Allison Simmons

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So far Allison Simmons has created 53 blog entries.

President’s Letter

It’s hard to believe 2018 is coming to an end.   I read a quote from John Wooden, Hall of Fame basketball coach, UCLA, that has stuck with me.  “Without organization and leadership toward a realistic goal, there is no chance of realizing more than a small percentage of your potential.” 

I am not a basketball fan, but I do know that Coach Wooden’s success in basketball remains unmatched almost 40 years after he retired.  Most of the success his teams enjoyed was due to a strong, healthy organization at UCLA and great leadership, both on and off the court!  

We all have a short term goal of finishing the year strong with high patient volumes, cash collections, quality, and customer satisfaction. We all also have longer term “get through the next mile” objectives of preparing for new year insurance changes, achieving the 2019 budget, and building stronger teams.  In order to lead the healthcare industry with service, outcomes, performance and innovation, it’s critical as leaders that we focus and achieve both our short and long term goals.  

AAHAM celebrated 50 years this year and Three Rivers AAHAM had an exceptional year. We set a goal to increase membership and we succeeded.  Another goal was to increase attendance at our Fall Conference and we accomplished that.  We are seeing interest in our certification program increasing as well.  We will set our 2019 goals at our December Planning meeting and I have confidence that next year will be as successful as this year.    The success of our chapter is thanks to the great sponsors and membership we have.  Without all of you, we would not be where we are today! 

As a chapter with a diverse membership, we all have something to contribute.   As we continue to see more and more of our long-term members retiring, it is essential that our students and younger members get involved to set the foundation for the future.   If you know a student in healthcare or someone interested in AAHAM, do not hesitate to get them involved in AAHAM.   Please reach out to me or any of our Board members if you have questions.  

Let’s end the year with strength and prepare for an outstanding start to 2019!   

Respectfully, 

Brenda Fraas 

Three Rivers AAHAM President 

December Holiday Meeting 

The Three Rivers AAHAM Chapter Holiday meeting was held at the Sheraton at Station Square in Pittsburgh, PA on December 7, 2018. Fun was had by all that attended! The morning started off with Kandi Housleyour Chapter Vice President, thanking everyone for attending, and then in a new way of introductions – we all went around the room and stated our names, what organization we were from, as well as letting everyone know one of our favorite Christmas traditions or memories! Let me say that it was entertaining to say the least! Brenda Fraas, our Chapter President, addressed the attendees with all of the national and chapter AAHAM updates and current news. Brenda also solicited for members for our Communication Committee. If interested, please let Brenda Fraas or Alyshia Ravida know.  

Starting us off was Rick Fries, Vice President of Finance/Interim CFO of the Physician Organization at Allegheny Health Network. Rick provided an overview of the Medicare program, as well as governmental reimbursement updates and developments. He also discussed wage index base rate reductions in our region, as well as what other changes to expect.  Rick specifically focused on several payment reform methods: Hospital Acquired Conditions (HAC), Hospital Readmissions Reduction Program (HRRP), and Value Based Purchasing (VBP). Another hot topic of Rick’s presentation was the CMS price transparency requirement and the definition of ‘Standard Charges’. Hopefully we will be hearing more about this topic at our Spring Meeting! 

Our next speaker was Lauren Cerqua, MPT, Manager of St Clair Hospital Outpatient Rehabilitation Department. Lauren is certified in many aspects of Yoga and relaxation techniques, and spoke to us about Self Care for Healthcare. Especially with the chaos of work, families, and the holidays, this was an important, yet personal topic to cover for all of us! Lauren shared with attendees several deep breathing exercises and positions which really workedGlad she did it right before lunch and not after, or we would have all been asleep, especially the volunteers! 

The last speaker was Bill Bollinger from Experian HealthBill gave us updates about safe guarding not only your financial information, but your health information as well. He spoke about managing and protecting our patients identities, and the importance of identity verification tools. Bill really got everyone’s attention with the Circle of Terror and knowing your patient fingerprint!  It truly is amazing how anyone looking can get any information pretty easy from the Internet! Bill also shared about Experian’s efforts at leveraging a universal patient identifier. The message: The need is more, but the want is greater. Also, an important reminder, that if you lose your personal wallet, make sure you alert your health insurance provider. People often remember credit cards and drivers license, yet forget about this important piece to prevent health insurance fraud.  

For the second year in a row, the chapter held a silent auction. Holly Horn, our new Membership Chair, did a wonderful job pulling together donations for this event. Due to all the hard work, we are proud to say that we were able to donate $1,744.00 to the Brothers Brother Foundation.  In addition, Nancy Baker led our efforts for the 50/50 raffle, which placed another $149.00 into our scholarship fund   

What a great event as always – Meeting new people, putting names to faces, and learning so much! Already looking forward to next year Happy Holidays! 

2018 Western PA Healthcare Summit

Several years ago, a group of healthcare leaders throughout Pittsburgh decided to join forces to host an annual event, Western PA Healthcare Summit (PAHS). This group consists of Pittsburgh’s leading healthcare business education organizations from the Allegheny County Medical Society, Three Rivers AAHAM (American Association of Healthcare Administrative Management), ACHE (American College of Healthcare Executives) of Western PA, Western PA Chapter of HFMA (Health Financial Management Association), HIMSS (Health Information Management Systems Society) – Western Pennsylvania Chapter, and WPHIMA – Western PA Health Information Management Association.  This years’ event was held on Friday, October 19, 2018 at Noah’s Event Venue in Cranberry Township, PA. 

The Opening Keynote speaker was Pittsburgh’s own, Joe Mull, M.Ed, Healthcare Leadership Trainer, who presented, “No More Team Drama – Ending the Gossip, Cliques, & Other Crap that Damage Workplace Teams’.  One major perk of his presentation was that every attendee received a copy of his latest book, ‘No More Team Drama’, definitely a must read! 

The event had two tracks offering a variety of hot topics: 

  • Track #1 – Effective Healthcare Administration 
  • Opioid Epidemic presented by Brooklynn A. Riordan, Special Agent, FBI/Pittsburgh Division 
  • Implications of Recent Disruptive Changes in Healthcare: What does the future holdpresented by Dr. Marylou Buyse, Vice President of Integrated Health Solutions, Highmark 
  • Beyond Benchmarks: Two Perspectives, One Goal – Operational Excellence presented by Stephanie Dorwart, CEO, Altius Healthcare Consulting Group 
  • Cultural Competency in Healthcare: A 21st Century Differentiator in Healthcare Delivery and Outcomes presented by Dr. Lonie Haynes, Vice President of Diversity and Inclusion, Highmark  

 

  • Track #2 – Data Utilization Throughout the Patient Experience 
  • Analytics: Dr. AI will see you now: Artificial Intelligence and the Future of Healthcare presented by Sam King, MPH, MBA, CPHIMS, CPHQ, FHIMSS, FHFMA, Professor, University of California Irvine 
  • Enabling Precision Medicine and Immunotherapy through UPMC’s Genome Center presented by Samantha J. Mentch, PhD, Bioinformatic Analyst, UPMC Genome Center  
  • Current Cyber Security Trends and How to Protect Your Organization presented by Anthony Catalano, Director – RAS Security, Privacy & Risk at RSM US LLP 
  • Data Governance Roles and Responsibilities presented by Anthony E. Roscoe, MSL, RHIA, Manager, Core Architecture, Highmark Health Solutions 

Even the lunch session provided an interactive panel titled, Bending the Execution Curve: Implementing Successful Organizational Change in Hospitals and Healthcare Organizations. The moderator for this discussion was Mark A. Kissinger, MPH, FACMPE, Executive Director of Genesis Medical Associates, Inc.  He was joined by several of his colleagues including Atul Vaidya, MD, Eric Scott Griffin, DO, as well as Lana Savrese, Population Health Performance Specialist, Highmark.  

RECENT TRENDS IN ERISA

Submitted by:  Charles J. Hilton 

Currently, out-of-network self-funded employer ERISA plans are paying Medicare based fee schedules for patients not on Medicare. 

Within the last year or two, self-funded employer ERISA health plans who opted not to pay a premium and purchase health insurance for their employees from insurers who contract with health care providers; opted not to contract directly with healthcare providers for contractually agreed upon discounts and opted not to participate in PPO networks who contract with healthcare providers for discounts, have unilaterally elected to limit allowable benefit levels in their plan documents to Medicare based fee schedules plus a certain percentage.  

In short, the ERISA health plans are limiting benefit levels for their employees and dependent beneficiaries to levels slightly above Medicare.  The result is that on many occasions, if not a vast majority of accounts, providers are getting paid at levels