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THE JOURNAL
Fall
AAHAM 2019
OF HEALTHCARE ADMINISTRATIVE MANAGEMENT
How Do You Handle “Primary Care First Model” Transactions?
(Part One)
Accelerate Your Organizational Transformation by Taking These Five Key Steps
Encourage Courage, How Fear Can Fuel Success
Value-Based Reimbursement Management
Social Determinants of Health Don’t Just Impact Patient Health, They Directly Impact Your
Health System’s Bottom Line
AAHAM Certifications Offer You Solid Steps to your Professional Success:
Certified Revenue Cycle Executive-I (CRCE-I) Certified Revenue Cycle Specialist-I (CRCS-I)
Formerly known as the Certified Patient Account Manager (CPAM) Formerly known as the Certified Patient Account Technician (CPAT) for
for directors and executives front-line staff
Certified Revenue Cycle Executive-P (CRCE-P) Certified Revenue Cycle Specialist-P (CRCS-P)
Formerly known as the Certified Clinic Account Manager (CCAM) Formerly known as the Certified Clinic Account Technician (CCAT) for
for directors and executives front-line staff
Certified Revenue Cycle Professional-Institutional Certified Compliance Technician (CCT)
For compliance professionals
(CRCP-I)
For mid-level managers Certified Revenue Integrity Professional (CRIP)
For revenue cycle professionals
Certified Revenue Cycle Professional-Professional
(CRCP-P)
For mid-level managers
TABLE OF CONTENTS
8 20 22 24
Departments Features
2 Letter from the Executive Director 8 How Do You Handle “Primary Care First Model”
Transactions? (Part One)
4 Letter from the National President By Rob Borchert, CRCE-I
6 Washington Wire 11 2019 ANI
By Paul A. Miller, PLC
20 Accelerate Your Organizational Transformation by
30 Committee Update Taking These Five Key Steps
By Alex Go
The Practices and Standards Committee
By Linda Sayre, CRCP-I
22 Encourage Courage, How Fear Can Fuel Success
By Patrick Sweeney
30 Movers & Shakers
24 Value-Based Reimbursement Management
31 Committee Update By Ruchir “Ricky” Patel, MHA, LSSGB
The Membership Development Committee & Tim Borchert, MBA, CHFP, PMP
By Timothy Moore, CRCP-I
27 2019 Annual Business Meeting
32 From the Desk of the Certification Director
By Matthew Hundley 28 Social Determinants of Health Don’t Just Impact
Patient Health, They Directly Impact Your
34 From the Desk of the Membership Director Health System’s Bottom Line
By Moayad Zahralddin By Rodney Napier
41 National Calendar
41 The JHAM Network
42 Did You Know?
By Moayad Zahralddin
Fall 2019 1
LETTER FROM THE EXECUTIVE DIRECTOR
AAHAM National Office Staff
11240 Waples Mill Road, Suite 200, Fairfax, VA 22030
Executive Director Sharon R. Galler, CMP
703.281.4043, ext. 5
sharon@aaham.org
Operations & Moayad Zahralddin
Membership Drector 703.281.4043, ext. 4
moayad@aaham.org
Certification Director Matthew Hundley
703.281.4043, ext. 3
matthew@aaham.org
Sharon R. Galler Certification Kristen Reamy
Manager 703.281.4043, ext. 7
kristen@aaham.org
Conference Manager Danielle Burns
703.281.4043, ext. 1
danielle@aaham.org
W ow, what a great ANI we had, “All In” was another big success!
The educational sessions were excellent, attendees were able to
get so many of their CEUs in the jam packed 3 days of education and Las
Art Direction Christopher R. Izzo
& Graphic Design CRI Design
401.595.9116
chris@cridesignstudio.com
Vegas is always such an exciting place to hold an ANI. The “All In” net- AAHAM National Executive Officers
President John Currier, CRCE-I
working gaming night was so much fun and the creative costumes were Executive Director
just fantastic. Please remember to thank our exhibitors and sponsors; we Revenue Cycle Management
Gibson Area Hospital & Health Services
couldn’t continue to have events like the ANI without their support. We 1120 N Melvin Street
Gibson City, IL 60936
hope you enjoy this special post-ANI issue, with lots of ANI photos and 217.784.2613 | 217.784.5853
john_currier@gibsonhospital.org
highlights. There are even more photos on our website, Facebook, Linke-
Chair of the Board Victoria DiTomaso, CRCE-I
dIn and Instagram, so be sure to check them out! System Director, CBO
Lee Memorial Health System
This last Journal issue of 2019 has some very interesting articles; be P O Box 150107
sure to read our cover feature about Primary Care First Models by Rob Cape Coral, FL 33915
239.242.6011 | 239.242.6005
Borchert. Alex Go’s article on organizational transformation and ANI vicki.ditomaso@leememorial.org
keynote speaker Patrick Sweeney’s articles are both thought provoking First Vice President Lori Sickelbaugh, CRCE-I
Director Patient Financial Services
and motivational. Ricky Patel and Tim Borchert’s article on value-based Newberry County Memorial Hospital
P.O. Box 497
reimbursement was timely as was Rodney Napier’s article on social deter- 2669 Kinard Street
Newberry, SC 29108
minants of health I also hope you enjoy our regular columns as much as 803.405.7136
we enjoy writing them. In addition to our regular features, we have “Com- lori.sickelbaugh@newberryhospital.net
Second Vice President Amy Mitchell, CRCE-I
mittee Corner” columns which highlights specific committees and brings Director, Revenue Cycle Support Services
you up date about what they are working on. This issue features our hard- University of Utah Hospital
127 South 500 East #500
working Chapter Development and Practices and Standards Committees. Salt Lake City, UT 84120
801.587.6486 | 801.587.6675
Be sure to check out our blogs on the AAHAM website as well amy.mitchell@hsc.utah.edu
as follow us on our new Instagram page, AAHAM1968. A big AAHAM Treasurer Kenneth Paul Koerner, CRCE-I
Director of Revenue Cycle
thank you to our advertisers, exhibitors and sponsors, we couldn’t do it CGH Medical Center
100 East LeFevre
without you! Sterling, IL 61081
Have a wonderful holiday season, remember to be grateful. 815.564.4407 | 815.626.2896
815.564.4407
ken.koerner@cghmc.com
Warm regards, Secretary
Richard Rogers, CRCE-I, CRCS-I
Vice President, Strategic Services
Magnet Solutions
1822 North 60th Street
Milwaukee, WI 53208
414.774.6100
richard.rogers@ar-solutions.biz
Legal Counsel Richard Lovich, Esquire
Stephenson, Acquisto, & Colman
303 North Glenoaks Blvd. #700
Burbank, CA 91502
818.559.4477 | 818.559.5484
rlovich@sacfirm.com
2 The Journal of Healthcare Administrative Management
CRIP
Certified Revenue
Integrity Professional
The AAHAM Certified Revenue Integrity Professional
exam is intended for anyone in the revenue cycle
industry to help ensure that facilities effectively
manage their charge master, and bill and document
appropriately for all services rendered to a patient.
This certification requires an in-depth, working
knowledge of various revenue cycle areas and
proper skill sets needed to increase revenue and
reimbursement for facilities. It also ensures that
proper charging takes place to maintain compliance
within the insurance payer programs.
The four hour online, proctored AAHAM CRIP
exam contains 250 multiple choice and true/false
questions. A score of 70% must be achieved on each
section of the exam to pass. The exams are held four
times a year; February, May, August and November.
The exam is comprised of four sections:
1. Overall Review of Charge Capture
2. Ancillary Services
3. Surgical Services and Procedures
4. Recurring Outpatients and Clinical Services
AAHAM CRIP Eligibility:The AAHAM CRIP exam is
only available to national AAHAM members,
in good standing. Candidates must have a
minimum of either two years of healthcare
experience or a two-year college or
university associate’s degree.
Log on to www.aaham.org for more
information and to order your Exam
Study Manual today!
Fall
Fall 2019
2019 33
LETTER FROM THE PRESIDENT
Deadlines & Submission Guidelines
The Journal welcomes submissions from AAHAM
members. Submission deadlines are as follows:
Journal Issue Submission Deadline
Winter 2020 January 10, 2020
Send submissions to:
Executive Director, AAHAM
John Currier, CRCE-I 11240 Waples Mill Road, Suite 200
Fairfax, VA 22030
sharon@aaham.org
T he 2019 ANI is now behind us. There is
no doubt, it was a great one and if you
were not there, you missed out! This ANI was
as well as social events; places, times, speakers,
programs, etc. Those that have done this know
exactly what I mean. By the time I ran for
n Please send a copy of your submission via email to:
Sharon@aaham.org.
n Leave a one-inch margin on the top, bottom, and
sides.
bittersweet for me, as my Presidency ends this Chapter President, I had a good grasp on things
n Use upper-and lower-case letters as you would in
year. I now get to enjoy the role of Chair of the involving the Illinois Chapter. Therefore, as the typing any correspondence.
Board as Lori Sickelbaugh takes over the Presi- Chapter President, I appreciated all my officers,
n Indent the first line of each paragraph five spaces.
dential duties of AAHAM. chairs and board members, having served in
I am excited for Lori and KNOW she will those positions. n Include a cover page with the following information:
Author’s name, (degrees, certifications)
provide excellent leadership to our association. As you know, as a Chapter President, I had Place of employment
A heartfelt thank you to the team: The Ex- the privilege to serve on the National Board of Position
Address
ecutive Officers, Committee Chairs, Chapter Directors, where I was a member of the mem- Phone/Fax number
AAHAM Chapter Affiliation (if any)
Presidents, STAT Association Management, bership committee. I was fascinated at my first
Rich Lovich and Paul Miller. Please know that board meeting, to see the organization, plan- n Any article submitted for reprint in the Journal must
be accompanied by written permission to reproduce
your commitment, dedication, and hard work ning, and work that goes in to the operations from the original source.
did not go without notice and appreciation. I of this association. After my time as Chapter n Do not use abbreviations or italics.
would like to express my appreciation to you President, and sad that it was over, I got a call
n All photos become the property of AAHAM, unless
that attended the ANI. I would also like to from then President Laurie Shoaf asking me to you specifically request that they be returned. Each
picture should be accompanied by a listing of all in-
express my appreciation to all of our Corpo- serve as her Chapter Development Committee
dividuals in the picture (left to right). Black and white
rate Sponsors, whether it’s your local Chapter Chair. Clueless at exactly what that meant, I pictures reproduce better than color.
support, your National support, your Legisla- graciously accepted. n All articles are subject to editing by AAHAM. AAHAM
tive Day support, your exhibit booth support, The following January, there I was, Com- reserves the right to hold articles for future Journal
issues when space is limited.
your gifts in kind, your sponsorship of the ANI; mittee Chair of the Chapter Development
n Articles referring to or endorsing specific products or
whatever it may be, thanks so much. We cannot Committee, with my first task being in charge of services will not be considered.
do it without your support, your attendance, the Chapter Operations reports. Now known
The Journal is published quarterly by the
your participation and your membership! as the Chapter Excellence report. I found out American Association of Healthcare Administrative
Management, 11240 Waples Mill Road, Ste. 200,
I pondered what to say to the Board of Di- rather quickly what I had agreed to do! Fairfax, VA 22030. Opinions expressed in this
rectors as my parting message. I chose to talk That was an exciting time and I learned a publication represent the viewpoint of each author,
and do not necessarily reflect the policy of AAHAM.
about succession planning; at both the Nation- lot about our members and chapters. I loved Advertisements do not necessarily imply sponsorship
al and the Chapter level. the experience. I ran for National Treasurer, by AAHAM.
I will use myself as the example, because which was another eye-opening experience, Subscriptions are included with AAHAM
I know that path. Initially, I got involved in dealing with AR, AP, budgeting, etc. I also had membership. Reprints are available from the
National Office in portable document format (PDF)
the local level by serving on the Board of Di- oversight of the Membership and Chapter De- for a $75 fee per article. Prepayment is required.
rectors of the Illinois Chapter. From there I velopment Committees. Next, I was elected © Copyright 2019 by the American Association of
served as committee chair for different areas of as Second Vice President and in charge of the Healthcare Administrative Management.
need. Then decided to move into the officer Government Relations Committee and Legis-
role, starting as Second Vice President to “get lative Day. That was also an exciting time and
my feet wet” if you will. Serving as First Vice what a learning experience. Then I was elected
President really got me involved. First Vice
President is in charge of educational meetings Continued on page 37 www.aaham.org
4
CRCS Certified Revenue Cycle Specialist AAHAM certifications can give you a powerful competitive advantage with employers. Certifications demonstrate that you have mastered the common body of knowledge for your profession. AAHAM Study Manuals will help assist you in preparing for AAHAM certification programs. These manuals are the gateway to studying for and passing these exams. The manuals include review questions and study tips. Log on to www.aaham.org for more information and to order your Exam Study Manual today! Fall 2019 5
WASHINGTON WIRE
When a Television Show
Becomes Reality
Paul A. Miller, PLC
Principal, Miller/Wenhold
Capitol Strategies
AAHAM Congressional Liaison
pmiller@mwcapitol.com
I ’m sure everyone’s seen at least one episode
of the Netflix hit television series House of
Cards. I’ve binge watched the series and found
I’m not going to try to convince you if the
President is guilty or innocent, that is for you
to decide. I did want to share with you what
by Supreme Court Justice, John Roberts. Un-
less we learn something new or the President
turns on Republicans (which could happen)
myself shaking my head and smiling when comes next, what it means for both parties and the Senate, along party lines, with the Republi-
people would ask me if that’s really how Wash- the upcoming election, and more importantly, cans voting not to impeach and the Democrats
ington works. My response used to be “it’s a what it means for AAHAM’s legislative agenda. voting to impeach. Meaning, we have the sta-
television show, not reality. You can’t get away Today, the House of Representatives led tus quo. Yes, Trump has to live with history
with things like that in Washington.” Looking by Speaker Nancy Pelosi voted 232-196 in defining him as only the third President in U.S.
back, I think I may have been wrong. Now I favor of beginning the impeachment process. history, joining Bill Clinton and Andrew John-
simply say “I’m not sure.” I used to think House Two Democrats joined with Republicans in son, as the only other two Presidents to be im-
of Cards was a show based on a fictional char- opposing moving forward with impeachment peached.
acter, Frank Underwood. I kind of think now hearings. Representative Collin Peterson (D- So, starting in mid-November, the coun-
they might have stolen their scripts from real MN), whose district Trump carried in 2016 try will be glued to their television sets watch-
life events taking place here in Washington. by 30 points over Hillary Clinton, and Repre- ing the real edition of the House of Cards. Im-
Like House of Cards, real life Washington took sentative Jeff Van Drew (D-NJ), whose district peachment comes at a risk for both parties.
some different twists today. Trump won by 6 points over Hillary Clinton For Democrats, impeaching President Trump
Today, kids woke up, put their Halloween voted to protect their political future by siding could backfire and make him stronger and
costumes on and headed off to school. Here with the Republicans. Voting to proceed with more popular with voters as it did for Bill Clin-
in D.C, we woke to a continuous celebration impeachment would have likely cost both men ton. Democrats risk over playing their hand,
from the night before with our baseball team, their seats in the House in 2020. This matters, meaning voters might look at this process
the Washington Nationals capturing their first because Democrats could not stand in front of and say Democrats spent a year investigating
World Series title ever. And, to top it off, we the media and say the Caucus is united behind the President with nothing to show for it and
braced for an 11:00a.m. vote on the House this process. It also gave Republicans an op- take their frustration out on them at the ballot
floor, which set in motion the rules and pro- portunity to focus their messaging on unity, box. This is a real possibility given there is a
cedures that would guide the House through which boy did they. large population of voters who don’t care the
the possible impeachment of President Trump. Now that the Democrats have pulled the President asked a foreign leader for dirt on his
And people wonder why so many in this town band-aid off the scab, what comes next? Make 2020 rival Joe Biden in exchange for foreign
are ready to jump off a cliff. We can’t figure out no mistake, the House will vote to impeach aid. This group sees this as a non-story or what
if we’re suppose to be happy, disappointed, sad, President Trump. It’s not a question of if, but some view as a candidate (Trump) doing op-
or outraged. At any given moment this town when. For some, a vote to impeach will be position research on his opponent (Biden).
will turn on a dime and have you wondering something they’ve wanted from the day the This is why Speaker Pelosi has been so reluc-
what just happened. So, while half the city was President was sworn into office. For others, it tant to go down the impeachment path. She
celebrating a World Series win and kids were will be just another effort to derail a President was forced to hold this vote because her caucus
counting down the hours until trick or treat- who has been “Making America Great Again.” was getting antsy.
ing, the rest of us were counting down the After the House works its will, the Arti- For Republican’s, they risk losing even
minutes until the official vote was to take place cles of Impeachment will be sent to the United more than the 40 seats they lost in 2018.
in the United States House of Representatives, States Senate, where Majority Leader, Mitch They already have 25 current members re-
which would officially begin the Trump im- McConnell (R-KY) will schedule the official
peachment saga. impeachment trial, which will be presided over Continued on page 7
6 The Journal of Healthcare Administrative Management
WASHINGTON WIRE
continued from page 6 harder and smarter. Congress will shutdown ing millions trying to ensure arbitration is not
to a degree, but Democrats are going to have in any final bill sent to the President. Today,
tiring. Most of these seats will be in play for to prove they can impeach and govern at the big money is pouring into Washington in an
the Democrats. Republicans run the risk that same time. AAHAM has made great strides on effort to scare members of Congress off from
something damning comes out during the im- issues like surprise billing and the Telephone supporting arbitration. Some have big money
peachment process, which will cause voters to Consumer Protection Act (TCPA) and is not while AAHAM has big ideas that work. It
take their anger out on those Republicans who stopping now because of the impeachment hasn’t been easy, but AAHAM is winning the
stood by the President. Watch how fast Repub- distractions. Impeachment simply means AA- battle and I’m confident it will win the day on
licans will run away from the President should HAM has to work harder and be ready should this issue.
public opinion shift even further towards the any issues hit the floor of the House and Senate Today Washington is not an easy town
pro-impeachment camp. What is something for votes. to maneuver. The rules change hourly. The
damning that could take Trump down today? I AAHAM isn’t veering or shutting down agenda changes by the minute. And, we have
don’t think we know. He’s admitted to a pay to for the year. It can’t afford to. Part of the strat- to deal with a Congress that at times looks like
play scheme with Ukraine. As did his personal egy is to continue to meet with key allies in it governs by Tweets. Today AAHAM’s pres-
attorney, Rudy Giuliani and the President’s the House and Senate like Sen. Bill Cassidy ence in Washington is more critical than ever
own Chief of Staff. All three later recanted (R-LA). Last month AAHAM had the oppor- before and why your leadership team hasn’t
and walked their admissions back. If these tunity to sit down with Senator Cassidy to dis- stopped coming back to Washington. They
admissions aren’t the smoking guns that will cuss the critical need for an arbitration clause come to make sure the hard work you put in
turn voters against the President, I’m not sure to be added to any surprise billing legislation during Legislative Day wasn’t for nothing.
the Democrats have one that will matter to a that hits the President’s desk for his signature. So, grab a bowl of popcorn, a beer and
large segment of voters next November. We’re AAHAM continues to meet with key lawmak- get ready for the worst show on earth to be-
about to find out what Frank Underwood, I ers on both sides of the aisle on this issue and is gin. Just know that while this train wreck is
mean President Trump will do next. making progress. In addition to having to deal taking place, your leadership team is working
So, what does this all mean for AAHAM? with the impeachment distractions, AAHAM overtime to make sure your voice is still being
Well, it means you will need to work longer, is having to battle big money groups spend- heard and your issues are being addressed.
Fall 2019 7
How Do You Handle
“Primary Care
First Model”
Transactions? (Part One)
cian practices. CPC+ is a regionally-based, as maintaining the quality patient care associ-
By Rob Borchert, CRCE-I multi-payer care delivery and payment model ated with both the simpler and more complex
Principal, Federal Advisory Partners that includes 2 separate tracks. Depending diagnostic conditions. Thus, we move into the
Member of the AAHAM Virginia Chapter on their care delivery and health information “Primary Care First Model options.”
rob@bpa-consulting.com technology (IT) capabilities, practice may ap- Primary Care First Model Options is a
ply to either Track 1 or Track 2 of the CPC+ set of voluntary 5-year payment options that
T he Center for Medicare and Medicaid
(CMS) is continually modelling vari-
ous types of plans and programs in striving to
program. Track 1 is intended for practices
that have the health IT and other basic infra-
structure necessary to deliver comprehensive
reward value and quality by offering an inno-
vative payment structure to support delivery
of advanced primary care. Primary Care First
minimize their payouts but at the same time primary care. Track 2 is intended for practices is based on the underlying principles of the
expressing the “quality of care” agenda. We proficient in comprehensive primary care that existing Comprehensive Primary Care Plus
have seen many changes since the first ma- are prepared to increase the depth, breadth, (CPC+) model design
jor change of Resource-Based Relative Value and scope of medical care delivered to their pa- • Prioritizing the doctor-patient relationship
Scale (RBRVS) back in 1992. Over the past 17 tients, particularly those with complex needs. • Enhancing care for patients with complex
years, CMS has collected a vast database of in- Members of the CPC+ program are paid on a chronic needs and
formation regarding the treatment of patients “per beneficiary per month (PBPM)” system • High need, seriously ill patients
with both various diseases and specific dis- known as a “Care Management Fee (CMF).” • Reducing administrative burden, and
eases. Treatment patterns, associated tests and For Track 1, the average PBPM is $15; for • Focusing financial rewards on improved
procedures, timelines for treatment and prog- Track 2, the average PBPM is $28. The pay- health outcomes
nosis stability, etc. have provided both CMS ments for these tracks are broken down into Primary Care First Model Options will be
and numerous health insurance companies to tiers, which consist of diagnosis from the “Hi- offered in 27 regions of the U.S. in 2020. Some
fine tune the data and more importantly align erarchical Condition Category (HCC).” Each of these states and regions have previously par-
the data (both diagnosis and practice patterns) tier is part of the quartiles associated with the ticipated in the CPC+ program so it will be a
with various reimbursement strategies. There HCC; the first quartile pays the lowest rate matter of remaining in their current choice or
have been reductions in the relative value units PBPM and the fourth tier pays the highest. applying for this new model. The statewide of-
(RVUs) as well as combinations of procedures This program continues and offers practices ferings will be for:
with one price. We have seen Ambulatory Pa- the ability to assess their operations and pro- • Alaska
tient Groups (APGs) and Ambulatory Patient fessional care standards as reflected in their • Arkansas
Classification (APCs) developed and imple- own data submitted to CMS. With all of this • California
mented to further strive to reduce payments data collected over the last couple of years, • Colorado
for physician services. The “experiments” and CMS is offering a set of new models that can • Delaware
strategies continue. further challenge practice behavior. For pa- • Florida
In 2017, Comprehensive Primary Care tient accounting, it becomes an area for new • Hawaii
Plus (CPC+) was initiated in 14 regions of our strategies to take place in properly and compli-
country involving 53 payers and 2,891 physi- antly billing and collecting for services as well Continued on page 10
8 The Journal of Healthcare Administrative ManagementFALL2019 Fall 2019 9
continued from page 8 model provides participating practitioners sociated with the various elements. We can all
with the freedom to innovate their care de- accept the flat primary care visit fee of $50.52
• Louisiana livery approach based on their unique patient (adjusted regionally). To this is added a popu-
• Maine population and resources. The program re- lation-based payment of PBPM. This payment
• Massachusetts wards participants with additional revenue is tied to the average hierarchical condition
• Michigan for taking on limited risk based on “easily un- categories which are segmented into 5 groups.
• Montana derstood, actionable outcomes”…says CMS. The payments for this range based on the over-
• Nebraska CMS will use a focused set of clinical qual- all risk factor of the patient population. So, this
• New Hampshire ity and patient experience measures to assess is the first part of the standard payment struc-
• New Jersey quality of care delivered at the practice. There ture. The 10% incentive is an annual consider-
• North Dakota are certain standards that the practice must ation based on if the practice met the quality
• Ohio meet that reflect quality of care. These mea- benchmarks established for them.
• Oklahoma sures were selected to be actionable, clinically The final piece of this payment structure
• Oregon meaningful and aligned with CMS’s broader is 50% which is broken into three sections: na-
• Rhode Island quality measurement strategy. Measures in- tional adjustment, cohort adjustment, and con-
• Tennessee clude: tinuous improvement adjustment. This model
• Virginia • A patient experience of care survey payment is scheduled to be paid on a quarterly
The regions offering this model are: • Controlling high blood pressure basis and each section has a part of the total
• Greater Buffalo, New York • Diabetes hemoglobin A1c poor control 50%. The first section is national adjustment
• Greater Kansas City, Missouri and Kansas • Colorectal cancer screening and of 10%. This addresses the question “is prac-
• Greater Philadelphia • Advance care planning tice performance above the national acute hos-
• North Hudson-Capital region, New York Practices will be incentivized to deliver pital utilization minimum benchmark?”…yes
• Northern Kentucky patient-centered care that reduces acute hos- or no. The next section is known as the cohort
Primary Care First addresses the needs pital utilization. This model focuses and is adjustment and ask “is the practice performing
of Medicare beneficiaries from chronic condi- oriented around comprehensive primary care in the top 50% of Primary Care First practices?
tions to seriously ill patients. This is addressed functions: If yes, the practice is eligible for an adjustment
in the fact that there are 2 models, Primary 1. Access and continuity of up to 34% based on performance compared
Care First focusing on advance primary care 2. Care management to peers. Data review coming from CMS will
and Primary Care First for seriously ill patients 3. Comprehensiveness and coordination have to be closely examined when this infor-
(SIP) focusing on the needs of patients with 4. Patient and caregiver engagement mation is released. You may have to do some
highly serious illness, hospice or palliative 5. Planned care and population health investigation yourself to validate published
care. Part Two of this article will address more The participation in this CMS model is findings. You should also ask how all of this
specifics regarding the SIP model. open to all primary care practitioners certified data is collected and evaluated by CMS in its
Primary Care First focuses on the needs in internal medicine, general medicine, geriat- decisions. The last 16% consideration is based
of chronic condition patients by creating a ric medicine, family medicine and hospice and on continuous improvement which means
seamless continuum of care and accommo- palliative medicine. The SIP model will focus “did the practice achieve their acute hospital
dates a continuum of interest providers. The on the key certifications of geriatric medicine, utilization improvement target?”
payment options test whether delivery of ad- hospice and palliative medicine. Each of these sections in the payment
vance primary care can reduce total cost of The payment mechanism for these mod- structure are also adjusted based on where the
care, accommodating practices at multiple els has, supposedly, been designed to be sim- practice falls into the percentile levels. For
stages of readiness to assume accountability ple. There is a flat primary care visit fee added instance, if the practice performance falls into
for patient outcomes. This model will focus on to a population-based payment (PBPM) for the 40 to 60 percentile level, the practice will
advanced primary care practices ready to as- the practice. To this, there is a quarterly per- receive a 20% boost, not the 34% potential al-
sume financial risk in exchange for reduced ad- formance-based adjustment providing up to a location. Confused yet?
ministrative burdens and performance-based 50% increase in revenue based on the measures As professionals, we are asked to manage
payments. Based on all the data collected, discussed above. There is also a 10% incentive and lead in the patient accounting arena. Mod-
CMS will prioritize patient choice in the as- to reduce costs and improve quality (e.g. low els like these can be confusing not only in col-
signment of Medicare beneficiaries to Primary hospital admission rate). Sound simple? Well, lecting and validating the data but in explain-
Care First practices. it can be stated as simple but you should rec- ing the results to others.
Although this may sound different, this ognize there are a number of calculations as-
10 The Journal of Healthcare Administrative Management2019
AAHAM ANI
October 9-11, 2019
Caesars Palace
Las Vegas, Nevada
Summer
Fall
Fall 2019
2019 2019 11
112019 AAHAM Annual National Institute
This year’s ANI was fantastic, great speak- for more topical educational sessions. After a
ers, wonderful educational sessions, fabulous quick break, everyone gathered for the popular
exhibitors, generous sponsors and more net- Thursday night networking reception, “All In
working opportunities than ever! Gaming Night” and learned how to play Craps,
After a delicious Wednesday kick-off buf- Roulette, Poker and Black Jack while enjoying
fet lunch, AAHAM President John Currier, sliders, wings and a tater tot bar. Party goers
CRCE, officiated the annual business meeting got into the Vegas spirit and came dressed as
and awards ceremony where he presented the ecutive and professionally certified members their favorite Las Vegas performers.
Journal awards and recognized our outgoing attended the annual CRCE/CRCP Breakfast On Friday, attendees started their morn-
and incoming executive officers and awards ceremony. Awards included the ing off with coffee and snacks with the exhibi-
The prestigious Chapter Excellence, Pres- Certification Excellence awards for high- tors while completing their ballots for Best
ident’s and Bill Spare awards were bestowed as est exam scores and awards for chapters with Booth Design, Best Giveaway, Friendliest
well as a special gift to outgoing Chair of the the most certified members. After coffee and Booth Team and Best Sales Presentation. Af-
Board, Victoria (Vicki) Di Tomaso, CRCE. snacks with the exhibitors, everyone enjoyed terwards, they gathered in the exhibit hall for
Keynote speaker, Patrick Sweeney presented keynote presenter Lindsay Boccardo’s inter- a final buffet lunch and exhibitor drawings.
the opening keynote session, “Using Fear as esting session, “Motivation and the Millen- The afternoon kicked off with the popular
Fuel” about his experience of facing fear head nial Mindset: Harnessing a Multigenerational panel discussion, “Price Transparency” which
on after being diagnosed with Leukemia, and Workforce” about how engaging your multi- impacts all providers of care. The day ended
how he learned life’s secrets to success. Later, generational can help you maximize the value with the closing session, “Healthcare, Politics,
first time attendees and new members met and of generational differences on your team. and Trump: Separating the Politics from the
mingled with the AAHAM Board of Directors. Afterwards, attendees enjoyed a tasty Policy” by Paul Miller, AAHAM’s Govern-
The evening culminated with a lively welcome lunch buffet in the packed exhibit hall when the ment Affairs Liaison. After prize drawings, the
reception in the spacious exhibit hall, where concurrent sessions ended. Awards for chapter ANI came to a close, but everyone promised to
attendees enjoyed delicious appetizers and vis- milestones, achievement, retention and $9,000 meet again at next year’s ANI in New Orleans,
ited our fantastic exhibitors. in scholarship winners were also announced. Louisiana, at the popular Sheraton New Or-
On Thursday, almost one hundred ex- Later, the group filled the meeting rooms leans hotel, right in the French Quarter.
The following awards were presented at the ANI this year:
Bill Spare National Recognition Award National President’s Award
The Bill Spare National Recognition Award is given to an individual The National President’s award is a special award the President makes
nominated by their peers for recognition of having excelled in the pro- to recognize a member who they feel has made an exceptional contribu-
motion of their chapter and the profession of healthcare administrative tion at the national level towards furthering our noble profession.
management. • This year it went to outstanding member and Treasurer, Kenny Ko-
• This year it went to stellar member Lisa Laudeman, CRCE, President erner CRCE, of the Illinois Chapter.
of the Pennsylvania Keystone Chapter.
Chapter Excellence Award
The Chapter Excellence Award recognizes AAHAM chapters for excel- Chapters with 61-99 National Members
lence in pursuing the goals of AAHAM. “Excellence” is defined as First Place: The Wisconsin Chapter
outstanding, innovative and balanced performance in four categories: Second Place: The South Dakota Rushmore Chapter
Programs and Activities in Support of AAHAM’s Mission, Education
Chapters with 100-199 National Members
Programs, Professional Development, and Membership Development.
First Place: The Pennsylvania Keystone Chapter
Chapters with under 60 National Members Second Place: The Vermont/New Hampshire Twin States Chapter
First Place: The Massachusetts Chapter
Chapters with more than 200 National Members
Second Place: The Connecticut Chapter
First Place: The Maryland Chapter
Second Place Tie: The Virginia Chapter and Illinois Chapter
12 The Journal of Healthcare Administrative Management2019 AAHAM Annual National Institute
Journal Award Leslie A. Hampel Award
The Journal awards are divided into three categories based on the num- The Leslie A. Hampel Award was awarded to the Florida Sunshine
ber of national members within a chapter. The criteria that the judging and the Virginia Chapters for having the most new CRCE certified
is based upon are divided into the following sections: Visual/Graphics, members. The Maryland Chapter won for having the most new CRCP
Text/Articles, Organization/Production and an Overall Evaluation. certified members and the most new CRCS certified members. The
Philadelphia Chapter won for having the most new CRIP certified
Chapters with 61-99 National Members
members. The Illinois Chapter won for having the most new CCT
First Place: The Pennsylvania Three Rivers Chapter “Reflections”
certified members.
Second Place: The Minnesota Gopher Chapter “Gopher Tracks”
Chapters with 100-199 National Members
Certification Excellence Award
The Certification Excellence Award was awarded to Makayla Gerard
First Place: The Pennsylvania Keystone Chapter “The Keystone
CRCE-I of the Vermont/New Hampshire Twin States Chapter for hav-
Journal”
ing the highest score on the CRCE-I exam. Carrie Kuennen, CRCE-P,
Second Place: The Vermont/New Hampshire Twin States Chapter
of the Iowa Hawkeye Chapter won for having the highest score on the
“Ledyard Ledger”
CRCE-P exam. Jane Patrock, CRCP-I of the Maine Pine Tree Chapter
Chapters with more than 200 National Members won for having the highest score on the CRCP-I exam and Tara Gillon,
First Place: The Maryland Chapter “AAHAM Connection” CRCP-P of the Florida Sunshine Chapter won for having the highest
Second Place: The Florida Sunshine Chapter “The Florida Buzz” score on the CRCP-P exam.
All journal award submissions were evaluated complimentary by an outside Scholarship Awards
public relations firm, the Ehlers Group, www.theehlersgroup.com. The scholarship awards are given to deserving members and children
of members to assist in college tuition, books and expenses. Members
Carolyn Gostomski Award who win receive $2,500 and children of members receive $1.000 each.
The Carolyn Gostomski Membership Achievement Award recognizes $5.00 of your annual dues helps fund this worthwhile cause.
the efforts of chapters who have increased their national members by a
Members who won this year were:
specified percentage. The winners were:
Joshua Johnson, CRCE-I from the Illinois Chapter
Chapters with under 60 National Members Dayle Harlow, from the Nebraska Aksarben Chapter
The Missouri Hawthorn Chapter
Children of members who won this year were:
Chapters with 61-99 National Members Nicholas Clark, son of Karen Clark, CRCS-I from the Maine Pine Tree
The Ohio Western Reserve Chapter Chapter
Angelina Gagliano, daughter of Lisa Gagliano, CRCE-I from the New
Chapters with 100-199 National Members
Jersey Chapter
The Vermont/New Hampshire Twin States Chapter
Paige Morgan, daughter of Frederick Morgan, CRCE-I from the Mary-
Chapters with more than 200 National Members land Chapter
The Western Region Chapter Alexander Zawojski, son of Maryann Zawojski from the New Jersey
Chapter
The National Membership Retention Award
Milestone Award
recognizes the efforts of chapters who have retained their national
We would like to commend the following chapter on reaching mile-
members by a specified percentage:
stone anniversaries in 2019:
Chapters with under 60 National Members
The Northeast Pennsylvania Chapter 35 Years
The Utah MountainWest Chapter
Chapters with 61-99 National Members
The South Dakota Rushmore Chapter Vendor Awards
Chapters with 100-199 National Members IC System won for the “Friendliest Booth Team”
The Carolina Chapter RSource Healthcare won for the “Best Giveaway”
KeyBridge Medicare Revenue Care won for the “Best Booth Design”
Chapters with more than 200 National Members
Nemadji won for the “Best Sales Presentation”
The Illinois Chapter
Congratulations to all of our winners!
Fall 2019 132019 AAHAM Annual National Institute 14 The Journal of Healthcare Administrative Management
2019 AAHAM Annual National Institute Fall 2019 15
2019 AAHAM Annual National Institute 16 The Journal of Healthcare Administrative Management
2019 AAHAM Annual National Institute Fall 2019 17
2019 AAHAM Annual National Institute 18 The Journal of Healthcare Administrative Management
2019 AAHAM Annual National Institute
A special thank you to our sponsors for their generosity and support of AAHAM and our mission:
ApprioHealth Parathon by JDA eHealth Systems MyCare Finance.com
Law Offices of Stephenson, Acquisto & Colman NHI Billing Services Commerce Healthcarea
Fall 2019 19Accelerate Your
Organizational
Transformation
by Taking These Five Key Steps
were still not fully supportive of restructur- its restructuring needs and execute on them.
By Alex Go ing. Unsurprisingly, their prior restructuring 4. Address your toughest decisions first – Once
Vice President, Freed Associates efforts had failed, despite multiple interces- leaders and staff members have analyzed and
atg@freedassociates.com sions by external consulting firms. identified the greatest needs for restructur-
2. Determine and communicate your vision ing success, courageously tackle these high-
A s organizations evolve and grow, they also
inevitably need to adapt and occasionally
restructure their processes, systems and even
for success – Plan to communicate not only
the “what” of your restructuring but also the
“why.” Employees need to understand the vi-
est areas first. If this involves personnel de-
cisions, handle it as you would want done
for yourself. The examples you set in your
teams. It’s a necessary part of success for any sion, rationale and context for your desired decision-making, in terms of decisiveness
healthy organization. Done well, restructuring changes to support them. Paint a picture that and consideration of others, will establish
can weed out operational inefficiencies, boost enables employees to envision your desired the tone and likelihood of success for your
morale and improve overall productivity and future state and rally behind the direction. future efforts.
performance. Handled poorly, restructuring Prospects improved for a restructuring an While a company’s restructuring did not
can be disruptive and unnecessarily drive qual- organization’s finance department when it involve downsizing, it still meant multiple
ity employees away. began working to determine its future needs new roles, responsibilities and processes. By
Whether you’re about to undertake a re- and engaged its employees in the decision- previously articulating the “big picture” ne-
structure or it’s on the horizon, how can you be making process. This new collaboration cre- cessity of these changes, and engaging staff
sure it goes well? You’re more likely to achieve ated a consensus for a revised department throughout the restructuring process, the
a successful restructuring when adhering to the structure. company’s leaders were able to work collab-
following five critical steps. 3. Give your restructuring the transparency and oratively with team members to achieve suc-
1. Commit to a successful organizational trans- support needed to succeed – The single most cess.
formation – Your restructuring will not suc- important factor in restructuring success is 5. Think long-term needs, then prioritize into
ceed until the organization’s leaders and their leaders who prominently and proactively logical phases of work – It’s easy in restruc-
direct reports are aligned around the neces- “walk the talk.” You need to regularly cham- turing to think primarily in terms of physical
sity of an organizational transformation, the pion and communicate about the restructur- operations, such as eliminating inefficien-
steps to get there and the effort required. If ing process, especially amid inevitable delays cies and getting the right people in the right
operational or internal political reasons are or setbacks. Your leaders need to make them- places. Your work does not end there. Think
keeping you from making that kind of com- selves accessible to those directly leading the of what’s needed long-term. This can range
mitment to restructuring, your likelihood of restructuring. Provide these managers with from ensuring your changes are delivering
success greatly lessens. the coaching, training and resources they their intended operational benefits to sup-
Consider the example of a large health need to succeed. porting cultural shifts necessary to support
system which had expanded through ac- Leaders in a newly restructured organi- your changes.
quisitions and was still trying to operate as zation did not fully understand the respon-
if were a smaller single-entity hospital. The sibilities and challenges of key departments Once a company implemented its new
health system’s processes were fragmented and thus could not help these areas prioritize structure, roles and processes, attention turned
across entities and employees were function- their work and create efficiencies. To address toward engaging senior-level leaders on a
ing under outdated job descriptions, creating this deficiency, this organization brought in phased implementation strategy. This included
duplicative work and staff frustration. De- an experienced external resource to provide
spite these issues, the organization’s leaders the sage counsel needed to objectively assess Continued on page 21
20 The Journal of Healthcare Administrative Managementcontinued from page 20 and thanking staff for their ongoing support, to describe your organization. By commit-
knowing it would be vital for the organization’s ting yourself to these five critical restructuring
updating department policies and procedures long-term success. steps, including properly leading it and ensur-
and providing corresponding staff training. Restructuring initiatives often have a less- ing the availability of sufficient resources, you
Along the way, the organization made a point than-stellar reputation due to ill-planned and are more likely to succeed and retain the good-
of celebrating all major restructuring successes poorly executed efforts. This does not need will of your workforce.
Fall 2019 21Encourage Courage,
How Fear Can Fuel Success
a culture of courage that will have five amazing lem uncovers the best solution, or someone
By Patrick Sweeney effects on your organization: who hasn’t done the same thing the same way
www.pjsweeney.com for years thinks of a new method. Those ideas
#1 Creates an environment of safety and only come forward if the team has the courage
D o you remember your first week at work?
You probably got up extra early to get
ready, put on the perfect outfit, made sure you
trust
If you are working at a place where you are
encouraged to take risks, to face your fears, to
to speak up, even if they aren’t the highest paid
person in the room.
were the first one to the office, and attacked make mistakes and even to fail, you are more #5 Saves a ton of energy
your new position with the energy of a ten- likely to be creative, innovative, and more dar- It is so tiring spending your day trying to
year old trick-or-treating on a sugar high. Part ing than the competition. read the minds of other people. In a toxic work
of your motivation was undoubtedly fear, you environment where fear is used to manipulate
might have used fear of failure in a healthy way #2 Attracts the best employees and intimidate, employees waste half of their
to motivate you to do a great job and work The most productive, driven and happy day trying to figure out the chess game of inter-
hard. But you likely made some fear-based employees are those with the confidence and nal politics. Ambitious employees try to figure
choices that, in retrospect, look pretty silly now. courage to be authentic. If you practice push- out the answers their boss wants to hear, while
Were you afraid to ask for advice because you ing out of your comfort zone, then you are less tenured staff is terrified of change or try to pro-
thought you’d look stupid? Maybe you didn’t likely to be concerned about image, protocol, tect their knowledge so they will remain neces-
speak up when you had the best idea because or trying to be someone you are not. Authen- sary. These fear-based behaviors are why more
you were the “new guy.” We’ve all been there at ticity requires courage, and when companies than 60% of American’s hate their job and can’t
some point. It’s in that spirit that I’m assigning encourage their team to be themselves and are wait for the weekend.
you a task this week. You have to find the new- accepting, amazing things happen.
est members of your company and encourage Keep in mind that hate, anger, and judg-
them to act with courage. You are their new #3 Puts a spotlight on opportunities ment are not our enemies. The thing that keeps
courage coach. When the amygdala in your brain acti- us from living the life of our dreams, a life of
Think about all the things that took you a vates, it’s telling you to fight, flee or freeze be- harmony, peace and love, is fear. If we can be
long time to build up the courage to do. Maybe cause there is a chance in the world of the cave- strong enough to recognize when fear is mak-
it was presenting to the whole executive team man that you might get hurt or die. Usually it’s ing us react, and realize it is just a two-million-
or suggesting an innovative idea, perhaps go- elimination from the tribe or not looking the year-old piece of software running on our lizard
ing on-site to a hospital. Whatever you wish most attractive that our primal mating wiring is brain, we can let it go. It’s fear that causes hate
you did earlier in your career, I want you to find trying to guard against. The ironic part is that and anger. If you can help someone who does
someone in your organization and coach them when the amygdala activates, it is almost always not have the same self-awareness and confi-
to do that thing. I want you to encourage cour- a sign there is a big growth opportunity that has dence that you have, it will help develop their
age. It will make you a happier and better per- just revealed itself. If you are open to those mo- character and make you stronger. You need to
son for changing someone’s life, and it will help ments, they build up into an amazing career. make choices that are not about survival but
someone grow in confidence. Even if you are about happiness, love, success and fulfillment.
not the CEO, you can be the change you want #4 Results in the best ideas Learning to use fear as fuel is what gives us the
to see in your company. You can help engineer Oftentimes, a new set of eyes on a prob- strength to do that.
22 The Journal of Healthcare Administrative ManagementFall 2019 23
Value-Based
Reimbursement
Management
• Infection rates tively participate in a VBR program. This step
By Ruchir “Ricky” Patel, MHA, LSSGB • Costs also outlines areas where an organization may
Managing Consultant, • Customer service metrics be performing optimally from a cost or quality
Federal Advisory Partners Hospital managed care departments have perspective that could be beneficial within an
RPatel@federaladvisory.com traditionally been responsible for payer reim- VBR arrangement.
And bursement contracts and have now taken on Step 2: Supplemental Site Research
Tim Borchert, MBA, CHFP, PMP the responsibility of managing the many items Once the overview of the organization’s
President, Federal Advisory Partners related to value-based programs. The additional capabilities related to a VBR program are
Member of the AAHAM Virginia Chapter complexity of value-based contracts requires identified, hospital managed care organiza-
TBorchert@federaladvisory.com working with data sets and hospital depart- tions should seek to dive deeper to understand
ments that may not be familiar to a traditional willingness and abilities to participate at the
V alue-based reimbursement (VBR) pro-
grams have been in place for many years
and are expected to be even more prevalent in
managed care department and its role/func-
tions. The following key steps outline Managed
Care and Business Administration functions
department level. Buy-in from key administra-
tive, IT, and clinical leaders should be obtained
to ensure initial and long-term success. Ad-
the healthcare reimbursement arena for many that should be carried out to ensure appropri- ditionally, KPIs should be reviewed and dis-
more years to come. The Centers for Medicare ate structures are in place effectively manage cussed along with ensuring the resources will
and Medicaid’s (CMS) Shared Savings models VBR programs: be available to monitor and deploy initiatives
have demonstrated program success in cost sav- Step 1: Analytics, Prioritization and to increase performance. Continuous review
ings and the increase in collaboration and qual- Triage of KPIs should also occur to ensure alignment
ity have made these reimbursement programs Analytics play a major component in VBR to VBR programs. This engagement will also
“in-demand” versus being a popular buzz word. agreements, specifically quality and customer allow for more insight into patient focused de-
This shift from volume to value has presented a service data. An organization looking to begin partments related to patient satisfaction/cus-
new dimension of back-end revenue cycle man- a VBR arrangement with a payer should under- tomer service, as these elements are prevalent
agement and demonstrates the critical need to stand the key metrics to be tracked and then within VBR programs. Finally, this should be
analyze and coordinate activities between key look within the organization to assess those conducted within the entire care team as many
healthcare business and clinical functions that metrics. The availability and standing of those other clinical and administrative areas serve as
are not in the traditional revenue cycle. metrics should be the primary focus here. Hos- key inputs for integrated care and VBR pro-
VBR programs are expanding within CMS pital managed care organizations should work gram coordination.
and have also become widespread within com- with quality and clinical leaders to understand Step 3: Payer Outreach
mercial insurance plans. In fact, payers across the availability of such data, performance, and Once a greater understanding of internal
the nation have incorporated value-based ele- trends. Additionally, understanding they key metrics, performance, and abilities for key de-
ments within existing reimbursement struc- systems, tools, priority service lines, and Key partments to implement improvement efforts,
tures or are offering separate provider terms Performance Indicator’s (KPIs) is imperative managed care should develop a plan to begin
based on value-based elements, some of which to knowing your organization from a VBR payer engagement. Most payers have existing
are outlined below: perspective. This step is critical as it lays out VBR programs, but the details may not be pub-
• Readmission rates the foundational items from a value perspec- licly available. Managed Care should assess the
• Preventative care measures tive and where an organization may need to
focus greater attention or resources to effec- Continued on page 26
24 The Journal of Healthcare Administrative ManagementYou can also read
