Mike Todai
Trusted Advisor who Delivers Outstanding,Measurable & Sustainable Results

 Areas of Expertise Include

  • IPPS 2014 rule changes and its impact on hospitals
  • Rapid assessment, analysis & implementation of case management programs
  • Change Management
  • RAC Audit, Appeals Management
  • Training
  • Length of Stay Management
  • Develop Post Acute Care Support and continuum of care in community
  • Denial Management
  • Physician Profiling
  • Patient Throughput
  • Emergency Room Case Management
  • Medical Necessity Guidelines: Look beyond the world of screening guidelines & use of critical clinical thinking
  • Observation Management and One Day Length of Stay Compliance
  • Community Resources
  • Clinical Documentation
  • Improve Patient, Staff and Physician Satisfaction
  • LTACH, Rehabilitation unit – Case Finding; Increase Volume, Market Share
  • Reduction in Readmissions
  • Staffing Model

Prior to starting his consulting firm, he provided consultation and hands-on implementation of projects for a healthcare consulting company for several years. Mike has worked on turn-around initiatives for several small and large acute-care hospitals.

Mike has achieved significant reduction in length of stay and denials and has improved clinical documentation, RAC compliance, patient throughput (including case management in the Emergency Room), and customer satisfaction by redesigning integrated case management. He has successfully integrated clinical staff and physicians to improve patient care. He has achieved this by providing staff with the appropriate training and monitoring tools to reach hospitals’ desired goals. He develops leaders at the hospitals who can administer the day-to-day operations to maintain and enhance results.

Mike has successfully delivered results for both large and small hospitals across the country. He was Director of Clinical Resource Management at the largest (600 bed) for-profit hospital owned by Tenet Health Systems. Additionally, the hospital included psychiatric patients of all ages. He was Director of Case Management at the 778 bed, not-for-profit, teaching hospital in Chattanooga, TN. This hospital system included a children’s hospital with a separate ER for children.

Areas of Accomplishments Include

– 881 bed facility in June 2009:
Substantially reduced $3.5 million of financial write-off and increased labor productivity by $130 K in less than 8 weeks

– From July 2008 to March 2009 at two hospital systems in Florida:
Improved physician satisfaction in four months
Increased hospital revenue by more than $1 million dollars in 6 months
Reduced hospital LOS by 0.4 days in 4 months
Reduced the LOS of the hospitalist group of 10 physicians and
improved their documentation in 3 months
Reduced LOS of high-volume physicians by 1 day in two months
Developed and mentored staff to share physician profiles

– 56 bed (not for profit) hospital in Texas:
Identified revenue enhancement worth $1.5 million dollars in less than 4 weeks
Provided hands-on case management and trained new case management staff

– 220 bed (for profit) hospital in Texas:
Reduced LOS by 1.5 days in 7 months
Saved $3 million in LOS reduction
Provided an in-service regarding physician profiles to Corp and Regional leadership

– 150 bed (not for profit) hospital in Oklahoma:
Reduced LOS by 1.2 days in 6 months

– Improved businesses at 18 low-census hospitals in 6 months
Spent less than 2 days per site
Enhanced corporate Gold Standards for census building
Trained marketing and operation team responsible for census building at 110 hospitals

– Pennsylvanian hospital with average daily census of 120 (not for profit):
Implemented case management program
Reduced LOS by .8 days in 3 months
Reduced denials by 44%

– Turned around 24 rehabilitation units in 6 months
Generated savings: $400,000 in six months
These results made the hospital profitable again

Mike is a Registered Nurse and has a Bachelor’s Degree in Engineering and Accounting.
He graduated from the University of Houston with a Bachelor’s Degree in Engineering. In 1994, Mike received his license as a Registered Nurse from Regents College of Nursing. Mike has provided direct patient care at a 400 bed hospital in Houston, TX, for more than 7 years in all areas of the hospital. The healthcare division of Electronic Data Systems (EDS, headquarters in Plano, TX) presented Mike with the rarely-given Bright Idea award and recognized his outstanding nursing services and contributions to the company.

PROFESSIONAL EXPERIENCEHCM LLC Signal Mountain, TN July 2008 to present
President and Founder. Hospital Case Management; Independent Case Management Consultant

  • A Corporate Director of Case Management over 5 hospitals. Assess, quantify opportunity, recommend case management process enhancement, redesign case management, generate support and implement the plan.
  • Improved RAC compliance at the 9th largest acute care hospital System in 8 weeks, The hospital annual write off rate off $3.5 million was decreased by 90% in first 2 months of implementation.
  • Increased observation to in-patient conversion rate by 66% at two acute care hospitals through training and education in Oct 2008. Increased annual gross revenue by 1.4 million and maintained 2 years later.
  • Developed and implemented in-service to help physicians Hospitalists group. Developed physician profile and shared it with key physicians. Top Hospitalist reduced LOS by 1.0 day in two months.
  • Completed RAC chart audits for medical necessity and clinical documentations at acute care and Critical Access Hospitals. Provided system wide education to hospitals in Iowa, Idaho and Ohio.
  • Improved and sustained acute Rehab hospital census with appropriate case findings by 66% in three weeks. Annual gross revenue increased by $3.6 million for the hospital system.
  • Completed Case Management basic training at 415-bed hospital in California. Completed staff in-service with CEU. Developed staffing recommendations. Mentored managers and staff. Helped to automate several aspects of discharge planning referrals and communication to community providers.

CareNexus St. Louis MO 12/04 to July 2008
Case Management Consulting Organization
Senior Managing Consultant: On-site assessment and analysis of the client needs prepare work plan, budget, and time line for implementation; deliver results, client and team communication. Hands-on training and implementation of program at client site.

  • Reduced LOS by 1.2 days; operating margin up 16% at 150 bed hospital in Oklahoma in 6 months
  • Identified an opportunity to improve revenue by $1.4 Million annually at 56-bed hospital in TX in 4 weeks.
  • Reduced denials by 40%; reduced LOS by 0.8 days at 180 bed hospital in Pennsylvania
  • Diversion rate reduced from 90% to 15% in 12 months at 500 bed not for profit teaching facility in FL
  • Designed integrated case management model and staffing recommendations for several hospitals
  • Helped 18 out of the 26 Rehab units nationwide. Increased revenue by $540K in 3 months
  • Assessed Case Management programs at ten LTACH and 130 Acute Care Rehabilitation facilities for case management opportunities with average daily census volume of 2200 to 2600 patients

Enhanced gold standards used at RehabCare. Trained Regional Directors, Marketing Directors, liaisons, Medical Directors, case managers across the country on appropriate case findings

Erlanger Health System, Chattanooga, TN 2/02 to 12/04
Not for profit, (557 ADC, licensed 788 Acute care Bed), Teaching facility provides all medical services including Trauma Level I, Children services, and burns and renal transplants. 28,312 in-pt, 90,900 ED visits per year. 3 Campuses

Director, Care Management – Responsible for Utilization Review, Case Management, Discharge plan

  • Saved 12,211 bed days and $3.6 million. 18% increase in admission. Expenses below budget.
  • Denial Rate decreased from 6.0% to 0.55%. Saved $400,000 per year without increasing staff.
  • 55% of cases discharged before expected LOS. Reduced ED diversion from 17% to 3 to 5% range.
  • Lower LOS, denial rate and fiscal mgmt saved $1.1 million per year by refinancing long term bonds.

Tenet Health Systems 3/99 to 2/02
Tenet Brownsville Medical Center, Brownsville, TX 3/1999 to 2/2000 (210 bed acute facility) then promoted to Saint Francis Hospital, Memphis, TN Feb 2000 to Feb 2002

For Profit 607 beds. Teaching facility provides all medical and psychiatric services
Director, Clinical Resource Utilization: Case Mgmt, Utilization Review, Social Services, Infection Control

  • 70% of redundant work was eliminated. Under budget even with higher volume growth.
  • Patient satisfaction increased in 2 years in a row at 600 acute care hospital

In-patient score increased from 93% to 97%; Out-patient score increased from 96% to 99% Case Management Department Voted as Number #1 Department by Peers.

  • First Prize from APIC at National Level. Infection Control Saved $106,000 by reducing UTI.
  • Successfully implemented electronic InterQual, Milliman, ECIN (now called Allscripts) and VoicertI
  • Reduced Length of Stay by 6000 acute care bed days or saved $3 million in 7 months at Texas Hospital
  • Prepared effective Physician Profiles in less than 60 days and helped 17 Texas region hospitals.

EDUCATION

  • Master’s in Nursing (MSN) – Expected graduation in Dec 2014
  • Registered Nurse – TN – Current License. Associate Degree in Nursing, Regents College, NY 1993
  • Bachelor of Science in Electrical Engineering, University of Houston, Texas. 1990
  • Graduate Vocational Nurse, Memorial City General Hospital, Houston, Texas 1983
  • Bachelor of Commerce with major in Accounting and Auditing, University of Bombay, India 1980

SKILLS
· Rapid qualitative and quantitative assessment to recommend implementation steps..
· Rapid deployment of Business Intelligence system a reliable decision making tool and easy to use
· Daily work flow monitoring processes and management of cases. On-site and remote monitoring
· Physician Profile, education · Clinical Resource Management; Effective case presentation/communication
· Clinical documentation to help meet medical necessity & RAC related issues.
· Effective use of InterQual® · Milliman® for medical necessity, denial management
· Electronic Discharge Planning; HEDIS and NCQA standards; Managed Care contract reviews
· MS Word, Excel, Power Point, Email, One staff scheduling, Kronos, Horizon, Care Manager
· Meditech · SMS · Allscripts · Midas · STAR McKesson, · 3M HDM, · Voicert · Tele Tracking
· Crimson – physician profiling tool, Epsi – Budget Management
· Decision support systems; Relationship building with physicians and community liaisons
· Communication including presentation at all levels · Leadership training, mentoring
· Trained in Quint Studors; Institute for Healthcare Improvement (IHI); work safety; leadership
· Marketing Systems: Sander’s Training and Miller and Heiman
· Proven skills to increase appropriate volume at LTACHs and ARUs in short period of time
· Staff training, confidence building, mentoring, interacting with patients, physicians and co-workers

Affiliations

  • Member of Case Management Society of America
  • American Case Management Association

Honors, Awards, Publication and Software Development

  • Received AWARD for Outstanding Service and contributions (1984)
  • Recipient of rarely given BRIGHT IDEA AWARD; Earned awards for outstanding services (1994)
  • Successfully completed Leadership training programs: Improve Quality, Satisfaction and Safety
  • Received First Prize from APIC (infection Control Society) for paper submitted by the Department (2000)
  • Helped physician build a case management system with elegant solution using pathways recognized in Chattanooga, TN Press.(2002-2004)
  • Case Management department recognized as number #1 Dept by peers at 600 bed hospital (2001)
  • Ranked First in the high school and the district.. Earned National Merit scholarship (1974)
  • Ranked in top 1% of First year of business college at University of Bombay out 14,000 students (1975)
  • APC roll out jointly published with Tenet Corporate team. It was distributed at over 100 hospitals – FY 2001
  • Developed algorithm for admission process for Tenet Corporation in FY 2001
  • Developed proprietary software to calculate Observation hours in 2003. Conducted work shop.
  • Developed software for Measurement While Drilling (MWD) and increased lab productivity by 90% (1992)
  • Won awards in five different sports at college level in second year of the business college (1975-76)
  • National Speaker at the World Research Group Conference held in Philadelphia in April 2010
  • National Speaker at 2011 Observation Patient Management Congress Feb 28 2011 €¢ Las Vegas, NV.

Testimony Letter and recommendations