Acucare Health Strategies, Inc.: Outcomes: Operations & Management


	"Under Acucare's leadership, I have observed significant and steady progress toward meeting our service and financial goals"

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 This client was subsequently advised by the State in which it operates that its license was revoked.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: An organization with multiple departments performing similar tasks was not able to meet their customers' needs. Departments were in different physical locations and different time zones from the client. The departments were unaware of each other's existence and were unaware of their need for dependence on each other. Each department had a different view of how to meet customers' needs and a comprehensive time frame was needed to meet those needs.

Outcome:

Created an inter-departmental workflow and defined the key players in each of the key service areas
Worked with department heads to document and define each teams roles and needs
Created an end-to-end service plan
Facilitated the drafting and implementation of a service level agreement designed to ensure that the needs of the patient were met
Redesigned and created processes to facilitate meeting defined service level agreements with company's external and internal customers
Successful implementation of these processes resulted in reduction of response to customer service from 5-7 days to 24 hours with a 25% rise in customer satisfaction

Challenge: A financially strapped internal medicine practice, with physicians at times declining their salaries, wanted to practice holistic medicine without the pressures of seeing more patients to maintain the financial viability of the organization. Patient dissatisfaction was growing due to long patient wait times to see a physician. A lack of technology existed within the office hindering the facilitation of workflow. A lack of knowledge also existed concerning HIPAA's new regulations regarding privacy and security.

Outcome:

Created new service lines to increase revenue while allowing the physicians to continue to practice as per their conscience despite the pressures for the declining insurance reimbursement
Created professional development and training plans
Redesigned the charge master
Renegotiated managed care and service contracts
Redesigned scheduling process and implemented technology for scheduling, patient reminders, and actual visit documentation in order to reduce wait time and actual time needed for each visit
Conducted patient satisfaction surveys and implemented many suggestions
Oriented staff and physicians to new law and regulatory requirements
Redesigned and implemented process changes to meet regulatory requirements

Challenge: Through an internal audit, a national healthcare provider identified falsification of clinical records by a contractor.

Outcome:

Reviewed clinical records with a focus on patients' signature and visits time verification to payroll data
Verified all contractors' records relevant to the services provided and the involved staff
Audited the contractors' payroll and billing practices from the initial date of the agreement to determine the scope of the problem
Assisted legal counsel and the client to self report

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 to 27%
Enhanced existing information system, created and implemented databases to review demographics and utilization data, collected statistical information, evaluated trends, and tracked referrals
Increased the average daily census in the newly acquired markets by 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 strategic alliances 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