How Physi­cian Lead­er­ship And A Pop­u­la­tion Health Strat­egy Boosted Sav­ings For A Fixed-bud­get Hos­pi­tal

Modern Healthcare - - NEWS -

As part of a five-year bud­get­ing ex­per­i­ment be­tween the state of Mary­land and CMS, all Mary­land hospi­tals have vol­un­teered to op­er­ate on global bud­gets through 2019. In or­der to suc­ceed on a fixed in­come, Saint Agnes Hos­pi­tal turned to its ED man­age­ment part­ner for help.

These five tips:

were pre­sented in a we­bi­nar on Sept.13. The en­tire we­bi­nar can be ac­cessed at mod­ern­health­care.com/FixedBud­getHospi­tal.

1 Iden­tify strong physi­cian lead­er­ship through key char­ac­ter­is­tics.

To be suc­cess­ful in to­day’s health­care en­vi­ron­ment, or­ga­ni­za­tions need to rec­og­nize the im­por­tance of physi­cian lead­er­ship. Physi­cian lead­er­ship is cru­cial be­cause they are the front­line providers and are re­spon­si­ble for the cost of care. In ad­di­tion, physi­cian lead­ers have the abil­ity to en­cour­age change and cam­paign new ideas among their col­leagues.

“In my mind, physi­cian lead­ers must have the fol­low­ing char­ac­ter­is­tics: they must be per­son­able, they must be well-re­spected, they must be some­one oth­ers will lis­ten to, and they must be some­one that ‘gets it’ in an al­ways-chang­ing world,” said Dr. David Bird­sall, Vice Pres­i­dent of Op­er­a­tions for CEP Amer­ica. "You can find these types of em­ploy­ees any­where from popup func­tions, spon­sored sem­i­nars, and even through rec­om­men­da­tions at staff meet­ings. That’s why it’s im­por­tant to en­gage physi­cians in con­ver­sa­tions wher­ever you go.” Hav­ing the right physi­cian leader can bring about more com­mu­ni­ca­tion and col­lab­o­ra­tion, while also fa­cil­i­tat­ing big-pic­ture goals for your or­ga­ni­za­tion.

2 Im­ple­ment care plan­ning for fre­quent uti­liz­ers.

Manag­ing "fre­quent fly­ers", or pa­tients that fre­quently uti­lize your hospi­tals ser­vices, is an area often fo­cused on by physi­cian lead­ers— even more so in hospi­tals with capped rev­enues. For Saint Agnes, they found many of their "fre­quent fly­ers" had care costs that ex­ceeded $150,000 an­nu­ally.

To man­age these fre­quent uti­liz­ers ef­fec­tively, they formed a Care Plan com­mit­tee. Mem­bers in this com­mit­tee col­lab­o­rate with other physi­cians in the hos­pi­tal to cre­ate in­di­vid­u­al­ized his­to­ries and rec­om­men­da­tions for each pa­tient. Those plans are em­bed­ded into the hos­pi­tal elec­tronic med­i­cal record and re­gional health in­for­ma­tion sys­tem so the in­for­ma­tion is read­ily ac­ces­si­ble when a pa­tient comes to the emer­gency room.

This strat­egy aims to help physi­cians man­age chronic con­di­tions and im­prove care con­ti­nu­ity for pa­tients. “Our high­est uti­lizer had a chronic con­di­tion that was greatly ex­ac­er­bated by nar­cotics abuse. With im­proved man­age­ment of his care plan, he went from spend­ing 250 days a year in­pa­tient to zero,” said Dr. Adrian Long, for­mer Ex­ec­u­tive Vice Pres­i­dent and CMO at Saint Agnes. “Con­trol­ling uti­liza­tion and hav­ing the best qual­ity care at the low­est cost was para­mount to our or­ga­ni­za­tion.”

Con­trol­ling uti­liza­tion and hav­ing the best qual­ity care at the low­est cost was para­mount to our or­ga­ni­za­tion. Dr. Adrian Long, for­mer Ex­ec­u­tive Vice Pres­i­dent and CMO at Saint Agnes

3 De­ter­mine pop­u­la­tions that stand to ben­e­fit from in­no­va­tive strate­gies.

Once physi­cian lead­ers are iden­ti­fied, you can be­gin col­lab­o­rat­ing on ini­tia­tives of or­ga­ni­za­tional im­por­tance. These can be im­prove­ments in read­mis­sion rates, long-term pro­grams, or other ar­eas of pop­u­la­tion health.

For physi­cian lead­ers to be ef­fec­tive, they are go­ing to need en­cour­age­ment and men­tor­ing through­out the process. Show these lead­ers you ac­knowl­edge and value their skills, place them in charge of com­mit­tees, in­volve them in dif­fer­ent ac­tiv­i­ties, and find new ways to ex­pand their roles as they de­velop. Nur­tur­ing your physi­cian lead­ers will ex­pand their con­fi­dence and ex­per­tise, and pro­duce tremen­dous re­sults in the end.

4 Man­age care tran­si­tions through med­i­cal lead­er­ship.

Manag­ing care tran­si­tions is also im­por­tant to suc­cess­fully op­er­ate un­der capped rev­enue. If pa­tients need to be trans­ferred, or re­quire ad­di­tional ser­vices at an­other fa­cil­ity, you will need physi­cian lead­er­ship to es­tab­lish re­la­tion­ships with or­ga­ni­za­tions around you that can help.

Saint Agnes ac­com­plished this with Fu­tureCare, a long-term acute care fa­cil­ity that’s home to a skilled nurs­ing fa­cil­ity and a 50-bed ven­ti­la­tor unit. “We de­vel­oped a pro­gram with Fu­tureCare so that when a high­cost, high-uti­liz­ing ven­ti­la­tor pa­tient is pre­sented to the emer­gency de­part­ment, they’re trans­ferred to Fu­tureCare’s fa­cil­ity in­stead. There, pa­tients are at­tended to with the ap­pro­pri­ate IV an­tibi­otics, di­ag­nos­tic test­ing, and spe­cial con­sults they specif­i­cally need," said Dr. Ben­jamin Frizner, CEP Part­ner and Direc­tor of the Long-term Ven­ti­la­tor Unit at Fu­tureCare. “By keep­ing those high uti­liz­ers with mul­ti­ple co­mor­bidi­ties and com­plex pro­cesses at Fu­tureCare in­stead, our early workups and around-the-clock mon­i­tor­ing cut down large amounts of pre­ventable in­pa­tient stays in Saint Agnes, which makes pa­tients hap­pier and the hospi­tals run more ef­fi­ciently."

5 Man­age care tran­si­tions through med­i­cal lead­er­ship. Seek the help of a part­ner for re­sources not avail­able to your or­ga­ni­za­tion.

While re­sults are at­tain­able, many hospi­tals through­out the coun­try lack the physi­cian lead­er­ship and ef­fec­tive pop­u­la­tion health strate­gies to accomplish their goals. If your or­ga­ni­za­tion is in short sup­ply, or can­not al­lo­cate the nec­es­sary in­ter­nal re­sources, seek out and en­gage a part­ner. This part­ner can be a con­tracted group, IPA mem­bers, or even a lo­cal group of physi­cians. “Don’t try to go do this alone. It re­ally does re­quire col­lab­o­ra­tion and co­or­di­na­tion among physi­cian lead­ers across in­sti­tu­tions,” Dr. Bird­sall said. That co­or­di­na­tion pro­vides a look at care both in terms of episodes, and lon­gi­tu­di­nally as a con­tin­uum, to help your or­ga­ni­za­tion run more ef­fec­tively and ef­fi­ciently.

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