Tropical News April 2014

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1 Tropical News April 2014 I N S I D E T H I S I S S U E : Mensaje del Editor 2 Reglas de las dos 3-4 Medias Noches Foro de Salud del 5-6 Colegio de CPA Region 2 by Bruce K. 7-8 Liebel The Value of 9 Certification Wine Tasting New Events 12 Sponsors From the Chapter President s Desk Dear Members, Our calendar year is almost coming to an end; a year of great experiences and challenges. During my Presidency, we introduced some new activities: A local Mini LTC Tax Seminars in San Juan and Ponce Certification seminars in San Juan and Ponce Still to come is our 2014 Golf Classic to be held at Costa Caribe Golf Club in Ponce on May 23, 2014, and the our Annual Assembly to be held at the San Juan Marriott Hotel and Casino on May 30, You are all invited. Our Past President, Axel Ramirez, took the chapter to its maximum during calendar year , obtaining a 100 score and a Platinum Award on Education. We took that challenge very seriously and have worked very hard to keep that level of excellence. As such, we have offered record level of education hours, increased our membership over 10%, improved the members satisfaction survey by approximately 20%, and obtained a record support from our sponsors, exceeding previous years contributions. Thanks to God and to HFMA s Board of Directors, volunteers, sponsors, and the Sistema de Salud Episcopal San Lucas team which have all made the difference. My best wishes to Aristides Castro, incoming President, and to the new HFMA Board members. I am confident that they will continue our Chapter s growth, excellent member service and leadership in the Puerto Rico healthcare market. Health and Wellness.

2 MENSAJE DEL EDITOR Por: Leslie Resto, CPA From left to right President elect CPA Hector Vazquez, current president CPA Aristides Castro, Monique Elias, Secretary / News Chair, Sally Montes, Program Chair/Vice President, and Jesús Manuel Corazón, Treasurer. They will become the new Board of Directors for the Puerto Rico Chapter All currently attending the 2014 LTC in Washington DC. The past year 2013, brought about many new great experiences that contributed to my professional development in the Health Industry. Being part of HFMA gave me the opportunity to view things from a different outlook and to understand indepth financial and accounting processes. I encourage you to participate actively from HFMA's educational and other activities. I can assure you all efforts will bring about benefits for yourself and the business you represent. My appreciation to our outgoing President CPA, Julio Colon for the opportunity of working with him for the benefit of professionals in the Healthcare field in Puerto Rico. Hope to see you soon... P A G E 2

3 Volumen II; Edicion 1 VOLUME N II; EDICIÓN 1 LA REGLA DE LAS DOS MEDIA- NOCHES ( TWO MIDNIGHT RULE ): Por: Iris M. Monrouzeau, JD, CHC, CHPC Arroyo & Monrouzeau CSP, T F E. En el mes de agosto del pasado año Centers for Medicare and Medicaid Services (CMS) emitió las reglas finales para el sistema de pago prospectivo por hospitalizaciones para el año 2014 (Final FY 2014 IPPS Rule). Este conglomerado de normas incorporó la regla que ha sido bautizada como Two Midnight Rule la cual establece una presunción de calificación para pago bajo la Parte A del Programa Medicare si la admisión de un paciente se prolonga al menos por dos medianoches. Por el contrario, si la admisión se extiende por menos de dos medianoches se presumirá que no califica para pago bajo la Parte A. Siendo así, las revisiones para determinar necesidad médica estarían concentradas en cuánto duró la hospitalización, en lugar de basarse en el juicio clínico. En palabras sencillas, el Two Midnight Rule establece que una admisión al hospital y el pago correspondiente bajo la Parte A se considera apropiado si al momento de la admisión el médico tiene la expectativa de que el paciente permanecerá en la institución al menos dos medianoches. Nótese que en esta determinación no se toma en consideración la severidad de la condición del paciente o la intensidad del cuidado requerido. Las únicas excepciones al requerimiento de las dos medianoches de estadía son: 1. que aunque hubo una expectativa de que la estadía excedería dicho término, ocurrieron circunstancias imprevistas que resultaron en una estadía más corta, tales como la muerte inesperada, traslados, abandono en contra de consejo médico o mejoría clínica; 2. que los servicios que requerirá el paciente están incluidos en la lista de servicios que han sido calificados como inpatient only. En las guías de CMS se establece que la mera admisión de un paciente a una unidad de cuidado especializado, como lo puede ser telemetría o cuidado intensivo, no constituye una excepción a la regla de las dos medianoches: [a]n ICU label is applied to a wide variety of services, therefore CMS does not believe that a patient assignment to a specific hospital location, such as a certain unit or location, would justify an inpatient admission in the absence of a 2 midnight expectation. El período de tiempo para que el médico tome una determinación respecto de la expectativa de la estadía comienza desde el período observación en un área de servicios ambulatorios, en la sala de emergencias, en la sala de operaciones o en alguna otra área de la institución. La Regla en cuestión enfatiza la importancia de documentar adecuadamente el expediente para apoyar la determinación de la necesidad de la estadía por al menos dos medianoches consecutivas. Aunque el período previo a la admisión no se considera para la estadía de las dos medianoches, el revisor de Medicare ( Recovery Audit Contractors o MAC) puede considerar, si a base de lo acontecido en dicho término, era razonable y generalmente apropiado esperar que el paciente fuera a permanecer en el hospital por los menos dos medianoches. En conclusión, la orden de admisión se constituye en una certificación, no solo sobre la razonabilidad y necesidad de la admisión al hospital, sino del estimado de tiempo que el médico entiende que el beneficiario deberá permanecer hospitalizado. Esta certificación deberá estar completa, firmada fechada y documentada antes de que el paciente sea dado de alta. P A G E 3

4 VVOLUMEN II; EDICIÓN 1 El 2014 IPPS Rule incluyó además la posibilidad de que las estadías con una duración menor de dos medianoches sean facturadas a través de la Parte B de Medicare, siempre y cuando las reclamaciones se presenten dentro del término de un año de la fecha del servicio. Por ello, si el hospital factura por medio de la Parte A y la misma es denegada por el fundamento de que el beneficiario pudo haber recibido el servicio de manera ambulatoria y decide apelar dicha decisión, deberá estar pendiente de que no se le pase el término del año para reclamar bajo la Parte B, pues estaría en riesgo de perder la totalidad de la facturación. La vigencia del Two Midnight Rule se proyectó para el 1ro de octubre de 2013 pero la implementación de su totalidad se pospuso para el 30 de septiembre de Como era de esperarse, múltiples entidades, entre ellas la Asociación Americana de Hospitales objetaron que CMS adoptara una regla para la determinación de necesidad médica basándose en tiempo de estadía. Entre las objeciones se destacan que el Two Midnight Rule no provee flexibilidad para el juicio clínico y que existen múltiples circunstancias en que un paciente puede requerir una sola noche de hospitalización antes de ser dado de alta (Ej. paciente con síntomas de fallo congestivo cardíaco, infartos al miocardio; pacientes con condiciones múltiples o complejas). Desde el punto de vista económico, no solo los hospitales sufrirán un duro golpe a sus finanzas, sino que los beneficiarios del Programa Medicare estarán expuestos a copagos y deducibles por servicios que en lo sucesivo se considerarán como provistos bajo la Parte B. La presión por el rechazo a la regla de las dos medianoches ha sido tal que el 5 de marzo de 2014 se presentó un proyecto de ley bipartita (S.2082) ante el Senado de los Estados Unidos de América para la aprobación de una ley denominada: The Two-Midnight Rule Coordination and Improvement Act of 2014 cuyo propósito principal es requerir a CMS que desarrolle una metodología para el reconocimiento de pagos para estadías cortas que no se rija meramente por la duración de la hospitalización, sino que tome en consideración factores de necesidad médica y otros factores que justifiquen apropiadamente una estadía menor de dos medianoches. Por otra parte, la pieza legislativa propone posponer la vigencia de la Regla para el 1 de octubre de 2015 o hasta que CMS desarrolle los criterios para pagos por estadías cortas y prohíbe a los MACs llevar a cabo auditorías aplicando el Two Midnight Rule, hasta tanto CMS no cumpla con lo requerido. Las Asociaciones de Hospitales de múltiples jurisdicciones de los Estados Unidos han manifestado su apoyo al proyecto de ley de los senadores Robert Menéndez de New Jersey y Deb Fisher de Nebraska por entender que el Two Midnight Rule afecta financieramente a la industria y reduce las protecciones y beneficios de los beneficiarios de Medicare. American Hospital Association: The AHA strongly supports this important legislation, which will delay enforcement of the so-called two-midnight policy. This policy is bad news for seniors as it undermines medical judgment of physicians. The bill also calls on the agency to develop an acceptable long-term payment solution. Nota: La información que aquí se ofrece es para fines informativos solamente y no pretende constituir ni constituye asesoría legal. En Arroyo & Monrouzeau, CSP, estamos a su disposición para servirles. Arroyo & Monrouzeau CSP, T F E. P A G E 4

5 Foro de Salud Colegio de Contadores Públicos Autorizados de Puerto Rico On On March 21, 2014, we co sponsored the CPAs 2014 Annual Healthcare Forum. An activity that gathered over 150 industry professionals. Our HFMA Vice President, Jose Solivan, was the president of that committee. By: Julio Colon, CPA, FHFMA President Puer Rico Chapter TROPICAL NEWS APRIL 2014 PAGE 5

6 Photo Gallery Foro de Salud 2014 Colegio de CPA P A G E 6

7 THE REGIONAL FRONT Bruce K. Liebel, FHFMA, Regional Executive Sgt. Thomas W. Liebel, Carmela Liebel & Bruce Welcome to the Spring Edition of my final The Regional Front, where as Regional Executive, I ve been providing information on our seven chapters. It s been a pleasure communicating chapter, regional, and national HFMA information to you. This month s article has a little different twist, as I m starting by going back to the President s Message I wrote for the Spring 2008 edition of Fine Print the Western New York newsletter, and getting my inspiration. My President s Message back then started with the word PRIDE. I wrote how that word did not have a lot of special meaning to me until my son Tom joined the U.S. Army. His transformation after 8 weeks of boot camp at Ft. Jackson in South Carolina, led to training time at Ft. Lee, Virginia, then assignment to Fort Carson in Colorado Springs. It was at that time of my message, that my family and I were preparing for his deployment to Iraq. Though it was going to be tough on us, we were proud of his commitment to his job, in serving our country. From there I went on to convey my thoughts in serving as President of the WNY Chapter of HMFA. With the help of a committed team of volunteers, we were able to accomplish a lot meeting goals, improving the chapter, and Making a Difference in our jobs, organizations, and even our communities. The chapter also provided me with much, with their confidence, trust, friendships, and the push to join the ranks of certified members. Yes, another type of PRIDE in and what our team was able to accomplish and provide our members., along with the opportunities afforded me. Fast forward to April 2014, where much has changed, but really, much has not. My son notified us last month that he is to be deployed next month to Kuwait for 9 months. After a 3-year stint in Germany, a promotion to Sergeant, and a recent move to Ft. Huachuca in Arizona, he continues to serve our country well. We have been fortunate to have visited him at each stop, but while it tests our strength being away for long periods, what does not change is the PRIDE we have for him and his family, with their service. And me, with but one month left in my term as Region 2 Regional Executive, I would have thought that I could not have been more proud of HFMA after having served as chapter President, but I have more PRIDE in it after having served in this position. Following the footsteps of Tom Crilly and a great line of Region 2 RE s, last May I oversaw a rewarding Mini-LTC in Cooperstown, followed by the accomplishments of our Fall President s Meeting in August. Shortly thereafter in October, I had the satisfaction of witnessing a great Region 2 Institute, which was the result of working with a great team of coordinators for almost ten months, along with a group of chapter volunteers that came together in the end to assist us. P A G E 7

8 THE REGIONAL FRONT Bruce K. Liebel, FHFMA, Regional Executive Bruce K. Liebel, FHFMA, Regional Executive Being in constant contact throughout the year with the Chapter Presidents, via meetings, conference calls and s, I was able to hear of their accomplishments and concerns. It showed me not only their commitment to this organization, but to their members as well. It has led me to believe more in HFMA and its volunteer leaders, and to that I must say THANK YOU to Karen, Kristen, Chris, David, Jeffrey, Julio & Rabin. As for the President-Elects, I see them ready to move up and successfully lead their chapters. With the help of the incoming Regional Executive, Teresa Figueroa, from Puerto Rico, the Region is in good hands. I can t thank Teresa enough for her support this past year, along with her friendship. Waiting in the wings as RE, is Mollie Kennedy, from Northeastern New York, who I know will do a great job as well. The culmination of the year will be the upcoming opportunity to witness our Chapter Presidents walk on stage at ANI in June to receive, not only their chapter awards, but the expected Region 2 Yerger Awards, that are a result of the collaboration of the seven chapters. As I reported at several sessions this year, our chapters should be most proud of the results of the annual Chapter Member Satisfaction Survey. Below they show that for the last 5 surveys, REGION 2 is #1 in the NATION, as a result of the 7 chapters combined efforts. Members' Overall High Satisfaction Ratings: FY06 to FY10: Worst to FIRST! Region FY14 FY13 FY12 FY11 FY10 FY08 FY Yes, PRIDE; a word that continues to take on more meaning, as I soon leave the helm of this group. I cannot be any prouder of what we have been able to provide our members and accomplish as a Region, and cannot thank you all enough for the opportunities it has afforded me. Allowing me to be your representative at the Regional Council Meetings and in communications with National HFMA, and entrusting me to lead your meetings and Institute, I only hope that I have fulfilled the role as well as those that have gone before me. In friendship and with my special thanks, Bruce P A G E 8

9 The Value of Certification Many healthcare organizations in today s challenging economy recognize their workforce as their most valuable asset. As such, these organizations tend to hold workforce development as a primary business strategy. Investment in developing the talents, knowledge and skill sets of staffs are critical to the organization s success. HFMA s Healthcare Financial Pulse research identified this dynamic and noted that successful organizations today commit to the bread and butter of financial management, i.e. technically strong and comprehensive financial management. Likewise, many individual financial managers today recognize the importance of assuming personal responsibility for their careers success. More than ever before, individuals understand the importance of acquiring and maintaining comprehensive skill sets to ensure their ability to provide the financial management demanded today. These individuals frequently seek out relevant professional development opportunities. The larger business environment resulting from these forces is a heightened interest in workforce development initiatives including certifications and credentialing. Credentialing programs have exploded across the past couple of decades and include: professional associations offering certifications community colleges offering curriculum-based certificates corporate sponsored in-house credentials for employees technology companies providing proprietary credentials to customers HFMA certification provides a fundamental business service to our industry, namely HFMA certification offers: Assessment of job-related competency The opportunity for an individual to demonstrate skills and knowledge Independent verification of the skills and knowledge Confirmation that an individual is current in the practice field The value of HFMA certification can be seen in several reported value-adds : Increased departmental cooperation Heightened self-confidence among participants Increased performance against selected metrics Verification of staff knowledge and skills Assistance in structuring career paths HFMA is committed to being the indispensable resource that defines, realizes and advances healthcare financial management practice. As such, HFMA provides professional certifications to achieve this purpose in today s business environment. This makes HFMA Certification a smart workforce investment strategy. For more information on HFMA Certification, contact Ian E. Guillen at and visit Certification coaching courses will be provided by the Puerto Rico Chapter. Additional information will be provided soon. P A G E 9

10 Wine Tasting On March 6, 2014, we had our wine tasting at Vendimia Restaurant in San Juan. We had over 50 participants enjoying food and wines from Castle Rock Winery. A great gathering. By: Julio Colon, CPA, FHFMA President Puer Rico Chapter TROPICAL NEWS APRIL 2014 PAGE 10

11 Photo Gallery Wine Tasting P A G E 11

12 NEXT EVENTS SAVE THE DATE 2014 HFMA Golf Classic May 23, 2014 Costa Caribe Golf Club In Ponce Annual Assembly May 30, 2014 San Juan, Marriot Hotel & Casino P A G E 12

13 Thanks to our Sponsors P A G E 13

14 Thanks to our Sponsors P A G E 14

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