PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at Becker’s Annual CEO & CIO Strategy Roundtables, November 18-19, 2015.
The presentation explored:
Data being aggregated by the government, as well as new approaches by regulators.
Public relations and litigation risk from the public dissemination of data by the government.
Big data connections to payment through quality metrics and the potential for new theories of False Claims Act (FCA) suits.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Presentation Uncovers Trends in the Unpredictable Healthcare IndustryPYA, P.C.
With the healthcare industry in a state of flux, not much is known about what lies ahead; but trends across the industry have become apparent and are likely to stick. These trends were the subject of a presentation given by PYA Principal David McMillan at the PKF North America Healthcare Fly-In.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
Alliances between AMCs and Community HospitalsPYA, P.C.
PYA Principal Jeff Ellis spoke on alliances between academic medical centers (AMCs) and community hospitals April 16, 2015, at a Greater Kansas City Society of Healthcare Attorneys luncheon meeting.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
Healthcare Audit and Accounting Update PresentedPYA, P.C.
At the 2013 Tennessee Society of Certified Public Accountants Healthcare Conference , PYA Principal Doug Arnold, CPA, provided a “Healthcare Audit and Accounting Update.” The presentation outlined emerging accounting developments impacting healthcare financial reporting--from recently issued and now-in-effect Accounting Standards Updates (ASUs) to Governmental Accounting Standards Board (GASB) Pronouncements to other healthcare-specific items, such as ICD-10.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at Becker’s Annual CEO & CIO Strategy Roundtables, November 18-19, 2015.
The presentation explored:
Data being aggregated by the government, as well as new approaches by regulators.
Public relations and litigation risk from the public dissemination of data by the government.
Big data connections to payment through quality metrics and the potential for new theories of False Claims Act (FCA) suits.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Presentation Uncovers Trends in the Unpredictable Healthcare IndustryPYA, P.C.
With the healthcare industry in a state of flux, not much is known about what lies ahead; but trends across the industry have become apparent and are likely to stick. These trends were the subject of a presentation given by PYA Principal David McMillan at the PKF North America Healthcare Fly-In.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
Alliances between AMCs and Community HospitalsPYA, P.C.
PYA Principal Jeff Ellis spoke on alliances between academic medical centers (AMCs) and community hospitals April 16, 2015, at a Greater Kansas City Society of Healthcare Attorneys luncheon meeting.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
Healthcare Audit and Accounting Update PresentedPYA, P.C.
At the 2013 Tennessee Society of Certified Public Accountants Healthcare Conference , PYA Principal Doug Arnold, CPA, provided a “Healthcare Audit and Accounting Update.” The presentation outlined emerging accounting developments impacting healthcare financial reporting--from recently issued and now-in-effect Accounting Standards Updates (ASUs) to Governmental Accounting Standards Board (GASB) Pronouncements to other healthcare-specific items, such as ICD-10.
PYA Principal Jim Lloyd was among the faculty who spoke at the 2013 Mid-South Commercial Law Institute during a panel discussion on “Healthcare Facilities in Bankruptcy.” The presentation provided an overview of healthcare facilities and key issues, healthcare regulatory environment, valuation of healthcare facilities, and red flags for healthcare businesses in bankruptcy or distress.
ACA, Health Insurance, and Taxes--A Full-Plate Discussion for Small BusinessesPYA, P.C.
A recent “Lunch & Learn,” jointly presented by PYA and Careadigm, provided businesses with answers to often-asked questions about healthcare reform, the Affordable Care Act (ACA), and the effects on health insurance coverage and taxes.
PYA Presents Intro to Healthcare Valuation PYA, P.C.
PYA Principal Jim Lloyd, along with other presenters, provided a “Healthcare Valuation 101” during a pre-conference workshop at the 2013 AICPA Healthcare Industry Conference.
Gates Advocates for Proactive Tax Planning for Medical Practices PYA, P.C.
PYA Principal Greg Gates, CPA, recently addressed financial professionals who work with healthcare providers at the 2013 Tennessee Society of Certified Public Accountants Healthcare Conference. Gates discussed the importance of being a proactive tax advisor.
Webinar Discusses Safeguarding Your Practice with Financial ControlsPYA, P.C.
Financial Controls—consider them a security system for your medical practice. With the correct internal controls in place, your practice can better protect its assets and minimize the risk of loss from errors, lawsuits, and fraud. “Medical Practice Financial Controls…or Lack Thereof” was the topic of a recent National Association of Certified Valuators and Analysts (NACVA) Consultants Training Institute (CTI) webinar presented by PYA Principal Lori Foley and Senior Manager Tynan Olechny.
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
501(r) regulations will soon take effect for not-for-profit hospitals nationwide. Are you ready? These complex IRS rules outline how providers ensure access, provide charity assistance and properly collect uncompensated care. The rules can affect your revenue cycle, financial assistance and collections, as well as your Form 990 and tax exemption status.
Healthcare Financial Transformation: Five Leading StrategiesHealth Catalyst
Healthcare financial transformation—improving care delivery while lowering costs—has been an ongoing challenge for health systems in the era of value-based care and an even more prominent concern amid COVID-19. While better care and reduced expense to organizations and consumers might seem like opposing goals, by understanding the true cost of services and other drivers of expense, organizations can successfully manage costs while maintaining, and even improving, care delivery. To that end, health systems can use data- and analytics-driven tools and strategies to addresses financial challenges, including uncompensated care, prolonged accounts receivable days, discharged not final billed cases, inefficient resource use, and more.
Reduce Bad Debt: Four Tactics to Limit Exposure During COVID-19Health Catalyst
Health systems have always faced bad debt—from charity care to insurance claim denials—and COVID-19 has exacerbated its impact on revenue. While hospitals and clinics are responsible for providing care to populations, they can still generate revenue from care delivery without compromising care accessibility or quality. An effective bad debt management approach provides the patient with every financial resource possible and allows the health systems to focus less on payment and more on delivering the best care.
With four tactics, health system leadership can identify bad debt and implement effective processes to minimize it without undue burden on patients:
Identify bad debt exposure early.
Educate patients about alternative payment options.
Leverage technology within the workflow.
Understand the true cost of care.
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
Medicaid: What You Need to Know (CSH and Foothold)Ronan Martin
In our first session, Foothold Technology Director of Client Services, Paul Rossi and Senior Advisor, David Bucciferro, along with Sue Augustus from CSH, will bring us back to basics of all things Medicaid. They will cover topics ranging in commonly used terms, coverage and eligibility and the differences between Medicaid and Medicare. This webinar series is designed for beginners and experts alike. Beginners will walk away with a strong foundation and experts will have the opportunity to contribute to the conversation.
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. David W. McMillan, CPA
PYA Principal
David McMillan provides financial and strategic services to the
Firm's healthcare clients. David's areas of concentration are:
feasibility studies for various healthcare entities;
mergers, acquisitions, and affiliations among providers;
strategic planning and forecasting, clinical integration
services; and valuations and operational analysis.
American Institute of CPAs
#AICPA_HEALTH
1
3. Overview
In this session, we will examine the importance and
meanings of community benefit.
We will review the nuances within the Federal
reporting requirements.
We will also present best practices for developing a
workplan to aid hospital staff, counsel, the CSuite, and the Board in preparing a uniform
message.
American Institute of CPAs
#AICPA_HEALTH
1
2
4. Agenda
Importance and Meaning of Community Benefit
Federal Reporting Nuances for Community Benefit
Economic Value of Community Benefit
Community Benefit Uniform Message
American Institute of CPAs
#AICPA_HEALTH
1
3
6. Community Benefit Standard
Adopted in 1969 by the IRS
Basis for recognizing hospitals as income tax-exempt
under Section 501(c)(3) of the Internal Revenue Code
Most common test applied by IRS to determine if a
hospital is operated to promote health in a manner that
serves a charitable purpose and merits tax-exempt
status
American Institute of CPAs
#AICPA_HEALTH
1
5
7. Public Perception
Narrow interpretation
= charity care
Broad interpretation
= virtually everything a
non-profit hospital does
Most common
perception - mixture of
the two interpretations
American Institute of CPAs
#AICPA_HEALTH
1
6
8. Demographics of Hospital Sector
The American Hospital Association reports that
there are more than 5,700 hospitals throughout the
country.
Of these, more than 2,900 are non-governmental notfor-profit hospitals.
Around 1,025 are for-profit community hospitals.
The remainder are state and local government
hospitals.
Per AHA Hospital Statistics, 2013 edition. Data from the 2011 annual survey.
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9. Community Benefit Test – Federal Level
Charities provide for a charitable class of people.
(such as food, clothing, and shelter to the poor or
distressed)
A non-profit hospital, however, is required to show it
benefits the community it serves through the
promotion of health.
• A non-profit hospital may provide services to persons outside of a
charitable class.
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10. Practice Perspective
Catholic Health Association released a set of
guidelines for hospitals to use in identifying
community benefits:
• To qualify as “community benefit,” the program must respond to
an identified community need and meet at least one of the
following criteria:
Improve access to healthcare services within the community
Improve health of the community
Advance medical or health education within the community
Relieve or reduce the burden of government or other
community efforts
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11. What is Community Benefit?
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12. What does community benefit mean?
The answer lies within the question, “How does one
meaningfully differentiate a tax-paying, for-profit
hospital from a non-profit hospital that enjoys
exemption from federal and state tax, exemption
from property tax, and eligibility for favorable bond
financing?”
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13. What is required for federal tax exemption?
1
Neither the Internal Revenue Code nor the underlying
regulations explicitly provides for the exemption of
non-profit hospitals from federal income taxation.
2
We have long recognized that hospitals may quality
for exemption under section 501(c)(3).
3
Five Factors within the Community Benefit Standard
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14. The Community Benefit Standard - 5 Factors
1
2
A community board
An open medical
staff
4
The admission of all
types of patients
including those able to
pay for care either for
themselves or through
third-party payers
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3
A full-time
emergency room
open to all
regardless of ability
to pay
5
How excess funds are
used, such as for
expansion and
replacement of existing
facilities and equipment,
medical training, education,
and research
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15. Other Factors
Facts and circumstances
determination, with no one
factor controlling
Exemption also based on
providing charity care
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16. 501(c)(3) Considerations
Community benefit standard is not the only
requirement hospitals must satisfy
Requirements for exemption under section
501(c)(3), including:
• Prohibitions against inurement and the payment of excess
compensation, and impermissible private benefit
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17. Distinguishing Tax-Exempt from For-Profit
An open medical staff, participation in Medicare and
Medicaid, and treating all emergency patients
without regard to ability to pay are characteristics
now shared by tax-exempt and for-profit hospitals.
Although they remain factors in
assessing entitlement for tax
exempt status, they no longer
meaningfully distinguish one type
of hospital from another.
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18. State Tax Debate
Provena case in Illinois proved that Federal tax
exemption is no longer always dispositive of how a
state or local government will regard a hospital.
More than a dozen states have codified their
hospital community benefit requirement in law or
within regulations. Another nine have established
community benefit requirements through broader
hospital licensure laws, interpretive attorney general
guidelines, and property tax exemption standards.
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19. Legislative Intervention
In July 2007, Finance Committee member Senator
Grassley put forth a proposal to quantify the
community benefit that tax-exempt hospitals ought
to provide.
• “No hospital can maintain section 501(c)(3) status without
dedicating a minimum of 5% of its annual patient operating
expenses or revenues to charity care, whichever is greater.”
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20. IRS Form 990, Schedule H
Intended to make “apples to apples” comparisons of
hospitals
Provides clearer standards on:
• The types of activities reportable or not reportable as community
benefit
• The requirement that community benefit be reported at cost rather
than charges, or otherwise
• The requirement that community benefit be reported by employer
identification number, rather than by hospital or by system
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22. Required Reporting
IRS Form 990, Schedule
H, Hospitals
Medicare Cost Report –
CMS Form 2552, Worksheet S-10
GAAP/Community Benefit
Reporting
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23. Definitions
IRS Form 990, Schedule H
CMS Form 2552, Worksheet S-10
Uncompensated Care
Charity care and bad debt, which includes bad debt
and Medicare bad debt. Uncompensated care does
not include courtesy allowances or discounts.
Charity Care
•
•
•
“…free or discounted health services provided to
persons who meet the organization’s criteria for
financial assistance and are thereby deemed
unable to pay for all or a portion of the services”
General Rule – if create a bill, no longer charity
care, but might be bad debt if ultimately written
off
“Charity care” for Schedule H does NOT include:
- Bad debt or uncollectible charges recoded
but not paid
- Medicare revenue shortfalls (exception –
Subsidized Service Medicare Shortfalls are
Community Benefit)
- Contractual adjustments
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Health services for which a hospital demonstrates
that the patient is unable to pay. For Medicare
purposes, charity care is not reimbursable and
unpaid amounts associated with charity care are not
considered as an allowable Medicare bad debt.
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24. Definitions
IRS Form 990, Schedule H
CMS Form 2552, Worksheet S-10
Bad Debt
Health services for which a hospital determines the
non-Medicare patient has the financial capacity to
pay, but the non-Medicare patient is unwilling to
settle the claim.
Medicare Bad Debt
Amount of allowable Medicare coinsurance and
deductibles considered to be uncollectible but are
not reimbursed by Medicare.
Uninsured Patients
Individuals with no source of third party healthcare
coverage (insurance).
Medically Indigent Patients
Individuals who are unable to pay some or all of their
medical bills because medical bills exceed a certain
percentage of family income or assets. Usually
defined by a hospital under its financial assistance
policies.
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Individuals who use or commit all available current
and expected resources to pay for medical bills, and
not limited to a defined percent of the Federal
Poverty Guidelines, but follows specific hospital
policy.
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25. Reporting Period Differences
IRS Form 990,
Schedule H
Filed annually
Based on FYE
Electronic Filing
Due Dates: up to 11
months after FYE
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CMS Form 2552,
Worksheet S-10
Filed annually
Period can be
shorter
Electronic Filing
Due dates: 5
months after FYE
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26. IRS Form 990, Schedule H
Community Benefit - “The Chart” on Page 1 which
we know is a focal point for various internal and
external constituents – board, media, IRS, AG, etc.
IRS tasked to conduct review and report on percentage
of community benefit provided by hospital
Lines 7a-7c focus on Charity Care, Medicaid, and other
means tested programs
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27. IRS Form 990, Schedule H
Financial
Assistance at
Cost[1]
Line 7a
Schedule H Part I Line 7a-d
Gross patient charges at the full established rates[4]
Ratio of patient care cost to charges
Estimated cost
Medicaid provider taxes, fees, and assessments if payments received
were intended primarily to offset the cost of the financial assistance
Total community benefit expense
Column C
Net patient service revenue from Medicaid or other means-tested
government programs
Revenues received from a state organization to directly offset revenue for
financial assistance
Other direct offsetting revenue
Total direct offsetting revenue
Column D
Medicaid[2]
Other Meanstested
Government
Programs[3]
T otal
Line 7b
Line 7c
Line 7d
X
=
+
=
+
+
=
Net community benefit expense (community benefit expense – offsetting
revenue)
Column E
Total expenses from the organization’s Form 990*5+
Percent of total expenses
Column F
÷
=
[1] Financial assistance is sometimes referred to as Charity Care.
*2+ This includes Medicaid revenues and expenses from all states, not just the organization’s home state.
*3+ “Other means-tested government programs” refers to government sponsored health programs (other than Medicare and Medicaid) with
eligibility determined by the participants’ income or assets.
*4+ Gross patient charges refer to only those written off under the organization’s FAP for Line 7a. For lines 7b and 7c, enter the gross patient
charges for each applicable program.
[5] Do not include bad debt expense in this total.
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28. CMS Form 2552, Worksheet S-10
Required by all acute care
hospitals, including Critical
Access Hospitals
CMS uses data from the worksheet to:
Worksheet
S-10
- Calculate the amount of a hospital’s
EHR incentive payment
- Determine the amount that a
hospital will be paid from the
Medicare uncompensated care pool
DSH Change
- Payments to a hospital cannot
exceed the uncompensated costs
of furnishing hospital services by
the hospital to patients who are
Medicaid-eligible or have no thirdparty coverage
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29. CMS Form 2552, Worksheet S-10
EHR payments depend on the amount of charity
care a hospital provides.
• Inpatient Medicare Part A + Part C Days
• Total charity care charges (Line 20 of S-10)
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30. CMS Form 2552, Worksheet S-10
DSH payments reduced 75%
beginning in 2014
• Portion of the reduction is returned as
an additional payment for continued
uncompensated care costs
• Payment from the pool is determined
by:
Hospital’s percentage change in the
% of uninsured from 2013
Hospital % of aggregate
uncompensated care costs
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31. CMS Form 2552, Worksheet S-10
Hospital Uncompensated and Indigent Care Data
Uncompensated and indigent care cost computation
Line Item
Description
20
Partial payments by patients approved for charity care
23
Total
Cost of initial obligation of patient approved for charity
care (line 1 * line 20)
22
Insured
Patients
Total initial obligation of patients approved for charity care
(at full charges excluding non-reimbursable cost centers)
for the entire facility
21
Uninsured
Patients
Cost of charity care (line 21 minus line 22)
• Uninsured Patients: list patients’ total charges
• Insured Patients: patients covered by a public program or private
insurer with which the provider has a contractual relationship
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32. GAAP/Community Benefit Reporting
GAAP
No revenue for charity care recognized on
Financial Statements – only footnote disclosure
Charity care defined as “healthcare services that
are provided but are never expected to result in
cash flows”
Charity care is provided to a patient with
demonstrated inability to pay
New amendment to ASC 954 requires cost be
used as measurement
Includes both direct and indirect costs
Must disclose method used to determine cost
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33. GAAP/Community Benefit Reporting
GAAP
Medicaid and other means-tested programs
shown as gross charges less contractual and
other adjustments
Amounts reported on the accrual basis
Contractual and other adjustments can be based
on estimates
Bad debts shown as a reduction in net patient
revenue (for years ending after December 15,
2012)
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34. GAAP/Community Benefit Reporting
Community
Benefit
Reporting
No specific standards for reporting
Usually prepared by hospital marketing
department
Many based on charges vs. cost
Not all hospitals issue report to community
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35. Reporting Example
Hospital
Actual:
Worksheet S-10
Uncompensated
Care
Actual:
Form 990
Schedule H
Charity Care
Proposed Requirement:
Charity Care Expense at
5% of Total Patient
Revenue
Hospital A
$40,851,133
$18,343,174
$53,385,064
Hospital B
$21,858,117
$12,959,865
$59,300,452
Hospital C
$244,583,485
$137,924,438
$226,156,541
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38. Qualitative Factors
Proximity to Community Population
• Can residents get to the facility with relative
ease?
Services Available to the
Community
• Can resident use the services provided?
• Are there enough resources for residents?
• Ability for organization to attract, retain, and
grow talent. (No Docs, No Health Services)
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40. Value Determination
Ultimate goal is to
determine
• Is the community better off
because of the…
Hospital?
Affiliation?
Merger?
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41. Hospital Acquisition Laws
Many states, such as Georgia and Louisiana, have hospital
conversion laws whereby the Attorney General must review all
transactions related to the acquisition or sale of assets of a
non-profit hospital within the state to determine that sufficient
community benefit will stem from the transaction.
• In Georgia, the Attorney General must conduct a public hearing “to
ensure that the public’s interest is protected when the assets of a
nonprofit hospital are acquired by an acquiring entity by requiring full
disclosure of the purpose and terms of the transaction and providing an
opportunity for local public input.”
• The statute continues the public interest emphasis by providing further
that the “disposition of a nonprofit hospital to an acquiring entity shall
not be in the public interest unless there has been adequate disclosure
that appropriate steps have been taken to ensure that the transaction is
authorized, to safeguard the value of charitable assets, and to ensure
that any proceeds of the transaction are used for appropriate charitable
healthcare purposes.”
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43. Develop a Workplan
Identify Key
Stakeholders
Identify
Reports
• External
Reports
Develop a
Reconciliation
#
• Internal
Reports
#
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#
#
E.g.,
Decision
Support,
Finance,
Marketing
Identify
Timeline
• Audited
Financial
Statements
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44. Reconciliation Example
Schedule
S-10
Form 990
Sch H
Difference
Cost-to-Charge Ratio
Total Expenses
Less: Bad Debt
Non-Allowable costs
Non patient care activities
Medicaid Provider Taxes
Community benefit expenses
Total Adjusted Cost
Total Patient Charges
Less: Non patient related charges
Total Adjusted Charges
CCR
A
B
C
E
F
G
H
J
K
L
M = (H/L)
112,585,996
(19,247,068)
(2,432,568)
(849,936)
(1,054,053)
112,339,761
(19,247,068)
89,002,371
387,479,075
(6,069,922)
381,409,153
0.233351
(2,001,826)
(1,054,053)
(119,456)
89,917,358
387,479,077
387,479,077
0.232057
N
O
M
(M x N)
38,392,982
6,352,465
23.3351%
8,959,057
Q
M
R = (M x Q)
18,659,071
23.3351%
4,354,121
246,235
1
(914,987)
(2)
(6,069,924)
2
39,442,000
6,336,426
23.2057%
9,152,805
(1,049,018)
16,039
3
25,342,815
23.2057%
5,880,986
(6,683,744)
Medicaid
Gross Medicaid Revenue (Medicaid Charges)
Net Medicaid Revenue
Cost-to-Charge Ratio (CCR)
Medicaid at Cost
P=
4
(193,748)
Charity Care
Charity Care Charges
Cost-to-Charge Ratio (CCR)
Charity Care at Cost
1
2
5
(1,526,865)
Expenses for Schedule H are from Audited Financial Statements
Patient Charges for the Schedule H include gross inpatient and outpatient revenues.
3
External data (Summary Claims reports) is used to report Medicaid Revenue on S-10, whereas internal
sources (financial statements) are used to report for on Schedule H. Differences relate to claims lag or
payor classification.
4
The HS&R Report was used to report Net Medicaid Revenue for the S-10, whereas internal financial
statements/general ledger reports were used for Schedule H.
5
Charity Care Charges per S-10 do not include amounts for indigent.
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45. Educate the C-Suite and the Board
Share listing
of reports
Share and
discuss
reconciliation
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Share
Timeline
Prepare for
answering
questions
from
stakeholders,
reporters, gov
ernment
officials, etc.
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46. Summary
So what does the “community benefit” mean? We
have to understand it in context.
To value the economic benefit of community
benefit, we have to include qualitative and
quantitative factors.
In reporting community benefit we have to be aware
of the nuances between the various reporting
mechanisms and reconcile those differences in a
uniform message to the organization.
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The Community Benefit Standard was set out in 1969 in a revenue ruling (Rev. Rul. 69-545).
The community benefit standard is the center of what concerns people about non-profit hospitals, including the cost and delivery of care and the treatment of patients when it comes to billing and collection. To some, community benefit should be narrowly interpreted to equate with charity care; to others; it should be broadly construed to encompass virtually everything a non-profit hospital does. And there are still others that believe it fits somewhere in the midst of these competing interpretations.
Hospitals are a bit different from other charities. We ordinarily expect a charity to provide for a charitable class of people – a prime example is providing food, clothing and shelter to the poor or distressed. This is not necessarily the standard for a nonprofit hospital. Instead, the non-profit hospital is required to show it benefits the community it serves through the promotion of health in its community. Thus, in determining community benefit, the hospital may include services provided to persons commonly thought of as being outside the traditional definition of a charitable class – the poor or distressed.
So what does “community benefit” mean? We have to understand it in context. Non-profit hospitals operate alongside for-profit counterparts in many parts of the country. To the man on the street, a tax-exempt hospital may look remarkably similar to one that pays tax. And that same man on the street might reasonably ask why the standard discussed previously – that the hospital benefits the community it serves through the promotion of health – would not also be met by a for-profit hospital. So the tax policy and tax administration question that needs to be addressed is: How does one meaningfully differentiate a tax-paying, for-profit hospital from a non-profit hospital that enjoys exemption from federal and state tax, exemption from property tax, and eligibility for favorable bond financing? That is where the community benefit standard comes in – to help one make the distinction.
It may be somewhat surprising to learn that neither the Internal Revenue Code nor the underlying regulations explicitly provides for the exemption for non-profit hospitals from federal income taxation. Nonetheless, we have long recognized that hospitals may qualify for exemption under Section 501(c)(3). To qualify as an organization described in Section 501(c)(3), a hospital must demonstrate that it provides benefits to a class of persons broad enough to benefit the community, and it must show that it is operated to serve a public rather than a private interest. In a nutshell, that is the standard – a hospital must show that it benefits the public by promoting the health of that community. The community benefit standard looks at five factors.
The five factors are not the only factors. It is a facts and circumstances determination, with no one factor controlling. The 1969 ruling also modified (but left in place) an earlier revenue ruling that based exemption on providing charity care.
The health care industry has changed since 1969. Medicare and Medicaid now reimburse hospitals for medical care for the elderly and the indigent. Hospitals that participate in Medicare and have an emergency room are generally required – for reasons unrelated to the community benefit standard (EMTALA) – to treat any patient in an emergency condition, regardless of ability to pay.
Provena Covenant Medical Center is a 254 bed non-profit hospital in Urbana, IL. In 2002, the Champaign County Board of Review challenged Provena Covenant's tax-exempt status based on debt-collection tactics and amount of charity care offered. Ultimately, the Illinois Department of Revenue denied Provena Covenant's status, which led to the matter to be considered by the circuit court of Sangamon County, IL, which sided with Provena Covenant. The matter was then considered by the Appellate Court, and later, the Illinois Supreme Court which both rendered decisions against Provena Covenant's tax-exempt status. In a March 18, 2010 judgment by the Illinois Supreme Court, the Court agreed that the Department of Revenue had acted properly in denying charitable and religious property tax exemptions requested by Provena Hospitals. In the judgment, the Court noted that “a mere 302 of its (Provena Covenant's) 110,000 admissions received reductions in their bills based on charitable considerations.” The court added, “uninsured patients were charged PCMC’s “established” rates, which were more than double the actual costs of care. When patients were granted discounts at the 25 and 50 percent levels, the hospital was therefore still able to generate a surplus.” In response, the head of Provena Covenant Medical Center said, “We are deeply disappointed that the Illinois Supreme Court has denied the property tax exemption of Provena Covenant Medical Center,” said Jon Sokolski, Chair of the Board. “Provena…cares for all in our community who need our health services regardless of their ability to pay. In 2008, we provided more than $38 million in free care and other community benefits.”It increasingly appears that federal tax exemption is no longer always dispositive of how a state or local government will regard a hospital.
The House Ways and Means Committee also expressed interest in this issue. In July 2005, then-Chairman Thomas convened a hearing on tax-exempt hospitals and healthcare organizations, and the IRS’s administration of the area. He followed this in December, 2006 with proposed legislation requiring non-profit hospitals to provide a minimum level of charity care to individuals with incomes below the federal poverty limit, and limiting payments to the “average insured rate” for individuals with incomes less than two times the federal poverty limit. Sanctions would have included an excise tax on hospitals and the disallowance of charitable deductions to contributors.
The Form 990, Return of Organization Exempt from Income Tax, was completely redesigned for 2008. One of the goals of the redesign was to use the new 990 to contribute to the review of the community benefit standard. The IRS believed: better data would allow the public, the Congress, the IRS, the States, and other stakeholders to make better-informed decisions about this area. As part of the 990 redesign, the IRS added a new hospital schedule – the Schedule H – that requires non-profit hospitals to report community benefit and other information about themselves.The Schedule H addresses the “what,” the “how,” and the “by whom” aspects of community benefit, but it does not answer all questions pertinent to the debate. There remain some key areas where consensus does not yet exist (such as bad debt).
The quantifiable community benefit identified by hospitals is reported according to specific instructions outlined by the following: Internal Revenue Service, Centers for Medicare & Medicaid Services and Generally Accepted Accounting Principles.
Community Benefit, in the form of charity care, is reported to the Federal Government (and to the public) on each of the forms above. Though the terms the are the same, the definitions and therefore the resulting amounts, differ. Form 990 is a public document. It is available for viewing on GuideStar.org and must be provided by the organization upon request. The Medicare cost report is also a public document and may be requested from a Medicare contractor under the Freedom of Information Act.
Differences in charity care amounts reported on the forms above are attributable to:Variances in the manner in which charity care is defined; andTiming inconsistencies resulting from the varying filing requirements for each of the forms.
This is a summary of the “chart” at the bottom of Schedule H, page 1.
The Cost report is the “stick” and EHR payments and DSH payments (on the next slide) are the “carrot.”
When is an organization required to obtain audited financial statements? There are various external reasons that an audit may be required. Many states have a revenue threshold that would trigger the audit requirement. For example, a New Jersey nonprofit organization that must file a Charitable Registration Form CRI-300R is required to attach a certified audit if its revenue exceeds $500,000 (increased from $250,000 in February 2011). An audit may also be required by an individual or government grantor, which should be addressed in the grant agreement. An organization that receives over $500,000 in federal grants is required to have an annual audit in accordance with OMB A-133. If an organization has bank or other financing arrangements, the lender may require that an annual audit be performed.