Case Manager North Carolina

W. Mark Twilla, RN, BSN, MHA

**** ******* ***** 336-***-****

Raleigh, North Carolina 27609 ****************@*****.*** SUMMARY

Healthcare professional with extensive experience in medium sized community based, complex hospital/ system settings and post acute care settings. Clinical background with strong experiences in quality patient care. Exceptionally strong in operations and physician relations. Skilled in financial improvement, including turnarounds and physician practice management. Demonstrated experience in process im- provement and enhancing the patient experience. Strong vendor and payor contract negotiation skills. Recognized leader in the development of collaborative approaches in healthcare delivery with physicians, employees and other stakeholders.

PROFESSIONAL EXPERIENCE

WakeMed Health System, Raleigh, NC 2022-2025

WakeMed Health and Hospitals is a 919-bed healthcare system with multiple facilities placed around the metropolitan Raleigh, North Carolina area. WakeMed's main campus is located on New Bern Avenue in Raleigh. WakeMed serves multiple counties throughout the state and specializes in a variety of services including cardiology, gastroenterology, neurology, orthopedics, high-risk pregnancy, children's care, trauma, physical rehabilitation and critical care transport. RN, Hybrid Case Manager I/P and Emergency Room.

Responsible for managing throughput on an I/P Unit and ER. Was based at WakeMed North Campus. Performed all necessary processes to complete a successful discharge plan to include evaluating patient and families for discharge needs, review charts looking for:

● insurance coverage

● Emergency Contact information

● Therapy recommendations

● 30 day readmit

● patient historical hospital utilization

● Progress Notes

● Consult recommendations

● PASSR/FL2 review and obtainment if needed

● Choice List

● insurance authorization obtainment

● DME needs to include home 02 and IV therapy if needed

● All documented in an EPIC environment

● Responded and addressed all CM Consults ordered by providers

● Was challenged to be exclusive RN, Case Manager, first time WakeMed North has had a dedicated FTE.

● Worked closely with Providers, Physician Advisor in compliantly reviewing cases for appropriate status designation. Able to move OBS status rate from an average of 45% to 20%-30%.

● Able to discharge To Be Admitted (TBD) patients by an average of 45% while boarding 40-75 patients a day. This created bed capacity on the floor and in the ED, bed turns. Duke University Health System, Durham, NC 2020-2022 Duke Health integrates the Duke University Health System to include 3 regional hospitals, Duke University School of Medicine, Duke-NUS Medical School, Duke University School of Nursing, Duke Private Diagnostic Clinic (Duke physicians practices) and incorporates the health and heak=lth research within the Duke Global Health Institute as well as those in schools and centers across Duke University, including the Robert J. Magnolia Center for Health Policy. Case Manager, Orthopedics and Neurology

Responsible for managing 20-35 patients a day ensuring their discharge plan is executed efficiently with length of stay goal being ALOS<GMLOS. Work closely with physicians, patients, family members and all other clinical disciplines to execute discharge planning to home, home health or skilled nursing facilities. Ensure transportation, durable medical equipment and other patient needs are organized and delivered to the family members successfully.

● Maintained an ALOS<GMLOS over 98% of the time.

● Successful patient/family satisfaction as evidenced by Press Gainey scores over the 90%ile. University of North Carolina Physicians Network, Morrisville, NC 2017- 2020 A 3,000+ physician affiliated/employed network of multi-specialty providers who are aligned with the University of North Carolina Healthcare System. UNCPN is a clinically integrated network of providers who have developed operational and administrative capacities to mange traditional managed care con- tracting, as well as, operate an ACO model for full risk contracting with Medicare for a defined patient population in Wake and surrounding counties.

Case Manager, Population Health, Transitions of Care Responsible for managing and assisting in the coordination and implementation of a transitions of care plan for patients being discharged from any hospital ER/OBS or inpatient setting with a UNCPN affiliated PCP relationship. Ensure all key elements of a successful transition from a hospital setting to an outpa- tient environment is in place and that the patient/primary care giver are confident and equipped to mange the outpatient plan.

• Maintaining a 97% call completion rate with a goal of 95%.

• Effectively managing transitions activities with 0% chart omission rate.

• Successfully fulfilling role outcome metrics to receive quarterly bonus incentives 100% of available offerings.

• Team activities resulting on 9% reduction in acute care readmits and high cost healthcare Kindred Healthcare, Kindred Hospital Cleveland, OH and Palm Beach, Fl 2015 - 2017 The nation’s largest provider of post-acute care services in settings that range from transitional care hospitals to home health services. Operating in 48 states and over 100,000 employees nationwide. Chief Executive Officer

Responsible for two (2), at separate times, for-profit 60 and 70 bed licensed long term care facilities

(LTAC). Administrative responsibilities for annual gross patient service revenues of over $28 million, 250 plus employees, including Diagnostic Imaging, Laboratory, Environmental, Dietary, Comprehensive Wound Care Services program, Rehabilitation Services, Case Management, Plant Operations and all oth- er support departments. Reported to Market/District Vice President.

• Exceeded EBITDARM by 65% 15 out of 19 months, 79% over budget last 6 out of 7 months.

• Achieved EBITDARM margin percentage of 25.39% versus a budget of 16.37%, a 9.02% increase.

• Increased patient days from an average of 930 per month to an average of 1,043, an 11% increase.

• Increased average daily census from 41 to 53, a 29% increase.

• Achieved a Short Stay percentage of 12.3% versus a budget of 20.2%, a 7.9% decrease and from prior year of 18.9%, a 6.6% decrease.

• Increased “Call Light Response” percent always score from 17% to 92%.

• Increased “Overall Satisfaction” percent always and likely score from 54% to 83%.

• Reduced key quality performance indicators as follows:

• CVL patient days from 983 to 570, 42% reduction.

• CLABSI rates per 1000 from 3.05 to 1.91.

• CLABSI utilization rate from .72 to .33.

• Foley catheter days from 803 to 448, 44% reduction.

• CAUTI rates per 1000 from 9.96 to 2.46.

• CAUTI utilization rate from .59 to .26.

• Return to acute care percentage from 8.08% to 5.01%.

• Recruited numerous physician specialties which provided services to our patients resulting in an av- erage increase of the DRG weight by 20% to 30%, resulting in an average of $25,000 - $40,000 add tional revenue per case. All accomplished with compliant documentation training and education of new providers to ensure accurate outcomes.

Columbus Regional Health, Midtown Medical Center, Columbus, GA 2012-2014 Columbus Regional Health is a fully integrated delivery system consisting of three acute care hospitals, owned and employed physician practices, comprehensive cancer center and other subsidiary health services. Midtown Medical Center is a non-profit 413 bed licensed community based medical center with teaching services. Annual gross patient service revenues of over $700 million, 3,200 employees, Level 2 Trauma Center and 90,000 Emergency Room visits.

Vice President and Chief Operating Officer

Responsible for $516M revenue budget, $86M expense budget and 606 paid FTEs. Direct responsibilities for Volunteer Services, Retail Services, Maintenance and Engineering, Nutrition Services, Imaging Services, Environmental Services, Cancer Center, Respiratory Services, Pharmacy Services, Laboratory Services and Construction/Project Management. Active in all compliance programs and Joint Commission readiness. Reporting to Chief Executive Officer.

• Implemented biomed and imaging maintenance program resulting in an expense reduction of $6.5M.

• Achieved a $26M expense reduction and a 229 FTE reduction in 180 days.

• Developed a centralized Patient Intake Center allowing for single point of entry for all physician re- ferrals for diagnostic and surgical services for the system.

• Improved Radiological processes and workflow resulting in procedural increases of 2.8% in Diag- nostic Radiology and 50.1% in Interventional Radiology procedures.

• Re-negotiated two purchased services contracts for an expense reduction of $537,000 per year.

• Developed Cardiac PCI Program in conjunction with three cardiology groups, resulting in 100% compliance with door to balloon time less than 90 minutes and increased volume by 98%.

• Worked with local surgeons to open first hybrid operating room in a 13 county region.

• Administrator for 10 physician Comprehensive Cancer Center. Increased gross revenue by 6% and patient volume by 4%.

• Worked with Oncologists to increase new medical oncology patients by 38%.

• Managed $34M worth of construction and renovation projects.

• Operated 92% of all departments at target per Premier report for 18 months and running.

• Reduced ED border hours by 32% and reduced ED length of stay by 24%. Cabell Huntington Hospital, Huntington, WV 2008-2012 A non-profit 313 bed licensed community based academic medical center affiliated with the John E. Edwards School of Medicine at Marshall University. Annual gross patient service revenues of over

$740M, 2,400 employees and a Union Bargaining Unit. Level 2 Trauma Center and 55,000 Emergency Room visits.

Vice President, Support Services

Responsible for $380M revenue budget, $68M expense budget and 603 paid FTEs composed of Planning, Diagnostic Imaging, Laboratory, Pathology, Neurosciences, Neurosurgery, Environmental Services, Di- etary, Home Health Care, Home Infusion, Comprehensive Wound Care Services, Physical Rehabilitation, Cardiopulmonary Rehabilitation, Respiratory Therapy, Sleep Lab, Maintenance and Engineering, Con-struction, Bio-Medical, Safety, Security and Clinical Resource Management departments. Reported to the Senior Vice President and Chief Operating Officer (COO).

• Increased divisional revenue by 10%.

• Changed Case Management model resulting in a reduction of Observation days as a percent of total admissions from 33% to 9% and a $300,000 - $400,000 increase in payments per month.

• Developed Key Performance Indicators for all aspects of the revenue cycle.

• Implemented Clinical Documentation Improvement Program moving Case Mix Index by 3% in one year.

• Managed 8 physician departments of Neurology and Neurosurgery. Increased patient volume by 11% and gross revenue by 9%.

• Managed over $19M of internal and external capital construction projects.

• Re-organized Maintenance, Engineering and Environmental Services Departments, resulting in a 22% and 38% reduction in union grievances respectively.

• Reorganized Environment of Care Program management, resulting in a 70% reduction in RFIs iden- tified by the Joint Commission and a reduction from 291 PFIs to 3 PFIs on the hospital’s Statement of Conditions.

• Participated in Malcolm Baldrige Application creation and submission.

• Implemented and hardwired patient satisfaction initiatives resulting in “9 and 10 rating” increasing from the 60th percentile to 90th percentile, “Willing to recommend” increasing from the 60th per- centile to 85th percentile and “IP Overall” increasing from 50th percentile to 90th percentile.

• Implemented changes in Maintenance and Engineering Department resulting in a 5.2 FTE reduction.

• Increased Sleep Lab volume by 67% and Neurodiagnostic Lab volumes by 54%. Morehead Memorial Hospital, Eden, NC 2005-2008

A for profit managed 243 bed healthcare delivery system with revenues over $150M, 1,000 employees, full scope of general acute care hospital services, long-term care facility, oncology services, home health, primary and specialty physician offices and outpatient services. A Quorum Health Resources (QHR) managed facility.

Vice President, Operations

Responsible for 253 FTEs, $110M budget comprising the Pharmacy, Diagnostic Imaging, Laboratory, Environmental Services, Dietary, Physical Rehabilitation, Chronic Disease Management, Cardiac Rehabilitation, Cardiopulmonary, Cardiovascular, Sleep Lab, Occupational Health and Comprehensive Wound Care Services. Served as Compliance Officer. Reported to the President and CEO and Regional Vice President for QHR.

• Grew total gross revenues by 22.5%.

• Increased divisional revenues from 52% to 59% of total hospital revenue.

• Increased Cardiovascular Services productivity from 42% to 96% and increased gross charges by

$2M.

• Increased market share from 62.4% to 65.9%.

• Obtained Federal 340-B status resulting in $1.5M drug costs savings annually.

• Reduced Emergency Room wait time by 32% for door to discharge, 12% for door to bed and 18% for bed turn-around time.

• Developed comprehensive wound care center and Congestive Heart Failure (CHF) Clinic.

• Managed a move from four general radiologists to over 120 fellowship, sub-specialty trained Radi- ologists.

• Increased Press Ganey patient satisfaction overall score to the 91th percentile.

• Increased response rate on patient satisfaction surveys from 14.7% to 28.35%.

• Maintained outpatient services patient satisfaction scores at 96% or higher for a consecutive 15 months.

• Implemented initiatives to enhance physician and hospital administration relationships resulting in a 93rd percentile ranking.

• Improved CMS Core Measure scores to greater than 90%.

• Led organization to full accreditation status from JCAHO in 2007 for both laboratory and hospital programs.

• Increased case mix index by 7.2%.

• Reorganized Hospital Employee Safety Program resulting in a decrease of OSHA recordable em- ployee incidents by 48.5% and work related incidents by 26%.

• Instrumental in managing $45 million dollar expansion and renovation project.

• Implemented “Healthy Access”, a safety net initiative for 7,000 low income, uninsured citizens ob- taining over 95% Provider participation in program. EDUCATION

Bachelor of Science, Nursing, University of North Carolina, Chapel Hill, NC 2003 Master of Health Administration, University of South Carolina, Columbia, SC 1994 Bachelor of Arts, Political Science, North Carolina State University, Raleigh, NC 1990

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