Patient Driven Staffing Levels

On average, hospitals devote close to 70 percent of their budget to labor costs. Until robots replace humans in the delivery of patient care, selection of the proper skill mix and number of nurses remains a significant factor that determines cost in provider organizations.

Square Peg – Round Hole Problem

Rapid adoption of EHRs has been hindered by a variety of factors, including a fragmented marketplace, changing federal incentives, provider uncertainty about the regulatory landscape, and the striking lack of interoperability between systems.

Strategic Operational Plans

Standing up in a canoe is hard enough. Standing up in two canoes with one foot in each while traveling through Class 4 rapids is mind-boggling.
Class 4 rapids are defined as “intense, powerful but predictable rapids requiring precise boat handling in turbulent water. In many ways that sounds familiar to the turbulent waters providers try […]

Getting Ahead

Cloud-based applications maintained by vendors offer significant advantages in cost of ownership by eliminating the cost of upgrades, providing immediate access to the latest versions of applications, and reducing the costs associated with maintaining hardware.

Recent Articles:

Properly Staffing Our Organizations With Nurses?

Properly Staffing Our Organizations With Nurses?

As the healthcare industry shifts to value-based reimbursement and the associated reduction in reimbursement rates, hospitals look to cut costs throughout their organizations. With labor accounting for more than 60 percent of all hospital costs –nurses, who make up the bulk of those costs – find themselves shouldering the burden of labor-related cost reductions. These cost cutting activities manifest themselves through a reduction in staffing, leading to a decrease in nurse-patient ratios and the employment of less experienced professionals at lower salary levels.

Fortunately, the expansion in the use of electronic medical records provides the clinical content data that can help accurately drive patient acuity scoring.

Excerpts from: Acuity or Ratio: How Do We Properly Staff Our Organizations With Nurses?, June 9, 2014.

Photo Courtesy of  Don Guerwitz Photography – Lunch Break, Luxor, Egypt

Changes in Healthcare – Barry P Chaiken, MD and Steve Fanning at Inforum14

October 12, 2014 Featured, Health IT No Comments
Changes in Healthcare – Barry P Chaiken, MD and Steve Fanning at Inforum14

Hear about the upcoming changes in healthcare and how to respond to the changes. Barry P Chaiken, MD, MPH, CMIO and Steve Fanning, VP, Healthcare Strategy at Infor speak to these coming changes. Here is the link to the video – Inforum 2014


Bacchus and Healthcare

Bacchus and Healthcare

Showing great wisdom, our mothers cautioned us to never judge a book by its cover. Yet, when we purchase wine, we often look for the fancy label design, interesting back label story, or colorful capsule covering the cork. That said, most wine drinkers use price as the most important indicator of wine quality. Surely a $100 wine must be better than a $15 bottle, otherwise why would the retailer charge more for it?

In the absence of understandable, easily accessible quality metrics, we utilize price as a surrogate for quality. Sure, we may search reviews looking to see if the pretty label represents a 90+ point wine, but in the heat of the moment in a restaurant we read the wine list right to left choosing a wine by its price rather than its pedigree. Frankly, most consumers employ this this approach when they purchase products where quality and value are difficult to judge or trusted quality information is unavailable.

As we move to value-based reimbursement models where price matters, linking quality to price becomes more important than ever. The passage of the Affordable Care Act (ACA) dramatically changed the healthcare marketplace and the economics driving it.

Excerpts from: Bacchus and Healthcare. PSQH, May/June 2014

Photo Courtesy of  Don Guerwitz Photography – Gauchos, Tupangato, Argentina

WhatsApp Lessons to Engage Patients

June 7, 2014 Health IT, PSQH No Comments
WhatsApp Lessons to Engage Patients

Information technology has achieved some amazing changes in consumer behavior. Over the last 20 years, companies have decreased their costs simply by transferring the work previously done by employees to consumers. For example, think about the last time you took an airline trip. You probably bought your ticket online through an airline or travel website. You printed your boarding pass at home, at the airport kiosk, or pulled it up on your smartphone.

If you checked a bag, you entered the data into the airport kiosk while the agent simply checked your government ID and placed the tracking tag on your bag before tossing it onto the luggage belt. Does anyone miss the paper folder we used to hold our boarding passes and itinerary?

If you reviewed the typical airport counter a decade ago, you saw more than a dozen agents working quickly to assist travelers. Today, just two or three agents hold court at the counter. Instead, you see busy travelers doing much of the work formerly done by those agents. Numerous other industries present a similar story.

Rather than think this consumer engagement only benefits the companies deploying the technology, consumers embrace these new processes because they also obtain benefits from doing so. While information technology assists other industries to reduce costs and improve processes by transferring some of the work to engaged consumers, healthcare lags in its use of information technology to similarly engage patients.

Excerpts from: WhatsApp Lessons to Engage Patients. PSQH, March/April 2014

Photo Courtesy of  Don Guerwitz Photography – Fishing in the Moat, Hue, Vietnam

At All Cost?

March 1, 2014 Health IT, PSQH No Comments
At All Cost?

During the dot-com boom in the late ‘90s, many new companies based their business plans on the volume of website visits. This revenue model assumed that by capturing the attention of users as measured by clicks on the company website, the organizations would generate wild profits; however; when these companies went public, they assumed very high valuations without generating revenue. These companies never thought through their business models, nor understood their real costs.

For more than a half century, the healthcare industry applied the same confidence in similarly flawed models. Volume-based reimbursement tied revenues to volume, so organizations that maximized volume, in turn maximized profits. There was little incentive to focus on costs because organizations just inflated their charges to account for what they calculated as a rough estimate of their costs. If their calculations proved wrong for a particular line of business, they just upped the fees the following year to make up for it.

Recent reports from New York State Health Department, detailed in a December 9, 2013, article by journalist Nina Bernstein in The New York Times, show how variable and out of control healthcare costs are. The report listed hospitals with their charges and costs for a variety of conditions from 2009 to 2011. According to Bernstein, prices ranged from an $8 bill for treating a case of gastritis (cost: $2) to a $2.8 million charge for a blood disorder case that cost $918,462.

Without even knowing the details of the case, it is hard to believe the $8 bill for gastritis is correct when the cost of the treatment was only $2 – same must be said for the blood disorder case.

How does an industry survive—and how can our society expect healthcare costs to be reasonable—when hospitals do not know their costs of production or reasonableness of the bills they send to patients and insurance companies? How do organizations realistically set prices, compete in the marketplace, and accurately plan for their own survival and growth?

Excerpts from: At All Cost. PSQH, January/February 2014

Photo Courtesy of  Don Guerwitz Photography – Proboscis in a Tree. Bako National Park, Sarawak, Malaysian Borneo

Our Tower of Babel

November 5, 2013 Featured, Health IT, PSQH No Comments
Our Tower of Babel

The Bible describes why humans speak so many languages:

The narrative of the city of Babel is recorded in Genesis 11:1-9. Everyone on earth spoke the same language. As people migrated from the East, they settled in the land of Shinar. People there sought to make bricks and build a city and a tower with its top in the sky, to make a name for themselves, so that they not be scattered over the world. God came down to look at the city and tower, and remarked that as one people with one language, nothing that they sought would be out of their reach. God went down and confounded their speech, so that they could not understand each other, and scattered them over the face of the earth, and they stopped building the city. Thus the city was called Babel.

Although this explains well why communication is so difficult among people from different countries, it fails to address the inability of our various healthcare information technology (HIT) systems to exchange patient data seamlessly.

Although God confounded our speech to prevent us from turning away from His teachings, there is no equally important reason that HIT systems today do not communicate.

During a presentation to healthcare CIOs at the recent CHIME13 Forum in Scottsdale, Arizona (Chaiken & Vengco, 2013), attendees expressed their belief that the lack of interoperability among HIT systems represents a substantial barrier to utilizing innovative information technology tools, such as social networking applications, to manage the delivery of patient care. Only after what they described as a miracle event – true interoperability – did attendees believe that these new technologies could be used effectively to impact the quality and cost of patient care.

It is time to focus on the value delivered to the patient and our community derived from universal, easily managed HIT interoperability. Such a capability promises to deliver improved patient care; fewer redundant, unnecessary tests; and more accurate diagnoses and treatments.

Excerpts from: Our Tower of Babble. PSQH, November/December 2013.

Photo Courtesy of  Don Guerwitz Photography – Streetcorner Dentist. Hoi An, Vietnam

Evolving to Health 3.0

October 8, 2013 Health IT, PSQH No Comments
Evolving to Health 3.0

The dramatic shift to value-based reimbursement requires all providers to completely disrupt their care processes and workflows to ensure the delivery of high quality, safe care at a reasonable cost. For more than four decades these same providers thrived in an environment where providing more care easily generated higher prices and profits. In that former reimbursement model, a serious and dangerous moral hazard existed where the instinct to “do no harm” clashed mightily with a similarly powerful driver to maximize income.

Organizations that will survive under the new realities of ACA recognize the power of healthcare information technology (HIT) to assist them in reworking their business processes and clinical workflows to achieve the goal of high quality, affordable care. Effective approaches to change include leveraging recent HIT investments and the reinvigoration of legacy systems.

The era of Health 3.0 ushers in new, disruptive uses of HIT that leverage past technology investments to obtain maximum value from newly created technologies and digital trends. Health 3.0 pioneers the innovative use of information technology’s proved valuable in other industries to enhance the quality and safety of care delivery while delivering superior cost outcomes.

Excerpts from: Evolving to Health 3.0. PSQH, September/October 2013

Photo Courtesy of  Don Guerwitz Photography – The Mezquita. Cordoba, Spain

The Health Supply Chain

October 8, 2013 Health IT, PSQH No Comments
The Health Supply Chain

The shift to value-based reimbursement from volume-based reimbursement puts great pressure on organizations to obtain a detailed understanding of how and what resources they utilize to deliver care. Without a deep understanding of this issue, providers are unable to effectively manage care delivery and survive an environment of declining reimbursement.

Other industries focus on the supply chain to efficiently manage production and the delivery of products to customers. Although healthcare organizations similarly focus on the supply chain, they focus solely on tangible products utilized to deliver care to patients.

The Health Supply Chain model provides a broad, all-encompassing view of care delivery that links both administrative and clinical processes and workflows in the “manufacture” of patient care. This analytical approach assigns responsibility for the clinical and financial outcomes of patient care to all members of a provider organization, rather than dividing responsibility between administrative and clinical functional units.

The Health Supply Chain model affords a valuable framework for organizations to begin to understand their care delivery process and the costs of care.

Excerpts from: The Health Supply Chain. PSQH, July/August 2013

Photo Courtesy of  Don Guerwitz Photography – The Alhambra Under the Sierra Nevada. Granada

American Autos Circa 1970 and Healthcare

July 24, 2013 Health IT, PSQH No Comments
American Autos Circa 1970 and Healthcare

The Ford Pinto was a really terrible car. The gas tank was positioned such that, in a collision, protruding differential bolts would puncture the tank, leading to frequent car fires. This defect led to the death of more than 27 people and many others maimed. Cars made in the United States in the 1970s and 1980s were poorly designed, cheaply assembled, and reliably unreliable. Rather than designing for quality, American manufacturers relied on fixing problems after assembly. Is it any wonder that consumers soon abandoned these terrible cars and purchased Japanese models instead?

Japanese manufacturers followed the quality rules created by W. Edwards Deming in their pursuit of the U.S. car-buying public. Deming’s principals allowed Japanese companies to manufacture high quality automobiles at lower costs and with fewer defects than their American counterparts.

With the rapid shift from volume-based reimbursement to value-based reimbursement, organizations must change the way they deliver healthcare, with Deming’s quality rules offering clues as to what needs to be done. In the 1970s, U.S. automakers fixed defects in their cars after they rolled off the assembly line.

This approach to healthcare—fixing defects, not measuring quality, ignoring processes, and shunning transformation and change—cannot survive the new realities inherent in the shifting of reimbursement rules. Perhaps a few of Deming’s 14 key principles for transforming business effectiveness can provide a roadmap for what our organizations need to do to prosper in the years ahead.

Excerpts from: American Autos Circa 1970 and Healthcare. PSQH, May/June 2013

Photo Courtesy of  Don Guerwitz Photography – Window Watcher. Tibetan Kingdom of Mustang, Nepal

The Eyes Have It

April 12, 2013 Health IT, PSQH No Comments
The Eyes Have It

No matter what technologies are used, the end goals for any organization are adoption and behavior change to achieve desired clinical and financial outcomes. Well-designed workflows that satisfy the needs of users lead to high levels of adoption of information systems. High levels of adoption that do not facilitate behavior change replicate systems and the undesirable outcomes achieved before technology deployment. Therefore, techniques that encourage behavior change, such as clinical decision support tools and performance scorecards, must also be embedded seamlessly in the clinical workflow to be effective.

Tools exist for achieving effective clinical workflow, although we continue to learn and refine best practices. Throughout the 1990s, payers employed clinician profiling reports or scorecards in an attempt to identify outlier providers and effect change in clinician practice patterns. Few of these efforts proved successful due to problems with data sources and the delivery and content of the scorecards.

With the expansion in the use of electronic medical records, the data source for scorecards that can influence clinician behavior moves to a much more robust data source, a data warehouse populated with clinical information gathered from multiple clinical systems. In addition, analytical tools now exist that can easily comb through enormous data sets and generate insightful results presented in attention grabbing, meaningful graphics.

Excerpts from: The Eyes Have It. PSQH, March/April 2013

Photo Courtesy of  Don Guerwitz Photography – At the Catania Market, Sicily, Italy


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