SELECTED CASE STUDIES
CASE STUDY #1
Large medical oncology practice with numerous satellites in the Mid-West
Challenge: Determine the feasibility of acquiring radiation therapy and the potential for working collaboratively with one or both local community hospitals
Description: A large and diversified medical oncology group engages OMC to analyze the market potential and financial feasibility of acquiring radiation therapy capabilities. Consider both technical and professional revenues, capital expense, new physician salaries, and assess the potential for offering a collaboration to the two community hospitals, both of which also have radiation therapy:
- Estimate service volumes in the market.
- Project gross charges, collections, and operating expenses based on current experience.
- Project capital expenses and new physician salaries.
- Review financial implications of a new center versus relocation of equipment existing in the market.
CASE STUDY #2
Prominent academic outpatient oncology center in Texas
Challenge: Revenue Cycle and Chart Review, Operational Review, Long-term Support Resource
Description: An outpatient oncology center with academic physicians engages OMC to conduct a review of coding and billing in multiple departments, overall operations and efficiency for the center, and to provide on-going expert advice and assistance throughout the year:
- Complete revenue cycle and chart review of infusion services, medical oncology professional services and radiation technical services.
- Review of center staffing and operations for flow, efficiency.
- Periodic conference call consulting advise and email support on emerging issues, business plans, etc. and annual chart/operational review.
CASE STUDY #3
Community hospital in Western Massachusetts
Challenge: Assess the program offerings, Revenue Cycle and Chart Review, Oncology Financial Contribution, provide Interim Direction
Description: A small community hospital with employed medical oncologists engages OMC to assess the current performance of outpatient medical oncology to determine long-term feasibility and to lead the department during transition:
- Assess the cancer program’s scope of services.
- Review the coding and billing for infusion and physician professional services.
- Quantify the total financial contribution to the hospital for oncology.
- Provide interim administrative leadership during transition.
CASE STUDY #4
Urban for-profit hospital in the South-East
Challenge: Provide interim leadership for a developing service line
Description: A mid-sized hospital engages OMC to provide on-site interim leadership to assess and address existing issues and develop a cancer service line:
- Assess the cancer program’s operations and scope of services.
- Work with the hospital staff to address process, policy and performance gaps.
- Establish systems and structure for a service line model.
- Work with the hospital to relocate infusion services.
- Assist in recruiting a full time director.
CASE STUDY #5
Large multi-specialty physician group and community hospital in the Pacific Northwest
Challenge: Achieve alignment of the two entities and define future strategic direction
Description: A large multi-specialty private physician clinic and the community hospital they serve, engage OMC to assist in determining and selecting among the options for programmatic and financial alignment for outpatient cancer-related services. Considerable attention is necessary to overcome long-standing tensions and formulate joint strategy for growth:
- Interviews and review of financials to qualify and quantify the current state for both entities.
- Leadership summit leading to agreements regarding delineation of control, distribution of revenue.
- Task Force sessions result in shared vision, strategic programmatic priorities and marketing plans including development of a joint venture facility and a joint approach to entry into a new market.
CASE STUDY #6
NCI-designated center in the Southwest
Challenge: Review multiple subspecialty outpatient clinics for operational flow and efficiencies
Description: In order to ensure optimal throughput, utilization of capacity, and clarity of information flow, this NCI-designated center requested OMC’s assistance in evaluating the operational aspects of several tumor-specific outpatient clinics and the infusion area.
- OMC conducted in-depth interviews with line staff and involved physicians to learn the expectations and assumptions of the participants.
- Real-time observations of operations on-site revealed significant “disconnects” between management’s assumptions and functional realities.
- Recommendations included revision of job descriptions and development of consistent policies and procedures to maximize efficiency and to enable increased staffing cross-coverage.
CASE STUDY #7
Community hospital in a highly competitive metropolitan area near Washington DC
Challenge: Articulate a competitive strategy to reduce fragmentation of services and physician loyalties.
Description: OMC was invited to assist a community hospital faced with multiple competing community, academic and NCI-designated centers in developing a strategy to maximize physician loyalty and articulating a competitive strategy to attain market dominance in subspecialty services.
- Analysis of hospital financial position for oncology services to prioritize subspecialties for focused development.
- Market share analysis leads to identification of target niche program opportunities and physician drivers.
- Recommendations to reallocate prime office suites to key practices to drive higher levels of referral and utilization loyalties.
CASE STUDY #8
Community hospital in Central Plains
Challenge: Demand analysis and multi-year pro-forma for radiation therapy
Description: Prior to investing significant capital funds, this community hospital requested OMC’s assistance in evaluating options to develop radiation oncology capabilities:
- Market demand analysis and projections for radiation therapy services.
- Assessment of competition for radiation therapy.
- Five-year financial pro-forma under multiple volume scenarios
CASE STUDY #9
Non-profit health system and private medical oncology group: Upper Mid-west region
Challenge: Develop physician employment and compensation contracts for health-system owned private medical oncology practices.
Description: A health system and a private medical oncology group engaged OMC to facilitate the acquisition of the practice by the system’s for-profit arm, with particular focus on developing physician employment agreements acceptable to all parties including reasonable and appropriate performance incentives to ensure alignment of program and financial interests for the physicians and hospitals.
- Contractual terms re: control, work expectations, benefits…
- Options for performance measures (productivity, quality, efficiency)
- Thresholds and calculations
CASE STUDY #10
Prominent Academic Health System in Pennsylvania
Challenge: Create a Consistent Strategic Direction Across All Sites
Description: Multi-site, major academic health system in Pennsylvania engages OMC Group’s assistance with strategic planning across the organization including a top-level assessment to review and evaluate a professional affiliation with a renowned NCI designated cancer center. A highly charged political environment necessitates deliberate care and sensitivity to confidentiality issues. Engagement includes:
- Interviews and investigation to surface sensitive political issues and other critical concerns related to the NCI center affiliation, in particular its value, the potential for additional value, the potential impact of discontinuing the relationship, and opinions regarding other options and desired benefits.
- Comprehensive review of key data elements (tumor registry, financial and market data) to understand current and potential market position.
- Opinions and recommendations for future strategic direction for the multiple inpatient and outpatient sites, to guide individual institutional programs while building a consistent strategy across the system.
CASE STUDY #11
Two-Hospital Health System in Wisconsin
Challenge: Detailed Review of Operational Systems & Processes
Description: OMC Group is contracted to conduct an in-depth review of medical oncology operational systems and processes for a 2-hospital health system in a well-populated, suburban locale in Wisconsin. Processes evaluated include charge capture, charge entry, billing and budgeting for both pharmacy and infusion services. On-site interviews were conducted with line staff and management of the infusion center, outpatient registration, pharmacy, billing/patient accounts, finance, medical records, and more. OMC was able to:
- Locate inappropriate charge master mapping that resulted in over $20,000 in missed payments.
- Identify missed opportunities in unnecessary write-offs totaling nearly $100,000.
- Pinpoint significant gaps in system-wide processes, potentially saving in excess of $100,000 dollars in missed charges and denials.
CASE STUDY #12
Hospital-Owned Private Practice in Southern Pennsylvania
Challenge: In-depth Operations & Billing Process Review
Description: OMC Group conducted an operations and billing process review for a recently established, hospital-owned private practice in southern Pennsylvania. The delivery of chemotherapy had recently been restructured from a hospital-based service to a freestanding, private practice-based model and the new delivery model was to be assessed to ensure that the systems in place were appropriate. Specific attention was necessary in light of the recent changes put forth in the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). OMC Group’s team of billing and operations specialists observed and evaluated systems and procedures at multiple practice sites and:
- Revealed numerous areas for documentation improvement and reduced liability.
- Identified countless process and procedure enhancements to improve charge capture, clean claim production and collections.
- Implemented a number of methods to reduce denials and secure maximum appropriate reimbursement.
CASE STUDY #13
Community Hospital: Rural Indiana
Challenge: Investigate & Develop Multiple Potential Structural Models for Outpatient Cancer Care
Description: A small community hospital in rural Indiana enlists OMC Group’s experts to identify potential structural models for the delivery of outpatient cancer care. Aging equipment, a lack of visibility in the community and a fractured structure of cancer services have led to an out-migration of patients to other providers. OMC group:
- Outlined critical issues and high-level financial implications of joint ventures with one or more partners.
- Recommended alternative contractual arrangements for professional services.
- Developed a plan for the recruitment of specialists to private or hospital practice.
- Provided multiple options for on-going analysis and development.
CASE STUDY #14
Large Regional Health System: North Carolina
Challenge: Multi-Dimensional Business Development Engagement
Description: An intricate and wide-ranging engagement for a large regional health system in North Carolina. This health system is experiencing rapid growth in a competitive market and myriad challenges regarding the merger of two competing private practices. A number of politically charged situations and unique integration challenges have led to a particularly complex and delicate project. An across-the-board review included:
- A feasibility analysis for a proposed radiation joint venture.
- A comprehensive system wide strategic plan.
- Complete program planning for the new facility.
- Development of a hospital/physician relationship model.
- A detailed assessment of outreach market opportunities.
CASE STUDY #15
Mid-Sized Community Hospital: New York City Vicinity
Challenge: New Facility Development, Construction and Strategic Direction
Description: Mid-sized community hospital in a competitive market outside New York City requires support with facility development, construction and strategic direction for a proposed cancer center. An existing affiliation with an NCI designated cancer center was also to be reassessed. The new center will house physician-owned radiation, “time-share” suites for medical oncology, hospital-based infusion and several other cancer program components. This complex, multi-faceted engagement exposed rather delicate, politically sensitive situations requiring precise management and negotiations. Responsibilities included:
- Re-evaluating the value and terms of an academic affiliation with an NCI center.
- Developing strategy for succession planning in key practices and improvement of hospital/physician relationships.
- Facilitating detailed and substantially sensitive negotiations for medical oncology “time-shares” with multiple competing practices.
- Leading a task force to develop a comprehensive strategic plan.
- Developing policies, procedures and budget for the new infusion center.
- Successful preparation for an American College of Surgeons survey.
- Developing and negotiating the Medical Director contract.
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