The finance leaders at New Jersey's Barnabas Health have a new motivation for engaging with the quality department's efforts: reducing readmissions and cutting costs.
As the healthcare industry moves towards population health management and a value-based reimbursement model, finance and quality—which have long operated in separate silos—are starting to come together in new ways in order to improve patient care and protect profit margins.
Deborah Larkin, vice president, quality at Barnabas Health, an integrated delivery network based in West Orange, NJ, says that even though there is a lot of uncertainty around health reform, the changes it is forcing within her organization are encouraging.
"I think we are in a state like many other hospitals where we are not quite sure what to expect, how many patients are going to enroll, what the utilization will be, [and] what resources they are going to access. In many ways, it's a wait and see situation. Frankly, I don't think any hospital or integrated system knows the answer," Larkin says.
"With health reform, it's like a totally different ball game now. It's nice because finance and quality are joining in and trying to understand how processes matter with regard to the cost of healthcare."
Finance finds new motivation
From her perspective as a quality executive, Larkin appreciates the skill set that the finance team brings to the discussion.
"Just having the financial people at the table is amazing. They do bring a different value to the table because they are so analytical when they ask questions of the clinical folks… They are learning, and the clinicians are rethinking what they are doing," Larkin says.
As healthcare reform legislation unfolds and impacts the bottom line, the finance leaders at Barnabas have a new motivation for engaging with the quality department's efforts, and that's a good thing, Larkin says.
"I am so positive because I've seen the shift, and I think 'thank goodness.' We are going to be able to come together to improve care," she says. "Finance people are much more interested now in the process of care and how it impacts patients… This is where we are going to be able to change healthcare. This is going to be the transformational part."
Larkin says that as with any initiative, it is imperative to find a few senior-level champions to support the idea of integrating finance and quality within an institution.
An advocate among senior leaders
At Barnabas Health, one of those champions has been Patrick Ahearn, the system's chief operating officer and former chief financial officer. "The cost of healthcare is unsustainable, and it's not a surprise that something has to be done and that we have to figure out how to do more with less," Ahearn says.
Ahearn notes that despite having spent the bulk of his career as a "finance guy," he has always put an emphasis on providing quality patient care.
"I don't talk about money. I talk about doing it better and improving quality and efficiency. If we can do that, we'll make money and be able to survive," he says, citing examples such as reducing readmissions and hospital acquired infection rates and setting protocols for appropriate medical testing as particular areas of focus at Barnabas.
Ahearn agrees with Larkin that the move toward a pay-for-performance reimbursement environment is bringing finance and quality together with a common purpose and says Barnabas' immediate goal is to be in the 90th percentile or above for all quality metrics.
"Only if you have your head in the sand do you not understand that change is afoot… It's a challenge, but at the end of the day, I truly believe we are responsible for the health of the community," he says.
The health system is using data analytics tools to reach its objectives, Ahearn adds.
"We have created scorecards here across the system to have a friendly competition between all the hospitals… We want to be the best, and we are going to do that transparently. We issue reports weekly, monthly, some even daily, so everyone knows where they stand, and we really dive into the data."
Helping patients avoid a readmission
Barnabas also uses data analytics to identify patients that are at a high risk of being readmitted and provides a six-week follow-up to help them stay out of the hospital.
"The first week we do a home visit at no cost to the patient so we can physically see their home and check on their medication management," Ahearn explains. "After that, we make sure they have a follow-up appointment with their doctor and then we make sure they keep it. We reschedule the appointment for them if they don't make it."
In Ahearn's mind, it is incumbent upon the healthcare provider to help patients avoid a readmission, something he says hospitals in general have not traditionally emphasized enough.
"We are kidding ourselves to hand someone a piece of paper at discharge and expect them to understand," he says. "We've been more interested as an industry in checking off the box as opposed to actually making sure they understand."
While Ahearn is aware of the financial paradox that currently exists for hospitals that substantially reduce their readmissions rates while still operating in a largely fee-for-service world, he says it is what Barnabas is pushing for because it is the right thing to do for its patients.
"I tell people to do the right thing for the patient all of the time. It is up to the finance people to figure out how to stay ahead of the curve and keep the place financially viable. But as a hospital, you have to move in the right direction with patient care. You have to do the right thing even if no one is paying you for it."
For her part, Larkin believes that as healthcare reform brings previously uninsured patients into the market, it will become even more important for quality and finance to work together with a focus on patient-centric quality metrics and improved value throughout the care continuum.
"Regardless of what final form healthcare takes, the imperative will be to deliver high-quality, low-cost healthcare," she says. "The expansion of finance, quality, and care providers as a team will support these efforts and keep quality, safety, experience, and cost as the driving forces."