March 9, 2005
Reducing the variation in physician resource preference is vital to a hospital being able to control its costs. Key to reducing that variance is developing clinical care pathways that standardize major care activities and supply purchasing for common diagnoses and procedures. These strategies, however, require professionals with very different perspectives -- finance and clinical -- to work together in a largely unexplored area. The end result goes far beyond reducing supply chain costs; the ultimate aim is to improve outcomes and treatment efficiency.
HFMA brought together a group of healthcare finance and clinical executives last summer to explore how they bridge the communication gap to develop real-world solutions to their facilities’ challenges. The following is an excerpt of their discussion.
Q: How has the standardization of care affected physician satisfaction ratings within your organization?
We have a fair number of physicians who practice at St. Luke’s, and for them standard order sets are very convenient. If you’re admitting a patient with community-acquired pneumonia or congestive heart failure, having an order set available to you actually makes your practice much more efficient. So I’d say that they like them.
You can talk about standardization in several different ways. For instance, when it comes to pharmacy formulary: If you take a given drug type, like an ACE inhibitor -- which is a treatment for blood pressure -- there may be 20 of those on the market, but a given hospital may only have three or four available to the physician. So that actually causes the physicians to have to make a decision that’s somewhat limited with respect to the entire spectrum of drugs that are available to them if they were practicing in their offices. But I think that’s so common among hospitals that physicians adapt to that sort of thing. There’s another kind of standardization like, for instance, a Heparin protocol, where it’s very standard, and it’s done by the pharmacy, which again makes the physicians’ lives a lot easier. I think they like that. -- Michael Feltovich, MD, assistant medical director for St. Luke’s Episcopal Health System, Houston
We find that some of our physicians don’t like the protocols. They want to practice medicine the way they think they need to, and sometimes that is not consistent with our protocols. But then that physician gets a lot of attention. We have what we call a physician advisor who helps us with these kinds of issues, and he spends a lot of time with that physician; our CEO also spends a lot time with that physician. This is a new process for us. -- Philip Hacker, chief financial officer of Cleveland Regional Medical Center, Cleveland, Texas
It really started taking hold when we had some physician champions who stepped in and had not necessarily a strong financial background, but a real interest in looking at that part of the business. It’s amazing when you get three or four physicians in a performance improvement group or a quality management program -- they’ve challenged us in our ability to get and provide information. It’s forced us to be better at it. You can superficially bring in numbers and you can have length-of-stay drop by a day or two, but your costs have gone way out of line. Then you get a few doctors asking questions, so you’ve got to go back and really drill down below the numbers. It also forces your finance people to take on a whole new level of expertise. -- Clifford J. Bottoms, chief financial officer of the Harris County Hospital District, Houston
In terms of physicians’ willingness to participate in the process, it depends on whether or not they were involved at the start. It’s very important to get their buy-in; their input on the pathways, guidelines, and order sets; and their input into what’s being measured in the evaluations.
To get the physician to at least listen to you, it may be more effective to talk less about “standardization,” and more about “narrowing the variation of practice.” The art of medicine is not in having 500 ways of doing a single procedure; there might be five very acceptable ways that depend on the patient’s particular situation or the physician’s skill set, and you can pick one and still demonstrate your expertise. So the potential to decrease the variation of care using these methodologies can really get the physicians interested in participating. -- Thinh Tran, MD, medical director of clinical effectiveness for Methodist Hospital, Houston
SOURCE: Operationalizing Standards of Care: the CFO’s Role in Clinical Pathways, an HFMA Executive Roundtable, available through HFMA’s Resource Center
Additional Resources
- Key Financial Concepts Can Help Nonfinance Professionals Address Organizational Challenges, HFMA Wants You to Know, May 7, 2003
- Hospital Financial Management for the Non-Financial Manager, an HFMA on-site training course
- HFMA Executive Roundtable: Improving Performance with Clinical Service Lines
- HFMA Executive Roundtable: Improving OR Throughput: Real World Successes and Challenges
- Linking Supply Costs and Revenue: The Time Has Come
- Comprehensive Performance Management in the Operating Room
- More HFMA programs, articles, and tools on cost control
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble.
HFMA Wants You to Know ISSN: 1540-0697. Volume IV, Issue 5. Copyright 2005, Healthcare Financial Management Association. All rights