5 Environmentally Sustainable Tips for Health Facilities

Hospitals spend $10 billion every year disposing of waste according to the American Hospital Association. As industries everywhere are “going green,” healthcare facilities are implementing green technology programs as well, and the applications can be overwhelming. Not only do sustainability initiatives help reduce hospitals’ carbon footprints, but also increase operational efficiency and promote the patient experience, and hospitals’ relationship with the surrounding community as well as with their employees.

Health facilities consume about two and one-half times the power of a standard commercial facility. They are massive consumers of energy and utilities due to a multitude of contributing factors including:  lengthy hours of operations, constant volume environmentally filtered air management, complex waste control systems, and extraordinary primary and secondary power equipment.

5 Green Design Tips:

Get a handle on things. With different waste streams managed in different departments, overseeing waste management is a crucial step to ensure a successful waste treatment program. Hospital waste generally falls into 6 categories: solid, regulated medical, hazardous, pharmaceutical, universal and recycled. Once tracking is in place, health organizations may begin to execute a long term plan to measure sustainability effectiveness and set benchmarks. A facility wide audit of energy, waste and water usage can help in this endeavor to establish a baseline.

Upfront costs are easier to bear than you think. A 2007 survey in Building Design + Construction indicated an expected 3-15% premium for operationally beneficial “green” building materials and systems. Without argument, a short-term premium does exist for these types of facility upgrades, however the strategy is sound.  Some of the up front load can be minimized through manufacturers’ inducements and municipal incentives that include abatements or tax credits.

A first class example of a hospital leading the way with green initiatives is Newberg Oregon Hospital. It is the birthplace of the nation’s first hospital to operate entirely on green power. Newberg Oregon Hospital eliminated the burning of fossil fuels saving the environment from over three million pounds of carbon dioxide emissions each year. The hospital purchases in excess of 2,160,000 kilowatt hours of renewable power annually from Portland’s General Electric Clean Wind program. In addition, Newberg’s directive implemented processes to reduce solid wastes and increase water efficiency.

Another good example of a health system being proactive in sustainability practices is Catholic Healthcare West (CHW). In 2008 CHW increased food service environmental and sustainable programs by 30%. Also in 2008, the organization accomplished its long term goal of reducing solid and medical waste to less than or equal to 15 pound per adjusted patient for three years. More recently, after partnering with a medical device repurposing company, CHW was able to redirect their medical waste which saved the organization over $500,000 in supply costs.

The flexibility, renewability and sustainability of forward thinking non-polluting engineering design compliments the universal mission of healthcare. As if the benefit of minimal greenhouse effects were not positive enough, factoring for inducements, incentives, abatements, tax credits and energy savings, an educated team can construct near par and save millions for the future.

Through strategic sustainability practices, the savings are real. The truer question is not if hospitals should implement green directives, but when and how aggressive are they willing to be.

Source:hcrealty

Medical technology: Reshaping healthcare delivery

In this age, technology allows hospitals, outpatient facilities and other parties in the healthcare continuum to capture patient data from registration to diagnoses to post discharge helping reshape the way healthcare can be delivered. Even in this economic climate, hospitals are continuing to purchase new technology to improve patient outcomes. By shortening inpatient stays and fixing inefficiencies costs can be reduced.

In the above example I was referring specifically to electronic health records (EHRs) which are seen as a significant factor in the reshaping of healthcare delivery. Via EHRs all healthcare providers are able to share one secure chart, facilitating patient care and eliminating or at least reducing any inconsistencies such as wasted patient and travel time. With the current healthcare system disorganized and in need of a realignment, EHRs and other medical technology help care be delivered right, the first time, and allow for all providers to be on the same page as each other.

Hospitals are making evidence-based decisions that revolve around clinical studies demonstrating improved outcomes with the new technology. Though they are cautious in their approach of purchasing high-priced technology, improving health care quality, cost and safety are top concerns for all hospital executives and as budgets grow tighter finding solution to these issues is a must.

3 questions to consider before investing in new technology:

Will it improve patient care? If new technology is not in the patient’s best interest then it should not be considered. The new technology should be able to provide higher quality care at a lower cost for the patients. One example is advanced robotic surgery systems, which are a costly investment, but can perform less intrusive surgery making for a shorter hospital admission as well as recovery time.

Will operations be streamlined? Next to patient care, new equipment should streamline operations, resulting in cost savings for the hospital. Whether as a result from combining services, requiring fewer employees to administer care or simply replacing older equipment that costs more to maintain, new technology needs to make the health facility more efficient.

Is the full gamut of costs being considered? It’s not only the machines that cost money, but just as crucial is the time spent to train providers. For instance, radiosurgery is among one of most expensive capital item hospitals are purchasing and though it costs in the range of $3 million, there are the substantial costs involved of training employees to operate the equipment as well as supporting devices, which sometime require their own service providers.

Hospitals continue to operate on a small budget and though healthcare technology can be costly, it can also save money. In this time, there are many uncertainties, but by paying more attention to facilities’ inefficiencies, there is certainty that new technology can be impactful on bettering patient care and helping curb costs.

Source:healthcarefinancenews

Holding down costs a key materials management function

Materials managers are reaching the C-suite

"What we've seen in the past year is that CEOs and CFOs have cut as much as they can with labor and they're getting the best product prices possible, yet their supply chain expenses continue to go up," said Pam Poshefko, consulting manager at Chadds Ford, Pa.-based IMA Consulting. "They want to know why and what they can do to get those costs out."

On the product utilization side, clinicians are often targeted for reductions and questioned about their practices, which understandably can put them on the defensive. It can also put the MM in an awkward position, Poshefko said.

"MMs have a lot of data from information systems, but not a lot of knowledge from that data," she said. "They have not been able to accurately gauge utilization, which makes it difficult to deal with those who use the products. Without knowing whether clinicians are over-utilizing products, there is not much to say because they are the clinical experts and know how to use the products."

Even so, Poshefko recommends that materials managers get together with clinicians to discuss product utilization in a non-confrontational way.

"There is a lot of low-hanging fruit  -  not in pricing, but utilization opportunities," she said. "The job is much more than just contracting; it is teaching everyone how to better manage resources."

MMs maturing

Bill Stitt, past president of the Association for Healthcare Resource & Materials Management (AHRMM), says the MM's job has evolved over the years to include many more responsibilities and is a key cog in the healthcare financial machinery.

"Materials management is so much more than purchasing today," said Stitt, who serves as vice president of Materials Management for Robert Wood Johnson University Hospital in New Brunswick, N.J. "Sure, we still manage that function and it is important, but that's really more an output of so many other activities, rather than a principal part of our job."

Slowly, materials professionals have become more strategic and they are now charged with planning and implementing solutions rather than just managing transactions, Stitt said. Along with purchasing and logistics, materials personnel are asked to provide value analysis, manage reimbursement and become more involved in directing general operations.

Stitt agrees that MMs need to work on diplomacy when it comes to dealing with clinician product usage.

"We need to develop our presentation skills, our ability to look at things strategically and learn how to talk with physicians and clinicians even if we are not clinical ourselves," he said.

Change agents

To be sure, the conventional responsibilities of purchasing, order placement and product fulfillment are still part of the MM job, but the leader of supply chain operations needs to focus more on strategic global issues for the healthcare organization, added Bill Donato, executive director of supply chain management for the Cleveland Clinic and past president of AHRMM.

"The materials manager is still evaluated on day-to-day efficiencies and responsiveness, but that is only one area of focus," he said. "You have to make sure the day-to-day responsibilities don't distract from the strategic global view."

While materials managers are held accountable for supply chain costs, Donato is quick to point out that much of what they are in charge of is beyond their control. The MM's job, he says, is to operate as a "change agent" for the supply chain.

"We introduce the data, analytics, published studies and business details of the supply chain into the decision making process," he said. "When you take that and work with physicians and clinicians to integrate clinical expertise, we become very influential in the decisions that are made on cost, quality and outcomes."

Redefining supply practices

Over the past seven years at Intermountain Healthcare in Salt Lake City, Utah, Brent Johnson has diligently analyzed the intricacies of materials management in order to institute meaningful change that will benefit the organization in the future. One interesting discovery he made is that there are common misperceptions about expenditures outside of labor.

"So many think med-surg products represent the major part of the spend, but it only makes up about 30 percent," said Johnson, vice president of supply chain and imaging services. "Non-clinical products make up 40 percent, along with IT and food and nutrition."

Johnson entered healthcare supply after working in the electric utility industry. As he assumed control of Intermountain's materials department, his bosses gave him plenty of latitude to build a "robust, strategic supply chain organization" seen in other industries.

His desire to transform materials management is evident: "I think healthcare needs to be run like a business and more often than not it isn't. That could be because of the non-profit focus and the mission of delivering care."

Still, Johnson says his organization is "making good strides" in reducing costs and non-labor expenses. And in the process, he says the MM position has gained in stature and influence.

Source: healthcarefinancenews

8 kinds of waste driving healthcare costs

There's a tremendous amount of waste occurring in the healthcare industry. In order to address that waste, organizations are moving to lean management because it exposes what and where these wastes are and rethinks the way work is done via value streams.

Most providers are set up by departments, or vertical silos. In the case of manufacturing, it's products that traverse these departments, from receiving an order to collecting the money for it. In healthcare, what traverses departments are the patients.

Tracking patients horizontally through a healthcare value stream changes the way you think about what's value-added and what's not said Marc Hafer, author of the book Simpler Healthcare and CEO of Simpler, a firm globally dedicated to lean application, techniques and transformation in healthcare. "When you reconstruct patient flow through an experience at a clinic and you think horizontally... that's when you see all the waste there really is," he said.

Hafer shared with Healthcare Finance News the eight different types of waste that inhibit patient flow, add cost, increase poor quality and infection and decrease patient and clinician satisfaction. "When you remove waste, all these things change for the better," remarked Hafer. "The value-added stream method is fundamental for patient flow in healthcare organizations."

1. Transportation

Transportation is entirely non-value-added. "It contributes nothing to patient care. It adds to delays and increases likelihood there will be defects and dissatisfaction," Hafer said. Transportation includes moving patients from one department to the next, shifting supplies and equipment and moving instruments from sterile processing areas to the OR and back again – and even when patients travel to and from the actual hospital itself.

2. Inventory

Inventory can include pharmaceuticals, supplies, and patients, too, if you consider a waiting room in a hospital. The replenishment system should be based on use as opposed to some forecast. "Only what's needed when it's needed is a good approach with inventory," Hafer said.

3. Unnecessary motions

Reaching, bending, twisting, turning. These motions are all ergonomic issues abundant within healthcare. Clinicians are injured because processes like transporting a patient from wheelchairs to beds aren't designed ergonomically. Staff takes time off for rehabilitation when unnecessary motions incapacitate them, which can result in a loss of productivity and enhance overall costs.

4. Waiting

"Patients waiting for treatments, clinicians waiting for supplies... as cliche as it sounds, time is money," said Hafer. And sometimes it's a matter of safety, too. There are some medications that need to be administered within a certain amount of time  after a reaction or a procedure. Waiting can diminish the quality of the pharmaceutical and it's effectiveness with the patient.

5. Overproducing

Overproducing is creating more of something than what's exactly needed. Sending medications to a patient's room that won't be used because the patient has already been discharged is an example. Along the same vein, this type of miscommunication between departments can also extend a patient's stay which is another form of overproduction. Other examples include repetition of diagnostic tests and the multiple registrations a patient has to endure when checking in. It's a laborious, unnecessary process and one time should be sufficient enough.

6. Processing Waste

Creating reports that don't get read or aren't useful, administering duplicate tests – doing things where you produce 105 percent  when you only needed to give 100 percent is processing waste, Hafer explained.

7. Defects

There are countless defects within healthcare situations, such as hospital-acquired infections, early discharges that lead to readmissions, incomplete medical records or instrument kits in the ER and inaccurate medical billing. In many circumstances, these defects are covered-up through reworks and work-arounds, Hafer said, but with lean management, a light is shed on these defects, the root cause is figured out and a countermeasure is put in place that won't allow them to reoccur.

8. Unused human potential

With all the waste that already exists in healthcare, the last thing clinicians need to do is more non-value-added work, Hafer said, yet it happens all the time. Lean organizations involve people in redesigning work and real-time problem solving, Hafer explained, unleashing human talent on the right things to solve problems and reduce waste for patients.

Source: healthcarefinancenews

5 ways telemedicine is reducing the cost of healthcare

Telemedicine and mHealth have the potential to help the healthcare system meet the Institute of Healthcare Improvement's triple aim to simultaneously increase the quality of care, improve the health of populations and reduce the per capita cost of care.

"Collectively, investments in telemedicine and mHealth have great potential to reduce healthcare system costs," said Adam C. Powell, president of Payer+Provider Syndicate, a consulting firm that uses techniques from health services research to bring about change in the health insurance and hospital industries.

A 2011 study by Anna Sommers and Peter Cunningham released by the National Institute for Health Care Reform found that hospital readmissions within a month of discharge have cost over $16 billion each year. Telemedicine can be used to reduce readmissions and other adverse events at a cost that is less than the cost of the problems themselves.

Healthcare Finance News spoke with Powell, who outlined the five ways that telemedicine can play an important role in decreasing overall healthcare spending.

1. Use of remote analysis services. Remote analysis services, like telepathology and teleradiology, can contribute to lower cost and higher quality care as they enable highly trained professionals to work as a pooled resource. Use of these remote services enables low-volume providers to have around the clock coverage at a lower cost. In smaller facilities, there may not be sufficient volume to keep a pathologist or radiologist fully occupied. Telemedicine enables fractional employment.

2. Remote monitoring technologies. Remote monitoring technologies are enabling patients to be monitored on an ambulatory basis when they previously may have needed to be monitored as inpatients. Given the high cost of providing inpatient services, though, moving some forms of observation to an outpatient basis substantially reduces the costs borne by the healthcare system.

3. mHealth monitoring technologies. The use of mHealth monitoring technologies reduces the cost of complications due to chronic disease. For instance, an increase in body weight due to fluid retention is often a sign that someone may soon need to be hospitalized due to heart failure. Disease managers with access to daily weight information may be able to help a person experiencing fluid retention get the care they need before a crisis occurs. Averting crises both improves the quality of care and lowers costs.

4. At-home Triage Services. At home triage services facilitated by televisits with nurses and primary care physicians reduces the unnecessary (and expensive) use of emergency room visits.

5. Telemedicine Appointments. By offering telemedicine appointments, providers can reduce the amount of their unused capacity that goes to waste. Many services allow providers to start or stop accepting patients based upon their current availability. As this capacity would otherwise not produce any revenue, providers are able to provide remote patient visits at a rate that is lower than the one they normally offer. This in turn reduces system costs by enabling patients to receive care at a lower price point.

Source: healthcarefinancenews

Controlling healthcare costs through work-site clinics

Thirty-one percent of companies employing 500 or more people had on-site clinics according to a 2011 survey by Mercer, a human resources consultant. Not only seen as a way to help control employee healthcare costs, but as a brand enhancer, productivity booster, and potential hospital referral source, company work-site clinics are a helpful service.

Work-site clinics are not too new to the scene. More common prior to the 1980s, these care facilities revolved around work related injuries. As workplaces modernized and become less risky for hazards to occur, clinics began closing. In their recent rebirth, today’s workplace clinics focus more on health and wellness promotion and preventive care services.

A growing demand:

Clearly the driving factor for these types of facilities is controlling medical costs. These clinics can have a tremendous impact on avoidable hospitalizations and visits to the ER. Companies are able to strategize a long term employee health plan to curb costs and by doing so, fortify a healthier and happier workforce. On-site clinics provide other numerous benefits including:

•    Convenient medical services

•    Minimizes sick days

•    Promotes good health practices

•    Increases employee retention and recruitment

Useful for hospitals and business alike:

How well employees are feeling directly impacts their ability to perform their duties, which ultimately affects a company’s bottom line. While the company can offer employees preventive services, hospitals in the area can provide nurse practitioners to assist. Both organizations are bolstering their reputations and should the patient need advanced care, the clinic is a great referral source for the hospitals.

Source:healthcarefinancenews

Pros and Cons of Healthcare Reform for Hospitals

The Supreme Court’s decision for healthcare reform will occur very shortly, but in the meantime I wanted to give a run down of how I see reform’s consequences on hospitals: for better and for worse.

3 Pros and Cons of Healthcare Reform:

Pros

1. Becoming more efficient: Healthcare reform and all its provisions are already making hospitals find new ways to increase facility efficiency, better manage care and streamline costs. One item is renovating hospitals to cut down on operating expenses. Hospital executives allocated 21% of their budget to renovations compared to 16% for new construction in 2012 according to an ASHE 2012 survey. Another method is implementing new programs such as Seton Family of Hospitals did when they enacted a nurse call center which on a monthly average dropped emergency room trips by 12.1%.

2. New model of care: Hospitals are moving away from the contemporary fee-for-service model, a contributing factor for our excessive healthcare spending, and are switching to value based models of care. Before, the more services hospitals performed, the more money they would make. Now, that is changing with hospitals being held accountable for their patients. Patient treatment outcomes versus cost are compared and hospitals who meet the requirements receive a bump in federal payments.

3. Helps the bottom line: Though there will be substantial cuts to Medicare, should healthcare reform pass, the vast majority of uninsured costs would be covered, giving some money back for what was previously written off. This suggests more money will be available to healthcare providers and, if the theory holds, a healthier population that needs less care over time. Alhough, it also depends on the specific hospital’s surrounding community and amount of care performed for indigent patients compared to Medicare patients.

Cons

1. Administrative costs: Hospitals and health systems will have more to do on their own as they take care of the influx of new patients. That is much more paper work, disease and care management, over-seeing and time dealing with Medicare for the millions of newly insured patients.

2. Coverage: The sheer act of providing coverage to more people would produce a new order of challenges. If access can’t be improved then there is still a problem of providing care. Medicare and Medicaid patients already indicate it difficult to find a physician, and coupled with the high attrition rate of doctors, finding healthcare providers to treat these new patients will be in increasingly short supply.

3. Cut in payments: Yes, there will be excessive decreases to Medicare reimbursements, around $112 billion in the ensuing years according to the Congressional Budge Office. There will also be a loss in tax breaks. These are viable methods the government issues to help hospitals meet their costs.

While there are downsides to healthcare reform, there is so much opportunity. We like to talk about heath reform and make note of its importance, however the healthcare system is not waiting, and is improving in real time, independent of the final outcome.

Source:healthcarefinancenews