Presented by James DiGiorgio President, Applied Knowledge, LLC.

9 Innovations to Improve Emergency

Department Financial Performance

Presented by James DiGiorgio

President, Applied Knowledge, LLC

Webinar outline:

-Brief introduction-Perceptions of Emergency Department-ED statistics-Importance of your ED to your institution-ED Innovations-Q&A

Polling Question? Which phrase best describes your ED?

1. Important contributor to the success of the hospital

2. Necessary department but not a key contributor to hospital success

3. Not that important to hospital success

4. Other

Loss leader? ‘Department Chaos’? Focus of uncompensated care? Need to reduce visits to the ED? Front door to your community?

How do you look at your ED?

Increasing or decreasing ED visit trends Varies across country Impacted by ACA Impacted by HDHP

How do you look at your ED?

ED = over 140 million visits per year (visits = 44% of U.S. population)

28% of all acute care visits 2/3 of all acute care visits for uninsured 50+% of acute care visits for Mcaid and

CHIPS 50% of all inpatient admissions 70% of admits of Mcare patients

ED Stats

ED = about 4% of U.S. healthcare spending Inpatient care = about 31% of U.S.

healthcare spending Federal law requires EDs to evaluate and

stabilize all who present to the ED without regard for ability to pay, they serve as the “safety net of the safety net” for uninsured patients and Medicaid beneficiaries

ED Stats

ED Stats -CDC One or more emergency department visits in the past 12 months, by age and type of coverage: US 2002-2012

ED – your largest admitter 50% of all inpatient admissions 70% of admits of Mcare patients

ED is your largest ‘admitter’

Between 2003-2009 - 17% increase in unscheduled inpatient admissions from the ED.

More than offset a 10% decrease in admissions from doctors offices and other outpatient settings.

RAND study

ED is your largest ‘admitter’

ED admissions are projected to grow 23% faster than population growth (Health Affairs)

Acuity of admissions will increase and require more resources (more chronic conditions)

IOM study – EDs are overburdened, underfunded, and highly fragmented

Emergency Department – Admission Trends

EDs are evolving◦ Acute care◦ Urgent care◦ Primary care◦ Freestanding EDs◦ ‘Admitting department’◦ Observation care and 2-midnight rule◦ Specialized care

Cardiac, stroke, geriatric, behavioral health, etc

Emergency Department

Goal – innovations to improve operational and financial performance

Improve quality of care/outcomes Increase productivity Improve efficiency Lower cost of care Increase revenue

Emergency Department Innovations

EDs are complex systems Multiple connections to other departments Potential for system failure/low performance Opportunities for improved operations New approaches = more

efficiency/effectiveness


Polling Question? Which of the following ED metrics is most important in your ED?

1. Patient satisfaction

2. Patient throughput time

3. Reducing left without being seen patients

4. Other

Patient Flow/Throughput is KEY Impacts efficiency, revenue, cost, patient

experience Most EDs continually focus on improving

processes Like fixing a car engine while it is still

running (24/7)

Emergency Department Metrics

KEY ED Metrics: Door to Doctor time (key to pt experience) Provider to Decision time Decision to Departure Left Without Being Seen (LWBS) Patients per hour


Factors that affect ED Flow/Throughput: Patient volume/arrival time Ancillary testing time Physician specialist consultation time Ability to admit patients (boarding) Behavioral health patients (lack of capacity)


Scribes to increase provider productivity Implementation of EMRs has decreased

provider productivity Does it make sense to have high paid

providers perform clerical duties? Medical scribes take over documentation

duties from providers Increase provider productivity

Emergency Department Innovations - Scribes

Outsourced or home grown models Outsourced model Project leader comes on site to learn your

ED Simultaneously learns ED, recruits local

candidates, train them to be scribes, trains physicians to utilize scribes

30-90 day process


Positive financial impact of scribes◦ Increase productivity (patients per hour)◦ Increase revenue (several ways)◦ Reduce provider staffing◦ Reduce LWBS ED patients (capture lost revenue)◦ Improve documentation (increase reimbursement)◦ Enhance patient experience ($)◦ Reduce LOS in ED (more ED capacity)


Positive financial impact of scribes Cost or Return on investment (ROI)? Adjustment (decrease) in provider staffing

pays for scribes (most times ROI) Decrease/elimination of OT hours for

completing documentation Incremental increase in revenue


Medication reconciliation is a time intensive manual process

Time by RNs, Pharmacy Techs, Physicians 2-3 minutes per Rx to complete

reconciliation 15-20 minutes (avg), more for more

complex patients

Emergency Department Innovations - Medication Reconciliation Tool

Take advantage of electronic Rx data Aggregate data from Rx ‘switches’ Acquire data from pharmacy chain stores Capture Rx data from other sources Provide web-based Rx history lookup Reduce ‘med rec’ time by half or more About 80% success rate and improving


Rx tool is provided by web access Staff must be trained to use the tool Staff must be motivated to use the tool Based on demographic data input Searches cumulative Rx electronic database

for Rx history Used as to complement patient Rx info Compliance tool


Patient navigators/patient champions Video engagement/education Goal to improve coordination of care and

compliance with aftercare Improve outcomes, reduce re-admissions,

improve patient health, improve patient experience

Emergency Department Innovations - Patient Engagement Tools

Patient navigators/patient champions communicate with patients during and after clinical encounter to assure understanding and follow up care

Diagnosis specific videos are emailed to patients for use after clinical encounter to re-inforce follow up care/share with family


Improve outcomes, reduce re-admissions, improve patient health, improve patient experience all relate to reducing cost of care and meeting goals


Modeled after ‘call ahead seating’ at restaurants

Intended for low acuity patients – allows them to wait at home until time to come to ED

Goal ‘load leveling’ of patient arrival times Avoid surge of low acuity patients during

peak arrival times Improve ED efficiency

Emergency Department Innovations - Making Appointments for ED Care

Patient goes on line to search for ED services

SEO bring up your hospital near top of search results

Allows low acuity patients to select a time to come to your ED and wait in comfort of home

Patient comes to ED, seen in 15 minutes of arrival

If available, can select UC, ED, clinic


Very high patient satisfaction (90+ percentile)

Brand building tool for hospital/system in age of growing consumerism

Used frequently by FHOH, key decision maker

Attracts more insured patients than typical ED payer mix

Half of patients are new to hospital/system ROI/Payback in several months


Polling Question? Which of the following barriers would be the most difficult to overcome to implement innovations in your ED?

1. Funding/budget

2. Culture – ‘we have always done it that way’

3. Approval from hospital leaders

4. Other

Provides data driven management tool to analyze performance/optimize ED operations

Captures operational data from EMR and multiple other systems into data warehouse (EMR, payroll, billing, patient satisfaction, etc)

Ease of use allows managers to use data to make decisions, not spend time finding data

Insights from data drive positive change

Emergency Department Innovations - ED Dashboard

Allows quick drill down to provider or patient specific data

Provides analysis using multiple variables to uncover area for improvement

Identifies gaps in charge capture to improve revenue

Offered as a web based tool with minimal effort by hospital IT staff


Can provide retrospective (monthly) dashboard or real time dashboard

Monitor and key metric trends, performance Provides decision makers with access to

data needed to make decisions, improve processes

Offers analytic tools to find areas for improvement impacting service, revenue

One/two clicks – what is pt sat results for Dr. Smith among Mcare patients?


Communication system to digitize the process for reaching ‘on call’ physicians

Many current systems are paper based or old fashioned rolodex

Current systems are cumbersome and produce extended response times to pages from the ED (30- 60+ minutes)

Delays slow patient care and throughput

Emergency Department Innovations - ED Communications System

New web-based paging application offers HIPAA compliant 2-way communication

Offers efficient on-call system - smartphones

Allows direct and immediate responses Provider receives page with accurate info

about patient Images can be communicated for clinical

review


Facilitates direct voice or text communications between providers

Database of on-call schedules can be maintained centrally or distributed across enterprise

Changes to on-call status can be made instantly from smartphones by physician

Reduces on-call physician response time


New approach to ED design Smaller physical footprint for ED Improves patient capacity/patient flow Reduces patient throughput time Improves patient experience/satisfaction Reduces LWBS Increases revenue through efficiency Lowers capital needed for new/renovated

ED

Emergency Department Innovations -High Performance Design

Enhanced flow = more patients, more admissions = additional revenue

Reduced expense per patient through improved efficiency

Involves design, process change, culture change

Helps build reputation/brand in the om community

Emergency Department Innovations-High Performance Design

Tool: Captures revenue from written off accounts using ‘data mining’

Focuses on TPL cases that hospitals are unable to track

After written off accounts are downloaded, outsourcer does all the follow up and collections for contingency fee

Does not contact or collect directly from pts

Emergency Department Innovations- Revenue Capture

Tool: Improves documentation and coding to boost revenue in ED

Focuses on improving the documentation and coding processes

Identifies areas for improvement and re-educates staff on improving processes

Improvements range from $100,000s to $1,000,000s across all size hospitals


Expert guidance for delivery of Observation care

Focuses on improving the documentation and coding processes

Improves compliance with 2 midnight rule Help evaluate the impact of RAC program Improvements range from $100,000s to

$1,000,000s across all size hospitals


Optimize ED staffing using ‘big data’ Uses data science and advanced analytics

to develop most efficient staffing plan Improves performance to reduce

overstaffing (reduce cost) and understaffing (improves service)

Optimizes mix of personnel Case study: Identified $500,000/yr savings

Emergency Department Innovations- Improve using ‘Big Data’

Optimize ED (or other hospital) processes Uses digital simulation modeling vs. real life

trials to optimize processes Allows ‘what if’ scenarios testing at low cost

and fast results Has been used on departmental focused

projects and whole hospital projects

Emergency Department Innovations- Improve using ‘Big Data’

Questions????

Tel: 630-219-4118Email: [email protected]



Review charge master at least annually Do not have RNs assign charges or do

coding Develop cost based charges for services Train ED staff annually Use a tool to monitor/track/trend

operational and clinical performance

Emergency Department- Common Sense To Do’s

Presented by James DiGiorgio President, Applied Knowledge, LLC.

Documents

Transcript of Presented by James DiGiorgio President, Applied Knowledge, LLC.