The future for hospitals is not dependent on getting more dollars in the door to offset revenue restrictions but to focus on stopping dollars from going out the door. The Centers for Medicare & Medicaid Services' pain-for-gain revenue policies drive hospital leadership to pursue new revenue streams to relieve the pain, rather than reduce operational inefficiencies and preventable medical errors—each of which CMS continues to reward through cost reports and increasing DRGs, respectively.
On October 2008, CMS will tweak its traditional pain-for-gain policies in the inpatient prospective payment system and not reward reimbursement for select preventable medical errors. This contradicts prior CMS statements. On May 18, 2006, a CMS press release stated, "Reducing or eliminating payments for ‘never events' means more resources can be directed toward preventing these events rather than paying more when they occur." This is true for commercial insurers, not for Medicare, which usually pays less for healing than the cost of prevention. Even though CMS promotes Medicare benefits that cover a broad range of services to prevent diseases, it lacks a policy to do so for preventable medical errors. Hospitals should not be surprised that IPPS will not include the promised prevention funds that could be financed with a portion of projected savings unless CMS has an epiphany or a crisis of conscious.
Whether you chose to respond with new services or not, focusing on operational efficiencies, which are the rails quality travels on to achieve excellence in patient and financial outcomes, will keep dollars in the bank. It is what CMS wants you to pursue, but is clueless in how to manage the transition with less pain, so it remains committed to utilizing revenue pain-for-gain policies. You have to be committed to achieve excellence, pain or no pain. You can do this with little financial investment, but a major personal investment in using your leadership skills to inspire staff to execute the basics flawlessly.
My suggestion to leadership is simple to state but mentally hard to pursue. Start listening to your physicians, nurses, patients, and support staff —especially those you are actively avoiding. Rather than rounding with a "hi and good-day" approach, start engaging the staff throughout the hospital on a daily basis and become known as the barrier slayer. You are not there to go to meetings; you are there to facilitate the meetings of minds, ideas, and outcomes throughout the hospital. Implement a survey where all hospital services—from volunteers and housekeeping to the executive suites —are rated by other services in meeting their needs and identifying what barriers prevent them from achieving their goals. Be relentless in identifying all barriers every service feels or knows inhibit them from being efficient and quality driven. Learn to let the facts take shape and put feelings on hold before decisions are made. Create an environment where individual anxiety is to elevate excellence, not to compromise it. Inject comfort zones with large dosages of accountability. Inspire all leadership levels to be the force behind an efficiency evolution by adopting these tactics.
Remember that the No. 1 operational disease in hospitals is the communication breakdown that usually exists in the black hole of an information chasm under the oversight of complacent leadership. These characteristics do not inspire reflection, inquiry, and collaboration, which are critical to an efficiency evolution. Leadership, information, and communication are the three piers necessary to build the foundation for a culture of excellence in the shifting sands of the healthcare delivery system. If these piers are structurally weak, you limit the number of "pillars" your hospital can support, if any.
How will I know that you are in the midst of an efficiency evolution? When I enter your hospital and approach a housekeeper who has the emergency room looking exemplary and compliment him or her and then ask, "Do you know the CEO?" and I see a face light up with an affirmative response. I then look to the waiting area in the ER where patients look anxious but not angry, and I think, "This place is busy!" But my senses tell me this is not organized chaos because every staff member is moving with purpose, uninhibited by the sense of disorder that operationally inefficient ERs cultivate. And this affirmative response towards you and a sense of purpose by employees is repeated throughout my tour. Then I know this is a hospital in the continuous pursuit of excellence, because the people know that leadership believes in them and that they are the only means to make a hospital quality-driven, profitable, and great--no matter what pain CMS inflicts.
R. Daniel King is a retired healthcare consultant in Tyler, TX, with a background in operational, financial, and crisis-management for hospitals, medical practices, and skilled-nursing facilities.
Many marketers treat the 78 million baby boomers as if they were cut from the same cloth, but there are many sub-demographics of Americans born between 1946 and 1964. In order to market to them effectively, you've got to know the specifics.
Want to take your performance to that ideal level of highly effective and efficient marketing? It takes better access to detailed data and ROI discipline, but it also comes along with greater growth and better levels of budgets, according to the recently released Lenskold Group/Kneebone 2008 Marketing ROI and Measurements Study.
Business author and speaker Harvey Mackay outlines 12 secrets to sales success. Mackay says knowing something about your customer is just as important as knowing everything about your product, and that your reputation is your greatest asset. He also suggests positioning yourself as a consultant, a principle that more and more healthcare marketers are starting to embrace.
I hear it all the time from healthcare marketers and experts alike: hospitals and health systems should look to other industries for marketing and advertising ideas. After all, this tactic has worked in other areas of healthcare. Patient safety and quality have both been improved thanks to best practices borrowed from outside the healthcare field, for example. But will that innovation ever find its way into the marketing department? Or are healthcare marketers too entrenched in the "this-is-the-way-we've-always-done-it mentality"?
Here's the problem. The way it's always been done is not very well.
Really, how long will hospitals run ads with pictures of a team of doctors in white coats with their arms crossed or a nurse at a patient's bedside offering a comforting touch and a friendly smile or pictures of medical devices and buildings?
OK, so it's no secret that healthcare is a little behind the curve when it comes to marketing. And that's why some savvy healthcare marketers are looking beyond their own departments and hallways for inspiration, advice, and a new way to do things.
And there are lots of things that healthcare marketers can learn from other industries, especially in areas in which healthcare marketing is—let's face it—weak. From product development to how best to use new media to creating a brand that engages consumers to measuring return on investment (the latter being the weakest of all weak spots, for sure), why not turn to others for a little help?
So, who should you turn to?
In this month's issue of HealthLeaders magazine, I wrote about some of the lessons healthcare marketers can find in the business models of companies in other industries, such as pharmaceutical, finance, travel, and hospitality.
The people I interviewed for this article said you have to go beyond the obvious. Yes, hotels have valet parking and yummy room service choices. But there's more to it than that.
"Our patients don't understand why they can stay at the Marriott and have an accurate bill under their door the morning they leave the hotel, yet the hospital sends an inaccurate bill months after they are discharged," Lynne Cunningham, principal of Cunningham Associates, a healthcare consulting firm in Sacramento, CA, told me. "Patients don't understand why we have asked for the same information upon registration—every time—even if they are being seen on a regular basis."
So, what else can you do to learn from other industries? A few suggestions:
Get on mailing lists. Every time you order from a catalogue or drop your business card in a fishbowl at a conference, you'll increase the number of direct mail pieces that land on your desktop. More clutter, yes. But also more inspiration from a variety of industries upon which to draw. Don't forget that even industries that have nothing to do with healthcare are, in a way, your competitor—those direct mail pieces are competing for the time and attention of your audience.
Sign up for e-newsletters. Want to figure out what kind of online ads work? Well then, you have to look at a bunch of online ads. Sign up for marketing and advertising e-newsletters, of course. But if you have other hobbies—such as cooking, photography, personal finance, or the latest best-sellers—believe me, there is an e-newsletter (or five) for you. Even if you're not interested in the content, you can always open the e-mail and take a peek at what ads are inside.
Build your collection. Invite your colleagues from across the hospital to join your new recycling program—by dropping all the direct mail they get into your mailbox. Your physicians are getting direct mail from pharma, medical device companies, sporting goods companies, travel companies, credit card companies and a host of others. Nurses and staffers, too. If you want to know how to reach your internal audience, study marketing that targets them.
Step outside for a minute. Check out that crafts fair under way down the street from your hospital or pop by that art gallery opening after work. Breathe in the atmosphere, spy on the organizers to see how they're greeting and interacting with attendees, see what kind of food they're serving, and look for the posters and postcards they used to promote the current event as well as upcoming ones. You might get some ideas to liven up your next health screening or make your next employee appreciation event a little more fun.
You have to break out of the marketplace clutter. You must differentiate your organization from the rest. The best way to look different than everybody else might just be to look in a different direction from everybody else.
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
The strategic and economic rationale to maintain a strong relationship with female patients is well documented. Now healthcare organizations are renewing their focus in this area, developing new women's hospitals and expanding existing facilities.
Beyond full-service obstetric programs, personalized care in private rooms, and strong branding, cutting-edge women's hospitals have a number of common characteristics, such as a core physician leadership that focuses on programs such as urinary incontinence, gastrointestinal disorders, and minimally-invasive surgery.
To be a "player," you must replicate these characteristics—although it's not enough to distinguish your women's program in an increasingly competitive market.
Achieving a strong market position and annual net revenue or income growth of at least 7–10% requires clinical and operational innovation and an emphasis on customer service.
The following ten characteristics are fundamental to accomplishing that end:
1. Penetrate previously untapped or underserved patient pools by implementing clinical services unique to the market. Highly successful women's hospitals focus resources on implementing clinical services that will "drive" significant inpatient and outpatient profitability. In general, they are early adopters of new clinical technology and practices. For example, one women's hospital has a strategy to be one of the first to combine genetic testing and counseling for multiple diseases rather than just antepartum care. Another women's hospital has implemented cryopreservation of eggs for career women who desire a delayed start of families and patients requiring cancer treatment who wish to retain reproductive capability. A third women's hospital is providing intrauterine fetal surgery. Although wellness, education, retail, and other non-clinical services supplement core services, they're not sufficient to enable a women's hospital to achieve sustainable market leadership and generally do not have large net revenue or income potential.
2. Adopt a regional and potentially a national market penetration strategy by creating recognition for clinical expertise. Recruiting a physician or physicians who are regionally or nationally renowned for a particular service can bring both an established patient referral network and develop new relationships based on his/her clinical skills and entrepreneurial track record. Examples drawn from leading edge women's hospitals include attracting physicians with national reputations in minimally-invasive reproductive surgery, genetics, and urogynecology. In addition, strong women's hospitals also identify established members of the medical staff and work with them to build regional/national reputations and referral networks.
3. Provide superior service to primary care physicians (PCPs) in outlying target markets, encouraging them to shift referrals to your women's hospital. Achieving this end requires effective, ongoing interaction with the targeted physicians to understand and respond to the issues of greatest importance. Adequate capacity must be provided to treat their patient. On-line scheduling, utilizing electronic linkages (CPOE, PACS, and EMR) to achieve timely sharing of patient progress information should be offered. Clinical advancements should be ongoing, and patients should also be referred back to their PCP for continuing care. No amount of clinical innovation and architectural enhancement can substitute for these fundamental requirements.
4. Enhance operations to make the women's hospital unique in its ability to meet the needs of your medical staff. Leading-edge organizations stretch beyond the basics of regular investment in upgrading clinical tools and equipment and maximizing the clinical and interpersonal skills of the nursing and other staff. They devote resources to anticipating and resolving operational issues before they become bottlenecks. They aggregate and, where this is not feasible, virtually link interdependent clinical services are. They take proactive steps to maximize the cross-referral of patients between specialties/departments. And they employ a dedicated director of budget and business development.
5. Establish strong physician leadership. Commonly, physicians play an active role in setting the vision and direction of the women's hospital on a clinical and a strategic basis. Physicians frequently play a role within the senior management team. Some women's hospitals that are components of a larger hospital campus appoint a physician as chief administrative officer. Others involve physicians in management through medical directorships and medical advisory panels. At the same time, those individuals are held accountable for the performance of the women's hospital (financial, clinical quality, patient satisfaction, etc.) through pay-for-performance initiatives.
6. Make the facility unique in its ability to meet the needs of women in the market. Most significant to achieving this end is establishing an operational environment in which the diagnostic, therapeutic and related educational and psychosocial support services are more convenient than those available through competing providers. As an example, one women's hospital has established a single point of "entry" to health services for women. Patients are able to call one number or go to one site and schedule visits and procedures with physicians and multiple hospital departments. They receive the assistance of a care navigator in working through the process.
7. Develop relationships with niche patient pool segments. One of the best opportunities to achieve growth is to create relationships with patients in previously untargeted niche groups that are attractive from a payer mix standpoint. Several women's hospitals have developed culturally sensitive clinical programs specifically oriented to the Hispanic, Middle Eastern and Asian-American communities. Similarly, other women's hospitals have designed clinical programs to age-specific niches such as adolescent medicine; women athletes; and other groups.
8. Establish an environment that enables the organization to become an innovation center in women's health. Form strategic partnerships with other organizations. Physicians and researchers who are clinical entrepreneurs frequently find the patent rights and other economic restrictions of universities and some corporations too restrictive and are willing to move to more favorable environments. This presents an opportunity for a women's hospital to act as a catalyst in establishing an independent, freestanding facility that is one part collaborative "think tank," one part applied laboratory and one part funding mechanism. Several benefits may be derived. First, the innovation center may be used to draw to the hospital leading-edge physicians that can lend their clinical reputation and "star power" to the women's hospital by practicing at the facility. They can contribute their own clinical advancements to the continued evolution of medicine delivered at and thus differentiation of the hospital. They may also draw pharmaceutical, biotech and information technology companies eager to use the facility as their beta site for advancements in care specific to women.
9. Maximize the impact of market visibility tools. Most women's hospitals utilize a multi-media approach to build awareness and preference for their medical staff and facility. The use of the Internet is crucial. Women avidly conduct online research in support of healthcare decisions. Innovative organizations will convert these Websites, particularly social networking sites, into proactive relationship vehicles through the use of bi-directional communication and the single point of entry concept referenced in point 6 above. Actual social networking also plays a prominent role. A competitive edge may be achieved through a combination of establishing physical and virtual networking events.
10. Demonstrate clinical quality in a proactive way. Quality initiatives must go beyond internal data collection, benchmarking, and corrective action plans. Given the proliferation of public report cards and patients who are increasingly conducting Internet-based research, it's crucial that women's hospitals proactively manage their quality of care image. This entails setting and managing to operational performance targets that will enable differentiation. It also entails use of proactive public relations campaigns to highlight distinctions achieved by members of the medical staff and the hospital as a whole.
Establishing a successful, cutting-edge women's hospital is a huge logistical challenge. However, a dedicated management initiative following these steps can make it possible.
Mark Dubow is a senior vice president with the Camden Group. He may be contacted at (310) 320-3990, or by e-mail at mdubow@thecamdengroup.com.
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