There will be a lot of discussion from your Director's and Managers over the coming weeks about our need to find savings. Please do not take these discussions lightly. Our May financial results reported a current LOSS of $700,000 year to date.
This is not good for many reasons. First, and simply, it is never good to lose money. It is especially bad when people loaned you $57 million to build the new hospital in New Brunswick with the intent that we would make money and run our business efficiently.
The reasons for our current financial state are three fold which involve operations, inpatient and outpatient census. The first is that we have had higher costs, energy etc, that we couldn't have anticipated. Second, we were off just 1.3 days on inpatient census and that small amount reduces our revenue by almost $500,000 through May. Third, we are 13,000 “half-hour units” below where we need to be on the outpatient side and we are struggling to fill 12 open therapy positions. All of these things have left us in this predicament.
There is a light at the end of the tunnel and I’m happy to report our census has picked up on the inpatient side thanks to the great work of our admissions team and clinical staff.
We are currently examining all of our expenses and seeing if there are things we can push off until next year or do differently to receive immediate savings. I know that when we all pull together we will identify savings.
Our Foundation has graciously agreed to pay for our recognition around the NJBIZ gifts. We are so fortunate that they are always willing to step in and support us when they can.
I personally wanted to make sure that I gave you the most current information we have because I know the rumor mill has already started.
Of course your questions and suggestions are always welcome.
26 comments:
Hi Amy:
We are all personally feeling this economic crush. Energy costs are getting the best of all of us. Just as we look to make cuts in our personal budgets we should look at our organizational budget for cuts as well.
Just some ideas on saving $$$.
Do away with the financial incentive plans that exist within some non-clinical departments.
Promote and support four day work weeks, less employees less energy used.. even if it is only 1 day a week. This will also assist the employee in their carfare budget.
Consider more employees working from home 1-2 days a week again a win for all.
As for unfilled units of service. If there is no work, the provider both therapy and Ambulatory should go home/stay home. Again 1 less provider less energy used. However, this should not be construed as Unscheduled TOP.
As for the hard to fill positions consider reimbursing a candidate/employee who opts out on health insurance. This is a big thing in alot of other organizations. A portion of the organizations savings could be passed onto the employee. This will help with retention as well. Again a win on both sides.
Just some things I have seen work elsewhere in the past.
Under no circumstances should we do away with the financial incentive plans for non-clinical staff. We bust our chops here from morning to night, and enough has been taken away from us already.
Under no circumstances should you do away with financial incentives for non-clinical staff. We work hard from morning to night, and enough has been taken away from us already.
AMEN TO THAT...
Hi Amy:
We are feeling the crunch at home as well, as indicated in an earlier blog. How we try to save is by using less lighting in the home. Some ideas for saving money at CSH would be to use less overhead lights in the individual offices, and of course turn off computers completely after work day, not put in a lock mode. I would love to be able to not take the elevator just up one flight, but unfortunately we cannot use the fire door to exit the building after work on Plum Street. I think it is a waste of energy to use the elevator to go up one flight, if you are capable of climbing stairs, and the energy use has to be a lot to lift the elevator for one person, even if that person is a tiny 128 pounds. Can we rethink this. I'm all for saving money for the hospital.
Our computer printer spits out multiple nearly-blank pages every night while it prints the Latex Allergy, DNR, unsigned meds, vaccines given, and other reports. Each report is preceded by a nearly-blank page announcing the report, and then followed up by a nearly-blank page stating "end of report". If there is no data, we get a third nearly-blank page stating "No data qualified for this smslist".
Right now I am holding 18 sheets of nearly-blank paper that our printer has spit out tonight between 11pm and 2am. The only thing we can use it for is scrap paper. Is there a way I.T. can modify the report printing program, to cut down on this silliness?
Not much else we can think of down here; we are already trimmed pretty much to the bone.
-Toms River LTC night nurse
"Incentive marketing is the difference between success and failure".
I am one of those "non-clinical department" employees, and I would like to offer real solutions to a big problem.
Let us first consider the difference in salary between clinical vs non-clinical staff: we work just as many hours, and just as hard as a clinical staff member, but make significantly less money for the same time and effort. Then take into account that there is less money for us to pay bills and buy food & clothes with, let alone have any left over to actually put into savings.
Those of us who are attempting to better our situation by going to school then have books, tuition, and travel expenses to consider as well.
And as for our children, we also have to set aside money for them to be able to have food, clothes, sports equipment, and savings for college.
Given the discrepancy between our relative amounts of emolument, do you not think that it would be wiser to suggest cutting salaries and/or the bonuses of clinical staff or those making more money?
No, this also is not the answer. That would be unjust as well; although those persons would at least be better equipped to withstand the effects of such an action.
I say the answer lies in taking a long, hard look at the underlying causes of our financial woes.
1. Last minute cancellations on the outpatient side that cannot be filled. Not much we can do there, but we can try to offer incentives to keeping scheduled appointments, (such as every fifth visit free for those who pay out of pocket, or something like that).
2. Therapists seeing patients for services that have not been approved by the insurance company. Increased efforts to properly educate therapists about service codes and insurance requirements might help to minimize this from happening so often. We lose a significant amount of money in write-offs because of such situations...
3. Rethinking HAP. This service is grossly misused. It seems that once a family is approved for hospital assistance, every child in the family ends up in CSH for multiple services. Maybe we should be more stringent in our approval process, or at least reduce the amount of assistance offered. Although this would most probably decrease the amount of services we provide to these patients, it would possibly increase the revenue generated by opening up slots for patients with commercial insurance for which we can be reimbursed.
I too agree that we should make some changes in our energy usage within the hospital, as well as our use of paper. We have shred bins for paper containing private information, but think about how much paper is thrown into those bins that does not have personal information on it. Each of these pages probably has a completely blank side that could be used as scrap paper within the hospital for notes and telephone messages, etc... Why not recycle it?
Another note on recycling - instead of the cafeteria spending thousands of $$$ per year on stirofoam cups, why not encourage the use of something that we can wash and reuse that also keeps our beverages cold? Maybe offer a CSH logo sports water bottle?
Allowing non-essential personnel to work from home, especially if ill, would also be a valid option. Instead of employees coming to work and spreading germs to their coworkers and missing time, they can keep up with their work in their jammies and keep their germs to themselves. Productivity would not fall and the employee would not lose a TOP day.
Has research been done on what we are gaining financially by offering camps and outpatient programs? 90% of families who apply for financial assistance are 100% approved. Some of this money is funded through the Foundation, but the cost to pay clinical staff to run these types of programs seems far greater than what is taken in. Also, take into consideration that clinicians cannot treat patients while running the programs so less revenue is received during this time.
It's nice to be able to provide these types of programs to families, but if we're losing money it doesn't make much sense.
I feel the same way everytime, I fill up my gas take, but i need to fill it up to get to work. But I really dont think taking away office supplies such as paper clips, scotch tape and staples is the answer either. So in other words your office workers should have to take money out of there own house hold budgets in order to maintain the organizational fundamentals of an office. Come on guys who wasted alot of time and money in college to come up with this one...
I had 8 PT evaluations no showing in a row between mar- may 2008 and the trend continues in june-july. Inspite of every effeort to call and confirm the date & timings of evaluation for therapy I observe there is increasing % of Cx and NS. There can be many reasons and I would like to share mine.
Not all evaluations are scheuled close to residence and many families may not like to pay extra for the gas as well as for the co pays. Families may need to be eduacted on this to avoid last minute cancellations or worse No shows.
There is increasing demand for therapy evals following improved awareness in the mediacl fraternity but we do not know if this really trickles to parent eduaction by the physicians to commit families for PT evaluation and regular visits for therapy.This is particularly true in certain socioeconomic groups who have multiple issues including trasnportation issues, communication specially if english is not native language and lack of family support system .I do not know if our schedulers are equipped to handle all these issues when they scheudle clients for evaluations. It may be worth doing a PI on the evals cancellations and no shows since evaluations generate sizable revenue. I would also add that we may also start taking some kind of punitive actions when families no show for evaluatiosn or cancel more than 2 times. All doctors office charge the person for noshows.
I understand how hard it is work in a non-clinical position, and not reap the same financial benefits, and in many instances, positive feedback as the clinical folks. I also know the sacrifices and financial burden required to work full time and go to school. However, I'm not sure cutting ANYONE's salary or incentive bonus is the answer. The clinical people, who may make more money, are often paying back student loans needed to earn master's and doctoral degrees, so they may not have more "means" to deal with a salary cut. Nor should non-clinical staff have to suffer the burden of loosing incentive bonuses, which they work hard to earn, and use for raising their families and paying for schooling. There are other ways of cutting costs. For instance, I don't truly need a gift for working at the hospital for 5, 10, or 15 years. Although the gesture is truly lovely, quite frankly the privilege of sharing space with so many talented therapists is enough of a gift. I would suggest reserving the gifts for people who are retiring after 20 or more years of service, and have a fun barbeque instead of an expensive dinner. Antoher way of cost cutting include sharing staff between sites, or swapping staff to allow for patient coverage when one site wants a clinician who is experience in a certain technique to mentor them. There are so many ways of reducing costs and so many great ideas have already been offered. I know our leadership is listening, to all of these great ideas, so lets all keep the ideas constructive and work together to solve this issue!
I got a chance to read all the comments from Amy's financial update and I wanted to ask "anonymous" who made the first comment - What financial incentive plans exist in non-clinical departments? I work in a non-clinical department and I have never heard of any kind of incentive plan.
Directors of all departments have the ability create an incentive plan for their employees. The director’s set a tangible goal for employees to meet and if the department meets or exceeds what is expected, then the employees receive a monetary incentive.
Patient Accounting is a good example. The CFO sets goals for how much money needs to be collected each month from insurance companies and payers to support our budget. If the staff exceeds their goal, the staff receives an incentive.
These non-clinical incentives need to be self-funded with in the department and the parameters need to be measurable.
I hope this clears up any confusion.
I think the HAP is a great program. We should not only be treating patients who have money and can pay out of pocket or those that have all-inclusive insurance plans. I know of a family who utilized HAP, and it was the only way they could get their son treated. Even after one year of HAP use, the guidelines changed and the parents had to pay some out of pocket expenses. They could barely handle that and thought about discontinuing services. We are about treating children and providing services for families; I think discontinuing HAP would be a negative reflection on us.
is there a reason the comment about cancelling the Beach Ball as a cost saving measure did not appear in the blog? Or the one about trying to bring Meditech training on-site or reduce number of staff and visits to Boston for training? I can understand censoring comments to make sure not profane or hurtful, but these were meant to be constructive suggestions.
All comments that have been received have been posted - I did not receive the comments about the beach ball or Boston training. Can you please resend? Make sure you fill out the word varifaction correctly.
We should not mistakenly view the downturn as a short-term event and address operational issues rather than strategic ones. A business can continue to reap profits during slowdowns if its strategy is formulated to account for the possibility of a future downturn.
We need to see beyond the current task-oriented environment and stop to evaluate economic elements, and then formulate a strategy that prepares our business for any tough times ahead.
Of course we can all do our share in helping to do things differently so we can see immediate savings, but the answer to our long-term success lies in strategic planning and decision making by those in charge. Failure to plan is like planning to fail. A prescription for today's success easily can become tomorrow's poison if changing conditions are not considered.
Anonymous.......
I agree with the person that said we should put a lot more effort and training into the registration process , making sure we verify patients' insurance information and receiving approval for the services we render before we do so. It not only makes for a much more efficient billing/collections process but ensures more of our claims being paid in a timely manner and with less losses and bad debt issues. It would definitely help if even we are consistently verifying patients' and parents' personal as well as insurance information at every visit.Many times insurance coverage is verified but approval is not sought because a parent says differently or otherwise, we should be making this a priority. These people pay a lot out of pocket for their healthcare, the carriers should in
turn be paying their bills. Let us do what we can to make sure of this.
Anonymous.......
I agree with the person that said we should put a lot more effort and training into the registration process , making sure we verify patients' insurance information and receiving approval for the services we render before we do so. It not only makes for a much more efficient billing/collections process but ensures more of our claims being paid in a timely manner and with less losses and bad debt issues. It would definitely help if even we are consistently verifying patients' and parents' personal as well as insurance information at every visit.Many times insurance coverage is verified but approval is not sought because a parent says differently or otherwise, we should be making this a priority. These people pay a lot out of pocket for their healthcare, the carriers should in
turn be paying their bills. Let us do what we can to make sure of this.
I think our reimbursement rates for the services we provide is abysmal!We need to re-negotiate some contracts and get paid for the great work we do.
I tend to agree with the idea someone presented earlier of charging parents a fee for no shows without prior notice...it's done in many places now. Also, don't know if "group" treatment is an option/reimburseable by insurance companies, but if so, maybe that would help us get more kids serviced - or even as an option for parents who are paying out of pocket.
While the Beach ball is a lot of fun, it is also probably expensive to run.Let's consider not having it this year, due to financial situation. Having a job helps morale more than having a big staff party.
Also, Meditech training seems very expensive due to the number of staff involved, several days in Boston at a time, etc. Can more of the training occur on our site, or involve fewer people who can represent others rather than have so many attend?
We are really struggling withg the beach ball. We have already put the deposit down that we can't get back. We also have all worked so hard this year, we need a chance to connect outside of work. But I agree - the focus must be preserving the services for our kids and our work environment. We are crunching the numbers to see if we can scale it back and then decide. It very well may get sacrificed.
On Meditech, we are looking at all of our projects. I don't want to delay the implementation or training because we know that we will gain great efficiency from having one system. I appreciate your suggestions and your commitment to problem solve during this tough time.
I want you to know that operations committee has struggled with the cancellation fee at some length. Issues that present huge challenges ar 40% of our outpatients are medicaid and we are prohibited from charging a fee. There is some % that is HAP so we couldn't charge them. Then for the remainder - let's be honest people are coming to us have kids with multiple disabilties and challenges. Do we charge it regardless of the reason? Ie kid is sick? Please know we continue to look at it - it just isn't easy.
On the rate issue - we will continue to fight hard to get the best rates we can. Hospital and physician rates continue to be reduced. President Bush just vetoed legislation to stop further reductions in Medicare. These are hard times for reimbursement negotiations but I am always available to discuss with you off line.
Regarding (the 20 posts up) TR LTC Nurse's issue
Spitting out paper
"Not much else we can think of down here; we are already trimmed pretty much to the bone.
-Toms River LTC night nurse"
Well First you can start with contacting the Helpdesk by e-mail or telephone, following the chain of command.
Post a Comment