1.800.360.0603

GE Healthcare Camden Group Insights Blog

Facing Bundled Payments

Posted by Matthew Smith on Apr 20, 2017 11:05:07 AM

By Dominic Foscato, Vice President, GE Healthcare Camden Group

Change in reimbursement isn’t waiting for tomorrow. It’s happening right now. Rather than paying for each procedure and office visit, government and private health plans are moving toward a payment model based on the health of an organization’s patient population. During this transition, an organization’s success depends on its ability to manage a variety of payment models.

Health care organizations must successfully administer these payment models — which continue to evolve and grow more complex —while optimizing quality, outcomes and patient satisfaction. In short, they must manage “fusion reimbursement” or risk significant cuts in revenue.

Clinical Integration, Clinically Integrated Networks

Reprinted with permission from the February 2016 issue of Trustee magazine, vol. 69, no. 2. © Copyright 2016 by Health Forum Inc. Permission granted for digital use only

Topics: Bundled Payments, Value-Based Payments, Alternative Payment Models, Dominic Foscato

Are You Operating Your Hospital With a ‘Hurry-Up’ Offense?

Posted by Matthew Smith on Sep 15, 2016 2:40:26 PM

By Dominic Foscato, Senior Vice President, and Ryan Treml, Senior Manager, GE Healthcare Camden Group

In American football, many teams have turned to a "no huddle, hurry-up" offense in order to disrupt their opponent’s ability to make defensive adjustments in scheme or personnel. While effective for sports, operating a hospital or department without formal communication standards or too many well-intended huddles/rounds can be a recipe for inefficient, ineffective care delivery.

Nationwide, hospital systems continue targeting ways to improve care coordination in an effort to reduce cost, improve quality, and increase patient/provider experience. Most end up identifying communication as a major component in limiting unnecessary delays, turning to a variety of meeting formats as a way to implement change.

Examples include:

  • Daily Bed Huddles – house-wide discussions led by Patient Placement and involving department leaders to identify expected discharges, admissions, and transfers
  • Long Length of Stay ("LOS") meetings – led by Case Management to review long-stay patients, assist in removing barriers; ultimately integrating with UM committees
  • Unit Huddles – shift meetings or safety huddles to communicate key priorities
  • Multidisciplinary Rounds – daily meetings led by case management/social work in conjunction with nursing, physical therapy, pharmacy, providers, etc to discuss the daily patient list, the plan of care, potential barriers to discharge, disposition needs, and escalation needs.
  • Discharge Huddles – case manager(s) meet with nurses and providers to identify current or next-day discharges
  • Teaching Rounds – educational rounds in Critical Care or teaching facilities with focus on detailed clinical history and differential diagnosis
  • Patient or Family Centered Rounds - discussions involve the care team and the patient/family to resolve care questions/concerns and education

All of these forums can be effective in improving communication across disciplines and addressing LOS challenges. There are readily available templates and guides that outline best practices--key questions to ask, the appropriate frequency, and suggested attendees. But the list of options is long and coordinating information across multiple meetings becomes increasingly difficult.

Does your organization use some/many of these forums? Are they all well connected and efficient? Are there gaps in communication, attendance, focus, walking/talking points and accountability for action items? 

  1. Do we have all the right members of the team or designees?
  2. Is it an efficient discussion of every patient, every day?
  3. Are we discussing plan for the day as it relates to the stay, progress towards medical milestones, and adherence to evidence-based medicine?
  4. Are we using these forums for other internal initiatives (e.g., new patient scripting, quality initiatives)?
  5. Is it led by a consistent member of the team that has been coached in facilitation?

If you’re like most organizations, you answered “no” or “sometimes” to some of the questions above. Regardless of the number of meetings, the members involved, the format, or the technology utilized, the success of any program is ultimately dictated by the quality, consistency, and timeliness of the information shared. When these initiatives fail, we typically see the following:

  • Programs are routinely initiated with clear objectives, comprehensive designs, and well thought-out tools. But after with an initial wave of positive progress, commitment wanes and results diminish. Staff get frustrated as old problems reappear. Teams begin a daily routine of “going through the motions."
  • There is an organizational mandate to have the huddles, but no accountability to the quality of the discussions. Meetings intended to improve communication and reduce ALOS will actually consume more staff time with no results. Which means the organization will have wasted a lot of time, effort, and money to further frustrate staff and maintain sub-standard performance metrics.

These pitfalls can only be prevented if leadership is fully engaged and supportive of the change. In high-performing hospitals, executives reinforce the importance of these programs by actively participating, gathering data, and reviewing dashboards to understand issues. They reward their staff for identifying opportunities and sustaining improvements. Until it is demonstrated that prompt elimination of barriers is the normal outcome, they know the culture will not change.


Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solution development. Mr. Foscato has deep domain expertise in improving clinical operations, implementing enabling technologies, optimizing revenue cycle and patient access functions for healthcare providers to deliver more effective patient care and financial performance. He also assists clients with activating strategy leveraging GE’s world-renowned management and leadership systems. He may be reached at [email protected].

 

treml.jpgMr. Treml is a senior manager with GE Healthcare Camden Group, with 12 years of management consulting experience. He has led a broad range of engagements including: improving perioperative serviced epartments through scheduling optimization and specific process improvements, developing comprehensive capacity strategy plansfor high occupancy institutions, implementing electronic event reporting tools, streamlining discharge planning processes, and increasing throughput in diagnostic imaging departments. He may be reached at [email protected].

 

Topics: Hospital Operations, Dominic Foscato, Hospital Discharge, Inpatient Occupancy Planning, Hospital Occupancy, Huddles, Length of Stay

Hospitals are Not Hotels: Examining the "Discharge By Noon" Strategy

Posted by Matthew Smith on Aug 25, 2016 10:11:15 AM

By Dominic Foscato, Senior Vice President, and Nehal Koradia, RN, MBA, Manager, GE Healthcare Camden Group

Most healthcare organizations have goals of shifting care from acute to ambulatory settings while maintaining or improving quality and satisfaction. That goal has not led to a drop in occupancy rates in every geographic market. Inpatient volumes continue to increase in many markets due to demographic changes, Medicaid expansion, and physician recruitment and consumer engagement projects.

Managing consistently high inpatient occupancy has created many ingenious tools/processes across the country. Healthcare providers have tried many approaches to solve inpatient capacity problems, but many have failed due to poor communication, lack of prioritization, fragmented approaches to change management, misaligned stakeholders, or unclear objectives. Not all of those ideas will solve the main problem (bed shortages) and some may negatively impact cost, quality and other desired outcomes.

Capacity_challenge.pngGE Healthcare Camden Group helps organizations design and implement new approaches to managing capacity/throughput challenges. Clinical leaders often ask our team to conduct three-to six-month studies to model their operations in a virtual environment while posing 3-4 key strategic questions and developing a macro capacity model using the following framework:

  1. Define specific objectives and create leadership committees responsible for the engagement decisions, timeline, and communication
  2. Analyze one-to-two years of available data from various sources to create a simulation model
  3. Create workgroups consisting of staff, department leaders, and clinicians to validate the model and assess potential impact of process or volume changes

One of the key strategic questions that we are asked to model is whether or not ‘Discharge by Noon’ or similar measures may inadvertently create more challenges than it solves. We typically find the following to be true:

  • Optimal patient flow dictates that beds are available when needed
  • Focus must be on the “occupancy overlap” when census spikes for 2-3 hours quickly followed by large numbers of discharges
  • There is a need to reduce ‘empty/unused bed time’--particularly when there is demand
  • Manage to ‘discharge order response’ times
  • Ideal flow would have discharge curve about 90-120 minutes ahead of bed request curve by type of bed needed
  • Achievable goals drive results
    • Generic ‘Discharge by ‘X’ as a house-wide goal often have higher observed/expected LOS ratios and rarely earlier discharges
    • Alternatively, we analyze which nursing units or hospital services need inpatient beds and then focus the care team on prioritizing activities to produce timely discharges

Cumulative_Discharges.png


Discharge_line_graph.png


But remember, it is not just about discharging a certain number of patients before noon when thinking about patient flow/throughput. If your organization already has a goal for discharge time, or is considering setting one, we recommend performing a thorough review by asking these types of questions:

  1. To prevent congestion, how many beds do you need? When do you need these beds?
  2. Which units or services need more beds? Which have too many?
  3. How will you design solutions that align the care team around designation, communication, and execution so that a patient can successfully be discharged in the morning?

Our most successful clients take a very structured approach to answering these questions and defining their capacity strategy. They balance the use of advanced analytic modeling with feasibility studies. The outputs from this process allow them to establish clear goals and expectations that motivate their entire organization. By setting reasonable and achievable unit/service level goals that contribute to solving organizational objectives (i.e., lower LOS, higher quality/satisfaction), the implemented changes have a higher impact and are more sustainable.

Inpatient Occupancy Planning


Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solution development. Mr. Foscato has deep domain expertise in improving clinical operations, implementing enabling technologies, optimizing revenue cycle and patient access functions for healthcare providers to deliver more effective patient care and financial performance. He also assists clients with activating strategy leveraging GE’s world-renowned management and leadership systems. He may be reached at [email protected].

 

KoradiaN.jpgMs. Koradia is a manager with GE Healthcare Camden Group. She has been leading healthcare organizations through transformation initiatives for over nine years. Ms. Koradia has worked with many large academic centers and community hospitals to transform their operating rooms, decrease readmission rates, increase early morning discharges, and reduce ER wait times by utilizing simulation modeling. She may be reached at [email protected].

Topics: Dominic Foscato, Nehal Koradia, Hospital Discharge, Occupancy Overlap, Inpatient Occupancy Planning, LOS, Priority Discharge, Hospital Occupancy, Length of Stay

Demystifying Length of Stay Projects

Posted by Matthew Smith on Aug 16, 2016 11:39:35 AM

By Dominic Foscato, Senior Vice President, and Bree Theobald, Vice President, GE Healthcare Camden Group

When educating healthcare executives to lead high-occupancy organizations, one of the fundamental outcomes-based measures to monitor is Length of Stay (“LOS”). Usually, the organization has tried many approaches to solving capacity problems but many have failed due to some of the following reasons:

  • Competing priorities
  • Misaligned incentives for key stakeholders (physicians and hospitals)
  • Perception of negative impact to revenue for percentage of charges and per diem payers
  • Poor communication within and between departments
  • Not aligning care models around the consumer experience
  • Lack of data to drive transparency and accountability

When healthcare leaders approach us with a LOS problem, we ask them the following questions before advising on how to proceed:

  • How do you define LOS? Current/in-house, discharged average LOS severity adjusted (comparing observed to expected benchmark)
  • Is it isolated to a specific hospital, department (Emergency Department (ED), Post Anesthesia Care Unit (PACU), etc.), nursing unit, service, disposition, time of year, day of week?
  • How much of a LOS problem is felt by a mid-afternoon census alert? Could it be a throughput/flow issue instead

We then want to understand the internal dynamics, such as:

  • How would other leaders and disciplines respond to the three questions above? Does your organization have a single, consistent point-of-view?
  • How frequently are LOS measurements and key process measures reported? Are department/hospital/system clinical leaders reviewing these metrics and continuously improving?
  • Are incentives aligned for the key stakeholders (especially those that are not in your organization)? How can you influence those groups to help you achieve your goals?

Once we’ve obtained a high-level understanding of the challenge(s), the next step is to understand stakeholder involvement, alignment, and expertise.

Case Study

Here’s a common scenario where health systems engage GE Healthcare Camden Group, coupled with our approach to improving operations:

Background

  • 450 bed, Level I Trauma Center in medium-sized city
  • State Medicaid expansion and physician recruitment have increased demand for IP beds
  • Hospital is working through many solutions: co-locating patients, redesigning hospital beds, planning for IP and ED expansions, managing internal projects on discharge timing, readmissions, and bundled payments

Challenge

The Performance Improvement department has recently assessed LOS and reported to its Senior Leadership Team that the organization has a LOS problem.

Our Solution:

  • Perform a ‘Flash Discovery’ by conducting key stakeholder meetings and data analyses
  • Create/Modify a Steering Committee charged with engagement oversight, communication, resource allocation, and executing decisions
  • Conduct a 3-5 month ‘Capacity Strategy’ engagement to model operations and unique patient pathways around 3-4 key strategic questions
Follow-on initiatives include:
  • Create highly efficient/effective, daily multidisciplinary rounds to discuss each patient’s plan for the stay/day, progress towards transition/discharge with all key members of the care team
  • Re-allocate beds to services based on historic demand, budgeted volume or other initiative to mirror the patient placement matrix
  • Redesigning Case Management to ensure appropriate staffing, staff utilization, resource utilization, workflow and expectations align with efficiently delivering healthcare
  • Target specific patient populations for administrative or clinical LOS opportunity (e.g., pneumonia, heart failure, hips/knee replacement)
  • Reduce elective variation in the Operating Room and create a more predictable outflow with ‘priority discharges’ to better align demand and availability of beds

Value

los.png

  • Each healthcare market is unique, but in this example, the hospital was losing patients to competitors due to capacity issues. By creating organizational alignment, studying LOS and process metrics and selecting a few initiatives to impact LOS, the client reduced severity-adjusted LOS and created capacity to treat new patients.
  • By treating more patients, referring physicians and network facilities were more engaged as the hospital was now more ‘accessible’ and information more widely trusted/understood.

There is great power in taking more of a transformative approach with this as a major initiative well supported by leadership, data driven, and executed in a way that involves a number of change management tools to help drive and sustain change.

 Capacity Management, Length of Stay


Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solutiondevelopment. Mr. Foscato has deep domain expertise in improvingclinical operations, implementing enabling technologies, optimizingrevenue cycle and patient access functions for healthcare providersto deliver more effective patient care and financial performance. He also assists clients withactivating strategy leveraging GE’s world renowned management and leadership systems. He may be reached at [email protected]. 

 

Bree_Theobald.pngMs. Theobald has been leading healthcare organizations through transformation efforts for 8 years with GE Healthcare Camden Group, focusing on utilizing simulation modeling and advanced analytical tools to optimize capacity, whether that be inpatient, procedural, or clinic capacity. This has allowed organizations to improve access for patients, streamline operations and improve financial performance, while also creating a culture of continuous improvement. Currently, in her role as a vice president, she has spent the last five years navigating and aligning academic medical centers to deliver measurable improvements. She may be reached at [email protected]. 

Topics: Dominic Foscato, Bree Theobald, Capacity Management, Occupancy, Length of Stay

Facing Bundled Payments

Posted by Matthew Smith on Feb 19, 2016 9:40:29 AM

By Dominic Foscato, Vice President, GE Healthcare Camden Group

Change in reimbursement isn’t waiting for tomorrow. It’s happening right now. Rather than paying for each procedure and office visit, government and private health plans are moving toward a payment model based on the health of an organization’s patient population. During this transition, an organization’s success depends on its ability to manage a variety of payment models.

Health care organizations must successfully administer these payment models — which continue to evolve and grow more complex —while optimizing quality, outcomes and patient satisfaction. In short, they must manage “fusion reimbursement” or risk significant cuts in revenue.

Bundled Payments

Reprinted with permission from the February 2016 issue of Trustee magazine, vol. 69, no. 2. © Copyright 2016 by Health Forum Inc. Permission granted for digital use only

Topics: Bundled Payments, Value-Based Payments, Alternative Payment Models, Dominic Foscato

Subscribe to Email Updates

Value Model, Health Analytics

Posts by Topic

Follow Me