How 15 hospitals eliminated waste, gained efficiency and saved millions

Here are 15 hospitals and health systems that were able to save millions of dollars through partnerships, data gathering and new operational programs.

These hospitals are featured after responding to a public solicitation for case studies in how hospitals are saving money.

Becker's Hospital Review will continue to feature hospitals and health systems that are saving millions and improving care quality. If you'd like to recommend a hospital or health system for upcoming lists on savings, or questions/comments on this list, contact Laura Dyrda at ldyrda@beckershealthcare.com.

Athens (Ga.) Regional Health System. Athens Regional Health System partnered with Navigant Healthcare in 2014 to implement a health IT system that would improve its financial health. Before the partnership, the health system began using EMR, which created an internal crisis. Through the partnership, Athens Regional incorporated the analytics tool Vital Stats into their hospital's processes. The technology provides a concurrent evaluation of physician coding practices, collections, productivity and volume statistics. The team then used conceptual framework for predictability modeling and helped nursing understand the ongoing day-to-day challenges of patient demand and then supply of clinical labor to staff with sustainable cost-savings. The hospital achieved its goals of $30 million in annualized improvements by July 2015 and a cumulative balance sheet benefit of $6.6 million within one year of the project's inception.

Baptist Health South Florida (South Miami). Baptist Health was able to use Nuance's Clinical Documentation Improvement program across five hospitals in October 2011 to ensure codes were accurately reflecting the patients' illness severity. The program also provided a higher quality medical record and ensured correct reimbursement. The information from Nuance CDI also enabled surgeons to make adjustments to patient diagnoses sooner while the patient was still in the hospital. The documentation process improved along with the physician response and agreement rate. Baptist Health also employed international physicians as clinical documentation specialists to ensure the documentation was done correctly and train caregivers in documentation methods. The program drove improvements in Baptist Health's case mix index, physician engagement and reimbursement with a rapid return on investment. There was a 13 percent increase in CMI across the system, translating to $45 million in appropriate reimbursement over four years.

Bethesda Health (Boynton Beach, Fla.). Bethesda Health adopted the Care Logistics hub-and-spoke production system that connects and coordinates the patients and care activities. The model manages care activities and throughput across all patients and departments in the hospital by establishing daily status and length of stay management, designating clinical care coordinator roles and deploying the clinical care coordinator to lead the standard operating procedures and throughput milestones in all units. The hospital saved $10.9 million in annual financial benefits through decreased inpatient and observation length of stay, lower labor costs, increased volumes and fewer readmissions. The hub-and-spoke care model led to 50 percent improvement in patient satisfaction scores and reduced emergency department wait times by more than 75 percent.

Cancer Treatment Centers of America (Boca Raton, Fla.). This five-hospital network dedicated to cancer treatment relies on lean principles to make improvements to clinical care, outcomes and business performance. The hospital uses the Lean Daily Management System to implement improvement initiatives, such as their prescription delivery service expansion. The system received patient feedback that lines and wait times at the pharmacy were too long, so the team began delivering patient prescriptions throughout the system, leveraging existing software platforms. The patients now receive their medications while in the infusion center, inpatient rooms or other locations around each hospital in the system. The system also engaged in an operating room efficiency improvement program to update surgery scheduling. The system reviewed current processes and found workflow efficiencies using lean concepts to double utilization. On-time starts then increased nearly 20 percent from historical levels. From just these two examples of the hospitals' initiatives, the monetary gross in dollars and time saved reached more than $1 million.

Dignity Health (San Francisco). Dignity Health implemented a sepsis biosurveillance program as part of the health system's analytics-powered Big Data platform developed in partnership with SAS, a business analytics company. The program automated alerts into the health system's EHR to notify clinicians of sepsis so they can deliver protocols for patients who are in decline or showing symptoms of an infection. Dignity piloted the program at 16 facilities and monitored an average of 69,000 patients per month. The average mortality rate for sepsis patients decreased 7.25 percent and the severe sepsis to all sepsis ratio was reduced by 14.9 percent. The physicians also reported response time with sepsis bundle orders dropped 51 percent, from approximately 210 minutes at the start of the project to less than 120 minutes after implementation. The program is now at 31 Dignity Health hospitals. The system realized more than $1 million savings as a result of the program since it began in 2014.

Florida Hospital (Orlando). Florida Hospital rolled out Nuance's Clinical Documentation Improvement program in the summer of 2014 and finished expanding it to all eight affiliated hospitals by May 2015. The program guides teams through accurate clinical documentation. After implementation, Florida Hospital saw its case mix index improve from 1.59 basis points to 1.88 by fall of 2015. The CMI basis points at the hospital are worth around $2.5 million per year, which resulted in around $72.5 million appropriate reimbursement increase as one basis point is equal to 1/100 of 1 percent. The hospital also saw quality improvements with the more accurate documentation of disease acuity; it was able to reduce observed-to-expected mortality rates by 48 percent in less than a year. The physician response rates to CDI clarifications are 87 percent to 92 percent.

University of Texas MD Anderson Cancer Center (Houston). The University of Texas MD Anderson Cancer Center replaced multiple competitive systems with the Nuance Dragon Medical and Nuance PowerScribe 360 as part of an enterprisewide physician documentation improvement initiative. The voice recognition solution rollout was part of a larger EHR rollout of the Epic system. The implementation began in radiology in 2014 and improved turnaround time for all radiologists, who now self-edit instead of sending records for transcription. The rollout of Dragon medical continued to 1,200 physicians and 800 to 900 midlevel providers, saving MD Anderson $6 million in ongoing operating costs. The clinicians now are able to complete clinical documentation before each shift, which drove an increase in physician satisfaction and received an especially favorable reception from physicians who reported English was not their primary language.

Mercy Hospital Fort Smith (Ark.). This 336-bed acute care hospital engaged analyticsMD, a software designed for staffing optimization, patient flow and resource utilization to improve emergency department flow. The ED receives around 50,000 visits per year and analyticsMD helped to achieve a 30 percent decrease in "left without being seen" rate. The hospital also saw a 24 minute reduction in length of stay and a 20 percent reduction in door-to-door time. The ED was able to accommodate 1,900 additional visits per year after the workflow update and is projected to report $1.3 million in additional annual revenue and savings through the increased capacity and reduced length of stay.

Mercy Medical Center (Springfield, Mass.). This hospital saved $7.9 million in annual financial benefit through the CareConnect initiative that implemented a hub-and-spoke "production system" from CareLogistics for care delivery. Mercy Medical Center applied the same logistics principles of package delivery companies with care managed from a central hub. The method was able to reduce observational length of stay at the hospital from 1.51 days to 1.31 days, length of stay from 4.6 days to 3.7 days and reduce patient 30-day readmissions from 13 percent to 9.5 percent. The hospital also made a 50 percent improvement in patient satisfaction percentile ratings and won the 2015 Massachusetts Hospital Association Accountable Care Compass Award for Excellence in Operational Efficiency.

Palo Verde Hospital (Blythe, Calif.). This 51-bed hospital partnered with HFS Consultants in 2013 to boost finances and productivity. The hospital had been losing a substantial amount of money two years prior to the partnership and was on the brink of losing its accreditation. Palo Verde Hospital was expected to run out of money within four months, but after the HFS team stepped in with an operational assessment they were able to identify areas for improvement. At the time, Palo Verde Hospital's board of directors wasn't regularly provided financial information and had little experience in the healthcare industry; the medical staff had lost credibility with the administration and staff weren't adequately trained on billing for third-party payers or Medi/Cal. The hospital handed over revenue cycle payer contracting to HFS and contracted with a new ER physician group. The hospital's board hired a new CEO who had clinical operations and quality backgrounds to get the accreditation back on track. The two organizations also negotiated for physicians to voluntarily take on a 20 percent reduction in compensation. The hospital eventually built up a cash reserve of $5.1 million.

Piedmont Healthcare (Atlanta). Piedmont partnered with Novia Strategies, a national healthcare consulting firm, to develop a resource stewardship structure with the goal of saving a minimum of $21 million recurring annual non-labor savings; they exceeded that goal and eventually reported $35 million in annual recurring savings in non-labor costs. The Piedmont team examined 13 controllable expense categories and prioritized six for further review. The team reviewed more than 250 datasets and interviewed more than 100 leaders, clinicians and staff members, ultimately leading to 89 savings opportunities. The hospital implemented a non-labor cost-reduction program through a "culture of change" and developed partnerships with supply chain, finance and quality department leaders along with caregivers for the culture shift. The team also tackled supply utilization and used real-time monitoring to detect any issues after implementation.

Robert Wood Johnson University Hospital (New Brunswick, N.J.). Robert Wood Johnson University Hospital had been a longstanding user of Kronos, a workforce management solution, when it decided to implement the workforce analytics and mobile applications as well for more effective management and productivity. The hospital was able to reduce labor costs with the time and attendance application designed for the hospital environment. The solution helped managers make evidence-based staffing decisions, track labor back to clinical research, ensure adequate staffing during big events or incidents, address employee absenteeism and minimize unnecessary overtime, over staffing and inflating costs. The hospital realized $10 million savings by using the analytics platform.

St. Joseph's Hospital Health Center (Syracuse, N.Y.). St. Joseph's Hospital Health Center was able to save $11.6 million after implementing the Care Logistics hub-and-spoke production system. The model establishes daily status and length of stay management protocol, appoints a clinical care coordinator that leads the standard operating procedures and throughput milestones in all units. Hub-and-spoke production manages care activities across The model manages care activities and throughput across all patients and departments in the hospital by establishing daily status and length of stay management, establishing clinical care coordinator roles and deploying the clinical care coordinator to lead the standard operating procedures and throughput milestones in all units. The hospital was able to reduce the number of patients leaving without treatment by more than half and saw a steady decline in falls and other preventable harms measures.

University of Michigan Health System (Ann Arbor). The University of Michigan Health System's Fast Analytics team adopted tools from Tableau Software to solve complex problems surrounding revenue cycle and billing data. Their analysis identified more than $3 million in recovery audit contractor money. The Fast Analytics team was also able to eliminate more than 10,000 hours of work, which is the equivalent of around five full-time employees in a single fiscal year. The Fast Analytics team also used tools from Tableau Software and Epic to give physicians and administrators answers to their data questions sooner and eliminate bottlenecks in the information flow process.

Westchester Medical Center Health Network (Valhalla, N.Y.). Westchester Medical Center Health Network, which includes seven hospitals on five campuses, partnered with healthcare supply chain company ASP Global to generate savings. The health network was able to eliminate 20 stock-keeping units on the 100 product program — it was able to save $70,000 per year just by sourcing a new digital thermometer. The initial 20 products cut in 2013 generated an average savings of 32 percent; the program doubled in size the next year to 50 products cut that generated $1 million in savings on a $3 million spend. The system reached programmatic growth to 80 products cut in 2015, saving around $1.4 million on $4 million global spend, according to a report published in Becker's Hospital Review.

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