HMC News•
on July 14th, 2010•
HMC honors cutting-edge hospitals
NEEDHAM, MASS. – July 14, 2010 – The Healthcare Management Council, Inc. (HMC) has recognized client hospitals for its first annual Top Quality Award winners.
“Over the past several years the microscope has been increasingly focused on improving quality in healthcare,” notes HMC Principal John Whittlesey. “The Centers for Medicare & Medicaid Services (CMS) has adopted the Agency for Healthcare Research and Quality (AHRQ) standards for uniform reporting on patient safety and inpatient quality across all hospitals in the United States, and more indicators are coming down the pike.”
To assist clients to achieve their performance initiative goals, in 2008 HMC implemented the Quality Benchmark tool. HMC has steadily improved the product since then, and subsequently, most clients have deployed it as part of their integrated performance improvement programs. ” Many clients have successfully realized significant improvements across a wide variety of indicators, and HMC is recognizing these high achievers with its 2010 Top Quality Awards. We congratulate the winners,” says Whittlesey.
The need to improve quality is increasing, given the prevalence of easily accessed data sources about hospital performance. Whittlesey notes that quality comparisons are readily available online to the public via web sites. Moreover, consumers are quickly becoming savvier about evaluating cost and quality measurements in making their healthcare decisions. “Hospitals are also on the financial hook for off-quality events that occur in their facility,” he says. “So there’s a strong incentive to reduce these events and improve patient outcomes.”
Six winners judged according to strict criteria
HMC scored each of its client facilities along five dimensions:
- Overall AHRQ patient safety quality score in the best one-half of peer group
- Cost versus quality performance in the upper left quadrant of the peer matrix (i.e., low cost/high quality)
- Overall patient safety quality score showed improvement versus the previous year
- Off-quality savings potential was less than two percent of total inpatient clinical costs
- Off-quality savings potential decreased versus the previous year
Finalists had to score “Yes” in each of the five categories to qualify. HMC also considered additional tie-breaking factors including: performance on AHRQ inpatient quality indicators, percent improvement in quality score; largest decrease in off-quality excess; and lowest ratio of off-quality excess to total clinical costs.
The Best Overall Performer was Logan, Utah-based Logan Regional Hospital, a nonprofit, full-service regional medical center located 80 miles northeast of Salt Lake City. It is a member hospital of the Intermountain Healthcare system. ”Logan showed one of the highest overall quality scores in the HMC partnership and has been in the top quartile of cost versus quality for the past two years,” says Whittlesey.
The facility saw a 14 percent improvement in overall quality score from 2008 to 2009, and a 30 percent improvement since 2007. It also realized a 40 percent reduction in cited savings potential for off-quality cases, and had only .28 percent of its clinical costs in off-quality excess.
The Top Performer was American Fork Hospital, based in American Fork, Utah (and also an Intermountain Healthcare member), a 117-bed community hospital and a runner-up for HMC’s 2009 Top Performer Award. “AFH has traditionally been one of the lowest cost facilities in HMC’s database, and this year saw a remarkable improvement in its quality position, as well,” says Whittlesey. “AFH had the largest reduction in cited excess for off-quality from 2008 to 2009 and the second largest improvement in overall quality score.”
In the Honorable Mention category were Sentara Leigh Hospital, based in Norfolk, Va. (part of Sentara Health System); Howell, Mich.-based Saint Joseph Mercy Livingston Hospital, and Ann Arbor, Mich.-based Saint Joseph Mercy Hospital (both are members of the Saint Joseph Mercy Health System). The most improved facility was Rome, Ga.-based Floyd Medical Center.
For inquiries regarding the Top Quality award, please contact John Whittlesey:
Email: jwhittlesey@hmccentral.com
Office number: (781) 449-5287
HMC News•
on June 22nd, 2010•
Supplies, computer systems, and other issues keep nurses from bedside
NEEDHAM, MASS. – June 22, 2010 – The Healthcare Management Council, Inc. (HMC) has found time-consuming and redundant patient processing and documentation are among the biggest time-wasters for nurses.
Time away from patients to complete redundant or non-medical tasks is a huge source of frustration to nurses. It can reduce quality of care, create patient dissatisfaction, and lead to staff turnover, says Michelle Gray-Bernhardt, an HMC knowledge manager. “Time-wasting is a serious problem for nurses. They are eternally frustrated by the tasks that take them away from patients. Their aggravation can create low morale and that causes turnover. That means you’re spending time, money, and resources to hire and train more nurses. That’s expensive, and it’s not always an easy thing to do, given today’s healthcare climate,” she says.
To address this, HMC recently sponsored an online survey on the KnowledgeWeb portal to pinpoint where the greatest inefficiencies were. “We asked nurses what tasks take them away from the patient bedside and feel like time-wasters,” Gray-Bernhardt says. “A wide-ranging sample of nurses from various units chose broad categories, such as documentation, gathering supplies, physician interaction, patient flow, and the lack of support staff.”
And the winners are….
Nurses outlined the greatest time-wasters as follows below. Each category is ranked in the order of the percentage of nurses that selected it:
Charts and documentation (55%). These are interrelated topics: Overall, documentation creates inefficient processes, but especially when nurses are working with computer systems. Nurses cited electronic documentation as the worst time waster – this includes having to enter data twice into separate incompatible systems, or working with “hybrid” paper and electronic systems.
“Anything that requires duplication and looking at different sources of information is a waste of time,” notes Gray-Bernhardt. “In some cases, nurses enter patient status information on one system, and then have to reenter the identical data on another system.” Nurses were also frustrated when discovering that charts were missing or incomplete, or by situations that required them to add what they considered excess information.
Finding and gathering supplies and equipment (19%). Whether seeking supplies or equipment, time spent searching equals time spent away from patients. Hospitals should look at improving utilization patterns to ensure the availability of supplies in the particular units where nurses are.
Patient flow (15%). Nurses in medical and surgical groups said waiting for – and sometimes admitting – patients was a major time-waster. Also in this category were the unavailability of exam or treatment rooms and having anomalous patients on units. Sometimes nurses found they needed to find patients and retrieve them from other units, as well as locate beds for them when their own units had no available space.
Physician interaction (15%). Waiting for communication with physicians is highly frustrating for nurses. Moreover, doctors and hospitals are behind the curve when it comes to high speed electronic communications. Nurses often wait for return phone calls, and find it challenging to gather post-round information, medication orders, discharge orders, and other necessary information.
Redundant and decentralized communication with families (11%). Patients’ family members call frequently and unexpectedly, and when there is no clear family spokesperson, this leads to redundant communications. Factor in that multiple family members will call daily with status requests and discharge information, and the result is that nurses spend too much time providing the same data.
HMC offers solutions to these challenges and many others on its KnowledgeWeb portal, available to clients.
HMC News•
on June 9th, 2010•
Physicians drive cost without performance feedback
NEEDHAM, MASS. – June 9, 2010 – The Healthcare Management Council, Inc. (HMC) is creating a new cutting-edge physician scorecard tool.
Given that physicians drive most healthcare costs, it’s crucial for hospital managers to better understand their performance. In turn, managers must communicate with the doctors about their performance, and how it affects overall hospital quality and patient satisfaction. They order the tests, approve supplies, and suggest admissions and treatments. However, doctors receive no feedback on how their decisions impact cost, and little empirical evidence about how their decisions impact quality.
“Auto manufacturers and retailers pay close attention to their primary cost drivers,” notes Shelley Burns, head of knowledge management at HMC. “Why not healthcare? To that end, we’re organizing a peer group that will focus on building meaningful physician scorecards. This virtual group will collaborate via the HMC KnowledgeWeb with surveys, discussion forums, and Webinars. Our databases already house extensive clinical data and comparisons. Additionally, clients have asked about standard metrics or reports to find opportunities to improve utilization and quality via physician profiles or scorecards.”
HMC will enable hospitals to understand the impact of their physician groups. The scorecard will uncover how physician practice, utilization, length of stay (LOS), and quality directly impact the bottom line, patient satisfaction, and market share.
A physician scorecard will enable insight in the following areas:
Pattern comparisons. Managers will understand practice patterns and cost variations by LOS, supplies, and ancillary utilization. It will uncover practice variations that drive costs, outcomes, and clinical utilization across physicians.
Profitability. This will enable managers to understand which physicians are losing or making money for the organization. It will also permit administrators to uncover internal cost variances and compare them to external costs.
Quality. Administrators can identify the physicians who are negatively impacting quality, and the ones improving it.
HMC clients interested in joining the development group, please click here and start to explore the world of physician scorecards.
HMC News•
on May 11th, 2010•
Medicare reimbursement levels force hospitals to improve
NEEDHAM, MASS. – May 11, 2010 – The Healthcare Management Council, Inc. (HMC) has found that current conditions demand hospitals consider the Medicare break-even point (BEP) as a key strategy for profitability.
Medicare is typically the single largest hospital payer by far, covering 45 percent to 65 percent of all inpatient costs. HMC research of 40 facilities revealed only 10 percent of them were profitable with Medicare, and 10 percent were on the cusp of Medicare profitability. The large majority of hospitals lost significant money on Medicare work. With the healthcare reform bill now law, hospitals face an even greater payment reduction risk. In light of this, HMC found its more successful clients proactively reevaluating their Medicare management and reimbursement strategies.
“Medicaid, the other major public funding mechanism for hospitals, in most states has negative margins, and that’s not likely to change in the foreseeable future,” says John Whittlesey, principal at HMC. “With that in mind, facilities must find a way to reach a financial BEP with their Medicare patients. Resetting your facility’s ‘water table’ by even just a few percentage points can mean the difference between thriving versus merely surviving. Achieving a Medicare BEP as an organizational strategy will shift the cost position for the rest of the payers, and make overall profitability more secure,” he says.
Currently, there are a growing number of Medicare cases risking denied reimbursement because of hospital acquired conditions (HACs), such as decubitis ulcers. Additionally, it’s likely the government will establish benchmarks for quality-based performance in healthcare, with the potential for additional financial incentives and punishments alike. Addressing the issues around cost, resource utilization, process flow, and quality for all patients will provide a strategic advantage. “HMC has been highlighting this concept for the past couple of years,” says Whittlesey. “We see focusing on better management of physician utilization and the reduction of off-quality events as major opportunities for real cost savings in the future.”
Given these factors, three of HMC’s more cutting-edge clients are actively pursuing a Medicare BEP strategy as part of their overall financial plans, he says. Senior management in each facility sees it as a key component to long-term financial viability. Whittlesey notes how some clients are more focused on how much their total cost structure has to change beyond just Medicare, as well. “Breaking even on Medicare is just a pointer towards how to target their cost management efforts across the board,” says Whittlesey.
Managers: Think about nursing levels, margins, and supplies
In general, facilities that are profitable on Medicare have slightly more aggressive cost positions, particularly in supplies and ancillaries. Recently, HMC used its proprietary data to create a benchmark to see which hospitals were profitable on Medicare patients. One client used this data to see how it compared against its standard benchmark analysis for each of its five facilities. Overall, reaching the client’s Medicare break even required a 16 percent more aggressive improvement plan target, a significant ratchet up. Three of its facilities showed 15 percent, 28 percent, and 49 percent higher excess. Two of its facilities were 5 percent and 9 percent lower in cited savings.
HMC also made discoveries administrators can use to improve performance in the following areas:
Margin requirements. Many organizations would benefit significantly from achieving a 5 percent reduction in inpatient cost position. Hospitals typically view a 5 percent margin as healthy, making that a worthwhile goal to attain.
Nursing levels. HMC found that nursing levels didn’t vary much for Medicare BEP facilities versus others, while overhead and support functions were mixed.
Supplies and ancillary functions. In this category, HMC found much greater differences in BEP facilities when compared with other hospitals. This indicates that those hospitals with stronger Medicare cost positions also demonstrate leaner and more efficient clinical resource utilization.
HMC News•
on April 20th, 2010•
NEEDHAM, MASS. – April 20, 2010 – The Healthcare Management Council, Inc. (HMC) has compiled a cutting-edge white paper of best practices to address the expensive and widely prevalent problem of decubitus ulcers.
Research from HMC has indicated that decubitus ulcers cost around $575,000 for an average hospital annually. A patient acquiring a pressure ulcer requires an average of $9,200 in extra care. This cost is not reimbursed by Medicare or Medicaid and in the future probably won’t be reimbursed by private insurers, either. What’s worse is that this is a preventable off-quality condition, according to Shelley Burns, HMC’s director of knowledge management.
There are solutions, however, says Burns. “Being able to readily discern patterns in your ulcer incidence increases the likelihood that you can fix your decubitus ulcer issues quickly and effectively,” says Burns in a recently released white paper. The first step required is to identify the prevalent patterns of the ulcers in a hospital with the HMC Cost of Off-Quality online cascade. Other types of data analysis are available in the HMC tool set. For instance, the HMC Clinical Analyzer can present many types of rich data around decubitus ulcer incidences, including diagnosis-related groups (DRGs), Physician of Record, Length of Stay (LOS), and cost.
What to look for
Using this data, wound care coordinators and skin teams can identify patterns and begin to take action, says Burns. Administrators should look for these common patterns:
Nursing unit and diagnosis-related group clusters. Ulcers tend to appear most in particular nursing units and DRG clusters. Because of this, administrators can target remedial action through specific training programs. This approach costs less time and money than implementing a facility-wide educational initiative.
Long LOS. Typically, patients with longer stays are more likely to develop ulcers. If the ulcer incidence is clustered in patients with a longer LOS, wound care coordinators can ensure there are special measures applied, such as more frequent skin assessments. Or they can initiate preventive care protocols for these patients.
Admitting Physician. Sometimes there is a correlation between the admitting physician and the occurrence of pressure ulcers in their patients. Wound care coordinators can take action to see if the pressure ulcer assessments are effective and if the physicians are showing due diligence in their documentation.
Random occurrences still happen, too
Of course, there are also facilities that will face ulcers that appear outside these categories, seemingly at random. Clinicians in facilities with random ulcer patterns should then consider common patient characteristics, such as nutrition. If they can’t find a common factor, they should assess the house-wide skin protocols, procedures, and education.
HMC News•
on March 5th, 2010•
HMC finds Hospital-Acquired Infections and other problems budget busters
NEEDHAM, MASS. – March 8, 2010 – The Healthcare Management Council, Inc. (HMC) has found that by improving care to eliminate the off-quality treatment of patients, a 200-bed hospital can potentially save $2 million each year.
Using federal Agency for Healthcare Research and Quality (AHRQ) indicators, HMC has analyzed the performance of hundreds of facilities ranging in size from 75 beds to over 800 beds. Now in a recent study, HMC identified the top Hospital Acquired Conditions (HACs) and established how much extra care each of these HACs requires. HACs have resulted in nonpayment from Medicare and Medicaid, and in the future, private insurers will likely stop covering HAC-related costs, as well.
Given HACs are preventable, few would argue they shouldn’t happen: moreover, some even result in death. According to the U.S. Centers for Disease Control, there are an estimated 1.7 million healthcare-associated infections (HAIs) annually, causing 99,000 deaths. The overall annual direct medical cost of the HAIs to U.S. hospitals is as high as $45 billion, claims the CDC, with an estimated cost of HAI per patient as high as $25,903.
Now, further analysis based on 2009 data from HMC revealed how just a handful of off-quality cases are the biggest drivers of these enormous extra dollar costs. These findings, which demonstrate which HACs are the most costly, can provide guidance to patient care improvement and the preservation of hospital assets and resources.
HMC has listed the HAC categories below in order of prevalence, with their average total cost per hospital annually. Also listed is each HAC’s per-patient average cost increase. Because of the higher volume of some of the HACs, such as decubitis ulcers, they were more expensive overall for a hospital to treat, even if the per-patient cost was relatively low compared to other HACs.
HACs take financial toll
Decubitis ulcers were the most prevalent HAC, and because of that the second most expensive condition, costing a facility an average total of roughly $536,900 annually. A patient acquiring a bedsore requires an average of $9,200 in extra care.
Postoperative pulmonary embolism and deep-vein thrombosis (DVT) comprised the second most prevalent category, and the most expensive, costing a total of $564,000 each year. These two related HACs require $15,500 more in care expense per patient.
Accidental puncture and laceration comprised the third most prevalent category, and the fifth most costly, averaging a total of $248,100 per hospital. A patient affected by these typically requires $8,300 in healthcare dollars.
Post-operative respiratory failure was the fourth most prevalent and third most expensive HAC, at $261,000 in total per hospital. An afflicted patient requires $21,900 more in spend.
Infections due to medical care made up the fifth most prevalent HAC. It was the fourth most expensive category, costing $252,600 per hospital on average, and each afflicted patient, on average, requires $24,500 more in care.
Solutions to off quality exist
“The old saw that ‘An ounce of prevention is worth a pound of cure’ is truer in a hospital than most people realize,” said Shelley Burns, director of knowledge management at HMC. “With the proper focus on how physicians or diagnosis-related groups (DRGs) are actually the drivers of these off-quality results, big changes can happen.”
She went on: “While the statistics paint a gloomy picture, nevertheless, virtually all these HACs are preventable. However, hospitals must follow best practices, analyze the root causes of their off-quality issues, and engage clinicians in improving processes. HMC has assembled compelling best practices from all our clients. These are not theoretical, but ones that are actually on the ground and working. In some cases, they require education or performing special patient assessments, but generally it’s a small investment that can save hundreds of thousands of dollars annually.”
HMC News•
on February 26th, 2010•
First Year HMC Showcases Excellent Work of Clients
NEEDHAM, MASS. – February 8, 2010 – The Healthcare Management Council, Inc. (HMC) named its 2009 eight “Top Performer” hospitals. In selecting the winners, HMC scored each hospital according to seven dimensions, or criteria, including cost per adjusted admission, overall profitability, and patient satisfaction. HMC believes these criteria enable hospitals to accurately measure how effectively they are delivering healthcare value.
This is the first year HMC has assembled a Top Performer list. “We wanted to document the excellent work our client hospitals are doing using benchmark data,” explained John Whittlesey, principal at HMC. “There was stiff competition among the top contenders,” he observed.
The 2009 Top Performer was Dixie Regional Medical Center (DRMC), a 245-bed referral center based in St. George, Utah. The other three Top Performers were St. Joseph Mercy Saline Hospital, based in Saline, Mich.; Howell, Mich.-based St. Joseph Mercy Livingston Hospital; and American Fork Hospital, in American Fork, Utah.
For judging, HMC applied seven performance criteria. They are:
- Overall cost per adjusted admission in lowest one-half of peer group
- Overall quality score in best one-half of peer group based on the federal Agency for Healthcare Research and Quality (AHRQ) rankings
- High quality and low cost performance in the upper left quadrant versus peers
- Overall profitability > 5 percent
- Overall patient satisfaction score in best one-half of the peer group
- Overall cost per adjusted admission improved over previous benchmark
- Cited savings potential decreased from previous benchmark
We also gained some valuable insights,” Whittlesey said of the judging. “For instance, most of the Top Performers were part of health systems, and tended to be smaller-to-medium size hospitals, as opposed to big tertiary teaching facilities. Some people think big and complex is always better, and that’s not always the case.”
Other Top Performers
The “Honorable Mention” category included Sentara Leigh Hospital, in Norfolk, Va., and Utah Valley Regional Medical Center, based in Provo, Utah. In the “Most Improved” category were Sentara Williamsburg Regional Medical Center, based in Williamsburg, Va., and the Greeley, Colo.-based North Colorado Medical Center.
HMC News•
on February 4th, 2010•
Utah-based Dixie Regional Medical Center uses HMC tools to control costs and maintain patient care quality
NEEDHAM, MASS. – February 2, 2010 – The Healthcare Management Council, Inc. (HMC) named Dixie Regional Medical Center (DRMC) as its national “Top Performer” hospital.
This is the first year HMC is recognizing outstanding hospitals as Top Performers. In selecting the winners, analysts scored each hospital according to seven criteria, including cost-per-adjusted admission, overall profitability, and patient satisfaction. HMC believes these criteria enable hospitals to accurately measure how effectively they are delivering healthcare value.
HMC analysts found DRMC met six of the seven Top Performer criteria. A 245-bed referral center based in St. George, Utah, DRMC has been an HMC client for nearly 10 years. The DRMC is also part of Intermountain Healthcare, a Salt Lake City-based system with more than 32,000 employees and 23 hospitals.
“Finding the right balance between cost management, quality improvement, and growth is a tall order these days,” said John Whittlesey, HMC principal and one of the Top Performer judges. He explained DRMC had one of the strongest overall cost positions in its peer group, scored in the upper quartile for quality using the federal Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Quality Indicators, and has consistently maintained a positive bottom line.
“Moreover, DRMC scored the highest in its peer group for overall patient satisfaction, and showed a remarkable 22 percent decrease in cited savings potential over the previous year’s benchmark report,” Whittlesey said.
According to Mary Hatch, chief financial officer for DRMC, the HMC tools enable staff to do drill-down analysis for cost control. “We have been able to make changes that didn’t affect the quality of patient care, but did make a cost savings,” said Hatch. This “tightening up” included the standardization of supplies and equipment to receive better pricing from suppliers, the conservation of power and water, and other similar initiatives, she explained.
Among HMC’s eight Top Performer hospitals, three, including DRMC, were part of Intermountain Healthcare. Another was American Fork Hospital, based in American Fork, Utah, which was a Top Performer. The third was the Utah Valley Medical Center, based in Provo, Utah, which won an HMC “Honorable Mention.
HMC News•
on January 3rd, 2010•
HMC has launched a new web site describing how hospitals use the HMC Span of Control Analysis™ and the HMC Smallest Practical Organization Modeler™ to improve their hospital organizations.
NEEDHAM, MASS. – January 3, 2010 – The Healthcare Management Council, Inc. (HMC) has launched a web site showcasing its enhanced span of control analysis. The HMC Span of Control Analysis gives you a clear picture of where your management structure can be streamlined, reducing your payroll costs and improving decision making without sacrificing care.
The new Web site is located at http://www.HospitalSpanOfControl.com and contains:
Contact us for a personal tour of the Analysis and Modeler.
