OF ST. ROSE HOSPITAL

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Nov 18, 2013 (3 years and 10 months ago)

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O
PERATIONAL TRANSFORMATION
OF ST. ROSE HOSPITAL

Edwin Hernandez

Travis Young

Natalie
Eloskof

Chintan

Somaiya

THE DEBT

-
$75
million debt

STRATEGY OVERVIEW


Improve operations


Physician integration and creating a favorable
payer mix


Community outreach

Quality
Care

Employee
Engagement

Revenue
Generation

STRATEGIC PLANNING PROCESS

Execute Plan & Assess
the Success Rate

Implement Strategies
& Set Measurable
Goals



Identify Objectives,
Major Initiatives & Key
Success Areas

SWOT
Analysis
and Core
Competencies



Identify Effects of External
Environment

CHANGING PAYER MIX

-
32

-
5

-
3

16

24

-40
-30
-20
-10
0
10
20
30
Uninsured
Non-Group
Market
Employer
Sponsored
Medicaid
Exchanges
Americans In Millions

Americans

FINANCIAL IMPACT ON HOSPITALS

Payment Area

Payment Reduction
Over 10 years

(Billions)

Payment

Reductions:


New Payments

for Care

$177.3


Market Basket Update

$
-
112.6


Disproportionate Share

Cuts

$
-
36.1


Reduced Readmissions

$
-
7.1


Hospital Acquired

Conditions

$
-
1.5


Accountable

Care Organization

$
-
1.5

Net Aggregate Financial Impact on U.S. Hospitals

$17.06

INSURANCE PROFILE

Area

Population

Uninsured

All ages

0
-
17

years

18
-
64 years

Alameda
County

171,430

12%

6%

15%

Hayward

22,289

16%

7%

21%

Eligible People in Service Area

Population

Percentage

74,981

390,615

19.2%

* Approximately 30% of inpatients receive services out of the area

Alameda

Alliance for Health: Market Share by Hospital

2010

2011

St. Rose Hospital

14.4%

16.4%

PRIMARY GOAL

Increase the volume of Insured
Patients

FINANCIAL PROFILE

2010

2011

Operating Revenue

$147,013,000

$160,444,000

Operating Expense

$130,801,560

$150,681,628

Operating Margin

-
0.27%

-
14.57%

Days in A/R

65.1

44.7

Charity

Care Charges in ED

$5,044,888

$5,091,996

* Large change found in unaudited and audited numbers

REVENUE CYCLE IMPERATIVES

Changes with

Accountable Care Act

Expanded
Coverage

Payment Cuts

New
Requirements

Economic
Incentives

Improving Performance

and Efficiency

Eligibility

Process

Denials

Prevention


Charity Care
Policies

Physician

Integration

KEY OPERATION INITIATIVES


Nurse Navigator in the ED informs patients of financial
resources


Provide automated pre
-
admission insurance verification,
counseling, and price estimates
at
registration


Distinguish between charity care and bad debt accounts


Renegotiate contract with Alameda Alliance Health


Re
-
license suspended beds for pediatric services ( 7
-

beds) and
medical surgical services (10
-

beds)





PEDIATRIC SERVICES

We cannot give Washington Hospital


Fremont the sole responsibility for
caring for pediatric patients.

SRH

service area population age distribution

2016

Projection

Population

% of Total

Age 0
-

14

85,798

20.4%

Based on WHF’s charge master price for Pediatri
c room and care

Revenue

from 7 Pediatric Beds

$2,063,418

OPERATIONAL BENEFITS

Projected

from Comparable Hospital’s results

Overall Increase cash as a % of net revenue

Reduce Bad Debt

Charges by 48.6%

~$5 million

Reclassify

Bad Debt to

Charity Care by 15.5%

~$7 million

Decrease in Overall Uncompensated Care by 16.6%

~$2 million

Additional

Revenue

from Pediatric Beds

~$500,000

Total

~$14.5

million

* Source Healthcare Financial Management Association

NEXT STEPS

Compare
Performance

Adopt Best
Practices

Measure
Performance

IMPROVING PHYSICIAN
INTEGRATION

1.
Create a sense of urgency

2.
Select physician champions to become
advocates for the hospital to increase referrals

3.
Create and train a physician leadership team


IMPROVING THE CONTINUUM OF CARE


ACA will not pay for readmission


Be proactive


Create bonuses off decreasing
readmission rates


Telemedicine and discharge planning


Decreasing
readmission rates




READMISSION RATES

21%

17.47%

27.10%

18.20%

16.36%

0%
5%
10%
15%
20%
25%
30%
St. Rose
Hospital
Top 10%
Safety
Net
Hospitals
Heart Attack Patients
Heart Failure
Pneumonia
PHYSICIAN LEADERSHIP TEAM GOALS

Analyze
continuum of
care

Improve
communication

Empower
physician
leadership team

Review results

CREATING A FAVORABLE PAYER MIX

40

40

14

6

Actual

Medi-Cal
Medicare
Third Party
Indigent
27

30

40

3

Target

% of Payer Mix

PLAN

Determine
service lines that attract
third
-
party patients

CAN WE INCREASE UTILIZATION?


Analyze cardiology and obstetric departments system issues


Can we increase utilization? Is patient scheduling an efficient process?




Study the demographics


Hispanic
-
33%, Asian
-
29%, Caucasian
-
22%


According to Screenvision.com, 85% of Hispanics go to the movies


Average household income in Alameda County
-

$75,284




STEPS TO INCREASE UTILIZATION


Improve search engine marketing


Purchase
Google
ad words associated with cardiology and
obstetrics


Create a user friendly website


Make it a 1
-
2
-
3 step process to scheduling a patient


Have a number to call for consultation


Create a general inquiry form


Purchase
movie screen advertisements for $18/screen


Promote profitable service lines at health fairs


Blood pressure screenings, planned parenting classes, etc.


OBSTETRICS SERVICES


SRH
market share (28
%)


1
of
6
hospitals with a
Percutaneous Coronary
Intervention (PCI)
contract in Alameda
County


Kaiser
-
Hayward closing


i
ncreased
occupancy


Current: 60
%
capacity


Target: 85% capacity






SRH market share (15
%)


85% of patient discharges
are
Medi
-
Cal


Current:
44%
capacity


Target: 85% capacity




CARDIAC

SERVICES

REVENUE AND PROFIT


Increasing the Cardiology department capacity
from 60
-

85% will bring in $700,000 of revenue


Increasing the
Obstetrics department
capacity
from
44
-

85
% will bring in
$1.8 million
of
revenue

MEASURE A FUNDS



Appeal to
Alameda County
Board of Supervisors for
more
Measure A Funds due to


St
. Rose Hospital (SRH)


Medi
-
Cal
-

60
% (largest amount in county)


7.6%
-

indigent
care


2.5%
-

Measure
A
funds


Alameda County Medical Center (ACMC)


76.5%
-

indigent
care


75%
-

Measure
A Funds


RESULTS


Profit


Cardiology: $700,000


Obstetrics: $1.8 million


Retention


P
hysician loyalty


Reimbursement


Measure A funds


$5 million


IMPROVING COMMUNITY OUTREACH
SERVICES


Modify community
b
enefit
s
ervices


Proper access to primary
c
are


Transform Silva Pediatric Clinic


MODIFICATIONS TO COMMUNITY
BENEFIT SERVICES


Address key
h
ealth concerns:


Hypertension and obesity


Educate with health monitoring and preventive
care measures


Asthma


Utilize Care
-

A
-

Van services for early
detection of the health issues


PROPER ACCESS TO PRIMARY CARE


Educate community on access to
primary care


ED navigator


Triage patients to urgent
c
are and
o
utpatient services



TRANSFORMATION

Silva
Pediatric
Clinic

Silva
Outpatient
Clinic

TRANSFORM SILVA PEDIATRIC CLINIC



Retain the Silva Pediatric Clinic


Transform it into an outpatient clinic


Manage overcrowding at the ED


Currently, functioning
at 103% of it capacity


Potential stress due to Kaiser’s relocation


Modify urgent
c
are and outpatient
c
linic
h
ours


Urgent care: 10:00 am to 12:00 am


Clinic
h
ours: 7:00 am to 7:00 pm

STRATEGY BENEFITS


Improve operations


Collection process


Financial guidance


Renegotiating
contracts


Physician integration


Cardiology: $700,000


Obstetrics: $1.8
million


Measure A funds
adjustment: $5 million


Community outreach


Improve patient
access


Efficient utilization

Quality
Care

Employee
Engagement

Revenue
Generation

$75 million Debt

$14.5 million
from Operation
benefits

$5 million from
Measure A funds

$2.5 million from
Cardiology and
Obstetrics

TACKLING THE DEBT