Healthcare Happenings


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January 1, 2013

Healthcare Happenings Inside this issue: President’s message

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Social Corner— Fall Conference

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WHY GIVING ADVICE DOESN’T WORK By Mark Murphy, CEO of Leadership IQ One mistake many leaders make is delivering advice instead of constructive feedback. People often think it’s nicer to phrase criticisms more gently by injecting words like:

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should, would, ought, and try. The problem is that by using these words, your constructive feedback becomes advice. And this only confuses the matter, raises the other party’s defensiveness, and pushes them in the opposite direction of great performance.

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Samples of advice include:

MHA Update

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National Webinar Schedule & virtual Conference

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Region 8 Update

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Customer Loyalty Article

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OIG article Member News/Job Bank

»Personally, I wouldn’t bother the client before noon. »If it were me, I’d get started on this right away. »Have you tried talking to the client?

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»You should probably make a few extra just in case. There’s no language in any of the above statements that indicates that the would, should, etc., is mandatory. Trying to trick employees into thinking they have a choice when they really don’t doesn’t make the work any more enjoyable. And if they interpret your feedback as optional, do it their way and it turns out wrong, everyone suffers. If it’s not optional, then don’t imply it is. There are five core reasons why advice negates the effectiveness of constructive feedback and raises defensiveness. Let’s take a look. (Cont on page 4)

Upcoming Events You Won’t Want to Miss February 20-22, 2013

Winter Workshop Camden on the Lake—Lake Ozark, MO (see page 10 for more info)

May 15-17, 2013

Spring Conference, Harrah’s, St. Louis

August 21-23, 2013

Region 8 Conference, Ameristar Hotel & Casino St. Louis, MO (see page 18 for more info)

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HEALTHCARE HAPPENINGS

Message from our President I hope everyone enjoyed a great holiday season and is now set to go for the New Year. When I thought about what I wanted to say in this quarter’s newsletter, I realized I could fulfill two promises with one story. First, I promised Mike Dewerff, our Region 8 Regional Executive, that I would share what HFMA has meant to me. He presented some of my story at our Summer Conference. Second, I made a promise to a retired nurse (who also is a member of the Kaiser Permanente Board in CA) that I met when my daughter and I were enjoying a few days at a mother-daughter week held at a spa that we sometimes go to in Ojai, CA. During the course of a meal there, the retired nurse heard from my daughter about the stroke I suffered 5 years ago and she made me promise that I would talk about my experience. I told her that one of the deficits that I still experience is projecting my voice and that I would not be able to do so, but I could write about it. Her reason for me sharing my story is that I am living proof that a healthy lifestyle really can save your life. It was in the first week following the stroke while I was still in the ICU and I had seen little progress in the recovery of the use of the left side of my body. Being the oh so patient person that I am (that’s a joke!), I was feeling a little sorry for myself and thought “why did I spend all that time exercising and eating right if this was going to happen anyway?!” It wasn’t 10 minutes later that one of the physicians came in and his first words were “Good thing you took good care of yourself or you probably wouldn’t have survived this stroke!” I looked upwards and kind of whispered to God – OK – I got your answer! The following is what I wrote for Mike: I guess I have a very different perspective on my HFMA experience. In the early years, I used HFMA as a way to be educated in the industry. I had been in public accounting & controller of a company in another industry. I felt I needed education specifically about Healthcare. I started by going to one of the National seminar clusters and learned about the local chapters, so I sought one out and joined the Show-Me chapter. I attended meetings & conferences at the chapter level for several years, but didn’t have the time to get involved much with the chapter due to my role at the hospital. Terri Winning asked me if I would run for the board in

2007. I didn’t realize that if you were on the ballot, you were in! So, on Thursday, May 10, 2007, I was installed as a board member at our joint conference with GSL chapter in Branson, MO. Three days later on Mothers’ Day 2007, I suffered a severe stroke (intracerebral hemorrhage) losing use of the left side of my body along with deficits in processing abilities. Obviously HFMA was not the first thing on my mind in those first months following the stroke. After a week in two different hospitals and about 2 months of intensive outpatient therapies (OT, PT & ST), I was released to go home, but I wanted to return to work, so I began a hybrid work schedule of a few days per week at the hospital and the rest of the time working from home. Even though all of my processing capabilities had come back, I battled fatigue, so being able to work from home enabled me to work in the morning, rest as needed and then work in the afternoon. Fortunately, by that time, I had a great staff that stepped up to enable me to do so. I know it was probably about the fall of 2007 before I was able to be on our board calls. In one of the first times I was back in my office, I received an email that I thought was from Stephanie Fennewald, (Remember my processing capabilities at that point were still very limited!!) who was the 20072008 president. I responded to the email telling, I thought, Stephanie what had happened. I took me a long time to respond as I had limited use of my left hand at that point. I sent it & it actually went to Jan Pederson who emailed me back a response. I asked her to forward my email on to Stephanie as I didn’t have the energy to draft another one to Stephanie! (Continued on page 3)

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HEALTHCARE HAPPENINGS

(Continued from page 2) President’s Letter They must have suspended the rules for me on board call attendance that year, as Shelly Hunter asked if I would be Treasurer for her term as President the following year. I wasn’t sure if I should do it as I was advised to keep my stress level as low as possible, but the fact that the accounting for the chapter would be pretty easy, I thought it would be a way to step back & do some fun accounting & get more involved in the chapter. One thing that going through a traumatic event like I did is that you lose a lot of self confidence because even though I had lived a healthy lifestyle, there was nothing that I could have done to prevent what happened to me. The doctors did tell me that living the healthy lifestyle was what helped me survive the event, but still it screws with your self confidence! I thought going to the Leadership Training conferences & other events would put me into situations where I would have to meet & speak to new people as I still felt that one of my lingering deficits was in speaking. I still feel this way & continue to try to improve. Next, I used the Certification process to prove to myself (& I suppose to my staff & boss) that my Healthcare accounting skills were still adequate. I passed the Core exam with Shelly Hunter as my proctor in November 2008 and then went to ANI in June 2009 to take the Accounting & Finance Prep course & take the test which was proctored by Joe Ewers. I passed that exam & became certified in 2010 & had enough Founders points to become a fellow in 2011. SO, I used HFMA as part of my extended rehabilitation from the stroke that could have made me fade into the sunset if I would have let it! You have met my husband, so this won’t surprise you that for Christmas 2007, Paul gave me 3 books on stroke recovery. He thinks you read a book & you can do it. (Of course, he can, but me, not so much!) At that point, I could barely read for 10 minutes at a time, but I got through all 3 gaining a bit of knowledge from each one. I have since reread them all & the recovery of the brain is a fascinating journey. The book that made me feel best was written by neuroanatomist who experienced a stroke at the age of 36. She said she was still recovering 8 years later, so it gave me hope that I can still experience some areas of recovery since it has only been 5 years since this occurred. I was incredibly lucky to have the care & excellent rehab that I did. So many people helped me on my journey to recovery, but HFMA played a huge role in my professional recovery! I have met so many incredible people within the industry through my involvement in HFMA and the publications that HFMA national puts out are an invaluable resource to keep updated on the Healthcare Finance industry. I don’t know if my story is appropriate for what you are looking for, but there it is. Janet Putting these two stories together has made me realize both have the same moral. I had been exercising and eating right most of my life to avoid the heart problems that caused me to lose both of my parents. I had joined HFMA to make me a better Healthcare CFO. I did not foresee that the crucial role both commitments would have in my surviving a catastrophic event. It is the unintended consequences of doing the right thing that sometimes matters most. Thanks for reading my story and my best to you all for a fabulous 2013! Janet Taylor Show Me HFMA President

Important Chapter Information Chapter Balance Score Card - Every year National sets goals for each chapter— we wanted to keep you updated throughout the year on how we are doing. The reporting year runs from May 1, 2012—April 30, 2013. Membership

Goal 251 members

Actual 243 members

Education Hours

Goal 3,975 hours

Actual 3,630 hours

Education Hours/member

Goal 15.9

Actual

14.5

Certification

Goal 8.2% of members certified or 4 exams taken Actual 8.8% of members / 3 exams taken

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(Cont from page 1) Why Giving Advice Doesn’t Work Why Advice Doesn’t Work Reason #1: Judgmental When you give unasked-for advice, it sends an underlying and very judgmental message: ―You’re obviously not as savvy as me because if you were, you’d have already figured out what I’m telling you.‖ You may not consciously intend to promote this message, but it’s usually what the person on the receiving end hears. And it won’t inspire anyone to become a Hundred Percenter (aka a high performer). What’s more, if you continually offer unsolicited advice, there’s a good chance people will retaliate and let you know, in no uncertain terms, about your own faults. You may think you’re being helpful, or you may truly believe you know better, but you won’t convince anyone who’s stuck listening to your advice. The person on the other side of your endless stream of ―You should..., you better...‖ is probably thinking, ―Who the heck is this bozo to be giving me advice? He should clean up his own mess and then come talk to me.‖ Why Advice Doesn’t Work Reason #2: Directive When you give advice, in essence, you’re telling somebody else what to do. This implies you have all the answers about what works and what doesn’t. But how could you? Chances are you don’t have all the background information on the situation, nor do you understand the other person’s emotions and what makes them tick.

“Trying to trick employees into thinking they have a choice when they really don’t doesn’t make the work any more enjoyable. “

There’s absolutely no constructive value in statements like, ―Well, if it were me, I would...‖ It’s not you, and hearing this kind of advice only puts the other party on red alert that it may be time to check out of the conversation. You asked the employee to partner in dialog, so allow that person to provide additional facts about the situation. Or, if the employee has nothing to voluntarily offer, ask a few questions that prompt responses to fill in the blanks. But be careful. Sometimes the questions we ask are no more than a thinly disguised form of unsolicited advice. I had a recent experience where my laptop froze while I was at a client site. The client called in his tech support department and the first thing one of the IT guys asked me was, ―Did you try rebooting it?‖ Now, that may be the question everybody asks, but it’s not a question that indicates that the person asking it sees the other person as intelligent. Instead, it’s directive, a form of speaking down, and it comes off sounding strongly like advice. Here’s the internal reaction I had to his ―advice‖ question: ―Holy crap, you mean you can restart a laptop? Why didn’t I think of that? I mean, every day I turn it ON, but I never thought about turning it OFF. They clearly don’t pay you enough because that is absolute GENIUS!‖ Of course, I bit my tongue and answered his question. But what if he’d instead asked me, ―What actions have you taken so far?‖ There’s a big difference between that question and, ―Did you try rebooting it?‖ The former acknowledges that you consider the other person’s input and intelligence as something valuable. It’s also a legitimate attempt to gather information. The latter, as we have said, is unsolicited advice. When It’s Okay to Be Directive I don’t mean to imply you should never be directive. When you’re a superior telling a subordinate what to do, it’s perfectly acceptable. But even in that situation, you still need to be careful that you’re giving directions—not advice. Because if you give advice, you’re only setting the stage for a terrible dynamic. (Cont on page 5)

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(Cont from page 4) Why Giving Advice Doesn’t Work Here’s an example: Scenario: Boss sees Employee writing a report and says to Employee: BOSS: ―I wouldn’t use those colors for that report. I’d go with something brighter.‖ EMPLOYEE: ―Sure, okay.‖ Later that day, the Employee has finished the report and presents it to Boss. BOSS: ―What the heck is this? I told you to use brighter colors.‖ EMPLOYEE: ―No, you said YOU would use something brighter. I liked the colors I was already using just fine.‖ BOSS: ―Listen, when I tell you to do something, I just want you to do it.‖ EMPLOYEE: ―Then next time, tell me what you want.‖ As a superior, you have the right (and obligation) to give directions and make corrections. However, when you phrase it as advice, it sounds more like a recommendation than a directive. And as we’ve seen, that creates a misunderstanding that wastes everyone’s time. If what you need to tell a subordinate is NOT optional, then be honest with them. Don’t play coy and pretend they have a choice when they actually don’t. Why Advice Doesn’t Work Reason #3: Gotchas

“When you catch someone off guard and hit them upside the head with advice; there’s virtually no chance they’ll be in an open emotional state

When you give advice, you offer the other party only two choices: take the advice or ignore the advice. And in either case, there’s the possibility of a ―gotcha.‖ If your advice is taken, that means the other person must tacitly admit you’re right and he or she is wrong. This automatically gives you credit for being smarter. That’s Gotcha #1 and it’s a dangerous scenario, one that’s almost guaranteed to create defensiveness. When advice is ignored, it invites the possibility of an ―I told you so.‖ That’s Gotcha #2. And that can prompt our old friend, the wall of defensiveness, to spring into action and block out the feedback. Even if you don’t outwardly acknowledge the failure to take your advice, the person who passed on taking it may fear you’re insulted. This scenario can shut down the employee from attempting any future discussion on the topic (or any other topic for that matter). And then, there’s always the chance that your constant advice and ―gotchas‖ have you positioned as someone to be avoided. Why Advice Doesn’t Work Reason #4: Narcissism

to hear what you Let’s be honest. Sometimes we give advice to demonstrate how smart we are, or because we feel left out or need to be needed. There are even cases where constructive feedback is manipulated say.” to vent anger or to purposely hurt someone. But it’s always done under the thinly veiled guise of trying to be helpful. Before you offer constructive feedback, consider your reasons. If your purpose is not to help someone achieve great performance, you probably want to rethink giving the feedback. Why Advice Doesn’t Work Reason #5: Unsolicited Most advice is unsolicited. This means the other party didn’t ask to be judged, corrected, or directed. When you catch someone off guard and hit them upside the head with advice; there’s virtually no chance they’ll be in an open emotional state to hear what you say. Listen, there are many ways to give feedback. Giving advice, though, often makes people defensive, comes off as arrogance or can just seem like a suggestion rather than a command. Constructive feedback can push good employees toward Hundred Percenter performance, but advice generally just doesn’t work all that well. And remember, while advice may be fun to give, it’s generally not that much fun to get.

Mark Murphy’s latest book, Hundred Percenters, has an entire chapter devoted to the topic. Leadership IQ offers a teleconference on the subject as well. www.leadershipiq.com

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Social Corner Below: Day Equsquiza presenting on Wednesday Right: attendees at the opening session

Brian McCook and Jessica Johnson running the registration desk.

Brian Coffey and Kyle Lee

Mary Jonscher and Amy Richter

Left: Greg Johnson, Tami Kradik and Jon Branstetter at Wednesday evening’s reception

Jim Mozena, Matt Levsen and Elaine Watson

Connie Stimpson, Janet Taylor and Susan Duncan

Jeff Woody having a little fun at his booth.

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Janice Janssen and Janet Taylor

HEALTHCARE HAPPENINGS

Participants enjoying Wednesday evening’s reception

Thursday Night Entertainment— Brian Powers, Hypnotist and some brave volunteers We laughed until we cried, well, some of us. The hypnotist was terrific and everyone had a great time. It was very entertaining and even had the audience participating! Right: Karen Bentley participating in the warmup exercises Jim Driscoll, Janet Taylor, Kyle Lee, Jon Branstetter, Christine Reyes, and Mary Jonscher under hypnosis.

Jon Branstetter and Mary Jonscher trying to figure out how many fingers they have!

Social Corner

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HEALTHCARE HAPPENINGS

Winter Workshop (Replacing the Annual Summer Conference) Camden on the Lake Lake Ozark, MO February 20-22, 2013 Topics include: RAC Panel Wage Index HFMA Value Project

OIG Update Advanced Medicare Workshop Medicaid DSH Changes

Room Rates are $89 per night. Reservations by calling 888-365-5620 or https://book.camdenonthelake.com/IRMNet/(S(xqcqvq45kscsniadlzqvlj55))/Login.aspx Group Code is HLTH0213

There will be a free vendor fair for all Show-Me Chapter Sponsors Only!! Please Contact Jennifer Ogden to RSVP for the vendor fair— [email protected]

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MHA Convention

The Show-Me Chapter held a luncheon for HFMA members and had great attendance. We also sponsored two educational sessions one by Rob Schile from CliftonLarsonAllen and the second by Mike Badolato with the FBI at the Annual MHA Convention on November 7, 2012 at Tan-Tar-A Resort at Lake Ozark, MO, as well as hosting a booth at the vendor fair. Thanks to everyone who participated!

HEALTHCARE HAPPENINGS

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Steve Renne and Andrew Wheeler, MHA, presented an afternoon session on November 30 at University of Missouri . After their presentation on Healthcare Reform, a networking session was held—this was the first time we had collaborated with the University on an education/networking session and the feedback and attendance was terrific! We look forward to collaborating with them again in the future.

MU Education and Networking Event

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MHA Update

HEALTHCARE HAPPENINGS

By Andrew Wheeler

Medicaid Expansion Supports Hospitals, Missouri’s Economy As health care finance leaders, we know that numbers matter. In 2013, Missouri lawmakers will decide whether the state will adopt Medicaid expansion provisions of the Affordable Care Act. Their actions will have broad implications for the state’s economy, the ACA’s mechanism to offset cuts with coverage and hospitals’ revenue streams in the years ahead. The hospital community is taking the lead in educating Missourians and their elected leaders about the consequences of the choice. First, there’s the question of revenue reductions. Hospitals’ Medicare revenue streams currently are being reduced through the ACA and the Middle Class Tax Relief and Job Creation Act of 2012. In addition, without a deal on sequestration, hospitals will experience a 2 percent cut in Medicare reimbursement beginning in January. Combined, these reductions amount to $3.3 billion between 2013 and 2019. Medicaid disproportionate share hospital payments also are reduced by approximately $704 million through proposed regulations. In theory, these cuts would be offset in part through the expansion of Medicaid. However, the Supreme Court’s decision on the ACA allowed states to opt out of Medicaid expansion, jeopardizing the offsetting revenues. One way to mitigate the loss of revenue through Medicare and Medicaid disproportionate share hospital reductions is to expand the Medicaid program. Between 2014 and 2020, the federal government will fund the majority of Medicaid costs for individuals eligible through the ACA’s expansion — 100 percent in 2014-2017, and incrementally reduced to 90 percent by 2020. State budget officials project that 259,000 adults would enroll in Medicaid in 2014, offsetting much of the costs of the DSH cuts and reducing uncompensated care. There’s additional good news for the state. According to a study performed by the University of Missouri School of Medicine and Dodson DaVanzo and Associates, the federal expenditure for Medicaid expansion will inject $8.6 billion into Missouri’s economy between 2014 and 2020, supplanting the adverse economic effect of the payment cuts described above. This expenditure will create a total effect (cont on page 14)

Healthcare Humor Laughter is the Best Medicine

Surgery Joke Son Operates on Dad An older gentleman was on the operating table awaiting surgery and he insisted that his son, a renowned surgeon, perform the operation. As he was about to get the anesthesia, he asked to speak to his son. 'Yes, Dad, what is it? ' 'Don't be nervous, son; do your best and just remember, if it doesn't go well, if something happens to me, your mother is going to come and live with you and your wife.' Heheheh ... please say you got it at MediJokes.Com :)



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(Cont from page 13) MHA Update (direct, indirect and induced) of an additional $9.6 billion in value added output in the state — increasing jobs by 24,008 in 2014, increasing payroll by nearly $7 billion between 2014 and 2020 and increasing the state gross state product by .53 percent. Moreover, Governor Nixon’s budget office estimates that the expansion will allow for a state surplus in the early years of expansion and a break-even Medicaid budget in 2021. There is a strong business case for the Medicaid expansion. The expansion would create jobs and economic activity, support the stability of the state’s Medicaid budget and reduce cost shifting that leads to the “hidden health care tax” that individuals and employers pay. In addition, coverage will contribute to a healthier workforce and a healthier Missouri. The Missouri Hospital Association is a member of a coalition of providers urging lawmakers to support the Medicaid expansion. However, support isn’t exclusively from the provider community. A number of state and regional business groups have endorsed expansion as well. I encourage hospital finance leaders to weigh-in with their elected officials on Medicaid expansion. Numbers matter. And, without expansion, making the ledger balance will be very difficult.



I would just like to take the opportunity to thank everyone who has helped me with the transition of taking over the newsletter this year. Everyone that has contributed articles, taken pictures, given me member news items, reported new members, ect. I have really enjoyed working on the newsletter! Thanks and I hope you have a wonderful 2013!! Jennifer If you have items of interest or suggestions for our newsletter, please contact me. All feedback is appreciated!! [email protected]



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Healthcare Financial Management Association's live webinars offer you convenient ways to earn CPEs and obtain the information you need on pressing healthcare finance topics. HFMA also offers on-demand webinars that qualify you for DCMS education hours. Most live and on-demand webinars are free for HFMA members and $99 for non-members. UPCOMING LIVE WEBINARS January 2013 Value-Based Purchasing: Getting Ahead of Pay for Performance (January 24, 2013) Is Your Revenue Integrity Program Prepared to Acquire Another Hospital? (January 29, 2013) February 2013 Detecting Product Equivalency to Drive Lower PPI (February 14, 2013) Note: This is the sixth in a series of six webinars sponsored by McKesson in conjunction with the Association for Healthcare Resource & Materials Management (AHRMM).

HFMA's Virtual Conference is back by popular demand with all new content and in a new format! Four Live Dates in 2013: February 6 | April 11 | July 17 | October 16 A two-month on-demand period follows each live date giving attendees access to archived educational presentations and sponsor information.

Mark your calendar for this live event – free to HFMA members. HFMA’s Virtual Conference provides you with unique and cutting edge programming–all from the convenience of your home or office! Each date offers new education content including a keynote presentation, a session that presents the latest findings from HFMA’s Value project and a real-world case study that provides solutions to improve the quality of care and reduce costs. Attend all 4 live event dates to receive 12 CPE credits! Non-member registration is only $155, which also includes membership for those new to HFMA. Check out the February education agenda of outstanding speakers. To learn more, visit hfma.org/virtualconference or call (800) 252-4362, extension 2.

HFMA Members Free Non-Member Registration: $155 includes membership for those new to HFMA

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2013 Show-Me Chapter Corporate Sponsors Thank you to all of our 2013 sponsors—we had a terrific sponsorship drive this year and it means a lot to our chapter to have their support!

Diamond Level

Bronze Level

BKD

Meridian Leasing

CliftonLarsonAllen

HRS Erase

Missouri Medical Collections

Gold Level Emdeon The Sevenex Group

Silver Level Berlin-Wheeler D-MED Corporation MedTran Direct Human Arc Kramer & Frank MSCB, Inc. Midwest Health Care, Inc.

Midland Group Avadyne Health Professional Credit Management Hawthorne Recovery Services, Inc. Medical Data Systems Account Resolution Corporation Commerce Bank Consumer Collection Management Mail Communications Group Craneware The Law Offices of Jay B. Umansky, P.C. SecureBillPay

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Region 8 Update Greetings HFMA Region 8 Friends and Colleagues!

Mike Dewerff Regional Executive

I hope you are all having a happy and healthy holiday season! 2013 promises to bring many challenges to the healthcare industry. Your chapter leaders have done a very nice job putting together high quality educational programs and great networking events. If you haven’t done so already, please take the time to get to know your chapter leaders, thank them for their dedication to the chapter, and get involved in your chapter’s activities. Believe in yourself and the skills you could bring to a leadership role. Leadership Matters! You’ll find that by getting involved you’ll gain so much more from your membership!

This fall, I had the pleasure of meeting with the Region 8 Chapter Presidents and Presidents-Elect, the HFMA Regional Executive Council Chair-Elect and an HFMA staff member at our annual HFMA Fall Presidents Meeting in September. As has been the tradition the last few years, the Fall Presidents Meeting took place on a cruise ship. This year’s itinerary started in Miami, and visited the Bahamas, Coco Cay, and Key West. The three days provided ample time for each person to share ideas, offer ―best practices‖, and hear from National personnel regarding current events, policy changes, and other national perspectives on a number of important issues. Naturally, there was time allocated for social time and dinners that allowed the attendees to network and build strong relationships with new and current colleagues. I thank you again for the opportunity to serve Region 8. I welcome your questions and comments, anytime! My telephone number is 515-574-6603 and my email address is [email protected]. Mike Dewerff, CPA, MBA, FHFMA HFMA Region 8 Regional Executive 2012-2013

HFMA Region 8 is coming together for a live education event and Cardinals Baseball game in St. Louis, MO August 21-23, 2013 Don’t miss the opportunity for education and networking with your Region 8 members (9 Chapters) For more information, please contact:

Tracy Packingham Chris Vairo Teri Reger Stephanie Hultman

[email protected] [email protected] [email protected] [email protected]

Conference Information Conference Information Sponsorship Opportunity Speaking Opportunity

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5 Benefits of Customer Loyalty Tim Larkins, CEO, E5Xcellence

Loyalty is an important yet rare quality in our culture. It is demanding and volatile. Without an environment containing consistency of trust and attentive care, it will not survive. Customer loyalty is no different. Your customers want and hope they can trust you. They demand the care that anticipates their unspoken needs and quickly responds to their spoken requests. The organizations recognizing this are able to create and sustain customer loyalty not because they are lucky or just happen to hire the right people. They do it deliberately. And they are deliberate because they understand customer loyalty is a vital key to sustained growth and profitability. The first area of benefit from creating loyal customers is obvious yet significant – fewer of your customers choose others to provide the service they originally entrusted to you. Most companies spend too much time and money on the marketing efforts of ―hunting and fishing‖ and not enough on nurturing their existing customers. Engage your staff’s creativity to determine how your team can make each customer encounter special.

A motivated staff is the next benefit. This is the lynchpin to creating customer loyalty – creating staff loyalty within your own organization. Engaged, educated, empowered, enriched, and energized team members will supply their discretionary effort at work to ensure your customers are satisfied. It is leadership’s responsibility to model behavior that is caring, trusting, and supportive. In other words, take care of the people you have entrusted with the care of your customers. How would you like fewer complaints while serving more clients? Does it sound too good to be true? With greater customer loyalty, over time it becomes a reality. This frees you and your staff to pursue more productive work. The fourth benefit is pure magic as your customers become your promoters. As you quickly close the loop on complaints and anticipate the needs of the customer , they will tell the story of your outstanding service to other potential customers. Most understand that things go wrong. What they don’t understand is why it took so long to fix, why it happened again, why they had to keep calling back for updates, and why there was no sense of urgency with your staff. Think of it this way. People are going to tell stories of their experiences. When your company ―blows it‖, your customer is going to tell their peers, friends, and whoever else will listen. It is nothing personal. They do not think about this hurting your reputation in the industry. Resolving complaints timely, effectively, and to the customers satisfaction puts you in control of the end of the story. Now they still tell the story but with a happy ending where you and your staff are the heroes. Finally, a stronger, more predictable bottom line will result as the first four benefits become reality. Organizations struggling to achieve distinction in their industry, memorability with their clients, and profitability on their bottom line need to focus on creating loyalty with their customers. They want confirmation that choosing your organization was a wise decision. They want you to do what you promised and respond to their needs and requests timely. Your challenge is to do this and provide the ―what else.‖ So how are you doing? Maybe a Customer Loyalty initiative could help.

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For more information on becoming certified or opportunities for the Show-Me Chapter to help you obtain certification, please contact Janice Janssen, [email protected]

Sample Certification Question:

When one is evaluating how many FTEs are needed for department staffing which of the following should be taken into consideration: a. The number of non‐productive hours for the position b. The hours the function or position must be staffed c. Whether the position could be staffed with part‐time employees d. All of the above

Healthcare Humor I n c r e d i b l y D a n g e r o u s Fo o d A hospital's consulting dietician was giving a lecture to several community nurses. He said, "the crap that we put into our stomachs and consume should have killed most of us sitting here, years ago. Red meat is horrible. Fizzy drinks eat your stomach lining. Chinese food is loaded with MSG. Vegetables are now "iffy" because of fertilizers and pesticides ... and none of us seem to realize the longterm damage being done by the rotten bacteria in our drinking water. However, there is one food that is incredibly dangerous, and we all have, or will (likely), eat it at some time in our lives. Now, is anyone here able to tell me what food it is that causes the most grief and suffering for years after eating it?" A 65-year-old nursing sister sitting in the front row raised her hand, stood up and said, "Wedding cake."

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What’s “New” in the OIG Work Plan By: Kathy Ruggieri, Senior Director, Revenue Cycle Services The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has recently issued the Fiscal Year (FY) 2013 OIG Work Plan. This is an annual Work Plan that addresses the current focus areas of the OIG, including projects still in process from prior FYs in addition to new focus areas for the upcoming year. Although the Work Plan addresses initiatives for all types of providers, this article will focus on some of the new hospital audits. Some of these audits may or may not be indicative of future Medicare payment reductions. It is recommended that Hospitals stay abreast on these focus areas throughout the year to best anticipate future revenue reduction initiatives. 1. Diagnosis Related Group (DRG) Window The DRG Payment Window Policy has been a component of the Inpatient Prospective Payment System (PPS) regulations since 1983. There have been changes to this policy over the years, and in 2012, the DRG Payment Window was expanded to include wholly owned physician practices. The OIG focus for 2013 will be to analyze claims data to determine how much CMS could save if it bundled outpatient services delivered up to fourteen (14) days prior to an inpatient hospital admission into the DRG payment. The current DRG payment Window Policy bundles all outpatient services delivered three (3) days prior to an inpatient admission. The OIG anticipates that significant savings could be realized if the DRG window was expanded from three (3) to fourteen (14) days. Hospitals should pay close attention to these audits as an expansion to this program will have significant financial implications to hospital outpatient service revenue. 2. Compliance with Medicare’s Transfer Policy The Medicare Post Acute Transfer Rule was implemented in FY 1998 and has been expanded in FYs 2005, 2006, 2007, 2008 and 2012. Pursuant to federal regulations, a hospital discharging a beneficiary is paid the full DRG amount. In contrast, a hospital that transfers a beneficiary to another facility is paid a graduated per diem rate for shorter lengths of stay. The OIG has performed significant audits of claims that were reimbursed the full DRG rate and has provided guidance to CMS on claims processing edits that would concurrently identify claims that were actually transferred to another facility and would result in the lesser per diem rate. Based on these recommendations, the Medicare Administrative Contractors (MACs) have implemented claim edits to identify these situations to prevent overpayment situations. Historical OIG audits identified the effectiveness of these edits. OIG audit results have revealed an 85% effective rate with the claims processing edits. The MACs were charged with making additional changes to these edits to further improve the effectiveness. In 2013, additional audits will occur to evaluate the effectiveness of these claim edits to determine if the edits have improved. (Continued on page 22)

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(continued from page 21) OIG Work Plan 3. Payments for Discharges to Swing Beds in Other Hospitals The OIG will review Medicare payments made to hospitals for discharges that were coded as discharges to a swing bed in another hospital. Swing beds are inpatient beds that can be used interchangeably for acute care or skilled nursing care. Currently, federal regulations allow for a full DRG payment for discharges coded as ―Swing Bed‖ (patient discharge status code of ―61‖). However, Medicare pays hospitals a reduced payment for shorter lengths of stay when beneficiaries are transferred to another PPS hospital. This is based on the assumption that acute care hospitals should not receive full DRG payments for beneficiaries discharged ―early‖, and then admitted to another post acute provider post discharge. Since Medicare does not pay a reduced payment for discharges to a ―Swing Bed‖, the OIG will evaluate these situations and if appropriate, recommend that CMS evaluate their policy related to payment for hospital discharges to swing beds in other hospitals. In the event this change is implemented, hospitals who discharge patients to ―Swing Beds‖ and utilize patient discharge status code of ―61‖ will experience further claim reductions as additional claims will be impacted by the Medicare Post Acute Transfer Rule. 4. Non –Hospital Owned Physician Practices Using Provider Based Status The OIG will assess the impact of non-hospital owned physician practices billing Medicare as provider based physician practices. A determination will also be made with regard to whether provider based status meets CMS billing requirements. Since provider based status can result in additional Medicare payments, it also increases a Medicare beneficiaries’ coinsurance liabilities. Hospitals that bill with a provider based status should evaluate whether the Medicare criteria specific to provider based physician status is met. It is clear that the OIG is looking for opportunities to further reduce Medicare reimbursement. It is important for Hospitals to keep current on these potential revenue reductions. It is recommended that Hospitals continue to take full advantage of comment periods to communicate concerns with regard to payment reduction initiatives. BESLER Consulting can help your organization recover otherwise lost revenue, maximize reimbursement, increase compliance, improve efficiencies and reduce costs. For more information, please contact Kathy Ruggieri at (732) 392-8227 or [email protected].

Silver Sponsors

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MEMBER NEWS Damon Longworth, Southeast Missouri Mental Health, was the winner of the free conference registration for the Fall Conference. Congratulations!!!

New Members Samantha Champagnie Mercy Health Revenue Cycle Director Ellisville, MO Lori Norton Health Management Associates Divisional Revenue Cycle Manager Poplar Bluff, MO Daniel Kempker Missouri Coalition for Primary Health Chief Financial Officer Jefferson City, MO Andrea Elliott BKD, LLP Managing Consultant St. Louis, MO

Director of Accounting - Missouri Delta Medical Center has a career opportunity for an individual seeking a rewarding and challenging position. This position will manage our Accounting Department in a 182 bed Hospital. Qualified applicants must have a minimum of a Bachelors in Accounting. 2 years of experience in public accounting plus hospital experience preferred. The career move offers an outstanding opportunity to enjoy a very competitive salary and benefits program. Interview and relocation expenses are provided. Interested applicants please submit resumes to: Missouri Delta Medical Center Attn: Jon Branstetter 1008 North Main Sikeston, MO 63801-5099 573-472-7730 FAX or email at [email protected] Equal Opportunity Employer