FOCUS Operations Review
CawleyJohnson’s hallmark consulting offering, FOCUS Operations Review, provides an industry best analysis of your organization’s behavioral health care strategic challenges and opportunities, and current operational landscape. FOCUS furnishes clients with a measurable strategic business plan for delivery of mental health and addictions services that includes:
- Specific recommendations for service line operational and financial sustainability
- Clear direction regarding clinical practice and utilization issues and concerns
- Identification of the resources, skills and structure required for success of existing or prospective services
- Determination of what behavioral health services should be initiated, maintained, reconfigured or discontinued
FOCUS Operations Review delivers a deep dive analysis of indicators in five key areas:
INANCIAL
- Perform a detailed analysis of behavioral health services on a consolidated and program by program basis, and include a percentage of overhead allocation to get at a clearer profitability analysis
- Perform a detailed analysis of provider productivity using a Worked Relative Value Units (wRVU), compare with national productivity benchmarks and develop recommendations
- Perform a detailed Revenue Cycle Review that evaluates the clinical and business processes from the initial clinical assessment and documentation to determine a level of care, all the way through the UR/UM processes to justify the continued care and discharge, and the business office processes that establishes a patient bill and collections for hospital and professional services rendered.
- Analysis of the reimbursement impact of Medicare PPS/DRG and disproportionate share mechanisms
- Analysis of behavioral health departmental financial reports
- Preparation of financial pro formas for potential new services or changes to existing services
- Review of current physician compensation agreements and recommendation of alternative models and resource plans to support current and future strategies
PERATIONAL
- Evaluation of ease and efficiency of access to care issues (patient triage, assessment and disposition from the emergency department or intake and admissions, on-call response, ease or barriers to admission, etc.)
- Assess assessment tracing tools and reports
- Review and analysis of operational policies and practices compared to best practices
- Review and analysis of the current organizational structure, and what will be needed to support the current and future strategic business plan
LINICAL
- Review and analysis of the clinical content of program schedules with benchmarking against industry and regulatory best practice standards
- Analysis and benchmarking of clinical staffing to support best practices
- Review of treatment team planning process and documentation in relationship to best practices and efficiencies
- Review Environment of Care for safety and operational challenges or efficiencies
- Review of the physical plant for strategic planning needs and assess how the physical layout contributes to staffing efficiencies, challenges, risks, etc.
- Review of risk management and performance improvement planning process and compare to industry practices
TILIZATION MANAGEMENT
- Review and analysis of Utilization Management (UM) process and the claims denied data for trends, follow up and performance improvement plans
- Evaluate UM and regulatory requirements, documentation, pre-certifications, continued stay communications, etc.
- Review admissions and continued stay and discharge criteria compared to actual practice and evaluate against best practice
TRATEGIC
- Evaluate and define key future mission and margin issues for behavioral health services
- Meet with key management, clinical staff and providers to obtain their ideas regarding growth, margin contribution and mission obligations
- Interview as applicable regional stakeholders, other providers and competitors to gauge how they might impact or support growth, and evaluate other ventures that may help the client meet its clinical and fiscal obligations
- Prepare market assessment and projections for potential new service lines and establish realistic performance expectations for those services within the strategic plan
- Determine whether and how to consolidate, expand or discontinue current behavioral health services – or initiate new services to meet mission and margin needs
Today’s environment rewards those who move forward through expert, timely and comprehensive evaluation and planning. Whether or not you currently offer organized behavioral health services, use CawleyJohnson’s FOCUS Operations Review to chart your organization’s path in behavioral health patient care delivery.
Need more information or have a specific issue you want to discuss? Contact us today for a no-obligation phone consultation.
The CawleyJohnson Group, LLC
6250 Shiloh Road Suite 240
Alpharetta, GA 30005
6250 Shiloh Road Suite 240
Alpharetta, GA 30005