Acucare Health Strategies, Inc.: Outcomes: Financial Management


	"This team has billed 2,700+ claims in a 60 day (holiday) period with some claims as old as 2+ years. All of this happened in the midst of a major billing system conversion. This is almost an unimaginable accomplishment and impressive to say the least"

Challenge: A national hospice provider was instructed by the Health Care Financing Administration to close down one of its agencies due to numerous violations of the Medicare Conditions of Participation. This client was also at risk in 4 other locations. The client also identified inadequate leadership, resulting in loss of market share and excessive staff turnover.

Outcome:

Entered into an agreement to manage operations. Our team reported to CEO and Board Chairman
Managed a $98 million budget with 32 offices nationwide
Realized $7.7 million in operations efficiency within 8 months
Increased the patient admission conversion ratio by 26% to 88%
Increased the length of stay by 24 days to 79 days and the market penetration by 26%
Implemented audit tools to ensure regulatory and clinical compliance, reduced claim denials, and improved Accounts Receivable collections

Challenge: As a result of a patient complaint, a survey by the Health Care Financing Administration found nine (9) violations of the Medicare Conditions of Participation and decertified this national home health and hospice provider in a specific marketplace. This client was subsequently advised by the State in which it operates that its license was revoked. An internal audit revealed similar compliance issues in most of its locations.

Outcome:

Entered into an agreement to manage operations. Our team reported to Health System's CEO and the Board of Directors
Implemented a compliance plan to meet all regulatory guidelines
Wrote a plan of correction based on the survey findings that were acceptable to HCFA and the State Agency
Identified and corrected the organizational problems that led to non compliance
Negotiated with HCFA to rescind the decertification in lieu of a 30 days penalty
Reduced the fines levied by HCFA and the State Agency by 81%
Created and implemented a "Synergy Program" to achieve a continuum of care for the Health System's patients by coordinating services between the hospitals, long term care facilities, and other entities owned and operated by the Health System
Managed a $51 million budget
Managed 19 offices, 2 inpatient facilities, one HME center and an infusion pharmacy
Realized cost savings of $4.4 million
Increased the conversion ratio by 17%, the length of stay by 14 days, and the market penetration by 29%
Increased staff productivity to 5.6 visits per day
Achieved a net income of 28.42%

Challenge: JCAHO accredited regional home health and hospice provider with fragmented operations had several locations with conflicting ownership. Provider lost patient care focus and market share.

Outcome:

Successfully placed cohesive top level management
Implemented a marketing strategy for managed care division that increased home health annual visits from 15,000 visits to over 70,000 visits
Launched a Congestive Heart Failure disease management program with over 50 patients on monthly capitated payment (payor calculated $800K in annual savings)
Redesigned internal operations and installed new information system achieving outcomes reporting, cost accounting capabilities, ensured regulatory compliance, increased productivity by 25%, and reduced fixed cost by $1 million
Assisted in the acquisition of a major competitor and successfully integrated operations reducing costs by $4.2 million while improving the continuity and quality of patient care
Increased hospice average daily census from 50 to 200 through internal growth and acquisition

Challenge: A large health system discovered through a financial audit that $7.5 million in accounts receivable was at risk. Retained for accounts receivable management and recovery. Project consisted of clinical audit and billing review for accurate claim submission to Medicare.

Outcome:

Uncovered serious regulatory and compliance violations causing us to invoke attorney client privileges and retain outside counsel to assist client with potential fraud and abuse issues
Utilized audit outcome to create a staff education program regarding patient care issues, compliance, fraud and abuse, and documentation
Audit outcome precipitated a process redesign and the re-engineering of operations
Launched a new information system to support the agency's new processes
Collected $57.8 million dollars
Reduced Day Sales Outstanding (DSO) from over 270 days to 55 days

Challenge: Medical practice considering acquisition of another group and the startup of an outpatient surgery center.

Outcome:

Assisted the practice in acquiring the smaller group and achieving economies of scale
Implemented compliance measures to overcome potential regulatory violations with self-referral to the outpatient surgery center
Advised client on self-referring to their physical therapy practice
Implemented operations and billing efficiencies realizing annual savings of $2.3 million
Recovered $900,000 of uncollected receivables and reduced aging to 62 days

Challenge: A large hospice provider lost 25% of its market share and experienced increased cost in patient care and administrative overhead. They considered the acquisition of another local hospice.

Outcome:

Entered into an agreement to serve as a member of the executive team reporting to the Board of Directors, with responsibility for the strategic plan, its implementation, and all marketing efforts for new programs and services
Conceived and implemented new clinical services to support the hospice programs, increasing referrals by 19%
Reengineered operations, which improved the conversion ratio and increased admissions by 18%
Initiated and oversaw the acquisition of another local hospice, and created a parent company to optimize efficiency and economies of scale in a non-profit environment. Subsequently acquired two additional hospices and created a regional presence
Directed public and media relations and maintained relationships with elected officials
Actively participated in fund raising, budget development and implementation
Expanded the local average daily census by 20%, the length of stay by 22%, and the market penetration among cardiac and COPD patients to27%
Enhanced existing information system, created and implemented databases toreview demographics and utilization data, collected statistical information,evaluated trends, and tracked referrals
Increased the average daily census in the newly acquired marketsby 100% within 70 days

Challenge: Medicare & JCAHO accredited healthcare provider lost market share and exhausted its credit line. Considering bankruptcy proceedings and looking to sell its California offices.

Outcome:

Organized and completed the leveraged buyout of four Southern California offices
Established the vision of the organization; introduced and implemented a variety of programs to gain market share in a highly competitive environment
Negotiated managed care contracts at executive management levels,obtained contracts with physician groups, and joint ventured with strategicalliances and insurers
Increased total annual revenue to $6.5 million within two years and to $14 million within six years
Increased home health and hospice annual revenues to $4.5 million
Established new and profitable programs in home medical equipment, hospice, outpatient rehabilitation, psychiatric home care, and infusion pharmacy
Conceived and established a highly successful shared risk capitation program to control utilization and increase profitability


NAHC Member	AHHIF Member	TAHC Member	AHHC Member