Geisinger Health System Creating a Revenue Cycle Strategy for Mergers and Acquisitions (B08)

October 29, 2013

Presented by

Barbara M Tapscott, CHFP, CPAM VP Revenue Management, Geisinger Health System

Session Objectives

• Overview of GHS Revenue Management mergers

and acquisition strategies for integration

• Why create an M & A team?

• Mergers and Acquisitions key considerations

• Review project tools and documentation

• Lessons learned

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About Geisinger

Mission

Enhancing quality of life through an integrated

health service organization based on a balanced

program of patient care, education, research and

community service

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Geisinger Health System An Integrated Health Service Organization

Provider

Facilities

$1,760M

Physician

Practice Group

$825M

Managed Care

Companies

$2,093M

•Geisinger Medical Center – including Hospital for

Advanced Medicine (HfAM), Janet Weis’ Children’s

Hospital, Geisinger Shamokin Community Hospital

•Geisinger Wyoming Valley Medical Center

including Geisinger South Wilkes-Barre, the Henry

Cancer Center, and Pearsall Heart Hospital

•Geisinger Community Medical Center

•Geisinger Bloomsburg Hospital

•Marworth Alcohol & Chemical Dependency

Treatment Center

• MountainView Care Center

• Bloomsburg Health Care Center

• 1,623 licensed inpatient beds

• > 79K admissions/Obs & SORU

•Multispecialty group

•~ 1,020 Physician FTEs, ~ 700

advanced practitioner FTEs

•78 primary and specialty clinics

•2 outpatient surgery centers

•~ 2.4 million clinic visits

•~463,000 members (including

~77,000 Medicare Advantage and

112,000 Medicaid members)

• Diversified products

• ~37,000 contracted

providers/facilities

• 43 PA counties

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•Last updated 11/12/09

Geisinger Health System

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Hospital for Advanced Medicine Janet Weis Children’s Hospital

Geisinger Wyoming Valley (GWV)

Geisinger Community Medical Center

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Geisinger Bloomsburg Hospital

Marworth (Drug/Alcohol Treatment)

Geisinger Grays Woods

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Creating a Revenue Cycle Strategy for Mergers and Acquisitions

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A Changing Industry

• During the past decade the healthcare industry has experienced

extensive consolidation through mergers and acquisitions

• A major theme of this growth has been hospital campuses

transitioning to larger systems, and consolidation of physician

practices

• HFMA: “Hospital mergers and acquisitions have been the

primary means to consolidate, with goals to increase

market share and negotiate leverage with commercial

payers. Gaining size and scale remains a key reason to

consolidate.”

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Life Cycle of an Acquisition

Agreement signed by Entities, Regulatory Approvals

Communication to Employees, Patients & Public

Operational Analysis – People, Process, Technology

Integration Project Plan Development

Project Plan Execution & Communication

PROCESS IMPROVEMENT

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Geisinger Revenue Management

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End-to-End Revenue Cycle

ADMINISTRATIVE

SERVICES

PROFESSIONAL

OPERATIONS

CODING & REVENUE

CAPTURE

HOSPITAL

OPERATIONS

THIRD-PARTY

BILLING

CLINICAL TRIALS

COLLECTIONS

THIRD-PARTY

BILLING

COLLECTIONS

CASH

MANAGEMENT

CREDENTIALING

PATIENT CALL

CENTER

HOSP-PROF

SYSTEMS

SUPPORT

PHYSICIAN

EDUCATION

PHYSICIAN CODING

REVENUE CAPTURE

CONCURRENT

CODING - CDIP

REVENUE

ENHANCEMENT

PROFESSIONAL

REIMBURSEMENT

HOSPITAL CODING

CHARITY

PROCESSING

MA PENDING

ELIGIBILITY

INTEGRITY

ACCESS

SCHEDULING CALL

CENTER

QUALITY

ASSURANCE

PATIENT

REGISTRATION

SELF PAY

COLLECTIONS

HOSP-PROF

REVENUE

ENHANCEMENT

CREDIT BALANCES

PRE-VISIT

CLEARANCE

FINANCIAL

COUNSELING

CORPORATE

IMAGING

CHARGE MASTER

BUDGET &

PLANNING

INTERNAL

CONTROLS

BUSINESS

ANALYSIS

CHARGE CAPTURE

AUDIT

POINT OF SERVICE

COLLECTIONS

TRAINING

COMPLIANCE

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Integration Challenges

Culture

Technology

People

Performance Preservation

Geography

Policies

Patients

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Geisinger Growth

January 2012

February 2012

July 2012

January 2012 – Geisinger Shamokin Area Community Hospital

February 2012 – Geisinger Community Medical Center.

Geisinger Community Medical Care, Inc., Geisinger

MountainView Care Center

July 2012– Geisinger Bloomsburg Hospital

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How was this accomplished?

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It started with a “Check List”

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The Project Plan

• Having a check list quickly proved inefficient

• There was a need to retain decisions to model

and deploy future growth

• Project planning was fragmented. Departments

worked in silos, setting their own priorities

unintentionally disregarding co-dependencies

• There was risk in diluting resources with multiple

priorities, and ultimately impacting results

• The Mergers and Acquisition team was born!

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M & A Team • Responsible to manage the integration from a revenue cycle

perspective: People, Process & Technology

• Empowered to seek and engage subject-matter experts to collaborate

on issues that cross departmental lines or require external input

(Human Resources, Information Technology, etc.)

• Charged with Project Management including:

o Due Diligence

o Process and Decision documentation

o Communication of project status, challenges, barriers

• Identifying resource needs prior to project kick-off assists in

maintaining emphasis on core business during integration

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Selecting team members for M & A

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End-to-End Revenue Cycle

ADMINISTRATIVE

SERVICES

PROFESSIONAL

OPERATIONS

CODING & REVENUE

CAPTURE

HOSPITAL

OPERATIONS

THIRD-PARTY

BILLING

CLINICAL TRIALS

COLLECTIONS

THIRD-PARTY

BILLING

COLLECTIONS

CASH

MANAGEMENT

CREDENTIALING

PATIENT CALL

CENTER

HOSP-PROF

SYSTEMS

SUPPORT

PHYSICIAN

EDUCATION

PHYSICIAN CODING

REVENUE CAPTURE

CONCURRENT

CODING - CDIP

REVENUE

ENHANCEMENT

PROFESSIONAL

REIMBURSEMENT

HOSPITAL CODING

CHARITY

PROCESSING

MA PENDING

ELIGIBILITY

INTEGRITY

ACCESS

SCHEDULING CALL

CENTER

QUALITY

ASSURANCE

PATIENT

REGISTRATION

SELF PAY

COLLECTIONS

HOSP-PROF

REVENUE

ENHANCEMENT

CREDIT BALANCES

PRE-VISIT

CLEARANCE

FINANCIAL

COUNSELING

CORPORATE

IMAGING

CHARGE MASTER

BUDGET &

PLANNING

INTERNAL

CONTROLS

BUSINESS

ANALYSIS

CHARGE CAPTURE

AUDIT

POINT OF SERVICE

COLLECTIONS

TRAINING

COMPLIANCE

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Skills & Experience

M & A

Project Management

Information Technology Experience

Documentation

Training Skills

Revenue Management

Workflows

Communication Skills

Relationship Builders

Clinical Workflows

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Continuously Expanding Roles

Each member of this team must be:

Flexible

Quick Study Adaptable

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Team Objectives • Ensure due diligence and all aspects of

integration are addressed and on schedule.

• Facilitate communication among stakeholders

• Communicate project status to management and to various workgroups

Communication

• Assess current state of operations with key stakeholders

• Propose future state of operations; develop plan

Analysis and Development

• Document RM project questions, decisions, tasks, issues, changes to policies or standard operating procedures

Documentation

• Enforce RM project plan execution to achieve milestone dates Enforcement

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Integration Strategies

Project Plan Tools

Establish Milestones

Due Diligence Documentation

Document Storage

Communication

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Project Plan Tools

• Select a Project Manager

• Agree on a single platform or software for Project

Management

• Assign security and rights to key project stakeholders

• Establish central location for all files

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Establish Milestones

• Many revenue management components are

inter-related

• Agree on co-dependencies

• Establish desired milestones with desired project

end-date

• Milestones set the pace of the project

• Understand there will be mini-projects within the

larger context

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Due Diligence Documentation

• Ensures tasks are completed and decisions

documented

• Promotes efficiency – many revenue management

areas have co-dependencies

• Documentation is stored centrally and is

accessible to all stakeholders

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Document Storage

• Agree on a centralized location for all documents

• Agree on nomenclature:

– Workgroup

– Workgroup Task

– Workgroup Deliverable(s) Product

• Assign rights to edit or view

• Ensure your software retains versions

• Easily navigable

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Communication

• Over-communicate

• Establish frequency, day and time for Integration

meetings. A set date and time ensures participation

of most team members

• Assign resources to capture meeting minutes

• Disseminate minutes timely

• Publish meeting and milestones calendars

• Communicate progress and challenges, seek

solutions to barriers, communicate results

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Communication

• Clear definitions of acronyms and terminology

is essential

• Communication does not stop with management.

Line staff whose everyday work assignments and

roles may change, must understand how they are

affected

• Clinical or other operational staff may not be aware

of their impact on revenue management processes.

These individuals require training also

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Communication

• Never assume decisions or changes have no effect

on other areas. Information gathered and changes

may impact more employees than anticipated

• Ensure your message is heard:

– E-mail

– Meeting minutes

– Centrally share documents, decisions, project status

– Provide contact for questions

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Project Planning, Tracking and Documentation

• Workgroup meetings, topics and agenda are

managed by M & A team

• Required collaboration between M & A, revenue

management and other departments

• Collaboration with Information Technology and

Human Resources is essential

• Budget planning

• Managing expenses vs. plan

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M & A Workgroup Meeting Schedule • Meetings held through the course of the project are agenda-

driven; attendees can decide if topic is applicable to their role

• Example schedule:

o Meeting 1 – Enterprise Scheduling

o Meeting 2 – Pre-service Financial Clearance

o Meeting 3 – Patient Access – ADT

o Meeting 4 – Financial Counseling

o Meeting 5 – Charge Description Master

o Meeting 6 – Charge Capture

o Meeting 7 – Coding

o Meeting 8 – Patient Accounting

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Management Plan

• Identify key characteristics of the project

• Define key components that may impact people

– Changing roles and job descriptions

– Compensation considerations

– Technology

– Process change

– Reporting relationships

• Each integration is different. Accept this.

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RM Structure and Workgroup participation

Coding

• Charge Capture

• Coding

• CDI

• PRC

Hospital RM

• Billing & Collections

• Cash Application

• Contract

Management

Professional RM

• Billing & Collections

• Self-Pay and PSCC

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Administrative

Services

• Provider

credentialing and

enrollment

• Training and Quality

Assurance

• Testing and Security

• Technology platform

support

• E-systems support

Human Resources

• Compensation

• Job description

development

• Employee orientation

Access

• Scheduling

• Pre-Reg

• Admissions

• Financial Counseling

Integrity

• Internal Controls

• Charge Master

• Credit Balances

Information

Technology

• Financial Systems

• E.H.R.

Other Mergers and Acquisition Considerations

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Helping Managers through Change

• Recognize that new roles, operational changes and

new technology can become overwhelming very

quickly

• Take additional steps to help managers and line

employees through change:

– Communicate what to expect and how to prepare for

the project

– Review existing and proposed workflows, roles, etc.

– Provide shadowing opportunities in addition to initial

training

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Helping Managers through Change

• Engage new managers and employees in decision-

making

• Present options and recommendations, review

decision and obtain agreement

• Show empathy to project team and new employees

• Be sensitive to how messages are relayed;

messages are not always heard or accepted as

originally intended

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Helping Managers through Change

• Accept that change management will demand

additional time

• Address the fear of “new technology”, “losing

jobs”, etc.

– Encourage staff to self-test for skills assessment to

understand training opportunities and appropriate role

assignments

– Encourage staff to be open to transition to better-suited

roles

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Geographic challenges

When facilities are geographically distant from the

central business office challenges faced include:

• Employee travel time

• Long work days and employee burn out

• Potential accommodation needs

In some instances these can be overcome by the use of

technology

• Conference calls

• WebEx

• Video conferencing

Visibility is important

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Project Management Options

Depending on the size and scope of the project, there are

multiple options to consider:

• Outsource project management

• Take on the project internally

• Use a blend of internal and external resources

In our experience, each acquisition had its unique

idiosyncrasies; we had to understand and accept their

differences, and adapt our approach

Regardless of size, roles and timelines, project

management strategies and disciplines remain the same

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Adaptable M & A Strategy

Concepts and strategies are scalable for any size

project

At Geisinger, the M & A team is responsible for

integration of hospital and other providers

Projects of all sizes are managed using this

approach

New Group

Practices New Clinic Locations

New Services New

Departments New

Providers

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Conclusion

• As a health network expands it is critical internal

analysis is conducted to ensure resources are

assigned to accomplish integration

• A dedicated team who can direct such an endeavor

will prove to be a valuable resource allocation

• Collaboration among all project participants is

essential to the success of the project. This includes

revenue management, human resources, information

technology and clinical operations

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Contact information

Barbara M Tapscott, CHFP, CPAM

VP Revenue Management

Geisinger Health System

100 N. Academy Avenue

Danville, PA 17822-4944

Phone: 570-271-6432

e-mail: bmtapscott@geisinger.edu

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Appendix

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Project Plan Example

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Major Milestone List Example

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Due Diligence Documentation Example

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