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RIT providing Lean Six Sigma training for Crouse & Welch Allyn workers, EMS providers
SYRACUSE — The Rochester Institute of Technology (RIT) is again providing Lean Six Sigma training to a group of employees from Crouse Hospital, engineers from Welch Allyn, and regional emergency-medical service (EMS) providers. The training at Crouse started the week of April 15. The training and performance-improvement collaboration, which Crouse launched in 2012 with RIT […]
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SYRACUSE — The Rochester Institute of Technology (RIT) is again providing Lean Six Sigma training to a group of employees from Crouse Hospital, engineers from Welch Allyn, and regional emergency-medical service (EMS) providers.
The training at Crouse started the week of April 15.
The training and performance-improvement collaboration, which Crouse launched in 2012 with RIT and Rural/Metro, continues through late June. When the 25 participants finish the course and their respective performance-improvement projects, RIT will award those involved Lean Six Sigma “Green Belt” certification.
Crouse already uses Lean Six Sigma in its quality-improvement efforts, says Derrick Suehs, chief-quality officer at Crouse Hospital. It’s designed to improve work processes and reduce complications from a clinical and operational perspective.
Lean is a performance-improvement methodology which had its start in the manufacturing sector, with a focus on decreasing waste within a given process, according to Crouse. Six Sigma is process to improve performance by decreasing variation within a system.
Over the years, according to Crouse, experts have recognized the synergy of the once-considered separate improvement methods.
When the process is put in place, it creates improvements that drive customer satisfaction and, in the case of health care, is intended to improve medical care and outcomes.
Professors from RIT’s Center for Quality and Applied Statistics and its Center for Excellence in Lean Enterprise are providing the training. A New York State Business Development Grant, managed through Onondaga Community College, is paying for the training.
The Crouse program is the first and only Lean Six Sigma training program in the U.S. that includes a hospital, EMS providers, and a leading manufacturer, Crouse contends.
About the training
The training involves five project teams, each comprised of five members, including employees at both Welch Allyn and Crouse Hospital, as well as EMS providers.
Crouse has a dozen participants involved, including workers in the hospital’s emergency services, neurological services, obstetrical services, patient and guest relations, and medical/surgical nursing, with a mix of directors, managers, and front-line staff, says Dr. Michael Jorolemon, senior quality officer for emergency services at Crouse.
The six participants from Welch Allyn include employees from its research, new product development, information systems, and business operations.
The seven EMS members have relationships with several different agencies or departments, representing Onondaga, Cayuga, and Cortland counties, Jorolemon added. The agencies include North Onondaga Volunteer Ambulance (NOVA), North Area Volunteer Ambulance Corp. (NAVAC), and fire departments serving communities such as Jordan, Weedsport, and Cortland.
The teams are learning and applying the principles of Lean Six Sigma, while working on projects to improve the quality of care around stroke patients, those patients needing spinal immobilization, obstetrical patients, and the throughput of patients in the health-care system, Crouse said.
Each team is working on a separate problem, says Jorolemon.
One team is working on the patient experience. “How do you maximize that and make that the best possible experience for them and their family,” Jorolemon says.
A second group is working on the mobilization of patients, including the state guidelines that emergency-medical workers must follow in transporting a patient to a hospital.
“When we transfer that patient to the hospital, [are] there opportunities there to manage that mobilized patient quicker, more effectively because they can develop complications if they’re mobilized too long,” he says.
Another team is examining medical throughput, a term that applies analytic instruments specifying the number of tests that can be performed in a given time.
Other teams are focused on the care of obstetric (pregnant) patients and stroke patients, and examining methods to figure out if medical personnel can begin caring for those patients quicker and transmit the information to the hospital more effectively and efficiently.
“We’re on the clock because certain therapies have to be started from the time they hit the hospital … [and] need to be done within an hour,” Jorolemon says.
The effort is meant to drive better outcomes for the patient, he adds.
The purpose of the training is to do “the right thing at the earliest opportunity,” says Suehs.
“And as a result of that, you’re able to reduce your time in the [emergency department], so that reduces cost. You’re able to prepare the team so they know what to do and therefore, there’s an efficiency improvement that comes into play there,” Suehs says.
Handling situations the proper way from the beginning of care reduces complications and creates better care plans, he adds.
When asked if the training will eventually lead to potential cost savings for the patient or Crouse Hospital, Suehs indicated that it’s hard to know what money might be saved because the processes aren’t completed, Suehs says.
One Welch Allyn official sees the training as beneficial.
“Through this partnership, our leaders and new product-development teams will obtain a better understanding of our customer’s issues that impact performance, efficiency and effectiveness,” Tony Wagner, Welch Allyn senior director for new product development, said in the Crouse news release.
Contact Reinhardt at ereinhardt@cnybj.com
New dental practice opens in downtown Syracuse
SYRACUSE — Two Syracuse dentists, Tyler W. Mead and Christopher J. Zimmerman have teamed up to form a new dental practice, dubbed Downtown Dental Syracuse, P.C. The office of Downtown Dental Syracuse is in the University Building at 120 E. Washington St., in the same location of a dental practice formerly known as Zimmerman’s Downtown
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SYRACUSE — Two Syracuse dentists, Tyler W. Mead and Christopher J. Zimmerman have teamed up to form a new dental practice, dubbed Downtown Dental Syracuse, P.C.
The office of Downtown Dental Syracuse is in the University Building at 120 E. Washington St., in the same location of a dental practice formerly known as Zimmerman’s Downtown Dental, according to a news release.
Downtown Dental Syracuse services include white fillings, crowns and bridges, veneers, dentures, partials, root canals, pediatric dentistry, tooth whitening, invisalign, cleanings, periodontal therapy, placement of dental implants and tooth extraction.
“We have the same treatment philosophy, so the partnership works well. It allows for a consistency in the office that translates into an excellent quality of care,” Mead said in the release.
Mead is a graduate of Le Moyne College and the University at Buffalo School of Dental Medicine. At Buffalo, Mead minored in oral diagnostic sciences and was awarded the American Academy of Orofacial Pain Award. In 2008, he completed a one-year general practice residency at York Hospital in York, Pa. Mead furthered his education and skill in all aspects of general dentistry, while gaining additional training in the placement and restoration of dental implants.
Zimmerman has been in practice since 1993, according to the release. He incorporated CAD/CAM technology, which allows patients to receive highly esthetic dental restoration, to his practice. In addition to his private practice, Zimmerman gained invaluable experience treating geriatric and traumatic brain injury patients while serving at the Centers at St. Camillus as a dental consultant for 10 years, the release said.
Contact The Business Journal at news@cnybj.com
Structural requirements of managed-care reform
“The purpose of life is a life of purpose.” — Robert Byrne New York State’s Medicaid Managed Care Initiative continues to create challenges and confusion for Medicaid service providers. As of Jan. 1, 2014 with the implementation of the national health-care reform law, the number of New Yorkers eligible for Medicaid will increase from 5
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“The purpose of life is a life of purpose.” — Robert Byrne
New York State’s Medicaid Managed Care Initiative continues to create challenges and confusion for Medicaid service providers. As of Jan. 1, 2014 with the implementation of the national health-care reform law, the number of New Yorkers eligible for Medicaid will increase from 5 million to 6 million residents. This is about 25 percent of the state’s population. The increase in eligibility is a direct result of the law boosting eligibility for Medicaid to those with incomes at 133 percent of the federal poverty level.
We all know that Medicaid is big business. This is particularly true in New York state with thousands of Medicaid service providers addressing the health and human-service needs of Medicaid-eligible recipients. The recently adopted state budget for the current fiscal year, ending March 31, 2014, continued to emphasize the state’s unwavering commitment to controlling Medicaid spending through the formation of managed-care organizations and implementation of managed-care, cost-containment principles.
The Medicaid reform initiative has three primary objectives, as described in the state’s Medicaid waiver application to the federal government:
§ Better health outcomes for individuals
§ Better quality of care
§ Reducing costs through increased efficiencies
The pace of change is extraordinary. The structural requirements of managed-care reform have led to a significant increase in the formation of provider networks, which are generally supported by a contract between the service provider and a managed care organization/fiscal intermediary.
Essentially, the 50-year history of service providers contracting with and submitting claims directly to the New York Medicaid system is being dismantled. The formation of managed-care organizations (MCOs) and the introduction of competition among regional provider networks (RPNs) represents a dramatic sea change in provider procedures, knowledge, and strategies for successful Medicaid program participation.
These Medicaid reform initiatives have resulted in an “alphabet soup” of new acronyms being added to or used more frequently in the evolving requirements of negotiating and signing managed-care contracts.
The following acronyms are just a few examples of the new lexicon under Medicaid managed care:
MLTCO : Managed long-term care organization
HH : Health homes
BHO: Behavioral health organization
DDISCO: Development disability individual service care organization
MCO: Managed-care organization
MSO: Management (shared) service organization
FI : Fiscal intermediary
PACE: Program for all inclusive care for the elderly
PCMH : Patient-centered medical home
CCM : Coordinated case management
ACO : Accountable-care organization
ACN : Accountable-care network
PMPM: Per-member, per-month payment to provider
FFS : Fee for service
P4P : Pay for performance
As a result of the foregoing, each and every Medicaid service provider should have or hire a designated, experienced individual who is assigned the responsibility of negotiating the terms and conditions of managed-care contracts. The successful negotiation of these contracts, together with the state’s objective of eliminating fee-for-service reimbursement to providers results in a mandate for providers to develop and implement expert contract-negotiation skills.
While the focus of this column is on Medicaid services, the following top 10 list can also be applied to Medicare and commercial-insurance contracts.
Contract-negotiation skills are an art not a science. The following top 10 list represents the primary issues to be addressed by providers in every managed-care-contract negotiation, as follows:
§ What payment rate will the provider be paid by the contracting MCO? The contract should formally document all rates of payments for services provided under the contract.
§ What services are covered under the provider contract? These should be specified in an addendum to each contract.
§ What, if any, services can be billed separately or to the individual Medicaid / Medicare / insured recipient directly?
§ What, if any, financial risk is being transferred to the provider based on the contract terms? Payment mechanisms that reference capitation, partial capitation, and/or service carve-outs require intense focus.
§ What performance incentives or penalties are included in the contract?
§ How frequently can the provider bill for services provided under the contract?
§ What are the expected payment terms from the MCO to the provider once a “clean claim” has been submitted?
§ What requirements or initiatives are planned/contracted for by the MCO in its agreement with the NYS Medicaid program? (e.g., full capitation, health-outcome requirements, performance measures, etc.) How and when will these initiatives be implemented?
§ How will the payment rate for services by the provider be determined and when will it be adjusted? (i.e., What Medicaid rate or basis will be used for payment?)
§ What is the dispute-resolution process described in the contract and is it acceptable to the provider? (e.g., arbitration, litigation, rate appeals, etc.)
Every Medicaid service provider has been or will be deluged with standard contracts from MCOs, which essentially allow the service provider to participate in that MCOs provider network. While these contracts are frequently submitted to providers for signature without any negotiation anticipated, every contract should be subjected to provider review and development of satisfactory, negotiated terms and conditions.
The following top 10 list provides direction on the service provider’s strategies and positioning related to managed-care contracts.
1. Beware of standard contracts and contract templates.
2. Never accept or sign a standard/template contract without some addendum or changes specific to your organization.
3. Always require a supplemental schedule that specifically defines covered and non-covered services.
4. Always be sure that the payment rates are specified, agreed to, and provide for periodic renegotiation.
5. Avoid “evergreen contract renewal provisions” in almost all situations.
6. Specify termination and withdrawal provisions that are favorable to you as the service provider.
7. Define the process and approach to be used to confirm/verify individual Medicaid eligibility.
8. Do you Need to sign this contract and be a participating provider in each and every network?
9. What are the Specific duties and responsibilities of the managed-care organization to the service provider?
10. What processes will be used by the managed-care organization to reduce approvals for Medicaid services and/or increase efficiencies in its Medicaid case-management structure?
Finally, here’s a third top 10 list that describes the typical contract clauses that should be evaluated and potentially negotiated by each service provider with the appropriate MCO representatives:
1. Definition of terms in the contract
2. Responsibilities of the service provider
3. Responsibilities of the MCO
4. Quality assurance and utilization-management requirements
5. Billing, claims processing, and payment arrangements
6. Description of the medical/financial records and reports to be provided by the MCO and/or prepared by the service provider. There should be a “right to audit” provision that allows the service provider to verify the accuracy of claims processed by the MCO.
7. Contract term and termination provisions
8. Requirements for liability insurance coverage for the service provider and related indemnification clauses
9. Methods to be used by the MCO for disclosure of participating network providers, use of service provider’s name, and the requirements of the MCO related to service referrals to the provider
10. Regulatory compliance requirements, dispute resolution, and written notice requirements.
Your number one priority is to develop a healthy, respectful working relationship between you as the service provider and the MCO. Careful, yet knowledgeable negotiating strategies will position your organization for success under the government’s managed-care reform initiative.
Gerald J. Archibald, CPA, is a partner in charge of the management advisory services at The Bonadio Group. Contact him at (585) 381-1000, or via email at: garchibald@bonadio.com
Medicare Made Simple educates seniors about choices
SYRACUSE — She refers to herself as “The Medicare Lady,” and Theresa Cangemi is using her insurance background to help clients understand the many facets
Commerce Department authorizes Chenango County as foreign-trade zone
NORWICH — The U.S. Department of Commerce has granted Chenango County authority to establish a foreign-trade zone (FTZ), becoming the 15th such trade zone in
Have you ever noticed you are governed by a ruling class? This is an elite group. You might liken them to the aristocrats of olde England. The lords and ladies and sirs and muckamucks. These are folks who simply know it is their job to govern us. Does not matter what their qualifications are for
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Have you ever noticed you are governed by a ruling class? This is an elite group. You might liken them to the aristocrats of olde England. The lords and ladies and sirs and muckamucks. These are folks who simply know it is their job to govern us.
Does not matter what their qualifications are for ruling you. Or what their experiences have been. In their minds, they are on this earth to rule. You are here to be ruled.
Lately, some of them have popped up in the news. We have Anthony Weiner, for instance. He is the former Congressman from the New York City area who got caught tweeting lewd pictures of his crotch to young girls. Once caught, he resigned.
Ahh, but now he wants back. He has rolled out a big PR campaign. To smooth the path to maybe run to be mayor of the Big Apple. Does not matter that his tweets should tell us he is a dimwit with less than zero judgment. Doesn’t matter that his lack of judgment just might harm the city’s residents if he was mayor. Nah. He feels he is entitled to rule.
Elliott Spitzer is another of the anointed. He was drummed out of the New York governorship. For sneaking off to meet a hooker in a D.C. hotel. Judgement? Squat. But these days he keeps testing the waters. To check whether it is time for him to run for another office. Or to prove to a governor or president that they should appoint him to a big position. He clearly feels he is entitled to rule us, from one office or another.
And then we have JFK’s daughter. She feels she is entitled to be an ambassador to one of the big countries. Because she knows anything about diplomacy? Nope. Because she is a Kennedy. And Kennedys are entitled to rule us. It is in their DNA, you are supposed to realize.
Chelsea Clinton. Her own parents have suggested her for high office. As have other members of the elite. Experience? Skills? Intelligence? Who needs them when you are a Clinton?
Don’t forget ex-governor of South Carolina, Mark Sanford. He stole state travel funds and disappeared. To sneak off to Argentina to sleep with a woman not his wife. (Elliott Spitzer, eat your heart out.) That forced Sanford to retire.
Well, he is back. He is clearing hurdles in his quest to be nominated for a seat in the U.S. House. Did he behave like a selfish idiot? Yup. Did he act utterly irresponsibly? Yup. Did he show voters he did not deserve to manage the kennels at the dog pound? Yup. And does he now feel he deserves to be a member of Congress? Yup.
If he gets there, he will feel so at home. He will be surrounded by other corrupt sleazebags. And he will be back among those who know it is their destiny to rule us.
If he is elected, he will be living proof that American voters have no memories Or have grown so cynical they don’t give a hoot who governs them and spends their tax money.
From Tom…as in Morgan.
Tom Morgan writes about political, financial, and other subjects from his home near Oneonta, in addition to his radio shows and TV show. For more information about him, visit his website at www.tomasinmorgan.com
State awards Cornell funding for construction project at experiment station
GENEVA — New York has awarded Cornell University $4.7 million for a construction project at the New York State Agricultural Experiment Station in Geneva. State
Chemung Financial Q1 profit falls 33 percent
ELMIRA — Chemung Financial Corp., parent company of Chemung Canal Trust Co., reported that its first-quarter net income fell 33 percent to $2.4 million, or
2013 Legislative Session — 2nd Half: Our Obligation & Opportunity
I am eager to join my colleagues in Albany to begin what I expect will be an active and effective remainder of the 2013 Legislative session. With a third consecutive on-time budget behind us, it is time to roll up our sleeves and get to work on critical areas and issues affecting the people of
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I am eager to join my colleagues in Albany to begin what I expect will be an active and effective remainder of the 2013 Legislative session. With a third consecutive on-time budget behind us, it is time to roll up our sleeves and get to work on critical areas and issues affecting the people of this great state. A great deal has happened since the state budget was finalized, and the priorities take on added importance in Albany.
Restoring the public’s faith in government
Recent corruption charges brought against a few Albany lawmakers generated disturbing headlines and rightfully heightened the public’s concern about the integrity and honesty of their elected officials. As public servants, I firmly believe that our greatest obligation during the remainder of the 2013 legislative session is to deliver meaningful and effective initiatives that root out corruption, curtail abuses of power, and restore public confidence in government.
The governor’s recent announcement of a “Public Trust Act” is intended to create a new class of public corruption crimes and improve prosecutors’ ability to crack down on corruption. It is an encouraging step. But it is only a first step.
During the next several weeks, I will work with my colleagues to expand on existing bills and develop new legislation that specifically targets the problem of corruption and criminal activity in state government. The Assembly Minority Conference has proposed measures that directly address this issue and we are committed to advancing initiatives that:
§ Provide for the forfeiture of pensions for convicted state officials;
§ Institute term limits for legislative leaders;
§ Increase criminal penalties for wrongdoers;
§ Evaluate campaign-finance rules and regulations; and
§ Review the effectiveness and current construction of the Joint Commission on Public Ethics, or JCOPE.
This is an opportunity to take meaningful and unprecedented action that effectively curtails the abuse of public office by elected officials. The time is now. I will do everything in my power to ensure essential policies and responsible legislation moves forward. The people of the Finger Lakes expect and deserve nothing less.
New Yorkers’ needs remain front & center
As we work on these efforts that try to restore public confidence in government, we must not be distracted from the real, everyday needs of hard-working New Yorkers. I have said that the 2013-2014 state budget was on time, but off-target. We need more jobs, lower taxes, and fewer regulatory hurdles to get upstate New York back on track — and the public demands it. The energy, passion, and voices Finger Lakes residents have displayed about their state government and the direction we need to take has never been stronger.
During the past two weeks, I hosted two events to provide an opportunity for the public to express comments and concerns about the most pressing issues in the Finger Lakes region. More than 2,000 people participated in my recent Tele-Town Hall Meeting. And, a standing-room-only crowd attended my educational forum on the NY Safe Act to ask questions, express their displeasure, and exercise their First Amendment rights in speaking out against terrible public policy.
Strength in numbers
What’s important now is for people to continue to make their voices heard and to keep the momentum moving forward. Collectively, voters can make change happen — it’s one of the fundamental principles on which our democracy was founded. The discussions we will engage in regarding public integrity, quality-of-life programs, and protecting our constitutional freedoms must continue. Now, more than ever, it is imperative that we continue the fight for initiatives that will lead to a vibrant New York state.
Brian M. Kolb (R,I,C–Canandaigua) is the New York Assembly Minority Leader and represents the 131st Assembly District, which encompasses all of Ontario County and parts of Seneca County. Contact him at kolbb@assembly.state.ny.us
Baker named outreach coordinator for Ithaca Commons project
ITHACA — The city of Ithaca and the Downtown Ithaca Alliance (DIA) announced the recent hire of Tammy Baker as outreach coordinator for the Ithaca
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