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Q UALITY P ROFESSIONALS : You’re Worth Your Weight in Gold – Can You Prove It? JENNIFER WOLFE-PEARCE, RN, MBA, CPHQ InAHQ Scottsdale Healthcare Scottsdale, Arizona Three community hospitals 818 beds DNV Certified InAHQ Objectives Describe a strategy for ensuring that QI projects are the best value for the organization’s quality dollars. The Value Proposition. Discuss methods of securing resources Review of data elements needed Using an objective decision-making strategy Ensure alignment with other organizational objectives 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 InAHQ The Value Proposition InAHQ The Value Proposition Why does all this “finance stuff” matter? The Perfect Storm: Terrible economy, sweeping healthcare changes, anxiety You need to protect your department’s future Pay for Performance Quality has a direct link to the bottom line 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 InAHQ Misadventures in Process Improvement InAHQ The Value Proposition Which group gets the resources? Brainioplasty Stickectomy 1,500 Cases/Year 85% Medicare 75% to SNF Our LOS: 5.6 Days Benchmark: 4.0 Days InAHQ 1,000 Cases/Year 85% Medicare 75% to SNF Our LOS: 5.6 Days Benchmark: 4.0 Days The Value Proposition The results: Brainioplasty Stickectomy Decreased ALOS by 1.6 No change in LOS Days No change to revenue How: Aggressive D/C planning – quick transfer to SNF or home with What Happened????? Home Health Care visit Brainioplasty is subject to one day post discharge Lost $1,275,000 InAHQ the Transfer DRG Rules The Value Proposition Objective #1: The Value Proposition Definition: The analysis and review of benefits and costs associated with an activity VALUE = BENEFIT – COST OR Where it gets tricky: quantifying benefit What’s the cost of a complication? How do you measure what didn’t happen? InAHQ The Value Proposition 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 InAHQ The Value Proposition 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 InAHQ The Value Proposition 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 InAHQ The Value Proposition 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 InAHQ Of Special Concern: Beware of new technology The Value Proposition Carefully assess and monitor new technologies and processes Example: The Super Duper Pain Pump Claim: Improves patient experience, decreases pain, the end-allbe-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: InAHQ Consider new technologies very carefully Always follow up and make sure things are going how you expected them to go! Securing Resources InAHQ Securing Resources Objective #2: Securing Resources Communicating Financial Value Talk the talk Take your finance champions to the “war room” before you pitch your proposal Use dollars & sense Validate & seek input Be conservative and say so Use evidence State your metrics InAHQ Include meaningful measures of financial performance Securing Resources What are meaningful financial measures? ALOS Cost of care Know what a day costs your organization Lowering ALOS also frees up a bed 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? InAHQ Securing Resources 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 value How do we keep this program off the chopping block? InAHQ 20 DAYS BEFORE (N=105) 19 DAYS BEFORE (N=118) 18 DAYS BEFORE (N=128) 17 DAYS BEFORE (N=151) 16 DAYS BEFORE (N=170) 15 DAYS BEFORE (N=198) 14 DAYS BEFORE (N=228) 13 DAYS BEFORE (N=266) 12 DAYS BEFORE (N=315) 11 DAYS BEFORE (N=372) 10 DAYS BEFORE (N=422) 9 DAYS BEFORE (N=479) 8 DAYS BEFORE (N=555) 7 DAYS BEFORE (N=638) 6 DAYS BEFORE (N=777) 5 DAYS BEFORE (N=922) 4 DAYS BEFORE (N=1121) 3 DAYS BEFORE (N=1374) 2 DAYS BEFORE (N=1727) 1 DAY BEFORE (N=2208) Consult date (N=2680) 1 DAY AFTER (N=2126) 2 DAYS AFTER (N=1752) 3 DAYS AFTER (N=1408) 4 DAYS AFTER (N=1188) 5 DAYS AFTER (N=1014) 6 DAYS AFTER (N=873) 7 DAYS AFTER (N=761) 8 DAYS AFTER (N=656) 9 DAYS AFTER (N=577) 10 DAYS AFTER (N=512) 11 DAYS AFTER (N=467) 12 DAYS AFTER (N=419) 13 DAYS AFTER (N=371) 14 DAYS AFTER (N=327) 15 DAYS AFTER (N=297) 16 DAYS AFTER (N=266) 17 DAYS AFTER (N=233) 18 DAYS AFTER (N=213) 19 DAYS AFTER (N=192) 20 DAYS AFTER (N=177) Securing Resources Case Study – Supportive Care $2,500.00 Avg Cost Per Day = $1,652 $2,000.00 Avg Cost Per Day = $1,286 $1,500.00 $1,000.00 $500.00 $0.00 Cost Per Day of Stay InAHQ Average Cost Per Day (Trendline) First encounter with Supportive Care Securing Resources 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? InAHQ Securing Resources 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 InAHQ Securing Resources 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 Make it personal Patient cases where this change would have helped “What if it was you or your family who needed this care?” Turn up the heat InAHQ “Every 1% reduction in mortality means 5 patients don’t die” Challenges & Resources InAHQ Challenges & Resources Objective #3: Challenges & Resources Challenge: I’m not comfortable with financial calculations Challenge: My business case isn’t as strong as I wish it was Solution: Your new friend in Finance 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. InAHQ Challenges & Resources Market my department? Are your staff involved in the “stuff”? Do people know how to find you? Charitable (foundation, helping in hospital’s name) Hospital activities (walks, health screenings) Continuing education (attending and presenting!) 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 InAHQ Challenges & Resources InAHQ Challenges & Resources Resources Staff in other departments Your peers at other facilities (hint: you’re sitting with them right now!) Your network (including InAHQ!) Professional Journals (not just your profession) Decision Support, Finance, Strategic Planning, Managed Care Contracting… What do your executives read? External Organizations: Advisory Board SG2 Healthcare Financial Management Association (HFMA) InAHQ InAHQ Challenges & Resources Meaningful Use InAHQ Source: Pat Wise, HIMSS Challenges & Resources So what do you do first? ACOs ICD-10 What’s keeping your executives awake at night? MU ???????? InAHQ Source: American College of Health Executives (01/24/11) Challenges & Resources 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! InAHQ Wrap-Up Questions? Email: [email protected] InAHQ