volume 46 issue 16 summer 2016 our new leaders · 2019-05-24 · if you’re more socially...

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Volume 46 Issue 16 Summer 2016

OUR NEW LEADERS

TreasurerDIANE MCCARTHY, CPA, FHFMA

SecretaryDONNA SKURA

Immediate Past PresidentMEREDITH SIMONETTI, FHFMA

PresidentDAVID WOODS

President-ElectMARYANN J. REGAN

Vice PresidentMARIO DI FIGLIA

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PAST PRESIDENT2014-2015 Wendy E. Leo, FHFMA2013-2014 David Evangelista2012-2013 Palmira M. Cataliotti, FHFMA, CPA2011-2012 John I. Costa2010-2011 Edmund P. Schmidt, III, FHFMA2009-2010 Cynthia A. Strain, FHFMA2008-2009 Mary Kinsella, FHFMA2007-2008 Gordon Sanit, CPA, FHFMA2006-2007 Elizabeth Carnevale

EX-OFFICIOAll Past Presidents of the

Metropolitan New York Chapter, HFMADaniel Sisto,

President, Healthcare Association of New York StateKenneth E. Raske,

President, Greater New York Hospital AssociationKevin W. Dahill,

President & CEO, Nassau-Suffolk Hospital Council

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Chapter Officers and Board of Directors

Metro NY HFMA Newscast Schedule

Electronic Publication Date 10/23/16

Article Deadline for Receipt by Editor 9/19/16

OFFICERS 2016-2017President David WoodsPresident-Elect Maryann J. ReganVice President Mario Di FigliaTreasurer Diane McCarthy, CPA, FHFMASecretary Donna SkuraImmediate Past President Meredith Simonetti, FHFMA

BOARD OF DIRECTORSClass of 2017

Ann M. Amato, CPA, MBA Jason GottleibAlex Balko Patrick S. Semenza, CPA, CHFPCatherine Ekbom

Class of 2018Martin Abschutz, CPA, CGMA Shivam Sohan, MPA,HCA, CHFPChristina Milone, Esq. Andrew Weingartner, CHFP Sean P. Smith, CPA, MBA

Newscast Committee

EDITORS:Marty Abschutz, CPA, CGMA, Editor

James G. Fouassier, JD, Esq., Assistant Editor

COMMITTEE MEMBERS:Kiran Batheja, FHFMAJoel DziengielewskiPaulette DiNapoliPhil HoltzmanTina Jaggi

Mary Kinsella, FHFMAGinette Laliberte

Wendy Leo, FHFMAAndrew Natkin

Edmund P. Schmidt, III, FHFMAKen Sheridan

John Scanlan, FHFMACynthia Strain, FHFMA

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President’s MessageDavid Woods ...........................................................................................................................Page 5

Editor’s MessageMarty Abschutz, CPA, CGMA...................................................................................................Page 7

Calendar of Events ...............................................................................................................Page 8

New MembersRobin Ziegler ..........................................................................................................................Page 9

Committee Listings 2016-2017 ........................................................................................Page 10

Annual Business Meeting.................................................................................Page 13, 18, 23, 22

September Mourn Peter Siriani .........................................................................................................................Page 14

Medicare’s Settlement Conference Facilitation (SCF) ProgramEllen Scott, RN .....................................................................................................................Page 19

Men’s Health – “Knowledge Is Power” Dinner.................................................................Page 22

The Regional FrontEric A. Fehrman, CPA ...........................................................................................................Page 24

High Deductible Health Plans: Increasing in Popularity with Consumers and What That Means for HospitalsKevin Oakley .........................................................................................................................Page 27

HFMA Metro NY 60th Anniversary.....................................................................................Page 29

Equipment Financing and Bond Financing - How Healthcare Organizations are Making the Best Use of Each Financial ProductFirst American Healthcare Finance. .....................................................................................Page 37

I am honored you have selected me as your 2016-2017 President of the Metropolitan NewYork Chapter of the Healthcare Financial Management Association. I am also honored tohave such an outstanding dedicated and hardworking team of Officers, Board of Directors,Committee Chairs and Co-Chairs.

First, I would like to thank our Immediate Past President, Meredith Simonetti. Under Meredith’s leadership, thechapter received three National Yerger awards and shared in two additional Yergers for Region 2. We also receiveda Bronze award for Education. Meredith served the Chapter and its members proudly. Congratulations Meredithon an outstanding year!

At this year’s Leadership Training conference, National Chairperson, Mary Mirabelli, rolled out her theme, entitled“Thrive.” This certainly is an appropriate theme this year; our industry is evolving in so many different ways,creating multiple opportunities for each of us to Thrive, perhaps thinking and acting differently than we have inthe past. The Metro chapter will “thrive” by making sure our seminars and events are most helpful to you. Thiscoming year, look for more changes.

As we embark on a new education year, our committees will be addressing the latest industry issues that we face.Furthermore, we are going to continue our back-to-basic series, so we can help our newer members get up tospeed, while refreshing our veterans’ skills. As more of us find it difficult to leave the office to attend seminars, we will continue to offer you more webinars.

Our Joseph A. Levi 58th Annual Institute kickoff meeting occurred on June 2nd. We had a great meeting with lotsof new and exciting ideas for the program. I am confident that our volunteer committee will continue to set highprogramming and content standards. I look forward to another successful Institute. Also, we received such positivefeedback about our new location at the Uniondale Marriott, we have decided to keep this venue for 2017’s AnnualInstitute. The dates are March 9 and 10, 2017…mark your calendars.

Our website continues to grow and offer more information for you. Special Events will offer new social andnetworking opportunities, such as our first ever German night in July. On the other hand, we will keep some ofthe old favorites, like the Annual Golf Outing.

These are just some of the ideas we plan on implementing. Our Corporate Sponsors and volunteers help makeeverything possible. Corporate Sponsors play a key role in this organization. They allow us to educate ourmembers and our community. We thank them for their generosity to and continued support of the Metro NYChapter.

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Our Community Outreach Committee (of one person) puts on more than 15 learningsessions a year. Our newly developed Knowledge is Power Series Committee put on aHeart Health awareness dinner, with speakers and physicians from local hospitals, thispast year. It was very well attended and the feedback was extremely positive. We are goingto continue to host these events. In addition, we are going to be more involved incommunity service for those less fortunate. We will continue our food drives and will be adding other charitablework. Giving back to the community is very important; our chapter will continue to make this a priority.

I want to thank our volunteers, the current Executive Board, the Board of Directors, and all program chairs andco-chairs. Without their dedication, energy, knowledge and time commitment, this chapter would cease to exist.They truly are the driving force behind this chapter. I will have the pleasure of rolling up my sleeves to workbeside each and every one of them, this year. I ask all of you to consider volunteering on a committee. Volunteeringhas a positive impact on you, your colleagues and the members who reap the fruits of your efforts.

As your President, I want to make sure that your membership needs are being met. If there is anything I can doto improve our Chapter, please let me know. If you would like to become more involved in the Chapter byparticipating on a committee, please let me know.

I look forward to a successful year and the opportunity to serve you.

David WoodsPresident

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By Marty Abschutz

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This is a column I have written several times and in several ways. It’s about the benefits you can get out of yourHFMA membership. I used the word “can” to emphasize that not everyone gets the most from their membership.

Getting more from your membership involves you. Funny that I chose the word “involves” too. I believe oneimportant way to get the most from your membership is to involve yourself in a committee. There are more than30 committees from which to choose. If you’re the type of person that likes to dive right in, consider joining theAnnual Institute planning committee. The Annual Institute is our chapter’s signature education event. It takesplace over two days in March 2017. There are many aspects to the event, i.e., plenty of opportunities to volunteerto help on some part of the event.

If you’re more socially inclined, consider joining the Social Events, Community Outreach or Newscast committees.Yes, I am making a shameless plug for the Newscast Committee. Among the challenges for the NewscastCommittee are keeping our LinkedIn and Facebook pages relevant, while tweeting on Twitter, too. Currently, PhilHoltzman does a great job. Our Social Events committee has come up with a Day at the Races and Oktoberfest,while still making time to plan the Annual Golf Outing and Long Island Ducks baseball. The Community Outreachcommittee presents health-related programs to the general community.

For those of us who are interested in more technical subjects, we have something for almost everyone. The rangeof subject matter education committees starts at Auditing, Continuing Care and Corporate Compliance/InternalAudit to Managed Care, Medical Group Management, Management Information Services and Patient FinancialServices. Right in the middle of the pack three huge education-related committees: Finance/Reimbursement,General Education, HIM/UR and Legal Affairs.

While that is a substantial breadth of possibilities, we have several more committees that might pique yourinterest: Central Registration is a good committee, which enables you to easily meet lots of members, whileperforming an essential good for the Chapter; Corporate Sponsorship is a good committee if you like meetingpeople in the course of increasing the Chapter’s revenues (which enables us to finance our great educationprograms); Membership is another great committee for meeting members, even if you’re a new member yourself;if you have web skills or interest or would like to assist fellow members looking for opportunities, the Webmasterand Personnel Placement Committee might be for you; the Yerger Award Committee does a great job of writingup our annual applications to National HFMA, identifying the many innovative programs, education or social,that our chapter implements each year – sometimes collaborating with other chapters in HFMA Region 2. Did Imention the Region 2 Committee…?

I didn’t mean the above to be an exhaustive list of the opportunities to get involved; it’s not. Please check the fullCommittee and Committee Chair list that appears a few pages after this. If you don’t see something there, contactDavid Woods, Chapter President, with your thoughts. Enjoy the rest of summer; I’ll “see you in September”October.

2016 IMPORTANT DATES

September 21, 2016 Community Outreach East Rockaway Library

September 23, 2016 Mid-year Reimbursement Update TBD

September 27, 2016 Community Outreach Hillside Public Library

September 29, 2016 Medicare Fundamentals LaGuardia Marriott

October 5, 2016 Community Outreach Lynbrook Seniors Grp

October 21, 2016 Community Outreach Island Park Senior Library Group

November 14, 2016 Accounting & Audit Update TBD

December 1, 2016 Academy/Mini AI LaGuardia Marriott

FREE Webinars (Check www.hfmametrony.org and

www.hfma.org for more)

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HFMA Seminars provide timely, in-depth strategies and metrics to help you keep

pace with the healthcare finance topics you care about the most. View all upcoming

HFMA Seminars and register at www.hfma.org/seminars.

The Metropolitan New York Chapter of HFMA Proudly Welcomes the Following New Members!

By Robin Ziegler, Membership Committee Chair

MetroNY HFMA is pleased to welcome the following new members to our Chapter. We ask our current membership to rollout the red carpet to these new members and help them see for themselves the benefits of HFMA membership. Encouragethem to attend seminars and other Chapter events. We ask these new members to consider joining a Committee to not onlyhelp the Chapter accomplish its work, but to expand their networks of top notch personal and professional relationships.See the list of MetroNY HFMA Committee Chairs, along with their contact information, listed in this eNewsletter.

MARCH 2016

Winifred MackNorthwell Health

Nikolla GazivodaHospital Receivables Systems, Inc.

Peter AllenNYU Medical Center

Sue SmithVee Technologies

Ketan Patel

Peter FleischutNew York Presbyterian

John MollicaPricewaterhouseCoopers

John J. FernandezNorthwell Health Physician Part-ners

Michael DiCarloNorthwell Health Physician Part-ners

Michael GottesmanNorthwell Health

Regina Brandow

John BrynePena4

Steve SchumannParker Jewish institute for HealthCare & Rehabilitation

Tatiana ValenzuelaOptum360

Nadezda RichardsThe Connex Group

Richard KunkelNetwork Recovery Services

Eileen O’DonnellPricewaterhouseCoopers LLP

Eveline Van BeckKPMG LLP

Vinod NairNorthwell Health

Asha A. CesarNorthwell Health

Laura Conte

APRIL 2016

Julia SweeneyMedAssets + Predyse

Michael TsangNYULMC

Roseann ClohessyOptum360

Samira ChowdhuryGrant Thornton

Carolyne HoeyGrant Thornton LLP

Kyth TrieuMount Sinai DSRIP PMO

Janet ThomsonHexaware Technologies

Jenny DachowskiZiegler

MAY 2016

Lisa Chan

Janine BeineMercy Medical Center

Stuart PenaMontefiore Medical Center

Sonia BarbosaHealthfirst

Jacqueline MyronPeconic Bay Medical Center

Nick KrzemienskiStandards & Poor’s

James WoodsWells Fargo

Robert BraunEpiscopal Health Services, Inc.

Gina CeledonFlushing Hospital

Taylor ReganPOM Recoveries, Inc.

Andrew NguyenNorthwell Health System

Galen RobbinsBank of America

Joe BlundoTCV

Gerald ArguttoPOM Recoveries, Inc.

Salvatore ArguttoPOM Recoveries, Inc.

Amy EspinalPOM Recoveries, Inc.

Lauren SerafinPOM Recoveries, Inc.

Christa ViscusePOM Recoveries, Inc.

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CommitteeName Chair Co-Chair ViCe Chair 1 ViCe Chair 2 ViCe Chair 3

adVisory CouNCil Wendy leo david evangelista John Coster Cindy strain

[email protected] [email protected] [email protected] [email protected]

(516) 454-0700 (718) 206-6930 (516) 240-8147 (516) 796-3700

58th aNNual sean smith Christian Borchert andrew Weingartner Bob Jacobs Jim argutto

iNstitute [email protected] [email protected] [email protected] [email protected] [email protected]

(516) 562-6013 (315) 530-8079 516-240-8147 (516) 616-0200 ext. 201 (631) 761-1028

auditiNg John scanlan gordon sanit edmund schmidt Joe guaraccino


(718) 283-3911 (516) 918-7065 (516) 255-1666 (914) 681-2130

BylaWs donna skura maryann regan mario di Figlia

[email protected] [email protected] [email protected]

(516) 572-4498 (516) 576-5601 (516) 876-1386

CeNtral robin Ziegler annie lemoine Chrissy Kern

registratioN [email protected] [email protected] [email protected]

(516) 338-1100 x314 (516) 326-0808 ext 3312 516-296-1000

CertiFiCatioN Jim Petty Kiran Batheja art Cusack John scanlan

CoaChiNg [email protected] [email protected] [email protected] [email protected]

(516) 876-6022 (917) 603-7670 (718) 283-3911

CertiFied memBers Kiran Batheja

[email protected]

CommuNity Josephine Vaglio Christina milone david evangelista

outreaCh [email protected] [email protected] [email protected]

(516) 248-2422 (516) 296-1000 (718) 206-6930

CoNtiNuiNg Care Christina milone

[email protected]

(516) 296-1000

CorP ComPliaNCe/ ann amato laurie radler mathew schwartz

iNterNal audit [email protected] [email protected] [email protected]

(516) 632-3405 (646) 471-7409 (646) 453-1252

CPe’s edmund schmidt iii John scanlan

[email protected] [email protected]

(516) 255-1666 (718) 283-3911

dCms/ robin Ziegler henry serra david Woods

BalaNCed [email protected] [email protected] [email protected]

sCoreCard (516) 338-1100 x314 (516) 705-1895 (212) 979-4566

exeC. Comm. maryann regan mario di Figlia david Woods

& PlaNNiNg [email protected] [email protected] [email protected]

(516) 576-5601 (516) 876-1386 (212) 979-4566

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CommitteeName Chair Co-Chair ViCe Chair 1 ViCe Chair 2 ViCe Chair 3

FiNaNCe/ alex Balko Pat semenza tracy roland Kwok Chang

reimBursemeNt/ [email protected] [email protected] [email protected] [email protected]

audit (516) 632-3965 (718) 488-3715 (908) 377-5122 (212) 979-4324

FouNders aWards Paulette diNapoli shivam sohan


(718) 518-2064 (516) 576-1801

geNeral eduCatioN Catherine ekbom annie lemoine henry serra Jason gottlieb rachele hashinsky

[email protected] [email protected] [email protected] [email protected] [email protected]

(516) 745-0161 (516) 326-0808 ext 3312 (516) 705-1895 (646) 227-3156 (516) 296-1000

him/ur stacey levitt annie lemoine


(646) 732-5052 (516) 326-0808 x 3312

historiaN

iNVestmeNt mario di Figlia diane mcCarthy


(516) 876-1386 (516) 349-4643

legal aFFairs Christina milone Fred miller


(516) 296-1000 (516) 393-2250

maNaged Care James Fouassier david evangelista Patrick Nolan


(631) 638-4012 (718) 206-6930 (212) 430-6620

msP Kiran Batheja robin Ziegler


(516) 338-1100 x314

memBershiP robin Ziegler

marKetiNg [email protected]

(516) 507-5314

mediCal grP mgmt. Josephine Vaglio andrie Kazamias art Cusack


(516) 248-2422 (516) 918-7097 (917) 603-7670

mis rivka gross Ken reda dan Corcoran

[healthcare [email protected] [email protected] [email protected]

technology] (732) 551-3338

NeWsCast marty abschutz James Fouassier


732-906-8700 x 109 631-638-4012

NomiNatiNg meredith simonetti

[email protected]

(631) 465-6877

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CommitteeName Chair Co-Chair ViCe Chair 1 ViCe Chair 2 ViCe Chair 3ViCe Chair 4

reVeNue CyCle Christian Borchert Jill Prisco hayes robin Ziegler

Committee [email protected] [email protected] [email protected]

(Formerly PatieNt (315) 530-8079 (484) 832-9940 (516) 338-1100 x314

FiNaNCial serViCes)

PPdd meredith simonetti

[email protected]

(631) 465-6877

WeBmaster aNd andrew Weingartner Cindy strain shivam sohan

PersoNNel [email protected] [email protected] [email protected]

PlaCemeNt 516-240-8147 (516) 796-3700 (516) 576-1801

PuBliC relatioNs Jason gottlieb

& CommuNiCatioNs [email protected]

(212) 297-4549

regioN 2 John Coster Kiran Batheja


(516) 240-8147

regioN 2 mario di Figlia shivam sohan

CollaBoratioN [email protected] [email protected]

(516) 876-1386 (516) 576-1801

ryaN aWard meredith simonetti

[email protected]

(631) 465-6877

soCial eVeNts Kiran Batheja John Coster gordon sanit John mertz


(516) 240-8147 (631) 495-6596 (516) 632-3170

sPoNsorshiP Wendy leo maryann regan


(516) 454-0700 (516) 576-5601

yerger aWard dana Keefer michele manuel Jonathan segal


(315) 938-5624 (212) 857-5269 (212) 274-7230

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Photos selected by Marty Abschutz

September MournMy September 11, 2001 ExperiencesRememberedBy: Pete Siriani[Editor’s note: I received the following note from Pete Siriani,accompanying this article. I found the note and the article so powerfuland poignant that I present it here with barely any edits.]

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In September of 2001, my wife was away visiting her sister and baby niece at their summer home in Hampton Bays, LongIsland. I awoke at my usual 5:50 to shower, shave, dress and head off for the subway ride to my job at New York Hospitalin Flushing, Queens. I then remembered I had plenty of time as I would be attending a computer user meeting held atSiemens Eagle system offices at Two Penn Plaza that morning at 9AM. Penn Plaza, which is the building atop Penn Stationand Madison Square Garden, was just a walk from my Gramercy Park Co-Op apartment on East 21st Street. This gave methe opportunity to relax a bit before leaving home. It was a pleasant day, so I walked leisurely across and up town, as wasmy usual practice. I reached Seventh Avenue at 30th Street and turned north. I had been hearing sirens for a while; that isnot unusual in New York City. As I crossed 31st Street, fire trucks, horns blaring, were racing South past me. I did not turnto look downtown at that time, as I thought this was a typical fire department emergency. I entered Two Penn Plaza andtook the elevator up 20 floors to the Eagle System offices. Many of the other hospital users were already present. Just asthe meeting was about to begin, Julius Derdik, Eagle System manager, announced there had been a terrible accident: anairplane had crashed into one of the World Trade Center (Twin) Towers. The group was stunned. I, myself, had been a childwhen a World War 11 B26 bomber had accidentally crashed into the Empire State Building in 1945. My father had takenme to see the site in the following days. I recall the crew of the plane were killed as were many workers at Catholic Charitiesof New York, the office at the site of the impact. Shortly after we checked in, another member of our group arrived. Thisyoung lady, from a Brooklyn Hospital, actually had seen the plane crash into the Tower from the Brooklyn Bridge, as herhusband was driving her to the meeting. She was in a very disturbed state; as we digested the information, Julius Derdikentered the meeting room again to announce a second plane had crashed into the other Twin Tower building. By this time,radios and TVs were on, so we quickly learned that a similar attack by air had taken place in Washington, DC, at thePentagon. An erroneous rumor that similar suicide planes were attacking JFK airport in Queens and others were headingfor large buildings in Manhattan was spreading; since Penn Plaza was a well-known large building, we all decided to endthe meeting to try to get to work. However, a police officer was blocking the subway entrance on 32nd Street; we learnedthat subway services were curtailed, entrances were on lockdown, and bridges and tunnels were closed to all, saveemergency services. I tried to reach my employer in Queens, but land line and cell phones were not working at that time.I also tried to reach my wife to no avail. A fellow attendee at the meeting, Glen Ednie, worked for New York Cornell at theEast 38th Street business office. I decided to join Glen: I might be able to work at that location or be of some help to theirHospital Trauma Center on East 70th Street. As Glen and I crossed Sixth Avenue, the ground beneath us began shaking andwe turned South to see a huge explosion. The resultant cloud seemed like a volcano eruption, spewing ash and smoke. Itreminded me of the films I had seen as a kid of the Atom bomb cloud, rising over Hiroshima. Smoke filled the air; peoplein the street were screaming as the cloud of ash started to spread. The Tower had fallen, taking all those still inside andothers too close to the site with it. Mayor Rudolph Giuliani was at the scene and initially ordered 20,000 body bags to thesite. Glen and I arrived at the 38th Street Office. While all at the office were ready and willing to assist in any way possible,Karen Feeley, Assistant Director, advised us she had already contacted the Trauma Center; while they had more than enoughstaff, they would welcome RNs or other medical professionals, in the event their burn center experienced backups. I, again,tried to call New York Queens (NYQ) and my wife with no result, as calls were still not going through. I had left the muchsmaller Cabrini Medical Center the previous January to return to my former long-term employer, New York Hospital Queens.I had served Cabrini as Assistant Vice President in charge of Patient Finance and Access. Cabrini was much closer to thescene of the tragedy, so I realized I might be of help at that Institution. I walked down Second Avenue, past my co-op on21st Street, to the Cabrini Medical Center entrance on 19th Street between Second and Third Avenues. I was struck by the

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long lines of people in front of Cabrini ready to give blood for the injured. Sarah Walters, Cabrini VP, was standing by theentrance and welcomed me as I volunteered to help wherever needed. Sarah said help was needed on patient intake.Surya Jones, Admitting Director, was relieved to see me as she was trying to handle both Admitting and EmergencyRegistration duties at the same time. As I had been in charge of both of these areas at Cabrini, and was familiar with allemergency procedures, I took over the ED process and performed much of the “hands on” intake process. Cabrini had notbeen a high level Trauma Center, averaging 18,000 visits per year, while New York Queens was averaging almost 135,000visits per year. Many private staff physicians were volunteering and assisting the regular ED staff. Sebastiano Cassaro, aprominent private staff surgeon, placed himself at the Ambulance entrance and performed triage on incoming victims alongwith Sue Wright, RN, who was the Operating Room Supervisor. TV reports indicated many of the Trade Center injured werebeing treated at Beekman Hospital, a smaller affiliate of New York Presbyterian, as it was nearest to the scene of thetragedy. Most of the injured were being taken to St. Vincent’s Hospital, a much larger facility in Greenwich Village. Otherswere being taken to Cabrini and our neighbor, Beth Israel Hospital. Our ED was overflowing, so we commandeered theadjacent Wound Care Center to serve as temporary non trauma, while we treated the incoming Tower casualties in themain ED. I recall the first victims coming in, as Surya and I registered them, assigning them to patient areas and rooms.One young 21 year old woman kept screaming, “I see the wing, I see the wing.” An elderly Hispanic woman kept muttering,“Catolica, Catolica,” which I interpreted to mean Catholic. Cabrini was a Hospital administered by an order of Nuns foundedby Mother Cabrini, so there were always clergy about. I spotted a Priest and he went to administer to the Hispanic woman.The ED was soon overcrowded, and while the Hospital front entrance was on 19th Street between Second and Third Avenues,the ED and Ambulance entrance was in the back of the Hospital on 20th Street between Second and Third. Directly acrossthe street from this entrance stood the New York City Police Academy, the training ground for New York’s Finest. Needlessto say, Police instructors and cadets were clearing the street and volunteering to help in any way they could. Two of myclosest friends, Rich Del Gaudio and Jimmy Boyle, were Sergeants and instructors at the Academy. I spoke to Richie to seeif there was any new information coming from the site. He told me the NYC Disaster Command Post at the World TradeCenter site had been destroyed. Mayor Giuliani and Command Center Headquarters would be operating from the PoliceAcademy building. Rich had to get back to guard the Academy entrance, since some of the more aggressive media personnelwere unlawfully attempting to enter the Command Center without permission.vMore and more patients were arriving;numerous Police and Fire personnel were seeking assistance for smoke and respiratory issues. We were overcrowded andin an effort to make more space, we discharged those patients who were stable and ready for home. I had one bit of difficultywith a patient who refused to leave, although nothing other than his chronic alcoholism was the reason for his visit. Hewas what is called a “frequent flyer” in ED circles: he would call for an ambulance or walk into the ED anytime he felt likea free lunch. When I pulled a wheelchair over, and along with a Police Officer on duty, picked him up and put him in thechair, he began threatening us in foul and abusive language. The Officer pushed the chair out the door and down 20th Streettoward Second Avenue …and merrily he rolled along. In the late afternoon, we noticed fewer casualties coming in and then,most were rescue workers with injuries related to burns and eye problems. I had run out of Triage tags, so walked tonearby Beth Israel Hospital. The ED Director there let me have a few tags, but they too were running low on the tags.Returning to Cabrini, I spotted an NYC Fire Department Ambulance. The EMT’s on the ambulance did have a supply of tags,giving me a full bag. Back on duty in the ED, I finally reached my boss, Kevin J. Ward, at New York Queens. They haddispatched an ambulance to Manhattan, which had not reported back. The NYQ ED had seen a few patients who werepolice and fire rescue personnel returning to their homes in Queens and Long Island with problems related to the tragedy.Kevin said he understood the main volume of victims were being taken to Manhattan Hospitals, so I should stay at theCabrini ED since I certainly could be more useful there. As the afternoon turned to evening, fewer ambulances and victimswere arriving at the ED. Most coming in at that time were first responders with mainly respiratory issues. My friend JimmyBoyle stopped into the ED and asked if we had any news about his brother, Fireman Mike Boyle, whom Jimmy believed hadresponded to the disaster with his engine company from Lafayette Street in lower Manhattan. Jimmy, as well as Rich DelGaudio, were assigned to the Academy as instructors. They were both part of my “Friday Crew” at Paddy McGuire’s AleHouse, located right around the corner on Third Avenue between 19th and 20th streets. The previous Friday evening, MikeBoyle had stopped by Paddy’s to ask if we wanted to attend a rally for Congressman Peter King in Long Island. Mike livedon Long Island while Jimmy resided locally in Stuyvesant Town. This is the same Peter King who is now our best knownexpert on terrorism. I told Jimmy I would follow up by contacting other Hospitals. Concurrently, Karen Feeley at New YorkHospital called as one of her employees was trying to contact her daughter, who worked at the Towers. I had no information

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about this lady and called my friend Debbie Hallgren, who was manning the ED function at St. Vincent’s. I gave her the nameof the lady, as well as that of Mike Boyle. Debbie’s ED logs showed no such persons being seen at St. Vincent’s. I finallyreached my wife in Hampton Bays, advising her not to try getting into the city since bridges and tunnels were closed to allbut emergency traffic. My wife and her family were watching the news, which was now being carried on all channels. Herbaby niece, Savanna, had become quite upset by the sight of the second plane crashing and exploding on the Tower. Thatevening, as the night began, we were still busy with rescuers and other first responders presenting with various, if non-critical complaints. We were also dealing with hundreds of people coming into or calling into the ED to inquire about familyor friends who worked at the Twin Towers. Many of our Cabrini private physicians were still on hand, treating casualties.I chatted with my own Cardiologist, Ed Bernaski, as I, too, was beginning to feel some respiratory distress. At 9PM, ED intakewas slowing down. This is when I first realized the full scope of the tragedy and that we were seeing less victims becauseso many at the Towers already were dead. I went upstairs to check on patients who had been admitted to see if any changesin status had to be documented. I realized then that I had not eaten all day, so I left a staff member to cover and walkedup to Third Avenue and 20th street to grab a bite. I stopped at Paddy McGuire’s to see if anyone had information on theircustomers and friends, the Firefighters from the East 29th Street Firehouse, who all were still missing. At that point, mygood friend, Ed Hinch walked in covered in white ash, head to toe. Ed worked at a building adjoining the Towers. He wasjust out on the street when the first Tower came down showering him and all around him with white ash. I grabbed a quickslice of pizza at Iggie’s Pizzeria, where my friend Sue Wright, RN, was also catching a bite. She told me that althoughCabrini was considered a small hospital (350 beds), the Nursing staff was coping adequately with all problems. Back inthe ED, smoke inhalation and other problems (mostly eyes) continued to send people in. Mayor Giuliani already had setup the new command post at the Academy, so 20th street was overflowing with press and other media. A reporter from NewYork One, the local news channel, wanted to interview me; since I am naturally camera shy, I told him little was new savethe public continually calling in for information. At around 1AM on the 12th, Cabrini Administration held a meeting toreview the events of the day and to plan for future needs overnight and into Wednesday. I gave the ED and other statisticsto the group. I then was asked if I could come in on Wednesday in the event of further activity. I agreed as my boss at NewYork Queens had told me to stay where needed as long as necessary. At that time, the ED Medical Director reported thatone of the Cabrini Ambulances had made two trips to and from the site; it had not yet returned from a third. There was noinformation on the call at this time and all hoped for the best. I left the Hospital shortly after 2AM. I chatted with friendsand other Hospital staff on the corner of 20th St and Third Avenue; many were trying to determine the fate of friends or family.The corner was as bright as day due to all the Klieg-type lights set up by the media. I stopped into Paddy McGuire’s for astiff shot of Jameson’s, then walked up the block to my apartment on 21st St. Barricades were up on the corner, which wasguarded by Police Officers. I was asked to show identification before being permitted into the street. My eyes were burningfrom the accumulations of smoke and dust during the day, and I did have a tough time getting to sleep.

Being concerned about further activity, I awoke, showered, dressed and was back in the ED at 5:30AM. Patients withrespiratory and eye issues were still coming in. The Cabrini missing ambulance still had not returned. Most of the day wasspent fielding questions from concerned friends and relatives. Cabrini’s Human Resources Director asked me to prepare anotice to be distributed to people checking on missing persons. I did so, listing the locations and telephone numbers ofother Hospitals: New York Cornell, St. Vincent’s, Beth Israel and Beekman, who had all received a number of casualties. Ireturned home that evening to find the street blocked again, this time being manned by Suffolk County (NY) Police Officers.In the days following 9/11, thousands of Police and Firefighters came to the area to assist. The blockade on my street wasbeing manned by Miami, Florida or Cincinnati police officers and Maryland State Troopers. My building management wasdistributing ID cards with police approval, which identified those living on E.21st Street between Second and Third Avenue,allowing them to pass into the street. This was a precaution, due to the new Command Center now located on our block.The following morning before leaving for my regular position in Queens, I checked at Cabrini and learned that their missingambulance had been destroyed by the falling tower…one of their EMT’s had been found injured and alive and had been takenacross the Narrows to a New Jersey Hospital. The other EMT, Mark Smullins, was never found and later was listed amongthe dead. When I got into New York Queens on the 13th, I learned that they, too, had lost the ambulance they dispatched;fortunately none of their EMTs had been hurt. New York Queens had seen other casualties, who were returning to theirhomes or jobs in the borough. The immensity of the disaster came to light as learned Joanne Hycrack, one of my staff, hadlost her husband and our RN in charge of Oncology, Margaret Cawley, lost her firefighter son, Michael. In the following days,

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word came that Jimmy Boyle’s brother, Mike, was among the lost as well as all six from the E.29th Street fire station. Karen’semployee’s relative was gone, as was the daughter of one of my wife’s friends. The aftermath of the tragedy changed manylives. The morning of the 13th, I had taken the recently opened subway to work and went home via our New York Hospitalbus. As we approached the Queens Midtown Tunnel, law enforcement officers from Suffolk County boarded that bus toperform a quick search of the vehicle and riders. My friends, Rich Del Gaudio and other instructors at the Police Academy,went back into uniform and patrol duties. The young Police Cadets from the Academy were fast-tracked into regular patrol.The following days and week seemed surreal. The National Guard Armory on Lexington Avenue and 27th Street became animpromptu information center as family and friends of those still missing, were posting pictures of their loved ones on thefence surrounding the Armory, hoping for any information. The smoke and ash from the Twin Towers covered much of lowerManhattan. I had to have my eyes cleaned twice. At work and in my neighborhood, numerous groups were gearing up to holdcommemorative and charity events for survivors and families of the deceased. My friends and I decided to hold an eventat Paddy McGuire’s, where we had shared a beer or a Jameson’s with many of the deceased. On Friday, September 25th,an overflow crowd jammed Paddy’s to remember our lost friends. We raised a great deal of money, which was donated tothe Citywide fund to aid victims and families. All of our crowd attended the funeral mass for Mike Boyle at Saint Patrick’sCathedral, which was so full, many had to stand in the rear of the Cathedral. I noticed many politicians, past and presentwere in attendance. Mayor Rudy Giuliani, former Mayor Ed Koch, Governor George Pataki, former Governor Hugh Careyand many others came to pay their respects to Jimmy and Mike’s Dad, who had been NYC Fire Commissioner during theCarey years. I resumed occasionally driving to work and found law enforcement officers from all over America manning thecheckpoints Tunnels, Bridges and Rail Stations to relieve the NYPD of their workload. My wife returned from the Hamptons,picked up her 21st Street ID card; we experienced one of many life changes due to the 9/11 disaster. We had reservationsfor a fall vacation in Florida with Delta Airlines and Pier 66 Hotel. My wife made it clear she was too nervous flying at thistime. As we then planned to drive, we looked into vacation areas we had not been to previously. My sister recommendedRehoboth Beach, Delaware, as one of her friends had a vacation home there. We set out with no explicit area in mind anddrove over the Delaware Memorial Bridge, which also was being well protected by local Police and National Guardsmen.We continued South on Route 13 into Route 1. We drove through Rehoboth, saw the tax free shopping malls, somerestaurants and very few hotels. We subsequently learned the real activity in Rehoboth was not near Route 1, but eastwardtoward the water and beach. We continued down the highway and reached the lively Ocean City, Maryland. We registeredat the Carousel Hotel, finally relaxing in the town for the rest of the week. Many of the personnel and guests at the Hoteland the various restaurants we dined at were very interested in, and showed concern for, the condition of New York City.The trip and stay proved therapeutic to me…so much so we followed up with two more visits to Ocean City and were shownproperties by a real estate broker. In December, we purchased a Bayside condo as a second or vacation home, travelingbetween NYC and Ocean City until 2008. At that time, we purchased a larger condo in West Ocean City, where we relocatedfollowing my retirement from New York Presbyterian Hospital in 2013. I decided to write of my experience with the tragedyas I find memories begin to fade with the passage of years and I wanted to remember this time of all America pullingtogether to get through that most difficult period.

Pete was President of the Chapter 1975-1976 and an active member of the Metro NY Chapter for 48 years. The Chapterrecognized Pete with Retired Member designation, four years ago. He served as Editor of Newscast, Chairman of AnnualInstitute and was on many other committees, including HANYS groups working with managed care organizations. Petealso wrote many articles for the Chapter Newscast. On the lighter side, Tom Egan and he started the Past PresidentsDinner Dance, where Pete served as its chairman for the first 14 years.

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Medicare’s Settlement Conference Facilitation(SCF) Program: If You Haven’t Heard About it, You are not Alone.SCF is a New Initiative Intended to Alleviate the Profound Medicare Appeals Congestionat the Office of Medicare Hearings and Appeals

By: Ellen Scott, RN, on behalf of the Newscast Advisory Council

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So, you say that you have an expanding receivable tied up inMedicare Part A and Part B appeals stalled at theAdministrative Law Judge hearing level of appeal? You,certainly, are not alone. Providers in all corners of the countryhave the same lament. The U.S. Senate Finance Committee metin April, 2015, to discuss, “Creating a More Efficient and LevelPlaying Field: Audit and Appeals Issues in Medicare” to try totackle the rapid growth in the numbers of Medicare appealsand their efficient and fair adjudication. One of the go-forwardinitiatives (after an initial pilot) was a phased-in SettlementConference Facilitation program. To date, this program seemsto have been either the best kept secret in Medicare appeals ora decided flop. Here’s the information you should know todecide if this is a viable option to rid yourself of that Medicareappeals receivable.

BackgroundThe U.S. Department of Health & Human Services’ (HHS) Officeof Medicare Hearings and Appeals (OMHA) administers theAdministrative Law Judge (ALJ) hearing program (the thirdlevel of Medicare claims review), as well as entitlementappeals under sections 1155,1869, 1876, 1852, and 1860D, ofthe Social Security Act. OMHA is only one of three separateagencies under the umbrella of HHS tasked with administeringthe four levels of Medicare claims review and appeal. Thereare actually five levels of appeal rights per Regulations. Levelsone and two are administered by the Centers for Medicare &Medicaid Services (CMS). Contractors to CMS conduct the firsttwo levels of this review. Level three is tasked to OMHA. Levelfour, or the Medicare Appeals Council, is administered by theDepartment Appeals Board (DAB), and the fifth level of appealis heard at Federal District courts when the administrativeremedies have failed.

OMHA, the site of the Settlement Conference Facilitationprogram, was established in June, 2005, as part of theMedicare Prescription Drug, Improvement, and ModernizationAct of 2003 (MMA), transferring responsibilities from theSocial Security Administration to HHS. As a further safeguardto the independence of the Office and its decisions, OMHA was

established as a separate agency (functionally and fiscally)within HHS. Initially, the vision was that OMHA would be ableto adhere to a 90-day appeal turnaround time, which,essentially, was true until Fiscal Year (FY) 2010. However, the90-day time frame became folly once Medicare’s NationwideRecovery Audit program (RA) erupted on the scene, generatingvast numbers of Medicare denials and ensuing appeals.

These appeals were often pursued at this third level of appeal,inundating OMHA’s resources. The increasing caseload, due tothe RA program, was abetted by increasing appeals fromincreasing Medicare enrollment and utilization, including theMedicare Prescription Drug (Part D) program, and dually-enrolled (Medicare/Medicaid) beneficiaries. While OMHAreported that productivity doubled from FY 2009 to FY 2014,it also reported that by the end of February 2015, theadjudication time frame was 572 days; a far cry from theplanned 90-day turnaround. The OMHA appeal queue is notfirst come, first served, either. Beneficiary requests go to thefront of the line, as do Part D expedited appeals, which areassigned a 10-day turnaround time; so, yes, provider appealsare last in priority. It is no wonder that providers are dustingoff two-year-old cobwebs from pending appeals at OMHA andthinking about the viability of an alternate review process;could SCF be the answer?

The ProblemWith the charge - justice delayed is justice denied, and withthe ALJ appeals backlog reaching critical mass, HHS facedlegislative pressure related to increased beneficiaries waittimes, and provider organizations pointing to growing providerreceivables. In response, two major initiatives were put intoplay, one addressing the backlog and the other addressingcapacity. In September 2014, a massive settlement was offeredto providers related to level of care denials, i.e., short stayinpatient (Part A) claims denied to an outpatient (Part B) levelof service. CMS offered providers 68 cents on the potential PartA dollar. While many providers agreed to the settlement, CMSreported that there still were 800,000 appeals in process,post-settlement. Funding increases were also enacted in FY

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2014 and FY 2015, allowing OMHA to hire an additional 12ALJ teams and open a fifth field office in Kansas City.Furthermore, in June 2015, the Senate Finance Committeepassed the Audit & Appeals Fairness, Integrity and Reforms inMedicare (AFIRM) Act. The Act included steps for streamliningmethods to address the mounting numbers of appeals. One ofthe programs enacted to reduce the ALJ inventory, hailed with“great expectations,” was described to the Committee by NancyJ. Griswold, Chief Administrative Law Judge, OMHA. This wasthe SCF Pilot. In short, the program, started in June 2014 andaimed at reducing the providers’ appeals backlog, employsalternate dispute resolution techniques to adjudicate multipleclaims filed by one appellant, thereby avoiding hearings. ThePilot uses existing staff and budget to alternatively resolveMedicare claims appeals via the use of mediation. At that time,Judge Griswold touted that the SCF process had resolved over1000 appeals, the appeal workload of one ALJ team over a fullyear.

Without dispute, OMHA is a bottleneck in the Medicare appealsprocess, and a portion of this delay stems from the veryadministrative law judge process that affords beneficiaries andproviders a de novo hearing on the specific denial and claimissue at hand. Furthermore, OMHA review rules exemptprecedent-setting from prior decisions, or combining likeissues to speed adjudication. Each claim must be addressedon its own merits…until now. The SCF process turns the tenetsof this measured, individualized OMHA review upside down.Instead of a detailed, de novo, case review from anadministrative law team, SCF provides the opportunity toaggregate 50-plus similar issue appeals into one facilitationconference for a bulk adjudication. While intriguing, whoserves to gain the most from SCF - HHS and OMHA, orproviders, or both? Let’s delve into the SCF in further detail.

SCF: How it Works, and Response from theProvider CommunityIn overview, this program is an attempt to sidestep the delayedALJ hearing process by using an alternative method to bringCMS and the appellant (the provider) together to discuss, andfind mutually agreeable ground on which to resolve Part Aand/or Part B OMHA appeals at hand. It sounds like areasonable, almost business-like approach by a Governmententity. OMHA states that the facilitator, an employee of OMHA,is neither a fact finder, nor an official decision maker. Thefacilitator tries to bring CMS and appellant positions into focus,and then into alignment.

SCF has evolved through three phases; Phase I was the Pilot,

in which OMHA reported a total of over 2,000 Part B claimappeals settled prior to the initiation of Phase II. What OMHAdoesn’t report is the denominator, or the universe of appealsthat entered into the SCF process, but went “un-facilitated.” Inother words, how many appeals ultimately were not settled bymeans of SCF, once the settlement process was initiated? Suchun-facilitated claims could have been due to a low settlementoffer by CMS or other unsatisfactory proposed resolution.Remember, once an offer is on the table from CMS, the providerhas the option to reject the offer; if rejected, all appeals revertback to the ALJ hearing process and appeal queue.

Phase II, initiated in the fall of 2015, expanded the eligibility ofPart B claims for SCF. Most recently (2/25/16), Phase III wasopened for business. Phase III heralded the further expansionto include certain Part A appeals. Before diving into SCFeligibility and the detailed process, let’s explore why a providermight find SCF an intriguing option; there are manyconsiderations here. First, SCF offers a Medicare provider achance to quickly eliminate an aging (aging to the point ofbeing geriatric – pun intended) receivable. Remember, allappeals upheld at level two (the reconsideration level ofappeal) are subject to full CMS recoupment; appeals are oftenaging at OMHA awaiting an ALJ hearing for years! Cash flowis probably the number one incentive driving providers toexplore the SCF process.

Poor prior ALJ outcomes may be another SCF incentive.ALJ hearings are time consuming to providers and their staff.This provider administrative expense/burden can be minimizedby a consolidated settlement. This would be especially sweet,if the provider has experienced a low overturn rate afterexpending administrative time pursuing such appeals.

Some providers, faced with mounting RAC or other Medicareauditor denials, took the position, “appeal everything,” - weprovided and billed appropriate care, compliant with Medicareregulations; we should be paid. We should fight! That positionproved successful for Part A providers who were able to takeadvantage of the 2014 68% appeals settlement and theexpanded Part A to Part B re-billing opportunity. However,fighting other denials that fell into further types of Medicareservices and issues remain, lingering in the OMHA’s appealback log. The SCF allows providers with any of those issues avenue to adjudicate the “appeal everything” denials for ‘some’reimbursement, i.e, the ‘bad breath is better than no breath’school of thought.Here are the Phase III requirements for claims appeals to beeligible for the SCF:

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• The appellant must be a Medicare provider with an NPI• Appeals at issue must have been upheld at level two andsubmitted to OMHA for level three, with a hearing not yetscheduled

• The request for hearing must have been filed on or before12/31/15

• The beneficiary cannot have been found liable at anypoint in the appeals process

• At least 50 claims must be at issue, representing at least$20,000 in controversy

• Each claim must have an amount in controversy of nomore than $100,000

• All eligible OMHA claims for the same item or servicemust be included in the SCF

• Part A appeals, which were eligible for the 68%settlement, but not settled are ineligible for SCF

• The appellant has not filed for bankruptcy• To date, there is no expiration to the SCF program

If the provider has enough claims and the appropriate dollarsin controversy, they can proceed to start the process.Remember, any party can decline to participate at any time inthe SCF process. So, here’s the drill:

• Appellant submits a SCF “Expression of Interest” form forPart A claims, Part B claims, or forms for both Part Aand Part B to OMHA

• OMHA sends notice to CMS to identify whether CMSwishes to participate. If CMS decides to participate, it willproduce an eligible claims list and send it to the appellant

• The appellant then will have 15 days to file a completeSCF request and OMHA will confirm appeals potentiallysubject to a settlement

• A pre-settlement conference is held between theappellant, CMS, and the OMHA facilitator(s). This will bescheduled approximately four weeks after confirmation

• A settlement conference will be scheduled three to fourweeks after the pre-settlement conference

• If that conference yields a settlement, all requests forlevel three ALJ hearings are dismissed; if a settlement isnot reached, all appeals will go back into the ALJ queuein roughly the same order as originally requested, i.e., noharm, no fowl.

Question/Answers?What is an average recovery for an average group of claimssettled under this program? What methodology is used by CMSto come to an offer of settlement? How many providers to datehave gone through SCF? How many providers accepted theCMS settlement; how many declined? These are good

questions, which have not, to date, been answered to anyone’ssatisfaction. Here’s the rub and the provider reluctance toengage in a process with only eligibility requirements and nodetail or estimate of value ‘at the end of the rainbow.’

So, I went to the source, querying OMHA for any tidbit of “why”providers should be interested in participating in SCF. Thisyielded the following response, “currently, we do not disclosedetails related to the specific terms of settlement agreementsreached via Settlement Conference Facilitation. We canconfirm that, to date, SCF has resolved 8,068 appeals. Thisrepresents the dispositional output of over eight AdministrativeLaw Judge teams in one year.” Consider the 800,000 claimspurported to be in the appeals process after the Part A 68%settlement; this dwarfs this two-year program’s outcomes todate. Why have so few claims been settled through SCF? Eitherfew appeals were taken to SCF, or CMS’ proposed settlementswere not adequate for providers to move forward.

This lack of statistical information has created less than highprovider interest or confidence in the program. Providers evenmay be unaware of the program’s existence at all. A little over8,000 settled claims nationwide to SCF’s credit is an anemicresult, even if judged by the OMHA’s crucible of sparing ALJteam efforts. The SCF question of what’s in it for providers hasnot been answered. In the Part A 68% settlement, providersknew the financial implications up front. That is far from thecase in the SCF program. CMS needs a better sales job on thisinitiative!

My discussions with several senior hospital financial managershave run the gamut from outright yawns to “let’s wait and seewhen more data is published on this,” or “I would have to becrazy to jump on this, since I’m winning 75% of my appeals athearing.” At least for the near future, SCF does not appear tobe an answer to OMHA’s or providers’ appeals delayheadaches.

Third Level of Appeal: Hearing by an Administrative Law Judge – Centersfor Medicare and Medicaid Services. Retrieved from https://www.cms.gov.6/17/2016Office of Medicare Hearings and Appeals Settlement Conference FacilitationPilot Fact Sheet. Pages 1-13. Retrieved from http://www.hhs.gov/omha.3/21/2016HHS.gov, Settlement Conference Facilitation Pilot. Retrieved fromhttp://www.hhs.gov/omha. 3/21/2016Statement of Nancy J. Griswold Chief Administrative Law Judge Office ofMedicare Hearings and Appeals on “Creating a More Efficient and LevelPlaying Field: Audit and Appeals Issues in Medicare” Before the United StatesSenate Finance Committee April 28, 2015. Retrieved fromhttp://www.hhs.gov/omha. 3/21/2016

MEN’S HEALTH – “KNOWLEDGE IS POWER” DINNER

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On Tuesday, April 21st fifty-five individuals gathered at an intimate restaurant near the Mineola Train Station. Theyassembled to learn more about Men’s Health and support the General Education and Community Outreach Committees.Building upon the Women’s Health event in 2014, our leadership has committed to sponsoring a personal health focusedseries with the next event focused on the Heart.

The Men’s Health evening covered three topics during the delicious meal at the Davenport Press: Prostate and SexualHealth- Dr. Aaron Katz, Maximizing Colon & Rectal Health- Dr. Dean Pappas and The Role of Palliative Care in the Treatmentand Support of Men’s Health- Eileen Roberto, RN.

Similar to other attendees, I walked out of there with a list of things of personal health investments to make: reduce badfats (found in red meat, butter, cheese & processed foods), increase consumption of Tomato Paste, Pumpkin Seeds (goodfor urine flow), Vitamin D, Calcium and the easiest of all to recall- Pinot Noir.

Additional key nuggets of information worthy of note is that 50% of men over 50 have some form of Erectile Dysfunctionincreasing by 10% with each passing decade and yet most cases are treatable. Blood in the stool is never good and oneshould quickly seek diagnosis. Americans do not eat nearly enough fiber in their diet and that over the counter mixes areequivalent to eating an apple. How can one regularly consume 38 grams of fiber daily for men and 25 for women? Doingsome behind the scenes investigation on the best fiber-packed foods: Split Peas 16.3 g per cup, Lentils 15.6 g per cup, BlackBeans 15 g per cup, Lima Beans 13.2 g per cup, Artichokes 10.3 g per cup, Peas 8.8 grams per cup, Broccoli 5.1 g per cup,Brussel Sprouts 4.1 g per cup, Raspberries 8 g per cup, Blackberries 7.6 g per cup Avocados 6.7 g per half, Pears 5.5 gper medium fruit, Bran Flakes 7 g per cup, Whole-Wheat Pasta 6.3 g per cup, Pearled Barley 6 g per cup, Apples 4.4 g permedium fruit and Oatmeal 4 g per cup.

As for Palliative Care, like many people I had previously mingled that service in with Hospice but Eileen clarified thatpalliative care is specialized medical care for people with serious illness not necessarily at the end-of-life stage. Palliativecare focuses on the relief of pain with the goal of improving or maintaining current quality of life for patients and theirfamilies. This services helps foster communication between medical staff, families and patients regarding choices formedical care, navigation through the health care system, advance directives such as Proxies and Living Wills and offeringemotional and spiritual support for patients and their loved ones.

New York State’s Palliative Care Information Act took effect on February 9th, 2011 mandating that “if a patient is diagnosedwith a terminal illness of condition, the patient’s attending health care practitioner shall offer to provide the patient withinformation and counseling regarding palliative care and end-of-life options appropriate to the patient…” This directivehelped spur much needed communications as stated above and most insurance plans cover all or part of the palliative carereceived whether in the hospital or in other health care settings.

Preparations are underway for the next installment of the Health Series sponsored by our chapter. These education sessionsare free for members and our members are encouraged to bring a loved one. This series is another way that our chaptergoes beyond the standard financial and operational education meetings and social events offered throughout the year.

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By Eric A. Fehrman, CPA, 2016-17 Regional Executive

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Beginning June 1, 2016, I begin my new role as the 2016-17 Regional Executive for Region 2, taking the reins from MollieKennedy, the 2015-16 Regional Executive. First, I would like to thank Mollie and all the outgoing chapter leaders of Region2 for all the effort put forth that resulted in another successful year across the region. I am honored to be elected to thisrole and I look forward to assisting the Region 2 chapters this upcoming year in carrying on our region’s tradition of successand ensuring a smooth transition to my successor, Kristen Zebrowski, 2017-18 Regional Executive from the Hudson ValleyNew York Chapter.

To provide a little background on myself, I am a Partner with Fust Charles Chambers LLP in Syracuse, New York and haveover 20 years of experience auditing and providing consulting services to healthcare organizations. I have been an activemember of HFMA since 1999 and have previously served the Central New York chapter in numerous roles includingPresident, President-Elect, Treasurer, Secretary, Program Chair, Sponsorship Chair and Region 2 Institute Coordinator. Iam also the holder of the William G. Follmer Bronze Award, the Robert H. Reeves Silver Award, the Frederick T. Muncie GoldAward and the Founders Medal of Honor Award. I have been happily married for almost 14 years to my beautiful wifeChristine and we have been blessed with 3 beautiful children – Laura (12), James (11) and Ryan (10) and a 6-month oldCavalier King Charles Spaniel puppy – Rocky.

As documented in the HFMA Regional Executive Job Description, the role of the Regional Executive is to serve as theprimary volunteer and policy link between the chapters and HFMA National, assist chapter leaders in serving members,promote and lead change efforts to drive HFMA’s strategies, foster dialogue and communication at all levels of HFMA,represent the needs and interests of chapter leaders to the HFMA Board and staff, work to create a seamless system ofservice for HFMA’s members, and encourage chapters to collaborate and help other chapters. Specific responsibilitiesinclude serving on HFMA’s Regional Executive Council who is charged with setting policy and goals related to the ChapterBalanced Score Card, Davis Chapter Management System and Founders Merit Award Program; conducting a yearly reviewof the Region 2 Operating Agreement to ensure it is adhered to and updated; conduct ongoing communication with chaptersto encourage and support positive performance and provide guidance in areas where chapters are facing challenges; conductperiodic meetings with chapter presidents to assess chapter performance and provide reports during Regional ExecutiveCouncil meetings. In addition to the national-level roles and responsibilities, there are additional specific responsibilitiesfor the Region 2 Regional Executive under the Region 2 Operating Agreement with the largest responsibility involving theAnnual Region 2 Fall Institute.

Since January, I have been actively leading the coordination of this year’s Annual Region 2 Fall Institute being held October19th – 21st at the Turning Stone Resort & Casino in Verona, New York. The Institute is the region’s premiere event andrequires a lot of effort to keep the event fresh and informative to our members. I have a team of Coordinators from eachchapter participating in the development and administration of this year’s Institute whom I want to recognize – MicheleMecomonaco from the Central New York Chapter, Christy Spencer from the Hudson Valley New York Chapter, John Costerfrom the Metropolitan New York Chapter, Alyson West from the Northeastern New York Chapter, Rafael Rodriguez from thePuerto Rico Chapter (currently being fulfilled by Alba Cosme from the Puerto Rico Chapter in the interim), Paula Tinch fromthe Rochester Regional Chapter, and Chris Eckert from the Western New York Chapter. Also participating is Kristen

By Eric A. Fehrman, CPA, 2016-17 Regional Executive

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Zebrowski, John Cousins (Region 2 Treasurer) and Kiran Batheja. Thank you to everyone for all your efforts with this year’sInstitute. The theme for this year’s Institute is “The Future of Healthcare: Adapt Today, Thrive Tomorrow”. The Coordinatorsare currently putting the finishing touches on a very exciting program this year that features Daymond John, Founder andCEO of FUBU and Investor on ABC’s Shark Tank, and Ceci Connolly, President of Alliance of Community Health Plans andFormer Washington Post Reporter.

That is all I have for an update as of now. I hope everyone has a wonderful summer and I look forward to serving asRegional Executive this upcoming year. See you at the Annual Region 2 Fall Institute!

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High Deductible Health Plans: Increasing in Popularity with Consumers and WhatThat Means for Hospitals By: Kevin Oakley Associate, Lancaster Pollard

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To date, the Affordable Care Act (ACA) has resulted in an estimated 32 million newly-insured Americans since 2010; nearlyone-third of which purchased coverage through exchanges. On the surface, it appears that this would be nothing but positivenews for health care providers, as their ability to collect for billed services should be enhanced with more insured consumersseeking care. However, taking a closer look at the plans the newly insured are choosing reveals a growing issue in collectionsfor providers: the increasing popularity of high deductible health plans (HDHPs).

Users of the insurance exchanges and corporate consumers of health insurance are starting to shift their health planchoices toward higher deductible options. The tiered structure of offerings on the exchanges allows consumers to choosetheir plans based on cost. This is leading to an increase in popularity for HDHPs which typically include lower upfrontpremiums but higher total costs for many services. The number of HDHP enrollees rose to nearly 17.4 million in Januaryof 2014, up from 15.5 million in 2013, 13.5 million in 2012 and 11.4 million in 2011; an average annual growth rate ofapproximately 15% since 2011.1 As consumer preferences shift further towards these HDHP offerings, the need for hospitalsto adapt their billing and collection strategy increases; otherwise bad debt and charity care could evaporate profits.

Coinciding with the increasing interest of HDHP among consumers, more employers are offering HDHPs, and in some casesoffering only HDHPs, to help control costs. This trend is expected to continue as companies react to the new laws governingtheir benefits and try to find ways to manage the increased cost of expanded coverage while avoiding penalties such as the“Cadillac” tax. The result is increased financial burden for patients and changes in their ability to pay and their willingnessto forgo treatments due to cost.

Figure 1 demonstrates HDHP enrollment levels as a percentage of total enrollees, bothon and off the exchanges. The data, collected by the U.S. Department of Health andHuman Services and eHealth, Inc., captures both new and existing consumers of healthcare plans from the ACA open enrollment periods (Oct. 1, 2013 through March 31, 2014,and Nov. 15, 2014 through Feb. 15, 2015).

Silver, bronze and catastrophic plans contain deductibles that meet the IRS 2015definition of HDHP. Of these new HDHP consumers, many are forgoing the typicalmitigants for high deductibles such as health care savings accounts and flexible spendingaccounts. The consumers purchasing coverage on the exchanges are more likely to forgosavings accounts and in many cases are not even given the option. According to the

National Center for Health Statistics, 36% of Americans under age 65 with private health plans are enrolled in an HDHP,and only one-third of those consumers are enrolled in plans linked to health savings accounts. With the out-of-pocket costsfor patients increasing due to the popularity of HDHPs, and with so few purchasers taking advantage of savings plans, therisk of bad debts and charity care increases for health care providers.

As consumers become responsible for a greater portion of their health care costs, hospitals will see their role as collectionagent grow. The need for an effective billing and collections department will result in increased overhead and more expensesfor providers. Patients who receive services may be unable or unwilling to pay their high deductibles, putting furtherpressure on hospitals due to lost revenue from bad debts and charity care. Some patients may even go as far as deferringor avoiding preventative care, prescription medications and other treatments due to costs, resulting in even more lostrevenue for hospitals.

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How are Hospitals Coping?

Hope for hospitals is not lost, however. There are still benefits to the increased number of insured consumers and thepreference for HDHPs is only another challenge for the industry as the effects of the ACA settle in. Many hospitals andsystems have already started to put in place new programs and processes to offset some of the effects of HDHPs. Point-of-service collections, requiring whole or partial payment at the time of the appointment, are becoming an increasingly popularway for hospitals to collect payments for procedures and visits. Some providers are offering medical bill financing services,either directly or through partnerships with third-party banks and lenders. These services allow consumers to make smallerpayments over time to control the burden of upfront costs, often for negotiated total amounts with little to no interest.

Most hospitals are placing an increased focus on their collections services by implementing new processes and programsto help improve billing and collections departments. Additionally, having discussions with the patient about costs throughoutthe entire treatment process is important. Many providers have found that focusing on communication and consumereducation with regard to health care decisions, both treatments and coverage options, has created better results with bothpatient satisfaction and bill collection. In cases where costs to collect become too burdensome, there are an increasingnumber of outsourcing options that providers can consider.

With risks on the horizon due to the growth in HDHPs, it is time to revisit charity plans and examine how bad debts aretreated. Charity care plans will need to start incorporating patients that technically have health insurance but are currentlyunable to afford the full deductible to pay for their care. Communicating with patients from the beginning of treatmentplans can lead to a mutual agreement about payment plans and increase the likelihood of whole or partial collections. Thebilling discussions can lead to better budgeting on a per-patient basis and a more accurate forecast of charity care and baddebts. Forecasting, budgeting and managing the collections could be improved through separating the HDHP accounts fromother insured patient accounts.

Guidelines should be established to determine how to set up payment plans, what incentives to offer, and how much of totalcost could be forgiven. Identifying which patients qualify for income-based reductions, as well as those that would benefitfrom financing plans, can enhance efforts to recover outstanding billings. The more providers understand about theirpatient’s individual health care plans and financial situation early in the treatment cycle, the more accurately the providercan determine a collection plan and budget for discounts and assistance. Consideration should also be made to betterdefine the distinction between charity care and bad debts. Providers will need to better understand and document whatportions of outstanding statements are from HDHP patients, and when those amounts become bad debt and need to bewritten off.

What Does this Mean for Financing?

Because of the new challenges to revenue and collections in the health care space, lenders will become more focused onaccounts receivable and census mix. Providers need to be aware of the shifting focus and make sure they are paying attentionto those variables. Revenue management will be more closely tracked by ratings agencies, lenders and anyone looking athospital credit. Historically, a lender’s focus on receivables has been on the aging schedule and net collections from thedifferent payer sources. With the evolving landscape of insured private-pay patients, lenders will begin paying more attentionto the charity care plans and analyzing bad debts. Being able to determine when a debt becomes uncollectable,distinguishing between the different types of payers and understanding the payment plan schedules will be an importantconversation between lenders and providers.

Clear, defined processes and strategies regarding billing and collections from private payers have become essential forthose involved in health care financing. It is important for providers to be aware of the challenges brought on by changesin health care plan preferences and to start implementing strategies to combat those risks.

Sources: Moody’s “Hospital Median Report”; Fitch Ratings “2014 Median Ratios”; Kaiser Family Foundation; America’sHealth Insurance Plans, “2014 Census.”

Kevin Oakley is an associate with Lancaster Pollard in Columbus. He may be reached at [email protected].

1. AHIP Center for Policy and Research, Annual Census Report, “January 2014 Census Shows 17.4 Million Enrollees in Health SavingsAccount—Eligible High Deductible Health Plans (HAS/HDHPs)”, July 2014.

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Equipment Financing and Bond FinancingHow Healthcare Organizations are Making the Best Use of Each Financial Product

Bond FinancingHospitals and other healthcare organizations across the

country have looked to debt markets as an attractive

term projects or equipment that may have a useful life less

d

Figure 1, comparing a 20-year

$180,000

$150,000

$120,000

$90,000

$60,000

$30,000

21 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

YEARS

Useful Life of Equipment

Interest Costs: Bond vs. Equipment Financing

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restrictive covenants and blanket liens that limit future

the biggest risk if an organization is not able to be nimble

Equipment Leasing & Financing

equipment or projects that have a useful life of seven years

Figure 2

Since leases are collateralized by the equipment being

covenants the organization might have due to prior debt

reference Table 1

structure can be a strategic, cost-effective and timely

source of capital, especially for short-term assets like

Useful Life in Years

Furniture, Fixtures & Buildout

Revenue Generating Equipment

0 10 20 30

Equipment Financing

Bond Financing

IT Equipment & Software

Data Storage & Networking Equipment

Revenue Generating Equipment

Mobile Devices

Buildings

Furniture, Fixtures & Buildout

Medical Equipment

Matching Useful Life with Financial Product

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Leasing or Financing through First American Bond Financing

2-7 years

$100,000 to $20,000,000 $5,000,000 to $200,000,000

Lease Rate Not applicable

Costs None

Short useful life equipment like

equipment and vehicles

Buildings, real estate, construction and

Collateral Letter of credit, insurance, real estate

Lien solely on leased assets Blanket lien

None Common, including debt limitations

Minimal:•

Extensive:•

statement and bond purchase agreement• Legal documents such as loan

• • Legal opinions•

letters and appraisals

2-10 days

Equipment Financing vs. Bond Financing

volume 46 issue 16 summer 2016 our new leaders · 2019-05-24 · if you’re more socially...

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