Operations Foundations

Shannon NielsonManager, Transformation and Compliance

HealthSpan Solutions (Formerly Health Partners Consulting)

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Operations Foundations

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Operations Management

Operations Management: Administration and business practices to create the highest level of efficiency possible within the organization

FQHC Operational Challenges:• Mission vs. Business• Which hat am I wearing?• Staffing• Compliance, Compliance, Compliance• Clinical vs. Operations• Feds vs. Me

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FQHC Operations

• FQHC Compliance Requirements:– HRSA (330 Grant/19 Requirements)– FTCA– UDS

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330 Grant/ Program Review

• Section 330 of Public Health Service Act• Qualification for enhanced reimbursement from

Medicare and Medicaid• Must Meet Program Requirements • 3 Year Project Period• Annual Budget Progress Period

Updates

What does FQHC mean?

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Poll Question

• How familiar are you with the 19 program requirements?– A. Very familiar– B. Somewhat familiar– C. Not really familiar– D. What requirements?

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Program RequirementsSubject Requirement

Need

Needs Assessment

Services

Required and Additional Services

Staffing Requirements

Accessible hours of operation/locations

After Hours Coverage

Hospital Admitting Privileges and Continuum of Care

Sliding Fee Discount

Quality Improvement/Quality Assurance Plan

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Program Requirements Cont…Subject RequirementManagement and Finance

Key Management Staff

Contractual/Affiliation Agreements

Collaborative Relationships

Financial Management and Control Policies

Billing and Collections

Budget

Program Data Reporting Systems

Scope of Project

Governance

Board Authority

Board Composition

Conflict of Interest Policy5/1/2014

HRSA Requirements:Making it work for me…• What does your needs assessment tell you?

– Gaps in service? – Service Expansion?– Marketing opportunities?– Supply vs. Demand – Patient focus and satisfaction– Potential Collaborations

• Services– Access– Do we have the right staff? Do we have the right roles?– Do we have the right partners and collaborators?– Do we have what the patient wants?

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• Management and Finance– Reporting mechanisms– Alignment between departments– Consistency around definitions and measures– Who are our partners? Vendors? Stakeholders?

• Governance– Who represents us?– Who do we need on the Board?– Who/What will help our organization?

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Poll Question

• I use the UDS for more than just submission in March?– Yes– No

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Uniform Data Set (UDS)

• Standardized set of data (financial, demographic, clinical)– Ensure compliance with legislative

and regulatory compliance– Improve and report performance– Appropriations funding– ***Management Information Tool***

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UDS Quality Measures• Quality of Care:

– % pregnant women beginning prenatal care in 1st trimester

– % of kids will appropriate IZ before 3rd

birthday– % women 21-64 with pap– % of 2-17 YO with BMI documentation,

nutrition counseling and physical activity counseling

– % of 18+ with BMI documented and follow up plan documented if over/under weight

– % of 18 YO queried about tobacco use and % 18+YO who are users of tobacco and received advice to quit

– % 5-40 YO with persistent asthma and prescribed acceptable pharmacological therapy

– % 18+ discharged alive with AMI, CABG or PTCA or have dx of IVD who have documentation of aspirin or antithrombotic therapy

– % 51-75 YO with appropriate screening for colorectal cancer screening

• Health Outcomes/Disparities– % DM patients 18-75 most

recent A1C value– % of HTN patients 18-85 most

recent BP – % of births less than 2,500

grams

• NEW MEASUREs 2014:– Depression Screening and

Plan for 12+ YO (proposed)– Follow up for 1st time dx HIV

pts (proposed)– Lipid Control for CAD patients

(Disparity Measure-proposed)

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UDS: Information At Your Fingertips

• Cross table referencing– Operating Revenue Vs. Expense growth-

operational efficiency– Cost per user/encounter-what is your

payer mix? What is our scheduling protocols, EBG?

– Visits/User –outreach needs? Over utilization?

– Disparities? Cost? Clinical?

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UDS: Make it Continuous

• Reporting Mechanism• Trending Data• Information for your Management Team

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Federal Tort Claims Act (FTCA)

• Medical Malpractice for Health Centers• Annual deeming process• Key Components:

– Credentialing/Privileging– QI/QA

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FTCA: Make it Worth it

• Liability, Liability, Liability– Streamline your credentialing and privileging

process– Internal checks and balances– Relationships with payers, ODH and other

stakeholders

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What is the common thread?

Quality 

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Surface Level QI

• Purpose and Plan• Structure• Reporting/Feedback• Methodologies

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Key Driver Overview

What are the key day to day steps that impact our Key 

Drivers?

What are the key concepts that driveOUTCOMES

Implement Registry• Determine staff 

workflow• Populate data

Use Health Registry• Identify needed 

services>80% DM with A1C <9

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Structure, Staff, Systems

• RACI– Responsibility Assignment Matrix

• R-Responsibility• A-Accountability• C-Consult• I-Inform

• Same Thing, Every time, Every Patient• Use the UDS, HRSA Requirements and FTCA

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RACI

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Homework

Work with Clinical/QI team Complete a RACI for UDS

Depression MeasureReview Key Driver with QI lead (Do

you agree? Do you have to adjust?)Review FMEA with QI lead (does it fit

RACI)

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Stuck?

• Reach out for help:– Contact Chelsea Horn to request a ½ hour 1:1 to

walk through any areas that seem muddy: cehorn@healthspan.org

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