ARUP Institute for Learning Outreach Conference 2012

Laboratory outreach programs typically get one chance to secure administrative buy-in for their program, so it’s critical to do it right the first time. Developing a robust business plan is vital to gaining the necessary support to start or expand an outreach program. This presentation will review the key components to include in a business plan and lay the ground work for the rest of the workshop.

During this session attendees will learn:

1. The key components to include in an outreach business plan.
2. Methods of calculating market opportunity.
3. Ways to forecast revenue and translate that into expected numbers of new tests and requisitions.
4. How to calculate costs associated with starting up or expanding an outreach program.
5. How to create a financial pro forma with return on investment (ROI).

Coordinating primary care services and facilitating collaboration across different providers and organizations are key objectives of patient-centered medical homes and accountable care organizations (ACOs) under healthcare reform. Understanding how these two models redefine the economic value of diagnostic testing where patient care is integrated and value is rewarded over volume helps bring into clearer focus a shifting paradigm for lab organizations, which will result in new industry winners and losers.

During this session attendees will learn:

1. The role of sales and marketing under a revamped marketplace.
2. How certain lab business models fulfill their organization’s strategic goals.
3. How today’s sales reps could become tomorrow’s utilization consultants.

Establishing an appropriate legal structure for a hospital-based outreach program presents a difficult challenge. There are many financial considerations that need to be addressed either upon startup or when the outreach business grows to a point when profits pose a risk for a not-for-profit hospital.

During this session attendees will learn:

1. Pros and cons of operating the outreach business as hospital-based verses the establishment of an independent laboratory.
2. Problems associated with common patient registration and billing practices.
3. Financial impact various charge structures may have on reimbursement.

Test-utilization management is increasingly important for healthcare organizations. In an outreach environment, two major opportunities exist. First, your laboratory may be losing significant amounts of money on expensive proprietary tests that in many cases lack clear medical value. Second, by assisting doctors with appropriate test selection, your laboratory can raise the level of service from simply filling orders to becoming a true diagnostic partner. This session will provide a framework for assessing utilization-management opportunities as well as suggestions for implementation.

During this session attendees will learn:

1. The medical and financial needs for test-utilization management.
2. Mechanisms for identifying which tests and ordering physicians need attention and for creating a corrective action plan.
3. Options for creating changes in physicians’ ordering practices.

Access to provider agreements with managed-care organizations is often a critical barrier to establishing or growing laboratory outreach programs. Ancillary provider contracting is not commonly understood by hospital contract managers. This session will identify common MCO situations and, through discussion of case studies, will provide experience and strategies that will help in overcoming obstacles to obtaining provider agreements.

During this session attendees will learn:

1. Reasons why and how ancillary provider agreements can be part of the development strategy for hospital outreach programs.
2. Common obstacles to securing ancillary provider agreements with managed-care organizations.
3. A process for approaching managed-care organizations.
4. Key elements in the development of a successful value proposition.

No capital, no outreach! Understanding core concepts related to the financial justification of capital purchases is essential to operating a successful and thriving outreach program. Speaking the language of profit margin is the key to gaining the support of your chief financial officer and other various executives who control the purse strings within your hospital or health system. During this session, several common evaluation methods will be taught, including the payback method, simple rate of return on investment (ROI), net present value (NPV), and internal rate of return (IRR). Important yet often misunderstood concepts such as the time value of money, cost of capital, and discounting cash flows will be discussed. The common financial hazards of reagent rental arrangements will also be revealed. Practical, real-life examples will be demonstrated.

During this session attendees will learn:

1. Why the concept of cost of capital is critical in choosing projects accretive to the profit margin.
2. The financial implications of reagent rental arrangements and the potential impact such arrangements can have with respect to an enterprises ability to fund a successful outreach program.
3. How to impress your chief financial officer by understanding the most common equipment purchase assessment methods.

There are many known and unknown compliance risks associated with operating a laboratory outreach program. Billing for services as well as sales and marketing activities can pose serious risks for a healthcare organization. Penalties for inappropriate activities can result in fines as well as Medicare sanctions.

During this session attendees will learn:

1. An overview of Medicare fraud.
2. Pricing and discounting policies and procedures.
3. Sales and marketing activities–the dos and don’ts.
4. What to include in a laboratory service agreement.

Many laboratories invest in automation due to declining reimbursements, an aging workforce, outreach opportunities, and a desire to reduce costs and improve quality and safety. This session will review a proven process for identifying steps in the laboratory’s present workflow that are best candidates for automation and re-engineering. It will also provide recommendations and examples of several measures useful in assessing lab performance before and after automation, and offer an overview of the many laboratory automation systems that are commercially available.

During this session attendees will learn:

1. The steps necessary to evaluate the role and value of automation in their clinical laboratory.
2. The process to successfully implement laboratory automation.
3. Useful parameters for measuring outcomes and benefits of the automation project.

Today’s laboratory outreach programs have a major competitive advantage over commercial laboratories when considering the health systems that give them life. This session will outline the framework for developing a laboratory sales strategy that should be aligned with the overall healthcare system strategy, demonstrate how leveraging information technology is the key component of a successful sales strategy, and explain how and where to invest resources to win and keep business.

During this session attendees will learn:

1. How to define and communicate the laboratory’s competitive advantages within the context of the health system’s strengths, exploiting the obvious.
2. Why physician office connectivity and innovation should be front and center with any successful sales strategy–what’s hot today may be passé tomorrow.
3. How to use a break-even analysis tool to determine what resources can be profitably offered to sales prospects.

Executing a successful lab outreach program is a daunting task in and of itself; however, functioning with all the restrictions placed on programs operating within the hospital environment and ensuring that inpatient lab services do not suffer is beyond challenging. Billing successfully and leveraging the financial information related to the book of business provided by an outreach program is often overlooked. This session will examine the billing pitfalls that must be overcome and help lab administrators determine whether they have the capabilities and resources to perform this function in-house.

During this session attendees will learn:

1. What can be done to more effectively get bills out the door right the first time and effectively manage the claims that have yet to be billed.
2. The process of working rejected claims and how staff can be assigned and managed to dramatically reduce the percentage of AR that is greater than 90 days.
3. Different strategies for pursuing the increasing percentage of business that is self-pay by differentiating bill cycles and statements for true self-pay versus insured patients with greater co-pays and deductibles.
4. What type of billing information should be looked at to determine whether an outreach program is meeting its financial as well as service objectives.
5. The factors that determine client profitability and what variables can be affected to improve the contribution margin of a client or line of business.
6. How to quickly determine if current billing efforts will adequately support an existing outreach program.

Patient service center development and placement can be an effective and valuable component of an outreach business plan. Putting first things first, it’s critical to assess a strategic site location and then project the financial opportunity of establishing a PSC. Minimizing risk and knowing how to measure the success of incorporating PSCs into your outreach operation are important considerations.

During this session attendees will learn:

1. How to develop a PSC site-specific business plan.
2. Space leasing dos and don'ts.
3. Appropriate staffing and expense allocation.
4. Effective PSC marketing.

Control of an efficient logistics system is a critical element of most successful outreach programs. Couriers are often the most recognized “face” of the laboratory in client offices and can be a huge asset for your program, or a reason your services are viewed unfavorably. Management of a courier staff and fleet requires a specialized crew of drivers, and knowledge of transportation requirements, route planning, and dispatch procedures. Controlling the cost of logistics may represent the difference between a profitable outreach program and one that is on the road to extinction.

During this session attendees will learn:

1. Courier staffing and training procedures.
2. Route and dispatch management tools.
3. Marketing opportunities inherent in regular courier stops.
4. Internal and external fleet development and operations management.
5. Basic DOT and IATA rgeulations and exemptions.

Laboratories must find new ways to connect with their physician customers in order to deliver the highest-quality and most responsive service. The dramatic increase in physicians adopting EMRs presents obstacles to getting this done efficiently.

During this session attendees will learn:

1. Methods available for connecting labs to physician customers.
2. New ways to ensure the capture of clean orders, regardless of how the order is placed.
3. New tools for patient services centers (PSCs) that improve productivity and revenue, and provide a competitive edge for the lab.

Social media is the hottest topic next to healthcare reform, and businesses of all kinds, including hospitals, labs, and other healthcare companies, are using sites like Twitter, LinkedIn, Facebook, and YouTube to increase their visibility, build relationships, and drive growth.

The lab industry is also getting in on the action, seizing this opportunity to leverage social media and drive growth in a number of different ways. This session will help you implement an effective social media program to grow your outreach business and recognize the pitfalls to avoid.

During this session attendees will learn:

1. What social media marketing is and why it’s so important.
2. Key considerations when developing a social media marketing strategy that will drive growth.
3. The critical components every social media plan should include.
4. How to effectively communicate and implement your social media marketing plan.
5. Specific examples of privacy policies and guidelines for using top social media sites.
6. Essential steps and methods to create an effective policy for your lab.

Rob Atlas is the chief executive officer of Atlas Development. He has been involved in healthcare IT for more than 25 years as a manager of information systems, a software designer/developer, and an IT products solution provider. In 1989, he co-founded Atlas Development and went on to build a number of high-performance, mission-critical applications for healthcare industry leaders. Over the last decade, he has become well-known in the laboratory industry as an innovative designer and developer of lab IT solutions that drive operational efficiency and leverage competitive advantage. Mr. Atlas is a graduate of the Massachusetts Institute of Technology.

Kristen Deem is the senior web editor and social media specialist for ARUP Laboratories. In her current position, she develops the content on ARUP's five web properties, as well as the strategy and communication for ARUP's social media presence.

With more than 18 years experience, Ms. Deem has a well-rounded background in advertising, writing, editing, and online marketing. She received her bachelor of arts in journalism at the University of Utah, and has worked in PR, published articles in magazines, and sold advertising for a newspaper. She has been with ARUP Laboratories for the past 10 years.

Ms. Deem is involved in several community and industry organizations, including International Association of Business Communicators (IABC) Women's Tech Council, Social Media Club, and the Utah Society for Healthcare Communications and Marketing (USHCAM). She can be found participating in any number of online forums and blogs about marketing, healthcare, social media, pop culture, travel, and food. Connect with her on Facebook (www.facebook.com/kristendeem), LinkedIn (KristenDeem), or Twitter (@kristendeem).

Dr. Charles Hawker is the scientific director for automation and special projects at ARUP, where he has worked for 20 years, and an adjunct professor of pathology at the University of Utah School of Medicine. He received his PhD from the University of Pennsylvania and his MBA from Washington University, St. Louis. While at ARUP, Dr. Hawker has installed several major automation and robotic systems that have made ARUP one of the country’s most automated laboratories.

He is a past president of the Association of Clinical Scientists, the National Academy of Clinical Biochemistry (NACB), and the Clinical Ligand Assay Society (CLAS). He received the John V. Bergen Award from the Clinical and Laboratory Standards Institute in 2010, the NACB's Professor Alvin Dubin Award in 2005, and the Association for Laboratory Automation's Becton Dickinson Award in 2000. Dr. Hawker is the co-author of chapters on automation in the fourth edition of the Tietz Textbook of Clinical Chemistry and Molecular Diagnostics and the sixth edition of the Tietz Fundamentals of Clinical Chemistry.

A frequent lecturer on laboratory automation to national and international audiences, Dr. Hawker has three issued patents and has published 40 peer-reviewed papers, 13 book chapters or invited reviews, two invited editorials, and 42 abstracts. His most recent research efforts have focused on the use of machine vision systems for automated quality inspection of clinical laboratory specimens, particularly the development of an automated camera system that uses optical character verification (OCV) to identify mislabeled specimens.

P. Thomas Hirsch has extensive experience in the management and operations of hospital and independent laboratories. He is currently the co-founder and president of Laboratory Billing Solutions, which performs billing services for hospital outreach and smaller independent laboratories.

From 1984 until 2003, Mr. Hirsch was president and CEO of Path Lab, Inc., a highly successful hospital-based independent laboratory. The company was sold to LabCorp in April 2001 for more than $100 million. Path Lab was the second largest laboratory in New England, with annual sales of $70 million. The laboratory was an industry leader in working with institutions and developing innovative solutions to enhance laboratory performance. Path Lab managed six hospital laboratories and five major physician office labs, and had management agreements with New York University Medical Center and Clinical Laboratory Partners, a wholly owned subsidiary of Hartford Hospital.

Mr. Hirsch also served as president of Diagnostic Laboratory Services in Honolulu, Hawaii from 1989 to 1994, and as an associate in the Health and Medical Division of Booz-Allen & Hamilton in New York, where he performed strategic planning and financial management assignments for large hospitals and academic health centers.

Mr. Hirsch's earlier positions include administrative and financial planning responsibilities at the Boston Department of Health and Hospitals. He also served as director of affiliation administration for the New York City’s Health and Hospitals Corporation, where he managed a $160 million contract program that provided all physician services in New York City’s 16 municipal hospitals.

Mr. Hirsch has worked on numerous laboratory consulting assignments with academic health center and other major hospital systems. He has worked with several healthcare private equity firms in evaluating laboratory acquisitions and mergers and, most recently, has worked closely with Accretive, LLC, in developing its lab sector initiative, aLabs.

Mr. Hirsch served on the board of directors of the American Clinical Laboratory Association from 1995 until 2001. He currently serves on the board of ConVerge Diagnostics Services and counsels many of his billing company clients on strategic matters.

Mr. Hirsch earned his MBA degree from the Harvard Graduate School of Business Administration and his BA, magna cum laude, from Duke University.

Cyndee Privitt Holden is assistant vice president of Marketing and manager of Integrated Marketing Communications at ARUP Laboratories. In her current position, she is responsible for overseeing all aspects of marketing communications, public relations, and advertising at ARUP.

With more than 25 years experience, Ms. Holden has an extensive background in both corporate and consultative marketing. Her educational and career experience in marketing, research, brand strategy and planning, group strategic planning processes and market positioning theory allows her to provide a full range of marketing advice and counsel to ARUP and its clients.

Ms. Holden is involved in several community and industry committees, including American Clinical Laboratory Association (ACLA) ambassadors and public relations committee, Women’s Tech Council advisory board, Utah Technology Council public policy board, Utah American Marketing Association, International Association of Business Communicators (IABC), and Social Media Club.

John Kangas currently serves as the business development and logistics manager for the Avera Laboratory Network, a full service hospital-based reference laboratory operating as an integrated network of four strategically located testing centers throughout South Dakota owned by Avera Health.

Mr. Kangas completed a marketing degree at Winona State University in Minnesota and received medical histology training from Chippewa Valley Technical College in Eau Claire, WI. He is ASCP certified in histotechnology.

He has been with Avera Lab Net since 1999; however, he has performed various roles in laboratory management and hospital-based lab outreach since 1993.

Ms. Ludwick is an experienced business professional with more than 30 years administrative and clinical experience in the healthcare industry, focused primarily on business development, compliance, and operations improvement for hospital-based clinical and anatomic pathology laboratories. Ms. Ludwick has extensive experience in commercial laboratory business development, compliance, and operations.

Ms. Ludwick is currently the director of outreach development for ARUP Laboratories. In this role, she is responsible for acting as the national spokesperson and providing strategic direction for ARUP Direct™, which serves as an umbrella structure for ARUP outreach services to provide clients with critical services and skills necessary to compete in local and regional marketplace.

Ron McFarland has more than 28 years experience in the field of accounting, finance, and business management in various industries, including telecommunications, grocery, and healthcare. After receiving his bachelor’s degree from Brigham Young University, he began his career in the Salt Lake City-based Bonneville International Group of companies, receiving his certified public accountant certificate in 1986. He is past chief financial officer of Bonneville Market Information Corporation, a national provider of real-time financial market data and currently serves as vice president, treasurer of ARUP Laboratories.

Joe Miles is an experienced business professional with more than 30 years of administrative and clinical experience in laboratory medicine, focused primarily on operations, network management, and business development for hospital-based clinical and anatomic pathology laboratories. Mr. Miles also has extensive experience in managed-care contracting and multi-facility network development.

Mr. Miles is currently senior consultant for Business Development with ARUP Laboratories. In this role, Mr. Miles is responsible for conducting outreach infrastructure evaluations and readiness assessments for ARUP clients. His responsibilities include assisting ARUP clients in growing their laboratory outreach programs by identifying improvement opportunities in operations and organization and by creating solutions for their business challenges. Mr. Miles is also responsible for leading the development of business strategies for ARUP in response to new healthcare delivery models emerging from the national healthcare reform movement.

Prior to joining ARUP, Mr. Miles was the general manager of Frontline Laboratory Network (FLN), a hospital-based laboratory alliance operating in Colorado, Wyoming, Nebraska, and Montana. Under his leadership, FLN grew to become a nationally recognized network with a reputation for innovation, success in managed-care contracting, and growth in member outreach development.

Mr. Miles received his bachelor’s degree and medical technology training at the University of Colorado and earned a master’s degree in healthcare systems from the University of Denver. He has presented at national meetings and written for industry publications on several occasions. He has also been active in lobbying efforts for the laboratory industry for more than 10 years, including regular communications with and annual visits to congressional offices representing the Rocky Mountain region.

Scott Romney is a marketing graduate of the David Eccles School of Business at the University of Utah. His master’s work at Westminster College included emphasis on healthcare information technology for strategic advantage. He began his career at ARUP Laboratories and has since worked at a variety of health sciences firms as the senior sales and marketing leader. As the marketing director of laboratory services at Intermountain Healthcare, Mr. Romney leads a team of sales and marketing professionals and has championed physician office connectivity to double laboratory outreach business over the last five years.

Khosrow Shotorbani has extensive experience in the health care industry, most specifically in the areas of medical technology and business development. He has been with ARUP Laboratories for more than 20 years and has provided strategic sales direction and oversight for ARUP's external sales team. Mr. Shotorbani has led ARUP's expansion of outreach and consultative services and been a driving force in the advancement of cost-management and diagnostic-support best practices in the areas of sales and business development.

Mr. Shotorbani received his MBA from the University of Phoenix and earned a BS in clinical laboratory science from Weber State. He has been an active member of the American Congress of Healthcare Executives (ACHE), Health Information and Management Systems Society (HIMSS), Healthcare Financial Management Association (HFMA), and Utah Technology Council (UTC). In the past, he served as a president and board member of the Utah chapter of CLMA, as well as a member of the Health Care Policy Committee of the national CLMA.

Certified in health care compliance, Chris Young is a compliance professional with 20 years of experience in laboratory compliance and over 40 years working in clinical laboratories. He serves as the laboratory representative on the Medicare Carrier Advisory Committee for Arizona and is CLMA’s representative on the Pathology Coding Caucus. Mr. Young speaks and writes locally and nationally on health care and laboratory compliance issues, Medicare/Medicaid billing, and other laboratory topics. He is an independent consultant specializing in regulatory matters and developing compliance officers and programs for clinical laboratories.