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Published by kellygoldfrank, 2017-07-31 14:59:38

Feather River Proposal

Feather River Presentation

PREPARED FOR
JACKIE FULLERTON
VICE PRESIDENT, PATIENT CARE SERVICES

Response to Request for Proposals by

PREPARED BY: President, Founder & Chief Executive Officer
Chief Operating Officer
Dr. James Okoh Chief Financial Officer
Barrett Hardy Vice President, Business Development
David Whinter
Kelly Frank

EXECUTIVE SUMMARY

NRC is an established and well respected pillar of the medical community. We provide market
leading radiologic interpretations as well as interventional services to the facilities we serve. Our
practice interprets a mix of modalities across the radiology spectrum including but not limited to;
X-rays, CT, MRI, Ultrasounds, Women’s Imaging and Fluoroscopy procedures based on a facility’s
need.

NRC, its physicians, and staff are committed to providing timely, accurate radiologic image
interpretations and interventional radiology service 24/7/365. Our goal is to ensure physicians make
the most informed decisions possible when treating their patients, ultimately providing the best
possible patient care and outcomes.

National Radiology Consultants (NRC) is uniquely qualified to provide market leading diagnostic

and interventional radiology services. We are committed to supporting Feather River Hospital’s
mission to expand and enhance its professional radiology services. NRC is recognized as
consistently providing the fastest Turn-Around Time (TAT) for image diagnosis, while still

maintaining the strict quality of care and accuracy that our referring physicians and their patients
expect us to deliver.
(See TAT below)



ADDED BENEFIT

NRC’s fully integrated PACS, RIS, and VR technology complement our existing on-site
physicians by allowing for subspecialized reads and overflow backup coverage during peak
coverage periods with the added benefit of providing a redundant PACS and VR technology
platform at no cost to our hospital customers. With our current technology, we can respond to
Hyper Acute Studies (STROKE ALERTS) in under 20 minutes as well as STAT studies in
under 30 minutes of receipt of all images.

National Radiology Consultants will:

• Provide all care and services in a manner consistent with Facility’s mission, vision
and values.

• Achieve Facility’s targets for patients, families, physicians and staff satisfaction.
• Expedite patient flow to the appropriate and necessary level of care.
• Provide timely response to patients and staff.
• Provide the appropriate care based on medical necessity and within the scope of the

patient’s benefit plan.
• Enhance and maintain the continuity of care through effective communications with

physicians and other clinical staff regarding treatment, condition and continuing care
needs of the patients.
• Improve financial performance while maintaining high-quality patient care.
• Manage appropriately the utilization of hospital-based resources.
• Utilize and enhance existing protocols and order sets to improve care.
• Maintain effective communication and care planning with Case Management as
necessary.

DESCRIPTION OF SERVICES

• National Radiology Consultants will provide Feather River Hospital Facility with on-
site and remote coverage on a 24/7/365 basis.

• Standard Diagnostic Services will be inclusive of:
• General Diagnostic Imaging
• Nuclear Medicine Coverage
• Neuroradiology Coverage
• Women’s Imaging
• Select Interventional Radiology Coverage

COVERAGE

Coverage will be 24/7 at the Feather River Hospital location. All other locations
and clinics will be covered remotely via the National Radiology Consultants
PACS system.

After-hours coverage will be provided by NRC and will include final
interpretations on a 24/7 basis. Such interpretations will be delivered to the
facility via an HL/7 integration.

BILLING

National Radiology Consultants will bill payors and or patients directly for the
professional component of the services it renders at Feather River Hospital.

NRC will collaborate with Feather River
Hospital to establish metrics and goals which
will include:

• Turn-Around-Time Reporting
• Critical Results Logging and Communications
• Medical Director Meeting Attendance
• Radiology Peer Review Data
• Collaborative participation with the Facility as related to regulatory requirements

NOTE: All coverage will be provided by USA, Fellowship Trained, Board Certified Physicians

ON-SITE PHYSICIAN SKILL-SETS TO BE PROVIDED

Diagnostic Imaging Radiologist(s) with
Women’s Imaging and Interventional Skill-set

• Women’s Imaging – Mammography, Breast MRI, Stereotactic Breast Biopsy, etc.
Neuroradiology

• Nuclear Medicine
• Cross Sectional Imaging
• General Diagnostic
• Interventional Radiology (Skill-set sufficient to cover those procedures exclusive to

radiology)

TECHNOLOGY

National Radiology Consultant’s PACS system to include a Unified Worklist with
Feather River Hospital.
Voice Recognition System delivering real-time final reports to Feather River Hospital
on a 24/7/365 basis.
Physician Workstations, excluding monitors.
HL/7, ADT, ORM, ORU Interfaces to support standardized real-time final reports.

COVERAGE *Access to subspecialty expertise 24/7/365

WEEKDAY COVERAGE 4 RADIOLOGISTS - STAGGERED SHIFTS, TWO WEEKS ON - TWO WEEKS OFF
MONDAY - FRIDAY 8AM TO 5PM ONE INTERVENTIONAL RADIOLOGIST PLUS CALL
MONDAY - FRIDAY 10AM TO 7PM ONE DIAGNOSTIC RADIOLOGIST

WEEKEND COVERAGE ONE INTERVENTIONAL RADIOLOGIST PLUS HOLIDAYS, PLUS CALL
SATURDAY AND SUNDAY 8AM TO 2PM ONE DIAGNOSTIC RADIOLOGIST PLUS HOLIDAYS
SATURDAY AND SUNDAY 2PM TO 9PM
ADMINISTRATIVE ACCOUNT MANAGER WILL BE ASSIGNED TO FEATHER RIVER
CALL COVERAGE PACS AND VR COVERAGE AND SUPPORT PROVIDED AT ALL TIMES
24/7/365 ADMINISTRATIVE CALL COVERAGE

24/7/365 PACS CALL COVERAGE

COST OF SERVICES

NRC will require a revenue guarantee of $2,696,000, in monthly increments of $224,667.25.
The first installment is due at the commencement of services. Subsequent monthly installments
will be decreased by the collections received by the group during the previous period.
To the extent NRC collects more than the guarantee amount in any given month, the parties will
agree to allocate the overage as follows: If NRC has a net deficit with the hospital, then a
portion or all of the overage amount will be paid to the hospital. Any deficit remaining
following the allocation of the overage will be carried forward to the next month. If NRC has no
deficit and has collected more than the guarantee amount, then NRC shall retain any overage.

NRC will provide monthly reporting of billing and collection activities.

Based on the data provided by Feather River Hospital, NRC estimates the annual
revenue generated by services to be $1,906,840. Based on these calculations, NRC
estimates collections to have an annual deficiency of $789,160 to the revenue
guarantee at revenue cycle maturity. This estimate can change based on the actual
performance of collections due to differences in volumes, payor mix, or procedure mix
from the estimates provided by the hospital.

COST OF TECHNOLOGY

• There are no recurring technology costs to Feather River Hospital.
• NRC will hold the exclusive professional radiology services agreement for all the

diagnostic radiology services it performs for a minimum 3-year period or as
otherwise mutually agreed.

REFERENCES

Montie D. Scott Carlos Farias R.T. (R)(CT)
Director of Radiology
Director- Imaging Services Doctors Hospital of Laredo – Laredo, TX
Person Memorial Hospital, (956) 523-2505

a Duke LifePoint Hospoital - Roxboro, NC

(336) 599-2121 Sue Ruge

Director of Radiology

Oak Hill Hospital - Brooksville, FL

Carmen Sedano (352) 597-6632 Jose Hernandez

Manager – Imaging Services Director of Radiology

Saint Anthony’s Hospital - Chicago, IL Promise Hospital of Miami - Miami, FL

(773) 484-4318 (786) 609-9200

NRC TEAM Dr. James Okoh
Founder, President, CEO

Executive Assistant

David Whinter Barrett Hardy John Young Jennifer Christmas Radiology
CFO COO, VP, Pacs, IT Admin. Pacs, IT Admin. Chairperson
Operations
Kelly Frank
Director of Physician Radiology Operations Annamaria Menoni VP, Business
Recruiting Coordinator & Credentialing Development
Operations Call
And Physician Center PACS Administrators
Enrollment

Director of Revenue Physicians Radiologists Radiology Physician
Cycle Management Recruitment Assistant

Manager

Medical Coders & Interventional Nurse
Billing Support Practitioners

DR. JAMES OKOH, M.D.

James I. Okoh, M.D.
President and National Chief Medical Officer

The Founder, President, Chief Executive Officer and National Chief Medical Officer is responsible for
articulating the National Radiology Consultants’ mission and strategic direction and for leading efforts to achieve
compassionate, high quality, cost effective health care delivery by upholding the organization’s mission and
values and by using them to guide decision-making.

Position Summary:

Together with the NRC Team, Dr. Okoh develops and implements initiatives that are aligned with NRC’s growth
strategy and creates a sustainable vision and business model for the long-term development and operation of the
practice, including systems, metrics, and dashboards to enhance quality, productivity, utilization, outcomes
management, and cost management.

Principal Duties and Accountabilities:

Duties include:

Developing engagement strategies for physicians with the goal of building cohesion around a common clinical vision,
aligning strategic and economic incentives, and advancing quality improvement and patient safety initiatives.
Leads a transformation to a more results-oriented culture, ensuring that standardized practices and a common set of
metrics are extended across regions, with sensitivity to the nuances necessary to ensure that unique market needs are
met.

Recruits, assimilates, and retains premier culturally-aligned physicians to achieve NRC’s strategic initiatives and
growth plans and to ensure that the practice’s unique presence in each of its markets meets the needs of that market
and its hospital customers.

Monitoring and enhancing physician productivity and clinical performance to national benchmarks. Assessing
physician compensation and benefit plans and updating them as appropriate to ensure these plans remain market
competitive and fully aligned with future strategies.

Monitoring and enhancing physician productivity and clinical performance to national benchmarks. Assessing
physician compensation and benefit plans and updating them as appropriate to ensure these plans remain market
competitive and fully aligned with future strategies.

DAVID WHINTER, CFO

David Whinter
Chief Financial Officer

Together with the National Radiology Consultants’ Executive Management Team, the Chief Financial Officer
is responsible for articulating the National Radiology Consultants’ mission and strategic direction and for
leading efforts to achieve compassionate, high quality, cost effective health care delivery by upholding the
organization’s mission and values and by using them to guide decision-making.

Position Summary:

The Chief Financial Officer is responsible for administering the general accounting, patient business
services, including third party reimbursement, financial and statistical reporting functions of the Practice in
accordance with established policies and accounting procedures. This position works collaboratively with the
Practice President in the development of long and short range practice operations plans and capital budgets
as supported by the NRC's long and short range objectives. The CFO monitors NRC’s fiscal performance on
realizing its established plans and objectives and identifies and reports undesirable trends with remedial
action recommendations to the CEO for final review and approval. The CFO assumes a lead role in
exploring and implementing means of managing and improving the financial performance of the practice as
well as oversees internal accounting controls, all areas of receivables management, and other business office
systems and procedures to achieve efficiencies in the business office.

Principal Duties and Accountabilities:

The Chief Financial Officer is responsible for the day-to-day financial operational activities of National
Radiology Consultants, PA and its subsidiary entities.

This includes revenue and growth, expenses, costs and margin-control; and monthly, quarterly, and annual
financial goal management.

The CFO contributes to the business development of services, participates in strategic and growth planning
and builds collaborative relationships with NRC’s Physicians, Management Team and other senior leaders.

The on-site Management of Feather River Hospital will be managed by the Medical Director recruited to
work at the facility.

MEDICAL DIRECTOR

To be Recruited
Medical Director/ Radiation Safety Officer

Position Summary:

•Holds the senior medical administrative position at Feather River Hospital Department of Radiology on behalf

of National Radiology Consultants, PA.

•Responsible for several activities related to the delivery of medical care and clinical services such as cost

management, utilization review, quality assurance, and medical protocol development.

•Oversees the activities of group physicians, including the recruiting and credentialing processes.
•Reports to the Practice President/ National Chief Medical Officer.
•Attend standing meetings (tumor board, committee, etc.)
•Develops and manage a budget, including presenting monthly financial reports to practice staff with the

support of administration.

Principal Duties and Accountabilities:

• Monitor quality and appropriateness of medical care to the facility
• Proved guidance and leadership for performance guidelines
• Develops policies and procedures
• Manages strategic development/ service line growth for the facility. Oversees

local clinical peer review
• Manage physician relations and/or representation
• Handles local clinical patient complaints
• Addresses emergency issues
• Supports physician education
• Manage community relations
• Handles physician policy adherence issues

Quality Performance Policy:

Purpose:

Quality Improvement efforts by NRC Radiologist staffed hospitals ensure the continuous improvement in safety,
performance, and outcomes for our practice and our hospital partners and are aligned with the mandates of
regulatory organizations. NRC Radiologists must actively participate in a Practice Quality Improvement project
approved by the American Board of Radiology and as required by each hospital facility in order to meet ongoing
Maintenance of Certification (MOC) requirements.

Definition:

Quality improvement is an umbrella term that includes:

(a) quality assurance programs for continuous improvement in quality;
(b) processes to improve staff and patient safety; and
(c) procedures to improve the clinical, technical, and diagnostic performance of all staff.
Quality Improvement is intended for use by individuals, healthcare teams, and healthcare systems to improve
the care delivered to patients. In our practice, the focus of Quality Improvement is to improve the performance
of and processes related to Diagnostic and Interventional Procedures, the selection of Imaging and Procedural
Services, the Quality and Safety of Healthcare delivered, and the Effectiveness and Management of all Imaging
Services.
The Quality Program for NRC staffed imaging departments encompasses many aspects of an extensive Quality
Initiative. Practicing safe, effective, value-added radiology is a goal for our practice as we continually strive to
improve our performance and to perpetuate the highest quality of patient care to maintain competitive
advantage in this rapidly changing healthcare environment. The following table highlights NRC’s Quality
Program goals and metrics.

Goal Outcomes

Improve Personal Service to Patients and Referring Quality Improvement
Physicians
Develop an IT Infrastructure to Better Support Our •Physician Quality Reporting System (PQRS)
Hospital Partnerships
•Medicare Access & CHIP Reauthorization Act (MACRA)

•Meaningful Use

•Maintenance of Certification (MOC)

•Radiation dose

•Decrease in inappropriate testing (inpatient)

•ACR RadPeer Peer Review
• Core group of physicians in each hospital

• Medical directors in each facility

• Increase participation of group members on committees (operations,

marketing, billing, finance, IT, quality improvement)

• Demonstrate innovation

• Cloud-based solution for image sharing

• Big data (data analytics)
• Subspecialty coverage (teleradiology/remote reading)
• Radiology call center
• Radiology 3D lab (workflow, standardized imaging delivery,

quantitative data, destination for advanced imaging studies)

Strengthen Our Hospital Relationship Hospital Outcome

•Decreased length of stay
•Increased contribution to operating margins, amortization of hospital
fixed costs, and shared capital resources
•Cost awareness and active cost management
•Increased efficiency and process improvement • Measurable service
quality
•Service Improvement Metrics
•Quality
•Patient management
•Departmental efficiency
•Patient safety (radiation, contrast, contraindications)
•Strategic growth
•Cost management (capital resources)
•Process awareness and improvement
•Communication of critical findings Strategic Collaboration
•Support the C-Suite (regular meetings)
•Support Centers of Excellence at each Facility
•Alignment of recruitment and areas of growth
•Strategic planning with health system

SUPPLEMENTAL INFORMATION PROFORMA

NATIONAL HEALTHCARE PROVIDERS Feather River Hospital
PROJECT PRO-FORMA 7/6/17
SITE:
DATE UPDATED:

I . REVENUE (ANNUALIZED) BASE YR YR 2 YR 3 YR 4 YR 5

ANNUAL CASES 71,078 71,078 71,078 71,078 71,078
ANNUAL REVENUE (EST)
$1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03

I(B), FEE POTENTIAL (OWNED PRACTICE) $1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03

II. COSTS ONE TIME COSTS

TECHNOLOGY PLATFORM $1.50 $106,617 16,881 WORKSTATIONS $40,000.00
PHYSICIAN COST 4 $1,600,000.00 3,554 BILLING/FINANCIAL SYSTEMS
VACATION COVERAGE 0 $10,000.00
TELERAD $- $50,000.00
OTHER MISC. COSTS 5% $124,386.50
BILLING/SUPPORT $381,368.01
$152,547.20

$2,364,918.71

YEAR 1 2 3 4 5 TOTAL
REVENUE $1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03 $1,906,840.03 $9,534,200.17
SUBSIDY
RECURRING COSTS $- $- $- $- $- $-
ONE TIME COSTS $2,364,918.71 $2,412,217.08 $2,460,461.43 $2,509,670.65 $2,559,864.07 $12,307,131.94
PROJECTED ANNUAL MARGIN ($)
PROJECTED ANNUAL MARGIN (%) $50,000.00 $- $- $- $- $50,000.00
-$508,078.68 -$505,377.05 -$553,621.39 -$602,830.62 -$653,024.03 -$2,822,931.77
Monthly Collections
-26.60% -26.50% -29.00% -31.60% -34.20% -29.60%
Monthly Revenue Net of Expenses
$158,903.34 $158,903.34 $158,903.34 $158,903.34 $158,903.34

-$42,339.89 -$42,114.75 -$46,135.12 -$50,235.89 -$54,418.67

SAMPLE MONTHLY REPORTING




















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