November 17, 2004
In this era of slim margins and surging demand for clinical effectiveness, efficiency, and safety, the biggest gains in improving overall business performance most often can be achieved through a multidimensional approach that addresses clinical, operational, and financial performance. To achieve this, providers must integrate data from these three domains to identify opportunity, measure performance change, and facilitate accountability.
A new HFMA educational supplement, sponsored by McKesson, outlines three key performance improvement strategies and discusses the role that integrated information systems play in these strategies. The following are examples of two healthcare providers' successful performance improvement initiatives.
Physician-Directed Performance Improvement
The physician-directed Clinical Effectiveness and Quality Improvement (CEQI) program at the University of Pennsylvania Health System prioritizes opportunities based on the organization's overall goal of maintaining the highest level of quality patient care while reducing wasteful resource utilization and unnecessarily long hospital stays. Because physicians direct a large percentage of all healthcare expenses, the fundamental design of CEQI was to create a program for clinical utilization management led and monitored by physicians with intensive support from nursing, case managers, social workers, and pharmacists.
Initiated in 1999, CEQI targeted FY00 savings of $4.3 million through managed care denial reductions, length-of-stay (LOS) reductions on care-related DRGs, diagnostic utilization reductions, appropriate utilization of pharmacy resources, and contract price enhancements.
By June 2004, CEQI was reporting more than $28 million of cumulative savings across the health system. One specific success story emerged from the neurosurgery department. This department was able to reduce the LOS of craniotomy cases from 8.9 days to 5.4 days and reduce denials, amounting to approximately $40,000 in monthly savings. The success was achieved, in part, by providing more intensive preoperative education and preparation of the patient and family. This enabled the department to safely eliminate a standard preoperative day for elective cases and optimize patient stays postoperatively.
Improving Treatment and Outcomes of Patients with Acute Myocardial Infarction
Middletown Regional Hospital (MRH), a 310-bed community hospital in southwestern Ohio, used performance improvement data and clinical practice guidelines to reduce variation in the treatment and outcomes of patients with acute myocardial infarction (AMI).
Following a study of national mortality data, MRH recognized the need to decrease the variation in treatment, outcomes, and LOS of its AMI patients. Among other specific care process improvements, MRH staff wanted to increase use of thrombolytics, which had been proven to have a significant positive impact on outcomes for AMI patients, and decrease the average "door-to-needle time" for their use.
Performance measures selected for this improvement initiative included:
- Total patients with AMI, receiving and not receiving thrombolytic therapy
- Door-to-needle median time for thrombolytic therapy
- Timeliness and use of aspirin and beta-blockers
- Mortality rate
- Morbidity and readmission rate
- LOS
- Cost-per-case
MRH developed and implemented a clinical pathway for AMI and tracked pathway use by physician, LOS on and off the pathway, and readmission rates by diagnosis and physician. Heparin protocols, which helped reduce variation in AMI outcomes, were included in the AMI clinical pathway. Physicians were integrally involved in the improvement initiative and kept informed of their progress on an individual and organization-wide basis.
The results? Following AMI guideline implementation:
- LOS decreased from 4.9 days to 3.3 days
- Average door-to-needle time for thrombolytics decreased from 84 minutes to 24 minutes
- AMI mortality rate decreased from 10.9 percent to 6.5 percent
Accountability, Opportunity, and Measurement
The complex interplay of business and clinical factors that drive the business of health care in the 21st century requires organizations to simultaneously assess and improve clinical, operational, and financial performance. The prerequisites are a culture of continuous improvement and accountability, identification of improvement opportunities, and use of appropriate measures as "actionable intelligence" to drive process improvement. The results: enhanced clinical outcomes, increased operational efficiency and effectiveness, and improved financial performance.
SOURCE:
Key Strategies for Sustained Performance Improvement, an HFMA educational supplement sponsored by McKesson and published in the November 2004 issue of hfm.
Additional Resources
- HFMA Roundtable: The Road to Better Care: Merging Financial and Clinical Pathways
- Executive Roundtable: Improving Performance with Clinical Service Lines
- Executive Roundtable: Operationalizing Standards of Care: The CFO's Role in Clinical Pathways
- Executive Roundtable: Improving OR Throughput: Real World Successes and Challenges
- Linking Supply Costs and Revenue: The Time Has Come
- Back to Basics: A Self-Help Approach to Achieving Financial Success
- Cost Control: Comprehensive Listing of HFMA Products and Services
- Coming in 2005: Watch the HFMA web site for tips on improving clinical, operational, and financial performance in cardiovascular surgery, orthopedic surgery, and aparoscopic cholecystectomy.
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 III, Issue 24. Copyright 2004, Healthcare Financial Management Association. All rights reserved.