One day, Doug Johnson plans to write a book about opening a hospital. He'll have plenty to write about.
Presbyterian Healthcare Services' newest facility, Rust Medical Center, Rio Rancho, N.M.-a 92-bed, full-service hospital-opened Oct. 23, and Johnson played an integral role in the facility's planning and development as its clinical project manager.
In the past year, Johnson helped design and implement several leading-edge approaches at Rust Medical Center, including acuity-adaptable rooms that have reduced patient transfers and an electronic ICU that combines telemedicine, software, and 24/7 monitoring technology.
To help identify and test these novel approaches, Johnson developed an innovation lab-of which he is now director.
In a recent interview, Johnson discussed what the innovation lab does and offered advice to health system leaders on inspiring and implementing breakthrough improvements.
How was Rust Medical Center's first week in operation? Is there anything you would do differently?
Doug Johnson: Very emotional and exciting, yet stressful. We tried a soft opening: surgery on the first day, labor and delivery on the second day, and the emergency department on the third day. This was an effective approach to ease into care and allow staff to be comfortable.
The amount of volumes we had was more than we anticipated. For example, in our labor and delivery area, we had a lot of babies born the first week. Our first baby born was a Cesarean section, so we broke that area in real fast. We also anticipated having an average daily census in our six-bed ICU of two patients, and we quickly went to four.
In hindsight, there's probably a million things I'd do differently. Before we opened up, we did mock runs using a lot of our leaders as patients. I would have spent a little bit more time on these simulations with more resources, ensuring the processes we built were running as smoothly as we had hoped they would.
Can you explain what your hospital's innovation lab does?
Johnson: The innovation lab is a space within our facility that is set up for testing and trying new ideas and innovations that will be implemented across the health system.
I have six full-time employees who lead and create innovation projects. It's too soon to talk about the ideas we're working on now, but these won't be things like reducing the ED's left-without-being-seen rate from 3 percent to 2 percent. That's very specific, and the improvement is relatively small. We're looking for disruptive innovation, something that's huge-40 percent to 50 percent improvement.
The innovation lab has mobile walls so we can create spaces for brainstorming meetings and observation areas. In the observation areas, we can mock up patient rooms and design concepts that can be monitored. Everything in the lab is on wheels, so it can be moved and configured in any way quickly.
How is process improvement different from innovation?
Johnson: Process improvement is looking at what you already know how to do, and trying to make those processes better. For example, when our length of stay is too long and we want to reduce it, we identify the steps or tasks that are adding to our excess length of stay and we try to make those steps more efficient.
With innovation, we're trying to come up with completely different ways of doing things. We are not necessarily looking for the financial impact, although that's important. Our focus is on the customer experience. We want to create a great, healthy experience for patients.
Can you provide examples of your innovation approach?
Johnson: We spent a lot of time in our other facilities videotaping and conducting a work analysis on our nurses to see what they spend their time on. We found that between 30 percent and 40 percent of the time nurses are traveling, they're walking.
So we decentralized our nursing stations. For a 24-bed unit, we have 12 decentralized nursing stations. We have four medication rooms, which means that every six beds has one automated medication dispensing cabinet. We also decentralized to much smaller supply rooms, equipment rooms, and utility rooms. By decentralizing our nursing stations, we reduced the number of miles each of our nurses travels a year by about 150 miles. That's huge.
Another example is our acuity-adaptable rooms. We've made it so patients will never have to leave their rooms during their stays unless they require ICU-level care. Each room can be adjusted to match a patient's acuity, including the addition or removal of medical equipment. We also bring much of the care to the patient; for example, dialysis and gastrointestinal procedures are done at the bedside.
The patient rooms are separated into two sections. One is the worker area, where there is a sink for caregivers to wash their hands, a table where nurses or physicians can work on their charts, and a computer for the nurse to record vital data without disturbing the patient. The other side is our family zone, which has a sleeper sofa, a workstation for family members, and a wardrobe. We don't have visiting hours. We think family members are just as important in a patient's healing and caregiving as we are, so we want them here.
We also put patient lifts in every patient room to prevent back injuries for caregivers and to provide for the dignity of the patient. Instead of four or five people moving a patient from the bed to a chair, one person can do that using a patient lift.
Can you share one important lesson learned about creating a foundation of innovation?
Johnson: Culture is everything. Innovation is a word, but it happens through people.
We have intentionally designed our culture around our mission statement: "We are healthcare professionals who partner with our customers to create an exceptional healthcare experience through innovation."
To help our staff embrace our mission, we identified the competencies that we felt were important:
Then we pulled our employees together and asked them to help define these competencies. For example, for service orientation, we asked employees: What service principles do you feel are most important? How are you going to design what you do? How are you going to create the behavior standards around the culture that we are trying to create?
These 40 frontline employees who helped design the culture came up with these service principles:
Do you have any advice that you would give healthcare leaders who may be undertaking a major project, such as opening a hospital?
Johnson: I use one phrase a lot: "Just be a real human being." When we first started designing this hospital, staff would ask questions like, "How are we going to do this?" or "How did we mess this up?" I'd look across the room of and say, "OK, anyone in this room who has ever built a hospital before, please raise your hand," and there wasn't a single hand that went up.
We absolutely have to be humble about how we go about things. I don't think that sharing with employees your humility as a leader is a bad thing. I think sharing your weaknesses, empowering your staff to strengthen you, and taking advice from them are probably the most important things that you can do.
Interviewed for this article:
Doug Johnson is clinical project manager, Rust Medical Center, Rio Rancho, N.M., and director of innovation, Presbyterian Healthcare Services, Albuquerque, N.M. (firstname.lastname@example.org).
Ontario Systems: Maximizing Self Pay Collections
The Claro Group: Helping Hospitals and Healthcare Systems Improve the Bottom Line
Deloitte: Helping Organizations Navigate MACRA
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
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.