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State Network Council Minutes and Handouts

October 10, 2012

The Critical Access Hospital State Network Council Meeting took place on Oct. 10 at Salina Regional Health Center in Salina, Kansas. There were 63 people in attendance at the meeting.

Click here to view meeting agenda

The day kicked off with a presentation entitled The Role of the CEO in Leading Revenue Cycle Improvement presented by Steve Boline, regional CFO, Nevada Rural Health Partners and Joan Hall, Nevada Rural Health Partners. Boline provided an executive summary of the revenue cycle assessment recently conducted on behalf of the Kansas Rural Health Options Project. Forty-six Kansas hospitals completed the assessment. Respondents included CAHs and rural prospective payment system hospitals. The assessment revealed several areas of strength present in the revenue cycle practices of Kansas hospitals: billing and coding practices, including utilization review; management of the charge description master and charge capture; and charity care and self-pay account management. The assessment also identified several areas for improvement related to revenue cycle practices: front-end patient processes including pre-registration and benefits/eligibility verification; point of service collections and financial counseling; third party payer management; and quality assurance/improvement activities.

Hall shared her hospital’s story with attendees. She is a CEO at a 14 bed rural hospital in Nevada that was in serious financial trouble in 2007. After completing the revenue cycle assessment, she put together a team to improve their practices which resulted in significant improvements in their situation. The theme of her message was that in order to significantly change your hospital’s revenue cycle practices, the CEO must actively participate in the process. The leadership to drive change and “permission” to change current practices must come from the top in order for them to be taken seriously. She challenged CEOs to assess their current practices by reviewing an all inclusive accounts receivable report, identifying abnormalities and start investigating the reasons for outliers. There is a need to review the current process for writing off accounts and examine current denials. Finally, a simple monitoring system must be established to allow you regularly benchmark key indicators and check for improvements.

Click here to view the handouts from Steve Boline.
Click here to view the handouts from Joan Hall.

The second presentation of the day was from Terry Hill, chief executive officer, National Rural Health Resource Center. He spoke about Strategic Options and Frameworks for Critical Access Hospitals. The NRHRC provides technical assistance to rural health care and focuses in five core areas: performance improvement, health information technology, recruitment and retention; community health assessments and networking. He discussed the need for strategic frameworks to improve quality and financial performance. He encouraged hospitals to look at the Baldridge process and LEAN training for employees. NRHRC has a number of tools, resources and recorded educational Webinars available on their Web site.

Click here to view the handouts from Terry Hill’s presentation.
Click here to access the NRHRC Web site.

The Kansas Department of Health and Environment, Division of Health provided attendees with updates. Mindee Reece, director, bureau of community health systems, reviewed the new organization of KDHE and share an overview of the areas they are currently working on. She also introduced Joyce Smith the new director of the health facilities program. Sara Roberts, director, rural health, discussed the announcement of the Kansas rural community health assessment grants program. The deadline for application is Oct. 25, 2012. She also reviewed the 2012-2013 small hospital improvement program. All hospitals will receive a total grant award of $8,525. At least $1,000 must go towards ICD-10 transition or improving data collection activities to report to the Centers for Medicare and Medicaid Services. There will be an informational Webinar on this year’s program at 2 p.m. on Nov. 8. There will be an announcement in mid November regarding application for 2013 advanced trauma life support training stipends. There was a request to redistribute the inventory of HCAHPS vendors that had been previously developed.

Click here to view the presentation by Mindee Reece.
Click here to view the updated provided by Sara Roberts.
Click here to access the HCAHPS inventory.
Click here to access more information about Federal Office of Rural Health Policy upcoming grant opportunities – Small Health Care Provider Quality Improvement and Telehealth Network

The day concluded with a presentation by the KDHE, division of healthcare finance. They reviewed the new payment rates for Critical Access Hospitals, Rural Health Clinics and FQHCs under the KanCare program. In addition, they answered questions regarding KanCare.

Click here to view an example calculation of the CAH adjustment factor effective Jan. 1, 2013 to be applied to inpatient and outpatient Medicaid payments.