During the presentation, Berger offered the following strategies for best-practice board reporting:
 •  Reports should contain multiple financial metrics that reflect the key strategic areas for review by the board. 
 • Detailed information could be prepared and reviewed, but needs to be readable and contain narrative for quick understanding. 
•  Review the board calendar to align reporting to adapt to key areas that follow the board agenda. Adjust the report, when necessary, to meet the needs of the board.
 •  Board reports must be actionable. If the reports just contain information, but do not allow for action by the board, the reports are not fulfilling their function.

Gardner, who did not meet his biological father until he was 26 years old, kept both promises to himself. But he found that “something just as lethal as drugs or alcohol” would challenge his ability to be a father to his child and pursue his dream position: “Life,” he says.

During ANI’s general session Wednesday morning, Gardner, the best-selling author of “The Pursuit of Happyness,” which was later adapted into a blockbuster movie starring Will Smith, shared the real-life story behind the movie with ANI attendees.

When Gardner was in his early 20s, he supported his wife and infant son by selling medical devices for $25,000 a year. It wasn’t his dream job, but he was making enough money that “I thought I was going to be okay,” he says.

Then he met a stockbroker who made $80,000 a month, and he had two questions: “What do you do, and how do you do that?”

All of a sudden, Gardner says, “I knew what I wanted to do.”

From that point on, Gardner spent much of his time 40 miles away from the city where he was supposed to be selling medical devices so that he could learn how to become a stockbroker from the man he had just met. He applied for every training program he could find, and spent a year interviewing for programs with financial firms—and was repeatedly rejected. “At that time, most programs required an MBA,” Gardner says, and he didn’t have a college education.

He also racked up a series of parking tickets—and accumulated $1,200 in fines. “With every dollar that came into my house, I had to make a decision: I could pay the tickets, or I could pay the rent,” he says.

Nine days before his interview with Dean Witter, the company that would ultimately accept Gardner into its training program, Gardner was arrested for failure to pay parking tickets—and was in jail the day the interview was to take place. It was only the kindness of a jail guard, who allowed Gardner to make a phone call to reschedule the interview, that allowed him to continue to pursue that dream position.

When Gardner, who had quit his job at one point to accept a position with a financial firm, only to find that the person who hired him was fired three days before Gardner reported for work, returned home from jail, he found that his wife had left their home, taking their son with her. “All I could think about was, does my son know that I didn’t leave him like my father left me?” Gardner says.

Ultimately, Gardner’s wife knocked on the door of the boarding house where he was living at 1 a.m. and left their son with Gardner to care for permanently. And because the boarding house did not allow children, “I was instantly evicted,” he says. “And that’s how we became homeless.”

For the next year, Gardner and his son, who was just 14 months old at the time, slept in hotels, a homeless shelter, bus stations, train stations, the park, and the airport—wherever they could find a place to sleep that they could afford on Gardner’s meager earnings. They went to church every day. Church services provided food for the soul, Gardner says; staff in the church basement provided a meal for them to eat at night.

Every day, Gardner would pack up Chris, Jr., with his stroller, a large box of Pampers, a duffel bag, and the two suits he owned and head for day care, then work, racing to leave work in time to pick up his son from day care and get a room at the first-come, first-served homeless hotel. During the day, he’d make 200 cold calls on a rotary phone. Some nights, he stayed too late at work to wrap up a business call. Those were the nights he and Chris, Jr., spent the night wherever they could find a spot.

“We lived that way for a year. It took me that long to save up enough money for a place we could call home,” Gardner says.

Even after Gardner was hired by the firm, making $5,000 a month, he still had trouble securing a home for him and his son. Many people held prejudice against a man who was homeless and raising a baby on his own, in spite of his credit record and income level. The day after he and his son finally spent the night in a house of their own, his son had trouble fathoming why they weren’t carrying all their belongings with them on the trip to day care.

“I told him, ‘You know what, son? We’ve got a key now. We’ve got a home,” Gardner remembers. “We both skipped to the train station that day—the same train station we used to sleep in.”

He never imagined his story would touch so many people. In fact, Gardner resisted telling his story for years. But the award-winning poet Maya Angelou convinced him otherwise. “She said, ‘This ain’t even about you,’” he says. “It’s about every father who ever had to be a mother, every person who ever had a dream.”

The success of “The Pursuit of Happyness”—both the movie and the book—continues to amaze him. “Who knew?” he says.

“The Robert M. Shelton Award recognizes chapters that have stepped up through the years with sustained, strong volunteer leadership,” said HFMA Chair Debora Kuchka-Craig, FHFMA. “Only a small number of chapters sustain high performance in a number of areas over time. To be recognized as maintaining excellence in a variety of chapter responsibilities over a five-year period is a remarkable achievement.”

The Nebraska Chapter has maintained one of the highest percentages of certified members over a five-year period, at 14.8 percent. For the past three years, the chapter has earned the full 100 points of the Chapter Balanced Scorecard. And, following several years of modest education hours per member, the Nebraska Chapter pushed to increase membership and education hours. Its efforts yielded growth in membership and a 23 percent average growth rate for total education hours over the past five years. The chapter closed FY10 with 25 education hours per member—the fourth highest of all chapters for the year.

“The Nebraska Chapter has developed a long-term strategy to be a top performer, and its members have certainly stepped up,” Kuchka-Craig said as she presented the award.

Nebraska Chapter past-president Carol Friesen said she was honored to accept the award on behalf of the chapter during a year that marks the chapter’s 50^th anniversary.

“We believe we have been called at this time and in this place to serve,” she said, shortly after the crowd gave the Nebraska Chapter a standing ovation.

At times like these, when all chapters are being challenged, “It’s nice to be recognized for our efforts,” she said.

Over the past five years, the Nebraska Chapter also has demonstrated consistent success by earning the following awards:

• Five Frederick Muncie Gold Awards for education

• Three C. Henry Hottum Awards for educational performance improvement

• Two Robert Reeves Silver Awards and two Williams G. Follmer Bronze Awards for membership growth and retention

• Two gold awards and one silver award for certification excellence

• Multiple Helen M. Yerger special recognition awards

The following five strategies could help providers avoid paying excessive subsidies to employed physicians:

•  Add quality measures to performance-based contracts for physicians.

•  Put contracts in place that pay bonuses for hitting productivity targets.

•  Ensure that the clinical outcomes that are measured on the hospital side of patient care are very specific.

•  Work with physician leaders to develop the criteria used in physicians’ contracts.

•  Ensure that physician practices are run by physician managers, not hospital managers.

The hospital identified a loss of revenue of $1.6 million in 2006 due to denials that were not resolved. St. Clair as an organization faced challenges with revenue cycle buy in, and its days in A/R were higher than desired. Little thought was given to process improvement within the revenue cycle.

St. Clair began its phased-in approach to reducing revenue cycle leakage by leveraging current technology. A close look at the hospital’s existing revenue cycle technology revealed that, although St. Clair had been using the same revenue cycle IT system for years, the hospital was only utilizing a small portion of the system’s functionality. Revenue cycle leaders weren’t fully aware of the system’s capabilities.

St. Clair collaborated with technology vendors to find solutions to its problems with revenue cycle leakage. The hospital also adopted Toyota’s LEAN methodology to redesign revenue cycle processes. St. Clair focused on three key areas through which all initiatives were driven: people, processes, and technology.

St. Clair also developed core competency teams that led each phase of the initiative. The hospital created a comprehensive training program for all stakeholders. The hospital’s mantra: “Don’t ask ‘why’ once. Ask ‘why’ five times to make sure you really understand the barriers to improvement,” says Roxanne T. Marhefka, manager of patient access for St. Clair.

The initiative led to a number of improvements for the hospital:

• St. Clair increased patient cash collections by $2 million.

• The hospital reorganized its revenue cycle staff structure and reduced staff in patient accounting and patient access by 2.0 FTEs.

• St. Clair maintained an average collection rate of 98 percent of average net patient revenue.

• Gross revenue increased by $90 million.

Frist shared the following observations as a follow up to his keynote address at ANI earlier in the day.

In regard to the preparations individual states need to make to be ready for health reform, there are some key decisions that must be made:
• What type of organizational structure will the state create to establish the healthcare exchanges?
• How will adjusted community rating occur within the state?
• What are the benefit options and specific plans that will be offered?
• How will states gain the administrative efficiencies needed in the plan? Will competitive bidding occur?

There are several provisions within the healthcare reform plan that address preventive care.
• The Department of Health and Human Resources (HHS) realizes that a key national strategy is preventive services, and has established a task force to address this issue.
• Preventive services are included as essential health benefits in the reform law to ensure access to these services.
• One area that still needs to be addressed is the types of individual incentives that will be established for patients to make needed prevention and wellness choices.

Hospital pricing should be defensible from either a ROI, cost, or market comparison. From an ROI perspective, if you can answer “no” to the following questions, prices are not excessive:
• Is ROI excessive?
• Is cost excessive?
• Is investment excessive?

When assessing price compared with peers, it is helpful to have data at the following levels:
• Facility level
• Department level
• Inpatient case level
• Outpatient case level
• CPT/procedure level

An appropriate pricing strategy should:
• Meet net income requirements
• Maintain or enhance competitive position
• Maintain pricing relationships
• Establish equitable distribution to case categories
• Establish equitable distribution to payers

“Somebody has to do something, and it’s going to be—and it has to be—you,” Frist told ANI attendees.

Frist commended President Obama for his ability to gain support for the healthcare reform legislation that was passed in March. “This fella pulled off what I didn’t think could be pulled off,” Frist says, adding that the passage of healthcare reform legislation is a good thing for our country.

But implementation of elements of reform will result in monetary challenges for government, providers, and consumers, Frist says. “You, and everyone in this room, will pay more (for health care)—a lot more,” he told ANI attendees. In truth, he said, the healthcare reform bill will lead to $2 trillion in additional healthcare spending.

During Tuesday morning’s presentation, Frist outlined several cost challenges related to implementation.

• “The single largest threat to the greatness of America is debt, driven by accelerating entitlement spending,” Frist told ANI attendees—and most of the entitlement spending in this country is Medicare and Medicaid spending. The level of debt currently owed by our nation equals about 63 percent of the American economy, and most of it is owed to foreign countries (China in particular). In about 10 years, if the rate of growth in our nation’s debt levels continues at its current pace, the level of debt will be equal to 100 percent of our economy—unless we address the rate of growth in Medicare and Medicaid spending, Frist says.

“Under current policies, by the end of the decade, 93 percent of federal revenues will be spent on Medicare, Medicaid, Social Security, and interest payments (on the nation’s debt),” Frist says. Where will this leave spending for education, defense, and other needs? Frist asked ANI attendees. “Will we have to go out and borrow that money (for other programs) because almost 100 percent of tax money will be spent on health care and Social Security?” he asked.

• Unemployment rates have risen dramatically in our country since 2007 (and late 2008 in particular). That is the backdrop under which reform was passed, when consumers are already being squeezed economically.

• Although the bill will result in insurance coverage for 23 million people who do not have coverage today, “it will still leave 20 to 25 million uninsured in 2020,” he says. And providing coverage for an additional 23 million people will be a “huge challenge.”

• Reimbursement to providers will be cut under healthcare reform. “Whatever you think you’re going to get paid in the future, it’s going to be cut,” Frist told ANI attendees.

• Additionally, the nation currently faces a physician shortage—particularly of primary care physicians—and this shortage is expected to get worse over the next decade. “We will need, over the next 10 years, 45,000 more doctors”—and it won’t be possible to add that many physicians over the next decade, especially when cuts in reimbursement make it harder for physicians to cover their costs. “A physician shortage could mean more limited access to health care and longer wait times for patients,” Frist says.

The challenges in implementing healthcare reform are a call to action for healthcare finance professionals, Frist says.

He encouraged those at ANI to get involved with the formation of insurance exchanges in their states. The healthcare reform law calls for state or regional exchanges to be established by January 2014. States are responsible for most of the implementation of the new healthcare reform law. “Are states ready to do that?” Frist asked, adding, “State budgets are dying. They’re dying today. And that was before healthcare reform.” Given that Medicaid typically has poor IT systems, he questioned whether states will be able to handle enrollment.

Accountable care organizations “may represent a viable way to better manage healthcare costs, but will require investment in the provider segment”—primarily hospitals, Frist says. He encouraged finance professionals to become actively involved in initiatives that improve quality of care and reduce costs: “I think we can bend the cost curve.”

Would Frist have voted for healthcare reform had he still been in the Senate? one ANI attendee asked. “I can’t honestly say,” Frist responded.

Even if the makeup of Congress changes after this fall’s elections, “We won’t see repeal” of the healthcare reform legislation, Frist said in response to another question from the audience. However, given the strict timelines for implementation of reform, we could see adjustments to those timelines, he says.

Reform is exciting—“It’s terribly scary and frightening, but it’s exciting,” Frist says. And it’s up to healthcare finance professionals to lead efforts to reduce costs in health care and bend the cost curve. “You may think, ‘I can’t do it.’ But somebody out there has to do it,” he told ANI attendees.

Today’s economic environment has created an atmosphere of uncertainty for providers, Clarke says. “There are some really big challenges ahead for us,” he says.

For example, when it comes to capital access, the recovery does not appear to be in full swing, judging by the results of HFMA Healthcare Financial Pulse research published in May. Drawing on the Pulse research during his opening session, “Living with Uncertainty: From Recession to Reform,” Clarke noted that 40 percent of respondents recently experienced challenges related to capital funding, and more than one in five report that debt costs have increased.

Fully 60 percent of respondents said they would increase capital spending in the event of an economic turnaround. However, because of the uncertainty regarding where the economy is headed for the long term, “There could be some worry about that,” he says.

Even though many hospitals have had to defer capital expenditures and cut operating costs, the recession actually has had a silver lining, Clarke says. “There were some key lessons that were learned (by providers),” he says.

For example, in response to economic challenges, many organizations have also implemented process improvements that support next-generation care delivery. Specifically, more than 80 percent of the financial executives responding to the Pulse survey reported that their organizations have devoted more attention to business performance throughout the enterprise, enhanced collaboration between finance and operations, and increased clinical department leaders’ engagement in business performance. “These process improvements and business performance improvements will be important as we move out of the recession and into an era of reform,” Clarke says. They are among the strategies needed to succeed in a reform environment, he says.

It’s important for providers not to forget the lessons that were learned during the recession. Healthcare reform will add “a layer of uncertainty to the environment that we started with,” Clarke says. Attention to the revenue cycle will continue to be “very, very key.” “We can’t lose track of the fact that there are ways that organizations can continue to drive their revenue streams that will allow them to fulfill their mission,” he says.

Above all, the changes and challenges providers will be faced with as a result of reform require that healthcare organizations be prepared to respond with speed, flexibility, and agility when needed. “No matter how small or how large (the organization), being a nimble organization in this environment is critical,” Clarke says.

One of the challenges for CMS in implementing the health reform bill will be the lack of a conference report, van der Walde says. Typically, this document provides the rational for what legislators were thinking as they developed the final compromise version of the bill between the House and Senate. When the actual legislative text is vague (when is it not?), agencies such as CMS can refer to the conference report for guidance. However, because the healthcare reform bill was moved through the reconcilation process, this document wasn’t created.

It is unlikely that the reform bill will either be repealed or replaced, van der Walde told ANI attendees. A more realistic strategy for opposition to reform is to use the appropriations process to underfund CMS’s implementation efforts. This tactic is far more likely, as it can be done without substantial majorities in each chamber or control of the White House, van der Walde says.

Van der Walde outlined several risks related to funding and the cost of health care.

• Funding from the tax mechanisms will collect far less revenue than anticipated, he says. Once you change the tax incentives, changes in behavior typically lower the yield of a given tax.

• Congress will lack the political will to implement payment cuts to providers–which many lobbies counted on when they supported the bill with significant cost cuts to industry players.

• Cost cutting in Medicare will drive more cost shifting to the private sector, further distorting the economics of care

However, van der Walde also sees several opportunities in the reform legislation as well.

• The number of Americans with coverage will significantly increase enlarging markets for all players within the healthcare sector. This will alleviate some of the previous distortion related to uncompensated care.

• There will be significant consolidation of players within both the provider and insurance sectors of the healthcare marketplace.

• There also will be significant opportunities for payers and providers to collaborate on payment models that significantly increase the value of care delivered, creating “win-win-win” situations for patients, providers, and payers.