In a real-world setting, many administrators struggle to balance pinching pennies and delivering care. As hospital reimbursement dwindles and innovation blossoms, hospital staff must find creative ways to save a buck without skimping on care. Staff members from three hospitals share solutions ranging from data dissemination to innovation to physician engagement.
More data, please
With more than 90 clinics and 11 hospitals, Allina Health acts as a healthcare delivery workhorse throughout Minnesota and Eastern Wisconsin. With 105,057 inpatient hospital admissions in 2011 alone and a $3.1 billion operating budget, the health system has sought to simultaneously reform care and cut waste.
While most hospitals have realigned their focus to cost savings, Allina has set the bar high with a goal of cutting $100 million in 18 months. “By our standards, we believe that up to 40 percent of healthcare is not value-added and can be improved upon,” says Christine Bent, senior vice president of clinical service lines at Allina.
To eliminate waste, Allina employs a triple aim and growth strategy that seeks to improve patient experience, patient outcomes and make care more affordable. A major aspect of this approach is improving performance measures and making data more transparent, says Bent.
Adding service line structures (eight to be exact) across the system has helped to coordinate care. Understanding where waste exists by driving down variation has been just one tactic to help slash high price tags.
At Allina, financial, EMR and other data from national cardiovascular registries, such as the Society of Thoracic Surgeons (STS) and the National Cardiovascular Data Registry (NCDR), are aggregated into a robust data warehouse to help track variation throughout the system. Based on the data, physicians receive feedback on a monthly basis that illuminates trends and highlights opportunities for improvement in outcomes.
At the Minneapolis Heart Institute, one of Allina’s cardiac centers, cardiologist Craig Strauss, MD, and colleagues developed a real-time clinical decision support tool to assess and improve PCI quality and outcomes. Data on the assessment tool, which used a pre-PCI bleeding risk score, were presented at ACC.12. They enrolled 8,309 PCI patients treated at three high-volume hospitals within the Allina cardiovascular service line between January 2009 and September 2011 and grouped patients by low risk (0-7), intermediate risk (8-17) and high risk (18+). Of the total cohort, 15 percent were classified as high risk, 48 percent as intermediate risk and 37 percent as low risk. Complication rates were 24.5 percent, 7.5 percent and 2.4 percent, respectively. Total costs were $22,821 for high-risk patients, $14,500 for intermediate-risk patients and $11,539 for low-risk patients.
“Depending on what category a patient falls into, they received a different care process,” Bent offers.
By providing real-time feedback, protocols have become better aligned. For example, Bent says that increasing bivalirudin (Angiomax, The Medicines Company) use from 25 to 50 percent in high-risk patients has the potential to save nearly $250,000 per year. “This is really all about standardizing care processes,” she adds. Another protocol that Allina is looking to master is attempting to discharge low-risk patients from the hospital earlier. By discharging these patients appropriately, the system could save nearly $600,000 annually, thanks to earlier transfer out of the intensive care unit.
In addition to cost-savings benefits, a focus on protocols such as increased bivalirudin also may result in fewer complications. “Upping our bivalirudin use has the potential for there to be 13 fewer complications per year,” she adds.
These strategies aim to evaluate initiatives designed to reduce variation in care and create value. And the key to finding potential value-based initiatives is transparency, Bent says. She adds that making these data available through the organization to physicians and other staff has helped generate ideas to transform care, cut costs and enhance patient care.
Innovation & cutting cost
A 5 percent drop in volume each year over the last five years and a decrease in reimbursement have made administrators and physicians at Brigham and Women’s Hospital (BWH) in Boston a little smarter and a little more apprehensive about spending.
“It is sad how much we get reimbursed for a right heart catheterization now,” says Ana A. Mercurio-Pinto,