Mountain talk

President Letter To

HFMA Members About

The 2016 WV Flood

Dear Fellow WV HFMA Members,

It has been an incredibly tough week here for many West Virgini-

ans who have been impacted by the severe flooding throughout

our state. Our prayers especially go out to the families that have

lost loved ones, lost their homes, and have been displaced by the

flooding. The stories, pictures and videos have truly been heart-

breaking.

Governor Tomblin declared a state of emergency for 44 of the

state’s 55 counties and ordered the deployment of over 400 mem-

bers of the West Virginia National Guard. Volunteer firefighters,

EMS, and other first responders have spent incredibly long hours

helping victims through debris-laden floodwaters to a place where

they are safe and can get their medical and nutritional needs ad-

dressed. We cannot express enough appreciation to these hard

working volunteers.

This tragedy has put our people to the test, but as a people, West

Virginians are as tough as they come! We’ve seen almost every-

thing Mother Nature has to offer, lived through tough economic

times, mining disasters, and even had our own water crisis here in

Charleston a couple years ago. To say we have been through a lot

would be an understatement.

With these cards that we’ve been dealt, many would fold and walk

away. Those that do are missing the best part of being a West Vir-

ginian…the Comeback. Our people band together during these

tough times, we reach out our hands, reach into our pockets, and

help our fellow West Virginians get back on their feet. We are re-

sourceful. We respect each other’s needs, and we show unexpected

love.

Many local and national fundraising efforts have kicked off and are

underway. The donations and volunteers have been tremendous

but we all know that this recovery will take time. Our WV HFMA

Chapter will be supporting these fundraising efforts in the upcom-

ing year. We will be working with other organizations, schools, and

families affected to make sure that after this initial wave of media

attention and fundraising has faded that these families’ needs are

still being addressed.

Please stay-tuned to our website (www.wvhfma.org) for additional

information about our Chapter’s fundraising efforts and please

click the “Volunteer today” button found on our homepage fill out

a volunteer application if you would like to help participate in

these efforts.

Together our state and these affected areas will again THRIVE!

Sincerely,

J. Ryan Lindsay, CPA, CHFP

Summer 2016

Transition in Healthcare

Mountain Talk

In This Issue Region IV Executive Fare-

well Page 4

Welcome Elected Region IV

Executive -Page 8

WV Hospital Association

Update Page 11

CMS Proposal -Page 12

Hospital Physician Align-

ment Page 16

Patient Deductibles Falling?

-Page 19

President’s Message

As I was preparing to write my first President’s message I put together an outline of all the

HFMA topics that I wanted to cover, but it was hard to ignore the tragic events that have

affected our state, our country and the world which we live in. It is a challenging time

right now for many people of our state who have to clean up from the worst flooding in

over 100 years. Our nation is dealing with significant political and social unrest, and many

areas of our world are dealing with extreme terrorist threats and attacks. These events

hurt us, let fear creep into our lives, and question the way we have done things in the past,

but above all these events bring us together as a state, a nation and a human race. I have

no doubt that we will overcome these challenges. Good will win over the evil and we will

again Thrive!

Mary Mirabelli, FHFMA, the 2016/2017 HFMA Chair calls on Health Care Professionals

to Thrive in the face of great change. Ms. Mirabelli delivered an inspirational message to

all the members in attendance at the Annual National Institute (ANI) in Las Vegas last

month. She encourages health care professionals to do more than simply respond to to-

day’s changes in healthcare. We must find a way to Thrive in the face of it. If you were not

able to attend this year’s ANI, I would encourage you to read Mary Mirabelli’s touching

story in the June HFM magazine and follow her on Twitter.

The WV Chapter had an amazing Spring Conference in May at Stonewall Resort. We had

some tremendous speakers and as always a great time was had at the networking events.

The new 2016/2017 Board was sworn in and we are all honored to be in a position to help

continue to grow and advance our Chapter.

The Spring Conference brought some new changes to our Chapter. This was the first

meeting in many years that we did a joint session with the West Virginia Hospital Associa-

tion. We heard Dr. Paul Mellor deliver a seminar on…(let me think….uh…oh yeah!)…

improving your memory! This also was the first time we have registered for a conference

with our new website, had an app for our conference, and had electronic evaluations.

Overall, the feedback on these new initiatives was very positive .

Fall 2016

President Message Continued

Our Fall Conference is scheduled for September 28th-30th at the Waterfront Place Hotel in Morgantown, WV. The pro-

gram committee has been hard at work recruiting speakers and planning networking events that you won’t want to miss!

This conference will focus on today’s Healthcare Issue but will also highlight the Early Careerists in our profession. HFMA

defines the Early Careerist as someone working in or considering working in the healthcare profession that is under the

age of 40. We want to encourage everyone to reach out to the under 40 professionals in your office and bring them to this

conference. We are developing a Wednesday afternoon session that will focus on issues that will appeal to the under 40

attendees but are also open to all conference attendees. If the Early Careerist is a new attendee of one of our conferences,

we are offering a special registration rate of ONLY $50!! That includes the entire conference (Wed-Fri) and over 15 hours

of CPE! It’s a great deal meant to encourage our Healthcare Leaders to introduce some of the Generation X or Millennials

to WV HFMA. Please look around your office and encourage these future leaders to attend!

I would like to encourage all of you to volunteer to help the WV HFMA Chapter thrive in the upcoming year. Becky Ham-

mer and many of the Past Presidents of WV HFMA have done such a tremendous job of giving their time and positioning

our chapter for continued success. We have so many initiatives ongoing that it’s sometimes hard to keep track of them all.

From secure data storage to webinar development our chapter continues to advance and succeed to meet our goals. This

can’t be done without the volunteers that our chapter is fortunate enough to have. If you would like to become a volunteer,

please go to our website – www.wvhfma.org and click the Volunteer Today button at the bottom on our home

page. Our new Volunteer coordinator, Belinda Bennett, will be in touch with you to welcome you and discuss opportuni-

ties.

One of my personal goals last year was to obtain HFMA’s Certified Healthcare Financial Professional certification before

my year at President began in May. Last fall, I registered for the first Module of the CHFP Program: Business of Health

Care. After a few weeks of reviewing the study materials at night for an hour or two, I sat for the online test. I received in-

stant feedback that I had passed the first Module and was now qualified to take the second part Module II: Operational

Excellence Exam. This time, I was a little more confident that I had a good grip on the concepts and probably only studied

the Module II materials a few days before taking and passing this section. The second part of the exam is more case studies

so your healthcare experience will help you more in Module II. This certification is something I plan to maintain my whole

career and I would encourage you to consider setting this goal for yourself. More information on this certification is availa-

ble on the HFMA website (www.hfma.org/certification/). As an incentive, the West Virginia Chapter reimburses the cost

of this exam for the first two members that pass the certification exam each year.

In closing, I want to thank all of the Sponsors, members of the 2016/2017 Board, and all of the Committee members for

dedicating their time and effort to support our Chapters efforts. You have all inspired me to be the best President that I can

be. I know we will have continued success and Thrive in the upcoming year.

Thank you for this incredible opportunity and please feel free to contact me with any thoughts or concerns you may have in

the upcoming year!

Sincerely,

J. Ryan Lindsay, CPA, CHFP

WV HFMA President 2016/2017

Region IV Executive

2015-2016 Farewell

Hello Region IV HFMA members.

I wanted to take a moment and thank you for a great 2015-2016 HFMA year while I served as

Regional Executive for Region IV. It was truly an honor to serve the chapters, their members

and leaders during my term. I was able to visit each chapter at least one time while serving as

Regional Executive and each visit provided an opportunity to observe both the similarities and

differences among the five chapters in Region IV. I had a great time meeting many of you

along the way and sharing with your chapters. Thank you for the hospitality! The commonali-

ties that come to mind as I look back on my experiences with the different chapters are pas-

sion, pride, quality, integrity, excellence, fun, loyalty, dedication and commitment. As I

worked closely with the chapter presidents and presidents elect of Region IV, and interacted

with leaders from other regions, it was clear to me that Region IV truly stood out from the oth-

ers and was clearly one of the best HFMA regions in the country.

Well, as they say, the proof is in the pudding. I am proud to say that during the 2015-2016

HFMA year, Region IV was the only region in the country to have all of its chapters achieve a

score of 100 on their Chapter Balanced Scorecards. This means that each chapter met or ex-

ceeded goals in: 1) Total Education Hours and Education Hours per Member; 2) Membership;

3) Membership Satisfaction; 4) Certification; 5) Days Cash on Hand; 6) Timely Reporting of

Chapter Events and Newsletters; and 7) Provider Board Composition of 40% and above. This

is a true indicator of the quality leadership and volunteers within Region IV that strive each

day to provide the very best in education and networking events for HFMA members. Con-

gratulations on a job well done!

As we begin the 2016-2017 HFMA year I ask that you please welcome my replace-ment, Okey Silman, as your Regional Executive for Region IV. Okey is a past president of the West Virginia Chapter and he is truly passionate about HFMA. Okey will honorably serve the needs of each chapter and the leaders within Region IV as they strive to meet and exceed their goals for this next year. Okey will also serve as a liaison between the Region IV chapters and the national office of HFMA, providing insight and feedback for both sides of the equation. Okey will do an outstanding job this year and I know that you will all make him feel at home as he visits the chapters.

The Region IV presidents, presidents elect and chapter board members for 2016-2017 are a great group of leaders. Please support their efforts and volunteer with-in your chapter any way that you can.

I wish you all the best in the coming year and I know that the Region IV chapters will have a great year!

Sincerely,

Tom

Tom Henderson 2015-2016 Region IV Regional Executive

Reserve your room today! Call 304-296-1700 for reservations. Group Name:

WVHFMA 62nd Conference

Enjoy the opportunity to network with your peers and vendors in HFMA as

well as the CEOs from around the state.

Co-sponsored with the WV Society of CPA’s (12 CPE Credits)

Join Us

WV HFMA Fall Institute

September 28-30, 2016

Waterfront Place

Morgantown, WV

FOLLOW US ON SOCIAL MEDIA

Did you attend the

Spring Education

Meeting at Stone-

wall Jackson?

A word from our

Elected Region IV

Regional Executive

Okey Silman II

I am honored to have been elected to serve as the 2016-2017 HFMA Regional Executive for Region IV. I want to

thank Tom Henderson, the outgoing RE for providing the support and guidance to our region and mentoring me over

the past year. Region IV was the only region, where every chapter achieved 100% on their chapter balance score

card metrics for the 2015-2016 chapter year. We have an outstanding group of chapter leaders and volunteers in our

region.

I joined HFMA 10+ years ago mainly for the quality educational sessions that HFMA offers as well as the infor-

mation provided on the industry changes and regulations. What I have learned, is that HFMA is so much more, if

you get involved and volunteer. After attending the educational sessions for a couple of years, I was asked if I

would have an interest in volunteering to serve on the program committee. And later asked, if I might have an inter-

est in going through the officer chairs. And now, I am beginning my term as Region IV’s Regional Executive.

HFMA has not only enhanced my professional growth, but personal growth as well. By volunteering, you build life-

long friendships and have the opportunity to meet and speak with industry leaders from all around the world. Net-

working events have provided invaluable knowledge that I have been able to utilize and implement in my organiza-

tion.

Each year HFMA elects a new person to sit as the National Chair for HFMA who is responsible for selecting a

theme for their year. Mary Mirabelli was elected as our 2016-2017 HFMA National Chair and her theme for this

year is “THRIVE”. During my year as President of the WV Chapter, I took the themes for the previous 5 years

molded them into a single statement. I would like to share that statement now. It is compelling and conveys a pow-

erful message.

“It is time for us to “STEP UP (2010)” as we “BELIEVE TO ACHIEVE (2011)” because

“LEADERSHIP MATTERS (2012)” as we do “WHATEVER IT TAKES (2013) in “LEADING

THE CHANGE (2014)” as we “GO BEYOND (2015)” our own boundaries by embracing change, al-

lowing the healthcare industry to “THRIVE (2016)”.

I would encourage all members to volunteer and get involved. I encourage non-members, to become

members, and experience all of the benefits of being part of such a rewarding volunteer organization.

Thank you for being a member of HFMA and volunteering your time and efforts. Thank you to our

providers for supporting those members in their efforts to make a difference in healthcare. Thank you

to our sponsors and vendors for the support and commitment to our chapters. The educational sessions

and events could not be done without all that you do for HFMA. In closing, I would like to express my

gratitude for the honor to serve as the Regional Executive for Region IV and getting to work with all of

the wonderful and talented members in our region. Please let me know if I can be of assistance to you

in anyway.

“Be open to change! Never stop learning! THRIVE!” Marry Mirabelli 2016-2017 HFMA National Chair

Respectfully,

Okey Silman II

West Virginia Chapter of HFMA

2016-2017 Regional Executive – Region IV

BLUE JEAN NETWORKING!!!!

DON’T MISS OUT!

By: Carol Haugen

VP Financial Planning

WV Medicaid Managed Care Update

Following a lengthy acquisition process, West Virginia Medicaid awarded managed care con-tracts for the term July 1, 2016 to June 30, 2017.

Contracted managed care organizations are –

CoventryCares of WV

UniCare

WV Family Health

The Health Plan

Trusted Health Plan

CareSource

Trusted Health Plan and CareSource are new managed care organizations to be entering the WV Medicaid market. As such, they are contractually subject to a readiness review and ap-proval prior to enrolling Medicaid beneficiaries. The timeline for those activities has not been determined; however, both organizations are developing provider networks, preparing WV Medicaid specific policies, and working toward successful entry to the WV market.

How one can define success is subject to interpretation, but hospitals are always looking for valuable business partners. With the ever changing landscape, new Medicaid MCO’s is only one example of adapting to the market changes.

CMS Proposes Hospital Outpatient Prospective Payment

System Changes to Better Support Physicians and Im-

prove Patient Care

The Centers for Medicare and Medicaid Services (CMS) proposed updated payment

rates and policy changes in the Hospital Outpatient Prospective Payment System

(OPPS) and Ambulatory Surgical Center (ASC) Payment System. Several of the pro-

posed policy changes would improve the quality of care Medicare patients receive by

better supporting their physicians and other health care providers. These proposals are

based on feedback from stakeholders, including beneficiary and patient advocates, as

well as health care providers, including hospitals, ambulatory surgical centers and the

physician community.

“The items in this proposal are designed to improve care and value when Medicare ben-

eficiaries receive care in an outpatient setting,” said Andy Slavitt, Acting CMS Adminis-

trator. “Today’s proposed updates better support physicians in providing beneficiaries

with the right care at the right time.”

Addressing Physicians’ Concerns Regarding Pain Management

Today’s proposed rule would address physicians’ and other health care providers’ con-

cerns that patient survey questions about pain management in the Hospital Value-

Based Purchasing program unduly influence prescribing practices. While there is no

empirical evidence of this effect, we propose to remove the pain management dimen-

sion from the Hospital Value-Based Purchasing program to eliminate any potential fi-

nancial pressure clinicians may feel to overprescribe pain medications. CMS continues

to believe that pain control is an appropriate part of routine patient care that hospitals

should manage and is an important concern for patients, their families, and their care-

givers. Thus, CMS is also currently developing and field testing alternative questions

related to provider communications and pain to include in the program in future

years. We will solicit comment on this alternative in future rulemaking.

CMS PROPOSAL

CONTINUED

Focusing Payments on Patients Rather

than Setting

In addition, CMS is proposing policies to

implement section 603 of the Bipartisan

Budget Act of 2015, which provides that

certain items and services provided by cer-

tain hospital off-campus outpatient depart-

ments would no longer be paid under the

OPPS. Currently, Medicare pays for the

same services at a higher rate if those ser-

vices are provided in a hospital outpatient

department, rather than a physician’s office.

This payment differential has encouraged

hospitals to acquire physician offices in or-

der to receive the higher rates. This acqui-

sition trend and difference in payment has

been highlighted as a long-standing issue

of concern by Congress, MedPAC, and the

Department of Health and Human Services

Office of Inspector General. This difference

in payment also increases costs for the

Medicare program and raises the cost-

sharing liability for beneficiaries.

Congress addressed this issue through the

Bipartisan Budget Act of 2015, and CMS

proposes implementation details in today’s

proposed rule. CMS believes these pro-

posed policies will help to ensure that Medi-

care beneficiaries – and the Medicare pro-

gram – do not pay more for care simply be-

cause of the setting in which that care was

received. The CMS Office of the Actuary

estimates that these changes should re-

duce OPPS spending by approximately

$500 million in 2017. CMS sought com-

ment and feedback from stakeholders dur-

ing the development of this proposed rule,

and CMS encourages further feedback dur-

ing this proposal’s comment period.

Improving Patient Care through Tech-nology CMS is supporting physicians and other providers through today’s rule by increasing flexibility for hospitals and critical access hospitals that participate in the Medicare electronic health records (EHR) Incentive Program. Earlier this year, CMS conducted a review of the Medicare EHR Incentive Program for clinicians as part of our imple-mentation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with the aim of reconsidering the program so we move closer to achieving the full potential health information technol-ogy (IT) offers. Based on that review, CMS streamlined EHR reporting requirements under the proposed rule to implement cer-tain provisions of MACRA to increase flexi-bility and support improved patient out-comes.

Today, we propose taking a similar step for

hospitals and critical access hospitals par-

ticipating in the Medicare EHR Incentive

Program. These changes include a pro-

posal for clinicians, hospitals, and critical

access hospitals to use a 90-day EHR re-

porting period in 2016 – down from a full

calendar year for returning participants.

This increases flexibility and lowers the re-

porting burden for hospital providers.

CMS PROPOSAL

CONTINUED

Emphasizing Health Outcomes that

Matter to the Patient

Finally, CMS proposes to add new quality

measures to the Hospital Outpatient

Quality Reporting Program and the Am-

bulatory Surgical Center Quality Report-

ing Program that are focused on improv-

ing patient outcomes and experience of

care. Other changes in the proposed rule

would enhance the outcome require-

ments for organ transplant programs, so

that the programs may help more benefi-

ciaries accept more grafts, while main-

taining compliance with Medicare stand-

ards for patient and graft survival.

CMS estimates that the updates in the

proposed rule would increase OPPS pay-

ments by 1.6 percent and ASC payments

by 1.2 percent in 2017.

To learn more about the proposed rule, please visit: https://www.federalregister.gov/public-inspection. CMS looks forward to feed-back on the proposal and will accept comments until September 6, 2016. Comments may be submitted electroni-cally through our e-Regulation website at: https://www.cms.gov/Regulations-and-

Guidance/Regulations-and-Policies/eRulemaking/index.html.

A fact sheet on this proposed rule is

available at: https://www.cms.gov/

Newsroom/MediaReleaseDatabase/Fact-

sheets/2016-Fact-sheets-items/2016-07-

06.html.

Networking

What are you

missing by not at-

tending your

Chapter Confer-

ences?!

If you attended

the Spring Con-

ference you

would know why

Okey is excited!

Michael Ehlan

Background: Establishing and monitor ing patient panels is a powerful tool for increasing practice revenue and reducing unnecessary practice expenses. Provider based primary care practices should care-fully define the patient panel size for their employed physicians and their physician assistants, (PA) and/or nurse practitioners, (NP). Panel size can be defined as the number of individual patients seen by a provid-er, or the entire practice, over a determined time period. Most practices use 12 months of data for their panel size calculations. However, 18 months is more ideal to capture some established patients, who tend not to visit the practice within a year time frame. If a physician’s panel is too large, the excess demand will spill over to other providers. Patient satisfaction will suffer. Care quality and practice revenue will spiral downward. This puts the practice in a position where it cannot be successful. There is only so much time in one day. If a physician’s panel is too small, the demand for services may not be enough to cover the practice’s expenses and large losses can occur. Current Patient Panel Size Determination: In order to perform meaningful financial analysis, each patient on the practice’s active patient roster should be assigned to one provider. Because there are going to be some patients, who have been treated by more than one provider in the practice, a set of rules should be used to designate which patients are assigned to each provider. Some of the more common rules for patient panel designations are:

Patients treated by only one provider are automatically assigned to that provider. Patients treated by multiple providers are assigned to the provider with the highest visit count for that

patient. Patients treated by multiple providers, where there is a tie between two or more providers for the high-

est visit count are assigned to the provider the patient saw on their most recent visit. Keep in mind that current patient panel size can be influenced by other factors such as weekly hours

available for appointments, the physician’s “bedside manner,” and the age and gender of the pa-tient panel population. As more physicians align with hospitals, consolidating information systems will allow for powerful enhancements to patient panel levels, i.e. making an adjustment to one pro-vider’s panel based on acuity to account for more return visits than the other providers in the same practice.

Improve the Bottom Line with Appropriate Patient Panel Size: Patient access can make or break a

practice. If daily patient demand for appointments is greater than daily provider capacity, backlogs and bottlenecks will occur. Patients may have to wait days for their next appointment. If one of the practice’s providers has a patient panel size, which is too big, leakage will occur as patients “lose their patience” and leave the practice. Staff will also be flooded with increased phone calls and cancellations. Many patients will experience poorer clinical outcomes, which increases return visit lengths, and puts more stress on the practice’s capacity and productivity.

A simple, but effective method to evaluate each provider’s panel size is to perform an “Effort versus Reward” calculation as follows:

1. Select a time frame to measure, at least 12 months, preferably 18 months. 2. Total all the net revenue received by the practice over the time frame selected. Total and

divide each provider’s patient panel net revenue by the total net revenue to compute the percentage rendered by that provider’s panel.

3. Total all the visits or treatments performed by the practice over the time frame selected. Total and divide each provider’s patient panel’s number of visits by the total number of visits to compute the percentage of “effort” rendered by that provider’s panel.

4. Compare the percentage of revenues for each provider panel to its corresponding percent-

age of effort. The higher the percentage of revenue compared to the percentage of effort, the better. An equal ratio indicates a provider is only getting out what they put in and margins are suffering. In those cases, where the revenue ratio is less than the effort ratio, further analysis is required as there are significant problems. Looking at panels this way helps identify scheduling issues quickly. The next step would be to look at specific pro-vider workflow issues such as shorter patient revisit intervals or the number of days a provider is booked for patient visits.

Summary: Besides the br ief panel size analysis above, there are many other physician practice performance drivers, where panel size financial analysis can be applied by today’s healthcare financial manager. Some of the more established uses are:

Adjusting for physician productivity: If a physician, whose bed-side manner creates longer office visits, resulting in a patient panel size that is 90 percent of the practice’s bench-mark patient panel size, their compensation might be adjusted to reflect this.

Predicting practice overhead: Patient panels can be used to budget or analysis demand for

tests, procedures and even some hospital stays based on age, sex and payor considera-tions.

Improving patient outcomes: Providers, who identify with their own patients, take owner-

ship of them through their patient panels, are able to make the commitment to continuous quality care, which leads to reduced costs or increased revenue or both.

The ability to extract key performance measures from a practice’s patient panel size by physi-cian, based on their individual scope of practice, patient mix and office hours can only improve future Hospital/Physician relationships. Michael Ehlen is a managing partner with M&E Healthcare Financial Advisor Group located in Hilton Head, South Carolina. He is a current member of the South Carolina HFMA chapter. If you have any questions regarding this article or hospital-physician alignment issues, Michael can be reached at mehlen@hcfagroup.com

Michael Ehlan

EMERALD LEVEL

HELP Financial

RUBY LEVEL

SAPPHIRE LEVEL

CBCS Credit Management Company

Gray, Griffith & Mays, CPA’s

The SSI Group, Inc.

PEARL LEVEL

Collection Service Center, Inc.

JP Recovery Services, Inc.

National Hospital Collections

Revenue Cycle Solutions, LLC

United Collection Bureau, Inc.

**This list of sponsors is based upon sponsorship renewals received at the time of this publication**

Median deductibles for marketplace healthcare insurance under the Affordable Care Act (ACA) have fallen to $850 this year from $900 in 2015, the Centers for Medicare and Medi-caid Services (CMS) said Tuesday.

CMS said the drop was attributed to the fact that “about 60 percent of 2016 HealthCare.gov Marketplace consumers qualify for financial assistance that reduces their deductibles, out-of-pocket maximums, and other cost-sharing ob-ligations.”

The federal agency also reported that “for the first time in our nation’s history, the uninsured rate last year fell below 10 percent,” with 20 million more people owning health coverage in the six years since enactment of the ACA.

In a data brief that often strikes a defensive tone, CMS writes, “Unlike many insurance pol-icies sold before the Affordable Care Act was enacted, all Marketplace plans have out-of-pocket limits that protect consumers from cata-strophic costs.” Calling its findings “consistent with other data showing that Marketplace policies are provid-ing consumers with access to care and financial protection,” CMS adds, “These facts may seem surprising given anecdotes about Marketplace policies with very high cost sharing.”

Other data cited in the CMS brief include:

Nearly one-third of Marketplace enrollees (32 percent) have deductibles less than or equal to $250, but 44 percent bear deductibles that exceed $1,000, with 17 percent of enrollees paying deductibles of $5,000 or more

Marketplace policies on average cover sev-en common healthcare services (most often ge-neric drugs and primary care visits) with no or low cost-sharing before consumers meet their deductibles

Marketplace consumers are overwhelming-ly choosing silver plans – which generally in-clude higher premiums, but lower cost sharing – in lieu of bronze plans, which generally offer the lowest premiums “These data show that the promise of the Af-

fordable Care Act is being realized for millions

of Americans,” CMS said. “It wasn’t that long

ago when too many of our friends and neigh-

bors were locked out of health coverage be-

cause it was too costly or because of a preexist-

ing condition. The Affordable Care Act

changed that.”

Chris Nerney July 13, 2016

Autumn Rogers

Title: Accountant

Company: Grant Memorial Hospital

City/State: Petersburg, WV 26847

Work Phone: (304) 257-1026

E-mail: brogers@grantmemorial.com

Dan Given

Title: Associate

Company: Arnett Carbis Toothman LLP

City/State: Charleston, WV 25301-1500

Work Phone: (304) 346-0441

E-mail: dan.given@actcpas.com

Marie Buffy

Title: Audit Senior Associate

Company: Arnett Carbis Toothman, LLP

City/State: Clendenin, WV 25045-8012

Work Phone: (304) 346-0441

E-mail: marie.buffy@act-cpas.com

Autumn Heaster

Title: Manager, ADT/ Registration

Company: United Hospital Center

City/State: Bridgeport, WV 26330-9006

Work Phone: (681) 342-1714

E-mail: heastera@wvumedicine.org

Holly L. Sabatino

Title: Financial Administrator

Company:

WVU Medicine - WVU Heart & Vascular Institute

City/State: Morgantown, WV 26505-2201

Work Phone: (304) 598-4922

Email: sabatinoh@wvumedicine.org

WV HFMA Fall Institute— Sep 28—30, 2016 Waterfront Place, Two Waterfront Place, Mor-

gantown, WV

Fall Revenue Cycle Meeting—Oct 19, Days Inn Conference Center, Flatwoods

Region IV MidAtlantic Meeting— Nov 13—15, Grove Park Inn, 209 Macon Ave, Asheville, NC

Upcoming Live Webinars

Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free

for HFMA members and $99 for non-members, unless otherwise noted. Become a mem-

ber today!

Aug 17, 2016

—2016 Proposed Rule Changes to the Outpatient and Ambulatory Service Center Payment Systems

Sep 10, 2016

—Aligning Physicians to Improve Reimbursement, Reduce Denials, and Enhance Regulatory Compliance

Feb 17, 2017

—Bridging the Clinical and Financial Divide for a New Era of Health Care

For more events visit HFMA webpage at http://www.hfma.org/

Advisory Past President Belinda Bennett, Lisa Simmons Keith Morgan, Jim Holden, Jan Strope Awards Dianna Cessa Belinda Bennett, Becky Hammer, Okey Silman, Ryan Lindsay Financial Review Outgoing President Whitney Patterson Webmaster Lisa Simmons Sponsorship Joan Namey Newsletter Laura Adkins Program and Entertainment Cindy Linger-Long Joe Barnes, Okey Silman, Dianna Marcia Leighton Cesa, Jamie DeMuth, Becky Hammer, Tony Rumberg Ryan Lindsey, Lynsey Berg, Chad Wright, Joan Namey, Leah Klinke, Lisa Simon, Patricia Weese, Whitney Patterson, Joshua Tuck, Kyle Pierson, Chris Rawlings, Debbie Kincell, Susan McDonald, Belinda Bennett, Laura Adkins Certification Ryan Lindsey Certification Contact Ryan Lindsey DCMC Contact Joe Barnes Founders Contact Dianna Cesa Nominating Lisa Simmons Okey Silman Revenue Cycle Tony Rumberg Jr. Link Ryan Lindsay Membership Linda Dugan Social Media Marcia Leighton Ryan Lindsay Communication Chair Leah Klinke Volunteer Belinda Bennett Ryan Lindsay

Comittee Name Chair Members

E

Certified Specialist Business Intelligence (CSBI)

Learn how to use your healthcare organization's data to make a wide range of business decisions.

Certified Specialist Physician Practice Management (CSPPM)

Understand the full range of topics and techniques central to effectively manage physician practices.

Certified Specialist Managed Care (CSMC)

Describes the "nuts and bolts" of managed care and thoroughly covers issues in the era of healthcare reform.

Certified Specialist Accounting & Finance (CSAF)

Strengthen your accounting and finance competencies and address financial reports and statements unique to health care.

Fellow of HFMA (FHFMA)

Get recognized for educational achievements, professional accomplishments, and volunteer leadership/service in the healthcare finance industry.

Certified Healthcare Financial Professional

(CHFP)

HFMA's CHFP certification provides a broad range of business and

financial skills necessary

to succeed in today's healthcare environment. LEARN

MORE.

Questions?

Call the HFMA Career Services Department at 800-252-4362, ext. 311

Visit hfma.org/certification

The Republican party has been constant in its call for repeal of the Affordable Care Act, and the 2016 plat-

form re-affirms its view that healthcare needs less government involvement.

But President Obama is now urging Congress to re-consider a public healthcare plan that would compete with private insurers in parts of the U.S. with limited options for consumers. He outlined his views in a lengthy paper published in the Journal of the Ameri-can Medical Association to go beyond the Affordable Care Act (ACA).

“The Affordable Care Act has made significant pro-gress toward solving long-standing challenges facing the U.S. health care system related to access, afford-ability, and quality of care,” Obama wrote. “Despite this progress, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewilder-ing system; and remain uninsured. More work to re-form the health care system is necessary.”

The president said he expects tools created by the ACA – such as the Center for Medicare and Medicaid Innovation and the Accountable Care Organization program – will continue to play “centrals roles in this work,” along with the Medicare Access & CHIP Reau-thorization Act of 2015 (MACRA).

While the Centers for Medicare and Medicaid Ser-vices (CMS) has said MACRA is designed to ease the burden of compliance and reporting requirements under meaningful use, it has been criticized by some providers and provider organizations as continuing in the wrong direction.

Noting that 12 percent of marketplace enrollees live in areas with fewer than three health insurance pro-viders, Obama suggested that lawmakers reconsider a public plan to fill the gap in available options.

“Some parts of the country have struggled with lim-ited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan,” he wrote. “The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Con-gress should revisit a public plan to compete along-side private insurers in areas of the country where competition is limited.”

Obama said a public plan would provide affordable options to consumers in areas with few insurers while also helping the federal government save money on healthcare.

In contrast, the Republican platform proposes a limit on federal requirements on both private insurance and Medicaid, explaining “For most Americans, those who are insured now or who seek insurance in the future, our practical, non-intrusive reforms will pro-mote flexibility in State leadership in healthcare re-form, promote a free-market based system, and em-power consumer choice. All of which will return direc-tion of the nation’s healthcare to the people and away from the federal government." The party endorses block grants for Medicaid and state programs.

"We believe that taking care of one’s health is an

individual responsibility," the platform reads. "Chronic

diseases, many of them related to lifestyle, drive

healthcare costs, accounting for more than 75 per-

cent of the nation’s medical spending. To reduce de-

mand, and thereby lower costs, we must foster per-

sonal responsibility while increasing preventive ser-

vices to promote healthy lifestyles.

Chris Nerney July 19, 2016

Ryan Lindsay, CPA CHFP

President, Certification Chair, LINK Committee Chair, Social Media Co-Chair

Gray Griffith & Mays

707 Virginia Street East—Suite 400

Charleston, WV 25301-2788 Phone: (304) 345-9400 Email: president@wvhfma.org

Joe A. Barnes, CPA

President Elect, DCMS Contact, Founders Contact

Grant Memorial Hospital

117 Hospital Drive

Petersburg, WV 26847-9566 Phone: (304) 257-5802 E-mail: presidentelect@wvhfma.org

Rebecca J. Hammer

Past President, Certification Co-Chair

Davis Health System

PO Box 1484

812 Gorman Avenue

Elkins, WV 26241-1484 Phone: (304) 637-3156 Email: pastpresident@wvhfma.org

Whitney R. Patterson

Treasurer

Fairmont Regional Medical Center

1325 Locust Ave

Fairmont, WV 26554-1435 Phone: (304) 367-7109 Fax: (304) 333-6295 E-mail: treasurer@wvhfma.org

Dianna L. Cesa

Secretary, Awards Chair

WVU Healthcare

PO Box 8031

Morgantown, WV 26506-8031 Phone: (304) 598-6376 E-mail: secretary@wvhfma.org

James J. DeMuth

Board of Director 2nd Year

Healthcare Financial Services

1204 Kanawha Blvd. E.

Charleston, WV 25301-2900 Phone: (304) 388-6865 Fax: (304) 345-4323

E-mail: director2@wvhfma.org

Leah S. Klinke

Board of Director 2nd Year, Communications Chair

WVU Hospitals

1 Medical Center Drive

Morgantown, WV 26506 Phone: (304) 598-4032 x74198 E-mail: director2@wvhfma.org

Lisa Marie Simon

Board of Director 2nd Year

Ohio Valley Hlth Services & Educ. Corp.

2000 Eoff Street

Wheeling, WV 26003-3823 Phone: (304) 234-8407 E-mail: director2@wvhfma.org

Jill Griffith

Board of Director 1st Year

Arnett Carbis Toothman

155 East Broad Street Suite 2100

Columbus, OH 43215 Phone: (614) 223-9209 Email: director1@wvhfma.org

Marcia Leighton

Program Chair, Social Media Chair

Patient Matters

518 South Magnolia Ave. 3rd Floor

Orlando, Florida 32801 Phone: (817) 228-9593 Email: program@wvhfma.org

Cindy L. Linger-Long

Program Co-Chair

Grant Memorial Hospital

PO Box 1019

Petersburg, WV 26847-1019 Phone: (304) 257-5815 x2161 E-mail: program@wvhfma.org

Tony D. Rumberg

Revenue Cycle Co-Chair

Charleston Area Medical Center

130 – 138 57Th St., Building 3

Charleston, WV 25304 Phone: (304) 388-1145 E-mail: revenuecycle@wvhfma.org

Joan M. Namey

Sponsorship Chair

Healthcare Financial Services

1204 Kanawha Blvd E

Charleston, WV 25301-2900 Phone: (304) 388-6802 Fax: 304-345-4323

E-mail: sponsorship@wvhfma.org

Laura A. Adkins

Newsletter

5658 Deepwater Mountain Road

Fayetteville, WV 25840

Phone: (304) 575-0398 E-mail: newsletter@wvhfma.org

Linda R. Dugan

Membership Chair

Linda R. Dugan

Monongalia General Hospital

1200 J. D. Anderson Dr

Morgantown, WV 26505-3494 Phone: (304) 285-2690 E-mail: membership@wvhfma.org

Belinda Bennett

Volunteer Chair

Plateau Medical Center

430 Main Street

Oak Hill, WV 25901 Phone: (304) 469-8620 E-mail: volunteer@wvhfma.org

Lisa Ann Simmons

Webmaster

WVU Healthcare

231 Wayland Street

Morgantown, WV 26505 Phone: (304) 598-6247 E-mail: websiteliaison@wvhfma.org

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www.wvhfma.org