F. Edward Nicolas, Jr., CPA Visiting Nurse Services of Connecticut

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1 2012 NAHC Annual Meeting & Exposition F. Edward Nicolas, Jr., CPA, VP/CFO, VNS of Connecticut Barry Gold, CPA, FHFMA, CFO, Mays Homecare Thomas E. Boyd, MBA, Principal, Boyd & Nicholas, Inc. F. Edward Nicolas, Jr., CPA Visiting Nurse Services of Connecticut Vice President/Chief Financial Officer

2 » INCENTIVE COMPENSATION Align compensation with services, performance and Agency Mission» POLICY STATEMENT VNS recognizes the value, commitment, and efforts offered by our quality clinical staff. The intent of the Productivity Incentive Program is to offer a reward/incentive to those salaried clinical staff (RN, PT, ST, OT) who exceed the productivity and efficiency standards as established by VNS. Productivity and efficiency standards include actual patient visits, travel, pre and post time, patient conferences and coordination, prior authorizations, complete, accurate and timely paperwork submission, and other customary practices and activities of clinicians.» VNS Example: Incentive based on 30 weighted visits per week +Prorated for part time employees Measured over a rolling 4 week period Visits are weighted based on expected time and complexity on average The program cannot compromise the integrity or quality of patient care and the related documentation Visits paid under other programs excluded: + Holiday, Weekends, etc. 2

3 » Process: Every 4 weeks Clinical managers receive a report for each staff member and +Review it for accuracy +Ensure the employee is current with their paperwork and there are no quality issues +Approve for payroll py processing» Productive vs. Exempt Hours: Clearly define which hours will be included in the productive hours base +Exemptions: Benefit time Clinics Hours compensated under other arrangements (Per visit) Conferences and Education Marketing Mentoring Orientation Etc. 3

4 » Calculation: Base hours Less exempt hours Productive hours Productive hours % 91.25% Standard Visits X Visit Base Actual weighted visits Less: pay per visits 0.00 Eligible visits Eligible visits excess 5.00 Visit rate Incentive rate 75% Incentive Payment » Other Incentives: Cross territory incentive +Out of area differential for per visit staff to provide adequate coverage across multiple l locations +Pay a flat amount per day plus mileage Education: +Don t short change this! + Recruiting and retention strategy Education expense vs. turnover costs 4

5 » Other Areas: Work with your vendors +Great time to discuss service and pricing + Utilize RFPs: Doesn t have to be a long drawn out process Allows you to evaluate all vendors on a level playing field +Negotiate, Negotiate, Negotiate!!!! Investment of: Time and capital wisely Plus knowledge and education Leads to Success 5

6 Barry Gold, CPA, FHFMA Mays Homecare Chief Financial Officer Health Insurance and Workers Compensation Insurance 6

7 » Salary levels, doubtful» Bonus programs, probably» Full time vs. PRN a good choice» Fringes most definitely The Affordable Care Act changes much of what can be done. Health insurance a major target Workers k compensation not enough attention 7

8 » Is self insurance the way to go? Greatest flexibility More risk, but manageable» Design a more thoughtful plan Focus on prevention Design a range of plans/options» A couple of examples Smoking cessation Physical fitness 8

9 » Many variations in design features Multiple choices for employees Deductibles Maximums Co pays Prescription benefits Eye/Dental options Open enrollment 9

10 » Cost of insurance coverage will increase Pre existing conditions Young adults on parents plan until 26 No dollar limits for lifetime Preventive and screening services at no chargeh» Opt out of providing health insurance with penalty» Changing Medicaid» Rethinking your health insurance fringe benefit program Keep it? Self insure at minimum allowable levels? Mini med programs will disappear Wait and see 2014 will be very important Try to read the law +PDF version is 4.27mb (consolidated is 2.7mb) +There are 10 Titles + 2,409 pages (consolidated is 974 pages) 10

11 » Significant variation from state to state» Mj Majority of states tt use NCCI recommendations dti (National Council on Compensation Insurance) 11

12 » Highest rates are typically applied to those who provide care to patients All disciplines Actually make visits to patients homes» Not all professionals fall into this category Be careful to eliminate non visiting nurses or other clinicians who do not make visits» The Mod factor Based on your actual experience in claims payments related to your premiums» Various discounts 12

13 » Employee education» Equipment testing» Dress codes (particularly shoes for those making home visits) Thomas E. Boyd, MBA Boyd & Nicholas, Inc. Principal

14 Chart 7.1: U.S. Population Trends and Projections by Age, (1) 500 Millions Years Years Years Years Historical and Projected Number of Medicare Beneficiaries Number of Beneficiaries (in millions) Source: 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. 14

15 Medicare Advantage as Percentage of Medicare Beneficiaries % 4% 25.6% Alaska United States Minnesota 0.6%»Outsource Payroll Human resources / personnel Accounting/bookkeeping Accounts payable Billing QA/UR Therapies 15

16 Payroll Services» Compupay Ceridian Corp ADP Paychex Ovation 16

17 HR Responsibilities Determine when additional staff is needed Place ads Interview staff Hire staff Set schedules and rates of pay Provide orientation Determine employee service area Discipline staff Evaluate staff Terminate staff Provide in-services to staff Supervise staff at all times Prepare budget and financial reports Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage, Worker Contribution 97% Total Premium Increase Employer Contribution $15,745 $8,003 $5, % Worker Contribution Increase $11,429 $2,137 $4,

18 Percentage of Firms Offering Health Benefits, by Firm Size FIRM SIZE Workers 55% 50% Workers 74% 73% Workers 88% 87% Workers 97% 94% All Small Firms (3 199 Workers) 65% 61% All Large Firms (200 or More Workers) 99% 98% ALL FIRMS 66% 61%» Increase years of service requirement for eligibility» Increase vesting period» Adjust percentage of contribution to be based on year end profitability or percentage of cost reduction from previous year (employee incentive) including the option of no match» Eliminate plan 18

19 » How to Get Better Deals from Suppliers, Vendors Selecting Vendors: the Role of RFPs How to Bargain & Negotiate with Vendors and Suppliers The Art of Negotiating Everybody Wins Seminar» Negotiating Outsourcing: How to Successfully Manage Outsourcing» Labor Management Negotiations Seminar» Women and the Art of Negotiating Coaching and Consulting Services com» The Negotiation Seminar 19

20 » Home Health Gold Outcome Concept Systems (OCS) PPS Plus Software Strategic Healthcare Programs Fazzi Associates Recertification rate is 31.5 percent. Should you be targeting a recertification rate more in line with the national average of 71.8 percent? Finding a relevant benchmark will help you dissect the factors that relate to your agency s specific performance. BENCHMARKING: A Compass for Change By Richard Chesney September CARING 20

21 Episodes By Type HHA WA Northwest National Full Episode % 85.03% 85.50% LUPA % 14.68% 13.37% Outliers % 0.30% 1.13% Average Payment Episode Full Episode HHA $2, $2, WA $2, $3, Northwest $2, $3, National $2, $2, Visits Per Full Episode W/O Outliers HHA WA Northwest National SN PT OT ST MSW HHA Total

22 EMPLOYEE STOCK OWNERSHIP PLAN (ESOP) National Center for Employee Ownership Tax Advantages Studies indicate: lower employee turnover higher profits 22

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