Here are quality and cost cutting tips for hospitals.
1. Don't pay to insure non-existent assets. When a hospital purchases a new MRI or CT Scan, the old equipment, if disposed, must be removed from the hospital's books to reflect what the hospital currently maintains, not a cumulative record of the hospital's historical assets. When the records aren't updated, hospitals may be paying insurance on obsolete assets that don't even exist, says Michael Staunton, a Director at Principle Valuation. A thorough inventory is needed to identify obsolete items and remove them from the hospital's books to ensure they have the proper insurance coverage.
2. Build a patient safety culture from the top. It would be difficult to establish and maintain a patient safety culture if it did not start at the highest level of the healthcare organization, says Matthew Lambert, MD, senior vice president at the healthcare consulting firm Kaufman Hall and vice chair of the board of directors at Sisters of Charity of Leavenworth. Governing boards, directors and executive leadership must promote a culture of safety and make their commitment evident to the rest of the organization.
"[Healthcare leadership] has to let everyone know that the well-being of patients and the quality of care they receive is the organization's goal and reason for being," Dr. Lambert says. "It should be the first thing everyone thinks about when they come to work and the last thing they think about before going home. It's a tone set by leadership, not something you talk about once in a while."
Visibility to staff. As the old adage goes, executive leadership also must "walk the talk" in order to foster a patient safety culture at their respective healthcare organizations. Dr. Lambert says board members and executives must move from the meeting rooms to patient care units and connect directly with physicians, nurses and patients. Increasing visibility shows both staff members and patients that the leadership's commitment to patient safety does not stop in the board room or the C-suite.
Visibility to other leadership. Dr. Lambert adds leadership must convey its commitment to one another at regular board or management meetings by making quality and patient safety the very first topic on the agenda. This emphasizes that patient safety is the most important issue for discussion.
At Sisters of Charity of Leavenworth, quality/safety committee meetings always begin with a patient care story. "These patient stories, which can be good or bad, bring quality and safety to the board in real human terms," he says. "A member of the executive team delivers that patient story, which can represent a failure or success by the organization to delivery safe care. Everybody loves it, and it certainly makes the discussion much richer. In addition, the board chair and the system's CEO attend every meeting."
3. Hire and maintain competent staff members for improved quality. Maintaining staff competency goes hand in glove with updating credentialing and privileging. When there is an explosion of new equipment, techniques, drugs and disease protocol — as we see in healthcare today — it's important to keep staff training up-to-date on these changes.
"Unfortunately, when hospitals have to make cutbacks because of declining reimbursements or other budgetary issues, the first of these casualties is often education and training," says Joseph Cappiello, chief operating officer of Healthcare Facilities Accreditation Program. "You have to be cautious of eliminating education programs because it raises the issue of staff competency."
When staff members aren't comfortable or knowledgeable in new processes or protocols, the level of patient care suffers. Training staff members appropriately gives them the confidence to administer drugs or follow protocols that maximizes patient safety.
4. Manage the revenue cycle. The first line of attack for increasing revenue is managing the revenue cycle, as it plays a key role in the service line's finances. Service line leaders should examine the charge description master by procedure and CPT code to identify any CPT changes. For example, payors may discontinue a CPT code, bundle some procedures under one code or unbundle procedures, according to Marshall Maglothin, principal at Blue Oak Consulting and former cardiovascular service line manager at Cincinnati-based Mercy Health. Verifying these changes prevents claims denials and ensures payment to the service line.
Service line leaders should also compare each procedure's charge with current usual, customary and reasonable fee schedules. Using the UCR schedule as a reference can help avoid over- or under-charging for procedures. For example, the service line may not have updated its charge for a procedure that uses a new technology, while the UCR provides a higher payment for this technology. "I cannot overestimate the importance of taking a business perspective of what you're charging and what's involved," Mr. Maglothin says.
It is also important to compare volumes from the service line's procedure reports with those in the revenue reports to ensure they match. In one instance, Mr. Maglothin says EKGs were mistakenly being attributed to the radiology service line instead of the CV line. The service line director should communicate any necessary changes to staff to ensure everyone uses correct billing practices.
5. Outsource HR to deal with high staff turnover. Best practices across the board say that high staff turnover is bad for business because it takes time and energy to train employees, and losing their expertise is a drain on hospital resources, says Alex Rintoul, CEO of Medical Center of Elizabeth Place in Dayton, Ohio. There are several reasons why a surgical hospital might have high turnover rates, including low employee satisfaction and higher wages at competing facilities. To meet these challenges head-on, hospital CEOs must have a sophisticated HR professional who is able to work with employees and executives to keep the turnover rate low.
The HR professional from MedHQ that visits Mr. Rintoul's hospital every week is able to deal with these types of issues because he doesn't have to deal with the day-to-day payroll and benefits issues. "I had my services increased out of MedHQ's central office so that I could contract with MedHQ to have the seasoned HR professional that I couldn't afford every day to visit once per week and handle the challenging HR issues," says Mr. Rintoul. "As my needs changed and new problems developed, MedHQ worked with me to solve my immediate problems and then looked at how to plan going forward to meet potential new HR complications."
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1. Don't pay to insure non-existent assets. When a hospital purchases a new MRI or CT Scan, the old equipment, if disposed, must be removed from the hospital's books to reflect what the hospital currently maintains, not a cumulative record of the hospital's historical assets. When the records aren't updated, hospitals may be paying insurance on obsolete assets that don't even exist, says Michael Staunton, a Director at Principle Valuation. A thorough inventory is needed to identify obsolete items and remove them from the hospital's books to ensure they have the proper insurance coverage.
2. Build a patient safety culture from the top. It would be difficult to establish and maintain a patient safety culture if it did not start at the highest level of the healthcare organization, says Matthew Lambert, MD, senior vice president at the healthcare consulting firm Kaufman Hall and vice chair of the board of directors at Sisters of Charity of Leavenworth. Governing boards, directors and executive leadership must promote a culture of safety and make their commitment evident to the rest of the organization.
"[Healthcare leadership] has to let everyone know that the well-being of patients and the quality of care they receive is the organization's goal and reason for being," Dr. Lambert says. "It should be the first thing everyone thinks about when they come to work and the last thing they think about before going home. It's a tone set by leadership, not something you talk about once in a while."
Visibility to staff. As the old adage goes, executive leadership also must "walk the talk" in order to foster a patient safety culture at their respective healthcare organizations. Dr. Lambert says board members and executives must move from the meeting rooms to patient care units and connect directly with physicians, nurses and patients. Increasing visibility shows both staff members and patients that the leadership's commitment to patient safety does not stop in the board room or the C-suite.
Visibility to other leadership. Dr. Lambert adds leadership must convey its commitment to one another at regular board or management meetings by making quality and patient safety the very first topic on the agenda. This emphasizes that patient safety is the most important issue for discussion.
At Sisters of Charity of Leavenworth, quality/safety committee meetings always begin with a patient care story. "These patient stories, which can be good or bad, bring quality and safety to the board in real human terms," he says. "A member of the executive team delivers that patient story, which can represent a failure or success by the organization to delivery safe care. Everybody loves it, and it certainly makes the discussion much richer. In addition, the board chair and the system's CEO attend every meeting."
3. Hire and maintain competent staff members for improved quality. Maintaining staff competency goes hand in glove with updating credentialing and privileging. When there is an explosion of new equipment, techniques, drugs and disease protocol — as we see in healthcare today — it's important to keep staff training up-to-date on these changes.
"Unfortunately, when hospitals have to make cutbacks because of declining reimbursements or other budgetary issues, the first of these casualties is often education and training," says Joseph Cappiello, chief operating officer of Healthcare Facilities Accreditation Program. "You have to be cautious of eliminating education programs because it raises the issue of staff competency."
When staff members aren't comfortable or knowledgeable in new processes or protocols, the level of patient care suffers. Training staff members appropriately gives them the confidence to administer drugs or follow protocols that maximizes patient safety.
4. Manage the revenue cycle. The first line of attack for increasing revenue is managing the revenue cycle, as it plays a key role in the service line's finances. Service line leaders should examine the charge description master by procedure and CPT code to identify any CPT changes. For example, payors may discontinue a CPT code, bundle some procedures under one code or unbundle procedures, according to Marshall Maglothin, principal at Blue Oak Consulting and former cardiovascular service line manager at Cincinnati-based Mercy Health. Verifying these changes prevents claims denials and ensures payment to the service line.
Service line leaders should also compare each procedure's charge with current usual, customary and reasonable fee schedules. Using the UCR schedule as a reference can help avoid over- or under-charging for procedures. For example, the service line may not have updated its charge for a procedure that uses a new technology, while the UCR provides a higher payment for this technology. "I cannot overestimate the importance of taking a business perspective of what you're charging and what's involved," Mr. Maglothin says.
It is also important to compare volumes from the service line's procedure reports with those in the revenue reports to ensure they match. In one instance, Mr. Maglothin says EKGs were mistakenly being attributed to the radiology service line instead of the CV line. The service line director should communicate any necessary changes to staff to ensure everyone uses correct billing practices.
5. Outsource HR to deal with high staff turnover. Best practices across the board say that high staff turnover is bad for business because it takes time and energy to train employees, and losing their expertise is a drain on hospital resources, says Alex Rintoul, CEO of Medical Center of Elizabeth Place in Dayton, Ohio. There are several reasons why a surgical hospital might have high turnover rates, including low employee satisfaction and higher wages at competing facilities. To meet these challenges head-on, hospital CEOs must have a sophisticated HR professional who is able to work with employees and executives to keep the turnover rate low.
The HR professional from MedHQ that visits Mr. Rintoul's hospital every week is able to deal with these types of issues because he doesn't have to deal with the day-to-day payroll and benefits issues. "I had my services increased out of MedHQ's central office so that I could contract with MedHQ to have the seasoned HR professional that I couldn't afford every day to visit once per week and handle the challenging HR issues," says Mr. Rintoul. "As my needs changed and new problems developed, MedHQ worked with me to solve my immediate problems and then looked at how to plan going forward to meet potential new HR complications."
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