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President’s Message

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Dear HFMA South Texas Chapter Colleagues, I am honored to serve as President of the South Texas Chapter for the 2016-2017 year. I want to thank the membership for the privilege of leading the chapter this year. I also want to thank outgoing President, Clint Owen, for his dedication and innovative ideas over the last year. Clint has set some very high standards, demonstrating what it takes to lead with passion and commitment. As a testament to Clint’s and last year’s board’s leadership the South Texas Chapter was awarded four awards at last month’s ANI Annual Chapter Awards Dinner — A Multi-Chapter award for the Region 9 networking event; A John M. Stagl Silver Award of Excellence for education; A Bronze Award of Excellence for membership growth and retention and a Helen M. Yerger Award for membership. As our new year begins the one thing that stays constant is change! Our chapter has, and will continue, to make significant changes to ensure we deliver — what you — our members need to be successful both personally and professionally. With a strong board, officer team and committee volunteer base, I am confident we will continue to be an indispensable resource for our membership. I am excited to tell you about a couple of new offerings: We now have a South Texas Chapter smartphone app! The app will enable you to communicate with chapter members and get real time/interactive information from the chapter. You can search the app stores for “hfma south…

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Millennials Force Healthcare in Digital Direction

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Millennials raised in the digital age with the convenience of online services are driving healthcare providers to change how they engage with patients and improve the customer service aspect of care. While older generations value in-person communication and cultivating relationships with medical professionals, millennials desire a different approach. Accustomed to instant gratification, millennials don’t want to phone in for an appointment and then wait weeks to see a doctor. Nor do they like to be locked in to health plan network restrictions. They often will search online for healthcare information, even before seeing a doctor. A key finding in a global survey of over 3,000 people is that millennials tend to select doctors based on referrals from family and friends. But while older patients express dissatisfaction directly to doctors, millennials share unsatisfactory experiences with friends, often on a social network. The survey also revealed that this generation is likely to trust social feedback, handing providers another challenge. Not only do providers need an online presence, they must monitor and manage their social reputation. Millennials aren’t tied to the notion that they must have one specific doctor; they don’t develop personal relationships with them. For standard checkups and consultations, some don’t feel the need to see a doctor at all, opting instead to see a physician assistant or nurse practitioner. They don’t want to spend hours at a doctor’s office for minor medical complaints. Part of this is due to millennials being generally healthy; pressing health concerns typically are for accidents…

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The Hospital Accelerator Model

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Evolving reimbursement models, the Affordable Care Act and the activation of patients as consumers are among the major drivers of anticipated disruption to the provider landscape. This shifting financial, regulatory and patient preference has led to not only industry veterans attempting to recalibrate ways of doing business, but has also notably attracted outside entrepreneurs and capital vying to establish a presence in a massive industry ($1.5 trillion was spent on hospitals, physicians and clinics in 2013, according to the Kaiser Family Foundation) that historically has had large barriers to entry. StartUp Health reported  that capital flows for digital health increased from $1.2 billion in all of 2010 to $4.7 billion in the first three quarters of 2015. Despite all the above tailwinds, however, adoption of new business models has been relatively slow. A number of factors must be overcome, including: Cultural Differences: Many new entrants come from outside industries, such as technology. Current health care leaders may question new players’ understanding of the intricacies of health care, including fund flows, the level of control any one entity has over an entire episode of care, privacy, compliance, etc. New entrants, for their part, may view incumbents as slow adopters who have not faced the sort of innovation-driving market competition seen in other industries. Both viewpoints have merit. Financial Incentives: While the Centers for Medicare and Medicaid Services (CMS) is moving toward value-based reimbursement models such as shared savings or capitated payments, many (if not all) regions of the country are still…

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Agency Options for Hospital Finance Better than Ever

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Today is a good day to be an issuer in the bond market. With paltry returns available through government bonds and investment-grade paper, fixed income investors are reaching for yield and aggressively bidding for nearly all non-investment grade municipal bond credits, including hospitals. However, not all hospitals are a good fit for tax-exempt bonds. Restrictive covenants, transaction and borrower size, and cost of the issuance are a few factors that may make a public bond issue unfeasible. Fortunately, there is a low-rate, long-term, covenant-light solution. The U.S. Department of Housing and Urban Development (HUD)/Federal Housing Administration’s (FHA) Section (Sec.) 242 program and the U.S. Department of Agriculture’s (USDA) Community Facilities (CF) program both made significant capital contributions to hospitals during 2015. Further, each program made strides toward becoming more user friendly, specifically with HUD’s new loan documents and USDA’s emphasis on processes and uniformity. Until recently, the FHA Sec. 242 program used closing documents, covenant package and regulatory agreements that were created in 1973. This led to some of the terminology and legal concepts being outdated. The antiquated documents resulted in closing delays and additional costs, as a borrower and its lender counsel would have to negotiate changes to update and revise language. In 2016, HUD introduced a new set of documents that are expected to be finalized later this year. Although the documents do not introduce sweeping changes, much of the terminology and standard loan document provisions have been included. The changes should help alleviate the closing delays that…

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President’s Message

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As your 2015-2016 President, I have been honored to assist in leading the chapter to achieve great success in delivering value to our chapter members. The time, like most things, has passed oh so quickly and it’s truly hard to imagine that my leadership as President has come to an end. However, I have grown so much having been involved for so many years and plan to do so moving forward. The value one can gain within HFMA is sometimes unmeasurable from education, leadership skills and most importantly the ability to truly impact and be impacted by great relationships forged over time and life lasting. Our goal this year was to continue to build upon the foundation that previous leadership has engrained in each of us. The South Texas Chapter has done an incredible job in accepting all the changes we have undertaken this year to better enrich each members experience within HFMA. As I stated from the outset, we would be making significant changes to better serve our members with new locations, new website, new chapter administrative support with DeMarse Meetings, thought provoking education and most of all more FUN! Yes, we have met some challenges but the overriding fact remains you the membership like what we are doing and with each and every event it is reflected in your evaluations. The National Theme this year was, “Go Beyond”, and we have and continue to do that. Coming out of HFMA LTC this year the theme is, “Thrive”! I…

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Planning for the Unknown: Triple Aim

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“In preparing for battle I have always found that plans are useless, but planning is indispensable.” This quote attributed to Dwight Eisenhower is good advice for strategizing in an environment where one knows that the conditions will change. Such is the case with the future of revenue for health care providers in America. U.S. health care is a $2.9 trillion complex and adaptive system of entities including insurance companies, hospitals, pharmaceutical companies, medical equipment manufacturers, technology companies and increasingly more stakeholders. Until recent years, the federal government had largely been a reactive participant since the advent of Medicare. For many Americans, the system has worked relatively well, with the average consumer enjoying access to quality care, state-of-the-art technology and a fair amount of options. However, the Medicare system has some glaring flaws that make it unsustainable as the population ages. The primary flaws include the unacceptably large percentage of the population without insurance and costs growing much faster than the rate of overall inflation, which led to the adoption of the Patient Protection and Affordable Care Act (ACA). While the ACA aimed to accomplish several things, perhaps the single biggest long-term change was the creation of the Center for Medicare and Medicaid Innovation (CMMI). CMMI is intended to drive changes through new payment models and performance metrics. Currently, CMMI is testing innovative payment and delivery system models that show important promise for maintaining or improving the quality of care in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), while…

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Denials Management – Post ICD10

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A number of years ago, I wrote an article entitled “Denial Ain’t Just a River in Egypt”, and it was picked up by several State HFMA‘s and a national publisher. At the time it appeared to be spot on with advent of the HIPAA transaction file and a good attempt at standardization and how to start a Denial Program. As with every morphing technology, Denial management” became the catch-all phrase for any process that healthcare providers hoped could lead to cleaner claims, standardized denial codes, and fewer denials from third party payers. Then along came ICD10, the Y2K of coding. Well, to the payers surprise it was the Y2K of 2015 all over. The healthcare providers did the hard work of absorbing the extra cost of setting up their systems and processes, testing them, running in parallel and making sure the transition would be as smooth as possible. The sky did not fall thanks to the efforts of the healthcare provider. Today, still, denial management can be part of an entire electronic medical record/billing system, or it can be a “bolt-on” to an existing system, possibly a Web-based system that reviews claims and normalizes data, it can also be a manual, retroactive review of denied claims off an excel spreadsheet. It is most often paid for through the up-front purchase of software within the current system, from the billing software, or by contracting with a vendor for a bolt on product for a percentage of collections or fixed monthly fee….

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