HCM-401Kemal Erkan, FACHE

Principles of Healthcare Management

Changing the Behavior

HCM-401 Week I

• Syllabus Overview• Group Project• Case Study• Midterm and Final

• Pre-test • Group Project Outline • Kyle Bain

• EMR Incentive Presentation• Meaningful Use Core Measure

• Week I presentation by Kemal Erkan

Changing The Behavior of

Responsible Parties

Changing the Behavior

• Cost • Profit

• Medicare• Medicaid

• Fee For Service• Length of Stay

• No Copay • No Deductible

PatientsPhysicians

And Hospitals

Insurance Companies

Government

Changing the Behavior

Changing the Behavior

United Medical Community Model

Changing the Behavior

• Advanced Surgery• Cardiology• Dermatology• Family Practice• Gastroenterology• Hospitalists

• Internal Medicine• Nephrology• OB/GYN

• Ophthalmology

• Optometrist• Pediatrics• Psychiatry

•Physical Pain & Rehab• Podiatry

• Pulmonary Disease• Radiology

• Rheumatology• Sports Medicine

• Urology

DHIN

Hospitals

CCHSBayhealthAI DuPont

Beebe

Labs

Other DHIN Organizations

ONE PATIENTCHART

• Patient Demographics• Medication History• Allergies• Progress Notes• Flow Charts• Immunizations• All Other Patient Related Records

United Medical Network

Changing the Behavior

United Medical ACO Qualifications based on CMS ACO Guidelines

• ACOs must have a formal legal structure to receive and distribute shared savings to participating providers.

• Each ACO must employ enough primary care professionals to treat their beneficiary population (minimum of 5,000 beneficiaries) as deemed sufficient by CMS.

• Each ACO must agree to at least three years of participation in the program. • Each ACO will have to develop sufficient information about their participating

health care professionals to support beneficiary assignment and for the determination of payments for shared savings.

• ACOs will be expected to include a leadership and management structure that includes clinical and administrative systems.

• Each ACO will be expected to have defined processes to promote evidence-based medicine, report on quality and cost measures, and coordinate care.

• ACOs will also be required to produce reports demonstrating the adoption of patient-centered care.

30 DAY READMISSION COST STUDY

Estimated # of Total Readmissions in 12 months 5,437Average Length of stay (4 days: 5437*4) 21,748# of Total Discharges 5,437Total Encounters-Days 32,622 Average payment per encounter $ 80.00

Total Payment for professional Services $ 2,609,760.00 (=32,622*80.00)

Total Payment for Hospital Stay $ 150,789,758.00 (=5,437*27,734.00)

This Estimate study does not take the reduction on the initial admissions in consideration but only focuses on 30 day Readmissions.

Changing the Behavior

Board of Partners

Executive Committee (EC)Doctors & Directors

Executive Director

Organizational Structure

Accounting Operations Legal

Changing the Behavior

Changing the Behavior

Old Method Of Reporting Sample

Changing the Behavior

United Medical ACO EHR Screen Shot for Patient Health Maintenance

Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Changing the Behavior

Balance Sheet 2011