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New Jersey health system owners allegedly embezzled millions as hospitals' debt swelled

The owner of Alaris Health is accusing the owners of Jersey City, N.J.-based CarePoint Health of embezzling millions from its money-losing hospitals, according to the Hudson County View.
CarePoint Health’s ownership group filed a lawsuit against Jersey City-based Alaris in December, alleging the company is interfering with CarePoint’s efforts to sell Bayonne (N.J.) Medical Center and holding up the sale of Christ Hospital in Jersey City and Hoboken (N.J.) University Medical, according to Bloomberg Law. Avery Eisenreich, the owner of Alaris, has a 25 percent ownership stake in Christ Hospital.
In a counterclaim filed with the Delaware Chancery Court Jan. 15, Mr. Eisenreich accuses CarePoint’s owners of embezzling from the hospitals as the hospitals accumulated more debt. His counterclaim comes after the New Jersey Commission of Investigation released a report finding CarePoint’s owners received more than $150 million in management fees from hospitals through a group of limited liability companies they own.
“Christ Hospital presently shows outstanding debts and liabilities on its balance sheet of approximately $30 million — the same amount of money withdrawn by the [owners] for fictitious management fees to Sequoia Healthcare between 2013 and 2016,” Mr. Eisenreich said in the counterclaim.
Regarding Mr. Eisenreich’s allegations, a CarePoint spokesperson released the following statement to the Hudson County View:
“CarePoint’s goal is to ensure that the hospitals remain open and it has been working tirelessly to further the sale process notwithstanding the conduct of Mr. Eisenreich. While we cannot comment on an ongoing legal matter, the claims filed by Mr. Eisenreich in response to the claims against him are frivolous and a desperate attempt to distract from his wrongful conduct.”
The spokesperson also noted that the New Jersey Commission of Investigation said last year that CarePoint’s hospitals may have closed without the investments and other actions taken by CarePoint’s owners.
The state’s investigation into CarePoint’s finances and use of management companies to extract profits from its hospital prompted three new laws in New Jersey that give state agencies and elected officials more financial and operational insight into for-profit hospitals.
More articles on healthcare finance:Medicare to cover acupuncture for chronic low back painTennessee hospital misses payrollWashington hospital closes: 4 things to know

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UPMC issues 154 layoff notices

Pittsburgh-based UPMC will lay off 154 employees when it closes its hospital in Sunbury, Pa., at the end of March, according to a Worker Adjustment and Retraining Notification Act notice recently filed with the Pennsylvania Department of Labor & Industry.
The health system announced plans in December to close UPMC Susquehanna Sunbury, citing dwindling patient volumes. Though the hospital will officially close its doors March 31, UPMC Susquehanna Sunbury will stop accepting ambulance transports Jan. 28 and cease all inpatient services Jan. 31.
Though the hospital’s 154 employees will be laid off when the hospital closes, some of them have already secured new positions. The hospital is ending inpatient services this month because employees are getting new jobs sooner than expected, which could leave the hospital under-staffed.
More articles on leadership and management:4 health systems that dropped the dual-CEO modelAmerican College of Physicians backs ‘Medicare for All,’ public optionHow 3 hospital CEOs put their community’s needs first

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45 financial benchmarks for hospital executives

Hospital leaders across the nation use benchmarking as a way to determine the areas of their business that need improvement. The continuous process of benchmarking allows hospital executives to see how their organizations stack up against local and regional competitors as well as national leaders.
Here are 45 benchmarks related to one of the most important day-to-day areas hospital executives oversee — finance.
Key ratios
Source: Moody’s Investors Service, “Not-for-profit and public healthcare – US: Medians” report, September 2019. 
The medians are based on an analysis of audited fiscal 2018 financial statements for 284 freestanding hospitals, single-state health systems and multistate health systems, representing 79 percent of all Moody’s-rated healthcare entities. Children’s hospitals, hospitals for which five years of data are not available and certain specialty hospitals were not eligible for inclusion in the medians.
1. Maintained bed occupancy: 66.6 percent
2. Operating margin: 1.8 percent
3. Excess margin: 4.3 percent
4. Operating cash flow margin: 7.9 percent
5. Return on assets: 3.6 percent
6. Three-year operating revenue CAGR: 5.6 percent
7. Three-year operating expense CAGR: 6.4 percent
8. Cash on hand: 200.9 days
9. Annual operating revenue growth rate: 5.5 percent
10. Annual operating expense growth rate: 5.4 percent
11. Total debt-to-capitalization: 33.7 percent
12. Total debt-to-operating revenue: 33.3 percent
13. Current ratio: 1.9x
14. Cushion ratio: 21.6x
15. Annual debt service coverage: 4.7x
16. Maximum annual debt service coverage: 4.4x
17. Debt-to-cash flow: 3.1x
18. Capital spending ratio: 1.2x
19. Accounts receivable: 45.9 days
20. Average payment period: 61.4 days
21. Average age of plant: 11.7 years
Hospital margins by credit rating group
Source: S&P Global Ratings “U.S. Not-For-Profit Health Care System Median Financial Ratios — 2018 vs. 2017” report, September 2019.
AA+ rating
22. Operating margin: 5.5 percent
23. Operating EBIDA margin: 12 percent
24. Excess margin: 9.2 percent
25. EBIDA margin: 14.8 percent
AA rating
26. Operating margin: 4.4 percent
27. Operating EBIDA margin: 10.1 percent
28. Excess margin: 6.7 percent
29. EBIDA margin: 12.4 percent
AA- rating
30. Operating margin: 3.4 percent
31. Operating EBIDA margin: 9.5 percent
32. Excess margin: 4.0 percent
33. EBIDA margin: 10.4 percent
A+ rating
34. Operating margin: 1.6 percent
35. Operating EBIDA margin: 7.4 percent
36. Excess margin: 3.3 percent
37. EBIDA margin: 10.1 percent
A rating
38. Operating margin: 2.1 percent
39. Operating EBIDA margin: 7.6 percent
40. Excess margin: 3.3 percent
41. EBIDA margin: 8.6 percent
A- rating
42. Operating margin: 1 percent
43. Operating EBIDA margin: 7.8 percent
44. Excess margin: 2.5 percent
45. EBIDA margin: 8.3 percent
More articles on healthcare finance:Medicare to cover acupuncture for chronic low back painTennessee hospital misses payrollWashington hospital closes: 4 things to know

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To receive the latest hospital and health system business and legal news and analysis from Becker’s Hospital Review, sign-up for the free Becker’s Hospital Review E-weekly by clicking here.

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Corner Office: Hackensack Meridian Health's CEO on the revitalizing power of cooking

Alia Paavola – Friday, January 24th, 2020 Print  | Email

Robert Garrett is CEO of Edison, N.J.-based Hackensack Meridian Health, an integrated system with 17 hospitals, 500 patient care locations and 35,000 employees. 
Under his leadership, Hackensack Meridian Health has formed unique partnerships to drastically expand and improve healthcare in New Jersey.
Over the last few years, the health system has merged with Carrier Clinic, New Jersey’s largest behavioral health provider, partnered with the New York Giants to raise money for pediatric cancer research and established a collaboration with Memorial Sloan Kettering Cancer Center in New York City. 
In 2016, thanks to Mr. Garrett’s steadfast leadership, the system opened Hackensack Meridian School of Medicine at Seton Hill University, New Jersey’s first private medical school in 60 years. 
Here, Mr. Garrett shares with Becker’s the healthcare problem he would eliminate overnight, his greatest talent outside of the C-suite and the piece of advice he always carries with him.
Editor’s Note: Responses were lightly edited for length and clarity.Question: What is one thing that piqued your interest in healthcare?
Robert Garrett: I was a political science major in undergrad, and I had some familiarity with the healthcare business, but I was on a different track. However, that path changed after I spoke with a family friend, Sister Mary Jean Brady, who was a hospital administrator at Mercy Hospital in Rockville Centre, N.Y. She spoke to me about healthcare and some of the challenges in the industry. I was so intrigued about what she had to say. She also offered me an internship with the facility. During the internship I rotated through major departments and worked directly with Sister Mary Jean to learn about hospital administration. Through the internship, which was a life-changing experience for me, I was able to see what servant leadership was about, how a hospital really works and how they help the community. I was sold after that experience. I never looked back.
Q: What do you enjoy most about New Jersey?
RG: What I love about New Jersey is its diversity and the variety the state provides from a business, social and entertainment perspective. It is a real melting pot of cultures and people. There are great towns, amazing restaurants, mountains and the Jersey shore. In addition, I enjoy the contrast of the urban, suburban and even rural areas. I also live in a small New England town that is very charming, and we also have a house on the shore with a beautiful beach and boardwalk.
I also have to say that I love two other things about New Jersey. Specifically, the Jersey musician Bruce Springsteen, who is one of my favorite artists. Additionally, I have to say I am a big New York Giants fan, and they play in New Jersey. Our health network happens to have a partnership with them, and people ask me all of the time if the partnership happened because I am such a big fan. My answer to them is yes. But in all honesty, they’ve helped us raise upward of $7 million for a cause called Tackle Kids Cancer, which funds pediatric cancer research. 
Q: If you could eliminate one of the healthcare industry’s problems overnight, which would it be? 
RG: I believe we need to build on the ACA instead of throwing it out. There are many great aspects to it, but the one thing I think needs to be focused on more is prevention. In the U.S. we do a great job at treating diseases, but there is more to be done related to the prevention of illness and improving the well-being of our communities. I think working with the government and incentivizing health systems and insurers to focus on prevention can help improve health outcomes. Prevention is one thing we are really missing as a country. It’s disturbing that life expectancy has been on the decline for the last few years, and a main driver is because suicide rates are up and other mental illnesses are prevelent and undertreated. A broader view of prevention would be the industry also focusing on behavioral health. 
Q: What do you consider your greatest talent or skill outside of the C-suite?
RG: Being curious about people and wanting to know what makes them tick and what excites them. I find that curiosity really helps me in and out of the C-suite. I really enjoy meeting different people and really getting to know them. One thing I can say is people really do come from different walks of life, but there are so many commonalities when it comes to their priorities and values. 
Q: How do you revitalize yourself? 
RG: One thing that keeps me energized and focused is working out. With my busy schedule, that usually means working out at about 5 or 5:30 in the morning. I have a personal trainer that I work with about three times a week, and I try on my own to do cardio on the other days.
Additionally, once in a while I dabble into cooking. My family sometimes makes fun of me and calls me a one-hit wonder because I make a mean bolognese sauce. Cooking relaxes me, it clears my mind and allows me to be creative. I should probably learn to perfect a few more dishes, though.
Q: What’s one piece of advice you remember most clearly? 
RG: “Leaders who don’t listen will eventually be surrounded by people who have nothing to say.”
My wife sent me that quote, which is from Andy Stanley. I wish I had learned earlier in my career that being a good listener is key to being a leader. I think it’s one of the most underrated skills of leadership. Usually when you think of leaders you think of people who are charismatic or dynamic, which is important, but curiosity and listening are equally, if not more, important. Q: What do you consider your greatest achievement at Hackensack Meridian Health so far?
RG: I’m going to give my top two. The first is creating and opening a new medical school, the Hackensack Meridian School of Medicine. It is the first new medical school in New Jersey in over 60 years. What I am most proud about with the new school is that the curriculum is so innovative that it’s changing medical education. For example, every student participates in a community immersion program where they pair up with families in underserved communities during their three or four years of medical education so they understand some of the challenges that those families have in staying healthy, and they can see firsthand how the social determinants play a role in one’s health. 
We also have interprofessional academics. The nursing school and allied health program have co-located to the medical school, so that students can learn and understand each other’s role on the healthcare team. I think it will be a game changer because research has shown that when these disciplines work together, patient outcomes improve. I am proud of the school and what we’ve done there. It’s been three years now, and we have close to 6,000 applicants for the 120 slots. It’s been a huge success.
The second one is how we’ve become a leader in behavioral health. We merged with Carrier Clinic, a New Jersey–based behavioral health provider in 2019 and are working to change the landscape in behavioral health.
Last year, we opened a first-of-its kind behavioral health urgent care center so that patients don’t have to navigate an emergency department when they need immediate behavioral health services. With the ED, they can be seen within minutes and meet with a psychiatrist via telehealth. This also helps cut the cost of care for patients, as the urgent care clinic is 70 percent less expensive than the ED. We are also building a comprehensive addiction treatment center in the state. A lot of times patients head out of the state to get addiction treatment. We want to reduce that burden of travel. We are also integrating behavioral health into our overall care plans. I am proud to be a leader on this vital front. 
More articles on leadership and management:
Politico: White House made a list of backup HHS secretariesAHA honors Wyoming hospital with rural health award4 health systems that dropped the dual-CEO model

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5 healthcare leaders reveal simple changes that saved money

Kelly Gooch – Friday, January 24th, 2020 Print  | Email

Hospitals and health systems consistently monitor costs amid today’s industry trends and changing reimbursement environment. 
Becker’s Hospital Review asked healthcare leaders to name a relatively simple change they made that saved money in the last year. Their responses are below, presented alphabetically.
Editor’s note: The following responses were lightly edited for length and clarity.
Thomas A. Biga, president of the RWJBarnabas Health Hospital Division (West Orange, N.J.) 
In the recent past, we moved our management team from a paid time off model, where hours were accrued and carried over up to a year’s worth of PTO, to the honor system for time off. The issue with the old PTO model was that when people left, they took the bank of PTO with them, and that proved to be very costly. In addition, as raises were given, the entire value of the PTO bank would be increased by the percentage of the salary increase. The management team now operates under an honor system, where there are no hours of time accumulated. Rather, days off are just recorded for monitoring purposes, but no definitive grant of hours/days off is set. The expectation is one will get their job done, and done well, while at the same time taking time off at their discretion.
Robert Gardner, CEO of Banner Ironwood Medical Center (Queen Creek, Ariz.) and Banner Goldfield Medical Center (Apache Junction, Ariz.)
I am a firm believer that small and simple changes can have a profound impact, for better or for worse. When it comes to cost-saving initiatives, the same principle holds true. Our organization realized sizable savings by converting the majority of our culinary dollar spend from brand-name products to generic versions with comparable quality. Each line item of change, when measured individually, was nominal and even borderline insignificant. However, the compounding effect of hundreds of similar-sized small and simple changes yielded a profound financial impact for the system.
Mike Marquardt, CFO of UVA Medical Center (Charlottesville, Va.)  
Reconciliation of contracts and technology platforms across health system entities. This includes consolidating duplicative, redundant or similar contracts, as well as eliminating one-off vendors/services that could be provided by the enterprise electronic medical record or enterprise resource planning system. 
Seung Park, MD, senior vice president and chief health information officer at Indiana University Health (Indianapolis)
Traditionally, our EMR build of drugs had listed the entirety of pharmacopoeia in all settings — whether or not the drug was actually on the shelf, in our formulary, or even whether it was still on the market. This caused large-scale costs in nonformulary drugs and delays in treatment when nonavailable drugs were ordered but could not be sourced. We turned off all nonformulary and nonavailable drugs from order in the inpatient arena and saw costs associated with nonformulary drugs drop by an order of magnitude within two months.
Dave Williams, MD, president and CEO of UnityPoint Clinic and UnityPoint at Home (West Des Moines, Iowa)
In 2019, our Laboratory Clinical Service Group prioritized thinking like a system, which included standardizing the vendors we were using, looking at how we could keep tests in the system, and identifying a primary reference lab. On paper, it might seem fairly straightforward, but coordinating between facilities across a three-state area took some elbow grease. It was a team effort, and we got it done, accomplishing an estimated net annualized savings of more than $7.3 million. It’s these kinds of transformations, which are designed around our patients, team members and communities, that help us move health care in a sustainable, aligned direction.

More articles on healthcare finance:Bon Secours to close Kentucky hospital, affecting 1,000 employeesTrump ‘going to look’ at Medicare cutsMedicare to cover acupuncture for chronic low back pain

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker’s Hospital Review, sign-up for the free Becker’s Hospital Review E-weekly by clicking here.

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Nearly 70% of cancer patients view their medical records online, ONC finds

Jackie Drees – Friday, January 24th, 2020 Print  | Email

Among patients offered online access to their health records, about 70 percent who have recently been diagnosed with cancer viewed their record at least once in the past year, according to ONC data.
For its January 2020 data brief, ONC combined 2017 and 2018 data from the National Cancer Institute’s Health Information National Trends Survey to assess the use of health IT by cancer patients.
Five report insights:
1. In 2017 and 2018, patients who had previously been diagnosed with cancer were offered online access to their medical records by a health provider or insurer at higher rate than individuals with no previous cancer diagnosis.
2. Patients recently diagnosed with cancer viewed their online medical records more frequently than cancer survivors and patients who have never had cancer.
3. Twenty-one percent of cancer patients viewed their online medical records six or more times per year in 2017 and 2018.
4. Among individuals who did not view their online medical records in the past year, more than half of patients with a previous cancer diagnosis said it is because they have no need to view the information.
5. More than 80 percent of patients who have previously been diagnosed with cancer and did not access their online health records in 2017 and 2018 said it is because they prefer to speak with their provider directly.
More articles on EHRs:Cerner exec takes leave of absence to focus on congressional campaignEpic releases software update to help identify coronavirus infectionsFormer Cerner employees sue company over retirement plan fees 

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