Revenue Enhancement
Retooling hospitals, one data point at a time
Kaiser Health News staff writer Julie Appleby, working in collaboration with
USA Today, reports: "When a car rolls off an assembly line, the automaker knows exactly what parts, labor and facilities cost. Not so in health care, and now some health executives are trying to change that. Although U.S. hospitals account for the single largest chunk of the nation's $2.7 trillion in health spending, few of them can say how much it actually costs them to care for every patient they admit. ... Today, the [University of] Utah health system is one of a handful in the nation with a data system that can track cost and quality for every one of its 26,000 patients. That data is shared with doctors and nurses for further input about ways to streamline cost and improve care."
"In theory, {healthcare} it's an environment ripe for collusion and imposition of market power-driven price increases on consumers, insurers and employers, who can be taken for a ride by dominant insurers blithely passing along price increases. In theory, excessive market power also squelches innovation and makes it difficult for new entrants to enter the market. Yet there's no evidence any of that is taking place. In fact, healthcare delivery appears to be at the dawn of new era of innovation that's helping drive down both volume and prices."
According to The Synthesis Project, an ongoing national study by the Robert Wood Johnson Foundation, hospital consolidation generally results in higher prices and a decline in care quality. A second study in the project concludes that for-profit hospitals are more likely to focus on highly profitable services than nonprofit hospitals.
Virtually everybody, from CMS to veteran muckraker Steven Brill, argues that healthcare costs are too high- but which costs are they really talking about? It's often hard to tell. After cracking his dusty business school textbooks and making the rounds of his finance experts, Michael Koppenheffer can tell you for certain what the problem is: People are talking about no fewer than six different types of "costs." Michael Koppenheffer outlines these six types of costs in an infographic.
Dr. Dexter provides an innovative and practical approach to staffing and allocation of operating room (OR) time to reduce overall OR expense and reduce variability in late staffing. The presentation has links to an intensive course in OR management offered through the University of Iowa.
The Daily Rx summarizes on a study led by Jeremiah D. Schuur, M.D., an emergency medicine specialist at Brigham and Women's Hospital in Boston, to reduce excess utilization and costs in the Emergency Department.
This paper is a case study of work done at Parkland Memorial Hospital in Dallas, Texas, to improve interventional radiology throughput with the main objective of reducing patient wait times and avoiding costly capital investment.
One hospital was able to reduce patient charges by over $300,000 annually by reducing the frequency of amylase and lipase testing for ED patients with abdominal pain and other conditions.
There are two keys to successful cost-cutting in healthcare: the first - necessary but not sufficient - is to apply proven tools and tactics from industrial engineering, lean, Six Sigma, and business process re-engineering; the second is to align the initiative with the organization's mission and culture and engage clinical and administrative staff across the organization to collaborate in the process.
This post from the HBR Blog Network describes how Banner Health, one of the nation's largest health systems, did it.
Neil Goldfarb, the executive director of the Greater Philadelphia Business Coalition on Health, was a guest lecturer at the Temple University Fox School of Business Seminar Series. His presentation addressed the impact of value-based purchasing on healthcare providers and consumers.
In this presentation at the 2011 SHS Conference, Lynn Alters describes how a system-wide performance improvement initiative improved margins by 40 percent at WellStar Health System using internal resources and fostering an environment of trust and respect. In addition to the financial benefits, the initiative created stronger leaders and will soon exceed its initial goals by three-fold.
Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care. Examples of improvements cited in the Modern Medicine e-zine article were to redeploy two pharmacists to clinical roles, consolidate unit medications, and reduce batching of IV medications.
A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.
Discusses the increasing importance of case management in reducing costs and improving reimbursement in the current environment.
The Dartmouth Institute for Health Policy and Clinical Practice, TDI, has been selected to support a national collaboration aimed at reducing costs for high-volume, high-cost chronic and acute medical conditions that have high cost variation. Dartmouth-Hitchcock Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Intermountain Healthcare and the Mayo Clinic have teamed together to take on such things as knee-replacement surgery where there is up to 50 percent cost variation.
Many U.S. healthcare organizations are already being exposed to Recovery Audit Contractor (RAC) reviews of Medicare and Medicaid billing as well as other third-party payor audits to assure accurate and non-fraudulent billing. In response, the authors propose an analytical approach to efficiently evaluate the accuracy of billing.
A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year.
Provides a case study presentation using Six Sigma to improve denials management. The first three months of the project produced 1.6 million dollars in annualized savings at the 97-bed Stanly Regional Medical Center.
Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.
Management Engineering: What is it?
Management engineers may need money to implement healthcare improvement. This article outlines several potential funding sources.
Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.
Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.
An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.
A productivity monitoring system is installed and used to manage budget
A productivity monitoring system is installed and used for each department in the system to measure budget compliance, production efficiency, and patient satisfaction. Decisions must be made regarding the weighting factors of each input to determine each department's relative score.
A consulting group presented their throughput ideas, including reasons why some department-specific projects fail to realize proposed improvements.
All processes in an ED are redesigned, with multiple outcomes showing improvement.
A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by a MD who became a lean coach.
This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.
Issues with billing denials can be addressed by creating and addressing a Pareto chart of top reasons for lack of payment. This is analyzed through implementation.
Billing error reduction as a Lean Six Sigma project
A lean project is done with a general physician clinic and an outpatient pharmacy; results are discussed.
A program is proposed that effectively confronts a majority of the issues with scheduling patient surgeries.
The author facilitates a lean educational journey through an ED.
Two supply cost projects are described, analyzed, and discussed.
The authors present a tool for introducing lean across a system. Results from selected projects are discussed.
Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently underway.
Pressure Ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.
ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.
A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.
Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.