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Preparing & Positioning for
the Hospice Medicare
Advantage Carve-In!
Presented by
Andrew Reed, System Analyst, CPA
CEO &Chief Teaching Officer
Multi-View Incorporated
Evolution or De-Evolution?
2
Professional Perspective
3
828-698-5885
828-698-5885
The Value of HumilityA spirit and attitude of Humility and
Openness allows a person to consider
alternative views and beliefs. Pride
and fear shut a person off from new
learning. We have to “let go,” at least
temporarily, of what we perceive we
know to make “space” for alternative
ways to look at things! This comes from
the domain of Integrity. moves!!!
Normally Distributed Bell Curve
1) Use unique/powerful methods of People Development.
2) Are highly “spiritual” organizations.
3) Have unique and different compensation practices.
Elevated
Consciousness
of Integrity
100% of the
organizations in
the 90th
percentile
long-term:
Focus on the 90th PercentileWe are NOT very interested in what the
majority (the huddled masses) are doing.
You can call up the Hospice next door and
find this type of practice information. To
become highly profitable based on
extraordinary quality, you will have to
become an “Outlier” and do things that
typical Hospices are ignorant of or are afraid
to do. It is a lonely but highly satisfying road.
NEVER focus on the mediocre majority!
The Bell-Curve…
is always with
us…
If we have Humility…
we will recognize that virtually all of the
major frustrations involved with creating and
running a Hospice have been either solved
or greatly alleviated by someone in the field.
Within all industries (Movement in the case
of Hospice), there is usually a small group,
or even a single organization, that has
discovered ways that greatly alleviate or
even solve such frustrations. This brings
great relief…… It is ok to imitate them!
To WIN with Medicare Advantage Providers It’s About…
1 … low costs… #1, #1, #1!
2 … quality…
3 … coverage…
4 … reality…your present numbers…
5 … making it a “No Brainer” to contract with you…
6 … their plan to get you addicted to patient-volume…
7 ... “out-managing” managed care…and THRIVING!
The best and soundest
strategy in uncertain times,
especially with the unknowns
of the Hospice MA Carve-In, is
to run a tight, highly-
profitable business…828-698-5885
It’s about low costs…
Slide 13
Your Hospice must be highly profitable
and in a position of strength as money is
the language of Managed Care. You must
be able to provide a SUPERIOR service
or experience for LESS cost than the
Hospice Medicare Benefit…and be
profitable at the same time or you can’t
survive… You must help the MA providers
make money and manage their MLRs.
1
It’s about low costs…
Slide 14
14% or Higher Profitability to have
options A Hospice can do this if it operates all areas a little better
than average or the median, so this is no big stretch. Top
Hospices are doing 20-30% margins. This gives you options!
Expert knowledge of cost or you will get
“played” Diagnosis
Referral Source – Nursing Home/ALF, Hospital, Physician,
Physician Practice, etc.
Payor
Clinician and Physician
Patient or Beneficiary
Clinical Team or Patient-Class
Age, Sex or other Important Demographic of a Healthcare
Population
1
It’s about quality…
Slide 15
MA providers (and perhaps you,
depending upon your deal) receive Bonus
Payments based on quality. Your Hospice
must contribute to these bonuses. High-
quality will only come from the quality of
your People as a direct result of the
quality of your People Systems. Perfect
Visits with Perfect Documentation is
key…
2
It’s about quality…
Slide 16
There is a constant stream of “quality
measures” being introduced as healthcare
in general grasps at this subjective
property. These will come and go.
The best strategy is to “be” high-quality
already! Usually your quality will translate
automatically to whatever measures are
instituted.
If a Hospice will FOCUS on Perfect Visits
with Perfect Documentation, it will cure
most Financial & Quality woes.
2
Perfect = To the
Standards of the
Organization
828-698-5885
How Perfect Visits Cure Most
Quality & Financial Woes! 1. Patients/Families are Happy! Complaints are RARE.
2. Team sizes of Clinical Managers easily increase.
3. Billing goes out on time with little effort.
4. Less Compliance Staff are needed.
5. Marketers don’t have to Lie…Quality is easy to sell in a
broken healthcare world.
6. Census increases as a direct result of radically increased
QUALITY!
7. Financials surge.
8. CAHPS scores surge.
9. Less Staff are needed and organizations can flatten.
10. You don’t have to worry about a ZPIC (or similar) KILLING
you off! You’re tight!
It’s about coverage…
Slide 19
MA providers prefer to contract with larger
Hospices. Historically, MA providers are
required to contract with a percentage of
providers (sometimes 30-50%). As a result,
there are many alliances, affiliations, mergers
and various business combinations happening.
The key is to try to only do deals with
organizations that have Indirects below 31%
and profits at or above 14%. Have “escape”
clauses in your contracts AND make sure the
“hooks” aren’t so deep you can’t get free from a
bad alliance.
3
It’s about coverage…
Slide 20
It’s just easier to contract with fewer
Hospices.
There are good relationships & affiliations and
there are BAD ones… What to look for: Look at their numbers via benchmarking.
Profits of 14% or greater for Hospice Homecare, 2% profit
for IPUs.
Indirects less than 31% If these numbers are NOT there, then the organization does not know
how to do them yet…and YOU may be their plan to do “economies of
scale.” The ones that know how to do this are already doing it!
Have “escape clauses” where you can quickly get out of bad
deals.
Do deals where it is month-to-month and not annual. Month-to-Month demonstrates CONFIDENCE. Annual or longer deals
reveal an entity that is NOT confident in their offerings.
Watch out for “hooks” in the deal which make it extremely
difficult to extract yourself from. Yes, we’ve done this a long time! Ha!
3
It’s about your present
numbers…
Slide 21
Your current numbers are your truth… MA
providers will want to see them…and you
will be judged by these numbers. You
must demonstrate expert knowledge of
costs and professional perspective via
Benchmarking. These can be improved
dramatically in 5-8 months with effort.
4
It’s about your present
numbers…
Slide 22
Your current numbers are the BEST you can
do… If you really could do better you would
be… This is Humility…
These numbers are national benchmarking (as
financially-oriented as possible). Limited use of
local, regional or state-wide benchmarks or you
will be less impressive.
Where do you stack up against the Herd? Financials
Quality
Cost Avoidance
Knowledge of cost
Coverage – Patient-Volume
Your numbers must be IMPRESSIVE via the
convention of COMPARISION!
4
It’s about making it a “No Brainer”
to contract with you…
Slide 23
You must make the decision to contract
with you a “No Brainer” with
UNDENIABLE value. Often this translates
to “cost avoidance” for MA providers. In
our many years of experience with
Managed Care, providers love to “dump”
their high-cost patients into Hospice. This
will force a Hospice to develop expertise
in CAP management.
5
It’s about making it a “No Brainer”
to contract with you…
Slide 24
This is easier to do that most think because most Hospices are
SLOW and are AVERAGE… This makes it easy to stand out
from the Herd!
Your Financials need to be in the 70-80th percentile compared to
all Hospices in the US.
Show quality scores (CAHPS, etc) as high as they can be. This
will come from the quality of your People Systems.
Show them exactly the populations you will help them gain profit
through cost avoidance/savings.
Let them see your Clinical Synthetic lab & methods.
Have them pick any clinician at random to see if he or she can
explain a Perfect Visit according to your proprietary method
where you go days and sometimes weeks without a single
complaint or documentation error.
Show the use of Advanced Bereavement Technologies rather
than cognitive approaches with quantified results.
Show them your method of SCALE.
5
It’s about their plan to get you
addicted to patient-volume…
Slide 25
And then decrease your reimbursement… Most
Hospices will innocently and ignorantly
increase Indirect costs and not structure costs
to fluctuate with patient-volume, especially their
compensation systems. Then they will be
reactive, facing a merger or other form of
unplanned end due to economic pressures.
The point is to anticipate this and be totally
prepared! The best strategy is to be highly-
profitable with large reserves.
6
It’s about their plan to get you
addicted to patient-volume…
Slide 26
This is unavoidable and is a human condition…so
we are not demonizing anyone here…
Many MA providers have quarterly calls with
shareholders that expect increasing profits.
In an effort to meet these expectations, there is
constant economic pressure to perform.
Ruthless deals will be offered… Eventually the
Hospice Benefit will be unbundled, at least by
some…
The strategy is to anticipate these moves and
intelligently structure your costs so they flex
automatically with patient-volume… Most of this will
be the result of how to structure your compensation
systems.
6
It’s about “out-managing”
managed care…and THRIVING!
Slide 27
Using the latest Best Known Practices (BKPs)
is your only option to stay ahead of slow
moving MA providers and other Hospices.
BKPs are your competitive advantage. There
are always new practices used by
organizations that live in the extremities of the
Bell-Curve to imitate! MVI benchmarks 769
Hospices monthly to discover & systemize
BKPs for our clients! Such BKPs will put your
Hospice in the 90th percentile statistically. The
world is not over! You can do this!
7
It’s about “out-managing”
managed care…and THRIVING!
Slide 28
Use this “crisis” as an opportunity!
It is our experience that with FOCUS, a
Hospice can be prepared in 5-8 months
as the practices to do this are already
known and don’t have to be invented.
Position your Hospice to be able take a 25%
decrease in reimbursement and still be
highly profitable.
Use entrenching strategies with Managed
Care.
Remaining tougher and more nimble!
7
828-698-5885
Of course there is more to the
topic, but this will get you
heading in a great direction!
And you will find yourself here on
the Bell Curve!Users of
Best Known
Practices
Recognize that your view of the world will change and Best Practices WILL
put you in a much smaller group, the 90th percentile.
And will people applaud and tell you how great your are?
NO! You will be ridiculed and held with contempt! BUT its OK!!!
Our Movement needs Heroes!
Lead by
ExampleBe rather than to Seem…
All Quality comes from the Quality of your
People
Questions/Contact Information:
Andrew Reed, [email protected]
Bill Taylor [email protected]
Michelle Ellsworth [email protected]
JT Lapp [email protected]
Rahma Brown [email protected]
Justin Wall [email protected]
828-698-5885
www.multiviewinc.comPresented by
Andrew Reed, CPA/Chief Teaching Officer
Multi-View Incorporated