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“If airline travel were like health care, each pilot would be free to design his or her own preflight safety check, or not to perform one at all.”
This quote was taken from a recent Institute of Medicine (IOM) report detailing the inefficiencies of the U.S. healthcare system. The report pegs the cost of waste in health care at $765 billion annually, nearly a third of what we spend on health care, due to everything from excess administrative costs to missed prevention opportunities to inefficiently delivered services.
The IOM cites a number of ways to help curb waste. But before we can reduce it, we need to define it, and therein lies the problem: Because of the lack of detailed data, we haven’t been able to compare the effectiveness of different products and processes to identify waste. We are changing this situation.
Earlier this year, Premier set out to define and benchmark waste and inefficiency for the 2,700 hospitals and 90,000 other care sites that are members of the alliance. This effort began with combing through data amassed as a result of the organization’s work with its members, and resulted in identification of 15 common causes of waste, which were placed into four buckets:
A closer look at just one example, blood management, demonstrates the possible opportunities for savings.
Inefficient use of blood represented a significant opportunity in this “waste report”—evidence suggests that inefficient use of blood in large part due to unnecessary transfusions may account for as much $1.06 million per hospital, per year. Blood is used every two to three seconds to treat up to 4.5 million Americans a year with conditions ranging from cancer to organ transplants to accidents and trauma.
So it comes as no surprise that blood has become a scarce commodity: The national blood supply is at its lowest level in 15 years, due in part to an increase in the number of complex therapies requiring larger amounts of blood.
Knowing these big categories of waste and the dollars at stake is a good start, but it’s not enough. Hospitals need to implement practices to tackle waste in these areas while maintaining care quality. And some are already doing just that.
Using evidence. With its campaign to safely reduce unnecessary blood transfusions during heart surgery, Marriottsville, Md.-based Bon Secours Health System, Inc., is demonstrating that it is possible to efficiently and effectively manage blood supplies without sacrificing quality or safety.
Bon Secours has benchmarked its blood use, and associated costs, against that of other hospitals in the Premier database to identify areas for improvement. The health system then investigated the transfusion practices of 12 heart surgeons practicing at five of its hospitals in Virginia, New York, and South Carolina.
It found wide variations in the use of blood from surgeon to surgeon, due in part to the lack of strong evidence to support a specific best-practice approach. This finding raised a number of questions. For instance, why would a 35-year old heart surgery patient with no preexisting conditions need the same amount of blood as a patient who is 65 and suffers from hypertension and diabetes? And would that 35-year old in good health even need a transfusion at all?
Surgeons were instructed to study their practices and the outcomes they achieved to develop data-driven, evidence-based blood-transfusion guidelines. Four years after implementing these guidelines, the hospitals have reduced blood utilization by 65 percent, adverse events by 14 percent, and length of stay by 20 percent—and saved nearly $2 million.
Marlon Priest, MD, Bon Secours executive vice president and chief medical officer, summed it up well: “Judgment without the use of sound evidence becomes opinion. We have far too much information to allow (opinion) to carry the day.”
Identifying ICU waste. Florence, S.C.-based McLeod Health also used comparative data to identify overuse of intensive or critical care services and excessive length of stay in these units as significant sources of waste. McLeod took a proactive approach to avoid the added costs and potential complications posed by this area of waste.
The organization focused on identifying and managing patients who might be at risk for complications due to unplanned or critical care transfers. It enacted a “rover program,” in which ICU nurses rove throughout the hospital 24/7 seeking opportunities for early interventions to manage use of the ICU.
By working with the patients’ standard nurses, reviewing clinical data, providing critical care perspectives, and coordinating transfers to the ICU, the nurses’ work has helped McLeod to avoid an average of 75 unplanned critical care transfers a month, for annualized savings of $1.4 million.
These are just two examples of opportunities to achieve significant savings in health care by reducing waste. There are many more to find, and the road to improvement begins with detailed data and measurement. The industry needs to define benchmarks and measures that take both cost and quality into account to identify and act on opportunities.
Mike Alkire is COO, Premier healthcare alliance, Charlotte, N.C.
Publication Date: Tuesday, January 29, 2013
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
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.
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.
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.
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.
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.
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.
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