NFPHC Confidential UMC Status Update May Status Meeting

NFPHC Confidential UMC Status Update May Status Meeting

NFPHC Confidential UMC Status Update May Status Meeting to the OCFO & DHCF 5/23/17 1 NFPHC Confidential Agenda Review of Budget Gap Initiatives Hospital-wide initiatives Revenue Cycle initiatives Review 3-year financial proforma and the underlying revenue and expense assumptions APPRENDIX: March and April Performance Data 2 NFPHC Confidential Hospital Initiatives Initiative 1 Implement InterQual Guidelines Physician training on InterQual, Admission Certification, 2 Observation, two midnight rule / medical necessity, and Meditech deployment scribe for immediate need for 3 Hire physician documentation Implement voice recognition for physician (Upon implementation, 4 documentation this will eliminate/significantly reduce scribes) 5 Accountability and monitoring of physician contracts Original Target Completion Action Date Date Date Owner 4/30/17 5/12/17 5/26/17 6/15/17 4/17/17 CEO/IT InterQual has been deployed and the initial set of super users trained; however the s/w requires IE 11 web browser which is being deployed throughout the hospital Case Mgmt / HIM / IT Physician training continues: - 2-midenight rule and Observation: online informational training module & Chief of Staff mandatory clinical documentation training - InterQual in process Meditech admission/2-midnight certification configuration CEO / Dr. Craig PO signed; positions being recruited IT implementation vendor selection IT/Dr. Craig completed. Next step develop implementation timeline. 9/30/17 Continuous Status On-going / continuous monitoring David/Dr. Craig - Current contracts for the Hospitalists and ED Services are being updated with additional quality & performance metrics target date of 6/30/17 - Plan to develop and release RFP for Hospitalists & ED Services this summer 3 NFPHC Confidential Hospital Initiatives cont. Initiative patients in the correct 6 Placing level of care 7 Training of RN/Providers on Observation Criteria Original Target Completion Action Date Date Date Owner On-going / continuous monitoring Immediate

5/12/17 6/30/17 Case Mgmt Maribel Status - Expanded morning rounds between Hospitalist and Case Mgmt to focus of appropriate level of care for patients - Permanent solution expected mid summer once case mgmt is 24/7 with staffing agency resources - Physicians training on-going - ED Nurses will be trained via annual competency modules Case Management 8 Implement in the Emergency Room 24/7 Immediate 6/1/17 David Solicited proposals from 3 vendors; selected RSI (staffing agency); PO for FY17 approved by Finance Committee and expected to be approved by the full Board on 5/24/17. Interviewing Director candidates on 5/24/17. of Case Managers and 9 Training Social Workers 5/12/17 6/16/17 Adam Employee level metrics and being developed and the corresponding training to ensure effectiveness and efficiency will be conducted Case Management assigned to 10 direct admission and surgery department 4/17/17 Adam Included in the staffing agency headcount Continuous Adam/Dr. Craig Extended stays decreasing; over the past 5 days 12-13 patients with stays of 10+ days (40% of patient days) v. 20-25 patients (70+% of patient days) 7/31/17 Maribel On plan. Currently 17 Medicare patients; 115 census (14.8%) 11 Reduce Length of Stay 12 Improve skill mix in SNF 4 NFPHC Confidential Hospital Initiatives cont. Initiative Original Date Target Date Completion Date Action Owner Status to implement hospital 13 Collaborate clinic visit billing 7/31/17 Billy On Plan. Initial stakeholder meeting held 5/16 hospital based clinic visit 14 Implement billing Develop/revise charge ticket & 15 define charge capture process for Clinic Visits 7/31/17 Billy On Plan. Initial stakeholder meeting held 5/16 7/31/17 Dr. Dennis/Billy On Plan. Initial stakeholder meeting held 5/16 Emergency Room triage and 16 Create workflow process

4/18/17 disposition nurse in 17 Institute Emergency Room Initiate communication with Payors 18 to re-negotiate all Master Agreements Provide AmeriHealth Master 19 Agreement(s) to Legal for review & red line Make business decision to enter 20 into new and/or revised Payor Master Agreement(s) 5/15/17 4/17/17 4/18/17 Maribel 6/16/17 5/31/17 4/30/17 David 6/16/17 Implemented best practices & streamlined processes to decrease overall ED LOS and improve patient experience. EMS off-loading reduced from ~29 mins in Jan-Apr to 17 mins in May (MTD). Need to continuously track effectiveness CEO & CFO finalizing paperwork David B & David T Prioritizing current agreements and outreach strategy / timeline CEO/David Outpatient pricing still being finalized. All other terms agreed upon. CEO See #18 5 NFPHC Confidential Hospital Initiatives cont. Initiative all outsourced vendor 21 Evaluate contracts to quantify savings Original Date Target Completion Action Date Date Owner 8/31/17 David Status Completed: - Talen Energy Retail, 2-May-2017, $40,000.00 - Ortho Clinical (Lab supplies), 30-Apr-2017, $228,006.00 - Crothall (Linen), 26-May-2017, $22,000.00 In-Process: - Anesthesia - ~$40,000 - Tenant Leases - ~$140,000 Evaluate supply chain department 22 and develop hospital-wide supply monitoring program 5/31/17 6/30/17 David - Working with vendor to transition GPO services - New Materials Director starts 6/26/17 23 Evaluate physical therapy contract 4/24/17 6/30/17 David Initial meetings conducted with the vendor. Developing applicable metrics and performance monitoring plan. the need for all physical 24 Evaluate therapy orders Prepare Service Line Proforma by 4/30/2017 & Develop 25 (OCFO) corrective strategies for underperforming programs 4/24/17 6/30/17 Dr. Craig 5/31/17 6/15/17 OCFO

7/15/17 CEO/David Evaluation being performed Initial proformas analysis performed by the CFO identified problems with system data. 6 NFPHC Confidential Hospital Initiatives cont. Initiative Original Date 26 Service Line growth plan(s) 7/28/17 Identify and document CEO's 27 strategy to increase/maintain sustainable volumes 6/30/17 Purchase and Implement phone 28 system to increase Outpatient appointments and implement HIM 29 Purchase 3M revenue cycle software 30 Evaluate the need for Gastroenterology orders 4/30/17 Target Completion Action Date Date Owner Dr. Craig/Dr. Morrow/Ada See #25 Service Line Proformas m/David CEO 6/16/17 6/30/17 4/17/17 Status 6/16/17 On Plan / working with department stakeholders David/IT Implementation of an ACD (automatic call distributor) is being deployed to distribute incoming calls to agents. Phone tree has been designed and the system will be configured. CEO/HIM/ CFO/IT Contract is with Legal for review; CIO will develop an implementation timeline once contract is signed so he can plan IT resources Dr. Craig Initial conversations with physicians indicated this is not an issue; however, a report is being developed to quantify how many patients are receiving GI orders within 1-2 days of discharge 7 NFPHC Confidential Revenue Cycle Initiatives Initiative Original Date Target Completion Action Date Date Owner 1 Implement Relay Health Clearance/AhiQa 2 Hire Coding Manager and 5 additional coders 3 Transition outsourced coding vendor to in-house coding 4 Accomplish coding review to identify areas of opportunity 5 Implement Quality Assurance Team between coding and clinical documentation (CDI) 6 Hire Documentation and Quality Assurance Audit Manager and 1 additional Clinical Documentation Liaison 7 Full assessment of CDI needs 6/30/17 Crystal/IT 6/30/17 Jeremiah 6/30/17 Jeremiah 6/30/17

Jeremiah/ CFO Jeremiah/ Anna 8 Accomplish 100% CDI review of Medicare and DC Medicaid records 9 Expand CDI review to include DC Medicaid Managed Care 10 Establish quality assurance billing audit process team 6/30/17 6/30/17 Anna 6/30/17 Anna 6/30/17 Anna 6/30/17 Anna 6/30/17 Jeremiah/ Veronica Status Working with Agency until FT staff can be employed Working with Agency until FT staff can be employed 8 Revenue Cycle Initiatives cont. NFPHC Confidential Initiative 11 Recruit Revenue Integrity Team (charge capture) 12 Implement charge capture process for all revenue generating departments 13 Develop workplan to implement hospital clinic visit billing 14 Set-up Clinic Visit charge in CDM ensuring coding & pricing is accurate 15 Ensure necessary information is captured on bill for hospital-based clinic billing 16 Ensure proper language exists in Managed Care contracts for reimbursable services provided by hospital 17 Provide/review reimbursement rates to Payors & Hospital Administration for Managed Care contracting Original Date Target Completion Date Date Action Owner 6/30/17 Amy 6/30/17 Amy 4/30/17 4/26/17 Amy 7/31/17 Amy/Veronica 7/31/17 Veronica/Amy Status To include review of ED Point system used for leveling Draft completed & circulated to stakeholders for comment 4/30/17 On-going Amy Information provided for AmeriHealth 4/30/17 On-going Amy Information provided for AmeriHealth 9 April Financials NFPHC Confidential 10 NFPHC Confidential 3-year Financial Proforma

See additional handout 11 NFPHC Confidential Appendix 12 Mar. Key Performance Indicators Budget Metric Actual Variance Fav/ Neut/ Unfav Budget FY2017 (Mar) Variance Actual NFPHC Confidential Fav/ Desired Neut/ Trend Unfav Actual Trend FY2017 YTD Emergency Department Number of visits 4,639 5,167 528 11.4% F 26,842 29,274 2,432 9.1% Number of visits by ambulance 1,253 1,476 223 17.8% F 7,247 7,814 567 7.8% F 250 320 70 28.0% U 1,418 1,866 448 31.6% U < 48 hr. 38 hrs. 70% <48 hrs 10 21% F < 48 hr. 38 hrs. 65% <48 hrs 10 21% F Patie nts in Observation Median length of stay in observation status

F Hospital Total admissions (hospital+SNF) 656 564 -92 -14.0% U 3,726 3,608 -118 -3.2% N Patie nt Days - Hospital 3,634 3,520 -114.0 -3.1% F 20,630 20,258 -372 -2% N Resident Days - SNF 3,264 3,217 -47.0 -1.4% N 20,572 19,262 -1,310 -6% U Average length of stay 5.6 days 6.3 0.7 days 12.5% U 5.6 days 5.7 0 days 1.8% N Number of deliveries 29 38 9 31.0% F 178 197 19 10.7% F 50% 19.00% -31.0% -62.0% U 50% 19.00% -31.0% -62.0% U 18 (before April: 18)

15.8 -2.2 -12.2% U 18 (before April: 18) 17 -1 -6.7% U 26 (May July: 26) N/A N/A N/A N/A 26 (May July: 26) N/A N/A N/A N/A 1.59 0.93 1.71 1.09 0.12 0.16 7.5% 17.2% F F 1.59 0.93 1.60 0.96 0.01 0.02 0.6% 2.7% N N Total number of ambulatory visits 1,654 1,662 8 0.5% N 9,561 10,317 756 7.9% F Number of radiology visits 1,348 1,137 -211 -15.7% U 6,743 6,618 -125 -1.9% N 74 107 33 44.6% F 488 623 135 27.7% F HCAHPS recommend hospital

Average daily census - Psychiatry Medicare CMI Medicaid CMI N/A N/A Ambulatory Care Same Day Surgeries Financial Days in AR 48 days -48 -100.0% 48 days 83.2 35.2 73.3% U Days cash on hand - Operating 45 days -45 -100.0% 45 days 52.5 7.5 16.7% F 1.5 -1.5 -100.0% 1.5 2.8 1.3 86.7% F Average Payment Period 60 days -60 -100.0% 60 days 58.2 -1.8 -3.0% N Deductible Ratio 66.50% -66.50% -100.0% 66.50% 65.20% -1.30% -2.0% N Operating Margin 1.00% -1.00% n/a 1.00% -10.20% -11.20% n/a U Total Margin 7.90% -7.90% n/a 7.90% -17.30% -25.20% n/a U

Current Ratio Productivity FTEs per average daily census (acute) Salary and benefits expense per FTE ($) % of salary and benefits expense 3.1 3.4 0.3 9.7% U 3.1 3.3 0.2 6.5% U $86,991 $84,109 ($2,882) -3.3% F $83,089 $84,764 $1,675 2.0% N 61.3% 51.8% -9.5% -15.5% F 60.6% 54.1% -6.5% -10.7% F 13 Apr. Key Performance Indicators Budget Metric Variance Actual Fav/ Neut/ Unfav Budget FY2017 (Apr) Variance Actual NFPHC Confidential Fav/ Desired Neut/ Trend Unfav Actual Trend FY2017 YTD Emergency Department Number of visits 4,520 4,923 403 8.9% F 31,362 34,197 2,835 9.0% Number of visits by ambulance 1,220 1,384 164 13.4%

F 8,468 9,198 730 8.6% F 297 324 27 9.1% U 1,765 2,190 425 24.1% U < 48 hr. 38 hrs. 70% <48 hrs 10 21% F < 48 hr. 38 hrs. 65% <48 hrs 10 21% F Patie nts in Observation Median length of stay in observation status F Hospital Total admissions (hospital+SNF) 615 565 -50 -8.1% U 4,341 4,173 -168 -3.9% N Patie nt Days - Hospital 3,405 3,204 -201.0 -5.9% F 24,035 23,462 -573 -2% N Resident Days - SNF 3,458 3,140 -318.0 -9.2% U 24,030 22,402 -1,628 -7% U Average length of stay 5.6 days 5.7 0.1 days

0.0% N 5.6 days 5.7 0 days #VALUE! N Number of deliveries 29 38 9 31.0% F 211 220 9 4.3% F 50% 45.50% -4.5% -9.0% U 50% 45.50% -4.5% -9.0% U 18 (before April: 18) 14.3 -3.7 -20.6% U 18 (before April: 18) 17 -2 -8.3% U 26 (May July: 26) N/A N/A N/A N/A 26 (May July: 26) N/A N/A N/A N/A 1.59 0.93 1.54 1.11 -0.06 0.18 -3.5% 19.6% U F 1.59 0.93 1.56 0.98 -0.03 0.05 -2.0% 5.3% N F Total number of ambulatory visits 1,602 1,539 -63

-3.9% U 11,163 11,856 693 6.2% F Number of radiology visits 1,391 1,125 -266 -19.1% U 8,134 7,743 -391 -4.8% U 100 107 7 7.0% F 488 730 242 49.6% F HCAHPS recommend hospital Average daily census - Psychiatry Medicare CMI Medicaid CMI N/A N/A Ambulatory Care Same Day Surgeries Financial Days in AR 48 days -48 -100.0% 48 days 82.5 34.5 71.9% U Days cash on hand - Operating 45 days -45 -100.0% 45 days 51.5 6.5 14.4% F 1.5 -1.5 -100.0% 1.5 3.0 1.5 100.0% F Average Payment Period 60 days -60 -100.0% 60 days 55.0

-5 -8.3% U Deductible Ratio 66.50% -66.50% -100.0% 66.50% 64.90% -1.60% -2.4% N Operating Margin 1.00% -1.00% n/a 1.00% -8.00% -9.00% n/a U Total Margin 7.90% -7.90% n/a 7.90% -15.30% -23.20% n/a U Current Ratio Productivity FTEs per average daily census (acute) Salary and benefits expense per FTE ($) % of salary and benefits expense 3.1 3.4 0.3 9.7% U 3.1 3.3 0.2 6.5% U $77,817 $85,804 $7,987 10.3% U $83,089 $84,911 $1,822 2.2% N 61.3% 51.8% -9.5% -15.5% F 60.6% 54.0% -6.6% -10.9% F 14

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