Progress Report From the President: Goals and Priorities
From the advent of EPCS and ICD-10 to a new practice in Tarrytown and major growth at Lawrence Hospital, the past six months have been some of the busiest in ColumbiaDoctors’ history. I’d like to share with you our key goals and priorities for the coming year–and progress toward those goals.
Expansion in Westchester
We expect rapid growth from the new practice in Tarrytown, which officially began seeing patients on Dec. 21 and became fully operational in February. We will be advertising, marketing and promoting Tarrytown’s launch for the next four months to ensure its success.
We’ve hired David Masini as regional director to coordinate Westchester activities, including development of 15 North Broadway location in White Plains. The location will have a significant NYP Medical Group presence. We are now establishing a budget and timeline for physical improvements and there is 2,435 square feet available on the lower level.
At Lawrence Hospital, we’ve added a number of new specialties and subspecialties, including medical oncology, thoracic surgery, radiation oncology, urologic oncology and a prostate program, pediatric urologic surgery, psychiatry, and a neurology stroke program. Other specialties, including pathology and gastroenterology, are now in development. The long-awaited opening of Lawrence Hospital’s Cancer Center will be celebrated with a ribbon-cutting later this year.
Practice Growth
In the city, we expect major practice growth this year on several fronts. In Midtown, we will expand the spine program at 51st Street, while relocating and enhancing dermatology, otolaryngology, and ophthalmology at 880 Third Avenue. Final floor plans have been approved for these three departments, with renovation planned for the summer and an opening in the fall. The space at 51st Street will need to be re-designed for the spine program.
Our radiology joint venture is set to begin in Midtown, with Tarrytown coming on board later in the year. Final Department of Health approval is expected after a site visit in April.
Morningside’s current two-person practice is expected to grow further this year. Our plan is to double the site’s clinician capacity and add specialties as appropriate. Endocrinology and orthopedics have sessions here, and we are continuing to recruit more internists.
NYP Coordination
Coordinating with NewYork-Presbyterian remains an important priority. We’ve established a care management group for the joint Accountable Care Organization, and brought on cardiologist and quality improvement expert Paul Casale, MD, (title, link) as executive director.
Hierarchical Condition Categories (HCC)/quality metric programs have also been initiated.
Telemedicine is also moving forward rapidly, with four use cases developed:
Second opinions: using Ground Rounds
Tele-stroke & tele-behavioral health
Patient remote monitoring
Follow-up care (post-op in global period)
Efforts related to bundled payments have presented more challenges. Orthopedics and NYP have been collaborating on a bundled payment program for total joint replacements (hip and knee), but have been hindered by separate IT systems, which make it difficult to plan for an episode of care across the outpatient and inpatient settings.
We’ve red-flagged length of stay as an area that needs significant attention: current LOS is worse than in July 2015, and we need to develop an aggressive plan with NYP to address this and other areas related to institutional access.
Quality
We’ve made great strides in quality benchmarking and our effort to create a monthly quality dashboard for ColumbiaDoctors. Our ACO and Key Ambulatory Quality Indicators (KAQI) measures data have been validated, and we have compiled a list of National Quality Forum specialty measures to present to the departments for applicability
For 2015, 99% of our practices have met meaningful use goals, achieving a $3.7 million incentive payment and avoiding $113,000 in penalties. For 2016, we expect an incentive payment of approximately $357,000 and $700,000 in penalty avoidance.
Patient Experience
We are nearing completion of a single registration process for all practices in midtown and at Tarrytown. A universal intake form has been implemented, and we are now evaluating vendors for a pre-visit/kiosk self check-in, which will be piloted at 51st St. and in Tarrytown.
Portal enhancements are also in progress. Online bill pay has been in place since June 2015, with improvements underway, and direct online scheduling to be in place by May.
Less successful have been our efforts to reduce practice cancellation rates to a target of 5%. Currently, our practice cancellation rate is essentially flat: 8.2% for FY16 year-to-date, compared with 8.6% for FY 2015. Departments that have kept their practice cancellation rates below 65 include radiology, neurosurgery, CAPNA, dermatology, psychiatry, and rehabilitation medicine, while departments with rates above 10% include pediatrics, Naomi Berrie, urology, neurology, and oral surgery. Our Access & Patient Satisfaction Committee is working on new strategies.
Business Metrics
Our goal for the monumental transition to ICD-10 was simple: to make it like Y2K–in other words, financially harmless. We achieved that goal, and have also met our target of reducing credit balances to less than 2.5% of accounts receivable. Our FY16 year-to-date balances are 2.3%, with pathology, pediatric, orthopedics, and radiology below 1.5%.
We’ve also successfully reduced our write-offs by 24.5% over the previous fiscal year, above our goal of 20%. Departments with the largest percentage decreases–greater than 50%–were pathology, surgery, pediatrics, and radiation oncology.
Still requiring more effort is the goal of reducing overall days in accounts receivable to 42, with no department above 45. We seem stuck at 45 days both in this fiscal year to date, as well as in fiscal 2015, but several departments have demonstrated excellence, with overall A/R days below 35: urology, ob/gyn, CAPNA, dermatology, and psychiatry.
Optimizing IT Systems
Timothy J. Crimmins, MD, RPVI, has signed on as our chief medical informatics officer; he also serves as NYP’s associate CMIO. Dr. Crimmins is now overseeing a CROWN optimization project to improve the physician user experience, and collaborating with NYP to make IT systems more efficient and user-friendly.
