COVID-19 Response: Urgent, Intermediate and Long-Term Strategies and Tactics for Operational and Financial Improvement
We are holding scheduled “office hours” free of charge, during which any healthcare leader may ask questions and discuss options with our advisors. Our office hours will connect you with our content experts in areas including cash flow management, quality/performance improvement, revenue cycle, population health, rapid strategic planning, capital options analysis, clinical service planning, physician-hospital alignment, post-acute care, and team-based care implementation.
URGENT SERVICES: Positive ROI and Net Cash Flow Improvement Realized within 90 Days
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CASH FLOW PROJECTION AND CAPITAL PLANNING STRATEGY
With the deferral of elective services and procedures, reduced primary care visits, and increased costs to prepare for the COVID-19 pandemic, rural and community hospitals are experiencing a significant decrease in cash flow leading to furloughed/terminated staff and restrictions to programs. Stroudwater will work with the rural hospital finance team to develop a weekly cash flow projection considering current clinical operations, increased preparation costs, and timing of CARES Act accelerated cash, grants, and loans. The cash flow projection will place a priority on defining the cash flow run rate of the organization and accessing loan and grant dollars available through the CARES Act of 2020. Hospitals should then develop specific strategies to immediately determine CARES Act programs to be applied, the process for submitting appropriate applications and paperwork, and the anticipated timing of cash receipts and subsequent paybacks if necessary, to be built into the cash forecast. Once the cash projection is developed, Stroudwater will assist in developing a strategy for identifying, prioritizing, and estimating the cash impact of the various CARES Act provisions. Within 90 days, these services will provide positive ROI and improved cash flow.Eric Jeff Jonathan Opal
REVENUE CYCLE STEERING COMMITTEE IMPLEMENTATION AND DASHBOARD CREATION
A Revenue Cycle Steering Committee (RSC) is essential to ensure that the facility revenue cycle performs exceptionally. The entire revenue cycle must work in concert to ensure all services are represented correctly and paid on a timely basis. Sound revenue cycle practices help to ensure adequate cash flow and financial viability. As such, Stroudwater will facilitate a project aimed at establishing a functional RSC that manages revenue cycle functionality through proper use of data, metrics, accountability, and prioritized action.John B. Laurie
TELEHEALTH AND COVID-19 LAB IMPLEMENTATION ASSISTANCE
Billing guidelines and payor expectations for both telehealth services and COVID-19 laboratory testing are being updated regularly. Revenue cycle staff must understand the correct use and implementation of these services to ensure clean claim submission and timely reimbursement. Stroudwater will lead a process to ensure chargemaster, pricing, utilization, and documentation are appropriate to support compliant submission of these code sets. Stroudwater will work with clinicians, coders, department leadership, and business office staff to ensure documentation, code identification, and claim submission are primed for successful representation of services.John B. Laurie
REVENUE CYCLE COVID-19 PERFORMANCE IMPROVEMENT ASSESSMENT
To ensure that revenue cycle operational decisions are thoughtful and well informed, Stroudwater will perform a multidisciplinary review of current revenue cycle processes and coordinate those findings with administrative priorities. The multidisciplinary assessment will center on two core components: revenue cycle leadership interviews and foundational data analytics. As a result of the conversations and data review, Stroudwater will develop an action plan to address issues and provide additional resources, training, and education where necessary to improve immediate operational efficiencies and outcomes.John B. Laurie
BUSINESS OFFICE REVIEW
Stroudwater will provide a formal business office review. The goal of the business office review will be to improve operational efficiencies, grow staff knowledge base, increase expectations, and improve protocols to ensure better revenue cycle outcomes. We will focus on generating consistent gross revenue and ensuring representative net reimbursement while mitigating compliance concerns. We will place specific attention on the structure, skills, and supervision necessary to manage remote staff and empower them to perform exceptionally.John B. Laurie
PAYER CONTRACT REVIEW AND RENEGOTIATION
Now, more than ever, healthcare systems and physicians must partner with their payers to survive the operational pressures and the cash flow needs the current crisis has placed on healthcare organizations. Immediate attention should be paid to timely filing and cash flow options. Stroudwater’s Contract Review and Renegotiation services can help providers navigate both practical and creative solutions to ease the operational and financial impacts when faced with extraordinary circumstances.Cindy
INTERIM COST REPORT MODELING
For critical access hospitals (CAHs), changes in volumes and costs have a significant impact on cost-based reimbursement rates; when not properly understood, these changes can negatively impact short-term cash, longer term reimbursement, and accuracy of decision making. The current pandemic has reduced volume for many while increasing costs, resulting in higher cost-based rates. Without a financial model to understand the impact of these changes on rates, CAHs are under-reporting financial results, deferring necessary cost-based cash, and losing revenue from Medicare Advantage plans that only pay a prospective cost-based rate without settlement. Stroudwater will work with the finance team to develop a model in which the finance team can input their monthly revenue detail and general ledger into an Excel spreadsheet that will update cost-based rates immediately. These updated rates can then be submitted to the CAH’s Medicare Audit Contractor (MAC) to receive new, more accurate rates.Eric Jonathan
PROACTIVE CARE MANAGEMENT
Comprehensive Care Management has emerged as a leading strategy to manage the health of populations, according to the Agency for Healthcare Research and Quality. During the current COVID-19 pandemic, it is critical for healthcare organizations to quickly identify their vulnerable, high, and moderate risk patients/members, ensure a process to review and prioritize the lists of identified individuals, and initiate proactive outreach to them. Immediate priorities will be to facilitate continuing patient access to chronic disease and other medically necessary care and services and to identify and begin to address any immediate or anticipated psycho-social needs or barriers to care.Louise
INTERMEDIATE-TERM SERVICES: Positive ROI and Increased Cash Flow Realized within 90-180 Days
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PRIMARY CARE DESIGNATION REDESIGN
Hospitals that own or manage primary and specialty practices must ensure the practices are optimized in terms of clinic designation, staffing models, provider complement, specialty service integration, and alignment with larger regional health systems. The realignment and designation of practices often lead to considerable financial gains for hospitals and systems. Hospitals, both Critical Access Hospitals (CAH) and rural PPS hospitals, that are evaluating the acquisition or realignment of primary care practices in their market may also consider this activity.Jonathan
CLINICAL CARE SPECTRUM DEVELOPMENT
Staff competencies, provider availability, and ancillaries offered often dictate the clinical care spectrum of a hospital; however, most hospitals do not go through a formal process of identifying the services that should be provided by the hospital. This leads to inefficiencies, confusion, and overall impact to the continuity of care. Stroudwater will work with the hospital to develop an inpatient, swing bed, and or ED care spectrum that defines the level and type of services offered at the hospital based on available resources and staff.Carla
SWING BED OPTIMIZATION
Swing beds represent a hospital service line that provides essential services, especially for rural residents who prefer care close to home; however, many rural hospital swing bed programs are underutilized. This impacts the ability of the rural hospital to generate revenue and often prevents larger urban hospitals (often urban affiliates of larger health systems) from managing their inpatient units optimally. Stroudwater’s swing bed optimization initiative focuses specifically on how to pursue and achieve volume growth by identifying and addressing internal and external barriers, thus improving the financial and operational performance of the organization.Lindsay Carla
EMERGENCY DEPARTMENT THROUGHPUT
Given the vital role of the rural and community hospital emergency departments, it is imperative that efficient practices are in place to ensure time-sensitive treatment, transfer, discharge, or admission. The Stroudwater assessment evaluates current practices and provides recommendations for action steps needed to improve access, workflow and efficiency to recapture admissions lost due to lengthy wait times and inefficient practices.Carla
PRACTICE THROUGHPUT AND OPERATIONS
Many practices have experienced temporary closure during the COVID-19 pandemic. This has resulted in delayed or lost revenue and a significant bottleneck in providing patient care and access. Practices must come back online in an optimized fashion to work through the backlog of patient care effectively and generate revenue. Stroudwater will perform analysis, conduct a one-day on-site visit to interview hospitals and review practice operations, and generate a report containing high-level recommendations.Opal
PAYER CONTRACTING AND REIMBURSEMENT STRATEGY
If there is ever a time to re-think your relationship and contract strategy with your payers, the time is now. The COVID-19 crisis has highlighted the underlying dangers of a fee-for service (FFS) reimbursement system that pays only for volume. As your organization weathers the crisis and then starts to regroup during the aftermath, rethinking both the changes in the way care is delivered must go hand in hand with rethinking the payment mechanism and methodology for those newly defined and re-designed services. Stroudwater can help you evaluate your current commercial contracts and work with you to develop reimbursement models and methodologies to better align with your newly emerging delivery system, provide reimbursement methodologies and rates that make financial sense for your organization and physicians, provide clinically aligned incentives, and create or improve the partnering relationship with your commercial payers.Cindy
LONGER-TERM CASH PLANNING SERVICES: Positive ROI and Increased Cash Flow Realized within 180-365 Days
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COST REPORT REVIEWS
Most critical access hospitals (CAHs) have opportunities to improve both the accuracy of their cost reports and their cost-based reimbursement. Opportunities are generally found when an understanding of rural hospitals’ operations and best practices is combined with a detailed review of cost report worksheets. These assessments can be completed with limited involvement from senior administration and on a short time schedule, with historical returns on investment of over 25 to one.Eric Jonathan
FACILITY MASTER PLANNING AND USDA PRELIMINARY ARCHITECTURAL REPORT (PAR)
Historically low interest rates from the United States Department of Agriculture (USDA) in their Community Facilities programs suggest that rural hospitals in need of facility investments may want to explore those needs and potential options in the near term. Whether investments are for smaller facility additions and renovations, or for full replacements, the current interest rates from the USDA present an excellent opportunity to consider facility investments. Much of the market analyses, volume scenarios, financial modeling, and the site and departmental analyses required can initially be accomplished virtually. Initial reports can be developed and paused, with an interactive session, rapid report refinement and engagement completion once on-site conditions improve to allow for on-site visits.John D.