STRATEGIES FOR MAXIMIZING AND DIVERSIFYING YOUR REVENUE

Transcription

1 STRATEGIES FOR MAXIMIZING AND DIVERSIFYING YOUR REVENUE Brent Copen MPA, Chief Financial Officer and EVP Business Development, Tiburcio Vasquez Health Center Ray Jorgensen CPC, CHBME, Co Founder, PMG, Inc. Everett Lebherz Co Founder and CEO, PointCare, LLC STRATEGIES FOR MAXIMIZINGAND DIVERSIFYING YOUR REVENUE OCTOBER13,2017 BY BRENT COPEN, CFO & EVP BUSINESS DEVELOPMENT 1

2 Align Culture with StrategicFinance Produce financial reports that are simple, clear, & quantitative Explore Rate Setting & Full Cost Recovery 2

3 Rebalance the ProgramPortfolio Apply economic logic to future plans $ Operating Deficits: Point of Sustainability Start-Up Proof of Expansion Sustainable Concept Operations Surplus: Reinvested towards future growth and / or quality enhancement Long-term Business Model Revenue Operating Expenses Source: Nonprofit Finance Fund Invest in businessdevelopment 3

4 Know when to say NO to new money Restructure the BalanceSheet? Brent Copen Ray Jorgensen Everett Lebherz 4

5 FQHCs are being asked to deliver more than ever. Grant-funded healthcare Pre 1990s Healthcare IT EHRs Early 2000s Coverage Education Early 2010 s Total Coverage Management Today Without the ability to adapt to the changing coverage landscape, you have problems. 5

6 Financial and operational uncertainty Unexpected changes to coverage programs Looking for sustainable revenue Stick to the fundamentals: Covered visits = sustainable revenue Case Study: The Value of Coverage Retention The Problem Patients churn all the time. 547 patients fell out of coverage at a leading FQHCs Results The FQHC was able to re-enroll 99.4% of those patient - adding a significant value to the tune of >$100,000 that would have been missed How Enrollment Validation reports and effective proactive outreach 6

7 Stay Covered Through Any Financial Storms (or Droughts) Implement tools to become data driven Focus on reactive and proactive enrollment Create proactive processes for your staff Persist with member retention efforts The Future Collaborative coverage management efforts between clinics and patients Patient has the ability to check their Medicaid coverage status on their phone, real-time Making it easier, not harder: Proactive and automatic notifications to the patient when coverage status changes Everett Lebherz Co-founder and CEO m 7

8 Long Term Sustainability Ray Jorgensen, CPC, CHBME, Co-Founder, PMG, Inc. Maximize Existing Dollars Percent of Medicaid PPS Less than 90%? Medicare PPS 80% expected except preventive - 90% of 80% (or 72% of approved PPS) - New patients should help due to 150% payment - What is Medi-Medi Expand Medicare population - New programs & relationships with senior centers G Code maximization Paid less of charge PPS max MSP & Medi-Medi good system in place? Unpaid claims & denials diligent persistence BER goal function without grant income 2017, PMG, Inc. All Rights Reserved. www. gopmg.com Other Potential Opportunities Expanded diagnostic labs - E.g., Echocardiograms - Other machine tests performed at hospitals - Discount or free to self pay mission based focus Ambulatory Surgical Center (ASC) - Already bill with ANSI 837-I & use Revenue Codes - Rent facility to other local - Discount or free to self pay mission based focus Opioid addiction management - National epidemic - Often cash business especially those seeking anonymity - Discount or free to self pay mission based focus 2017, PMG, Inc. All Rights Reserved. www. gopmg.com 8