Major team innovation handles a significant transition for Ohio hospitals.
Director Jackie Nussbaum and Managing Consultant Jen Goins seized the opportunity to lend their expertise after the new 3M™ Enhanced Ambulatory Patient Grouping (EAPG) System shook up the Medicaid reimbursement process for hospitals throughout Ohio in 2017.
The Health Care Performance Advisory Services (HCPAS) duo joined Director Tom Haldiman from BKD’s Big Data & Analytics (BDA) team to develop a sophisticated two-year reimbursement monitoring process for the Ohio Hospital Association (OHA) to help hospitals successfully shift to the complex EAPG system.
“It was a lot of planning, conversation with OHA and conceptualization, nailing down data logistics and weaving in vendors to help us with the process,” explains Jackie, the project lead, “before we finally said ‘We’ve talked about this enough, let’s move forward and get this accomplished.’”
Helping hands make life easier for others
Many hospitals were left without a clear grasp on how to monitor the payment transition. The team stepped in to develop the main monitoring project, called the base package. BKD has 113 Ohio hospitals participating in the base package—and more than 50 of those hospitals are now new clients.
The package involves monitoring millions of records of data, of vastly different forms, received directly from Ohio hospitals. The data is then used to provide quarterly reports to each health care facility, helping them monitor their transitions from fee-for-service to EAPG.
“Our reporting and monitoring allows us to do a lot of the work for these hospitals and help them focus in on the situations they need to address—ultimately making their life easier and the financial health of their hospital better,” says Jen, the subject matter expert.
Strong collaboration with the BDA team was crucial. Tom Haldiman helped build various reports through trial and error, analyze complex data and research issues that surfaced throughout the process. “This project has been one of the most challenging puzzles of my career, complete with pieces that change shape as you go,” he says.
Front: Parker, Elliot and Graham. Back: Patrick and Jen Goins. Jen reminds us BKDers are passionate and innovative—and fun.
As the main project progressed, the team realized many hospitals could benefit from a deeper analysis of the payment transition, specifically regarding billing and coding accuracy and taking advantage of potential opportunities. They developed the optional package, which helps hospitals navigate nuances within the Ohio Administrative Code to identify areas where they may be at risk of not getting paid optimally.
The team created a list of areas for potential benefits to report the accounts of claims billed and areas of opportunity for hospitals to gain additional reimbursement. BKD contracts 25 hospitals directly for the optional package. Jen has taken the lead in reviewing and processing these quarterly reports, which she and Jackie then discuss with clients.
“I’ve spent countless hours researching and running examples of claims to really work toward being that trusted advisor,” Jen says.
At the height of the project, Jen went on maternity leave and had her third child in December 2017. She completed significant training and documentation of information prior to going on leave, but upon her return she was met with the immediate challenge of catching up on the extensive information she’d missed.
Jackie Nussbaum with her family: Andrew, holding Riley the cat, Todd and Alison. Jackie is grateful for her time with family, “which is always an interesting dynamic,” she says.
While her teammate was out, Jackie knew she needed to get herself as up to speed as Jen was. “It kind of forced me to get there,” she says.
Throughout the project, Jackie managed the budget, helped keep tasks completed according to scope and maintained quarterly reporting quality and consistency. She’s also had her hands full outside of work, balancing time between baseball games and dance events for her two kids, Andrew and Alison. Her husband Todd works seven days on and seven days off as a pilot, so as she worked closely with Jen, Tom and OHA, she also kept a happily hectic life functioning well at home.
Just as BKDers don’t go it alone, neither do their families. “It’s easier now that the kids are a little older and I have a driver in the house,” says Jackie. “There’s a lot of things the three of us have to try to accomplish—but we make it work.”
Navigating industry trends brings new relationships to BKD
The overall firm support has been a great motivator on innovation. Insight from Managing Director Brenda Christman and partners Eddie Marmouget and Jerry Henderson has also been critical to the project’s success.
Open communication with Eddie and OHA helped the team overcome many challenges, Jackie explains. Some of the major obstacles included taking on more than they realized from a data standpoint and building in enough time within the budget for potential issues. Jackie’s managed a document of lessons learned and has since shared that knowledge with the HCPAS group to help cultivate a thriving culture of innovative collaboration.
In an industry that’s constantly changing, it takes innovative thinkers to match. It also takes resilience.
“We’ve had many roadblocks along the way that can really get you down,” Jen says. “You have to take a deep breath, make a joke and laugh about the situation and then put on your thinking hats and figure out how to solve the problem.”
Jackie Nussbaum leads an EAPG presentation for client staff in 2019.
The overall experience has helped BKD form many new relationships with hospitals throughout Ohio, including the Cleveland Clinic and most major health care facilities in the state. The team has met many new contacts and has had the joy of introducing them to BKD. Jackie and Jen also speak frequently about EAPGs at Healthcare Financial Management Association conferences and through webinars hosted by OHA, which typically have about 300 to 400 hospital staff participants.
“It’s also been fun to meet some of our contacts when we’re out presenting. We’ve talked over the phone many times, but haven’t always been able to meet face to face,” says Jen.
The two-year project finishes this year but doesn’t mark the end of BKD’s collaboration with OHA. The state is looking to change the EAPG methodology, and OHA anticipates involving BKD in another project designed to navigate and implement those changes.
“It’s been amazing to be embraced and put BKD out there as an expert in this, and to feel like the hospitals are seeing us that way and to have OHA supporting us,” says Jackie. “It’s important in consulting—or anything we do at BKD—to be innovative and on the forefront of bringing new ideas to our clients.”