ACHE of Central Florida January Event (Category II)
The subject for the January event, “Maximizing the Efficiency of Your Existing Infrastructure" was a very timely event given the anticipated influx of patients and changes in reimbursement with the upcoming healthcare reform. The Category II session was well received, thanks to the sponsorship of Florida Hospital and GE Healthcare’s Performance Solutions business experts.
Presenting were Jeff Terry, Managing Partner – Clinical Excellence for GE’s Performance Solutions and Dr. Anthony Schuster, MBA, Medical Director for Perioperative Services at H Lee Moffitt Cancer Center and Research Clinic. Mike Wright, GE’s local Performance Solutions contact, moderated the event
Mr. Terry started off the evening beginning with background on GE’s Performance Solutions business and proceeding with a thought leadership presentation on how to maximize the efficiency of your existing structure, care delivery plan, staff, and clinical assets without adding additional capacity, staff, or capital.
Mr. Terry's presentation focused on first determining the right balance of amortizing your fixed costs against the cost of congestion. Once this balance is determined, patient flow must be looked at next in order to achieve the right utilization levels. The key components of flow are:
- Proper alignment of your admittance and discharge curves in order to open beds to pull patients through your system versus pushing them
- Once you have bed availability you can then open capacity by maximizing the utilization of your front doors; ED, OR, and direct admits
- Understanding the balance of fixing both your process and scheduling and their affect on flow
- Understanding an managing the interdependent departments that interact with the patient and affect flow
Mr. Terry proceeded into details of how to affect patient flow, more specifically:
- Flow improvement is all about improvements in scheduling, governance and process.
- Every hospital has a discharge curve that peaks at around 3 pm, your goal should not be to move that peak to earlier in the day, but rather to better align it with the admittance curve to drive bed availability and improved patient care.
- Improved discharge planning has direct correlation to ED ALOS and boarding. Historically improving the discharge process has driven an 18% improvement in ED ALOS and a 65% reduction in PACU boarding, without any additional work in these areas.
- Improving your asset management program to drive improved patient flow, patient safety, patient and staff satisfaction and reduced cost. The key is to drive asset utilization by assuring the assets are in the right place at the right time in the right condition and you know where they need to go next. Typical clinical asset utilization runs at less than 60%, so the majority of hospitals are running with significantly high inventory levels.
Dr. Anthony Schuster, MBA, Medical Director for Perioperative Services at H Lee Moffitt Cancer Center and Research Clinic, followed Jeff presenting results of their recent OR improvement project. Moffitt was looking to drive improvement in several areas: 1) number of cases they were doing in their 12 ORs to facilitate improved operating margins, 2) the ability to recruit new surgeons, and 3) to delay the building of additions OR suites in this tough economy. Their performance improvement results were significant and they were able to drive an increase in output by 106 cases per month, decrease in OT by over $500k annually, and improved operating margins by more than $8M annually all while driving improvements in staff satisfaction. Dr. Schuster admitted this was not an easy process and that without outside help they would not have been able to do it.
Dr Schuster presented a key statistic that a typical OR is more than 90% blocked and under 60% utilized and Moffitt specifically had only 13% of first cases starting on time, their schedule was 100% blocked, and their rooms were 58% utilized. The keys to fixing this were:
- Open up block time by using technology to defragment the block, apply governance to assure block utilization, and using a 3rd party to socialize and adjust the improved block in order to drive surgeon buy in.
- Improve first time starts through technology, teamwork, governance and a buy in by all staff as to the definition of on time starts.
- Improve room utilization through the above and process improvement for room turnover times.
- Smooth the schedule of elective surgeries.
Moffitt’s specific improvements included:
- Improved first case start times from 13% on time to more than 80%
- Improved average room turn time from 42 minutes to 30 minutes
- Opened the block time by reducing the block from 100% blocked to 90%, opening up time for emergent cases and surgeon recruitment
- Improved room utilization to in excess of 80%
The presentation was then concluded with a Q&A session.
If you would like further information or did not pick up your Category II credits please contact Mike Wright at Michael.email@example.com or 813.957.2148.
Message from the President - Winter 2010
Regardless of the continued pressure for some type of healthcare reform, providers, insurers, suppliers and other stakeholders within the industry face unprecedented pressures. Just to name a few:
- Slow economic recovery.
Central Florida along with the rest of the state is likely to experience a longer general economic recovery than many of the other 49 states.
- Stalled population growth. The
State may still offer the “sunny rays” from above, but increasingly snowbirds and others are having to make difficult decisions between living in
Florida or residing in other parts of the country.
- Instability within physician practices and other provider groups. A combination of pressures from the general economy, a deteriorating payer mix and reimbursement cutbacks have caused once stable organizations to begin to show signs of foundational cracks.
- An increase in uncompensated care means providers, particularly hospitals, will have to enlarge their safety nets to deal with area residents who use their Emergency Departments as the place of last resort for treatment of non-urgent healthcare needs.
- A decreased tax base puts upward pressure on businesses, government and others to reduce funding for critical healthcare services at a time when those same services are in greater demand by the recently unemployed.
- And, affecting all sectors of the healthcare industry, expense growth is most likely far outpacing revenue growth.
So, is there a silver lining to this dark cloud hanging over the healthcare industry? Part of the answer was presented at the January 26 educational event sponsored by our chapter entitled, “Maximizing the Utilization of your Current Infrastructure.” This event featured speakers from the H. Lee Moffitt Cancer Center & Research Institute and Clinical Excellence for GE Performance Solutions. You can read highlights of the presenters in another article in this newsletter.
Along the same line, a panel of
Central Florida healthcare providers will offer examples of how to reduce expenses within an environment of constrained resources at our next chapter educational event on March 30. Look for registration information elsewhere in this newsletter for the program, “Sustaining a Financially Vibrant Healthcare Organization.”
Later this year our chapter plans to sponsor a program on talent management as well as another one on the topic of IT connections across healthcare organizations.
Our Board at ACHE of
Central Florida is committed to provide you with the tools, ideas and practices that can help you manage your way through the uncharted waters ahead. Also, make sure you keep your eyes open for the silver linings above as you paddle forward.
Keith D. Lundquist, FACHE
Date: March 30, 2010 - Register NOW
Topic: Sustaining a Financially Vibrant Healthcare Organization
Date: May 18, 2010
Topic: Disaster Relief-Hurricanes,
Haiti and H1N1
Date: September 21, 2010
Topic: Making Connections: RHIO, EMR and CPOE
Date: November 16, 2010
Topic: Making Margin on Medicare
*Reservation information will be available soon.
News and FYI
Government Health IT reports the Federal Communications Commission released its U. S. Broadband connection plan with important recommendations affecting healthcare delivery. According to Government Health IT, one example from the healthcare chapter in the plan is "...the FCC plan expressly supports changes to reimbursement methods so that health care providers will be assured of getting paid for conducting electronic health services."
Government Health IT further reports:
"The Federal Communications Commission formally adopted and forwarded to Congress a plan to significantly upgrade U.S. broadband connections that could greatly boost the adoption rate of health IT."
"The FCC’s health care recommendations are collected under four titles:
-- Create appropriate incentives for e-care utilization;
-- Modernize regulation to enable health IT adoption;
-- Unlock the value of data (which includes interoperability standards and patient access to electronic health care data);
-- Ensure sufficient connectivity for health care delivery locations."
Read more at Government Health IT "FCC broadband plan targets e-health expansion"
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