presented by james digiorgio president, applied knowledge, llc
TRANSCRIPT
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9 Innovations to Improve Emergency
Department Financial Performance
Presented by James DiGiorgio
President, Applied Knowledge, LLC
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Webinar outline:
-Brief introduction-Perceptions of Emergency Department-ED statistics-Importance of your ED to your institution-ED Innovations-Q&A
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Polling Question? Which phrase best describes your ED?
1. Important contributor to the success of the hospital
2. Necessary department but not a key contributor to hospital success
3. Not that important to hospital success
4. Other
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Loss leader? ‘Department Chaos’? Focus of uncompensated care? Need to reduce visits to the ED? Front door to your community?
How do you look at your ED?
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Increasing or decreasing ED visit trends Varies across country Impacted by ACA Impacted by HDHP
How do you look at your ED?
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ED = over 140 million visits per year (visits = 44% of U.S. population)
28% of all acute care visits 2/3 of all acute care visits for uninsured 50+% of acute care visits for Mcaid and
CHIPS 50% of all inpatient admissions 70% of admits of Mcare patients
ED Stats
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ED = about 4% of U.S. healthcare spending Inpatient care = about 31% of U.S.
healthcare spending Federal law requires EDs to evaluate and
stabilize all who present to the ED without regard for ability to pay, they serve as the “safety net of the safety net” for uninsured patients and Medicaid beneficiaries
ED Stats
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ED Stats -CDC One or more emergency department visits in the past 12 months, by age and type of coverage: US 2002-2012
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ED – your largest admitter 50% of all inpatient admissions 70% of admits of Mcare patients
ED is your largest ‘admitter’
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Between 2003-2009 - 17% increase in unscheduled inpatient admissions from the ED.
More than offset a 10% decrease in admissions from doctors offices and other outpatient settings.
RAND study
ED is your largest ‘admitter’
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ED admissions are projected to grow 23% faster than population growth (Health Affairs)
Acuity of admissions will increase and require more resources (more chronic conditions)
IOM study – EDs are overburdened, underfunded, and highly fragmented
Emergency Department – Admission Trends
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EDs are evolving◦ Acute care◦ Urgent care◦ Primary care◦ Freestanding EDs◦ ‘Admitting department’◦ Observation care and 2-midnight rule◦ Specialized care
Cardiac, stroke, geriatric, behavioral health, etc
Emergency Department
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Goal – innovations to improve operational and financial performance
Improve quality of care/outcomes Increase productivity Improve efficiency Lower cost of care Increase revenue
Emergency Department Innovations
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EDs are complex systems Multiple connections to other departments Potential for system failure/low performance Opportunities for improved operations New approaches = more
efficiency/effectiveness
Emergency Department Innovations
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Emergency Department Innovations
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Polling Question? Which of the following ED metrics is most important in your ED?
1. Patient satisfaction
2. Patient throughput time
3. Reducing left without being seen patients
4. Other
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Patient Flow/Throughput is KEY Impacts efficiency, revenue, cost, patient
experience Most EDs continually focus on improving
processes Like fixing a car engine while it is still
running (24/7)
Emergency Department Metrics
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KEY ED Metrics: Door to Doctor time (key to pt experience) Provider to Decision time Decision to Departure Left Without Being Seen (LWBS) Patients per hour
Emergency Department Metrics
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Factors that affect ED Flow/Throughput: Patient volume/arrival time Ancillary testing time Physician specialist consultation time Ability to admit patients (boarding) Behavioral health patients (lack of capacity)
Emergency Department Metrics
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Emergency Department Innovations
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Scribes to increase provider productivity Implementation of EMRs has decreased
provider productivity Does it make sense to have high paid
providers perform clerical duties? Medical scribes take over documentation
duties from providers Increase provider productivity
Emergency Department Innovations - Scribes
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Outsourced or home grown models Outsourced model Project leader comes on site to learn your
ED Simultaneously learns ED, recruits local
candidates, train them to be scribes, trains physicians to utilize scribes
30-90 day process
Emergency Department Innovations - Scribes
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Positive financial impact of scribes◦ Increase productivity (patients per hour)◦ Increase revenue (several ways)◦ Reduce provider staffing◦ Reduce LWBS ED patients (capture lost revenue)◦ Improve documentation (increase reimbursement)◦ Enhance patient experience ($)◦ Reduce LOS in ED (more ED capacity)
Emergency Department Innovations - Scribes
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Positive financial impact of scribes Cost or Return on investment (ROI)? Adjustment (decrease) in provider staffing
pays for scribes (most times ROI) Decrease/elimination of OT hours for
completing documentation Incremental increase in revenue
Emergency Department Innovations - Scribes
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Medication reconciliation is a time intensive manual process
Time by RNs, Pharmacy Techs, Physicians 2-3 minutes per Rx to complete
reconciliation 15-20 minutes (avg), more for more
complex patients
Emergency Department Innovations - Medication Reconciliation Tool
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Take advantage of electronic Rx data Aggregate data from Rx ‘switches’ Acquire data from pharmacy chain stores Capture Rx data from other sources Provide web-based Rx history lookup Reduce ‘med rec’ time by half or more About 80% success rate and improving
Emergency Department Innovations - Medication Reconciliation Tool
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Rx tool is provided by web access Staff must be trained to use the tool Staff must be motivated to use the tool Based on demographic data input Searches cumulative Rx electronic database
for Rx history Used as to complement patient Rx info Compliance tool
Emergency Department Innovations - Medication Reconciliation Tool
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Patient navigators/patient champions Video engagement/education Goal to improve coordination of care and
compliance with aftercare Improve outcomes, reduce re-admissions,
improve patient health, improve patient experience
Emergency Department Innovations - Patient Engagement Tools
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Patient navigators/patient champions communicate with patients during and after clinical encounter to assure understanding and follow up care
Diagnosis specific videos are emailed to patients for use after clinical encounter to re-inforce follow up care/share with family
Emergency Department Innovations - Patient Engagement Tools
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Improve outcomes, reduce re-admissions, improve patient health, improve patient experience all relate to reducing cost of care and meeting goals
Emergency Department Innovations - Patient Engagement Tools
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Modeled after ‘call ahead seating’ at restaurants
Intended for low acuity patients – allows them to wait at home until time to come to ED
Goal ‘load leveling’ of patient arrival times Avoid surge of low acuity patients during
peak arrival times Improve ED efficiency
Emergency Department Innovations - Making Appointments for ED Care
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Patient goes on line to search for ED services
SEO bring up your hospital near top of search results
Allows low acuity patients to select a time to come to your ED and wait in comfort of home
Patient comes to ED, seen in 15 minutes of arrival
If available, can select UC, ED, clinic
Emergency Department Innovations - Making Appointments for ED Care
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Very high patient satisfaction (90+ percentile)
Brand building tool for hospital/system in age of growing consumerism
Used frequently by FHOH, key decision maker
Attracts more insured patients than typical ED payer mix
Half of patients are new to hospital/system ROI/Payback in several months
Emergency Department Innovations - Making Appointments for ED Care
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Polling Question? Which of the following barriers would be the most difficult to overcome to implement innovations in your ED?
1. Funding/budget
2. Culture – ‘we have always done it that way’
3. Approval from hospital leaders
4. Other
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Provides data driven management tool to analyze performance/optimize ED operations
Captures operational data from EMR and multiple other systems into data warehouse (EMR, payroll, billing, patient satisfaction, etc)
Ease of use allows managers to use data to make decisions, not spend time finding data
Insights from data drive positive change
Emergency Department Innovations - ED Dashboard
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Allows quick drill down to provider or patient specific data
Provides analysis using multiple variables to uncover area for improvement
Identifies gaps in charge capture to improve revenue
Offered as a web based tool with minimal effort by hospital IT staff
Emergency Department Innovations - ED Dashboard
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Can provide retrospective (monthly) dashboard or real time dashboard
Monitor and key metric trends, performance Provides decision makers with access to
data needed to make decisions, improve processes
Offers analytic tools to find areas for improvement impacting service, revenue
One/two clicks – what is pt sat results for Dr. Smith among Mcare patients?
Emergency Department Innovations - ED Dashboard
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Communication system to digitize the process for reaching ‘on call’ physicians
Many current systems are paper based or old fashioned rolodex
Current systems are cumbersome and produce extended response times to pages from the ED (30- 60+ minutes)
Delays slow patient care and throughput
Emergency Department Innovations - ED Communications System
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New web-based paging application offers HIPAA compliant 2-way communication
Offers efficient on-call system - smartphones
Allows direct and immediate responses Provider receives page with accurate info
about patient Images can be communicated for clinical
review
Emergency Department Innovations - ED Communications System
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Facilitates direct voice or text communications between providers
Database of on-call schedules can be maintained centrally or distributed across enterprise
Changes to on-call status can be made instantly from smartphones by physician
Reduces on-call physician response time
Emergency Department Innovations - ED Communications System
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New approach to ED design Smaller physical footprint for ED Improves patient capacity/patient flow Reduces patient throughput time Improves patient experience/satisfaction Reduces LWBS Increases revenue through efficiency Lowers capital needed for new/renovated
ED
Emergency Department Innovations -High Performance Design
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Enhanced flow = more patients, more admissions = additional revenue
Reduced expense per patient through improved efficiency
Involves design, process change, culture change
Helps build reputation/brand in the om community
Emergency Department Innovations-High Performance Design
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Tool: Captures revenue from written off accounts using ‘data mining’
Focuses on TPL cases that hospitals are unable to track
After written off accounts are downloaded, outsourcer does all the follow up and collections for contingency fee
Does not contact or collect directly from pts
Emergency Department Innovations- Revenue Capture
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Tool: Improves documentation and coding to boost revenue in ED
Focuses on improving the documentation and coding processes
Identifies areas for improvement and re-educates staff on improving processes
Improvements range from $100,000s to $1,000,000s across all size hospitals
Emergency Department Innovations- Revenue Capture
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Expert guidance for delivery of Observation care
Focuses on improving the documentation and coding processes
Improves compliance with 2 midnight rule Help evaluate the impact of RAC program Improvements range from $100,000s to
$1,000,000s across all size hospitals
Emergency Department Innovations- Revenue Capture
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Optimize ED staffing using ‘big data’ Uses data science and advanced analytics
to develop most efficient staffing plan Improves performance to reduce
overstaffing (reduce cost) and understaffing (improves service)
Optimizes mix of personnel Case study: Identified $500,000/yr savings
Emergency Department Innovations- Improve using ‘Big Data’
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Optimize ED (or other hospital) processes Uses digital simulation modeling vs. real life
trials to optimize processes Allows ‘what if’ scenarios testing at low cost
and fast results Has been used on departmental focused
projects and whole hospital projects
Emergency Department Innovations- Improve using ‘Big Data’
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Questions????
Tel: 630-219-4118Email: [email protected]
Presented by James DiGiorgio
President, Applied Knowledge, LLC
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Questions????
Tel: 630-219-4118Email: [email protected]
Presented by James DiGiorgio
President, Applied Knowledge, LLC
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Presented by James DiGiorgio
President, Applied Knowledge, LLC
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Review charge master at least annually Do not have RNs assign charges or do
coding Develop cost based charges for services Train ED staff annually Use a tool to monitor/track/trend
operational and clinical performance
Emergency Department- Common Sense To Do’s