million; or
– 10% of operating cash flow plus 7.5% of investment income
• Should the Network Development Fee payable to CHS
reasonably pose a material financial risk to the hospital,
CHS may agree to abate the payment equal to an amount
the County agrees to abate its annual rental payment
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 19
20. Union County
Operating Surplus, Capital Approval and Governance
• CMC-Union is required to invest the hospital’s net operating
surplus in the facility for the provision of healthcare to the
citizens of Union County
– CHS cannot consolidate CMC-Union’s operating results
– CMC-Union borrows on it own credit
• CMC-Union is responsible for maintenance and any
improvements and additions to the hospital
– County maintains approval rights for any capital expenditure
exceeding $500,000
• A five-member Board of Directors governs the hospital; two
members are appointed by the Union County Commissioners and
three members are appointed by CHS.
• At lease termination, the County receives all hospital
property, improvements, long-term debt and monies
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 20
21. Union County
Development of CMC-Union During Current Lease
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 21
22. Union County
Development of CMC-Union During Current Lease
Service Lines and Clinical Services
The following service lines and clinical services have been added
at CMC-Union since 1995
• Cardiac rehabilitation • Advancements in diagnostic
and treatment technologies
• Diabetes center
• Palliative care
• Sleep center
• Waxhaw Health Pavilion
• Cancer center (pending)
• Family Practice rural • Union West Ambulatory
residency Surgery Center (pending)
• Wound Care center • Hospice of Union County
• Pain Management center acquisition by CHS
• Urgent care clinics
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 22
23. Union County
Development of CMC-Union During Current Lease
Facility Investments
During the current lease term, the facility improvements and additions
noted below have been completed at CMC-Union
• Outpatient Treatment Pavilion • Oncology services
• Women and children’s center • Materials management
renovation and expansion
• Coronary care and intensive
care units • Wound care center
• 24/7 emergency department • New Medical Office building
• Therapies expansion
• Emergency department
expansion and renovation • Information Technology
upgrades
• Day surgery and surgery
department expansion • Jesse Helms Nursing Center
• Union EMS base station
• Endoscopy department
• First Step renovation
• Cardiac diagnostic services
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 23
24. Union County
Development of CMC-Union During Current Lease
Medical Staff Advancement
• The CMC-Union Medical Staff has increased from 75 in
1995 to 475 as of the second quarter of 2011
• Growth has occurred in both specialists and primary
care physicians
• Specialties not currently represented include:
– Neurosurgery
– Endocrinology
– Psychiatry
– Thoracic surgery
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 24
25. Union County
Development of CMC-Union During Current Lease
Medical Staff Advancement (continued)
75 160 331 458 475
450 393 404
400
350
300 275
250
200
150 103
100 57 56 65 71
35 40
50
0
1995 1998 2008 2010 2Q 2011
Primary Care Specialists
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 25
26. Union County
CMC-Union Capital Spending Ratio as Percent of Total
Operating Revenue
$66M+
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 26
27. Union County
Future and Continued Development of CMC-Union
• Over the past 15+ years CMC-Union has noted significant growth in
its operations, medical staff and facilities
• In order to build on the momentum and growth created during the
current lease and transition towards a facility that provides higher
acuity treatments and tertiary-like services, CMC-Union will likely
need access to capital beyond what it can generate independently
• As noted in the industry update section, many community hospitals
faced with similar capital (and other operational) decisions are
determining to become member hospitals of larger health systems
to access the capital required to expand and the expertise needed
to navigate the healthcare industry’s uncertain future
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 27
28. Union County
Review of County’s Stated Goals and Objectives
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 28
29. Union County
Union County Goals and Objectives
At our work session in February, the County Commissioners articulated
the following as their primary goals and objectives for a “new” lease
regarding CMC-Union:
• Continuity in the delivery of healthcare within Union County
• Preservation of the existing clinical services in the County
• Additional services/ programs made available in the future in the
County, as clinically appropriate
• Continued high quality of care delivered to the hospital’s patients
• County should maintain ownership of the hospital
• Financial terms and conditions should benefit the County
• Term of lease should be long in nature and should not initially
exceed 50 years
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 29
30. Union County
Summary of Proposed Lease Amendment Terms
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 30
31. Union County
Financial Considerations
• On the following slides we have outlined our understanding to
the key terms under which CHS and Union County would
extend the existing lease agreement.
• If the County and CHS elect to move forward, these terms will
be incorporated into an Amended and Restated Lease
Agreement between the parties, which will be submitted to the
County Commissioners to consider.
• This agreement will further define these terms as well as
others that are typical in these agreements.
• It should be understood that these terms may change in the
Amended and Restated Lease Agreement as the document is
negotiated
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 31
32. Union County
Financial Considerations
• CHS will deliver to County, at closing, the amount of $54
million, which represents the agreed upon cash net of
outstanding indebtedness of the operating entity
– CHS will assume or extinguish the outstanding indebtedness of
the hospital
• The County will receive a total lease payment of $6.1 million
per annum for the initial 50-year lease extension (the Extended
Term), growing by 3% every five years should the lease be
renewed
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 32
33. Union County
Historical and Projected Lease Payments to Union County
Union County
Historical and Projected Lease Payments
2006 2007 2008 2009 2010 2012 & Beyond
Minimum Payment - - $ 1,400,000 - - -
10% of Operating Cash Flow $ 2,341,518 $ 2,134,777 - $2,809,175 $ 2,677,166 -
7.5% of Investment Income $ 490,954 $ 294,955 - $ 486,514 $ 479,164 -
Total Proposed Payment -- Operating Rent and Premium Payment - - - - - $ 6,100,000
Total $ 2,832,472 $ 2,429,732 $ 1,400,000 $ 3,295,689 $ 3,156,330 $ 6,100,000
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 33
34. Union County
Financial Considerations
• All of such funds – rent and the cash delivered at closing –
can be used by County in its sole discretion provided that
such payments cannot be used to compete with CHS
• The annual Operating Rent and Premium Payments will be
paid in full within the first 90 days of each calendar year
during the Extended Term
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 34
35. Union County
Put Option
• County will have the unilateral right within the first nine
months of each calendar year during the Extended Term to
require that CHS purchase CMC-Union for a purchase price to
be determined as of December 31 of such year (the Put Price)
• The initial Put Price will be an amount equal to $133 million
(the Initial Price) minus a portion of the lease payments that
have been paid by CHS according to a formula that will be
contained in the lease agreement.
– So long as North Carolina Certificate of Need laws regulate in-patient
beds (“CON laws”), the Initial Price will be increased annually by 2%;
upon the repeal of the CON laws, the Initial Price will not be further
increased
• The Put Price varies by year and will be included as a
schedule to the lease agreement
– From the Initial Price of $133 million the net Put Price declines to as low
as $128 million before increasing to $218 million by the end of the
Extended Term
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 35
36. Union County
Expiration
• Upon the expiration of the Extended Term of 50 years, CHS will
have the right to renew the Amended and Restated Lease
Agreement for an additional period of 25 years (the Renewal
Period)
• During the Renewal Period, the rights and obligations of the
parties will continue as set described except that the total lease
payment will increase to $6.283 million for the first year of the first
renewal period and will be increased by 3% every 5 years
thereafter during the Renewal Period
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 36
37. Union County
Expiration (continued)
If CHS does not elect to renew the Amended and Restated Lease Agreement upon
the expiration of the Extended Term, County will have the following two options:
1.Termination of Amended and Restated Lease Agreement
– Terminate the Amended and Restated Lease Agreement and require CHS to transfer
all CHS health-related operations and assets located in Union County (the Union
HealthCare Enterprise) to County and pay to CHS an amount equal to the Fair Value
of the Union HealthCare Enterprise on the termination date, minus the net Put Price
as of the termination date
– If County elects to require CHS to make this transfer to County, County would not
accept any direct or indirect financing assistance from a health system in terms of loan
guarantees, direct loans or other means to facilitate the transfer of the Union
HealthCare Enterprise to County
– In addition, County would agree, in writing, to operate all such assets for a transition
period of at least 5 years after the termination date with no indirect or direct
involvement in operations of such assets by another healthcare provider or operator
that is a competitor of CHS
– CHS agrees to provide any requested transition services at fair market value during
the transition period
– County may engage or hire a manager who is not a competitor of CHS to operate
Union County HealthCare Enterprise; or
2.Put Option – Exercise Put Option as previously outlined
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 37
38. Union County
Expiration (continued)
• Upon the expiration of the first 25-year Renewal Period, the County
and CHS will have the option to mutually agree to renew the Amended
and Restated Lease Agreement for one term of 25 years followed by
successive 10-year terms at the then current Operating Rent Rate to
be increased by 3% every 5 years thereafter
• If County and CHS do not mutually agree to any extension of the
Amended and Restated Lease Agreement, County will have the
following two options:
1. Termination of Amended and Restated Lease Agreement
– Upon at least 12 months prior written notice to CHS, terminate the
Amended and Restated Lease Agreement and require CHS to
transfer all Union HealthCare Enterprise to County and pay to CHS
an amount equal to the Fair Value of such assets on the termination
date minus the net Put Price as of the termination date
2. Put Option – exercise Put Option as previously outlined
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 38
39. Union County
Capital Investment
• During each 15-year period, CHS’s capital investments in the Union
HealthCare Enterprise will be no less than 75% of the capital spend at
other CHS facilities.
– This will be measured as the percentage of revenue spent at the Union
HealthCare Enterprise as compared to the percentage of revenue CHS
spends on capital for the entire system.
– However, the minimum capital spend will be limited to 75% of operating
margin of the Union HealthCare Enterprise
• Within 90 days after the end of each 15-year period during the
extended Term, CHS will submit a report to County summarizing the
investments made by CHS during the prior 15-year period
– CHS will have 5 years to make up its investment obligation if it is not met
for the 15 year periods.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 39
40. Union County
Capital Investment (continued)
• CHS will use reasonable efforts to complete the CON approved
bed tower project and the deferred capital expenditures including,
but not limited to:
– PET/ CT scanners
– Second ambulatory surgery suite
– Waxhaw emergency department
– Will endeavor to determine the unmet needs and determine the
feasibility of providing new and improved healthcare services
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 40
41. Union County
Assumption of Liabilities
• CHS will assume all of the liabilities of Hospital, known and
unknown, fixed and contingent, accrued or pending, including,
but not limited to:
– The existing long-term debt, arising out of the ownership or
operation of CMC-Union, including outstanding bond debt. CHS
will take all steps necessary to permanently remove the County
from the outstanding bond debt.
– Professional liability
– Compliance related issues from prior years, if any.
– Medicare and Medicaid RAC arising during the term of the
Lease
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 41
42. Union County
Employee Commitments
• CHS will offer to employ each existing staff employee at
CMC-Union who meets CHS’s criteria for hiring comparable
employees and who CMC-Union recommends for hire at
CHS’s current compensation rates and benefits
• Within a reasonable time depending on benefit plan years
and third party approvals, if any, CHS will provide to all
CMC-Union employees the full array of CHS benefits at the
same levels of all other CHS employees of the CHS
• CHS commits to maintain staffing levels at levels
comparable to similar CHS facilities
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 42
43. Union County
Governance
• The existing Community Trustee Council will be converted to an
Advisory Council
– The Advisory Council will include one sitting member of the Union
County Commission and at least two Medical Staff representatives
– The Advisory Council will regularly advise CHS concerning policy
matters and the operation of CMC-Union
• CHS also commits to nominate and support approval of a resident
of Union County to the CHS Board of Commissioners
• During the first six years of the extended Term, CHS will
nominate, as the Union County member on the Board, one of the
three Union County residents who have been recommended to
CHS by the Advisory Council
– In addition, for the purposes of maintaining community involvement
and further integrating the strategic planning process in a unified
manner between CMC-Union and CHS, during the first six (6) years
of the extended Term, the Union County member of the Board will
have a seat on the CHS Strategic Planning Committee
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 43
44. Union County
Other Key Terms
• Financial Assistance: CMC-Union will continue to provide
financial assistance to patients consistent with CHS policies in
offering discounted and free care to patients
• Prisoner Care: CHS will provide care to patients from the Union
County Jail at a discount equal to the discount given by CMC-
Union to patients who do not have insurance
• Medical Staff: The Medical Staff President of CMC-Union will
have the same rights to attend all CHS Board of Commissioners
meetings as other CHS Medical Staff Presidents
– CHS will continue to complete Medical Staff needs assessments
and will use reasonable efforts to recruit and retain needed
physicians, including specialists, to Union County
• IT: CHS will ensure that CMC-Union will be on the overall
system IT platform
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 44
45. Union County
Other Key Terms (continued)
• Quality and Safety: CHS will ensure that CMC-Union and
Union Physicians Network, Inc. are included in all CHS system
wide quality, safety and clinical integration initiatives, clinical
integration including, but not limited to, accountable care
organizations
• Commitment to Maintain Services: For a period of not less
than five years of the Extended Term, CHS will continue to
provide all the material clinical services and programs currently
being provided by CMC-Union so long as appropriate levels of
clinical quality and patient safety can be maintained with
respect to each of such services
– Any deletion of such services and programs within such time
period will be based upon clinical quality and patient safety factors
and will require the approval of the CMC-Union Advisory Board
– The final lease document will define how the services offered at
CMC-Union will be determined after the initial 5-year period.
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 45
46. Union County
Other Key Terms (continued)
• Partnership Relations: County recognizes the importance
of supporting CHS as a lessee of County owned assets. As
such, County will:
• Ensure CHS is not excluded from any bidding of health related
services for County employees
• Make reasonable efforts to ensure that County employees are
encouraged to access to CMC-Union facilities and programs
• Support the investment and expansion of health facilities and
programs by CHS in Union County
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 46
48. Union County
Advantages of Proposed Lease Amendment
• While we recognize there are key terms that must be negotiated, Kaufman
Hall believes that there could be significant advantages to the proposed
Lease Amendment
– Perhaps chief among them is that it eliminates the going forward challenges
facing standalone hospitals
– Further, it should enhance the level of healthcare services available to the
citizens of Union County through a more complete and comprehensive clinical
and operational integration of CMC-Union with other healthcare providers in
the CHS healthcare system
– Finally, a robust healthcare system in Union County should provide relatively
high-paying jobs and also assist in attracting other employers to the county
• In addition, the proposed lease:
– Compels CHS to invest in the hospital and in Union County as incentives
between CHS and the County are aligned and CHS will consolidate the
hospital’s operations into its overall system financials
– Removes the County’s financial obligations relative to operating a hospital
– Provides a meaningful capital source to the County at the inception of the
lease as well as in years to come while allowing future Union County
Commissioners to monetize the asset at a predetermined price
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 48
49. Union County
Other Considerations
• While we believe there are substantial benefits to Union County in
proposed Lease Amendment, there are other factors that should be
carefully considered
• We believe the most significant issues relate to control
– Amending the existing lease will extend the period during which Union
County has little operating control of CMC Union
– If Union County decides not to renew the lease in the future, the amount
required to reimburse CHS for the value it has added during the term of
the lease is uncertain
• However, we believe these considerations should be balanced by the
fact that many counties across the country are seeking to separate
themselves from the burdens of operating a hospital and Union
County currently has little operating control over CMC Union in the
current lease
Copyright 2011 Kaufman, Hall & Associates, Inc. All rights reserved. 49