inahq q uality p rofessionals : youre worth your weight in gold – can you prove it?
TRANSCRIPT
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QUALITY PROFESSIONALS:
You’re Worth Your Weight in Gold – Can You Prove It?
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Scottsdale Healthcare
Scottsdale, Arizona Three community
hospitals 818 beds DNV Certified
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Objectives Describe a strategy for ensuring that QI projects
are the best value for the organization’s quality dollars. The Value Proposition. Review of data elements needed Using an objective decision-making strategy Ensure alignment with other organizational objectives
Discuss methods of securing resources Communicating value in financial terms Communicating value in clinical terms Pitching the win-win proposal
Identify challenges and resources Review common pitfalls and how to avoid or correct
them Learn where to look in your own organization for the
support you need to be successful
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The Value Proposition
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Why does all this “finance stuff” matter?
The Perfect Storm: Terrible economy, sweeping healthcare changes, anxiety
You need to protect your department’s future Quality has a direct link to the bottom line
Pay for Performance You’re more than a cost center!
No money = no mission“No one would remember the good Samaritan if he had only good intentions; he had money, too.”
Margaret Thatcher
The Value Proposition
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Misadventures in Process Improvement
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Which group gets the resources?
1,500 Cases/Year 85% Medicare 75% to SNF Our LOS: 5.6 Days Benchmark: 4.0 Days
1,000 Cases/Year 85% Medicare 75% to SNF Our LOS: 5.6 Days Benchmark: 4.0 Days
Brainioplasty Stickectomy
The Value Proposition
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The results:
Brainioplasty Stickectomy
Decreased ALOS by 1.6 Days
How: Aggressive D/C planning – quick transfer to SNF or home with Home Health Care visit one day post discharge
No change in LOS No change to
revenue
Lost $1,275,000
The Value Proposition
What Happened?????Brainioplasty is subject to the
Transfer DRG Rules
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Objective #1: The Value Proposition Definition: The analysis and review of benefits
and costs associated with an activity VALUE = BENEFIT – COST
Where it gets tricky: quantifying benefit What’s the cost of a complication? How do you measure what didn’t happen?
The Value Proposition
OR
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Working effectively with Finance Gain a basic understanding of how the
money flows Learn the vernacular:
Costs: Direct Cost, Indirect Cost, Total Cost Reimbursement: Payer Mix, DRG vs. Percent
of Billed Charges, Managed Medicare vs. Medicare FFS, Carve-outs
Financial measures: Profit, Contribution Margin
Add a financial expert to your PI team Someone who can spot the red flags Example: Inpatient DEXA scanning
The Value Proposition
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Your friend in finance: You need them, they need you!
New tools for your toolbox Billing codes (HCPCS, modifiers, etc.) Procedure Charge Codes
Chargemaster (CDM) The $0 Charge Code
Ability to get data out of the financial system
The Value Proposition
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Thinking back to our example…
When we decreased ALOS did we help or harm the Brainioplasty patients?
We didn’t do the wrong thing; we just did it at the wrong time!
Prioritization
The Value Proposition
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How do you prioritize? Chose your favorite decision making strategy Be sure you factor in:
Clinical need (always high priority) Other benefits – be conservative Return on Investment (ROI) Cost of resources Can multiple projects with similar scope be
combined? Impact - Review cost reports for top 25 DRGs
(by volume) – any surprises? Time (2 small projects vs. 1 large project?) Organization goals The cost of failure/exit strategy
The Value Proposition
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Of Special Concern:Beware of new technology
Carefully assess and monitor new technologies and processes Example: The Super Duper Pain Pump
Claim: Improves patient experience, decreases pain, the end-all-be-all of pain control
Financial Impact: Lots of money spent on pumps, supplies, etc.
Outcome: Didn’t help patients. LOS longer. Increased GI complications
Two Takeaways: Consider new technologies very carefully Always follow up and make sure things are going how
you expected them to go!
The Value Proposition
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Securing Resources
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Objective #2: Securing Resources Communicating Financial Value
Talk the talk Take your finance champions to the “war room”
before you pitch your proposal Validate & seek input
Use dollars & sense Be conservative and say so
Use evidence State your metrics
Include meaningful measures of financial performance
Securing Resources
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What are meaningful financial measures? ALOS
Know what a day costs your organization Lowering ALOS also frees up a bed
Cost of care Will you use less supplies or manpower? Will you avoid treating complications (e.g., VAP,
BSI)? Will patients need less medications or invasive
treatments? Reimbursement
Will there be an impact on reimbursement?
Securing Resources
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Case Study – Supportive Care What it is: A service that supports patients
and families in times of crisis The problem: Generates no revenue; money is
tight Typical quality measures aren’t
demonstrating valueHow do we keep this How do we keep this program off the program off the chopping block?chopping block?
Securing Resources
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Case Study – Supportive Care
Securing Resources
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Case Study – Sepsis: The Challenge A higher-than-expected sepsis mortality rate Improvement requires a resource
New FTEs are hard to come by
How do we get the How do we get the resource we need to resource we need to
fix it?fix it?
Securing Resources
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Case Study – Sepsis: The Solution Show them the money:
Other hospitals demonstrated cost reductions of $5K - $7K per patient (Your patients) x ($5K) = $__________
What does your program cost? Create the Value Proposition for Sepsis
VALUE = BENEFIT – COST
Value = clinical PLUS financial advantage
Benefit = Cost savings & improved outcomes
Cost = Resources needed to implement
Securing Resources
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Pitching the Win-Win Proposal
Patient Benefit Financial Benefit
Use your Value Proposition Let your passion shine through!
Don’t be afraid to take it to the patient level Patient cases where this change would have helped
Make it personal “What if it was you or your family who needed this
care?” Turn up the heat
“Every 1% reduction in mortality means 5 patients don’t die”
Securing Resources
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Challenges & Resources
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Objective #3: Challenges & Resources Challenge: I’m not comfortable with financial
calculations Solution: Your new friend in Finance
Challenge: My business case isn’t as strong as I wish it was Solution: highlight the clinical benefits; be sure to
include an exit plan and plan for monitoring/review of all outcomes. Put some passion behind it!
Challenge: My organization doesn’t value quality activities Solution: demonstrate the bottom-line value.
Market your department.
Challenges & Resources
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Market my department?
Are your staff involved in the “stuff”? Charitable (foundation, helping in hospital’s
name) Hospital activities (walks, health screenings) Continuing education (attending and presenting!)
Do people know how to find you? Intranet site, presence at unit-level quality
meetings Tune up your “Public Relations”
Are the awesome things your staff does found in organization newsletters, website, etc.?
Consider your own newsletter
Challenges & Resources
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Challenges & Resources
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Resources Staff in other departments
Decision Support, Finance, Strategic Planning, Managed Care Contracting…
Your peers at other facilities (hint: you’re sitting with them right now!)
Your network (including InAHQ!) Professional Journals (not just your profession)
What do your executives read? External Organizations:
Advisory Board SG2 Healthcare Financial Management Association
(HFMA)
Challenges & Resources
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Meaningful Use
Challenges & Resources
Source: Pat Wise, HIMSS
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So what do you do first?
Challenges & Resources
Source: American College of Health Executives (01/24/11)
What’s keeping your executives awake at
night?
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Increase YOUR Value Proposition! Collaborate within your organization
Synergy NO SILOS!!!
Get out of the box (and your office) Your resume should always be spiffy Work your network Market yourself Write articles, volunteer, etc. Don’t forget InAHQ & NAHQ!
Challenges & Resources
