Finding Dollars in Unexpected Places: 4 Best Practices for Hospitals From Studer Group's Stephanie Baker

Hospital leaders seeking to improve the financial success of their facilities have two options: to increase revenue through higher volumes and more services or to decrease expenses by increasing efficiency and avoiding costs, says Stephanie Baker, RN, CEN, MBA, HCM, a coach with Studer Group, an outcomes-based healthcare consulting firm.

Ms. Baker shares the following four best practices for hospitals to help increase revenue and decrease expenses.

1. Hourly rounding on inpatients. Hourly rounding by nurses on inpatients can help reduce both falls and pressure ulcers, which can be costly to hospitals.

According to a study performed by Studer Group's Alliance for Healthcare Research —and published in American Journal of Nursing— hourly rounds can reduce patients' call light use by 38 percent, patient falls by 50 percent and pressure ulcers by 14 percent, while increasing patient satisfaction dramatically.

Studer Group estimates the cost of falls at $11,042, the Centers for Disease Control's national average at the time of the study. Thus, hospitals that are able to reduce falls may significantly improve the financial performance of their facilities. One hospital that Ms. Baker coaches saved $700,000 in seven months by reducing falls and pressure ulcers through hourly rounding.

So how should a hospital institute effective hourly rounds?

"Hourly rounding should be performed in a very prescriptive manner," says Ms. Baker "Nurses should check on all patients every hour and should complete any scheduled tasks for the patients during these rounds, since they're already in the room."

Ms. Baker recommends a protocol for hourly rounding that focuses on "the three P's" — pain, personal needs and positioning.

"The top three reasons patients use the call light is because they are in pain, they need to use the restroom or they need something that is out of their reach," says Ms. Baker. "The 'three P's' directly correlate to these patient needs."

In addition to the savings hourly rounds can provide to hospitals through cost avoidance, fewer call lights allow nursing staff to be more efficient by minimizing their interruptions. This improves employee satisfaction by giving nurses more control over their day.

2. Hourly rounding in the emergency department. Hourly rounding in the emergency department increases patient volume by decreasing the likelihood that patients will leave the department without being treated.

"If you have an emergency department where patients are in the waiting room for long periods of time without any information, they are more likely to leave," says Ms. Baker. "Some may think that it's only uninsured patients who are leaving the ED without being seen, but more than likely it's those that have insurance who are leaving since they have other choices."

At $400-$500 net revenue per patient, a 36,000 patient per year ED that reduces the left-without-being-seen rate by 4 percent through hourly rounding would yield an additional 1,440 patients per year, or $720,000 in captured net revenue.

Hourly rounds in the emergency department waiting room should focus on updating patients on wait times and status as well as on managing their pain. Rounds in the treatment area of the ED should include updating the patient on their plan of care and how long tests and labs will take.

"Hourly rounds in the emergency department absolutely create a better experience for patients, and a positive ED experience will spread through word of mouth in your community, improving your reputation and increasing your patient volume," says Ms. Baker. "Hourly rounding also reduces risk through lower litigation."

3. Pre-procedure and post-discharge phone calls to patients. Phone calls to patients with upcoming appointments or outpatient surgeries and post-discharge calls to inpatients can also positively impact hospital finances. By providing a reminder for the appointment, pre-procedure calls reduce the number of no-shows, yielding direct revenue gains, says Ms. Baker.

These calls are best completed 48 hours in advance of a patient's procedure, she says. By including the name of the provider that the patient will be seeing in the pre-call, providers establish a relationship between the patient and the caregiver even before the patient visit.

"If a call is made just 24 hours in advance, it's more difficult to fill slots by patients who want to reschedule," says Ms. Baker. "However, pre-procedure calls, done properly, will greatly reduce your patient no-show rate, which directly increases your revenue."

In fact, if a hospital pre-called 100 percent of its MRI patients and reduced no shows by three patients per day at $400 per patient, it directly increases revenue by $1,200 per day, or more than $400,000 per year.

Ms. Baker also recommends that hospitals perform post-visit phone calls for all inpatients that are discharged home. During these calls, hospital staff can confirm discharge instructions and ask questions about the patient's clinical status, which reduces patient anxiety and improves compliance with physician orders. By asking about patient concerns or complaints, leaders can make immediate changes to improve the patient experience immediately without waiting for survey results.

These calls can also reduce unscheduled readmissions. Since CMS does not reimburse for readmissions within 30 days for some chronic conditions, such as congestive heart failure, these calls can help hospitals avoid significant costs.

4. Peer interviewing. The activities associated with recruiting and replacing staff can be very costly, so strategies to reduce employee turnover are key to improving a hospital's financial picture. Selection strategies, such as peer interviewing, help ensure that the hospital is hiring the best candidate for the organization, which increases retention, Ms. Baker notes.

In the peer interviewing process, Studer Group recommends that candidates are first screened by the human resources department and then the department manager. The department manager then selects 2-3 candidates for each position, passing them along to a panel of 3-6 high-performing employees within the department. When selecting candidates to forward to the panel, it is important that manager only forward candidates that he or she would feel comfortable hiring. Using behavioral-based questions, these peers interview all candidates individually and then meet to decide on their preferred candidate.

"Peer interviewing requires a group of your top performers to agree and commit to the idea that this is the right person for your organization," says Ms. Baker "If you want to make good choices about hiring, peer interviewing is vital."

Hospitals also need to move quickly through their hiring process in order to attract the best candidates. "We recommend that leaders call and screen potential candidates within two business days of receiving their application," says Ms. Baker. "If you move slowly, you'll lose your best candidates to other institutions."

In addition to selection strategies, Studer Group recommends that hospitals interview new employees at both 30 and 90 days of employment to ensure early retention.

"There are a lot of risks in the first 90 days of employment," says Ms. Baker. "I recommend that all new employees have a formal sit down with their supervisors at 30 and 90 days. At 30 days, ask what is working well and who has been helpful to the employee. Find out about employee concerns and then discuss the employee's performance. At the 90-day mark, repeat these questions and also ask if the new employee knows anyone they might like to refer to the organization for employment."

Determining true financial impact
The best way to determine the true financial impact of these best practices is to use your organization's own real numbers, advises Ms. Baker.

"Since these numbers vary widely from one hospital to another and differ by geographic region, the most accurate measure of cost avoidance or higher revenue comes by calculating real costs in your own organization," she says.

Ms. Baker recommends that hospitals use their own data to determine the answers to questions such as: "What does a fall cost your organization," "how much does it cost you to recruit and train a new nurse" and "what is your cost for an MRI?"

"The best way to get buy-in from administration and staff is to present the data in a meaningful and timely manner," says Ms. Baker. "When you are trying to implement a change, showing a true return on investment will help get others on board so you can move organizational performance."

Contact Lindsey Dunn at lindsey@beckersasc.com.