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InAHQ Q UALITY P ROFESSIONALS : Youre Worth Your Weight in Gold – Can You Prove It?

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Presentation on theme: "InAHQ Q UALITY P ROFESSIONALS : Youre Worth Your Weight in Gold – Can You Prove It?"— Presentation transcript:

1 InAHQ Q UALITY P ROFESSIONALS : Youre Worth Your Weight in Gold – Can You Prove It?

2 InAHQ Scottsdale Healthcare Scottsdale, Arizona Three community hospitals 818 beds DNV Certified

3 InAHQ Objectives Describe a strategy for ensuring that QI projects are the best value for the organizations 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

4 InAHQ The Value Proposition

5 InAHQ Why does all this finance stuff matter? The Perfect Storm: Terrible economy, sweeping healthcare changes, anxiety You need to protect your departments future Quality has a direct link to the bottom line Pay for Performance Youre 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

6 InAHQ Misadventures in Process Improvement

7 InAHQ 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 BrainioplastyStickectomy The Value Proposition

8 InAHQ 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

9 InAHQ 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 Whats the cost of a complication? How do you measure what didnt happen? The Value Proposition OR

10 InAHQ 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

11 InAHQ 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

12 InAHQ Thinking back to our example… When we decreased ALOS did we help or harm the Brainioplasty patients? We didnt do the wrong thing; we just did it at the wrong time! Prioritization The Value Proposition

13 InAHQ 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

14 InAHQ 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: Didnt 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

15 InAHQ Securing Resources

16 InAHQ 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

17 InAHQ 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

18 InAHQ 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 arent demonstrating value How do we keep this program off the chopping block? Securing Resources

19 InAHQ Case Study – Supportive Care Securing Resources

20 InAHQ 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 resource we need to fix it? Securing Resources

21 InAHQ 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

22 InAHQ Pitching the Win-Win Proposal Patient Benefit Financial Benefit Use your Value Proposition Let your passion shine through! Dont 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 dont die Securing Resources

23 InAHQ Challenges & Resources

24 InAHQ Objective #3: Challenges & Resources Challenge: Im not comfortable with financial calculations Solution: Your new friend in Finance Challenge: My business case isnt 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 doesnt value quality activities Solution: demonstrate the bottom-line value. Market your department. Challenges & Resources

25 InAHQ Market my department? Are your staff involved in the stuff? Charitable (foundation, helping in hospitals 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

26 InAHQ Challenges & Resources

27 InAHQ Resources Staff in other departments Decision Support, Finance, Strategic Planning, Managed Care Contracting… Your peers at other facilities (hint: youre 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

28 InAHQ

29 Meaningful Use Challenges & Resources Source: Pat Wise, HIMSS

30 InAHQ So what do you do first? Challenges & Resources ???????? MUICD-10ACOs Source: American College of Health Executives (01/24/11) Whats keeping your executives awake at night?

31 InAHQ 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. Dont forget InAHQ & NAHQ! Challenges & Resources

32 InAHQ Wrap-Up Questions?


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