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

Q UALITY P ROFESSIONALS : You’re Worth Your Weight in Gold – Can You Prove It?. Indiana Association for Healthcare Quality May 6, 2011 J ENNIFER W OLFE- P EARCE, RN, MBA, CPHQ. Scottsdale Healthcare. Scottsdale, Arizona Three community hospitals 818 beds DNV Certified. Objectives.

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

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  1. QUALITY PROFESSIONALS: You’re Worth Your Weight in Gold – Can You Prove It? Indiana Association for Healthcare Quality May 6, 2011 JENNIFER WOLFE-PEARCE, RN, MBA, CPHQ

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

  3. 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

  4. The Value Proposition

  5. 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 • 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

  6. Misadventures in Process Improvement

  7. 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 • 1,000 Cases/Year • 85% Medicare • 75% to SNF • Our LOS: 5.6 Days • Benchmark: 4.0 Days

  8. The Value Proposition 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 What Happened????? Brainioplasty is subject to the Transfer DRG Rules Lost $1,275,000

  9. The Value Proposition 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? OR

  10. 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

  11. 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

  12. 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

  13. 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

  14. The Value Proposition 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!

  15. Securing Resources

  16. 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 • Validate & seek input • Use dollars & sense • Be conservative and say so • Use evidence • State your metrics • Include meaningful measures of financial performance

  17. Securing Resources 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?

  18. 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?

  19. Securing Resources Case Study – Supportive Care

  20. 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?

  21. 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

  22. 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 • 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”

  23. Challenges & Resources

  24. Challenges & Resources 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.

  25. Challenges & Resources 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

  26. Challenges & Resources

  27. Challenges & Resources 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)

  28. Challenges & Resources Meaningful Use Source: Pat Wise, HIMSS

  29. Challenges & Resources So what do you do first? What’s keeping your executives awake at night? Source: American College of Health Executives (01/24/11)

  30. 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!

  31. Wrap-Up • Questions? • Email: jpearce@shc.org

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