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