April 18th, 2017

The Most Sought After Competencies for Executive Talent in Health Care


This is the first in a series of blogs highlighting trends in the market for executive talent.

Business meeting in an office

Despite – or because of – wrenching changes initiated by the executive administration in Washington, DC, the demand for health care executive talent remains healthy due to a couple of trends. As boards of directors and executives contemplate yet more tumultuous change in reimbursement models and via executive orders from CMS and the Department of Health and Human Services, many baby boomer executives, with their retirement savings mostly recovered from the 2008 recession and not wanting to lead another retrenchment effort at their organizations, are scaling back by leaving full-time positions in favor of interim executive work or outright retirement. On another front, as boards of directors become more focused on metrics when evaluating CEOs, they have become increasingly critical of performance and shown a greater willingness to initiate a change in the executive suite.

Key Competencies of Senior Health Care Executives

Amidst these trends and across various functional areas, the most sought-after senior health care executives possess a few key competencies: Innovation, cross-functional collaboration, and leadership development. Though these competencies are not new, I have highlighted the emerging ways in which they are finding expression in provider organizations.

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February 8th, 2017

Information Clinics and Safety Providers Need to Know


magnifying glass and stack of papersThe following are updates on regulatory and other changes that impact FQHCs and other clinic-based providers including: new consolidated licenses available for community clinics; DHCS proposes a revised State Plan Amendment; HPSA updates are suspended; and a change to the Medi-Cal fiscal intermediary.

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January 13th, 2017

How to Not Lose Your SNF’s Medicare Certification


The efforts required to achieve and/or maintain Medicare certification have grown significantly and require ongoing accountability to develop, implement, and maintain systems to ensure regulatory compliance at all times. If your facility undergoes a survey and the amount of F-Tags increases, it is time to get a consultant into your building to assess the processes and identify opportunities to close the gap and bring the facility back into compliance. Optimally, bringing in a consultant prior to the survey to perform a mock survey can go a long way in avoiding the subsequent fines and/or loss of billing capabilities.

It is a leadership imperative to use strategies that will bring fresh eyes to a situation that you see every day to ensure survey readiness and assist in identifying actual or potential issues needing to be addressed. The human-factors phenomena of seeing an action or a behavior and disregarding it as little, not important, or doing the same thing over and over and expecting different results get facilities into trouble with both the accreditation and licensing departments of both the state and federal agencies. The impact is too great to ignore.

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August 15th, 2016

Revenue Cycle Review and Recommendations


revenue-cycle-gwen-300x200This article focuses on revenue cycle review. In an upcoming blog we will focus on implementing recommendations and outcomes of the implementation.

Three-Step Process

A fine-tuned revenue cycle is the backbone of a financially stable health care organization. Hospitals, clinics and physician offices that have financial issues need to look at their revenue cycle processes to improve cash flow and patient satisfaction. HFS has a three-step process to do just that, Review, Analyze and Recommend. Read the rest of this entry »


August 10th, 2016

HFS is Celebrating 25 Years!


25-years-of-successThis year HFS Consultants celebrates 25 years in business. What began with four people working out of their homes is today a thriving company with 80 employees and offices across the U.S. As the company marks a quarter century, it now finds itself embarking on a new chapter that offers the potential for exciting opportunities and continued growth.

In 1991, Rich Gianello and Steve Rousso founded HFS Consultants (formerly Healthcare Financial Solutions), and remain at the helm of the company today. They, along with their first employee, John Pfeiffer, (who today is a principal and head of the firm’s reimbursement practice), share their thoughts about 25 years in business.

How did the company start? Read the rest of this entry »


August 5th, 2016

Wipfli/HFS Profile: Megan Hartman, Director, Financial Feasibility & Capital Planning


blog-megan-hartmanWhether working on a financial feasibility study to support the financing for construction of a new healthcare facility, or an analysis of a proposed hospital expansion, Megan Hartman looks forward to creating the professional relationships that each project brings. She values the trust that clients and the entire Wipfli/HFS Feasibility team put in her to forecast the future financial potential of health care organizations of all sizes.

What has been your career path?

After college, I worked in Boston at KPMG as an auditor, primarily in the high tech sector, and also did some governmental audits. Being from Southern California, I wanted to move back West, and decided on San Francisco. Through my network of contacts I met HFS executives, Rich Gianello and John Pfeiffer and they offered me a job. That was 15 years ago. Read the rest of this entry »


July 26th, 2016

S-10 Bullet Dodged! (temporarily): Overlooked Cost Report Worksheet S-10 May Soon Drive $6B of Hospital Medicare Payments


header-proposed-changes-to-dish-payments-blogStarting in FFY14, CMS changed the long-standing methodology for paying Medicare Disproportionate Share Hospital (DSH) payments. It revised DSH reimbursement to pay 25 percent of the existing formula-driven amount and placed the other 75 percent into a new Uncompensated Care (UC) payment.

The UC payment is basically a pool (currently about $6B), which is shared by all hospitals nationwide in proportion to their percentage of uncompensated care. To date, each hospital’s percentage of the UC pool, known as Factor 3, has used a proxy composed of Medicaid Days plus Supplemental Security Income (SSI) days. The FFY17 proposed Inpatient PPS rule startled the industry by proposing a major change starting in FFY18–to allocate the UC pool using the cost of Bad Debts and Charity Care reported on cost report Worksheet S-10, using historical cost reports already on file at CMS. This would dramatically redistribute UC funds from high-Medicaid hospitals to those having high amounts of charity care and bad debts.

The industry inundated CMS with critical comments about the proposed rule, and fortunately CMS decided to soften the S-10 blow. In the FFY17 final rule, released August 2, 2016, CMS postponed implementation of the S-10 approach until no later than FFY21 (could be earlier). They also promised to implement quality control and data improvement measures before using S-10 to compute Factor 3.

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July 19th, 2016

Health Care Capital Markets Access: Smooth Sailing or Choppy Waters Ahead?


banksWhile there have been many pressing issues facing health care executives during the past year, fairly ready access to the health care facility financing markets interestingly has not been one of them.

Bond Market Overview

With current thirty-year tax-exempt bond rates hovering around 4.00%, these favorable market conditions have held equally true for both highly rated, large multi-hospital systems, urban medical centers as well as smaller community or rural hospitals, the latter of which may be below investment grade or unrated by the major credit rating agencies. Read the rest of this entry »


July 11th, 2016

Medicare Revalidation Process


medicare-revalidation-process-2CMS requires that the regional Medicare Administrative Contractors (Noridian for California) obtain updated information from all provider and suppliers enrolled in the Medicare program every five years. This requires you to revalidate the information you have on file with CMS regarding your organization, your clinic(s) and your authorized officials.

The revalidations are due beginning May 31st running through November 30th this year. In order to determine when your clinic is required to file, visit the cms website.  You can enter your facility name or NPI number and check the database for revalidation dates. Noridian will also be sending emails to the listed Authorized Official for the organization titled “URGENT: Medicare Provider Enrollment Revalidation Request”. Read the rest of this entry »


June 23rd, 2016

Challenges for Post-Acute Providers


challenges-for-post-acute-providersHospitals were challenged with Value Based Purchasing (VBP) that was authorized through the ACA in 2010, built on the inpatient quality-reporting infrastructure and initially rewards hospitals with incentive payments for quality of care.

Currently, a national focus and evolving pressure is on the post-acute care (PAC) utilization environment, resulting from both the Impact Act of 2014 (Improving Medicare Post-Acute Care Transformation Act) and the number of CMS alternative payment model pilot programs being tested, creating the opportunity for many hospitals and health systems to strategically identify their referral patterns and determine alignment for the future.

The Impact Act requires standardized and interoperable patient assessment data to create uniformity for comparison across PAC settings, facilitate exchangeability of data and drive improved discharge planning/care transition with predictability regarding the level of care needed, based on the assessment and resource intensity. The new assessment requirement begins in October 2018 and a staggered quality measure reporting timeline begins this year. Read the rest of this entry »


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