joseph a. levi 55th annual institute - hfma

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Volume 46 Issue 7 Winter 2014

March 13-14, 2014The LaGuardia Marriott Hotel

East Elmhurst, NY

JOSEPH A. LEVI55TH

ANNUAL INSTITUTE

Presented By the Metropolitan New York ChapterHealthcare Financial Management Education Foundation

18.00 Educational Credit HoursNYS Education Department Sponsor License # 000337

HFMA Metro New York Chapter is approved as a New York State CPE Provider in the area of specialized knowledge and applications. In accordance with the standards of the National Registry of CPE Sponsors the total credits

have been rounded down. CPE Credits have been granted on a 50 minute hour

2013-2014 CORPORATE SPONSORS

PLATINUM

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KPMG, LLP

McGladrey LLP

MCRC Group

Miller & Milone, P.C.

POM Recoveries, Inc.

PricewaterhouseCoopers LLP

RTR Financial Services, Inc.

Siemens Medical Solutions

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TRITECH Healthcare Management, LLC

WeiserMazars LLP

Betz-Mitchell Associates, Inc.

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M & T Bank

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NTT Data Healthcare Technologies

The Outsource Group

Pinnacle Strategies, Inc.

Professional Claims Bureau, Inc.

Reimbursement Services Group

Avadyne Health

Collection Bureau of Hudson Valley - CBHV

Connex International

Convergent Revenue Cycle Management, Inc.

DGA Partners, Inc.

Garfunkel Wild, P.C.

HCCS - Health Care Compliance Strategies

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TD Bank - Healthcare Lending Division

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PAST PRESIDENT2011-2012 John I. Costa2010-2011 Edmund P. Schmidt, III, FHFMA2009-2010 Cynthia A. Strain, FHFMA2008-2009 Mary Kinsella, FHFMA2007-2008 Gordon Sanit, CPA, FHFMA2006-2007 Elizabeth Carnevale 2005-2006 Jane C. Florek, CPA 2004-2005 John M. Scanlan, FHFMA

EX-OFFICIOAll Past Presidents of the

Metropolitan New York Chapter, HFMADaniel Sisto,

President, Healthcare Association of New York StateKenneth E. Raske,

President, Greater New York Hospital AssociationKevin W. Dahill,

President & CEO, Nassau-Suffolk Hospital Council

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Chapter Officers and Board of Directors

Metro NY HFMA Newscast Schedule

Electronic Publication Date 4/23/14

Article Deadline for Receipt by Editor 3/19/14

OFFICERS 2013-2014President David EvangelistaPresident-Elect Wendy Leo, FHFMAVice President Meredith Simonetti, FHFMATreasurer David WoodsSecretary Joseph J. GuarracinoImmediate Past President Palmira M. Cataliotti, FHFMA, CPA

BOARD OF DIRECTORSClass of 2014

Martin Abschutz, CPA, CGMA Donna M. SkuraPaulette DiNapoli Robin ZieglerJames Petty, FHFMA

Class of 2015Ann M. Amato, CPA, MBA Diane McCarthy, CPA, CHFPMario DiFiglia Maryann J. ReganJason Gottleib

Newscast Committee

EDITORS:Marty Abschutz, CPA, CGMA, Editor

James G. Fouassier, JD, Esq., Assistant Editor

COMMITTEE MEMBERS:Kiran Batheja, FHFMAJoel DziengielewskiPaulette DiNapoli

James G. Fouassier, EsquireWilliam C. Hammond, CHFP

Phil HoltzmanMary Kinsella, FHFMAMichael Lamothe

Wendy Leo, FHFMAMike McGrath, FHFMA

Andrew NatkinEdmund P. Schmidt, III, FHFMA

Ken SheridanJohn Scanlan, FHFMACynthia Strain, FHFMAStephanie Welsher

President’s MessageDavid Evangelista, FHFMA .....................................................................................................Page 5

Editor’s MessageMarty Abschutz, CPA, CGMA...................................................................................................Page 7

Calendar of Events ...............................................................................................................Page 8

New MembersRobin Ziegler ..........................................................................................................................Page 9

Committee Listings 2013-2014 ........................................................................................Page 10

The Regional FrontBruce K. Liebel, FHFMA .......................................................................................................Page 12

Should Health Systems Hold the Ambulatory Enterprise to a Different Financial StandardKate Lovrien and Luke C. Peterson.......................................................................................Page 14

HFMA Metro NY Golf Outing ..................................................................................Page 15, 19, 21

Top 10 New Year’s Resolutions for Hospital CFOsLewis D. Bivona Jr., CPA, AFE ..............................................................................................Page 16

Succeeding in the New Health Care EnvironmentLessons from the Montefiore ExperienceDavid Menashy .....................................................................................................................Page 20

Video Surveilance TodayBrian R. Selltiz......................................................................................................................Page 22

The HFMA Virtual Conference Ad......................................................................................Page 24

“Breast Cancer – Knowledge is Power” LuncheonJames G. Fouassier, Esq.......................................................................................................Page 25

HFMA Member-Get-A-Member Program ...........................................................................Page 26

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I hope that everyone had a joyous Holiday Season. I want to wish everyone a happy, healthy and prosperous New Year!What an extraordinary time to be in Healthcare Finance…2014 will present some truly historic changes for all of us. Whobetter to lead the change than the HFMA Metro NY Membership? Healthcare Exchange, Medicaid Expansion, Value BasedPurchasing, Population Management, Medicare Reform are only some of the changes impacting us in 2014. The Metro NewYork Chapter will be delivering education to assist you in navigating these changing times.

Our premier educational event, The Joseph A. Levi Annual Institute will be held on March 13 – 14, 2014, at theLaGuardia Marriott Hotel. Chairperson Maryann Regan and the entire Annual Institute Committee have organized anoutstanding 55th offering of this annual program. This year’s edition will include a “C Suite” level discussion of ManagedCare and the evolving dynamics between payor and provider, success stories on Physician/Hospital Alignment from aroundthe nation, and local leaderships’ responses to our current challenges. We modified your perennial member favorite, CFOPanel Presentation, to include CMOs. We paired these two positions to discuss their triumphs and challenges in the struggleto maintain revenue, decrease cost and improve quality. Day 2 of the Annual Institute will kick off with Super Bowl Championand legendary NY Giant, Harry Carson, discussing our theme, “Whatever it Takes.” Although I’m a Dallas Cowboy fan, I can’twait to hear Mr. Carson speak. There will also be featured sessions on the Affordable Care Act, Medicaid Redesign andPopulation Management. The flyer, with registration information, has been mailed to everyone; it is also prominentlydisplayed on our website, www.hfma.metrony.org.

In addition to our Annual Institute, our education committees have planned timely and informative seminars to educate ourChapter members. Our committees have offered several programs to date including two Academies. Here are someupcoming programs: On January 24th, The Medical Group Management Committee will offer Medicare Part B Updates atInfo Builders in Manhattan. On January 28th, The Revenue Cycle and Managed Care Committees will offer What You Needto Know to Get Paid at the LaGuardia Marriott. On January 31st, The Internal Audit and Compliance Committee will offerthe OIG Workplan at PricewaterhouseCoopers in Manhattan. On February 7th, the HIM Committee is offering an ICD -10program at the Uniondale Marriott. Our full calendar of Educational Programs is listed on our Chapter website. I knowthat many of our members have asked for alternative locations for programs. The Education Committee has offeredprograms at the Uniondale Marriott, The Hofstra Club, The LaGuardia Marriott and two Manhattan locations, Info Buildersand PricewaterhouseCoopers.

You asked and we responded…We know that your time is valuable and have also made many offerings of free webinars. I’mso proud of the launching of our Corporate Sponsor Webinar Series. These lunchtime webinars were offered free of chargeto our membership. Thank you to our Corporate Sponsors for providing quality education on several topics of interest. Ifany other Corporate Sponsors are interested in taking advantage of this opportunity, please contact Diane Masi [email protected] or me.

www.hfmametrony.org

Have you joined the Metro NY Group LinkedIn group yet? If so, you are enjoying frequentdiscussions on Chapter Events as well as some of the most pressing topics in Healthcare Finance.A special note of thanks to Phil Holtzman, who is our LinkedIn Lead Contributor. I enjoy thediscussions and especially the Chapter updates!

I would like to express my sincere gratitude to our Corporate Sponsors and our dedicatedvolunteers. It is with their support that we put forth exceptional educational programs to our members. We strive tocontinuously improve our Chapter’s educational programs and encourage you to provide us with feedback on how we cando better. Please don’t hesitate to reach out to me to discuss any concerns or ideas you may have. Also, please don’t missthe upcoming Chinese New Year celebration on February 8th. This event always is a great evening filled with excellent foodand drink, Chinese Dragon dancers and time with friends and family. I hope to see you there.

Best wishes for a happy and healthy New Year…and may you attain the greatest success possible.

David A. EvangelistaChapter President, 2013 - 2014

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By Marty Abschutz

The Weather Outside and More...

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The weather outside IS frightful. We are in the time of year when budgets, new reimbursement and payment rates and,perhaps, new systems are being implemented. It’s also the time of year when plans are being finalized for the Joseph A.Levi Annual Institute (see our cover). While the Annual Institute is our signature professional development event, we havemany other opportunities to grasp the latest industry developments. Regardless of, virtually, any interest that you mayhave, the Chapter Education Committee will have something for you. See the short representative program listing on thenext page; also, visit www.hfmametrony.org and www.hfma.org for more opportunities.

We start off this issue of Newscast with Bruce Liebel’s, FHFMA, “The Regional Front.” Bruce updates on what is happeningrelated to our Region; it includes all the chapters in New York State, plus Puerto Rico. He also gives us the save the datefor the Annual Region 2 Conference. This year it will be held October 22 through 24 at the Turning Stone Resort and Casinoin Verona, NY. Kate Lovrien and Luke C. Peterson share, “Should Health Systems Hold the Ambulatory Enterprise to aDifferent Financial Standard?” They make the argument that providers need a strong ambulatory network to thrive goingforward.

We follow that with a selection of photos from the Annual Chapter Golf Outing held at the North Hempstead Country Club.See the Chapter Facebook page for the complete album og more than 350 photos from the event.

Lewis D. Bivona, CPA, share his thoughts on the “Top 10 New Year’s Resolutions for Hospital CFOs. David Menashy, fellowArsenal Football Club supporter, presented, “Succeeding in the Mew Health Care Economy: Lessons from the MontefioreExperience” at the January 13, 2014, Reimbursement Update seminar. See his write-up to obtain a copy of his completepresentation.

Brian Sellitz gives us an unusual topic for Newscast, “Video Surveillance Today.” Read it give you some food for thought aboutwhat you are doing. Jim Fouassier writes about the “Breast Cancer – Knowledge is Power” luncheon held at the VillaMonaco Restaurant in West Islip. This session is part of a series sponsored by Betz-Mitchell Associates, Inc., Chaptersponsors.

Please remember to join us on LinkedIn and to like our Facebook page. Before too long, you will be able to follow thechapter on twitter, too. Two years ago, I wrote that we had 136 members of our LinkedIn group. I was thinking that if wereached 300 members in the next two years, we would be doing well. I am happy to report we have 462 members as of thiswriting. Also, remember to view our Facebook page where you will find all of the photos from our Chapter events.Stay warm!

2014 IMPORTANT DATES

January 31, 2014 OIG Workplan Update PWC, NYC

February 7, 2014 ICD-10 Readiness Event Uniondale Marriott

February 8, 2014 Chinese New Year Flushing, NY

March 13-14, 2014 Annual Institute LaGuardia Marriott

April 2014 Annual Medicaid Update TBD

April 2014 Annual ICR Seminar TBD

A selection of FREE Webinars (Check www.hfmametrony.org for more):

January 29, 2014 Implementation of the Proposed 501(r) Regulations from a RevenueCycle Perspective

February 5, 2014 Conflicts of Interest

February 19, 2014 Self Pay Collections and Third Party Liability

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HFMA Seminars provide timely, in-depth strategies and metrics to help you keep

pace with the healthcare finance topics you care about the most. View all upcoming

HFMA Seminars and register at www.hfma.org/seminars.

The Metropolitan New York Chapter of HFMA Proudly Welcomes the Following New Members!

By Robin Ziegler, Membership Committee Chair

MetroNY HFMA is pleased to welcome the following new members to our Chapter. We ask our current membership to rollout the red carpet to these new members and help them see for themselves the benefits of HFMA membership. Encouragethem to attend seminars and other Chapter events. We ask these new members to consider joining a Committee to not onlyhelp the Chapter accomplish its work, but to expand their networks of top notch personal and professional relationships.See the list of MetroNY HFMA Committee Chairs, along with their contact information, listed in this eNewsletter.

OCTOBER 2013

Catherine GallegoProfessional Recovery Associates, Inc.

Milagros ArceNYULMC

Valerie G Pardon, CPCMount Sinai Queens

Mahmood Usmani

Andrew T. Taffurelli,CPAErnst & Young, LLP

Brian HochEmerging Health Montefiore IT

Daniel DelaneyWinthrop University Hospital

Kamil Budhram-RamlallWeill Cornell Medical College

Mark DomaszotWeill Cornell Medical College

NOVEMBER 2013

April LackeyThe Brooklyn Hospital Center

Richard PascaleThe Brooklyn Hospital Center

Nabil RabNabil A Rab Business Consulting

Denise BurgosAllegiance Billing & Consulting

Nikhilesh RajaniNew York Eye & Ear Infirmary

John P. FiorilloNAPA Management Service Corporation

Vali GacheWyckoff Heights Medical Center

Melissa A. SkolnikHayes Management Consulting

David LevineAllianceBernstein

Pooja ShahGlobal Trading Analyst

Irene Y. FrohichGrant Thornton, LLP

DECEMBER 2013

Jessica LicontiErnst & Young

Mustfa K ManzurNew York Eye & Ear Infirmary

Joe AngelosanteAccess Nursing Services

Meghan McNamaraHinman Straub P.C.

Jen LauErnst & Young

Michael A. PesceNavigant

Kevin KerrAccess Nursing Services

Thu-Nhi Nguyen-PetitSt. Luke’s-Roosevelt Hospital

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www.hfmametrony.org

Advisory CouncilPalmira Cataliotti

[email protected] (516) 663-2311

John [email protected] (516) 240-8147

Ed Schmidt [email protected]

(516) 572-4834

Cindy Strain [email protected] (516) 796-3700

55th AnnualInstitute

Maryann Regan [email protected]

(516-576-5601

Jason [email protected](212) 297-4549Christina Milone

[email protected](516) 509-0277

Bob [email protected](516) 616-0200 ext. 201

Emily [email protected]

(614) 263-1043

Jim Argutto [email protected](631) 761-1028

Cathy [email protected]

(516) 745-0161


(516) 745-0161

Annie Lemoine [email protected] (516) 326-0808 x3312

AuditingJohn Scanlan


Gordon Sanit [email protected](516) 918-7065

Al [email protected](914) 365-3508

Joe [email protected](718) 250-6755

BylawsJoe [email protected](718) 250-6755

Fred [email protected](516) 393-2250

David Evangelista [email protected] (718) 206-6930

CentralRegistration

Robin Ziegler [email protected](516) 338-1100 x314

Diane Masi [email protected]

(516) 551-5839

Palmira Cataliotti [email protected]

(516) 663-2311

CertificationCoaching

Jim Petty [email protected] (516) 876-6022

John Scanlan [email protected]

(718) 283-3911

Kiran Batheja [email protected]

Art Cusack [email protected] (516) 546-4198

Certified Members Kiran Batheja [email protected]

Michael McGrath [email protected]

(516) 656-5374

CommunityOutreach

Josephine Vaglio [email protected]

(516) 248-2422


Continuing CareSteven Stella


Corp. Compliance/Internal Audit

Ann Amato [email protected] (516) 632-3405

Lauri [email protected](516) 616-0200 ext 216

CPE’sJohn Scanlan


DCMS/BalancedScorecard


(516) 551-5839



Wendy [email protected]

(516) 454-0700

Exec. Comm.& Planning


Wendy [email protected]

(516) 454-0700

Finance/Reimbursement/Audit

Mario [email protected]

(516) 876-1386

Kwok Chang [email protected] (212) 979-4324

Rachele [email protected](646) 227-3156

Sean [email protected]

(516)

Founders AwardsPaulette DiNapoli


General Education

Donna Skura [email protected](516) 572-4498

Diane [email protected](631)391-7748/

HIM/URAnnie Lemoine

[email protected] (516) 326-0808 x3312

Stacey Levitt [email protected]

(646) 732-5052

Co-Chair: Diane [email protected]

(516) 551-5839

Co-Chair:Jason [email protected](212) 297-4549

Committee Name Chair Co-Chair Vice Chair 1 Vice Chair 2

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HistorianMichael McGrath


Paul Cheng, [email protected](347) 581-7573

Legal AffairsFred Miller


Christina [email protected]

(516) 509-0277 Peter Egan

Link CommitteeRich Nagy

[email protected](631)444-4175

Jason [email protected] 297-4549

Managed CareRich Nagy


James [email protected]

(631) 638-4012

Patrick [email protected]

(212) 430-6620

MSP Kiran Batheja [email protected]

Michael McGrath [email protected] (516) 656-5374

MembershipMarketing



(516) 551-5839

Medical Grp Mgmt.

Josephine Vaglio [email protected]

(516) 766-0521

Diane [email protected](631) 391-7748

Heather [email protected](631) 454-4081

Art Cusack [email protected] (212) 226-8866

MISJohn Mertz

[email protected]

Annie Lemoine [email protected] (516) 326-0808 x3312

Ann Amato [email protected] (516) 632-3408

NewscastMarty Abschutz

[email protected](732) 906-8700 ext 109

James [email protected]

(631) 638-4012

NominatingPalmira Cataliotti


Patient FinancialServices

Paulette DiNapoli [email protected]

(516) 576-5638


(516) 745-0161

Patrick [email protected]

(212) 430-6620

PPDDPalmira Cataliotti



Webmaster andPersonnelPlacement

Mary Long Kinsella [email protected] (212) 297-5445


Public Relations &Communications

Region 2

Emily [email protected]

(614) 263-1043

Michael [email protected]

(646) 227-2396Phil Holtzman

Region 2CollaboratonCommittee


Kiran Batheja [email protected]


Meredith Simonetti [email protected]

(631) 465-6877

Diane [email protected](516) 630-3911


(516) 551-5839

Gordon Sanit [email protected](516) 918-7065

Ryan AwardPalmira Cataliotti


John [email protected] (516) 632-3170David Woods


Committee Name Chair Co-Chair Vice Chair 1 Vice Chair 2

Social Events Kiran Batheja [email protected]


SponsorshipMichael McGrath



Yerger AwardDana Keefer


By Bruce K. Liebel, FHFMA, Regional Executive 2013-14

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Welcome to the Winter Edition of “The Regional Front”, an article providing information to the chaptersof Region 2 from your Regional Executive. Comments always welcomed at [email protected].

A few noteworthy items to share:

REGIONAL COUNCIL MEETING:In November, the Regional Council convened in Chicago, with the purpose of discussing and setting the Chapter BalancedScorecard (CBSC) goals for the 2014-15 Chapter year. As always, some amounts are subject to change, depending on theresults from the current chapter year, but for the most part there is little change. National recognizes many of theconstraints we are facing these days, thus the education goal remains at the lesser of 16.1 education hours per member,or .5% growth. I expect the Region 2 chapters to easily meet the education goal this year, as most all are already aheadof last year’s pace, with 3 chapters 40+% ahead of last year education hours to-date.

One change that did occur in the CBSC, involved the Chapter Board Composition. The Council approved discontinuinggrandfathering all chapters; they must all meet the 40% provider threshold effective with the 2014-15 CBSC. The Councilalso approved expanding “provider” board composition to include organizational codes 0022 (HMO, Health Plans, orInsurance Company), 0039 (Third Party Administration) and 0035 (Managed Services/Outsourcing/Interim Staffing), a neworganization category for members who are doing the work of a finance professional within a hospital setting but are notemployed by the hospital.

Membership, always a struggle in our Region, was discussed and we attempted to get a pro-rating of points if a certain levelof membership was achieved, but it did not pass. As we are a membership organization, with national HFMA reaching outto new areas, such as physicians and insurers, our chapters must also reach out to these areas and not just the traditionalhospital personnel, to attract and retain new members. It should be noted that at mid-chapter year, Puerto Rico has alreadyreached their membership goal.

At the November meeting, the Council also reviewed the first draft of the 2014 Fall Presidents Meeting Framework andexpressed their suggestions and concerns, especially in regards to devoting enough regional time for the chapters.Beginning next year, all regions will be convening in Chicago for this annual meeting, that was previously planned by theregion as to location and time.

CHAPTER NEWS:As Regional Executive, it is important that I support the chapters in offering suggestions to meet their goals, improve theirprocesses and look ahead to sustain growth and membership.

As a result, I attended the November Board Meeting for the Central New York Chapter, offering information on such topicsas the Keys to Successful Leadership Development, the Challenge of Volunteer Participation, and Opportunities to AddAdditional Educational Hours. In addition, through observation of the workings of their board meeting and chapter activities,I picked up a few successful tips that I could offer other chapters.

By Bruce K. Liebel, FHFMA, Regional Executive 2013-14

www.hfmametrony.org

In December, my own chapter, Western New York, allowed me time to offer a presentation in a special board meeting, todiscuss not only the same leadership, volunteer and opportunities discussed with Central NY, but to provide them an in-depthreview of regional issues and opportunities available for their growth.

Lastly, in mid-December, I was fortunate to attend the Northeastern New York Chapter’s First Annual Institute. This event,which resulted from the planning that occurred at the Leadership Training Conference (LTC) back in April, resulted in asuccessful event with great speakers and attendance above what they expected.

Chapter leaders guiding their teams successfully in their board meetings, and providing great education to their members,along with networking opportunities, are all part of what has made Region 2 the top performing Region in the country, forthe last 4 Member Satisfaction Surveys. I look forward to attending other chapter events this year, to inspire and beinspired, so that we can continue the tradition of Region 2 being Number 1!

REGION 2 CONFERENCE – SAVE-THE-DATE - 2014Our largest event held as a Region, the Annual Region 2 Conference, will be held October 22 – 24, 2014, at the TurningStone Resort & Casino in Verona, N.Y. The committee who has already starting regular conference calls, is always lookingfor new sponsors and suggestions for speakers. If you have any prospects for either one, please email Teresa Figueroa,the current Regional Executive-Elect, who will be responsible for the conference this year. Her email [email protected].

Should Health Systems Hold the AmbulatoryEnterprise to a Different Financial Standard?By: Kate Lovrien and Luke C. Peterson

www.hfmametrony.org

Driven by softening volumes, risk-based reimbursementmodels favoring lower cost substitutes, consumerism andhigh-deductible health plans, health systems are working torespond to increased consumer and payor price and servicesensitivity. These trends suggest that the health systems thatcannot develop a strong ambulatory network increasinglywill be cut out of a larger and larger portion of the caredelivery marketplace. However, health systems’ financialsuccess with the ambulatory enterprise has been a mixedbag and that success often depends on hospital-basedpricing. This model is not sustainable as the hospital-basedpricing differential is an arbitrage opportunity that is quicklycoming to an end. So, with the specter of significant unitprice declines as hospital-based pricing advantagedisappears, can health systems continue to invest in buildingthe ambulatory enterprise?

The answer depends on the organization’s outlook. Forhealth systems that view the ambulatory enterprise as anextension of the hospital, investments in ambulatory careoften are “loss leaders”. Many hospital-centric healthsystems see the main role for the ambulatory enterprise asone of “feeding” inpatient admissions. As an extension of thehospital, this hospital-centric view often loads theambulatory enterprise with overhead and managementsolutions that are fundamentally geared towards theinpatient enterprise. The result is poor returns from theambulatory enterprise and the need to apply a financialmodel that attributes the downstream contribution to justifyambulatory investments.

Viewing the ambulatory enterprise primarily as a “feeder”and holding it to a different financial standard is strategicallydangerous. First, it means that the ambulatory enterprisedoes not need to stand on its own financially, thus causingthe organization never truly to investigate ways to makeambulatory services more efficient. Second, the “feeder”view applies capital-deployment metrics to whatfundamentally is a capability strategy resulting in focus onthe volumes that are funneled through the capital assets(typically hospitals) rather than the access to care solutionsthat are more convenient and lower cost. Third, as a feeder,the ambulatory enterprise is only grown where it can feedthe hospital, which discounts the value of markets furtheraway from any hospital assets.

These dangers are accentuating a move towards populationhealth. In a population health environment, having anefficient, convenient, well-established ambulatory enterpriseis one of the keys to the health system’s success. If the healthsystem’s bias against ambulatory care inhibits growing theambulatory enterprise or structuring it appropriately, therisk of being commoditized by market forces increases.Instead, health systems should hold all enterprises, includingambulatory, to a standard that demands that each enterprisecreate both value of its own and synergies within the system.

There are five steps to hold ambulatory care to the rightstandards:1. Recognize ambulatory enterprise’s differences from theinpatient enterprise and place it appropriately in theorganizational structure. The ambulatory enterprisereporting structure cannot be buried under the hospitalleadership if it is to stand on its own in the system.

2. Design the management model around the needs of theambulatory enterprise rather than overlaying aninpatient enterprise management model and overheadstructure. Processes must be streamlined with a focuson speed and efficiency.

3. Learn to live on outpatient pricing rather than becomeaddicted to the hospital-based pricing arbitrage. Thisis not to say that health systems should leave money onthe table but, rather, recognize that hospital-basedpricing arbitrage is rapidly coming to an end.

4. Use the right management financial metrics. As valueis created by deploying capabilities more than assets,the management metrics must look at total returnsrather than asset returns.

5. Get moving quickly. Most health systems have a veryunder-developed ambulatory enterprise compared totheir inpatient enterprise and will fare poorly in apopulation health environment without concentratingon ambulatory care.

Kate Lovrien and Luke C. Peterson are principals at HealthSystem Advisors. They can be contacted [email protected] [email protected]. Health SystemAdvisors is a strategy consulting firm with a mission toadvise leaders, advance organizations, and transform thehealthcare industry. For more information contact HSA at877.776.3639 or www.HealthSystemAdvisors.com

www.hfmametrony.org

Photos selected by Marty Abschutz

Top 10 New Year’s Resolutions for Hospital CFOs

By: Lewis D. Bivona Jr., CPA, AFE, Partner WithumSmith+Brown, CPAs

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It appears that 2014 will bring another year of challenges tothe hospital industry. Fifteen states have exchanges up andrunning on their own without the problems beingexperienced at the Federal level. The federal governmentthat has set up jointly managed or direct exchanges is oldnews and deeply troubled by IT and other issues. Thepanacea of affordable care for all is doubtful in that it isanticipated that most younger eligible are shying away fromthe exchanges while, as expected, those older and patientswith health issues are flocking towards the plans.

The most dangerous concern for all providers is the apparenttrend to select lower coverage plans which do little ornothing to protect individuals from financial devastation(high deductibles, co-pays, coinsurance and limitednetworks). These issues reemphasize the necessity ofhospitals to operate in the most cost effective and diligentmanner possible. Nothing is off the table when it comes tomanaging costs, whether it is human capital, provider,utilities, pharmaceuticals or supplies. There is a greatdegree of uncertainty in the industry, fueled by concerns overthe ability of developing ACOs to control costs, theimpending taxation of healthcare benefits, the roll out ofICD10, whether state exchanges will limit uncompensatedcare or just add to it, increased enforcement actions by OIGand RAC auditors, new Medicaid Integrity contractorsgearing up for intensive audits, bond covenant defaults, lackof capital for projects and erosion of the bottom line.

As a hospital CFO, what are the things you should bethinking about and doing, going into 2014? The following isa list of Top 10 New Year’s Resolutions every hospital CFOshould be making in order to move forward on a positive notein 2014:

1. Bundled payments are déjà vu all over again, as Ipredicted last year. With the advent of ACOs andchallenges of affordable care, hospitals should bepreparing, more than ever, to bundle hospital basedphysician costs (hospitalists, anesthesia, emergency,pathology, radiology, NPPs, social workers and

employed physicians) into your rates if you have notdone that already. Under healthcare reform, morepeople than ever will start to show up at your facilitybut not with the best insurance coverage; efficiency andcost controls will drive you toward profitability sincemost of these new patients will be eligible for Medicaidexpanded benefits it will be a strain on hospitals; withor without expansion the ACA reduces DSH payments,beware! Procedure demand will be up on an outpatientbasis since pent up demand from 2013 will finallymaterialize as Exchanges start to come online; don’tforget to price your procedures to be competitive withfree standing facilities, if possible. Monitoring patientstatus of insurance payments will also be critical sinceObamacare allows a 90 day grace period to pay whichcould result in retroactive denials for approved servicesif payments are in default; AHA has researched whetheror not hospitals could pay premiums if these instancesand there seems to be no prohibition although CMS isnot wild about the idea, but it might pay to do it on acase by case basis. Lastly, look out for changes in planofferings as employers move to different offerings(HDHPs and HAS’s) that can have a detrimental impactto your cash flow by forcing employees into higherdeductible plans.

2. Have you created medical homes? Medical homes areclearly going to be the key driver of managing healthcarecosts under reform even though it has had a dismalstart. Do your homework on how to adapt yourinstitution to be profitable in the new healthcareenvironment including aligning with payors or otherHMOs to develop co-branded products. If you have notaligned with your physicians yet, you better get busybecause medical homes will be driving volumes of bothinpatient and outpatient services well into the future! Byall means, don’t forget to factor in nurse practitioners andother complementary care extenders into your plans tocombat the anticipated physician shortage. Also, don’tforget to fix your contracts with payors before changingyour business model or service offerings. Equally

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important, don’t forget to factor in risk sharing andperformance criteria into your contracts and makecertain it is crystal clear how the savings are divvied up.

3. Just like last years, quality at your hospital will continueto be a paramount for reimbursement. Payment reformis rewarding facilities that can do the right things andmeasure them; the shared savings programs sponsoredby Medicare are proof of that! Healthcare acquiredinfections begin in FY 2015 so it is not too early to startlowering your rates now; hospitals that are in the lowestquartile for medical errors and serious infections willbe paid 99% of the IPPS rates. Quality also focuses onlowering readmission rates, those that don’t will sufferup to a 2% decrease to their payment; don’t forget thanin addition to the current readmission tracking (heartattack, pneumonia, and heart failure) CMS will beadding COPD and knee surgery to the list effective FY2015. More and more patient centered outcomes will bein the sights of the healthcare reform law. Don’t rely onthe government or payors to measure your quality, beprepared to support your activities and outcomes;remember how many reports have been issued in thepast that have erroneous measurement data that neededto be refuted? Also, don’t forget that patients will beasked to give feedback on their care which has nobearing, per se, on the real clinical outcome.Remember, even NJ Medicaid is rolling out qualityincentive plans; if you can’t measure your successes,someone else will tell you how you performed, thisoption is not preferred.

4. When in doubt, don’t layoff! Retask department heads,managers and line staff to be agents of change. A lotneeds to be done with new system implementations forACO participation and risk sharing deals, ICD-10 rollout, infection control, discharge planning, meaningfuluse measurements, and readmission avoidance and notto mention the criteria relating to the “two midnightrule”. Staff involvement guarantees better buy-in androll out of action plans that they are invested in, notthose by fiat. Don’t forget about your nurses and NPs,under reform there will be more of a demand for themthan in the past; older seasoned nurses might just giveup and retire if you are not attentive to their wellbeing.

5. Do not scrimp on compliance activities! While the 2014OIG Workplan will not roll out until on or about the timethis is published, it will probably be 2013’s on steroids.Make compliance a strategic initiative and ingrain themin your organizational culture. With the increased

scrutiny that hospitals will be receiving by allgovernmental payors, you cannot afford to side stepgood business and governance practices. Complianceand internal controls will be a key ally in saving yourhospital from embarrassing press articles and, evenworse, monetary recoupments and fines. Don’t forget,there are many new payors (COOP’s, new medicalpayors, new exchanges) that the government will beauditing to make sure they are not wasting tax money;this requires even more diligence on billing staff toassure that billing and reimbursement activities areaccurate.

6. Pay attention to revenue cycle coding including theimpending change to ICD-10. Many providers still havenot prioritized preparation activities for ICD-10 thinkingthat those changes would be pushed back one moretime; not so, CMS announced in its “Final Rule” that itwill be October 1, 2014 for real! Those that are notready will suffer financially. ICD-10 preparation cannotbe put off any longer since system testing and educatingbillers, coders, staff and physicians will be required. Thenew code sets are 5 times larger than ICD-9 so theyshould not be taken lightly. Also coding and mappingtests should be completed as the government auditorswill be all over errors as coding fraud.

7. IPPS increases are not going to make up for the overallincrease in your costs of business unless you think youcan hold your costs to less than one percent.Standardize physician preference items if you have notalready done so. It would also not hurt to standardizetreatment regimens but don’t attempt to do it withoutprovider buy-in. Hospitals and providers on the leftcoast are way ahead of us in paring down costsparticularly in the pharmaceutical area. There are greatcompanies out there that can help to benchmark yoursupply spend and ferret out the best deals withoutsacrificing quality. Some hospitals are also sendingpatients home with medicines to prevent inappropriatereadmissions. Watch out for expensive new biologicswhich could easily blow away other savings initiatives.Cutting costs while still providing quality care willbecome much easier in a shared savings environment!

8. Technology will become more prevalent with healthapplications that are being deployed by your institutionor related health partners. Evaluate security safeguardsand make sure to incorporate these strategies into yourrisk management program. As data is being shared withmore partners in the continuum of care, more

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opportunity for errors can arise.

9. Consider the possibility of a merger with anotherhospital for strategic reasons including the ability tomanage patients through a large network which is theheart of accountable care. M&A activity is expected topeak in 2014 and stand-alone hospitals will find that itis harder to achieve economies of scale that will berequired under healthcare reform. Review of datasupports that hospital systems typically perform 3-4%points higher than unaffiliated hospitals. Other benefitsof mergers or affiliations include ease of medical staffmanagement, better negotiating positions with payorsand enhanced access to capital.

10. High touch not only includes patient quality items.Remember your hospitals mission and continueoutreach activities in the community; remember thatcommunity services could on your 5500 Form! Patientloyalty is as important to future revenues as any otheractivity.

Remember that success rarely comes to those who wait… itcomes to those that do! Use these tips wisely to propel yourorganization forward in 2014!

Lewis D. Bivona, Jr., CPA, AFE, is a partner withWithumSmith+Brown, Certified Public Accountants andConsultants, based in the firm’s Princeton, NJ, office, withover 35 years of experience in the healthcare industry. Lewcan be contacted at 609-520-1188 or by email [email protected].

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Succeeding in the New Health Care Economy: Lessons from the Montefiore Experience.By: David Menashy, Associate Vice President for Finance, Montefiore Medical Center

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David Menashy is Associate Vice President for Finance at Montefiore Medical Center in the Bronx. For the past five years,he has been managing the preparation of the Medical Center’s cost reports, analyzing Medicare and Medicaid policies andpayments under health care reform, and assisting the Montefiore Health System in the evaluation of acquisitions and newprograms. On January 13, 2014, David delivered a 90-minute presentation to the HFMA Reimbursement Update Seminarat the La Guardia Marriott Hotel entitled, "Succeeding in the New Health Care Economy: Lessons from the MontefioreExperience."

David began his presentation by providing a service and financial overview of the Montefiore Health System, including howcritical the Medicare and Medicaid programs are to Montefiore's finances. He then reviewed the impact of Federal healthreform and the risks associated with the deficit reduction proposals being considered in Washington, as well as the changesbeing implemented in New York State as part of the Medicaid Redesign Team (MRT) process. David spent the bulk of histime discussing Montefiore's successful experience with capitation and other risk-based payment arrangements, includingthe Medicare Pioneer Accountable Care Organization (Pioneer ACO) and Bundled Payments for Care Improvement (BPCI)initiatives. David concluded his presentation by sharing lessons learned for other health systems looking to participate inthe growing movement towards performance-based reimbursement models.

If you need further information or copies of the presentation, please contact David Menashy at (718) 920-4686 [email protected].

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Video Surveilance TodayBrian R. SelltizPresident, Digital Provisions, Inc. is a New York State Licensed Security Integration Firmspecializing in legacy CCTV upgrades and migration to IP Video Surveillance Systems.

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Video Surveillance in Today’s Workplace – Are You Keeping Pace?Hospitals throughout New York, as well as the rest of the country, are facing manychallenges when tasked with upgrading their aging security systems. While budgets maybe shrinking, the existing legacy security systems are no longer able to keep pace withstaff requirements. Security directors are finding it difficult to justify the cost of acomplete system revamp and are instead turning to CCTV to IP conversion systems toget the best of both worlds. Security staff no longer need be challenged by blurry images,difficult to operate user interfaces or undependable DVR equipment.

Today’s Security Challenges in HealthcareIP Video Surveillance systems today present a giant leap forward over their analog CCTV ancestors. The main benefits thatIP technology offers over analog are:

• Increased Resolution – Currently up to 29 Megapixel (this is theoretically the equivalent of replacing 95 analog cameraswith one IP camera.) What this means to you is crystal clear imagery when viewing your cameras.

• Flexibility / Future proof – IP is the future, virtually all important security advancements are now based on the IParchitecture.

• Scalability – IP systems easily transition from one to thousands of cameras.• PoE – Since IP Camera utilize network cable instead of coax they can take advantage of Power over Ethernet whichsaves on installation cost and helps with remote troubleshooting.

• Ease of use – IP systems typically are easier to use than older cumbersome DVRs.

New security technology should be used to leverage your existing security force to better protect your facility and thepatients and staff within. Below are some typical problems faced by the health care industry along with the current securitytechnology available to help combat these issues:

Problem SolutionVandalism / Theft Smart Sensors & associated cameras tied into central Command Center for better staff alerting.

Sitter Utilization Audio & Video feeds to monitor patients from a remote location (no recording).

Guard Tours Mobile Device viewing allowing guards to watch cameras in key areas as they patrol other areas.

Guard Log Books Supplement with Video Bookmarks which corroborate log entries with specific video clips.

Parking Lot Safety Video Escort of Staff to their cars by control room operators, on or offsite.

While the above issues may be common, your facility may have other standard or unique security requirements. No oneknows your facility’s challenges better than you and we recommend you bring those experiences to the table when speakingwith your security integrator. Ask how to best apply the currently available technology to your solve specific issues.

Keep what you have, only make it better.Analog cameras at your facility, often numbering in the hundreds, represent a significant existing investment. Additionally,not having to re-wire and reinstall these existing cameras will often save tens of thousands of dollars in labor and materials.The technology now exists to take these old analog signals and turn them into newer IP feeds. This means that system

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upgrades can happen quickly and for a fraction of the cost of replacing all of the old analog cameras. Many of your existingcameras may be providing a sufficient image and may have 5 to 10 years of useful life left in them. Those that do requirereplacement or would benefit from a higher resolution image can be swapped out on an as needed basis, making the changeover a much simpler process.

Move Beyond the Old Technology and Integrate the Future‘Closed’ type security systems were common place in the old regime.Administrators would invest in a technology only to find that their options werelimited to one vendor or one supplier when the time came for system additions.A defining factor of IP based systems is that they are (or should be) ‘OpenPlatform’. Open platform gives you the ability to take advantage of an entireindustry’s innovation, increasing the value of your surveillance system. You havethe freedom to add new technologies as they are developed, allowing you tocontinually update and improve your security system. This means that if youlike the features of one particular brand or model of camera, your system shouldbe easily capable of incorporating it. The same goes for Access Control systems,Intrusion systems and anything else that will help you better secure your facility.Gone are the days of being stuck with one brand for everything.

Making it All WorkIP Video Surveillance Systems are finally delivering on the promise ofincreased security through the use of advanced electronics. • Security Directors benefit from quicker and easier identification of threatsthrough advanced alerting and crystal clear video.

• Multiple buildings no longer have to be considered separate entities andcan be managed as one single system.

• IT departments embrace the new technology because they speak the samelanguage. Now security integrators work closely with IT administrators,finding ways to leverage existing IT infrastructure without impactingoverall network performance.

• Administrators find value in these new systems, finding ways to recover existing security investments while leveragingnew technology to make their staff be more efficient and work smarter.

Overall it is a very exciting time in security and it may be easier than you think to take advantage of all of the availablebenefits

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April 24

“BREAST CANCER – KNOWLEDGE IS POWER” LUNCHEON

By: James G. Fouassier, JD

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Through the generous sponsorship of Betz-Mitchell Associates, Inc., and the courtesies of our Chapter’s General EducationCommittee more than 75 of our colleagues and guests attended an outstanding presentation on this ever-timely subject,along with a delightful luncheon, at the Villa Monaco Restaurant in West Islip on Thursday, August 22nd.

Chaired by Catherine Ekbom of Betz-Mitchell, our guests benefitted from the knowledge and experience of four outstandingexperts in this field. Bonnie Edsall, RN, the Breast Health Center coordinator at Good Samaritan Hospital Medical Center,presented a lively and informative session on her hospital’s breast health center and modern diagnosis and treatmentmodalities. A fascinating (at least to this writer) presentation on super-modern genetic testing techniques and protocolswas delivered by Amanda Laterza, CGC, of Good Sam’s Genetic Counseling Service; I especially was impressed by thegraphics that clearly illustrated just how the genetic history of a patient’s family was traced and how the data was madeuseful in diagnosing possible cancers of all kinds. Eileen Roberto, RN, of Good Sam’s Palliative Care program then presenteda thought-provoking and informative talk about palliative care, driving home the very important point that palliative careis not the same as hospice care and that optimum palliative intervention (sometimes from the point of diagnosis) not onlymay facilitate recovery but will help a patient deal with the physical, emotional and spiritual complications of a seriousillness. Last but certainly not least, Dr. Melissa Pilewskie of the Breast Care Service at Memorial Sloan Kettering CancerCenter presented on the latest in cancer screening, diagnostic and preventive techniques, with a focus on healthmaintenance (i.e. healthy ;life style choices) and screening. Focusing on the factors Dr. Pilewskie discussed will ensurethat everyone takes proper steps in doing the best job possible to reduce cancer risk and improve early detection.

Kudos to the Chapter and the General Ed Committee for doing something new and different here - reaching out beyond theborders of our profession by inviting members of the public, and in particular those most likely to be affected by breastcancer, to benefit from the expertise and experience of our colleagues and clinical associates. Given the success of thisendeavor we certainly expect to see more of these kinds of programs in the future.

I would be remiss if I did not acknowledge Diane McCarthy CHFP and Robin Ziegler who, along with Cathy Ekbom, pulledall of this together and made it happen. A very special “thank you” for all the really hard work (to say nothing of the time)that you put in so these Chapter programs run so smoothly.

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“ I turn to HFMA to keep up with the rapid change in the profession, enhance my career and strengthen our chapter. HFMA delivers the essential information that healthcare financial management professionals require to stay on top of their game and ahead of the curve.”

Mark A. Hartman, FHFAM, CPA, SVP Finance & Treasurer, Arkansas Heart Hospital

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