The New USFPG: An Investment in Our Future Update to USF BOT Health & Finance Workgroup

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1 The New USFPG: An Investment in Our Future Update to USF BOT Health & Finance Workgroup May 27, 2015

2 An Investment in Our Future FY2015 and FY2016 Top Improvement Priorities Topics to Discuss EPIC Improving the Ambulatory Experience Access Ancillary Operations Revenue Performance Provider Productivity and Compensation Looking Forward FY2017 and Beyond Wrap-Up 2

3 An Investment in Our Future Deficits generated in FY2015 and FY2016 need to be viewed as an investment in the future of USFPG. The good news is that USFPG had a healthy cash reserve at beginning of FY2015 ($50M or 75 days cash) from which to draw this investment. The plan is to draw down cash reserves to days between now and FY2016 with the plan to grow it back to 90 days in future years. The plan will require full commitment and support from the BOT and the USF Health leadership because some of the changes will be a challenge to the current culture of USFPG. 3

4 An Investment in Our Future FY2015 Financial losses Project just over $4M loss. Expenses growing faster than revenue because: Access 63% arrival rate; Almost 50 days for new patient appointment. Ancillaries Not maximizing margins on technical revenue. Revenue performance Coding and documentation, charge capture, revenue cycle and managed care contracting not optimal. Faculty productivity and compensation Approximately 55% clinical; Should be at least 70% - 80%. Need to protect very productive departments and faculty; Set aside $2.5M. Self-Insurance for Employee Health Increased claim history. EHR transition $9M incremental cost increase over 2 years. $5M in FY2015 ($2M operating costs and $3M capital). Consultants to support EPIC and Improvements. 4

5 An Investment in Our Future FY2015 5

6 An Investment in Our Future FY2015 PSR 63% Arrival Rate; Ancillary Revenue Suboptimal; Revenue Performance Suboptimal LIP Better than Expected 6

7 An Investment in Our Future FY2015 Recruitment and protection of very productive departments and faculty 7

8 An Investment in Our Future FY2015 Self-Insurance True-Up 8

9 An Investment in Our Future FY2015 EPIC Operating Costs and Consultants 9

10 An Investment in Our Future FY2016 Financial losses Project over $8M loss; reinvestment in practice plan required. The Challenges/Assumptions Access Moving to 70% arrival rate; Reduce new patient appointment lag to under 30 days. Central call center expanded. Ancillaries Improve technical revenue performance by 3%. Revenue performance Improve cash yield by 5% - 7%. Low income pool Currently being determined but assumed no change in FY2016. Faculty productivity Productivity improvements driven by access. EHR transition $5M in FY2016, all in operating. Assume a reduction in productivity from July September (10/40/20). Consultants Begin to decrease consultant support outside of EPIC. 10

11 An Investment in Our Future FY

12 An Investment in Our Future FY2016 PSR Arrival Rate to 70%; Decreasing Faculty Productivity for EPIC; Improving Ancillary Margin; Revenue Performance Improvements Increased Funding from TGH LIP Maintain Funding 12

13 An Investment in Our Future FY2016 Faculty Growth and Carry-Forward of the Protection of Productive Faculty 13

14 An Investment in Our Future FY2016 Year 2 EPIC Costs Expansion of Call Center Consulting Support for EPIC 14

15 An Investment in Our Future FY2017 and Beyond 15

16 Top Priorities FY2015 and FY2016 Most of the attention will be spent on optimizing revenue. Priorities include: Successful install of EPIC. Improving the ambulatory experience access. Ancillary margin improvements. Revenue performance optimized. Faculty productivity and compensation alignment. 16

17 Successful EPIC Install?

18 Why the Change to EPIC? EPIC leads the industry and we are getting it for a greatly reduced price. ICD-10: Organizations across the country are leaving All- Scripts because of readiness concerns. Shared medical record with primary teaching hospital allows us to enhance inpatient billing, assess quality, contract with payers to manage cost, and greatly increase our clinical research potential. TGH funding approximately 60% of EPIC costs. EPIC leads the industry in supporting population health. EPIC reduces variability, improves coding compliance, and increases charge capture. EPIC is a safe bet for Meaningful Use Stage 2. EPIC is the most integrated system in the country. 18

19 Successful Install of EPIC All improvements are dependent upon the successful transition to EPIC. EPIC platform not entirely new to our faculty. Training is underway. All scheduled appointments will be moved from IDX/GE to EPIC in July. Risks: Provider ramp up takes longer than expected. ICD-10 Interfaces between IDX/GE and EPIC. 19

20 Appropriate Access?

21 Improving the Ambulatory Experience Capacity Management Access Care Team and Space Utilization Call Management Efficiency and Quality Planned Care 21

22 Ambulatory Experience: Current and Future States Key Performance Indicator - Access New Patient Access Wait Time Bumps/Cancellation/No Shows Commitment Rate (minutes per ½ day clinic session) Current State Future State 45 days < 7-14 days 37% < 10%-12% 200 minutes 240 minutes Appts. Per Room Per Day Patient Satisfaction Access Not measured 95 th 98 th percentile Average Speed to Answer seconds < 30 seconds Call Abandonment Rate 2.0% % < 5% 22

23 Improving Ambulatory Experience - Access $ Opportunity: $10M - $15M For every 5 point bump in arrival rate, brings $5M additional margin. Goal: $5M per year over next three years Improvements begin by August 1, 2015 Move arrival rate from 63% - 80% over three years. Plan of Action: Physician scheduling templates redesigned by June 30, Central Scheduling will be expanded by August 1,

24 Appropriate Ancillary Operations?

25 Improving Ancillary Operations $ Opportunity: $3M - $5M ASC should be generating 10%-30% margins. Opportunity is up to $2M. Expansion of Lab should generate $1M margin. Imaging has opportunities to improve margins. Opportunity is $1 - $2M. Goal for FY2016: 3% improvement in revenues Improvements begin by August 1,

26 Improving Ancillary Operations Plan of Action: Add clinical laboratory services by January 1, Move phlebotomy to first floor of Morsani and STC by June 30, Develop a margin sharing plan as a reduction in shared services costs to align behaviors. Explore joint venture opportunity with TGH. 26

27 Appropriate Performance Management?

28 Revenue Performance Optimization $ Opportunity: $3M - $5M Documentation and coding improvements could yield another $2M - $4M in improvements. Revenue cycle improvements could yield onetime cash improvements of $1M. Managed care contracting could really boost margins, especially in the ASC. Goal for FY2016: Improve cash yield by 5% - 7%. Improvements begin by August 1,

29 Revenue Performance Optimization Plan of Action: Invest in training for documentation and coding. Implement electronic charge capture by August 1, Improve revenue cycle performance by moving to top quartile in FY2016. Overhaul managed care strategy, including our pricing strategy. Better manage our payer mix through management of schedules and coordination of USF Health and community assets. 29

30 Faculty Productivity and Compensation Alignment $ Opportunity: TBD Goal for FY2016: Design of new plan. Improvements begin by August 1, 2015 Plan of Action: FY2016 improvements tied to access improvements. Develop guiding principles for productivity and compensation. Begin to model new plan versus current. Implement new expectations by July 1,

31 Looking Forward FY2017 and Beyond For funding the losses in FY2015 and FY2016 and truly ensuring an investment mindset, the BOT must also see a return on this investment. Our goal is to achieve breakeven by FY2017 and 2% - 4% margins in FY2018 and beyond. This is the only way to grow our cash reserves back to 90 days and invest back in the growth of the departments. Risks: Faculty cooperation LIP Faculty recruitment State budget 31

32 Looking Forward FY2017 and Beyond 32

33 Looking Forward FY2017 and Beyond FY2016 Loss $(8,245) FY2017 Access Improvements 5,000 70% to 75% Arrival Rate Ancillary Improvements 1,600 25% bump in volume Revenue Perf & EPIC 4,845 Coding improvements and full productivity post EPIC Organic Growth 2,800 2% growth Other Revenue 1,649 2% growth; LIP flat Faculty Salaries (5,893) 47.5% of Revenues Other Expenses (1,442) Remove EPIC costs; Add merit increases; Add variable costs Operating Profit before Noncash Changes 33 $314

34 Looking Forward FY2017 and Beyond FY2017 Gain $475 FY2018 Access Improvements 5,000 75% to 80% Arrival Rate Ancillary Improvements 2,000 25% bump in volume Revenue Perf & EPIC 4,845 Coding improvements and full productivity post EPIC Organic Growth 3,174 2% growth Other Revenue 1,683 2% growth; LIP flat Faculty Salaries (7,966) 47.5% of Revenues Other Expenses (4,881) Add merit increases; Add variable costs Operating Profit before Noncash Changes $4,330 34

35 Wrap-Up The plan is achievable with support from the BOTs and USF Health leadership. This will be a huge cultural shift, meaning changing the status quo may be difficult for some. Until our targets are achieved, the focus should be on clinical recruits. We don t have a hospital as a backstop, therefore our clinical mission should be expected to perform using a private practice business model. Disruptive change = Strategic Opportunity 35

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