The Newsletter of the Massachusetts-Rhode Island ChapterVolume XXXV Number 6 July 2008The following Medal of Honor Award recipients were honored at the Annual Social and Awards Night on May28th: Peter Leone, McDermott, Will & Emery; James Sullivan, Deloitte & Touche LLP; Daniel Phillips, PhillipsDiPisa; Lawrence Martin; Carolyn Jacoby Gabbay, Nixon Peabody LLP; Edward Kennedy, Jr., Medical Bureau/ROI; Gail Schlesinger, Caritas Christi Health Care System; and Lawrence McManus, St. Joseph’s Hospital &Medical Center.
THE MASSACHUSETTS - RHODE ISLAND CHAPTER OF HFMAGRATEFULLY ACKNOWLEDGES THE 2007-2008 HFMA CORPORATE SPONSORSPLATINUMBank of America Beecher Carlson Healthcare Besler ConsultingBlue Cross Blue Shield of Massachusetts Deloitte & Touche LLPFeeley & Driscoll P.C. Harvard Pilgrim Health Care HBCSKPMG LLP PricewaterhouseCoopers Siemens Medical Solutions, USA, Inc.GOLDNixon Peabody LLP Physicians Insurance Agency of Massachusetts (PIAM)Ropes & Gray LLP TriNet Healthcare Consultants, Inc.SILVERBalanced Healthcare Receivables, LLC CareMedic Systems, Inc. Foley & Lardner LLPGragil Associates, Inc. Healthcare Financial, Inc. Kaufman, Hall & AssociatesMedAssist Medical Bureau/ROI Phillips, DiPisa & AssociatesPublic Financial Management, Inc. Specialized Receivables, Inc.BRONZEAction Collection Agencies, Inc. Citizens Bank Health Management Associates, Inc.Hewlett-Packard Financial Services LighthouseMD, Inc. Marcam AssociatesMedAptus, Inc. Noblis Center for Health Innovation Passport Health CommunicationsPowerHealth Solutions Sovereign Bank The SSI Group, Inc. TPMS, Inc.I need lawyers who areleaders in my industry,not followers.www.nixonpeabody.comNixon Peabody LLP · 100 Summer Street · Boston, MA · 617-345-1000The person in this ad is an actor depicting a fictional scene.Bank of AmericaBeecher Carlson HealthcareBesler ConsultingBlue Cross Blue Shield of MassachusettsDeloitte & ToucheFeeley & Driscoll, P.C.Foley & LardnerHarvard Pilgrim Health CareHBCSHealthcare Financial, Inc.KPMG LLPMedAssistMedical BureauNixon Peabody, LLPPhillips, DiPisa & AssociatesPhysician Ins. Agency of MassachusettsPricewaterhouseCoopersPublic Financial Management, Inc.Ropes & Gray, LLPSiemens Medical Solutions, USA, Inc.TriNet Healthcare Consultants, Inc.11947191327172514151824220102330122122
2008 - 2009Volume XXXVNumber 6July 2008OFFICERS & DIRECTORSPRESIDENTHEALTHCARE FINANCIAL MANAGEMENT ASSOCIATIONMANAGED CAREMarvin Berkowitz, FHFMAPRESIDENT ELECTGerard VittiSECRETARYMichael Connelly, CPA The Devil is in the Details.7The 2008 Form 990 Instructions. – By: Jeanne M. Schuster IMMEDIATE PAST PRESIDENTKathleen MaherPresident’s Message .6Another Successful Year for the Massachusetts-Rhode Island Chapter of the HFMA.TREASURERJeﬀrey, Dykens, CPAReigning In The Healthcare Cost Trend.4Pictures and Synopsis of the Managed Care Meeting Held on June 20, 2008.Current and Future Issues Affecting Graduate andUndergraduate Medical Education.8Pictures and Synopsis of the Research and Education Meeting Held on May 16, 2008. Draconian Cost-Control Measures:.13The Inevitable Response to Failed Market Forces? – By: Leanne BergeDIRECTORSRoger Boucher Frank Byrne, CPADennis Chalke William Grigg, FHFMA, CPATim Hogan, CHFPKathleen Kenny, CPAGerard O’Neill, FHFMAMarc Proto, FHFMA, MBARosemary RottyJeanne SchusterJ. Mark WaxmanDeborah Wilson, CPAThe Self Insurance Decision.,,.25More Employers are Choosing to Self Insure Their Employees Health Insurance.– By: Linda J. Guerra and Margaret J. MeehanDavid Dillon, FHFMA, CPAAnne FarmerOutsourcing an EMR System.17Service Level Agreements and Other Contractual Concepts You Need to Know to Reduce Your Risk.– By: Allen P. Weeks Annual Social & Awards Night.28Pictures and Synopsis of Annual Social & Awards Night of May 28, 2008 Second Annual Golf Tournament.32Pictures and Synopsis of Golf Tournament Held at Agawam Hunt Club on June 3, 2008 A New One Day HFMA Program:.34Health Care Finance For Not-For-Proﬁt Board Members Welcome New Members .35HFMA Massachusetts-Rhode Island List of New Members from June 1, 2008 to June 30, 2008 Calendar Of Events .36HFMA Massachusetts-Rhode Island Chapter Event Schedule, 2008-2009Roberta ZysmanNe wsletter CommitteRoberta Zysman, Executive DirectorBeth Israel Deaconess Physician Organization, LLC1135 Tremont Street, Ren-8Boston, MA 02120MASS MEDIA is a publication of the Massachusetts - Rhode Isand Chapter of the Healthcare Financial Management Association devoted to keeping membership currenton national & local healthcare ﬁnancial topics. Opinions and views expressed in the articles and features of the publication are those of the author(s) and do not necessarilyreﬂect the position of the Massachusetts-Rhode Island Chapter or The National Chapter of Healthcare Financial Management Association. Articles submitted are subjectto editorial changes made by the committee. Article submissions, comments and requests for further information and advertising rates may be forwarded to:Roberta Zysman, Executive Director Beth Israel Deaconess Physician Organization, LLC -1135 Tremont Street, Ren-8, Boston, MA 02120.
Reigning in the Healthcare Cost Trend:Is Massachusetts up for the Challenge? Are you?(continued from page 5)June 20, 2008Well over 200 people attended an educationalsession, “Reigning in the Healthcare Cost Trend:Is Massachusetts up for the Challenge? Areyou?”, developed by the Chapter’s Managed CareCommittee. Program Coordinators for this year’sevent were John Minichiello of Health AllianceWith Physicians, Inc. and Richard Wichmann ofPricewaterhouseCoopers, LLP, assisted by theother member volunteers of the Managed CareCommittee.The healthcare cost trend is of critical concern inMassachusetts. The educational program promoted discussion on initiatives and strategies directed at the balance of cost containment with serviceaccess and quality improvement. The subjectswere timely and the speakers offered unique andvarying viewpoints on these complex issues. 2005 BESLER CONSULTING. ALL RIGHTS RESERVED.A thorough federal and local legislative market update, given by Alexandra Calcagno andBob Gibbons, kicked off the morning. Subsequentmorning presentation topics included “The Commonwealth Responds to the Pressures to ContainHealthcare Costs” with speakers Melissa Boudreault, Katharine London, and Dr. Marylou Buyse,and “BCBSMA’s Alternative Quality Contract” withBlue Cross Blue Shield of Massachusetts Senior VicePresident for Health Care Management, PatrickGilligan. The middle of the day featured a luncheonand presentation from Guy D’Andrea who spokeabout the return on investment of pay for performance provider contracts. Wrapping up the daywas a lively panel discussion moderated by NancyTurnbull entitled “Is Massachusetts Doing EnoughTo Contain Healthcare Costs?”. Panelists includedAlan Hinkle, MD, Rich Parker, MD, John Chessare,MD, Delia Vetter, and Mark Hulse. A drawing forRed Sox tickets courtesy of PricewaterhouseCoopers, LLP ended the informative and enjoyable day.Boston Now HasBreadth DepthThe healthcare landscape in Boston has changed — itnow has the Breadth Depth of BESLER Consulting, oneof the nation’s leading healthcare financial andoperational consulting firms. That means access to abreadth of services from BESLER Consulting, plus thedepth of seasoned professionals.William A. Wheeler, director of BESLER Consulting Boston,not only understands, but effectively deals withhealthcare issues that are relevant to the Boston area.With over 30 years experience, Bill brings Boston anunparalleled expertise in Medicare reimbursement issues,including graduate medical education, provider basedentities and hospital prospective payment systems.Cathi Mosca, revenue cycle senior manager in BESLERConsulting Boston, brings over 20 years of revenue cycleexpertise. In the Massachusetts healthcare industry, Cathiis an expert in process improvement with wide-spreadexperience in claims processing and accounts receivablesystems. Cathi is currently serving as the president of theMassachusetts Association of Patient AccountManagement (MAPAM).Designed to meet the needs of today’s healthcareexecutive, the Breadth Depth of the BESLER Consultingprofessional team is far reaching.To find out how BESLER Consulting Boston can help yourorganization, please call 781.353.6419 today!One Adams Place859 Willard Street, Suite 400Quincy, Massachusetts 02169phone 781.353.6419fax 781.353.6499www.beslerconsulting.com
MANAGED CAREThe wonderful registration volunteers!Rosemary Rotty receives her CHFP certificate fromChapter President Marvin Berkowitz.Managed Care Co-ChairsJohn Minichiello (left)and Richard Wichmann(right) with speakersMelissa Boudreault andKatherine London.Afternoon panelists: Rich Parker, MD, Nancy Turnball (moderator), Allen Hinkle, MD, Delia Vetter, John Chessare,IssueMD,6 and Mark Hulse.5
MANAGED CAREAs I begin my year as President of the Massachusetts-Rhode Island HFMA chapter I want to expressmy gratitude to my predecessor Kathleen Maher for the Chapter’s achievements and successesduring the 2007-2008 year. The quality of the chapter’s educational programs was evidenced bythe high attendance and the positive feedback submitted in our program surveys. Recognition of thechapter’s successes also came from HFMA National through 2 awards made at this year’s AnnualNational Institute (ANI): membership growth and retention and for excellence in certiﬁcation.I also want to acknowledge the great contributions made to the chapter by Jim Heffernan, Immediate Past President of the chapter as he leaves the Board of Directors where he has served with greatdistinction since 1997. Jim provided visionary leadership in guiding the chapter through the consolidation with the RhodeIsland chapter and the corporate reorganization of the chapter. The overall quality of the chapter improved greatly underJim’s leadership.The chapter also beneﬁted from the involvement of the following directors who departed the board at the end of the 20072008 year: Joe Capezza, Rich Silveria, Rick Markello, Phil Geissinger and Bob DeVey. I thank them for their contributions and wish them well in their future endeavors.I also want to welcome the new directors who have joined the board for the 2008-2009 year: Dennis Chalke, David Dillon,Tim Hogan and Rosemary Rotty. I look forward to working with them on several new program initiatives during the yearahead.The HFMA National theme for this year is “Making Connections”. Certainly the chapter’s educational and social networking activities offer numerous opportunities for our members to make new as well as strengthen existing connectionswithin HFMA. Taking advantage of HFMA activities will also promote connections beyond HFMA to other individuals andhealth care organizations that will beneﬁt members in their career.Upcoming social activities include the annual golf tournament on August 7 in Juniper Hill Golf Club in NorthboroughMassachusetts. Previous tournaments have attracted more than 200 attendees and have been very enjoyable events.The chapter’s corporate sponsors provide great support to HFMA activities and are an integral part of the chapter’s success over the years. I want to thank our sponsors for their continued support. Our sponsors will be individually acknowledged during the August golf tournament. New sponsors for the 2008-2009 year will also be acknowledged in the nextissue of Mass Media due out in October.On September 19 our educational programs resume with the “New To Healthcare” program at Simmons College. Thisprogram provides an excellent orientation to health care ﬁnance for individuals within your organization who are new tothe world of health care.I want to encourage all members to attend this year’s educational programs and to promote these programs through participation on one of the educational committees. I personally discovered that the beneﬁts of HFMA membership increasedsigniﬁcantly when I joined a committee. Committees play a major role through organization of educational programsas well as through the submission of articles to the Mass Media journal. Chapter committees cover a wide range of issues and I encourage you to consider joining one of the committees. I also encourage committees to submit two or morearticles on the topics they address this year to Mass Media. The combination of programs and Mass Media articles ensurethat educational material is widely disseminated to our members.Thank you to all of the chapter’s members for their ongoing support. Again I look forward to meeting and working withyou during the year ahead. Please reference the chapter’s website at www.masshfma.org for additional information.Please also feel free to direct any questions and concerns to my attention at firstname.lastname@example.org.Regards,Marvin BerkowitzPresident, HFMA Massachusetts-Rhode Island Chapter
MANAGED CAREThe Devil is in the Details –the 2008 Form 990 InstructionsBy: Jeanne M. Schuster, Executive DirectorErnst & Young LLPThey say the “Devil is in the Details”1 and with theinstructions to the “new” Form 990,2 they reallymean it. First, there is a substantial amount of“details” – over 300 pages to the instructions. Itmight be the perfect solution for insomnia.A few of the surprises: the deﬁnition of “key” employees,3 another complex deﬁnition for determining who is an “independent” board member,4 and,some ﬂexibility in disclosing your organization’sFIN 48 footnote.5Deﬁnition of “Key” EmployeeIn the “old” Form 990, the ﬁling organization wasrequired to provide compensation information forthe organization’s trustees, ofﬁcers and “key” em-Issue 6ployees. “Key” employees were individuals withresponsibilities similar to an ofﬁcer, but, withoutthe title of “ofﬁcer.” For example, an organization may not have a Chief Financial Ofﬁcer. If thejob duties of the Senior Vice President of Financewere similar to those of a Chief Financial Ofﬁcer,the Senior Vice President of Finance would beconsidered a “key” employee and the compensation of the Senior Vice President of Finance wouldneed to be disclosed. The “old” Form 990 wentbeyond the “C” suite of ofﬁcers (CEO, COO, and,CFO). It considered individuals with control overthe organization’s activities or ﬁnances to be “key”employees. So, many healthcare organizationsneeded to evaluate whether other individuals, suchas the head of the medical staff, the top facilities(continued on page 10)7
Current and Future Issues Affecting GraduateSpeaker and program coordinator,Chris Francazio.Michael Rosenblatt, MD, spoke on the future ofundergraduate medical education, and the resulting considerations for academic medical centers.Research &EducationCommitteeCo-Chair,Joel Gardinerof Deloitte& Touche LLP,with speakerTerence Flotte,MD, andLisa Beittel,Associate toDr. Flotte.8Mass Media
and UndergradUndergraduate Medical EducationMay 16, 2008Members and non-members gathered on Maymetrics. In addition, attendees received the16th at the Doubletree in Westborough, Massa-“inside scoop” from the American Associationchusetts for Current and Future Issues Affectingof Medical Colleges.Graduate and Undergraduate Medical Education,The Research & Education Committee woulda program presented by the Research & Educa-like to thank the days’ esteemed speakers:tion Committee. This half day program helpedKaren Fisher, JD, American Association ofattendees gain a perspective on what is happen-Medical Colleges; Michael Rosenblatt, MD,ing with undergraduate medical education andTufts University School of Medicine; Ter-potential impacts on Graduate Medical Educa-ence Flotte, MD, University of Massachusettstion in the future. The program offered manySchool of Medicine; Kip Perlstein; Deloitteinsights on the latest regulatory trends and theirConsulting; Chris Francazio, Hinckley, Al-associated impacts, the impact of regulatorylen & Snyder; and J. Mark Waxman, Foley &issues on operations and finances, and leadingLardner. Their presentations and insight madepractice financial measurement approaches tofor a wonderful program. GME financial measurement and performanceThereʼs a Word That Describes WhatBeecher Carlson is Doing for Healthcare Risks. (continued on page 9) Issue 67
MANAGED CARE(continued from page 7)person, the person in charge of Information Technology, and, the leader of nursing, were “key”employees. The old deﬁnition worked just ﬁne formost healthcare entities.The draft Instructions to the new 2008 Form 990released on April 7, 2008 deﬁne “key” employeesas persons with overall responsibilities for the organization as a whole, as well as certain personswho manage or have authority to control 5%or more of the organization’s activities, assets,income, expenses, capital expenditures, operating budget, or compensation for employees ifthe individual’s compensation exceeds 150,000(Emphasis added).6 As an example of the devil inthe details, there is a potential inconsistency in thedeﬁnition of “key” employee. While the Highlightsto the Instructions state that “key” employees arethose who control “more than 5%,” Part VII of theInstructions states that “key” employees are thosewho control “5% or more.”7Financial Protectionfor Health Care ProfessionalsInsurance Medical Malpractice Business & Workers Compensation Health Insurance ProgramsFinancial Services Discounted Group Disability & Life New Physicians Retirement Program Deferred CompensationMedical Services Office SuppliesLaundry ServicesCommercial LendingEHR Financing800.522.7426www.piam.coma subsidiary of theMassachusetts Medical SocietyNow, 990 ﬁlers will need to review numerous additional job descriptions in light of the new, moreexpansive deﬁnition. While the 150,000 threshold for compensation should assist in narrowingthe positions to be reported and evaluated, we allknow that threshold amounts in the Form 990 arenot necessarily inﬂation adjusted, or adjusted oftenenough to keep pace with economic changes. So,while 150,000 sounds like a fairly large amounttoday – who knows whether 150,000 will be theequivalent of 50,000 in another decade.Complex Deﬁnition of an “Independent”Board MemberIn two separate places, the new form requires theﬁling organization to state the number of “independent” voting members of the governing body. Atrustee is ‘independent” according to the Instructions released on April 7, 2008 only if four factorsare met throughout the tax year:1. The individual is not compensated as an ofﬁceror other employee (with an exception for thosewho are part of a religious organization andhave taken a vow of poverty).2. The individual did not receive total compensation exceeding 10,000 from the ﬁling entityor from related organizations as an independent contractor. However, total compensationdoes not include expense reimbursements.3. The individual did not receive “materialﬁnancial beneﬁts” from the organization or arelated organization. A transaction in excess of 50,000 is automatically a material ﬁnancialbeneﬁt.4. The individual does not have a family member that received compensation or other material ﬁnancial beneﬁts from the organization ora related organization.In addition, an individual will not lack independence solely because the individual is a majorcontributor (i.e. donor) to the ﬁling organization.And, any beneﬁts received in the ordinary courseof the organization performing its exempt purposeare excluded.One difﬁculty of the above test is the deﬁnition(continued on page 11)10Mass Media
MANAGED CARE(continued from page 19) support services. Except for this outsourcedportion of the EMR System, the use of, andaccess to, the rest of the EMR System that remains on the Buyer’s site would be expected tobe the same as with an On-Site EMR System.To the extent that any component other thanthe EMR software is in the possession of theVendor, the structure will be moving towardsthe below-described ASP Services model.tion that is necessary to support the portion ofthe Buyer’s healthcare services that is managedby the EMR System; and all of those components of the EMR System will be under theVendor’s control and accessed electronicallyby end-users in the Buyer’s ofﬁces. (Of course,the Buyer’s end-users will exert some controlover the data processing and related activitiesvia that remote access.)ASP Services: When the Buyer obtains theVendor’s services via an ASP Services model,the responsibility for the operation and maintenance of virtually all of components of theEMR System actually or ﬁguratively will betransferred to the site of the ASP Services Vendor. That transfer will include the EMR software and other associated software, telecommunications equipment and servers, patientrecords and any other associated data/informa-In contrast to Hosting Services, in an ASPServices model, the Buyer is only purchasingservices from the Vendor. As a consequence,the software components of the EMR Systemdo not necessarily have to be licensed to theBuyer, because the software neither resides atthe Buyer’s facility nor is under the Buyer’scontrol. The exception to that licensing situation occurs when a “client” component of theEMR software, which enables the Buyer tocommunicate with the Outsourced EMR System, is distributed to the Buyer. In that case,use of the client software will be governed bya software license that probably will have tobe agreed to by each end-user in the Buyer’sorganization before the EMR software can beaccessed by an end-user. However, generallysome type of license that establishes the conditions for on-line access to the EMR software isassociated with the ASP Services model.Search resultsPhillips DiPisa style.IT Contract Terms that are uniquelyApplicable to Outsourcing TransactionsIn healthcare executive search, it's all about you.Your team. Your culture. Your choice of just theright executive. Our focus on you is why youshould look to us for your next search. Call DanPhillips or Ralph DiPisa today.(781) 740-9699www.PhillipsDiPisa.com20The contractual provisions discussedbelow address the fact that the responsibility forcertain elements of the Buyer’s EMR System andits related IT operations are no longer operated orcontrolled by the Buyer. In essence, these provisions describe the procedures that apply to the legal and operational relationship established by theBuyer and Vendor and, in addition, allocate various obligations and liabilities between the parties.It also is true that in many respects, an outsourcingrelationship more closely resembles a partnershipthan a typical vendor/buyer relationship, which(continued on page 21)Mass Media
MANAGED CARE(continued from page 20)may affect how the resulting relationship ismanaged.An example of how this different relationship isreﬂected in an outsourcing contract is demonstrated by the differences between the productwarranty usually offered by a software vendor andthe services warranty of an outsourcing servicesprovider. When software is licensed directly toan end-user, the license generally states that thesoftware will function in substantial conformitywith the product’s speciﬁcations or descriptiveliterature. If the software does not function as warranted, the accompanying remedy of repair/replacewill only be available to the licensee for a statedperiod of time, e.g., ninety (90) days, after deliveryof the software.While there may be speciﬁc performance obligations placed on a provider of outsourced services,as further discussed below, a vendor’s warrantyfor the performance of its services is less speciﬁcand is based on the application of a negligencestandard to the services. However, the outsourcingvendor’s services warranty will be in effect for theentire period during which the services are provided, not just the ﬁrst ninety (90) days of the EMRsoftware’s operation.The following discussion is about the speciﬁc provisions that mostly are found only in contracts foroutsourced services. As a result of that limitation,this article will not address, e.g., conﬁdentiality,indemnities for a third party’s claims of infringement of its Intellectual Property rights, choice oflaw or other like provisions that routinely wouldbe part of any IT transaction. Each of the belowcontract provisions is applicable in varying degrees to both Hosting Services and ASP Services. Ownership of Buyer’s Data: If the Buyer’s orits patients’ data or information (collectively,(continued on page 22)Issue 621
M ANAGEDC ARE(continued from page 21) customizeservicesto betterorassistthe opera“Data”), CMHCalso redesignedthe budgettectedby lawsand regulations(e.g., HIPAA),processlink thethe Vendordevelopmentof thebudgetresidestowithor a thirdpartyhiredmorecloselywiththeorganizationby theVendor,outsourcingstrategy.contract Tomustgether,Financeworkedtoprovidethat (i)andtheoperationsData is theleaderspropertyofdefinethe financialexpectedthe Buyer;(ii) the skillsVendoracquiresofnomanagers.ownerFinally,the managers’bonusprogramship rightsin that Dataor anyoutputwasfromrevisedtheto Vendor’sprovide aservicessystem ofthatincentivesincludes, foror isimprovedthe resultfinancialperformance.of, processingthat Data, unless that output alsoincludes the Vendor’s proprietary data; (iii)the Buyer has the right, which may have some conditions placed on it, to demand the returnIn ofCMHC’srealizingthe Dataexperience,within a timecertaintheandpotentialin a formof thatEnterprisePerformanceManagementrequiredis useable by the Buyer; and (iv) nation of the outsourcing relationship, tiof Data eitheris to beto thea yed, with an appropriate certiﬁcation bydeterminedtheregap betweeninthe Vendorthat wassucha destructionhasmakingoccurred. Meeting the Challenge of Change(for over 25 years) ADVISORS TO HEALTH CARE MANAGEMENT availableand puttingit to useto make formationSecurity:At a minimum,the Buyerneedstogoodbusinessdecisions.CMHCengagein aninvestigationthat concludedis sufﬁcienttheretoare assurethree essentialelementswhich an organizathe Buyerthat the toconﬁdentialityandtionsecuritymust attendwhen aimingto bydeployEnterobligationsimposedthe outsourcpriseingPerformancecontract andManagement.applicable Federal and Statelaws/regulationson anyData undercontrol First, create a singleversionof the ing a reliable Business IntelligenceVendor.The investigation also should proplatform.duce an understanding of the procedures that Second, develop a Performance Managementthe Vendor will employ to back-up and storesystem to focus operations leaders on aligningthe Data and any output from the outsourcedtheir efforts with key corporate strategies toservices, as well as the level of security thatimprove business performance. Use dashwill be applied by the Vendor to both the Databoards, scorecards and KPIs to provide usersand its other relevant obligations. Additionally,with all the information needed to make effecin today’s insecure environment, the process oftive decisions without being overwhelmed.obtaining and maintaining the appropriate level erformancedisaster contingenagementfrom theoryand potentialcyand urabledifferenceintheexecutionthe Vendor’s use of third parties to provide ofstrategyby addressingcriticalthird owledgeablepeople.Thebenefitof Entercan result in security gaps and other operaprise PerformanceManagementcan shouldonly bebetionalproblems. re in inconsulted regarding several of those mattersplacewhichassupportac-thisthisbullet,they areoperationsbeyond theleaders’scope ofcessanduseofthenewtools. Article.) Service Level Agreements (“SLA’s”): Asmentioned earlier, the warranty that the VendorAbout the Authorsis likely to provide for its outsourcing servicesShannonBanksunspeciﬁc,is ManagingbutPartnerof can closewill be hat gap by setting both standards for the Venwithto nceremediesif the Vendorbanksbellwether@gmail.comfails to meet those obligations. To be effective,however,the SLA’sincludea scheduleWayneBennettis Vi
The following Medal of Honor Award recipients were honored at the Annual Social and Awards Night on May 28th: Peter Leone, McDermott, Will & Emery; James Sulli
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
His awards include the Defense Superior Service Medal, Legion of Merit (2nd Award), Meritorious Service Medal (3rd Award), Navy-Marine Corps Commendation Medal (4th Award), Joint Service Achievement Medal, and Navy-Marine Corps Achieve-ment Medal (2nd Award). 11 Dr. Elaine Humphrey
improvised explosive devices are extremely dangerous assignments. During his service, Mr. Stone was awarded an Afghanistan Campaign Medal with Campaign Star, a National Defense Service Medal, a Global War on Terrorism Service Medal, an Army Service Ribbon, an Overseas Services Ribbon, an Armed Forces Reserve Medal with M Device, and a NATO Medal.