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November 2011
Cost Containment: Overcoming Challenges
C uncilHEALTHLEADERS MEDIA
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By Philip Betbeze
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Foreword
Leaders seek Next strategic LeveL of reveNue cycLe
Healthcare organizations have spent the past 10 years developing robust financial decision-support information and
tools to assist with performance improvement projects. Less energy was spent on developing comparable clinical
information. Now, organizations are beginning to place more emphasis on developing robust clinical data that will
need to be integrated with financial information. This integrated data will be a necessity if the organizations are to
meet the objectives of achieving improved clinical outcomes and standardized and efficient clinical operations.
Business intelligence systems and advanced analytical tools will be needed to achieve these lofty clinical efficiencies.
But most healthcare organizations do not believe we as an industry are close to having robust and integrated data
and tools.
HealthLeaders Media’s annual cost-containment survey shows that the revenue cycle is regarded as the top choice
(30%) of leaders seeking the greatest return in efficiency and cost reduction. That area can provide the highest yields
in efficiencies and cost reduction. But revenue cycle is very general as a priority. Significant numbers of healthcare
organizations are taking their revenue cycle operations to the next strategic level. At CHI we have seen significant
improvement in revenue cycle over the past 10 years, and we are undergoing an extensive diagnostic review of our
revenue cycle operations to identify the next strategic opportunities.
The survey identifies three other key areas of focus in which healthcare provider organizations must be more efficient
and cost effective: purchasing/supply chain; clinical operations, skilled and technical staff; and administrative and
overhead areas.
Past activities in supply chain were mostly concentrated in enhanced supply chain operations and GPO contract
compliance. The next level of improvements will need to be at a strategic level and will need to become more
integrated with clinical operations as the industry does more work with clinical preference and standardization
guidelines. Revised supply distribution models will see enhanced attention in the next three to five years. CHI is about
to begin an extensive diagnostic review of all supply chain operations to identify strategic opportunities.
Healthcare organizations have not put as much focus on clinical operations and outcomes over the past 10 years as
will be required as the industry prepares for lower reimbursement from all payers and transitions to pay based on
NoveMber 2011 | Cost Containment: Overcoming Challenges
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clinical outcomes. The need for better operating precision means healthcare organizations will emphasize operational
throughput and efficiency while enhancing clinical outcomes. These types of projects will be more complex than
previous administrative efficiency projects. Additionally, these projects will require better coordination and integration
of clinical, operational, and financial resources.
Healthcare organizations are beginning to plan for a performance improvement cycle that will be more significant
than any we have faced. Most experts believe that efficiency gains of as much as 20% may be needed. Many are
referring to this cycle as the “Medicare Profitability Project.” The magnitude and comprehensive nature of Medicare
profitability projects will be needed to address potentially significant reimbursement cuts from all payers as a result
of healthcare reform.
Dean Swindle
Executive vice president and CFO
Catholic Health Initiatives
Englewood, CO
Lead Advisor for this Intelligence Report
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Table of Contents
Foreword 3
Methodology 6
RespondentProfile 7
Analysis 8
SurveyResults 13
Operations Area With Greatest Return in Efficiency Improvement or Cost Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Difficulty of Achieving Results in Improved Efficiency and Cost Reduction by Clinical Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Use of Information Technology to Guide Cost Efficiency Programs . . 14
Most Critical Need for Performance Data Measurement. . . . . . . . . . . . 14
Staff Resources Dedicated to Cost Reduction and Efficiency . . . . . . . . 15
Efficiency Techniques or Systems Currently in Use . . . . . . . . . . . . . . . . . 15
Critical Functions Outsourced. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Year-Over-Year Direct Savings for Outsourced Functions . . . . . . . . . . . 16
Average Annual Savings From Cost Reduction Programs . . . . . . . . . . . .17
Additional Cost to Pull out of Operating Budget . . . . . . . . . . . . . . . . . . . .17
Biggest Obstacle to Cost Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Cost Reduction Initiative Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Main Cause of Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Method of Sharing Cost Savings Among Stakeholders . . . . . . . . . . . . . 19
Areas of Performance Affected by Programs That Eliminate Waste and Reduce Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Methodology
The 2011 Cost Containment Survey was conducted by the HealthLeaders Media Intelligence Unit, powered
by the HealthLeaders Media Council. It is part of a monthly series of Thought Leadership studies. In August
2011, an online survey was sent to the HealthLeaders Media Council and select members of the HealthLeaders
Media audience. Respondents work in hospital, health system, or physician organization settings. A total of 250
completed surveys are included in the analysis. The margin of error for a sample size of 250 is +/- 6.2% at the
95% confidence interval.
About The HealthLeaders Media Intelligence UnitThe HealthLeaders Media Intelligence Unit, a division of HealthLeaders Media, is the premier source for executive healthcare business research. It provides analysis and forecasts through digital platforms, printed publications, custom reports, white papers, conferences, roundtables, peer networking opportunities, and presentations for senior management.
Intelligence Report Editor philip betbeze [email protected]
PublisherMAttheW [email protected]
Editorial Director eDWARD pReWitt [email protected]
Managing Editor bOb WeRtz [email protected]
Intelligence Unit Director ANN MACKAY [email protected]
Senior Director of Sales Northeast/Western Regional Sales Manager pAUl MAttiOli [email protected]
Media Sales Operations Manager AleX MUlleN [email protected]
Copyright ©2011 healthleaders Media, 5115 Maryland Way, Brentwood, TN 37027 • Opinions expressed are not necessarily those of healthleaders Media. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.
Upcoming Intelligence
Report TopicsReform Readiness
Mergers & Acquisitions
2012 Industry Survey
advisors for this iNteLLigeNce reportThe following healthcare leaders graciously provided guidance and insight in the creation of this report.
Jeffrey limbocker CFOOur Lady of the Lake Regional Medical Centerbaton Rouge, lA
paul Kronenberg, MDCEOCrouse HospitalSyracuse, NY
Charles e. hart, MDPresident and CEORegional Health, Inc.Rapid City, SD
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Dean SwindleEVP and CFOCatholic Health InitiativesEnglewood, CO
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Respondent profile
Respondents represent titles from across the various functional areas including senior leaders, clinical leaders, operations leaders,
finance leaders, and information leaders. More than 40% of the respondents have senior leader titles. They are from hospitals,
health systems, and physician organizations.
| title
0
10
20
30
40
50
7%Finance leaders
2% Information leaders
31% Clinical leaders
19% Operations leaders
41%Senior leaders
Senior Leaders | Administrator, Chief Executive Officer, Chief Financial Officer, Chief Information Officer, Chief Medical Officer, Chief of Staff, Chief Operations Officer, Executive Dir., Partner, Board Member, President, Principal Owner
Clinical Leaders | Chief of Cardiology, Chief of Neurology, Chief of Oncology, Chief of Orthopedics, Chief of Radiology, Chief Nursing Officer, Dir. of Ambulatory Services, Dir. of Clinical Services, Dir. of Emergency Services, Dir. of Inpatient Services, Dir. of Intensive Care Services, Dir. of Nursing, Dir. of Rehabilitation Services, Service Line Director, Dir. of Surgical/Perioperative Services, Medical Director, VP Clinical Informatics, VP Clinical Quality, VP Clinical Services, VP Medical Affairs (Physician Mgmt/MD), VP Nursing
Operations Leaders | Chief Compliance Officer, Chief Purchasing Officer, Asst. Administrator, Chief Counsel, Dir. of Patient Safety, Dir. of Purchasing, Dir. of Quality, Dir. of Safety, VP/Dir. Compliance, VP/Dir. Human Resources, VP/Dir. Operations/Administration, Other VP
Finance Leaders | VP/Dir. Finance, HIM Director, Director of Case Management, Director of Patient Financial Services, Director of RAC, Director of Reimbursement, Director of Revenue Cycle
Information Leaders | Chief Medical Information Officer, Chief Technology Officer, VP/Dir. Technology/MIS/IT
base = 250
base = 142 (hospitals)
| Number of beds
1–50 20%
51–199 32%
200–499 34%
500–999 12%
1,000+ 2%
| type of Organization
base = 250
| Number of Sites
1–5 23%
6–20 29%
21–49 23%
50+ 25%
base = 75 (health systems)
Hospital 57%
Health system 30%
Physician organization 13%
base = 33 (physician orgs)
| Number of physicians
1–2 3%
3–9 12%
10–25 27%
26–49 24%
50–99 15%
100+ 18%
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Generally, as services and retail products get broader distribution, as competition kicks in and as
those services get democratized, they get cheaper. Healthcare doesn’t follow those rules. It gets
more expensive every year—and usually outpaces the rate of inflation, salaries, and everything
else. That clearly can’t continue ad infinitum.
The challenge of cutting costs
under one reimbursement system
while preparing for the advent of
another adds a degree of complexity
as well. That’s reflected in our
annual cost containment survey,
where eliminating excess cost and
waste is seen as a top priority but
where progress is seen as difficult
to achieve. In what areas is it most
challenging? Surgery and the
emergency department top the list,
where 48% and 65%, respectively, say
it is very or moderately difficult.
What makes the ED so difficult? “So
many things are out of your control,”
says Dean Swindle, executive vice
president and CFO at Catholic
Health Initiatives in Englewood, CO,
and the lead advisor for this report.
“Patients show up randomly and
severity is random. You have pretty
good information on some trends,
but you’re limited on what you can
and cannot do. The physician piece
Cost Containment Often Falters on Complexity By Philip Betbeze
What Healthcare Leaders Are Saying
“Operating room information management technology is one of few areas in
the hospital that stands to benefit substantially from a financial standpoint
with a solid return on investment in IT. Unlike other areas of the hospital,
the operating room is most akin to a factory production line, and has the
most to gain from IT implementation.”
—Chief of staff for a small hospital
“Physician program leaders have not been held accountable for cost/
efficiency outcomes, but have significant impact on costs. They are still
operating under the assumption that good quality costs more.”
—VP, director of operations for a midsize hospital
“Most of our leaders believe we have a cost problem, but they believe it
is either someone else’s responsibility to solve this problem, or there is no
solution. We need to move to collective accountability.”
—CFO for a midsize hospital
“We, like many other healthcare organizations, have not developed a way
to break down services into actual costs. Examples include breakdowns
for specific components of nursing care, food service, room cleaning, etc.”
—VP of nursing for a health system
“We can’t get beyond the idea stage. We run around like Chicken Little—the
sky is falling—must reduce costs now. Then, we get absorbed into the next
crisis and forget all about cost reduction. We need to appoint a leader, cre-
ate a plan with measureable goals, get buy-in, implement, and then monitor,
and reassess. We’re just too busy some days to reduce costs.”
—CFO for a physician organization
“Our most successful cost efforts are typically very targeted, which means
we have not been able to take advantage of any kind of hospitalwide effort.”
—CEO for a small hospital
AnAlySiS
NoveMber 2011 | Cost Containment: Overcoming Challenges
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is also tough, because you generally have to outsource
that directly and they have profit margins so you have less
control over your costs.”
Why else doesn’t healthcare follow the rules? For one,
the relationship between the patient (the end user) and
the healthcare entity (the producer) is muddled by the
presence of regulatory and payer bodies. A Byzantine
reimbursement system prevents—or at least discourages—
the type of competition and quality improvement
techniques that define so many other industries. But
that landscape is rapidly changing. It doesn’t mean that healthcare will get less complex—in fact
probably the opposite—but various changes in the way healthcare is evaluated and paid for are
causing healthcare senior leaders to focus as never before on cost control.
In a future that seems dominated by declining reimbursements and clouded by uncertainty,
costs are one area that healthcare leaders feel can be attacked with zeal. However, in many cases it
seems as though healthcare is still going through the experimental stage in this endeavor.
While senior leaders in the survey reported that programs that eliminate waste and reduce cost
had a positive or neutral effect on clinical outcomes and patient satisfaction—by an astounding
96% and 90% respectively—more than 30% listed “reducing cost while also maintaining service
and outcomes” as their biggest obstacle to successful cost reduction.
What gives?
Part of the problem lies in the fact that hospitals must continue to operate—and operate
profitably—in the fee-for-service world, which does essentially nothing to incent healthcare
providers to reduce costs other than through the blunt tool of cutting reimbursements across
the board. For at least a few more years, fee-for-service will continue to be the dominant payment
model. At the same time, leaders must tool up for a reimbursement environment that includes
incentives for lower costs.
AnAlySiS (continued)
“The schizophrenic reimbursement environment makes this extremely difficult.”
—Charles Hart, MD, CEO, Regional Health Inc.,
Rapid City, SD
NoveMber 2011 | Cost Containment: Overcoming Challenges
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“The schizophrenic reimbursement
environment makes this extremely difficult,”
says Charles Hart, MD, CEO of Regional
Health Inc., a system of five hospitals and an
assortment of clinics, nursing homes, and
assisted living facilities in Rapid City, SD.
In adjusting to a different reimbursement
environment, “I feel like I know where we need
to go, but getting there is so difficult,” he says.
“It takes your labor productivity standards and
blows them up because you have to put extra
resources in.”
He’s not alone. Throughput and efficiency are
the top choice of senior leaders (at 32%) when
asked which performance data measurement
area represents their biggest need. Much
of the waste exists there—not to mention problems with coordinating care, which will be a
big factor under future reimbursement schemes. With an eye toward those future schemes,
clinical outcomes (26%) and actual labor productivity (18%) are top priorities for data on which
managers—and physicians—can act.
“The clinical data that many of us use is chart reviews,” says Jeffrey Limbocker, CFO at Our Lady
of the Lake Regional Medical Center in Baton Rouge, LA. “But what you do want to do is be able
to compare high quality outcomes with financial outcomes to determine whether actions taken
to improve clinical quality or reduce cost are having a positive or negative impact on the other.”
Maybe healthcare gets a bad rap in cost containment. Although it’s relatively new to the sector,
most organizations are paying attention to it—to what level is debatable. Yet they do report
significant results, although those results are incremental. Some 70% of respondents said their
average annual savings over the past three years in cost reduction programs have ranged between
1%–5%, while 29% of respondents reported even bigger gains.
AnAlySiS (continued)
“What you do want to do is be able
to compare high quality outcomes
with financial outcomes to determine
whether actions taken to improve
clinical quality or reduce cost are having
a positive or negative impact on the
other.”
—Jeffrey Limbocker, CFO, Our Lady of the Lake Regional Medical Center,
Baton Rouge, LA
NoveMber 2011 | Cost Containment: Overcoming Challenges
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The savings will have to get bigger, says Swindle,
who envisions that over a seven- to 10-year period
CHI will need to achieve 20% improvement in its
operating budget. “Two-thirds of that will come
from operating efficiencies and better effectiveness.
As we work on Medicare profitability, we’ll pick
something like revenue cycle and, over a five-year
period, we’ll work on a 20% reduction in cost to
collect and collect 20% more cash. To effect that
kind of change, the structure can’t look like it looks
today.”
The programs organizations will use will run the
gamut. Yes, some do involve easy (and perhaps
shortsighted) efforts that involve cutting staffing
and other labor costs, but others are innovative
and take advantage of the largely untapped scale
of many hospitals and systems and their formal
relationships to each other. For example, with its GPO, Regional Health recently developed the
Northern Plains Premier Collaborative, a purchasing partnership with a geographically close
partner that pools purchasing power for 40–50 hospitals, Hart says.
“We began to put value analysis teams together to work on group purchase items, and it has
been so successful over the past three years,” he says.
From the simple to the complex, the collaborative standardized gloves throughout all the
hospitals, which saved Regional Health about $250,000 over the time period. “Where we see
the biggest change is in capital purchases where we will spend about $110 million among the
organizations next year,” he says. “You save 2%, 3%, 4% on those things. We bought CT and MRI
scanners together and we saved $30,000 per machine.”
AnAlySiS (continued)
“As we work on Medicare profitability, we’ll pick something like revenue cycle and, over a five-year period, we’ll work on a 20% reduction in cost to collect and collect 20% more cash. To effect that kind of change, the structure can’t look like it looks today.”
—Dean Swindle, executive vice president and CFO, Catholic Health
Initiatives, Englewood, CO
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Yet those kinds of wins might be a little more difficult for smaller players. Perhaps that’s why
nearly half (49%) of survey respondents told us they still have more than 6% to trim from their
operating budgets. Another 49% saw their targets as less than 6%, while 2% feel like they’ve
already achieved the savings they will need.
Because of expected reimbursement declines, it’s critical that not all of the savings from cost
containment programs be plowed back into other spending. That said, perhaps better buy-in
might be obtained if organizations involved in cost-cutting programs were inclined to share
some of the gains. Some 48% of respondents do not share savings at all among stakeholders,
while 30% say the direct benefit accrues at the facility level. Only 19% either use some of the
savings for implementing a bonus structure for participants or use a percentage of the savings
for discretionary reinvestment in that department.
One interesting area that deserves attention is, despite the fact that a large majority of healthcare
leaders say programs that eliminate waste and reduce cost either do not affect or improve clinical
outcomes and patient satisfaction, employee satisfaction often does take a hit, with 37% of
respondents saying the metric declines under the influence of such programs.
Perhaps a little sugar, in the form of sharing the savings, would help the medicine go down a
little easier.
Philip Betbeze is senior leadership editor for HealthLeaders Media.
AnAlySiS (continued)
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Very difficult
1 2 3 4
Not at all difficult
5
Emergency department 30% 35% 23% 10% 1%
Surgery 19% 29% 30% 19% 3%
Inpatient/med-surg/critical care 13% 37% 33% 14% 2%
Imaging 8% 20% 39% 28% 6%
Pharmacy 6% 25% 34% 28% 8%
Lab 4% 19% 42% 28% 6%
Outpatient/ambulatory 4% 21% 40% 28% 6%
Survey Results
FiGURE1 | Operations Area With Greatest Return in efficiency improvement or Cost Reduction
Q | Which area of hospital operations could yield the greatest return in efficiency improvement or cost reduction?
base = 250
0 5 10 15 20 25 30
30%
26%
16%
11%
8%
3%
2%
4%
Revenue cycle
Clinical operations, skilled and technical staff
Purchasing/supply chain
Administrative/fiscal overhead areas
Departmental directors/managers and mid-level leadership
Physical plant and environmental savings
Support services, skilled and technical staff
Other
FiGURE2| Difficulty of Achieving Results in improved efficiency and Cost Reduction by Clinical Area
Q | Please rate the following clinical areas on the difficulty of achieving results in improved efficiency and cost reduction.
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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01020304050607080
16%
67%
17%
Survey Results (continued)
FiGURE3| Use of information technology to Guide Cost efficiency programs
Q | Which statement best describes how your organization currently uses information technology to guide cost efficiency programs?
base = 250
We have robust clinical and financial data
integrated with solid business intelligence and
analytical tools to guide us
We have some reliable clinical and financial data that we use to
achieve results
We lack clinical and financial data for improvement at
this time
FiGURE4 | Most Critical Need for performance Data Measurement
Q | Which performance data measurement is your most critical need?
0 5 10 15 20 25 30 35
32%
26%
18%
14%
7%
3%
Throughput and efficiency
Clinical outcomes
Actual labor productivity
Individual clinician performance
Ambulatory service line costs
Other
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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0
5
10
15
20
25
30
22%
29%
22%
27%
Survey Results (continued)
FiGURE5| Staff Resources Dedicated to Cost Reduction and efficiency
Q | Please describe the staff resources your organization has dedicated to cost reduction and efficiency.
base = 250
0 FTEs 1–2 FTEs 2–5 FTEs 5+ FTEs
FiGURE6 | efficiency techniques or Systems Currently in Use
Q | Which of the following efficiency techniques or systems does your organization currently use?
0 10 20 30 40 50 60
57%
50%
50%
32%
Business process management/Continuous improvement process
Balanced scorecard
Lean
Six Sigma/TQM
base = 250Multi Response
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0%–2% 3%–5% 6%–10%Higher
than 10% Base
Pharmacy 16% 16% 26% 42% 19
Executive/administrative 60% – 20% 20% 5
Physicians (hospitalists, ED physicians, etc.) 25% 27% 28% 20% 60
Supply chain 4% 50% 27% 19% 26
Billing and collections 21% 33% 27% 18% 33
Food and nutrition services 16% 37% 32% 16% 76
Information technology services 29% 32% 24% 15% 34
Environmental services 18% 49% 18% 14% 49
Lab 32% 37% 21% 11% 19
Nursing staff 36% 36% 18% 9% 11
Plant operations 41% 47% 6% 6% 17
Survey Results (continued)
FiGURE7 | Critical Functions Outsourced
Q | What critical functions has your organization outsourced?
0 5 10 15 20 25 30
30%
24%
20%
14%
13%
10%
8%
8%
7%
4%
2%
29%
Food and nutrition services
Physicians
Environmental services
IT services
Billing and collections
Supply chain
Lab
Pharmacy
Plant operations
Nurse staffing
Executive/administrative
Nonebase = 250Multi Response
FiGURE8| Year-Over-Year Direct Savings for Outsourced Functions
Q | For each of the functions your organization outsourced, quantify the year-over-year direct savings.
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Survey Results (continued)
FiGURE9| Average Annual Savings From Cost Reduction programs
Q | What is your average annual savings from cost reduction programs over the past three years?
0
10
20
30
40
50
0% 1%–3% 4%–5% 6%–10% 11%–20% More than 20%
1%
41%
29%
21%
5%3%
base = 250
FiGURE10| Additional Cost to pull out of Operating budget
Q | Even with your cost reduction initiatives so far, how much additional cost remains to pull out of your operating budget?
0
5
10
15
20
25
30
0% 1%–3% 4%–5% 6%–10% 11%–20% More than 20%
2%
20%
29%26%
14%
9%
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Survey Results (continued)
FiGURE12| Cost Reduction initiative Failure
Q | Have you ever had a cost reduction initiative fail to achieve planned results?
FiGURE11 | biggest Obstacle to Cost Reduction
Q | What is your organization’s single biggest obstacle to successful cost reduction?
0 5 10 15 20 25 30
30%
16%
16%
10%
8%
7%
6%
5%
2%
Reducing cost while also maintaining service and outcomes
Lack of accountability, follow-through
Physician resistance
Lack of sustainable process for attacking cost
Leadership’s lack of understanding the urgency for accelerated change
Insufficient IT and/or professional infrastructure
Staff resistance
Lack of monitoring, measurement
Other
base = 250
68%Yes
32%No
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Survey Results (continued)
FiGURE13 | Main Cause of Failure
Q | What was the main cause of the failure?
0 5 10 15 20 25
23%
23%
22%
18%
8%
6%
Cost gains were overestimated
Poorly planned/implemented
Lack of leadership support/infighting
Not enough resources dedicated
Fatigue/took too long
Other
base = 171Among those organizations who have had a failure
FiGURE14 | Method of Sharing Cost Savings Among Stakeholders
Q | When your organization implements cost containment, how do you share the savings among stakeholders?
0 10 20 30 40 50
48%
30%
10%
9%
4%
Savings are not shared
Direct benefit is realized at the facility level
Implement a bonus structure for participants
Use a percentage of the savings for discretionary reinvestment in that department or organization
Other
base = 250
NoveMber 2011 | Cost Containment: Overcoming Challenges
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Improved DeclinedStays the
same
Clinical outcomes 44% 4% 52%
Patient satisfaction 39% 10% 51%
Employee satisfaction 33% 37% 30%
FiGURE15| Areas of performance Affected by programs that eliminate Waste and Reduce Cost
Q | Please describe how other areas of performance have been affected by your organization’s programs that eliminate waste and reduce cost.
base = 250
Survey Results (continued)