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  • Hospital Impact - Activity-based costing helps providers deliver high-quality, low-cost care
    of Healthcare Management by none other than Robert S Kaplan and Steven R Anderson who introduced the concept of ABC decades earlier More They stress that costs should be measured over the continuum of care and that isolating costs can not only lead to distortions but can paradoxically lead to higher costs Take for example a project recently led by Eugene Christian M D chief medical officer at Carolinas Medical Center in Charlotte North Carolina He was working with the total hip replacement unit that was using bupivacaine for continuous episodic femoral sciatic nerve blocks post operatively The project decided to try liposomal bupivacaine a longer acting version that had greater lipid penetration and cost significantly more As a result of this change the hospital was able to significantly reduce costs in anesthesia charges falls VTE due to earlier ambulation elimination of knee immobilizers and less opioid use The length of stay also decreased by 20 percent to 25 percent Robert Kaplan has demonstrated in a number of healthcare projects in the greater Boston area that hospitals can Replace higher cost practitioners e g physicians with advanced practice nurses APNs and physician assistants PAs Replace lower cost APNs and PAs with e health platforms solutions Replace steps such as triage in the emergency department with value added steps such as medical screening exams Replace higher cost practitioners e g surgeons who cost 12 min with scribes who are certified coders 80 minute to produce more timely documentation that generates higher revenues Reduce or eliminate idle time Reduce or eliminate unused capacity Serve larger volumes of people with existing capacity These projects demonstrate the importance of looking at all costs over the continuum of care and not isolating them into departmental or budgetary silos that inadvertently adversely affect the total cost of care Obviously having clinical business analytics to provide real time cost accounting information to all relevant providers payers and managers with decision support alerts is essential to actively manage costs when it can do measurable good The days of retrospective cost reports are gone for anyone who wants to compete for narrow tiered network referrals by large employers and payers Finally it will be impossible to contract for services with payers and healthcare plans without a reliable way to calculate potential margin in advance based upon real costs and to negotiate dynamic contracts that modulate over time based upon mutually agreed upon variables Time driven activity based costing is here to stay and with good analytic tools readily available there is no reason to hold on to antiquated cost accounting techniques that inhibit our ability to provide high quality low cost care Jonathan H Burroughs M D is president and CEO of The Burroughs Healthcare Consulting Network He s also a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit

    Original URL path: http://www.hospitalimpact.org/index.php/2015/05/20/activity_based_costing_helps_providers_d (2016-02-10)
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  • Hospital Impact - Strategies to survive a brave, new value-based world
    the lowest cost individual that can perform the functions of the job without sacrificing quality or service For instance advanced practice practitioners can perform 80 percent of the routine low risk clinical activities a physician can and e health solutions platforms can accomplish 80 percent of what an advanced practice practitioner can do at a fraction of the cost Supply chain management which can best be accomplished by an interdisciplinary value analysis committee through which management and physicians make key physician preference item choices and screen vendors for value quality cost and thus eliminate non value added variation and redundant cost 4 Grow the inpatient population health infrastructure According to the Centers for Medicare Medicaid Services 1 percent of Medicare beneficiaries make up 23 percent of Medicare costs critically ill injured and 5 percent of Medicare beneficiaries make up 49 percent of Medicare costs multiple chronic illnesses Thus the lowest hanging fruit is to mitigate these costs for your inpatients and this will have the greatest impact upon both the cost case and readmission rates Large employers have demonstrated that disease management programs and palliative care reduce morbidity mortality cost with a significant return on investment Regular disease management is a less intensive approach that provides evidence based care management for those with chronic diseases over a longer period of time by utilizing clinical cost analytics that provide predictive risk stratification and early interventions with decision support to minimize costs physician ED visits and readmissions while optimizing quality adjusted life years 5 Grow new sources of revenue Sickness is a 2 8 trillion industry that is overused and inefficient The good news is that the healthcare industry is much larger 5 trillion and can support the transition from sickness to health as population health measures take hold There is a significant opportunity to grow new revenues through alignment with retail outlets build buy lease or outsource to care for healthy individuals with minor acute problems and e health platforms solutions for convenient low cost access to routine healthcare services 24 7 Walgreens CVS and Wal Mart have aggressive growth strategies in this sector and many healthcare organizations benefit from symbiotic contractual arrangements that significantly enhance low cost access Vendors such as American Well lease e health platforms with or without 24 7 physician coverage that not only provides 24 7 access at a low cost 49 but will also link healthcare organizations systems to their extensive network of 100 million covered lives through large employers and health plans 6 Grow the ambulatory population health infrastructure Finally post acute care and home health programs can help the industry make the transition from fee for service toward some form of risk based capitation These programs include rigorous care management driven by a non physician care manager with medical direction wireless technology to the home that feeds into patient registries and centralized monitoring facilities clinical cost analytics with predictive analytics and decision support alerts to identify risk stratified at risk patients for early

    Original URL path: http://www.hospitalimpact.org/index.php/2015/04/01/strategies_to_survive_a_brave_new_value (2016-02-10)
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  • Hospital Impact - Are you ready for the e-health invasion?
    bandages glasses earbuds wristbands headbands necklaces contact lenses and garments Within the next few years it will be possible to commercially assess a patient s electronic health record DNA mRNA unique protein microbial and metabolic profile remotely so that individuals will not have to visit a doctor s office or emergency department to be evaluated Pharmacy data can be pulled up through vendors such as SureScripts and both health and cost based analytics are available to both the provider and patient to optimize care E health applications are currently being used for urgent care chronic medical management on demand inpatient consults emergency department case flow home health post discharge medical surgical follow up behavioral health and regional healthcare services For instance St Luke s Healthcare System in Boise Idaho has an e ICU that provides care for up to 100 acutely ill patients located in ICUs throughout the state at a cost far below the cost required to transfer all 100 patients to Boise A certified intensivist can manage all 100 patients through telehealth communication with qualified providers at each patient s bedside Large employers use e health kiosks within their physical plants in order to optimize their employees health and reduce absenteeism and presenteeism as well as the incidence of morbidity due to the presence of chronic diseases such as back pain hypertension depression diabetes and work related injuries Now when a patient has a rash without fever he or she can choose to go to an emergency department a walk in center a retail outlet e g Walgreens CVS or Walmart or pick up his or her iPhone download the app of any one of a number of vendors and contact a physician or advanced practice nurse within two minutes and get the rash diagnosed and treatment with a prescription phoned in for less than 50 Statistically most telehealth users are evenly divided between men and women are of working age ages 21 55 and use the service during normal working hours 8 a m to 6 p m with an even distribution throughout the week E health is being used to reduce hospital readmissions which can cost healthcare organizations up to 3 percent of their Medicare reimbursement address physician and primary care shortages in remote rural areas and contribute to health cost analytics for those using these tools for their accountable care organizations or patient centered medical homes The use of e health services is going to accelerate as high deductible policies proliferate out of pocket expenses increase and families increasingly feel squeezed out of the traditional healthcare market Consumers and patients now want 24 7 access responsiveness to market as opposed to sales driven demand reasonable margins based upon real not fabricated costs standardized evidence based evaluations treatments with elimination of non value added variation and outstanding and responsive service E health provides another option for individuals who are value starved for low cost high quality services and are willing to try alternatives that while perhaps

    Original URL path: http://www.hospitalimpact.org/index.php/2015/02/19/are_you_ready_for_the_e_health_invasion (2016-02-10)
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  • Hospital Impact
    H Burroughs Associate Justice Ruth Bader Ginsburg s minority opinion in the 2014 Burwell v Hobby Lobby Supreme Court case was prescient She predicted that the majority opinion favoring the right of closely held corporations a corporation in which five or fewer shareholders own more than 50 percent equity of the organization to opt out of the Patient Protection and Affordable Care Act s mandate to provide birth control coverage to employees on the basis of religious objection would be a slippery slope She stated that there are thousands of closely held corporations in the United States e g In N Out Burger and Forever 21 that could conceivably opt out of any federal law for religious reasons without any guidance from the Supreme Court as to the limitations of their objections Flash forward a little more than a year The Supreme Court has agreed to take up seven cases from throughout the country that have come before appeals courts contesting the current policy that permits religious employers to opt out of their obligation to provide birth control by relegating this responsibility to either the government or private insurance companies simply by notifying their insurers third party administrators or the government Several religious organizations such as Little Sisters of the Poor and the Roman Catholic Archdiocese of Washington D C argue that this makes them complicit in violation of their religious beliefs Read more Leave a comment ICD 10 Collaborative ways to reduce operating costs October 29th 2015 by Jonathan H Burroughs With the introduction of ICD 10 on Oct 1 there are now 132 500 new codes and new ways for healthcare organizations to be paid less based upon inadequate documentation or worse documentation that does not support the services rendered Thus it is incumbent upon healthcare leaders and physicians to come up with new ways to manage documentation through clinical documentation improvement CDI initiatives that lower operating costs improve the accuracy of documentation and improve the effectiveness of revenue cycle management performance What are organizations doing and how does this impact a physician s work flow I Training programs ICD 10 training programs have emerged as an opportunistic industry however organizations can deal with training physicians nurses and healthcare personnel in a far more cost effective way Most clinicians work with approximately 30 40 DRGs that make up 80 percent of their clinical practice It is important that they have at their fingertips the most common DRGs they are likely to encounter with a list of the documentation elements necessary to optimize reimbursement given any level of acuity Even better is to imbed decision support tools in the computerized physician order entry system so that if key elements are missing they may be given decision prompts Read more Leave a comment Medical overuse and why fee for service must go September 3rd 2015 by Jonathan H Burroughs It should not be a surprise to anyone why medical overuse occurs The traditional and politicized discounted fee for service reimbursement

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=1 (2016-02-10)
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  • Hospital Impact
    Congress in emergency funds that would include establishing 50 Ebola treatment centers throughout the country to prepare for a potential epidemic of Ebola cases that will probably never occur Twenty percent of Americans currently live in fear they will contract Ebola and some politicians reinforce these fears through advocating strict quarantines for everyone traveling from Western Africa whether they are symptomatic or not Read more Leave a comment St Luke s population health programs promote innovation October 23rd 2014 by Jonathan H Burroughs Some organizations choose innovation and rather than wait until change is mandatory move forward before it s required so they can design and forge their own way before it s imposed upon them by others For example St Luke s Health System in Boise Idaho an organization that builds an infrastructure for population health to prepare for the transition from fee for service to risk contracting and capitation while many others talk about it and wait Its most important innovation is that it defines itself not as a hospital or even a healthcare network but as a regional continuum and coalition of care extending from the home to the community schools home health access clinics diagnostic centers ambulatory procedure or long term care centers the acute care hospital post acute care and back to home Many of their strategic partnerships with schools community organizations wellness coalitions employers and corporate partners are non traditional and reflect the growing trend that only organizations with broad based coalitions will succeed in the 21st century Some of their innovative programs include Read more Leave a comment Silence can kill Doctors nurses and staff must hold each other accountable September 4th 2014 by Jonathan H Burroughs The field of patient safety became all too personal for me last week when my mother in law almost died from an iatrogenic C Difficile infection of the large bowel caused by the inappropriate use of antibiotics and the failure of healthcare personnel to report their concerns to management or the family My mother in law is 91 years old and lives in an Alzheimer unit in a senior living community in the Pacific Northwest Despite her significant cognitive impairment and increasing frailty she is in remarkably good health Four weeks ago she was prescribed Augmentin a broad spectrum antibiotic for suspected bronchitis and or pneumonia based upon a history of productive cough weakness and increasing cognitive impairment Doctors performed no complete examination sputum culture gram stain or X ray One week later her cough improved however she developed abdominal cramps loose stools and decreased appetite that worsened over a three week period She then spiked a fever for which doctors prescribed Cipro for a suspected urinary tract infection UTI without a complete examination or urine sample Two days later my wife and I found her in acute distress with left lower quadrant abdominal pain low grade fever dehydration and was transferred to the emergency department of a local hospital where doctors diagnosed her with her

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=3 (2016-02-10)
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  • Hospital Impact - Reduce caregiver stress, improve patient experience
    career advancement Bettering access to and quality of equipment supplies etc See Interventions aimed at improving the nursing work environment a systematic review and Improving Patient Care by Improving Nurses Work Environment One strategy because it is universally accessible affordable and effective at improving addressing stress and its causes deserves greater attention and use Mindfulness is the process of learning how to be with all experiences while being less judgmental and reactive Aspects of mindfulness practice include self reflection acceptance self care developing resources to care for others and opening to difficulties without avoidance This practice leads to an open heart according to Does Mindfulness Decrease Stress and Foster Empathy among Nursing Students In the first study of its kind linking the effects of mindfulness based stress reduction on nurse stress and burnout the authors concluded that mindfulness based interventions might offer nurses tremendous help in dealing with stress Researchers showed in a randomized controlled pilot that an eight week mindfulness based program may be effective for reducing stress and increasing quality of life and self compassion in health care professionals Another study evidences the potential of mindfulness training to be used with nurses and nurse aides to treat and prevent stress related problems and to promote coping and health It also suggests that training does not necessarily need to be implemented in the time intensive format in which it is usually provided to benefit individuals with high levels of job stress Most of the other strategies listed above to improve the hospital environment involve significant investments in time financial resources and planning Mindfulness based interventions are low to no cost in nature accessible at all times and in every circumstance and show promising evidence based results Healthcare organizations therefore have a powerful strategy at their disposal to improve the caregiver experience and ability to effectively connect with patients and their families Even if and when the physical environment remains the same mindfulness based interventions enable the inner environment within each of us to notice the causes of stress associated with our life experience without getting caught up in them Such an accepting nonjudgmental presence is the foundation for consistently practicing the evidence based practices that help us make effective quality connections with patients and their families and improve their experience and outcomes Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York where he directs an intentionally designed patient and family centered volunteer program oversees the front line valet and guest services teams and leads the service excellence element of the Patient Experience Initiative while co chairing the hospital s Patient Experience Team Follow Doug DougDellaPietra on Twitter Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus

    Original URL path: http://www.hospitalimpact.org/index.php/2014/05/08/title_124 (2016-02-10)
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  • Hospital Impact - Enhance patient experience with volunteers
    patient settings will greatly impact the patient experience Increasing the number of volunteer service assignments especially volunteer hours in patient settings could raise patient satisfaction scores A well developed volunteer program formal recruitment methods screening and interviewing techniques orientation and training policies service guidelines and risk management plans etc will positively impact the patient experience Researchers noted the limitation that their findings should be generalized to larger nonprofit teaching and Florida Association of Director of Volunteer Services FADVS member hospitals In a more recent and geographically expansive study 1 researchers gathered data from more than 100 hospital volunteer administrators from five northeastern and southern states S E Rogers and authors noted similar findings from the previous study To the point hospitals can more likely impact their overall performance patient satisfaction and the patient experience as measured by HCAHPS if they Have a quality maximization strategic orientation e g the hospital is focused on providing higher levels of quality even if doing so proves costly View the volunteer workforce and volunteer administrators as strategic human capital assets capable of delivering positive ROI and worthy of organizational investments Maximize the use of high performance volunteer resource management VRM practices such as those listed above in the Hotchkiss study findings More and more volunteer programs are transitioning from traditional volunteer assignments clerical work etc to ones with direct patient and family interaction and are shifting because patient and family focused assignments 2 Offer new and creative ways for volunteers to help Cultivate a more engaged loyal group of volunteers Increase volunteer willingness and eagerness to give their time and their talents Join me in celebrating healthcare volunteerism not only by recognizing volunteers in your organization but also by valuing volunteers and volunteer administrators as strategic human capital assets capable of delivering positive ROI and worthy of organizational investments Volunteers contribute greatly to personalizing humanizing and demystifying the hospital experience 3 Leverage the impact that your hospital volunteers can have on improving the patient experience 1 Rogers S E Jiang K Rogers C M 2013 The link between hospital strategy volunteer management and patient satisfaction Evidence from 107 U S hospitals Proceedings of the First Global Conference on Social Impact Mendoza College of Business University of Notre Dame South Bend Ind 2 Frampton S Guastello S Brady C Hale M Horowitz S Bennett Smith S Stone S 2008 Patient centered care improvement guide Derby Conn Planetree 3 Ibid Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York where he directs an intentionally designed patient and family centered volunteer program oversees the front line valet and guest services teams and leads the service excellence element of the Patient Experience Initiative while co chairing the hospital s Patient Experience Team Follow Doug DougDellaPietra on Twitter Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry

    Original URL path: http://www.hospitalimpact.org/index.php/2014/04/03/enhance_patient_experience_with_voluntee (2016-02-10)
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  • Hospital Impact - Embed patient experience advisors hospital-wide
    one patient experience advisor KGH s term for patient and family advisors As one KGH leader said Fixing things that don t matter to patients and family members is a waste of time Therefore understanding what matters most to patients and family members what they value helps focus on improvements that will transform their experience Embedding patients and family members at every level of and on all decision making bodies in the organization improves KGH s chances of focusing on what really matters to patients and their families 2 Patient led forums KGH s relentless commitment to continuous improvement is unmistakable In December 2012 the hospital launched Patient Led Feedback Forums to establish a mechanism for continuous improvement across the entire organization Not only has KGH mandated continuous improvement training for all managers but it also now requires every one of its nine clinical programs to conduct two forums a year and implement four improvements linked to the patient and or family feedback received at the forums See page 10 of KGH s 2012 2013 Q2 Master Performance Report for its definition of a patient led forum The process of setting up patient led forums includes Identifying and supporting patients or family members on the best way to share their recent hospitalization experience with staff and physicians Aligning the patient experience to a clinical program department or group Having the patient or family member engage in a 15 minute sharing of experience with the staff Facilitating staff discussion after the patient family member has left and identifying the positive and negative aspects of the patient family experience heard by staff and Staff selecting one or two improvements which may be immediately implemented or require a PDSA improvement cycle with a team that includes a patient experience advisor Staff and physicians are invited but not mandated to attend the forums Additionally KGH provides education for its managers so that they can help their teams process any negative feelings that may arise from the forums KGH s advice to other hospitals For hospitals interested in embedding patient and family advisors at all levels and across the organization KGH offers the following encouragement Have a vision for what you want to achieve Be clear and unwavering We want the patient perspective Don t get wrapped up in perfection before you start Just do it Make the commitment to transparency and when something doesn t go right acknowledge it and move forward Be an environment of continuous improvement W e knew we had to meet our strategic direction of transforming the patient experience and there was no time to lose Daryl Bell lead for KGH s Patient and Family Centered Care Initiative Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York where he directs an intentionally designed patient and family centered volunteer program oversees the front line valet and guest services teams and leads the service excellence element of the Patient Experience Initiative while co

    Original URL path: http://www.hospitalimpact.org/index.php/2014/01/29/embed_patient_experience_advisors_hospit_1 (2016-02-10)
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