Small Maine hospital shares experiences in making tough financial decisions

When it comes to making difficult financial decisions at hospitals, it’s crucial to maintain transparent communications with employees and the community. How one small hospital weathered a financial crisis was the focus of a presentation Oct. 26 at a hospital best practices workshop presented by the Maine chapter of the Healthcare Financial Management Association in Auburn, Maine.

Wendy Jones, controller at Blue Hill Hospital in Blue Hill, Maine, shared the successes of the hospital’s process of making important decisions during a difficult financial environment.

By the end of 2008, Blue Hill Hospital, a small, 25-bed critical access hospital, was “coming up on a year of huge operating losses with a 2009 fiscal year budget approved with a nearly $1 million deficit,” Jones said.

Historically, Blue Hill Hospital had always received a great deal of endorsement funds, however, due to the financial crisis in 2008, those endorsements had decreased substantially leading to the beginning of the hospital’s financial troubles.

“Blue Hill’s mission had never focused on finance. It was the culture of Blue Hill itself,” said Jones. “Until this financial perfect storm happened, the executive management couldn’t grasp the possible crisis coming, and when it did, the hospital’s governance committed to change but didn’t know what to do.”

Jones said it was at this time that the executive management of the hospital had to start making difficult decisions, which included closing the hospital’s well-known labor and delivery program.

In addition, Blue Hill Hospital utilized support from their hospital affiliate, Eastern Maine Healthcare Systems (EMHS), and began outsourcing areas of the organization to EMHS, including various fiscal services and accounting.

All of these decisions, said Jones, were made in conjunction with effective communication among staff and the community as a whole.

“Physicians were worried about how they would achieve their missions and continue to take care of the community, while the community was wondering, ‘will we still have a hospital to go to?’” she said. “It’s important to understand the diversity of your affected groups and their point of views that they are coming from. Putting as much information out there as early as possible – that tends to work well.”

During this financially challenging time, Blue Hill Hospital discovered a number of tactics for making difficult financial decisions that really worked well for them, Jones said. The successful tactics included management training to ensure managers were given the tools they needed; establishing attainable goals with time parameters; and always maintaining alignment with governance, which, in some cases, required new hospital committees to be formed. Jones added that as far as alignment with governance goes, it’s important to know “when to stop fixing the leak and realize something cannot be fixed.”

Jones also discussed the hospital’s utilization of a voluntary leave program for employees.

“In the process of aligning our budget, the hospital came up with a voluntary leave incentive program and six employees took the opportunity. They voluntarily resigned, and we didn’t have to do layoffs,” she said.

Despite the fact that Blue Hill Hospital was forced to make a lot of difficult decisions in order to get their budget back on track, Jones said the hospital looked at ways in which their decisions could serve as positive opportunities for them.

“It was an opportunity for us to replace low performers and begin a reutilization of space. Our labor and delivery area become an oncology unit,” she said. “Executive management was able to focus on new services and ensure their mission is sustainable into the future.”

Source: healthcarefinancenews

5 ways pharmacy automation saves money

With medication shortages, patient safety and accurate dosing creating daily challenges, some providers have found financial benefits in pharmacy automation solutions.

"Any time you put humans into a process, there's a massive risk of contamination, errors and other costly mistakes," said Bill Shields, global vice president of sales and marketing of Intelligent Hospital Systems in Winnipeg, Canada.

Shields outlined the five specific ways an automated pharmacy operation can save money and improve patient safety.

1. Reduced vulnerability to medication shortages

"Drugs haven't increased – doses have. Roughly 80 percent of prescriptions or dosages come from 20 percent of drugs," said Shields. "Pharmacies can't do the volumes needed, so they outsource the drugs. The outsourcers then get priority on the drugs, and in turn the hospitals pay an incredible amount for them. Usually five to six times more than they would normally pay if they were to buy directly from wholesaler in house." And, with more and more drug shortages occurring, what happens is that hospitals are being required to buy extra drugs from outsourcers, and when they do that they're actually just stockpiling them, presenting a whole slew of other issues. "The days of 'just-in-time' ordering are over," continued Shields. "Hospitals are either buying from outsourcers or buying them on a gray market. And if you run out? You're in big trouble."

2. Lowered cost-per-dose of medication

"While some drugs can be $24 per vial, which are single dose vials if a human is drawing off it, a larger vial through automation can be $2.50 a dose per vial. And you can do multiple draws off this, which means multiple dosages," Shields explained.

3. Reduced pharmacy and medication waste

"If a human draws two grams out of a ten gram vial, they have to throw away whatever's remaining. It cannot be used again," said Shields. If you have an automated system that's a fully contained, isolated unit than multiple draws from the same vial can occur because of how sterile the system is. "That's a massive savings when some drugs cost upwards to $40 or $50 a vial. If you're having to discard any, you're literally talking about throwing away thousand and thousands – if not millions – of dollars a year," Shields remarked.

4. Reduced need for medication outsourcing

Hospitals are looking for an easy way to get drugs. "When they go to an outsourcer, it's really about ease and functionality over anything else despite the fact that they're paying an exorbitant amount," said Shields. With automation, healthcare organizations can insource that drug, driving down the cost because of both that and the walkaway capability. "You just load a product in and push go. That human resource that loaded the system can then walk away for three hours while the queue is running through. They can do something else during this time," Shields said. "It's about doing more with less... or doing more with the same amount is really what it equates to: more drug perpetration with the same staff numbers."

5. Enhanced patient safety

By eliminating humans from the process, or at least by keeping them away from the actual reconstitutions in a bag or a syringe – an incredibly intricate process – errors and contamination are minimal. "What automation has over humans is that it does the same thing every time – it becomes predictable and reliable. If you load it correctly, it will never make a mistake," Shields said. It also reduces the risk of liabilities associated with drug errors. Shields explains that the error rate on any drug preparation is about 10 percent. More than half of that 10 percent error rate is attributed to intravenous drugs.

Source: healthcarefinancenews

5 ways to manage the cost of health IT

Managing costs in today's industry has been put front and center. And although incentive funds have been helping organizations to implement health IT, easy tweaks and innovative tips are always welcome to help cut corners.

Industry experts give use five simple ways to help manage the cost of health IT.

1. Think practically. According to Dave Williams, co-founder and principal of healthcare consulting firm MedPharma Partners, consider deploying overlay systems to extend the life of existing systems. An added bonus? This will also help organizations realize extended value from these systems. "Use the opportunity to prioritize the budget according to value generated," he added. "Consider outsourcing more functionality." Although there are ways for departments to prioritize according to need and costs, Williams said a different approach could make all the difference. "A nuanced approach with outside assistance is needed to generate meaningful results," he said.

2. Look for creative solutions. Despite the risks and perceived loss of control, it can be worth it to embrace the "bring your own device" phenomenon, said Williams. "(This allows) doctors and nurses to employ their own smart phones and tablets on the job and foster development of institution-specific apps by users," he said. "Point of care decision tools are relatively inexpensive but contribute greatly to patient care and employee satisfaction." Lastly, Williams looked to basic tools for a thrifty way to manage costs. "Leverage inexpensive cloud services, such as Google Apps," he said.

3. Don't underestimate the cost savings associated with training. It's essential to consider training and to not skimp on putting the time in to educate staff on new products, said Williams. "…Consider the need for training when making an investment decision," he said. "As Apple has shown in the consumer and business world, systems that are more intuitive require less end-user training and result in higher productivity and user satisfaction." Training is particularly important, he continued, when it comes to new IT and protecting PHI. According to Williams, technology to protect personal health information "ranks pretty high, but management processes and training are at least as important as the technology."

4. Think enterprise-directed IT. Lisa Suennan, managing member at Psilos Group and author of the blog Venture Valkyrie, argues the most cost-effective IT to invest in is enterprise-directed as opposed to consumer-directed IT. "Most of the technology that's interesting and cost-effective right now, although it may be different five years from now, isn't consumer directed—it's much more enterprise directed," she said.  Although consumer-directed IT, like those focused on wellness and mobile technologies, may be popular and in-demand, it's important to think ahead and not give into fads. "While they're [helpful] technologies, a vast majority of them aren't cost efficient," she said.

5. Consider investments and their cost savings in the long run. With a myriad of technologies popping up left and right, streamlining investments is key. And it may come as no surprise that, like Williams, Suennan maintains investments that protect against data breaches are some of the most important to be considered. A report released by ID Experts and Ponemon Institute found data breaches in U.S. healthcare organizations have cost providers more than $6 billion a year—an incredible cost that can be diffused with the help of training and smart investments. Some practical ways to protect against costly breaches? Encryption, said Mahmood Sher-Jan, vice president of product management at ID Experts. “An incident may not become a breach if it’s encrypted properly.

Source: healthcarefinancenews

Seamless workflow is key to the revenue cycle

Tight processes crucial for efficiency, effectiveness

From intake to the back end, healthcare providers need a revenue cycle management system that will provide a seamless workflow for each episode of care. From the moment a patient registers in the facility, it is imperative that the correct information follow along each point of care so that accurate billing information can be processed and sent, RCM vendors say.

"It's the old 'garbage in, garbage out' analogy," said Taylor Moorehead, partner for Carmel, Ind.-based Zotec Partners' west region. "We deal with hundreds of different information systems across the country and no matter how good the technology is, it still comes down to reliance on humans to put in the right field in the right format."

Getting the information right at the initial "counter encounter" is paramount, Moorehead said, because this is where the chances for getting something wrong are at their highest. Moreover, he said, failsafe measures should be implemented at various points down the line.

"It's still a 'people' process," he said. "The linkage is especially critical between the RCM company and the provider. That communication channel has to be very fluid and transparent to the extent that any denials are handled by a team."

Feedback has to be continual up and down the line to determine root causes of claims denials, Moorehead said.

"They need to get to the bottom of these denials and what specific errors are being made," he said. "It has to be a candid process or it won't work."

Blurred lines

The workflow process is a bit different at the small community hospital level, so it makes sense to modify the RCM system in a way that one person can manage several functions, said Steve Everest, executive vice president of financial solutions for Houston-based Prognosis Health Information Systems.

Prognosis has developed a system specifically for community hospitals and their unique workflow, Everest said.

"Community hospitals have a different workflow than their big city cousins," he said. "Where a large health system typically has people assigned to case management, revenue cycle and clinical care, those lines are usually blurred at the community hospital level."

Therefore, the Prognosis system increases the capacity for one person to perform all three functions without having to log on to separate systems.

"That way someone who wears a lot of hats can get a single user experience," he said.

Having a simple and effective workflow makes an organization more proactive and the entire revenue cycle smoother, Everest said.

"Silos are still a problem and we're trying to ease it," he said. "But we are helping our clients prepare for the future because with the challenges coming down the road, their jobs will get harder, not easier."

Tracking down $$$

Approximately 15 to 30 percent of provider revenue now comes directly from patients  -  double what it was 10 years ago. That makes tracking down patient deductibles, co-pays and cash liabilities more important than ever, says Kevin Weinstein, vice president of marketing for Louisville, Ky.-based Zirmed.

"Back then it was easy to ignore patient payments because they represented only a fraction of revenues," he said. "It is much different now."

Revenue collection is about efficiency and effectiveness, Weinstein said. On the payer side, providers have gotten to be much more efficient at claims filing and on average have about 90 percent of their claims paid on a timely basis, he said.

"It is all about efficiency  -  how to get that 90 percent with lower expenditures and fewer people," he said.

The effectiveness quotient refers to patient collections, which Weinstein says providers only receive about 60 to 70 percent of what they are owed. "There is plenty of room for improvement on this front," he said.

ED: Emergency dysfunction

The chaotic environment of the emergency department is the ideal place to install an automated RCM system. Even in the era of heightened cost consciousness, the ED remains over-utilized as a patient entry point, comprising 60 percent of all hospital admissions, said Mikael Ohman, COO for Dallas-based T-System.

Launching its RevCycle+ in June, the company has developed a comprehensive system specifically designed for the ED that links clinical processes with coding and billing to optimize the revenue cycle. By capturing patient data at the intake point, the system ensures accurate, up-to-date insurance information as well as documenting all billable services.

Over the past few years, the company has transformed its original clinical documentation system into a tool that builds the revenue cycle into the equation so that the components work together. Ohman says the bundling of functions has become a necessary model for running the ED.

"The emergency department is a mini hospital unto itself," he said. "It has historically been an island. If any environment needs an optimized workflow, it is the ED."

Source: healthcarefinancenews

5 benefits of healthcare translation technology

With over 47 million residents in the U.S. whose primary language isn't English it stands to reason that all hospitals and healthcare clinics will encounter multilingual patients. Increasing state and federal requirements for communicating with limited English speakers have challenged hospital administrators to find cost-effective solutions.



Among those solutions are technologies that offer speech-to-speech and text-to-text communication from one language to another, said Jonathan Litchman, senior vice president, Science Applications International Corporation (SAIC). SAIC produces Omnifluent Health, a linguistics translation program integrated with automatic speech recognition technology. "Multilingual communication solutions (have) a huge impact on the healthcare industry,” he said. “Not only does it remove the language barrier between patients and their physicians, it also reduces the cost of medical interpretation and time associated with it, while increasing productivity and accuracy."



Litchman outlined five benefits translation technology has for healthcare.



1. Reduced costs


Healthcare translation technology can significantly reduce costs for hospitals and providers in their interpretation needs, while also boosting productivity. "This sort of technology is a low-hanging fruit CFOs and senior admins hardly recognize," Litchman said. "That cost saving can be leveraged to be used for more critical, clinical applications that are much more sensitive to cost cutting."



2. Reduced administrative and staff burden


Some healthcare organizations have a limited number of people available for interpretation, especially on an immediate basis. "The wait time for interpreters can sometimes be upwards to 25 minutes," Litchman said. Speech-to-speech technology can solve this the wait time problem, which places less of a burden on staff while increasing patient throughput. "That level of healthcare productivity is really a goal for most hospital administrations. It's something that's highly sought after: reduce costs of translation and save money? That hits a benefit twice."



3. Increased quality and accuracy


Accuracy can be a major problem when it comes to translation and interpretation. "Usually the interpreters aren't the ones also filling out the paperwork. It's important to make sure that what was said in one language is accurately being reflected in another language," said Litchman. Inaccuracy can have significant implications on insurance reimbursement, billing, and healthcare record management. "As a patient and physician are sitting side-by-side having a conversation that's being recorded in both languages on a screen, they can see if there's a mistake or if something needs clarification. There's no wait time: immediate corrections can be made with people involved."



4. Mobility


Another benefit of healthcare translation technology is its mobility. Consider the back-up hospitals can face at an emergency department admissions desk due to lack of available interpreters. Having a translation product brought to the ER when needed can reduce wait times for patients. Instead of having to wait for an interpreter to be found, the technology is already available in the hospital. “It would increase the quality of patient care, throughput, and overall healthcare experience, which means patient satisfaction goes way up," said Litchman.



5. Clinical applications


Technology like this isn't just beneficial for the administrative side of hospital life; it also makes a big difference on the clinical side, too. "You have three people in a conversation - the person speaking the foreign language, an interpreter and the physician. It seems like communication should flow freely and evenly in a situation like this, but great nuances can be missed," Litchman said. Having two records in front of a physician, one in the patient's language and a translated version, allows medical practitioners to see whether the questions they're asking are truly being understood by both the patient and the interpreter. "This technology allows us to capture the spirit and intent of a physician’s effort to communicate with a patient while avoiding the game of 'Telephone,'" said Litchman. "The message isn't going to get lost along the way."

Source: healthcarefinancenews

5 financial benefits of voice recognition technology

Many may think of data in terms of numbers and text, but not only does voice documentation have a place in the array of data collection tools that can be used by healthcare companies, it offers financial benefits.

Documentation with voice isn't just about capturing information, which is historically how people have thought about it. "It's now doing it in such a way that the document can be reused throughout an organization's downstream for other efforts like billing, quality assurance functions and medical and utilization reviews," explained Mike Raymer, senior vice president of solutions management at M*Modal, a company that provides clinical transcription services, documentation workflow solutions and unstructured data analytics. "Voice is about turning information into a language of understanding," he said. "It takes unstructured text and brings meaning to it that's transferrable from system to system."

According to Raymer, there are five financial benefits that come with using voice recognition technology.

1. Reusable data

Voice data can be reused like any other data can be. "Studies show that two-thirds of U.S. hospitals are going to be absorbing a lot of penalties from readmissions. Data that's most predictive of readmission are ones bound in free text that's then been transcribed," said Raymer. The reusability that voice offers means accurately-coded and documented care that's immediately available for billing purposes.

2. Flexibility

Voice recognition isn't linked to a single device. "With today's technology there are cloud-based apps that allow the user to share a single profile across the board, so no matter where it's being used physicians have the ability to plug-in," said Raymer. From a reimbursement standpoint, the closer an organization is between delivery-of-care and recording-of-care the more accurate the information is, and the less challenges there may arise from an audit because the clinical documentation more succinctly matches.

3. Better clinical hand-off means less medical errors

The history behind clinical documentation started off when a physician referred a patient to another physician. "There needed to be a good way to hand-off care and provide understanding to one physician around the thought processes and actions of the original clinician," Raymer said. The best way to capture that was to record information with words. Unfortunately, organizations began to create templates that forced a patient's story into a structured format using drop-down lists, radio buttons and checkboxes. Those documents no longer service the hand-off from doctor to doctor, because they don't capture the essence of what's happening. "Think of the most critical conversations in your life," said Raymer. "You want to use your own voice, tone and words to express or explain yourself." The accuracy of that clinical hand-off is critical too, because that's where errors occur. Eliminating medical errors – which can be very costly – by using something like voice is better for the patient, better for budget.

4. Productivity

As EMRs are implemented, the underlying assumption is that physicians will be less productive. "However," Raymer said, "there's been several recent studies that have shown that physicians that document via voice transcription are actually able to see more patients thereby increasing their billing for more hours worked." Some physicians believe they can see one-third more patients by using voice transcription then working with a structured template within the EMR. And with baby boomers coming into the later years of their life and the shortage of physicians expected due to the increase in patients from Medicare, it is going to be crucial that physicians are as productive as possible.

5. "One and done"

According to Raymer, the accuracy rates using voice recognition technology are unparalleled. "Rather than a physician waiting for a transcriptionist, the accuracy levels are so high that they can use the product themselves to capture the information they need directly into their work station or mobile device. They can then see what they said, make small corrections, sign the documentation, then send it off. This 'one and done' advantage eliminates the need for multiple steps and people involved, and makes clinical observations immediately available to everyone else," said Raymer.

Source: healthcarefinancenews

Mobile health just beginning to break barriers

Most songwriters born before the year 1987 may remember that collaboration was a more arduous, physical process before Apple's GarageBand software application, smartphones apps and even email became widely adopted. Historically, the process involved meeting another human in person to play physical instruments that produced sound. Geographic boundaries actually hindered the songwriting process as time and space seemed to have a limited number of workarounds. One of these solutions involved sending recordings of song ideas through the mail where possible turnaround times hovered between days or weeks.

In contrast, the idea and act of sharing ideas in 2012 has been greatly reduced to the near effortless push of buttons and a decent Wi-Fi connection.

It's with that thought in mind I came across the report that four diabetic climbers have set their sights to ascend to the base camp of Mount Everest. Using an mHealth system including a glucometer and tablet, their vital signs will be monitored by their regular physicians to assist them in managing their meal times and blood sugar levels. At 16,900 feet, these monitors are expected to provide real-time data crossing not only national, but international boundaries. Just as recording technology has put the power of songwriting into the hands of content creators though modes of inexpensive recording and a medium to share ideas, so has the promise of mHealth unleashed the capability to influence patients' health and physicians' workflow in ways already apparent and those currently unimaginable.

With a thus far unabated rollout of calorie counting smartphone apps, health system text messaging initiatives, patient portal improvements and more, technology is priming consumers to take their health into their own hands through stripped barriers. From a peer-reviewed prospective, a Denmark-based provisional study found that an online dialogue between patients and their healthcare providers garnered a "feeling of security" for patients along with a sense of freedom of being readily available to contact their physician.

While there is concern that some apps may not be best suited for elder consumers--a group that is more likely to need such health-benefiting applications--the mHealth movement and it's products still are in a nascent stage. For reflection, the iPhone was unveiled in 2007 with its development beginning in 2004. It's been less than seven years since this now ubiquitous tool found its ways into the limelight for consumers, while currently there are some reports that two out of every three family physicians use smartphones. Mobile health's product and usability more than likely will improve with time as use cases become clearer and functionality for applications is narrowly defined.

And yet, even in its current stage, mHealth is a big hit among younger physicians. The technology allows today's physicians the work/life balance that their predecessors may not have experienced as ties to an office environment for tasks such as documentation and record reviewing gradually are being removed.

I suspect that while great strides of progress have been made in the mHealth arena benefiting both patients and providers, there remains much more innovation and initiatives to come that have yet to be seen. Some people still are getting used to the idea of taking a picture on a phone, much less face recognition technology. With more thought and creativity being funneled into mHealth initiatives and products, I imagine that with adoption, patient empowerment will spark a sea change in how we view our health and capabilities.

Source: fiercemobilehealthcare

Patients could drive provider data sharing

eHealth Initiative CEO Bordenick: Patients could drive provider data sharing.

Thanks to health IT, healthcare providers and other stakeholders are sitting on mountains of information--but it has yet to be mined to yield its full riches, says Jennifer Covich Bordenick (pictured), CEO of the Washington, D.C.-based eHealth Initiative, an independent, nonprofit organization geared toward improving healthcare quality and safety through the use of technology.

"We spent time figuring out how to collect data and the neat things we can do with it," Bordenick tells FierceHealthIT in an exclusive interview. "To do that, we need good analytic tools. CIOs recognize that, but a miniscule amount have the tools to do it."

The results of a recent survey from eHI and the College of Healthcare Informatics Management Executives "tell us a lot about what little we know," Bordenick says. That survey showed, for example, that while hospital CIOs considered the most important use of data to be analyzing clinician utilization and patient outcomes, the most common use of data was financial management.

Among the challenges, Bordenick says, are how to best analyze and share data when it's "sitting in lots of little buckets." Within a hospital system, for example, different departments control their own data, she says. Different stakeholders maintain their own information. Even when data-sharing is possible, according to Bordenick, issues of trust linger over data security and the quality of data maintained in another silo.

"But it's a good problem to have," she adds. "They have data and they're trying to figure out what to do with it. We used to pull [paper] medical records to figure this stuff out."

Accordingly, eHI's focus will begin shifting beyond the mechanics of electronic health record adoption, to helping the healthcare community connect and share data available through EHRs and other health IT, Bordenick says.

"It's really got to be in the hands of doctors and patients," she says. "We're not quite there. The expectation is they're not meeting that need because the systems are not set up that way now. That's where we want to get."

Meaningful Use "is just a step in the right direction," Bordenick says. "It's not just about EHRs."

For instance, she notes, retail drug stores have data. For that matter, so, too, do schools and insurers and public-health entities. That's important, she says, because consumers spend just a fraction of their time at doctor's offices or clinics.

"If you really want to impact somebody's health, you've got to get to them where they are 95 percent of the time," Bordenick says.

Somewhat surprisingly, she adds, consumers might be the driving force in prompting providers to figure out how to analyze and share health IT data in a meaningful way. Patients "have all of this information available in every other facet of their lives, and they're starting to expect the same level of convenience with healthcare," she says.

With the "techie generation" maturing, consumers also are becoming more willing to share their information, Bordenick believes, and more interested in reaping the benefits of data-sharing than worried about the risk of their information being compromised. "It's not as scary as it was initially," she says.

To that end, expect eHI to put increasing focus in 2013 on seeking out best practices for predictive analytics and data exchange, Bordenick says. The initiative will set the stage later this month with the release of a survey on health information exchange.

Bordenick declined to detail the findings, but hints that "the idea of data exchange has morphed. It's not about formal health information exchanges," she says. "It's about the act itself of exchanging information."

Bordenick adds that the organization also will focus next year on the link between accountable care and analytics.

Source: fiercehealthit