COO Report to the Board January 2020 Patient Revenue Enhancement - - PowerPoint PPT Presentation

COO Report to the Board January 2020

2

Patient Revenue Enhancement Strategy: Update

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Initiative Strategy/ Update Vol Var YTD $ Var YTD Issues Trend

Optometry: 2 additional clinic days at EWC

• UC Berkeley Optometry started one lane in

January w/ improvement in volumes (862) ($99,981) * Projections based on starting 2 lanes but during contracting in October, final contract with UC Berkeley only expands by 1 lane this year; discussions underway to add 2nd lane for FY21

Primary Care Clinic: 3% Volume increase

• Tactics include overbooking, group visit,

accepting walk in visit

• Peds/Adult med/Family Med adding extra

slot each AM session effective 11/15

• Provider-level productivity improved and

close to targets since December (11,043) ($1,308,756 * Several recent retirements with Epic have created vacancies that are being actively recruited (esp. Eastmont Wellness); offers made but not accepted, additional recruitment underway

Labor & Deliveries: 200 new births

• Actively working with community clinics in

efforts to increase CHCN referrals/ patients

• Lifelong – Other clinical rotations desired

(Medical specialties); Recommend urging Obstetric referrals as part of MOU

• Provided prenatal and lactation consultant

capabilities

• Provided updated FBC brochures/fact

sheets (116) ($603,459) Will not meet established target for the year. Looking at need to re-structure some clinics and services based on patient need/demand

OP Women Services: 5% volume increase

• Provider templates to include 2 additional

visits/ day- implemented August

• New templates with 2 additional visits/day

and open-access principles implemented February 17th

• Working with Alameda Alliance to
• utreach to members requiring Pap

Smear/ Cervical screenings—10k letters sent

• LEAN office involved to help with daily

huddles; provider engagement (6,287) ($932,503) * Letters mailed out slowly in batches delaying patient calls.

Patient Revenue Enhancement Strategy: Update

* Ambulatory revenue impact assumes that 25% of volume are non-billable visits

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Initiative Strategy/ Update Var YTD $ Var YTD Issues Trend

HGH IOP

Leverage operational resources between HGH and FMT campuses and decrease of 2 therapist FTE by year end. One of the 2 FTEs has been transitioned out. 1.60 $118,014

BHS Contract: 1 time payment to BHCS

Received confirmation from Alameda County that payment will be made in January, 2020. Completed.

EPIC Charge Capture: 2% improvement

Charge capture will be realized in the last quarter of FY 20. Daily HB & PB calls tracking revenue capture activity and addressing work queues real time. Hiring EPIC consultant to assist in finding solution for charge issues in EPIC. Prof Fee billing reconciliation issue prohibit posting of Prof Fee; Daily bed reconciliation for border patients.

Patient Revenue Enhancement Strategy: Update

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Population Health

• Outside Medical Services cost drivers include high cost purchased clinical services from UCSF, CPMC required for

HPAC and uninsured patients and delayed claims payments for Royal ambulance. ACTIONS

• Patient Financial Services has instituted changes in claims processing to help realize better UCSF payments

associated with timely claims. Additional staffing resources is expected to help catch up with past invoicing which will increase OMS expenses in short term.

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 1,186 1,407 220 15.7% 7,913 9,734 1,821 18.7% Registry 144 34 (110) (326.6)% 1,970 234 (1,737) (742.4)% Purchased services 289 327 39 11.8% 2,106 2,291 186 8.1% Materials and supplies (10) 9 19 202.0% 253 66 (187) (283.6)% Outside medical services 440 351 (88) (25.2)% 3,468 2,459 (1,009) (41.0)% General & administrative expenses 132 17 (115) (694.5)% 526 116 (410) (353.9)% Repairs/maintenance/utilities

• 100.0%

2 2 (0) (18.6)% Building/equipment leases & rentals

• 0.0%
• 0.0%

Depreciation (0) (313.0)% 1 (1) (350.8)% Total operating expense 2,181 2,145 (36) (1.7)% 16,241 14,902 (1,339) (9.0)%

• FTEs

115 132 16 12.4% 119 132 12 9.4% SYS Adjusted Patient Days 30,657 31,166 (509) (1.6)% 205,661 212,388 (6,727) (3.2)% FTEs / SYS Adj Occupied Bed 0.12 0.13 (0.02) (11.4)% 0.12 0.13 (0.01) (6.9)% Expense / SYS Adj Patient Day 71.14 $ 68.83 $ 2.31 $ 3.4% 78.97 $ 70.17 $ 8.80 $ 12.5%

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Provider Delivery

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,230 4,338 108 2.5% 26,523 29,479 2,956 10.0% Registry 26 1 (25) (2249.7)% 189 8 (181) (2350.2)% Contracted physician services 6,092 6,353 261 4.1% 44,847 44,474 (373) (0.8)% Professional Services

• 0.0%
• 0.0%

Purchased services 377 429 52 12.1% 1,863 3,002 1,139 37.9% Materials and supplies 130 77 (53) (68.3)% 487 541 54 10.0% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 188 242 54 22.1% 1,556 1,695 139 8.2% Depreciation 38.6% 1 38.6% Total operating expense 11,044 11,441 397 3.5% 75,465 79,200 3,735 4.7%

• FTEs

293 313 20 6.3% 278 310 33 10.6% Worked RVUs (wRVU) 81,361 83,573 (2,213) (2.6)% 556,082 585,012 (28,930) (4.9)% wRUVs/ Physician FTE 278 267 10.68 4.0% 2,000 1,887 113.16 6.0% Expense / wRVU 135.74 $ 136.90 $ (1.16) $ (0.8)% 135.71 $ 135.38 $ 0.33 $ 0.2%

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Ambulatory Care – Volumes

ACTIONS

• Same Day Clinic transition to Urgent Care beginning 3/17.
• Adult and Pediatric templates have been increased to 10 appointments per session (AM and PM) across all sites.
• Ambulatory leadership along with Women Services leadership is partnering with the STAR team to implement

structural change at the Women’s Clinic. New templates w/ additional slots went into effect February 17th; will expect increased performance in February financials

January BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD % Var

PRIMARY CARE SUMMARY Highland 6,100 6,351 (251) (4)% 39,317 41,717 (2,400) (6)% 40,926 (4)% HGH Same Day Clinic 1,050 1,267 (217) (17)% 7,210 8,175 (965) (12)% 7,130 1 % AH Primary Care

• 0 %

176 294 (118) (40)% 300 (41)% Eastmont 3,027 4,339 (1,312) (30)% 22,290 28,204 (5,914) (21)% 25,726 (13)% Hayward 2,910 3,050 (140) (5)% 18,638 19,370 (732) (4)% 20,262 (8)% Newark 2,062 2,354 (292) (12)% 14,207 15,026 (819) (5)% 14,800 (4)% Fairmont 104 84 20 24 % 504 599 (95) (16)% 416 21 % Total primary care 15,253 17,445 (2,192) (13)% 102,342 113,385 (11,043) (10)% 109,560 (7)% SPECIALTY CARE SUMMARY Highland 7,386 7,548 (162) (2)% 53,190 52,198 992 2 % 54,118 (2)% Alameda 1,006 1,020 (14) (1)% 6,895 6,815 80 1 % 7,623 (10)% Hayward 426 434 (8) (2)% 2,605 2,766 (161) (6)% 2,536 3 % Newark 132 148 (16) (11)% 754 949 (195) (21)% 749 1 % Eastmont 1,387 1,657 (270) (16)% 8,818 10,920 (2,102) (19)% 9,281 (5)% Total specialty care 10,337 10,807 (470) (4)% 72,262 73,648 (1,386) (2)% 74,307 (3)% Total visits 25,590 28,252 (2,662) (9)% 174,604 187,033 (12,429) (7)% 183,867 (5)%

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Ambulatory Care – Financials

NOTE: Variance in Building/Equipment/Leases/Rentals due to significant back-taxes paid for Hayward Wellness Center. ACTIONS Active recruitment of Primary Care providers for EWC. (Currently 4 vacancies)

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,083 4,437 353 8.0% 29,414 30,380 966 3.2% Registry 59 10 (49) (488.8)% 617 70 (547) (781.8)% Contracted physician services 3 3

• 0.0%

21 21

• 0.0%

Purchased services 98 114 16 13.7% 794 797 3 0.4% Pharmaceuticals 47 106 59 55.6% 448 713 266 37.3% Medical Supplies 242 265 23 8.5% 1,471 1,825 354 19.4% Materials and supplies 40 72 32 43.9% 349 504 156 30.9% General & administrative expenses 12 17 5 27.1% 58 119 62 51.7% Repairs/maintenance/utilities 20 33 13 38.8% 141 236 96 40.5% Building/equipment leases & rentals 551 195 (356) (183.1)% 1,752 1,363 (389) (28.6)% Depreciation 40 81 41 50.3% 471 567 96 17.0% Total operating expense 5,198 5,332 134 2.5% 35,534 36,596 1,062 2.9%

• FTEs

484 529 45 836.0% 497 521 24 4.5% Clinic Visits 25,590 28,252 (2,662) (9.4)% 174,604 187,033 (12,429) (6.6)% FTES / Clinic Visit 1.89 1.87 0.02 1.0% 1.99 1.95 0.04 2.2% Expense / Clinic Visit 203.12 $ 188.74 $ 14.38 $ 7.6% 203.51 $ 195.67 $ 7.85 $ 4.0%

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Acute Care – Volumes

ACTIONS

• Opened San Leandro 3rd floor med/surg beds early January to support patient transfers from HGH.
• Created a PIT model (provider in triage) in the ED to increase patient flow and reduce LWBS (SLH).
• Continue collaboration with S-ATC to increase transfers from HGH ED to SLH when appropriate

January BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD % Var DISCHARGES 1,242 1,355 (113) (8)% 8,996 9,252 (256) (3)% 8,804 2 % ALAMEDA 235 225 10 4 % 1,513 1,343 170 13 % 1,504 1 % HIGHLAND 776 869 (93) (11)% 5,956 6,339 (383) (6)% 5,815 2 % SAN LEANDRO 231 261 (30) (11)% 1,527 1,570 (43) (3)% 1,485 3 % AVERAGE DAILY CENSUS 225.0 237.0 (12.0) (5)% 203.7 213.0 (9.3) (4)% 217.0 4 % ALAMEDA 35.4 37.2 (1.8) (5)% 31.0 31.0

• 0 %

33.0 7 % HIGHLAND 154.4 163.3 (8.9) (5)% 144.9 150.7 (5.8) (4)% 155.3 (1)% SAN LEANDRO 35.2 36.5 (1.3) (4)% 27.8 31.3 (3.5) (11)% 28.6 23 % Average Length of Stay 5.6 5.4 0.2 4 % 4.9 5.0 (0.1) (2)% 5.3 6 % ALAMEDA 4.7 5.1 (0.4) (8)% 4.4 5.0 (0.6) (12)% 4.7 0 % HIGHLAND 6.2 5.8 0.4 7 % 5.2 5.1 0.1 2 % 5.7 9 % SAN LEANDRO 4.7 4.3 0.4 9 % 3.9 4.3 (0.4) (9)% 4.1 15 % Case Mix Index ALAMEDA 1.452 1.300 0.152 1.300 1.300

• 1.300

HIGHLAND 1.417 1.430 (0.013) 1.409 1.430 (0.021) 1.430 SAN LEANDRO 1.431 1.636 (0.205) 1.483 1.636 (0.153) 1.636 Occupancy 75% 79% (4)% 68% 71% (3)% 72%

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Acute Care – Volumes

ACTIONS

• Increased efforts to streamline the OR processes. This includes overhauling the booking process, weekly meetings and

dashboard validation discussion.

• Create a standard process for Census Reconciliation.

January BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD % Var SURGERIES 759 782 (23) (3)% 5,305 5,233 72 1 % 5,258 1 % ALAMEDA 172 185 (13) (7)% 1,307 1,277 30 2 % 1,314 (1)% HIGHLAND 447 476 (29) (6)% 3,143 3,080 63 2 % 3,145 0 % SAN LEANDRO 140 121 19 16 % 855 876 (21) (2)% 799 7 % EMERGENCY VISITS 9,353 9,128 225 2 % 61,085 61,306 (221) 0 % 58,587 4 % ALAMEDA 1,507 1,496 11 1 % 9,316 9,797 (481) (5)% 9,642 (3)% HIGHLAND 5,422 5,062 360 7 % 36,222 34,847 1,375 4 % 34,012 6 % SAN LEANDRO 2,424 2,570 (146) (6)% 15,547 16,662 (1,115) (7)% 14,933 4 % IP ER 1,115 1,080 35 3 % 7,077 7,055 22 0 % 7,188 (2)% ALAMEDA 198 167 31 19 % 1,139 1,064 75 7 % 1,149 (1)% HIGHLAND 674 663 11 2 % 4,592 4,463 129 3 % 4,743 (3)% SAN LEANDRO 243 250 (7) (3)% 1,346 1,528 (182) (12)% 1,296 4 % OP ER 8,238 8,048 190 2 % 54,008 54,251 (243) 0 % 51,399 5 % ALAMEDA 1,309 1,329 (20) (2)% 8,177 8,733 (556) (6)% 8,493 (4)% HIGHLAND 4,748 4,399 349 8 % 31,630 30,384 1,246 4 % 29,269 8 % SAN LEANDRO 2,181 2,320 (139) (6)% 14,201 15,134 (933) (6)% 13,637 4 % DELIVERIES 133 152 (19) (13)% 786 902 (116) (13)% 792 (1)%

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ACTIONS

• Continue to collaborate with HR to fill open positions to reduce higher premium pay (OT/Double OT and registry).
• Standard work process for sick call review with appropriate action.

Acute Care – Financials

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 21,129 21,327 198 0.9% 138,025 140,004 1,979 1.4% Registry 2,234 972 (1,263) (129.9)% 14,358 6,818 (7,540) (110.6)% Purchased services 1,380 1,293 (87) (6.7)% 8,836 9,051 215 2.4% Pharmaceuticals 2,351 2,184 (166) (7.6)% 16,190 15,135 (1,055) (7.0)% Medical Supplies 2,451 2,768 316 11.4% 18,381 18,415 34 0.2% Materials and supplies 879 915 37 4.0% 5,704 6,401 697 10.9% General & administrative expenses 72 228 155 68.2% 413 1,594 1,181 74.1% Repairs/maintenance/utilities 732 772 40 5.1% 5,917 5,688 (230) (4.0)% Building/equipment leases & rentals 150 127 (24) (18.8)% 1,430 886 (544) (61.3)% Depreciation 449 286 (163) (57.1)% 2,767 2,000 (767) (38.3)% Total operating expense 31,828 30,871 (957) (3.1)% 212,022 205,993 (6,029) (2.9)%

• FTEs

1,832 1,848 16 0.9% 1,807 1,763 (44) (2.5)% Acute Adj patient days 10,390 10,760 (370) (3.4)% 67,736 69,244 (1,509) (2.2)% FTEs / SYS Adj Occupied Bed 5.47 5.32 0.14 2.7% 5.74 5.47 0.26 4.8% Expense / Acute Adj Pt Day 3,063.31 $ 2,869.01 $ 194.30 $ 6.8% 3,130.12 $ 2,974.88 $ 155.24 $ 5.2%

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Behavioral Health – Volumes

ACTIONS

• New PES charge by hour has been established to track true length of stay for PES patients.
• Continue to have census hold in PES.

January BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD # VAR % Var

BEHAVIORAL HEALTH

PATIENT DAYS 2,105 2,081 24 1.2 % 14,872 14,428 444 3.1 % 14,544 328 2.3 % DISCHARGES 240 227 13 5.7 % 1,774 1,709 65 3.8 % 1,612 162 10.0 % Average Daily Census 67.9 67.1 0.8 1.2 % 69.2 67.1 2.1 3.1 % 67.6 1.6 2.4 % Average Length of Stay 8.8 9.2 (0.4) (4.3)% 8.4 8.4

• 0.0 %

9.0 (0.6) (6.7)% Occupancy 98% 97% 1.0 % 100% 97% 3.0 % 98% 2 % EMERGENCY VISITS 1,336 1,192 144 12.1 % 7,231 8,247 (1,016) (12.3)% 8,245 (1,014) (12.3)% CLINIC VISITS 1,714 1,757 (43) (2.4)% 12,463 11,792 671 5.7 % 11,656 807 6.9 % FMT IOP Day Care Cl 946 956 (10) (1.0)% 7,071 6,709 362 5.4 % 6,801 270 4.0 % HGH IOP Day Care Cl 656 564 92 16.3 % 4,352 3,870 482 12.5 % 3,819 533 14.0 % JGP Case Mix Index 1.151 1.056 0.095 9.0 % 1.094 1.056 0.038 3.6 % 1.056 (1.056) (100.0)%

13

Behavioral Health- Financials

ACTIONS

• Managers completed training to manage staffing according to census.
• Continue to recruit for vacant RN and Mental Health Specialist positions and utilize SAN staff instead of premium paid

(OT/Double OT) to staff the units.

• Monitor teams are adhering to pre-approval processes for OT/DOT.
• Continue to work with the County in finding solutions for the non-acute Behavioral Health patients who are not able to

be discharged from the units resulting a throughput issue in the unit as well as in the PES department.

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,681 4,083 (598) (14.6)% 31,934 28,182 (3,752) (13.3)% Registry 272 124 (148) (118.8)% 1,648 870 (777) (89.3)% Contracted physician services 801 1,035 234 22.6% 6,037 7,242 1,206 16.6% Purchased services 101 95 (6) (6.6)% 724 663 (61) (9.2)% Pharmaceuticals 18 23 5 21.5% 150 158 8 5.1% Medical Supplies 12 11 (1) (10.4)% 91 73 (17) (23.8)% Materials and supplies 47 64 17 26.4% 466 446 (20) (4.5)% General & administrative expenses 8 3 (6) (218.9)% 61 18 (43) (235.9)% Repairs/maintenance/utilities 197 89 (108) (120.2)% 1,030 730 (300) (41.0)% Depreciation 15 8 (6) (79.8)% 102 57 (45) (79.3)% Total operating expense 6,152 5,535 (617) (11.1)% 42,285 38,440 (3,845) (10.0)%

• FTEs

394 363 (31) (8.7)% 384 362 (22) (6.2)% BHS Adj patient days 3,237 3,311 (73) (2.2)% 21,074 22,264 (1,190) (5.3)% FTEs / BHS Adj Occupied Bed 3.77 3.40 0.37 11.0% 3.92 3.50 0.42 12.1% Expense / BHS Adj Pt Day 1,900.42 $ 1,671.60 $ 228.81 $ 13.7% 2,006.50 $ 1,726.54 $ 279.96 $ 16.2%

14

Post Acute Care – Volumes

ACTIONS

• Census continues to be a focus for throughput support and the sites having been running close to full capacity.
• Discharges back into the community continue to be a priority of the PA teams.

January BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD # VAR % Var POST ACUTE PATIENT DAYS 9,658 9,174 484 5.3 % 64,440 63,824 616 1.0 % 64,636 (196) (0.3)% DISCHARGES 99 66 33 50.0 % 662 458 204 44.5 % 533 129 24.2 % Average Daily Census 311.5 295.9 15.6 5.3 % 299.7 296.9 2.8 0.9 % 300.6 (0.9) (0.3)% Average Length of Stay 97.6 139.0 (41.4) (29.8)% 97.3 139.4 (42.1) (30.2)% 121.3 (24.0) (19.8)% Occupancy 99% 94% 5.0 % 95% 94% 1.0 % 95% 0 % REHAB CLINIC VISITS 17 10 7 70.0 % 116 66 50 75.8 % 79 37 46.8 % FMT Case Mix Index 1.241 1.102 0.139 12.6 % 1.151 1.102 0.049 4.4 % 1.102 0.049 4.4 %

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Post Acute Care - Financials

NOTES & ACTIONS

• Materials and supplies above budget due to census exceeding budgeted census.
• Pharmacy higher due to higher cost medication and census exceeding budgeted census.
• Repairs and maintenance above budget due to ~$15k unexpected maintenance and approximately $23k overage for

PG&E.

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,003 4,053 51 1.2% 28,550 28,564 14 0.0% Registry 64 125 62 49.1% 500 853 352 41.3% Purchased services 300 311 11 3.4% 2,285 2,176 (109) (5.0)% Pharmaceuticals 116 106 (10) (9.1)% 876 732 (144) (19.6)% Medical Supplies 175 161 (14) (9.0)% 1,172 1,277 106 8.3% Materials and supplies 168 209 42 19.9% 1,573 1,472 (101) (6.8)% General & administrative expenses 13 11 (2) (22.8)% 62 75 13 17.0% Repairs/maintenance/utilities 79 46 (33) (70.7)% 748 329 (418) (127.0)% Building/equipment leases & rentals 101 100 (1) (1.5)% 843 698 (144) (20.7)% Depreciation 21 5 (16) (361.6)% 129 32 (97) (305.0)% Total operating expense 5,040 5,127 87 1.7% 36,736 36,207 (529) (1.5)%

• FTEs

534 526 (8) (1.5)% 526 535 9 1.6% Post Acute Adj patient days 9,813 9,449 364 3.9% 65,729 65,675 54 0.1% FTEs / Post Acute Adj Occu Bed 1.69 1.73 (0.04) (2.2)% 1.72 1.75 (0.03) (1.8)% Expense / Post Acute Adj Pt Day 513.57 $ 542.58 $ (29.01) $ (5.3)% 558.90 $ 551.31 $ 7.59 $ 1.4%

16

System Support Services

ACTIONS

• Electricity expense in FY20 was up by 15% from budget and 13% from last year same period. We will partner with

PG&E to install submeters on the Highland campus to compare energy usage to the main Campus meter.

Stated in $000's January, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 6,267 6,857 590 8.6% 37,061 47,261 10,200 21.6% Registry 197 166 (31) (18.5)% 2,497 1,396 (1,101) (78.9)% Purchased services 4,158 3,105 (1,053) (33.9)% 25,491 21,737 (3,754) (17.3)% Pharmaceuticals 3 15 11 77.2% 25 103 78 76.0% Medical Supplies (17) (35) (18) (52.0)% (385) (240) 145 60.6% Materials and supplies 280 194 (86) (44.1)% 1,599 1,360 (239) (17.6)% General & administrative expenses 998 1,435 437 30.5% 8,575 10,047 1,472 14.7% Repairs/maintenance/utilities 774 798 24 3.0% 5,036 5,586 550 9.8% Building/equipment leases & rentals 263 360 96 26.8% 1,849 2,518 669 26.6% Depreciation 2,126 1,343 (783) (58.3)% 6,681 9,402 2,722 28.9% Total operating expense 15,050 14,239 (812) (5.7)% 88,429 99,171 10,741 10.8%

• FTEs

730 782 52 6.6% 676 781 105 13.4% SYS Adjusted Patient Days 30,657 31,166 (509) (1.6)% 205,661 212,388 (6,727) (3.2)% FTEs / SYS Adj Occupied Bed 0.74 0.78 (0.04) (5.1)% 0.71 0.79 (0.08) (10.6)% Expense / SYS Adj Patient Day 490.93 $ 456.86 $ 34.06 $ 7.5% 429.98 $ 466.93 $ (36.95) $ (7.9)%