1. Enlist the support of clinical staff. The OR manager and staff are involved in clinical issues but they need to understand how care is paid for. “We want staff to understand that the contracts we are working under are not my numbers; they are really all of our numbers,” Mr. Witt says.
With this in mind, the OR manager and other clinical leaders meet quarterly with Mr. Witt and his staff to discuss financial issues and get a feel for them. For example, they learn to see that more volume is not necessarily a good thing for the hospital. Some orthopedics cases, such as total hip or knee replacements under Medicare, actually lose money for St. John. The OR manager has also learned to identify such cases and determine if the hospital can do in these situations.
2. Redirect cases to surgery hospitals. Mr. Witt says CHRISTUS St. John, a Catholic hospital, has no intention of denying medical care, but it does not want to be taken advantage of by surgeons who also use two physician-owned hospitals in the area. Some of these surgeons have only been performing their money-losing cases at St. John. “These cases should not be done at St. John,” Mr. Witt says.
Reviewing the upcoming OR schedule, the OR manager marks money-losing cases to be done by surgeons who perform only one or two cases a month at the St. John OR. “That’s a red flag because its obvious a surgeon does not do one or two cases a month,” Mr. Witt says. The OR manager tells the surgeon the case cannot be done at the hospital. “They end up doing that case over at the surgical hospital,” Mr. Witt says. Unfortunately, this does not stop the surgeon from doing this again in the future, so the OR director must continue to be vigilant.
3. Work with device company reps. One representative for an orthopedic device maker was not telling the hospital what implant his surgeon had chosen for surgery. The hospital needs to know because it has to control this cost. “If the hospital gets $1,500 for the surgery and the implant alone costs $1,200, that doesn’t make any sense for us,” Mr. Witt says.
Mr. Witt asked the rep for a price sheet in advance of surgery and the rep agreed, but he did not follow through. “I called him up and said, ‘That’s strike one,’ ” Mr. Witt says. “Two weeks later he did it again, and I called up his boss and said, ‘That’s strike two.’ ” Mr. Witt then met with the rep and said, “Look, the doctor likes your product, so this is purely a hospital issue. But if you do this one more time, you can’t come back here.” The rep changed his attitude. “He was a different person after that,” Mr Witt says.
Learn more about CHRISTUS St John Hospital.
