Pinnacle Blog

Pinnacle’s Pick: Husch Blackwell Legal Alert: Missouri Medicaid Proposes Its Provider-Preventable Conditions Policy – January 12, 2012, Contributing Authors: Robert L. Hess II

Missouri’s Medicaid agency is proposing to expand the current payment prohibition to include healthcare acquired conditions as defined by Medicare and to require hospitals and ambulatory surgical centers to bill for provider-preventable conditions as the method for reporting such incidents to the state. Providers have 30 days from January 3, 2012, to file comments on the proposed rule.

 Read full article

About Husch Blackwell LLP

Husch Blackwell LLP is a full-service litigation and business law firm with 600 attorneys in locations across the United States and in London, serving clients with domestic and international operations.

Read more about Husch Blackwell LLP

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

Visit: www.PinnacleGroupHC.com & www.PhysicianFMV.com

* Content directly quoted from Becker’s Hospital Review – Business & Legal Issues for Health System Leadership To view the direct link, please visit Becker’s Hospital Review. Written by Molly Gamble | January 03, 2012 and directly quoted from Becker’s Hospital Review.

The following hospital mergers and acquisitions took place within the past two weeks, beginning with the most recent.

1. Kentucky Gov. Steve Beshear Rejects 3-System Merger
Kentucky Gov. Steve Beshear has rejected a proposed three-system merger between public University Hospital in Louisville with Jewish Hospital & St. Mary’s HealthCare in Louisville and St. Joseph Health System in Lexington, which would have combined a public safety-net hospital with a Catholic healthcare company to create a statewide system. 

To view the direct link and the rest of the article, please visit Becker’s Hospital Review.

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

Overview

Pinnacle Healthcare Consulting seeks an Analyst for its rapidly growing healthcare consulting practice.

The Analyst will help develop analytical models, perform market analysis/research and support report letter development for advisory projects for both private and public entities in the healthcare industry. These entities may be hospitals and health systems, physician groups, ancillary clinics, publicly-traded companies, etc. This position offers professional growth to the motivated candidate. This candidate will work closely with several team members and report to a Senior Consultant with Pinnacle Healthcare Consulting.

The ideal candidate will possess a Masters degree in Business, Healthcare Administration or Public Health. Bachelor degree candidates will be considered. The candidate should possess strong organizational abilities to handle multiple projects and meet ongoing deadlines; demonstrated effective oral, written and interpersonal communication abilities; and a strong understanding and proficiency with Microsoft Excel. The successful candidate must be committed to staying at the cutting edge of healthcare regulations, financial best practices and ethical standards. Salary will be commensurate with experience and market findings. Pinnacle offers a comprehensive benefits package including a 401k with an employer match.

Responsibilities

• Support healthcare related projects, physician compensation, employment arrangements, complex contract arrangements, etc.
• Analysis of healthcare data, including, but not limited to, physician productivity, practice/service line profit and loss information, industry structure and trends, economic factors impacting industry, impact of healthcare regulations, etc.
• Report letter generation and detailed financial modeling.
• Documentation of all work thoroughly and accurately.
• Review of all work for validity, accuracy of data and professional appearance.
• Demonstrate teamwork and responsibility with engagement project team members.
• Stay abreast of current business and economic developments relevant to the client’s business; and use current technology and tools to enhance the effectiveness of services provided.

Qualification Requirements

• Masters or Bachelor’s degree in healthcare administration, business administration with emphasis in healthcare, or finance.
• Demonstrated aptitude in quantitative and qualitative analysis.
• 1-3 years experience in healthcare administration or consulting – preferred.
• Well developed understanding of health care industry and in-depth understanding of health care data and the methods of data analysis.
• Ability to prioritize and manage concurrent projects, demonstrate initiative and work independently with moderate supervision.
• Excellent analytical, project-management, communication, interpersonal, and teaming skills.
• PC proficiency including MS Excel, Word, and PowerPoint.

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting, a member of The Pinnacle Group, provides a range of consultative services to hospitals, health systems, physicians and publicly traded companies. Pinnacle maintains a client network across the country. For more information please visit www.pinnaclegrouphc.com. a Resume with cover letter and references can be e-mailed to kberkey@pinnaclegrouphc.com, (please, no calls).

Season’s Greetings From

Pinnacle Healthcare Consulting!

From all of us at Pinnacle Healthcare Consulting, At this holiday season, our thoughts turn gratefully to those who have made our progress possible. In lieu of gifts, a donation will be made to United Way and Urban Peak. Thank you for your continued support and best wishes in 2012!

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations. Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support. Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services. Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges.

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

 Have you heard? Over 200 hospitals and healthcare organizations have found that the Physician Fair Market Value (FMV) Program empowers users to make smart and supportable decisions with regard to physician compensation and fair market value mattes. Listen to what Physician FMV Program participants are saying…

“I’ve been in hospital administration for 30 years. I could have used this program for the last 25.”

–          Chief Operating Officer, 245-bed hospital

“As in-house counsel and Chief Compliance Officer of our Medical Center, I have found the Pinnacle FMV Program to be invaluable.  It provides me with an efficient and cost effective tool for validating that our institution’s arrangements with physicians are compliant with fair market value requirements. It also gives me the ability to quickly respond to requests from my Executive colleagues with informed market data as they enter into business discussions with physicians and their groups.    Additionally, the Pinnacle team staff has been extraordinarily helpful in providing me with specific explanations,  regarding  the FMV tool and the underlying data and formulations, as well as with their robust perspective on various compliance and FMV issues, at both a local and national marketplace level.   I continue to be a very satisfied client of The Pinnacle Group.”    

–          Vice President of Regulatory Affairs and Chief Compliance Officer, Medical Center

“We engaged Pinnacle Healthcare Consulting (Physician FMV Program) to prepare physician compensation workbooks to comply with the Stark II, Phase II requirements, and have been extremely pleased with their work product.  We had looked at doing this ourselves, and not only would we not have had the expertise that Pinnacle has in this area, but the cost alone of having Pinnacle (Physician FMV) do this versus buying each individual survey ourselves was an overriding factor.  We have found Pinnacle’s (Physician FMV’s) work to be exemplary, and their staff professional, friendly and extremely competent.  We have some markets which require additional assistance, and they have been able to provide exactly what they need to support their reasonable compensation requirements.  I would highly recommend Pinnacle (Physician FMV) to anyone involved in physician compensation issues.”

–          Manager, Hospital System, Legal Division

About The Physician FMV Program

Determining appropriate and compliant physician fair market value (FMV) is complicated.  Diverse factors like the Stark Law and inconsistent internal payment policies make it difficult to confidently approach physician compensation negotiations.  Until now.

–          Access Physician Fair Market Value (FMV) Data anywhere there’s an Internet connection

–          Generate tailored Physician Fair Market Value (FMV) Reports for individual physician relationships

–          Track all physician arrangements and payment terms

–          Research hospital-physician relationships around the country

–          Manage access to the Physician Fair Market Value (FMV) data for others within your organization

The Physician Fair Market Value (FMV) Program dramatically reduces the complexity of determining fair market value for physician compensation.  It builds internal capacity and gives hospitals more control over the process by providing proprietary tools and powerful information to help make defensible decisions about physician relationships.

Over 200 hospitals and healthcare organizations have found that the Physician Fair Market Value (FMV) Program empowers users to make smart and supportable decisions with regard to physician compensation and fair market value mattes.  The Physician Fair Market Value (FMV)Program’s key benefits include:

–          Elevated compliance through broader application of Physician Fair Market Value (FMV) payment terms and greater consistency across physician contracts

–          Significant time savings – where resources can be redirected to other matters (strategy, operations, etc.)

–          Immediate return on investment after just two to three uses (i.e., avoiding fees for focused consulting reports)

–          Enhanced organizational capacity to address physician compensation, contracting and compliance

Hospitals using the Physician Fair Market Value (FMV) Program immediately possess greater knowledge on which to base physician contracting decisions, the reliability of a proven physician fair market value analytical methodology and improved capacity to manage / document compensation and other contractual terms.  Furthermore, Physician Fair Market Value (FMV) Program support includes: training, ongoing coaching, technical support and focused consulting (if necessary). 

To learn more about the Physician Fair Market Value (FMV) Program visit: www.physicianfmv.com or contact us today for more information: 303.801.0123

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

 Congratulations to Jana Sizemore who recently earned her Accredited Member designation with the American Society of Appraisers in the business valuation discipline!  Advancement to Accredited Member is granted after completion of education requirements and approval of full-time appraisal experience, educational background and an appraisal report reviewed by the ASA’s Board of Examiners. 

 Pinnacle Healthcare Consulting’s Business and Strategic Valuation Services

Pinnacle Healthcare Consulting specializes in healthcare business valuations for buy-sell and joint venture (JV) transactions. We provide valuation services that support transactional healthcare fair market value (FMV) requirements with a process that includes:

 • Detailed situational assessments

• In-depth fact-finding and interviews

• Market analysis

• Extensive financial modeling

• Rigorous valuation methodologies

 Our knowledge of the broader healthcare industry adds valuable insight to the risks and benefits of either a sale or acquisition. We ensure that you enter a transaction fully informed.

About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

Visit: www.PinnacleGroupHC.com and www.PhysicianFMV.com

 Pinnacle Healthcare Consulting is pleased to announce our recent participation as Silver-Level Sponsors for Colorado Healthcare Strategy and Management (CHSM). Though our sponsorship, we continue to support CHSM’s mission to bring outstanding educational opportunities to the Rocky Mountain healthcare community.

Join Pinnacle Healthcare Consulting at CHSM’s next event:  Integrated Delivery Systems: The Right Choice For Quality Healthcare?

Registration:   http://www.chsm.org/civicrm/event/info?id=33&reset=1

 Healthcare reform and modern-day economics are sparking a renewed drive toward integration of care into one seamless team providing the right help at the right time. While integrated delivery systems (IDS) promise higher quality care, lower costs, and competitive advantages, the results have been mixed. In Colorado, however, three organizations have been operating successful integrated healthcare systems for more than a decade. Join us as executives from Colorado Springs Health Partners, New West Management Services Organization and University Physicians discuss clinical integration strategies, key success factors, and the challenges they face in the brave new world of healthcare reform. Don’t miss this important event!

 When:   November 11th, 2011 7:00 AM   –   9:00 AM 

 Location: Doubletree Denver Tech Center – Indigo Room, 7801 E. Orchard Road, Greenwood Village, CO 80111-2508

 Contact Phone: 303-265-9224

 Email: customer.service@chsm.org

 Program Speakers

 Ruth N. Benton, MBA, CEO, New West Management Services Organization, Inc. and New West Physicians, P.C. 

 Deborah L. Chandler, MBA, CMPE, EVP/CEO, Colorado Springs Health Partners

 Elizabeth D. Kissick, MBA, Director of Health Plan Development at University Physicians, Inc.

Program Details

 Registration: Breakfast and Networking 7:00 a.m. – 7:45 a.m.

 Presentation: 7:45 a.m. – 9:00 a.m.

About Our Speakers

 Ruth N. Benton, MBA, CEO, New West Management Services Organization, Inc., New West Physicians, P.C. (collectively, New West) is the founder and owner of New West, a primary care group practice.  The company has grown to $50 million in revenue with 300 employees in 17 locations in the Denver area.  Previously, Ruth served as the vice president for HealthOne, HealthCare United, and HMO Colorado.  For the past five years, she has been one of Denver Business Journal’s “Most Influential Health Care Leaders in Colorado”.

 Deborah L. Chandler, MBA, CMPE, EVP/CEO, Colorado Springs Health Partners, has over 25 years experience in multi-specialty group management and administration, including over 10 years as CEO for Anchor Heatlh Centers in Florida.  Debbie serves on the boards of Colorado Springs Regional Economic Development, the Greater Colorado Springs Chamber of Commerce, Community Health Partners, Pikes Peak Workforce, and Southern Colorado American Heart Association.

 Elizabeth D. Kissick, MBA, Director of Health Plan Development at University Physicians, Inc., a not-for-profit corporation supporting medical services operations for the clinical practice of the University of Colorado School of Medicine.  She oversees all commercial contract transactions, rental network development and management, and business activities associated with population management within a faculty practice plan.  Previousy, Liz served as Senior Manager for Managed Care at Johns Hopkins Medical Services Systems.

LEARN MORE & REGISTER ONLINE NOW! For additional information about CHSM, please visit: http://www.chsm.org/

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations. Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support. Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services. Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges.

Contact Us Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

or visit: www.PinnacleGroupHC.com

Stay informed with what Pinnacle Healthcare Consulting (The Pinnacle Group) is reading in relation to current events and topics within the healthcare industry.

5 Big Ideas for Physician Groups

Margaret Dick Tocknell, for HealthLeaders Media , November 2, 2011

Last week’s Medical Group Management Association conference in Las Vegas featured four days of workshops, networking, and almost 100 sessions devoted to the challenges facing physician groups as they attempt to navigate the business of healthcare reform.

Here is my (Margaret Dick Tocknell’s) analysis of the big ideas discussed at MGMA:

1. The healthcare reform train has left the station.
If you’re sitting around waiting for the final court decision on healthcare reform before investing in electronic health records or exploring different payment models, then your practice is so far behind that it may never catch up. The feds have been pumping some serious dollars into demonstration projects and other initiatives to help physicians and hospitals develop the infrastructure to compete in the new world of healthcare.

Even providers that don’t participate in these projects are aligning themselves with other providers and payers to develop healthcare delivery systems and payment models that move patient care from volume to value and focus on higher quality and lower cost care. Through these partnerships, providers and payers are putting processes in place to collaborate, develop clinical engagement, and manage transitions of care. Healthcare has changed and it will not return to the old way of doing business.

2. The physician-patient relationship is in flux.
Physicians tend to make many treatment decisions for their patients, but implementing new healthcare delivery systems that emphasize collaboration will require patients to be more engaged in the decisions that affect their medical care. Studies show that, all things being equal, patients tend to select less invasive and less expensive procedures when they have the tools and information to assess the trade-offs of different treatment options. That means the physician or the staff must take time to provide the resources a patient needs to make informed healthcare decisions.

I predict physician practices will adopt a common practice of pushing decisions and jobs to the lowest level possible. A physician’s time will be reserved for patients who need more intensive care and physician assistants will handle more of the everyday medical cases. E-mail, once health plans agree to reimbursement terms, will play a larger role in patient-physician engagement.

3. Physicians have a role in incentivizing patient behavior.
My insurer tells me that I can earn $50 just by completing an online health risk assessment. I still haven’t taken the time. But what if my insurer put some real money on the table and got my doctor involved in the process? One insurer offered $1,000 for family members to complete an HRA, review it with their primary care physician, and then develop and follow a medical care plan. Its HRA completion rate jumped to a whopping 80%. By engaging physicians and adding a medical plan, this insurer added real value to the HRA.

4. Healthcare will be important to economic development.
Employers will send their jobs to cities and states that support a robust healthcare industry with sufficient providers. Some companies are already taking healthcare services into consideration when they look at facility locations. Employers are becoming more aware of how healthcare price competition and availability of medical services can affect their workforce and their bottom line.

5. Making a list and checking it twice isn’t just for Santa Claus.
Physician offices can benefit from developing checklists for even routine activities. A checklist clarifies a process so the same steps are taken each time. It establishes priorities, makes sure everything that needs to get done gets done, reduces errors, and can help the physician office staff function better as a team. It’s a relatively simple effort that can save a practice time and money.

These hot topics will change the practice of medicine for years to come. If you were at MGMA, or even if you weren’t, what’s your take on these big ideas?

(Please send your ideas to kberkey@pinnaclegrouphc.com and Pinnacle Healthcare Consulting will post your responses on our blog!

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

www.pinnaclegrouphc.com

www.physicianfmv.com

 Pinnacle Healthcare Consulting proudly introduces our newest team addition, Chris Fete, JD, MHA.  Christopher joined Pinnacle Healthcare Consulting in 2011.  As a Senior Analyst, he supports Pinnacle’s consulting engagements including fair market value reviews of physician compensation, Key Opinion Leader analysis, business plan development, financial and market analysis, community needs assessments and physician practice start-up / management assistance. 

 Prior to joining Pinnacle, Christopher was an administrative intern for a children’s medical center in St. Louis, MO.   As a team leader, he assisted in the development and organization of a patient access-line for Maternal Services between two hospitals.  In past positions, Christopher served as a clerk in the states of Michigan and Missouri.  He assisted attorneys in all aspects of trial preparation, memorandum and analysis of complex legal issues related to medical center operations.  Christopher has researched and prepared service arrangements, employee contracts, as well as compliance issues specifically related to Stark Law, False Claims Act, Fraud and Abuse, and Anti-Kickback Statutes.  He has additionally reviewed and analyzed university agreements with physicians, pharmaceutical companies, and service providers.  

 In his free time, Christopher enjoys participating in outdoor activities such as mountain biking, kayaking, camping and hiking.  He additionally enjoys lending a hand with community service projects and was an assistant high school varsity lacrosse coach for several years before moving to Denver.

 Expertise

–          Physician  Key Opinion Leader compensation planning and analysis

–          Regulatory and compliance analysis

–          Physician-hospital relationships

–          Healthcare industry trends and policy research

–          Financial analysis, forecasting and modeling

–          Strategic planning and business development

Professional Designations and Affiliations

–          Member, American Health Lawyers Association (AHLA)

Education

–          JD, St. Louis University School of Law and School of Public Health, St. Louis, MO

–          MHA, St. Louis University School of Law and School of Public Health, St. Louis, MO

–          BA, Creighton University, Omaha, NE

Additional: Health Law Certificate, Health Law Association, Moot Court

 About Pinnacle Healthcare Consulting

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Pinnacle Healthcare Consulting Today – 303.801.0123 or kberkey@pinnaclegrouphc.com

www.pinnaclegrouphc.com or www.physicianfmv.com

Pinnacle Healthcare Consulting is excited to extend a warm welcome to our new Senior Analyst, Chris Fete and Analyst, Rob McCabe.  We are thrilled to add two new key additions to the Pinnacle Team as we continue to enhance and develop our service offerings.

 Chris and Rob will assist Pinnacle Healthcare Consulting in the development of analytical models, perform market analysis / research, and support in report letter development for advisory projects in the healthcare industry, which includes hospitals and health systems, physician groups, ancillary clinics, publicly-traded companies, etc.  They will additionally contribute to and support healthcare related projects, physician compensation, employment arrangements and complex contract arrangements.  Please be on the lookout for their individual company biographies and expertise in the near future!  

Pinnacle Healthcare Consulting provides a range of strategic, financial and operational services to improve clinical and business performance for hospitals, health systems, physician groups and other healthcare organizations.  Pinnacle Healthcare Consulting is a nationally recognized leader in business valuation, physician compensation, medical staff planning, performance improvement and compliance support.  Other divisions of Pinnacle provide physician practice management, medical bill/coding, and technology/integration support services.  Pinnacle’s array of specialized and highly responsive client services promote advanced innovation while our dynamic team solidifies strong client relationships and assists in solving your most complex challenges. 

Contact Us Today – 303.801.0123 or kberkey@pinnaclegrouphc.com