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Community, Collaboration, Critical Access and Cash

June 10, 2024

BY DANIEL DOUGLAS
Vice President of Operations, Hospital Division, Coronis Health, Boston, MA

No, the “four Cs” represented above are not categories for diamond characteristics or qualities. Although these qualities can lead to brilliance and treasured outcomes when performed the “Coronis Way” in this space. 

Community, collaboration, critical access and cash represent the aspects and qualities required in Coronis Health’s model, operating within our client partnerships in parallel. Coronis has navigated and operated successfully throughout the community hospital, critical access and rural hospital marketplace for many years. We partner with critical-access categorization migrations. Critical access hospitals (CAH) can be defined by a twenty-five bed or fewer facility. Critical access hospitals are a large part of our hospital portfolio, and we possess key expertise in this space with coding, revenue cycle management (RCM) and preservice authorization. Additionally, the hospital team is experienced with larger hospital partnerships, actively working with providers maintaining 75-600 beds, typically in a coding, and in certain cases, a full-lift partnership. 

COMMUNITY

The facilities that we support are large-scale local employers, patient support and small micro-communities in rural parts of America. It is common for hospital employees to be visible to patients and colleagues locally at farmers markets, public schools and at their local town- and or community-sponsored events. There may not be a Starbucks within two hundred square miles, let alone another healthcare provider. This environment creates a sense of community and develops buy-in with employees and patients supporting these services. The provider may be twenty-five beds in a critical access setting or seventy-five to two hundred beds in a rural community environment. 

Our Coronis Health physician team supporting these partnerships has practical experience working onsite at a community hospital, which is typically independent, and has developed those experiences required to connect on any level with hospitals, from departmental level to administration. It is routine for our teams to travel onsite and review items in detail across the table with our hospital counterpoints, clinical departmental leadership and administration to aid in the development of additional onsite strategies and synergies. 

COLLABORATION

Our team’s success is measured by collaboration on various levels and includes a partner facility that entrusts Coronis to deliver the best possible quality and fiscal outcome, creating a tangible synergy. Collaboration with our global partners maximizes the efforts of all forces to combine and provide consistent best-practice delivery. Mutual respect from our partners, as well as our genuine teamwork exemplified by both shores, provides a predictable and consistent outcome to quality and service delivery. Coronis understands that if we do not collaborate with all parties, then the outcome will not be as successful. We believe that dedication, commitment and buy-in are the best strategies to create long-term relationships. 

CRITICAL ACCESS 

The critical access status conversion is trending, impacting many small, rural and community hospitals; and Coronis intends to continue to focus on this classification of facilities. The risk of closure with smaller, independent rural facilities is real without intervention from the Centers for Medicare and Medicaid Services (CMS). Congress identified criteria promoting critical access conversion, supporting the fiscal outcomes of these providers. These facilities must be thirty-five miles from any other hospital, maintaining no more than twenty-five inpatient beds and typically provide service to underserved areas. The fact these health providers must maintain abilities to service these populations is real; and, without this service, many will have to go without care or travel significant distances even for routine care. 

The benefits of critical access conversion and maintenance are as follows: 

  • Reduce financial exposure of rural facilities and maintain independence. 
  • Cost-based Medicare reimbursement and federal grant eligibility. Some states CAH’s may receive cost-based Medicaid reimbursement as well. 
  • Capital improvement costs included in allowable Medicare reimbursement. 
  • Provide patients with access to essential services locally.

Coronis has successfully partnered with many providers transitioning to a critical access status and has continued to work with them for many years post conversion. This navigation to CAH status can be incredibly challenging and can temporarily impact revenue or significantly delay reimbursement if not strategically mapped out. We at Coronis have a thorough understanding of regulatory requirements and the challenges that must be navigated prior to actual conversion. Additionally, we partner with facilities that have already achieved a CAH designation, continuing our subject matter expertise in this space. 

CASH 

All these aspects add up to cash. We cannot operationalize our clients to create cash without community, collaboration and our knowledge of critical access. Whether it is Coronis supporting an aged FTE, coding and/or RCM partnership or a full-lift operation, we capture all levels of revenue cycle operations from a day-one environment. This ranges from preservice authorization to coding, billing and RCM follow up. Like a diamond, this brilliance shines through when all these qualities are performing in unison, creating partnerships and revenue that are referenceable and long term. change management provides a foundation to make change stick and helps organizations build the culture to support their continual improvement. Clearly, the investment in business relations with other healthcare systems and third-party vendors are key for the “new world” transformation of the financial health of revenue cycle management. In summary, all parties—internal and external—will be required to plan and act differently and harness the momentum of major cost containment trends. This is the new definition of collaboration.


Daniel Douglas serves as Vice President of Operations for the Hospital Division at Coronis Health. Mr. Douglas is a thirty-year veteran of the revenue cycle industry and has worked in various roles including onsite at a large-scale for-profit acute care provider. Additionally, he has experience in all levels of revenue cycle with a concentration on front-end authorization, billing, coding and follow up. He currently leads a team that are experts in rural and community hospital partnerships. These relationships are making differences in these remote areas that are critical for patients access to care and facility solvency. He can be reached at danieldouglas@coronishealth.com.

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