How to Handle Troublesome Behavior in the Boardroom

Note: iProtean editorial staff will be on vacation through Labor Day. Look for the next blog/newsletter September 6.)

 

(From a recent interview with Karma Bass, Via Healthcare Consulting)

 

When fellow board members exhibit disruptive or troublesome behavior in the boardroom, they often don’t see it that way; that is, people don’t realize they’re being disruptive. They may believe that the ends justify the means, so they don’t realize that the way their message is being conveyed is really causing some pretty significant problems for the rest of the board.

 

Some suggestions about how to handle this include:

  • Get to know the person one-on-one to provide an opportunity to express his/her point of view.
  • Put yourself in their shoes to understand their motivations.
  • Look at the larger group dynamics—ensure no one feels isolated.
  • Find areas of agreement for the entire board and work from there.
  • Don’t attack troublesome board members, or tell them publicly that they are wrong, even when it feels like they are attacking you.

 

It may get to a point where additional strategies should be considered. For example,

  • Checking board job descriptions for requirements for behavior in the boardroom; that is, statements about expected behavior and decorum.
  • Having one-on-one conversations about how to meet those expectations of board member behavior

 

There will be some cases where you just simply have to take steps, albeit painful, to help somebody understand this is not the right fit for them. The board member may be a brilliant person, committed to the mission of the organization, but just simply is not someone that works well in a group setting. And board members must be willing to work collaboratively. At this point, the board should consult legal counsel about options in the bylaws for having someone removed from the board.

 

The board, not the CEO or legal counsel, must deal with this issue. If the board actually takes ownership of the issue, it really will make a difference. It’s not a quick fix and it’s not necessarily comfortable for everybody throughout the entire process. But when a board member hears information that his or her behavior is not in line with what other board members would like to see, it imposes a sort of peer pressure, and can have amazing results. If the board explains its behavior expectations, if it’s made clear what behavior is not within those expectations, and if the board is consistent in reminding their colleague that his/her behavior is not acceptable, many times the board member will actually remove him/herself from the board.

 

 

Check your library for the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Marian and Seth discuss the financial risks of ACOs and bundled payments, the strategic risks of not participating in an alternative payment model, clear trends and the characteristics of organizations that have successfully implemented one or more alternative payment models.

 

Coming soon: Strategic Issues for Boards featuring speakers on cyber security and the Medicare Access and CHIP Reauthorization Act of 2015.

 

 

For a complete list of iProtean courses, click here. www.iprotean.com/index.php/iprotean/onlineCourses/Available_courses

 

 

For more information about iProtean, click here. www.iprotean.com/index.php/iprotean/demo

CMS Releases IPPS 2018 Final Rule

Medicare payments to hospitals under the inpatient prospective payment system (IPPS) will increase by about $2.4 billion in fiscal year (FY) 2018 under final rule CMS issued August 2. The increase is less than the $3.1 billion anticipated under the proposed rule released in April. The rule will take effect October 1.

 

In its final rule, CMS wrote that it “relieves regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility, and innovation in the delivery of care.” (Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1677-F), CMS, August 2, 2017)

 

Some of the key points of the final rule include:

 

IPPS Payments: operating rates for inpatient stays in general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and demonstrate meaningful use of electronic health records (EHRs) will increase by about 1.2 percent in FY 2018.

 

Uncompensated Care: the rule will distribute roughly $6.8 billion in uncompensated care payments in FY 2018, up about $800 million from FY 2017.

 

  • Actual hospital uncompensated care costs from Worksheet S-10 of the Medicare cost report will be included to determine uncompensated care payments. This has drawn criticism from stakeholders including the American Hospital Association (AHA) which had urged CMS to delay the use of S-10 data in calculating DSH payments by one year to further educate hospitals about how to accurately and consistently complete the form, and to implement a stop-loss policy and audit process.

 

Hospital Readmissions: The final rule also took steps to add socioeconomic status adjustments to the Hospital Readmissions Reduction Program. CMS will assess readmission penalties based on a hospital’s performance relative to other hospitals with similar proportions of patients who are dually eligible for Medicare and Medicaid.

 

Shortened EHR Reporting Period: the final rule shortens the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from a full year to any continuous 90-day period.

 

Rural Community Development Program: the final rule modified CMS’s proposals for the Rural Community Demonstration Program to allow hospitals already participating in the program to continue to receive their “reasonable cost” payments without a gap in payments.

 

Long-term Care Hospitals: Based in part on the changes included in the final rule, overall payments to long-term care hospitals (LTCHs) will decrease by $110 million in FY18. CMS increased LTCH payments by 1 percent, as required by the Medicare Access and CHIP Reauthorization Act of 2015. However, LTCH PPS payments will decrease by approximately 2.4 percent overall in large part because of the continued phase-in of the dual payment rate system.

 

No Changes to Rate Cut

 

An AHA executive said the association was disappointed that CMS decided not to restore payments that were reduced in last year’s “excess cut to reimbursement rates for hospital services,” part of $11 billion in payment reductions as required by the American Taxpayer Relief Act of 2012. AHA said in its comment letter that the 1.5-percentage-point cut to hospital IPPS payments in FY17 was much larger than planned.

 

“While a reduction to the hospital update factor was mandated by law in 2012, CMS ignored Congress’s intent by imposing a cut that was nearly two times what Congress specified,” the executive said. (“Medicare Finalizes Controversial Method of Uncompensated Care Payment,” HFMA Weekly, August 4, 2017)

 

Sources: “Final Rule Boosts Medicare Payments to IPPS Hospitals by $2.4 Billion,” AHLA Weekly, August 4, 2017 and “Medicare Finalizes Controversial Method of Uncompensated Care Payment,” HFMA Weekly, August 4, 2017, CMS Fact Sheet and CMS Final Rule.

 

To read the IPPS 2018 final rule, click here.

 

 

To read the fact sheet, click here.

 

 

 

Check your library for the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Marian and Seth discuss the financial risks of ACOs and bundled payments, the strategic risks of not participating in an alternative payment model, clear trends and the characteristics of organizations that have successfully implemented one or more alternative payment models.

 

Coming soon: Strategic Issues for Boards featuring speakers on cyber security and the Medicare Access and CHIP Reauthorization Act of 2015.

 

 

For a complete list of iProtean courses, click here.

 

For more information about iProtean, click here.

Social Determinants of Health Gain Importance Through Population Health

Economists estimate that 80 percent of all the cost of health care relate to social determinants of health. These include everything from exercise and healthy diet and healthy weight, to avoiding substance abuse and/or other self-destructive behaviors, to ensuring that people have adequate nutrition and housing. Those are big social issues that hospitals and health systems often see as outside of their purview.

 

But according to a recent Deloitte Center for Health Solutions survey of about 300 hospitals and health systems, these organizations are ramping up spending on the social determinants of health.

 

The authors of the Deloitte research report noted that “hospitals and health systems are investing in health-related social needs, and that leadership support is high: 80 percent of hospital respondents reported that leadership is committed to establishing and developing processes to systematically address social needs as part of clinical care.” (Social determinants of health: How are hospitals and health systems investing in and addressing social needs? Deloitte, 2017)

 

The authors qualified their conclusions by noting that much activity is still ad hoc (i.e., occasional and only reaching some of the target population), and gaps remain in connecting initiatives that improve health outcomes or reduce costs.

 

Some of the key findings in the report include:

  • Hospitals are screening patients and intervening around social needs, though some activity is fragmented and ad hoc
  • The healthcare system’s shift toward value-based care may spur more investment and activity around addressing social needs
  • Hospital investments vary and sustainable funding may be a challenge

 

Most spending on social needs goes to nurses, social workers and care managers to address social needs; less goes to behavioral health professionals and translators. Hospitals tend to follow the more traditional clinical care model of having nurses address social needs. (“Amid Criticism, Hospitals Fund Social Determinants Spending, HFMA Weekly, July 28, 2017)

 

Capabilities for addressing social needs are still in early stages of development, according to the report. These capabilities include:

  • Having a well-defined process for connecting people to social needs resources
  • Measuring outcomes for some of their initiatives
  • Developing ties to community nonprofits or organizations that address social needs

 

The Importance of Addressing Social Needs

 

Research appears to justify social determinants of health spending by hospitals. A recent study found that unmet health-related social needs are associated with nearly twice the rate of depression, a 60 percent higher prevalence of diabetes and more than double the rate of emergency department visits. (“Amid Criticism, Hospitals Fund Social Determinants Spending, HFMA Weekly, July 28, 2017)

 

Stuart Altman, PhD, an economist and chairman of the Massachusetts Health Policy Commission, said, “One of the things we’re learning is how important the social determinants are—how the non-healthcare-delivery issues affect health. Most of the estimates suggest health care is just 20 percent of health.” (“Amid Criticism, Hospitals Fund Social Determinants Spending, HFMA Weekly, July 28, 2017)

 

The authors of the Deloitte report concluded that “The health care stakeholders we interviewed think that addressing health-related social needs is the “right thing to do,” and expect that alignment with value-based care will likely continue to spur partnerships and innovative solutions. (Social determinants of health: How are hospitals and health systems investing in and addressing social needs? Deloitte, 2017)

 

Marian Jennings, healthcare consultant and iProtean expert, noted “We certainly can’t solve all of those problems in our communities, but if we are going to be held accountable financially for managing the health of the population, we need to be finding ways to connect in our community to social organizations, social agencies, community agencies, public health and other partners to not only provide extraordinarily high quality health care, but to actually improve health by addressing the social determinants of health. (Marian Jennings, Financial Risks & Strategic Implications of APMs, iProtean, June 2017)

 

To read the full Deloitte report, click here.

 

 

 

Check your library for the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Marian and Seth discuss the financial risks of ACOs and bundled payments, the strategic risks of not participating in an alternative payment model, clear trends and the characteristics of organizations that have successfully implemented one or more alternative payment models.

 

 

For a complete list of iProtean courses, click here.

 

 

For more information about iProtean, click here.