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New York tackles Medicaid reform with DSRIP
New York state, at Gov. Andrew Cuomo’s direction, continues to implement the most dramatic health-care reform of any state in the country. The state’s reform initiatives directly affect the 25 percent of New Yorkers (6 million citizens) who are eligible for Medicaid. Beginning with the 79 recommendations of the Cuomo-appointed Medicaid Redesign Team (MRT) […]
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New York state, at Gov. Andrew Cuomo’s direction, continues to implement the most dramatic health-care reform of any state in the country. The state’s reform initiatives directly affect the 25 percent of New Yorkers (6 million citizens) who are eligible for Medicaid.
Beginning with the 79 recommendations of the Cuomo-appointed Medicaid Redesign Team (MRT) in 2011, the state Department of Health has been on an ambitious Medicaid-reform track to try to control the more than $50 billion of annual New York state (NYS) Medicaid expenditures. In March 2014, the state negotiated an agreement with the federal Centers for Medicare and Medicaid Services that requires transformation of the NYS Medicaid program from a fee-for-service (or FFS) to a value / performance-based reimbursement system, commonly referred to as pay-for-performance (P4P). Most health-care experts acknowledge that a transformation of this magnitude should take up to 10 years. New York continues to focus on a 3-5 year implementation plan, with 2015 representing a key transition point toward satisfying the transformational objectives.
As you know, we can’t do anything in health care without creating a few more acronyms. The Delivery System Reform Incentive Payment Program (DSRIP) serves as the umbrella description for the process of Medicaid reform. Under the DSRIP agreement between the state and federal governments, NYS can receive up to $8.5 billion of performance incentive payments ($6.5 billion for non-governmental service providers). The primary objectives of the DSRIP implementation over the next five years are as follows:
– Reduce/Eliminate avoidable hospital emergency room visits by 25 percent
– Reduce avoidable hospital in-patient admissions by 25 percent
– Reduce hospital readmissions by 25 percent
Reducing hospital utilization is the same objective that spawned the implementation of managed-care insurance plans some 40 years ago, following the federal Health Maintenance Organization (HMO) Act of 1973. Managed care for the employed population covered by HMOs essentially failed in its objective, which has led us to the proliferation of consumer-directed health plans, employer self-insurance, and medical cost shifting from employers to employees.
The stated goals of the DSRIP initiative are addressing a monumental challenge. The foundation structure of DSRIP is dependent upon the success of Performing Provider Systems (PPS). A PPS is a coalition of regional health and human-service providers linked to a lead hospital/health system.
The stated goals of DSRIP are:
– Promote community-based collaboration among health and human-service providers working in concert with the PPS lead health-care systems.
– Improve clinical performance, quality, and service outcomes to achieve primary P4P objectives.
– The $6.5 billion of DSRIP performance incentives will require a 25 percent reduction in “avoidable hospital use” over the next five years (i.e., primarily ER visits and hospital admissions/readmissions)
The success of the DSRIP initiative will be dependent upon the unprecedented cooperation and collaboration of hundreds of health and human-service providers in each of the 11 PPS regions of the state.
Last August, 88 applications were submitted for consideration and state approval to form PPS organizations. After approving 42 of the applications, coupled with consolidation of certain applicants, we now have 25 PPS organizations being formed in response to the DSRIP initiative. Each of these 25 fledgling PPSs generally involves hundreds of community-based network providers who will have to learn quickly to “play in the sandbox” together.
The DSRIP design structure identified more than 35 project initiatives for the PPS entities to address in their recently submitted Project Plan Applications (December 2014), in the following areas:
– Health-care system transformation projects
– Clinical-improvement projects emphasizing care coordination
– “Population Health” focused on a preventive-care agenda
The entire DSRIP initiative is proceeding at a break-neck pace. For example, the PPS Project Plan initiatives submitted in December require each PPS to select up to 10 initiatives from the 35 identified by the DSRIP team, These applications are being evaluated in the first quarter of 2015 with approval of project plans and grant awards in April.
As a taxpayer, it is hard to argue with the concept and stated objectives of the DSRIP initiative. The timing and coordination of Project Plan implementation, along with provider collaboration, will be a critical component of success. For many health and human-service providers, these project initiatives represent a seismic restructuring of the service-delivery system which has been carefully developed by NYS over the past 50 years since the enactment of Medicaid and Medicare legislation in 1965.
As a nonprofit board and/or management team member, the DSRIP PPS initiative will require timely evaluation and decision-making processes. Organizations that serve one or more of the high-cost vulnerable populations will be most significantly affected:
– Elderly — nursing-home residents/home-care services
– Mental health — Community-based integration coupled with case management to avoid hospital utilization
– Substance abuse — Rehabilitation intoxication in community-based program sites
– Intellectual/developmentally disabled — provide services in the least-costly, community-integrated location emphasizing independence and self-sufficiency
– At-risk youth — increased use of foster care in the home while diverting services away from institutional-based services
Services to these vulnerable populations will require effective strategic positioning of your organization to achieve success in this transformational restructuring of Medicaid service delivery.
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Gerald J. Archibald, CPA, is a partner in charge of the management advisory services at The Bonadio Group. Contact him at garchibald@bonadio.com
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Syracuse Orthopedic Specialists partners with Urgent Care of Auburn
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Health-care jobs are prominent on trending jobs list for CNY, Southern Tier
The Central New York and Southern Tier job markets are hardly booming, but for some jobs, candidates are in demand. The health-care field has a few of those positions. The New York State Department of Labor on Jan. 20 issued a list of the top five trending jobs for this year in regions around
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The Central New York and Southern Tier job markets are hardly booming, but for some jobs, candidates are in demand. The health-care field has a few of those positions.
The New York State Department of Labor on Jan. 20 issued a list of the top five trending jobs for this year in regions around the state, based on what employers are telling the agency are the positions they are struggling to fill.
In Central New York (Cayuga, Cortland, Madison, Onondaga, and Oswego counties), the following job titles (and their annual median wage) are likely to see greater than normal growth through the end of 2015, the Labor Department said:
• Industrial-machinery mechanic ($49,620)
• Certified nursing assistant ($27,630)
• Electrician ($52,870)
• Welder ($36,710)
• Registered nurse ($59,130)
In the Southern Tier (Broome, Chemung, Chenango, Delaware, Schuyler, Steuben, Tioga, and Tompkins counties), these five job titles (and their annual median wage) are likely to see higher than normal growth through the end of 2015:
• Heavy and tractor-trailer truck drivers ($37,290)
• Nursing assistants ($28,480)
• Personal-care aides ($23,200)
• Customer-service representatives ($31,380)
• egistered nurses ($65,660)
The lists are based on occupational survey data and regional needs projected by the state Labor Department’s regional analysts, the agency said in a news release.
These jobs are in demand despite a tepid overall job market in Central New York and the Southern Tier. The Syracuse metro area lost 1,800 total jobs between December 2013 and this past December, the most jobs lost of any New York state metro area, according to Labor Department data released Jan. 22.
The Binghamton metro area gained 500 jobs over the same 12-month span, an increase of 0.5 percent. But, that’s still shy of the state’s 1.2 percent job growth.
Karen Knapik-Scalzo, the state Labor Department’s regional labor-market analyst for Central New York, says the list looks at short- and long-term projections for job openings. The top five trending jobs are a sampling of employer-reported shortages, she says.
In CNY, health care and skilled manufacturing workers are in demand, according to Knapik-Scalzo. “Those two industries were the two largest ones in terms of need,” she says.
The list also helps apprenticeship programs and community colleges determine where to focus their training, Knapik-Scalzo says.
The Southern Tier is not seeing much growth in the private sector, which is making it difficult for people to find jobs and keep their skills up to date, says Christian Harris, the agency’s regional labor-market analyst for the Southern Tier. Many potential workers lack the soft skills — getting to work on time, problem solving and communication — that are needed for many of these in-demand jobs, Harris says.
Health-care services is an industry where an aging population demands more workers, he adds.
The New York Labor Department encourages job seekers to visit the Jobs Express website (www.jobs.ny.gov), a database of job openings sorted by occupation and region throughout the state. Businesses can also post job listings on the site.
Small-business lending at credit unions may get a boost from SBA, NCUA partnership
The U.S. Small Business Administration (SBA) and the National Credit Union Administration (NCUA) have signed an agreement to expand the accessibility of small-dollar SBA loans from credit unions. Alexandria, Virginia–based NCUA is the independent federal agency that regulates, charters, and supervises federal credit unions. By partnering, the two groups will be able to
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The U.S. Small Business Administration (SBA) and the National Credit Union Administration (NCUA) have signed an agreement to expand the accessibility of small-dollar SBA loans from credit unions.
Alexandria, Virginia–based NCUA is the independent federal agency that regulates, charters, and supervises federal credit unions.
By partnering, the two groups will be able to “increase awareness” about SBA’s loan programs for credit unions and the NCUA, the SBA said in a news release issued Feb. 6.
SBA administrator Maria Contreras-Sweet and Debbie Matz, NCUA board chairman, signed the memorandum of understanding “to invest in America’s entrepreneurial potential.”
SBA small-dollar loans don’t count against credit unions’ business-loan cap, so they are “well suited to expanding access to these loans,” Contreras-Sweet said in the SBA release.
“This provides flexibility to credit unions to distribute small-dollar loans, increasing access to capital to local economies and enriching the entrepreneurial communities which credit unions serve. Since 2011, the outstanding balance of SBA loans by credit unions has seen nearly a 50 percent increase … from $810 million to $1.2 billion. This signals a growing demand for SBA-loan programs. Millions of Americans have used their credit union to finance their car, home, or children’s education. We want to empower credit unions to finance small-business start-ups, too,” said Contreras-Sweet.
The SBA is making small-dollar loans a “top priority” in efforts to increase business lending and reach out to “underserved” borrowers, the agency added.
The agency is defining small-dollar loans as ones in the amount of $50,000 or less, the SBA said in response to an email inquiry from CNYBJ.
The federal government isn’t providing any additional funding for the loans, describing the arrangement as a “strategic outreach agreement on both sides,” the SBA added in its response.
The NCUA’s Matz calls it a “tremendous opportunity” for credit unions and small-business owners.
“SBA-guaranteed loans made by credit unions provide needed capital for existing small businesses and start-ups that might have difficulty obtaining loans from other institutions. With a significant portion of principal guaranteed by the full faith and credit of the United States government, SBA loans rank among credit unions’ safest loans. There is a vast untapped capacity for credit unions to make more SBA loans. This initiative will help us unlock that capacity and put it to work for credit unions, their members, and their communities,” Matz said in the news release.
St. Joseph’s Ruscitto talks electronic medical records, finances, physician network
SYRACUSE — St. Joseph’s Hospital Health Center’s leader believes its new electronic medical-record system will help improve the hospital’s annual financial performance in the coming years. St. Joseph’s last May launched SJLinked, an electronic health-record (EHR) system across its entire organization, including the hospital, clinics, and the primary-care offices of St. Joseph’s Physicians.
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SYRACUSE — St. Joseph’s Hospital Health Center’s leader believes its new electronic medical-record system will help improve the hospital’s annual financial performance in the coming years.
St. Joseph’s last May launched SJLinked, an electronic health-record (EHR) system across its entire organization, including the hospital, clinics, and the primary-care offices of St. Joseph’s Physicians.
The health-care organization has used electronic records since 1999, but the system-wide EHR means all providers are on the “same screen, ensuring consistency and improving coordination of care,” St. Joseph’s said in a news release in May 2014.
St. Joseph’s collaborated with Verona, Wisconsin–based Epic Systems to design SJLinked. Nearly 200 employees from various units worked with Epic for 18 months to build and test the customized EHR platform.
SJLinked enables St. Joseph’s doctors and nurses to share test results, medication lists, physician notes, and other information across hospital units, ambulatory services, and in-transitions between care settings.
The system connects “everything we do,” from the primary-care office through the hospital back out to the community, says Kathryn Ruscitto, president and CEO of St. Joseph’s Hospital Health Center.
“Over time, I’m told by other CEOs they see their capture of revenue increase by almost 5 percent on an annual basis,” she says.
Ruscitto spoke with CNYBJ on Feb. 5.
The electronic records could prevent repeat tests and/or duplicating procedures in the course of a patient’s treatment.
“It improves the quality of care, has less impact on the patient, and, over time, produces better financial performance,” Ruscitto says of SJLinked.
St. Joseph’s expected to finish 2014 with annual revenue of nearly $634 million, according to information it provided for the Jan. 26 CNYBJ Progress Edition. The health-care organization is projecting revenue of more than $660 million in 2015.
SJLinked allows St. Joseph’s personnel to attribute, “without handwriting,” every aspect of a given patient’s care.
Ruscitto conceded that implementation of the new EHR system resulted in reduced productivity because “everybody has to slow down, learn the system.” She expected 2014 to be a “bumpy” year.
“Now we’re expecting to really realize the benefits going forward and every year, it’s going to have a bigger payback for us because we will have gone from hand writing, hand attributing, to everything being automated,” says Ruscitto.
The system “immediately” codes and produces the patient bill, so it’s “more accurate, less bouncing back, less audit related to it,” she adds.
Its previous software vendor informed St. Joseph’s that it was “pulling the plug” on the system, something the organization didn’t anticipate happening.
“The last thing I wanted to do was rip [up] and replace a technology system the same year we were opening a new tower, but we had no choice,” she says.
Physicians and ACQA
St. Joseph’s and Excellus BlueCross BlueShield, Central New York’s largest health insurer, are collaborating on an ACQA, which is short for accountable cost and quality arrangement.
An ACQA — which is designed to “achieve enhanced care coordination, improve patient satisfaction and outcomes, and reduce health-care costs” — will benefit Excellus members who are under the care of St. Joseph’s-affiliated physicians, the organizations said in a news release they issued last Aug. 27.
Ruscitto describes ACQA as “private insurance.”
The ACQA is Excellus’ version in this market of what the state and federal governments are offering through the health-care exchanges under the Affordable Care
Act, she noted.
The organizations believe they can deliver “better” health-care quality and avoid “unnecessary” costs by “improving access to primary care medical services (to manage chronic illnesses such as diabetes and reduce the need for emergency room visits), improving medication adherence rates and limiting duplication of services,” according to the Aug. 27 news release.
The ACQA assesses quality performance through the use of national quality measures, which include performance thresholds for diabetes, blood pressure, and coronary-artery disease.
With its collaboration with Excellus, St. Joseph’s has formed a clinically integrated network (CIN) of physicians, says Ruscitto.
Physicians that currently work for the hospital are now branded as St. Joseph’s Physicians.
Ruscitto says “more and more” physicians want to be part of that network, so the hospital will “continue to offer that option.”
“But we also have a number of independent physicians who want to stay independent, so we’re joining together with them to create the clinically-integrated network [CIN],” she adds.
The clinically-integrated network involves all the physicians coming together to jointly begin to understand how to improve quality and reduce cost.
“The first product we will offer through the CIN is ACQA. [It] won’t be the only, but it will be the first,” says Ruscitto.
The group will also work to “better manage care” for the Medicaid and Medicare populations.
“It will be physicians, in a governance role, talking together and saying … why is orthopedics doing it this way and cardiac surgery doing it this way. How do we get a better common platform for how a patient moves, and when we share a patient in common, how do we do a better job?,” she adds.
As of Jan. 1, about 300 physicians had enrolled to offer the AQCA product, says Ruscitto.
Albany staffing firm plans to open Syracuse–area office
SYRACUSE — Albany–area staffing firm Fusco Personnel plans to open an office in the Syracuse region soon. Fusco Personnel’s clients include both job seekers and employers in various industries including health care, manufacturing, and insurance. The employment agency has some clients based in Syracuse that encouraged Fusco Personnel to look into opening an office
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SYRACUSE — Albany–area staffing firm Fusco Personnel plans to open an office in the Syracuse region soon.
Fusco Personnel’s clients include both job seekers and employers in various industries including health care, manufacturing, and insurance. The employment agency has some clients based in Syracuse that encouraged Fusco Personnel to look into opening an office in the area, Patricia A. Fusco, founder, president, and CEO, says in an interview. She spoke with CNYBJ via phone on Jan. 26.
“We have been approached within the last month or two to do some services out in the Syracuse area, so since that’s happened, we started exploring opportunities in Syracuse and other opportunities that have come to us,” Fusco says.
Fusco Personnel hasn’t yet picked its Syracuse home, Fusco says. She and her team are looking at office space in downtown Syracuse and the Liverpool area. At the time of the interview, they hoped to finalize the location by early February and move in within the month.
“Within the last 30 days is when we started to really look at office space out there, seeing that the need is so strong,” Fusco says.
She says some of the current staff may work in Syracuse, so it is too early to determine how many people the company will hire for the new office. Fusco Personnel, based in the town of Guilderland, just outside Albany, generates annual revenue between $3 million and $8 million.
Jason Moak, Fusco Personnel’s business development manager, says it was a natural progression to establish an office in Syracuse since the company already does work in the region. The area also resembles its home market.
“It’s a very similar demographic to Albany,” he says. “We do a lot of work in similar industries that are the focal point of Syracuse.” These industries include health care and insurance.
Fusco Personnel currently has 11 employees who work directly for the agency and 150 temporary contract employees it provides other businesses and organizations. The firm employed more than 450 temporary employees last year and placed over 450 people in direct-hire permanent or temporary-to-hire positions, according to Fusco.
Fusco founded her company in 1994. It is a certified women’s business enterprise (or WBE).
The company’s services include executive searches, human-resources consulting, analysis of institutional needs, providing mid-level recruits, as well as temporary, temp-to-perm, and contract staffing services, according to the Fusco Personnel website.
Stay up-to-date on the companies, people and issues that impact businesses in Syracuse, Central New York and beyond.