CASE STUDIES CLIENT LIST OMC GROUP… Outstanding experts, Outstanding results! Oncology Management Consulting Group 215-766-1280 • www.oncologymgmt.com solutions@oncologymgmt.com
• Financial and Market Analyses • New Center Development • Hospital/Physician Integration • Strategic Planning • Operational Assessments • Revenue Cycle Reviews • Implementation and Interim Leadership • Performance and Financial Benchmarking
Dear Colleague,
Teri U. Guidi, MBA, FAAMA President and CEO
“Oncology Management Consulting Group exhibits the most outstanding qualities I expect of a professional consulting firm. Their oncology knowledge is simply unsurpassed by any in the industry! They provide innovative, viable solutions to ever-increasing complex problems and challenges…they work closely with clients as team members! Their genuine collaboration with staff, skilled guidance and apparent depth of experience and expertise truly impress me! I would recommend them highly to any colleague.“ – Matt Sherer, MBA, MHA Administrative Director John B Amos Cancer Center Columbus Regional Healthcare System
Thank you so much for your interest in the Oncology Management Consulting Group’s services and qualifications. Our experience is both broad and deep, and includes work in virtually all settings where oncology care is delivered. The accompanying case studies represent just a small glimpse into some of the projects in which our expert consulting staff has been involved, providing examples of numerous types of clients and a variety of work scope samples. Some engagements are tightly focused on a particular issue while others incorporate several work areas and multiple deliverables. We take great pride in supporting the provider community, across all clinical and operational disciplines, making it possible for our clients to maximize their performance. Our focus has always been on ensuring the success of oncology providers. Because we tailor every engagement to each client’s specific needs, there are innumerable other cases that we are unable to publish due to space constraints. If you don’t see one that precisely illustrates our expertise relative to your circumstances, we would be most happy to discuss your particular situation and outline how our consulting professionals can support your success. We look forward to speaking with you and to assisting you and your oncology team in the future. Very best regards,
Teri U. Guidi Teri U. Guidi, MBA, FAAMA President and CEO
CASE STUDY #1
A large, multi-site medical oncology practice was planning to move one of their offices into the hospital’s new outpatient center. Physician Practice The practice and the hospital hoped to avoid Community Hospital duplicating services and sought ways to more efficiently provide chemo-infusion to Mid-Atlantic the community. The Oncology Management Consulting Group was invited to Challenge: Align programmatic work with both sides in order to and financial interests develop a more closely aligned relationship. • Interviews with key stakeholders to assess readiness; identify common interests and goals, and to articulate potential deal-breakers • Facilitate multiple working sessions with the planning group to negotiate the deal points • Complete analysis and projections of service volumes, costs, reimbursement under multiple ownership scenarios to quantify the value of various models • Definition of multiple contractual relationship options for integrated delivery of outpatient infusion services: ownership, governance, management control, etc.
and in the
CASE STUDY #2 Large Multi-specialty Physician Group Affiliated with the Health System, California
Multi-specialty group with a small medical oncology section asks for expert assessment and recommendations regarding staffing, flow, processes, and a review of coding and billing for chemotherapy and physician professional services. • Observations and in-depth interviews to identify areas for improvement
Challenge: Improve operational efficiency and safety for the medical oncology practice and infusion suite
• Analysis of staffing mix and productivity. • Comprehensive review of charts for appropriate documentation and coding
• Complete review of billing and collections • On-site interim leadership to institute multiple operational and safety recommendations: staff roles, productivity measures, training needs, etc. • Identification of over $600,000 in missed reimbursement annually
Community hospital with employed medical oncologists invited the Oncology Management Consulting Group to assess all phases of the revenue cycle for the infusion center and the radiation oncology center to ensure appropriate documentation, coding, billing, and collections. • Review charts for compliant documentation • Review charge masters for completeness and reasonableness of charge amounts
CASE STUDY #3 Community Hospital and Health System in Mississippi Challenge: Conduct a complete review of the revenue cycle for infusion and radiation therapy services
• Review claims and EOBs
Facing unprecedented growth in volumes, and working with the academic partner towards NCI-designation, this center required a full assessment of capacity, projected growth in demand, and facility expansion planning. In addition, strategies to sustain market dominance and to continually support NCI-designation efforts were needed. • Thorough data analysis: demand and market share, service volumes, expense/ revenue/downstream contribution margins
CASE STUDY #4 Large Teaching Health System in Eastern United States Challenge: Formulate strategic and facility plans for two cancer center campuses to support continued growth and coordination with academic partner
• Extensive interviews with stakeholders: administration, clinicians, referring physicians, community members, etc.
• Business pro-formas to quantify potential implications (expense, revenue, etc.) of initiatives
• Task force work to articulate and prioritize strategic initiatives
• Space programming and planning in collaboration with architects
CASE STUDY #5 Prominent Academic Health System in Pennsylvania. Challenge: Create a consistent strategic direction across all sites
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 • 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
The oncology division of a large multispecialty pediatric group faced inexplicable declines in volumes and pressures to deliver financial performance • Market assessment of demand for services, current market share, patient migration patterns • Review and benchmarking of practice financial performance
CASE STUDY #6 Health System Owned Pediatric Oncology Center Challenge: Formulate strategic plan and build financial management models
• Referral pattern research and recommendations
• Development of referral tracking tools
• Work with physicians regarding marketing and referral cultivation: marketing plan, coaching
• Development and training in use of budget planning and monitoring tools for manager
In order to ensure optimal throughput, utilization of capacity, and clarity of information flow, this NCI-designated Cancer 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
CASE STUDY #7 NCI Designated Center in the Southwest Challenge: Review multiple sub-specialty outpatient clinics for operational flow and efficiencies • 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 #8 Community Hospital in a Highly Competitive Metropolitan Area Near Washington DC Challenge: Articulate a competitive strategy to reduce fragmentation of services and physician loyalties
OMC was invited to assist a community hospital faced with multiple competing community, academic and NCI-designated Cancer 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 (recruitment, specialty services, technology expansion) • Market share analysis leading to identification of target niche program opportunities • Confidential interviews identifying physician drivers to key services and programs • Recommendations to reallocate prime office suites to key practices and drive higher levels of referral and utilization loyalties • Capitalize on unique sub-specialty niche of staff physicians
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 • Financial feasibility analysis of costs and expected revenues for a proposed radiation joint venture • Comprehensive system wide strategic planning for clinical and supportive services and programs • Complete program planning for the new facility • Development of new hospital/physician relationship models for two disciplines • A detailed assessment of outreach market opportunities
CASE STUDY #9 Large Regional Health System in North Carolina Challenge: Multi-dimensional business development engagement
CASE STUDY #10 Mid-sized Community Hospital in the New York City Vicinity Challenge: Multi-dimensional business development engagement
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, “timeshare” suites for medical oncology, hospitalbased infusion and several other cancer program components. This complex, multifaceted 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
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 #11 Large Multi-specialty Physician Group and Community Hospital in the Pacific Northwest Challenge: Achieve alignment of the two entities and define future strategic direction
CASE STUDY #12 Community Hospital in Central Plains Challenge: Demand analysis and multi-year pro-forma for radiation therapy
Prior to investing significant capital funds, this community hospital requested OMC’s assistance in evaluating options to develop radiation oncology capabilities: • Research and assessment of local/ regional competition for radiation therapy services • Market demand analysis: population, incidence rates and estimated cases • Projections for radiation therapy service utilization (professional and technical) • Projections for operating expenses: staffing, supplies, marketing, contracts, occupancy, etc. • Expense projections for major and minor capital equipment: clinical machinery, computer hard/software, furniture, etc. • Five-year financial pro-forma under multiple volume scenarios
CASE STUDY #13 Non-profit Health System and Private Medical Oncology Group in Upper Mid-West
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. Challenge: • Confidential interviews with all physicians and key health system executives • Review of physician income and expenses • Draft of proposed contractual terms, program control, productivity expectations, benefit structure, etc. • Benchmarks and options for performance measures and incentive structure: clinical productivity, service quality, operational efficiency, etc. • Develop a calculation model for financial results for physicians and health system
Develop physician employment and compensation contracts for health-system owned private medical oncology practices.
CASE STUDY #14 Two-Hospital Health System in Wisconsin Challenge: Detailed review of operational systems & processes
OMC Group is contracted to conduct an indepth 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 systemwide processes, potentially saving in excess of $100,000 dollars in missed charges and denials
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 #15 Hospital-Owned Private Practice in Southern Pennsylvania Challenge: In-depth operations & billing process review
CASE STUDY #16 Community Hospital in Rural Indiana Challenge: Investigate & develop multiple potential structural models for outpatient cancer care
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. • 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
CLIENT LIST Oncology Management Consulting Group has assisted many premier cancer centers, community hospitals, clinics and oncology practices throughout the U.S. Assistance has been far-reaching and varied and has encompassed all aspects of oncology services. The following represents a partial list of clients that we have supported: Akron General Medical Center Akron, OH
St. Joseph’s Hospital Buckhannon, WV
New Mexico Oncology Hematology Albuquerque, NM
Alamance Regional Medical Center Burlington, NC
Univ. of New Mexico Albuquerque, NM
St. Luke’s Hospital Cedar Rapids, IA
St. John’s Health Anderson, IN
Summit Health Chambersburg, PA
Provena Mercy Medical Center Aurora, IL
Charleston Area Medical Center Charleston, WV
Shivers Cancer Foundation Austin, TX
Riverbend Medical Group Chicopee, MA
‘Specially for Children Austin, TX
North Cypress Medical Center Cypress, TX
Battle Creek Health System Battle Creek, MI
Univ. of Colorado Cancer Center Denver, CO
Bay Regional Medical Center Bay City, MI
Morehead Memorial Hospital Eden, NC
Bend Memorial Clinic Bend, OR
Elmhurst Memorial Hospital Elmhurst, IL
Cascade Healthcare Community Bend, OR
The Regional Cancer Center Erie, PA
Suburban Hospital and Health System Bethesda, MD
Cook Children’s Health Care System Fort Worth, TX
Mountain States Tumor Institute Boise, ID
Univ. of Texas Medical Branch Galveston, TX
CLIENT LIST (continued) Jennifer Cadiz, MD Harris, NY
Montgomery Cancer Center Montgomery, AL
Holyoke Medical Center Holyoke, MA Wayne Memorial Hospital Honesdale, PA
BlueRidge HealthCare Morganton, NC
St. Vincent’s Health System Indianapolis, IN Memorial Hospital and Health Care Center Jasper, IN Dartmouth/Hitchcock Cheshire Medical Keene, NH Baptist Hospital of East Tennessee Knoxville, TN Lafayette Hematology-Oncology Lafayette, LA Our Lady of Lourdes Lafayette, LA Lewistown Hospital Lewistown, PA Univ. of Louisville – Brown Cancer Center Louisville, KY University Medical Center Lubbock, TX Centra Health Lynchburg, VA Virtua Health Marlton, NJ Sutter Gould Medical Group Modesto, CA
Cardinal Health Nashville, TN Merck & Co Whitehouse Station, NJ Ortho-Biotech Inc Bridgewater, NJ Claxton-Hepburn Medical Center Ogdensburg, NY Ottumwa Regional Medical Center Ottumwa, IA Lourdes Hospital Paducah, KY Parma General Hospital Parma, OH Singing River Hospital System Pascagoula, MS St. Joseph’s Hospital Paterson, NJ MNAP Oncology Center Philadelphia, PA Temple University Medical Center Philadelphia, PA Office of Frederic Price. MD Pittsburgh, PA Buxmont Oncology Hematology Associates Quakertown, PA
CLIENT LIST (continued) Rapid City Regional Hospital Rapid City, SD
Medical Offices of Dr. Rocco Caruso Stony Brook, NY
Renown Health Reno, NV
Capital Regional Medical Center Tallahassee, FL
SouthLake Clinic Renton, WA
North Mississippi Hematology & Oncology Tupelo, MS
William Beaumont Hospitals Royal Oak, MI Cancer Therapy and Research Center San Antonio, TX ICU Medical Inc. San Clemente, CA Central Coast Medical Oncology Santa Maria, CA Adirondack Medical Center Saranac Lake, NY Anderson Cancer Institute Savannah, GA Dendreon Corp. Seattle, WA Grandview Hospital Sellersville, PA Summit Healthcare Show Low, AZ Michiana Hematology-Oncology South Bend, IN Genentech, Inc. South San Francisco, CA Trinity Health Steubenville, OH
DCH Health System Tuscaloosa, AL Ventura County Medical Center Ventura, CA Precision Radiotherapy Center Warren, OH ProHealth Care Waukesha, WI Forsyth Regional Cancer Center Winston-Salem NC Franciscan Skemp/ Mayo Health System LaCrosse, WI San Antonio Community Hospital Upland, CA Sutter Medical Foundation Sacramento, CA Riverside Medical Center Kankakee, IL Martin Memorial Health System Stuart, FL
Oncology Management Consulting Group 215-766-1280 • www.oncologymgmt.com solutions@oncologymgmt.com