Atlantic General Hospital and Health System, Berlin, Md., and five other rural hospitals have developed a collaborative model for delivering intensive care unit (ICU) services using telemedicine technology. Called Maryland eCare, the model has helped Atlantic General reduce costs by $300,000 each year from shorter ICU length of stay (LOS) rates alone. More importantly, patients are 26 percent more likely to survive their stay in the hospital’s ICU.
In 2006, Atlantic General was struggling to maintain appropriate physician coverage in its ICU in the evenings and on weekends. That spurred the hospital to join Maryland eCare, a group of independent hospitals united by the same drive to improve quality and achieve cost savings in their ICUs. The project was funded by a $3 million grant from CareFirst Blue Cross Blue Shield of Maryland.
To roll out the collaborative model, the participating hospitals followed a series of steps.
Establish the legal structure. The six rural hospitals formed eCare as a limited liability company (LLC) so they could participate in joint contracting with the hospital operating the main telemedicine hub. Currently, the University of Maryland Medical System (UMMS), Baltimore, manages the hub and provides remote monitoring of ICU patients in the eCare hospitals.
Create an operational agreement. “The operating agreement sets the ground rules for the hospitals in the LLC,” says Michael Franklin, FACHE, president and CEO, Atlantic General. Specifically, this document spells out the leadership structure for the collaborative. Each member hospital has a seat on eCare’s board of directors and has voting rights that reflect the hospital’s number of monitored ICU beds, which range from four to 24.
The number of monitored beds also dictates how much each hospital contributes to the LLC for operating capital. Capitalization and operational costs not covered by the grant are the responsibility of each member hospital.
Additionally, the operating agreement creates the group purchasing model that allows member hospitals to receive a discount per monitored bed.
Develop a service agreement. The service agreement details the roles and responsibilities of UMMS as the hub operator and the six eCare hospitals as members. It also includes expectations for the vendor providing the telemedicine technology.
Franklin says the service agreement binds the member hospitals to create an environment that fosters collaboration and continuity through eCare. “Together, the eCare hospitals must maintain a minimum of 72 monitored beds to support University of Maryland’s capital costs so the service does not become a cost drag for that organization,” he says. “If a member pulls out of the LLC and we drop below 72 monitored beds, the beds we lose need to be covered by the other members. So it creates the incentive to keep us all working together and create a program that meets everyone’s needs.”
The service agreement also spells out the technical requirements that member hospitals must meet to ensure that the telemedicine monitoring equipment functions properly. The agreement also states that UMMS physicians working at the hub must be credentialed at each of the remote hospitals because they are prescribing patient care.
Educate staff, patients, and families. One of the early challenges that Atlantic General faced was allaying fears among the medical and nursing staffs that telemedicine would lead to reduced staffing and compromise patient care in the ICU.
“Fear is what prevents many people from using innovative technologies, but we believed that if staff could overcome their fears, they would see that this was the right thing to do for the patients,” says Colleen Wareing, MS, BSN, RN, NEA-BC, FACHE, vice president of patient care and CNO at Atlantic General. Early on, hospital leaders sought buy-in for telemedicine from the board of trustees and medical staff leadership, which helped ease some staff concerns. They also gave physicians the choice to opt their ICU patients out of remote monitoring early on.
Eventually, the fear lessened. “Staff members needed time to learn for themselves that telemedicine was truly an adjunct to the care they provided,” Wareing says. “We let them know that our objective was not to catch someone doing something wrong, but to add another layer of patient safety.”
Patients and families also needed reassurance and education, so the eCare hospitals created an educational brochure describing how ICU telemedicine can improve patient outcomes and reduce LOS. As more families experienced telemedicine, its acceptance grew throughout the community, Wareing says.
Analyze data and identify areas for performance improvement. As a member of the LLC, Atlantic General receives a quarterly report of its ICU quality indicators. Early data revealed that the hospital had an opportunity to reduce actual versus predicted deaths from sepsis. Predicted deaths are based on patients’ Acute Physiology and Chronic Health Evaluation II (APACHE) scores, which drive patient acuity measures.
To improve sepsis outcomes, Atlantic General adopted a sepsis management protocol from UMMS and rolled it out to its own medical staff. In just one quarter, the number of sepsis deaths dropped to less than predicted while the number of sepsis patients remained steady. The hospital also reduced the LOS for sepsis patients in the ICU.
In another data-driven performance improvement initiative, Atlantic General implemented a weaning protocol for patients on ventilators to reduce ICU ventilator days, another key quality metric. In just one quarter, they cut “vent days” from 35 percent greater than predicted to nearly the expected number.
Since joining the LLC, staff members at Atlantic General have improved their adherence to ICU best practices. As a result, the hospital has seen a significant reduction in complications and improved ICU outcomes.
Today, ICU patients are 26 percent more likely to survive the ICU. They also get discharged from the ICU 20 percent more quickly. Other outcomes include:
This reduction in ICU LOS translates to more than $350,000 in annual savings for the hospital, which is paid a fixed amount per admission according to Maryland’s all-payer rate setting system.
Atlantic General also has avoided an estimated $700,000 yearly cost to hire two additional intensivists to cover the ICU around the clock. Currently, the total cost of staffing 2.0 FTEs to cover the day shift seven days per week is $700,000, while telemedicine coverage on nights and weekends costs $228,000 annually. That translates to nearly $500,000 in savings each year.
“We’re basically getting full intensivist coverage at one-third of the cost,” Franklin says.
In the near future, Atlantic General and other eCare hospitals may use the existing telemedicine platform to treat stroke patients in their emergency departments, pending the finalization of state regulations.
With years of experience using telemedicine, leaders at Atlantic General believe their organization has learned how to gain the most from this type of collaboration. In particular, Franklin and Wareing credit eCare for providing a forum where they can share best practices that improve outcomes and reduce costs.
“Collaborating with other hospitals speeds up the learning time in our own location because we have more eyes on the same process or problem,” Franklin says. “This accelerates the performance improvement process, particularly our efforts focused on improving patient care.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Interviewed for this article: Michael Franklin, FACHE, president and CEO, Atlantic General Hospital and Health System, Berlin, Md.
Colleen Wareing, MS, BSN, RN, NEA-BC, FACHE, vice president of patient care and CNO, Atlantic General Hospital and Health System, Berlin, Md.
This article is based in part on a presentation at the Congress of the American College of Healthcare Executives in Chicago in March 2014.
ClearBalance: Boosting Patient Payment through Consumer-Friendly Loan Programs
Deloitte Consulting LLP: Employing Innovative Solutions to Optimize Revenue Cycle Performance
Grant Thornton LLP: Maintaining and Improving Collections During an EMR Implementation
KeyBank: Offering Expertise in Tax-Exempt Financing to Give Health Systems Flexible Options for Growth
Xtend Healthcare: Enabling Efficient Business Office Workflow
SSI: Bringing Patient Access to the Next Level
Deloitte: Helping Organizations Elevate the Healthcare Consumer Experience
TriMedx: Elevating and Streamlining Clinical Engineering
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.