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4 ways to unlock financial benefits for your bottom line

The financial challenges presented by value-based purchasing and other reimbursement changes have focused hospital CEOs’ attention on identifying additional ways to strengthen their bottom lines.

Analyzing hospital operations can reveal obvious, but often overlooked opportunities for cost savings, increased reimbursement and enhanced quality.

Reduce Percentage of Patients Who Leave Without Being Seen

One of the age-old challenges for hospital Emergency Departments has been the volume of patients who leave without being seen (LWBS). As the number of patients using the ED as their first site of care has increased, so have wait times. At the same time, patient satisfaction has decreased. The industry generally recognizes that the number of LWBS visits is an indicator of ED crowding and access-to-care issues. In many markets, the LWBS problem is getting worse. Nationally, it is estimated that 1% of patients who come to the ED eventually leave without being seen. That may not seem like much, but it represents hundreds of thousands of patients who are not receiving care and millions of dollars in lost revenue.

Recognizing that patient throughput is often at the heart of ED crowding and that it in turn contributes to extended wait times may spur hospitals to analyze work flow and implement technologies and enhanced processes that will put the right patient in the right setting of care at the right time. Collaboration and effective communication between the ED physician and the hospitalist are critical to reducing crowding, opening up access to ED services to all of those who come to the hospital for care. Having shared accountability to a single medical leader responsible for metrics in both hospital and emergency medicine is a proven method for creating stronger alignment between the departments, and with the hospital. In our group’s experience, we have seen instances of dramatic decreases in LWBS rates when these groups work in harmony.

Reduce Same-Day Cancellations in the Operating Room
Surgery is still a major revenue source for most acute-care hospitals, accounting for between 60 and 70 percent of total revenue in some facilities. That’s why many hospitals are focused on significantly reducing the number of same-day surgery cancellations. The costs to hospitals from these cancellations are steep, amounting to thousands of dollars per case. There are hidden fixed costs as well, including staffing and unused facilities and equipment. For an estimate of the impact on a particular facility, try a same day surgery cancellation calculator.

A Pre-Anesthesia Testing Clinic (PAT) managed by the anesthesia group has been effective at reducing same day surgery cancellations. The clinic process ensures that patients scheduled for surgery meet medical necessity standards, are pre-certified by their insurance carrier, have completed all recommended lab tests prior to the procedure and are stable enough for the procedure. A PAT clinic can significantly reduce cancellations, resulting in higher satisfaction for patients and surgeons as well as more efficient utilization of the surgical suite.

Improve Engagement With Community Resources
The models for reimbursing hospitals for care are clearly focused on enhanced collaboration and coordination with care partners who can assure continued high-quality care across the continuum. Identifying appropriate partners is one challenge. Making it as easy as possible for those partners to collaborate with the hospital is another.

Some hospitals are turning to outside experts for solutions. Mobile applications enable referring physicians to complete a direct admit to the hospital form and confirm a bed assignment, all with a few clicks on their smart phones or tablets. The result is a hassle-free experience for the referring physician and a hospital boarding pass for the patient. While this type of solution requires monetary investment in technology, the positive impact it has on productivity and smoothing processes creates financial rewards that are returned to the hospital many times over. Our experience has shown that hospitals using such a system become the preferred facility in the community, even among practices that are not otherwise strongly aligned with the system. The resulting market share gain can give the facility a lasting competitive advantage.

Develop a Trauma Program
When hospital CEOs hear trauma center, many see dollars flowing from the bottom line. The related expenses for facilities, equipment and staffing could easily outdistance reimbursement for the service line. But, completing the trauma designation or certification process changes all that, offering both operational and financial ripple effect benefits.

Partnering with an outside expert to help shepherd the hospital through the trauma start-up and certification or designation process is the first step for many hospitals embarking on the trauma journey.

There are several financial advantages related to achieving trauma center designation, including: disproportionate share funding, dollars flowing from portions of the Patient Protection and Affordable Care Act to fund trauma programs and the ability to bill for and collect certain trauma activation fees from government and private payers.

Perhaps even more important than these direct financial benefits are the ones resulting from the halo effect of trauma programs. Hospitals with trauma programs experience increased patient volume and throughput due to growing volume from emergency medical service (EMS) agencies. Once the trauma program has become established and EMS personnel develop positive perceptions and trust in the program’s capabilities, they will begin transporting not only trauma patients, but also additional non-traumatic patient injuries and illnesses to the hospital emergency department. As the hospital ED gets busier, so does the rest of the hospital. Beds fill more quickly with generally higher acuity patients. These patients typically use more hospital services such as imaging, laboratory and rehabilitation. General surgery and orthopedic referrals grow and surgery volumes increase.

Looking at current trouble spots in your hospital can often reveal new opportunities, especially once you recognize the innovative solutions that are now available to you. All of these approaches rely on alignment between the hospital administration and medical leadership. Working collaboratively with innovative partners moves the health system further, faster.


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