Despite renewed discussion around healthcare IT investments because of the federal stimulus package, most HIT budgets are still tight and providers are looking to IT vendors for creative solutions to keep projects moving. But a new report from KLAS says those creative solutions are virtually non-existent. The report, Executive Reaction to the Stimulus Package, explores the gap between what providers need and what vendors are offering to deal with a troubled economy.
Dunn Memorial Hospital did not send its front-end staff on a lavish junket during the National Association of Healthcare Access Management's Patient Access Week back in April. No trips to Las Vegas for NAHAM's annual show late last month.
In this economy, hospitals like Dunn Memorial in Bedford, IN, are lucky to make trips to sister sites, much less national shows across the country.
So what did its patient access staff do for Access Week? They painted.
The waiting room and their own office needed a makeover, so they did the work. The hospital and its fundraising foundation supplied the paint, and the staff supplied the labor.
What a fitting metaphor for how hospitals and their front-end staffs cope today in a recession.
The days of endless outsourcing and frugal spending on the best software systems seem to be gone for now. Facilities are finding ways to stay in the black inside their own walls.
In short, hospitals are doing the painting themselves today.
"Since Patient Access has a new supervisor, she was limited on funds and also wanted to create a ‘team project' to help build her team around her and each other," says Stephanie Smithson, CHAM, Patient Accounts director at Dunn Memorial. "She asked for ideas of team projects, and this is one she received back. Our hospital has redone all of our main hospital rooms this way. Employees design and submit for approval, then are responsible for picking a team to help complete rooms."
Dunn Memorial did its own "painting" in many other ways as hard times fell:
Shift changes. To save on staffing expenses, Dunn restructured shifts to provide "minimal" coverage on lighter days versus covering at its own comfort level. "We did this on days we had less volume historically," Smithson says.
New in-house tools. Dunn's I.T. department has developed new tools instead of seeking outside vendors for better reporting and workflow.
Less travel expenses. Travel and education expense allowances have been reduced and in some cases eliminated. Employees are encouraged to participate in sharing the cost of educational conferences or travel. Managers at every level are being reminded to staff to level appropriate and eliminate overtime except for "extreme need."
Free education. Dunn's Revenue Cycle team actively searches for new free education from all sources, including NAHAM, Passport, Medicare, Medicaid, and its own FI.
Contract negotiations. "We are looking at all contracts for vendors to see if prices can be renegotiated or a different product at a lower price can be found or a different product with more functionality at the same price," Smithson says.
Cash management. Dunn works on automating its payments, payment posting and scanning all in one solution and database.
Patient accounts management. Dunn now uses Electronic Funds Transfers in Patient Accounts for all available payers and seeks ways to streamline its work, including new worklist tools and Excel database spreadsheets. It has denial management and contract management tools to track and trend in a timely manner. It is developing in-house education and testing for Patient Accounts and Cash Management.
"All that being said, we are actually posting a positive cash flow for the first quarter of 2009 through a combination of all of these items plus an increase in revenue," Smithson says. "We are seeing a trend of increased payer mix on the commercial side in our inpatient stays. We believe this is due to people waiting longer to seek care and by then their illness has become more serious. We are seeing a downward trend in our physician offices and our walk-in clinic, while our ED visits continue to go up."
Editor's note: This is the second in a four-part series of stories on HealthLeaders Media talking to revenue cycle managers about coping in a tough economy.
Washing hands is a key component to preventing healthcare-acquired infections and improving patient safety. Yet, knowing which staff members are more compliant with hand washing policies is challenging at best for supervisors and senior leaders. Organizations often rely on observational studies to track and monitor hand washing, but if staff members know that they are being watched, they'll probably alter their typical behavior and wash hands more frequently.
I'm not suggesting that staff members are intentionally foregoing hand washing procedures, but given the pace of healthcare settings, it's an easy thing for clinicians to forget to do as frequently as they should. Soon, however, healthcare executives will have a new tool to track hand washing in their organizations and staff members will have a subtle reminder to wash hands if they forgot.
A new device, called HyGreen, is being developed at the University of Florida that can detect whether employees have washed their hands by "smelling" for alcohol, which nearly every hygiene soap product contains.
Here's how it works: Healthcare workers wear a badge with a unique identifier that sends out a signal about every three seconds. After employees wash hands or use waterless disinfectant products, they place their hands under a sensor, which flashes a green light when it detects alcohol. The detector then sends a signal back to the badge and a green light is activated. Staff members have 60 to 90 seconds to get within range of a device located above the patient's bedcurrently set at eight feet. Their badge sends out a signal denoting who the person is and whether they are clean. If too much time has passed or staff members forgot to wash their hands, the bed monitor sends out a signal that vibrates the staff member's badge as a reminder to wash hands. In addition, all of the data is sent over a wireless network to a central computer in real time that supervisors and senior leaders can evaluate.
HyGreen is currently being tested in the neuro-intensive care unit at Shands HealthCare at the University of Florida, and developers hope to have a commercial product available by the third quarter of 2009 or the first quarter of 2010, according to Richard J. Melker, MD, PhD, who is one of the developers of the technology and the chief technology officer of Xhale Inc.
This technology probably can't come soon enough for healthcare executives given the Centers for Medicare & Medicaid Services policy that it won't pay for certain never events, which are predominately infection related.
"We believe that if our system is deployed and we improve hand washing adherence by 20%, the system will cost far less than what organizations will lose in reimbursements," says Melker, who is also an employee at the College of Medicine at the University of Florida.
So what do clinicians think about the technology? Aside from a little concern about having to wear yet another badge, nurses have been receptive to it, says Richard Reed, nurse manager at Shands neuro-intensive care unit. Anything that healthcare clinicians can do to prevent infection will be positively received, adds Jeanette Hester, the clinical coordinator for Shands neuro-intensive care unit. "Direct healthcare providers want to do the right thing, even if that means they have to wear a bulky badge," says Hester.
The technology does provide healthcare organizations the flexibility to set the time requirement and the range of the sensors to meet the workflow patterns of individual care settings. Shands determined that eight feet still allowed nurses who were not doing direct patient care to peek and check monitors without being buzzed, while at the same time ensuring that any clinician caring for the patient and potentially touching bed rails or equipment had washed hands. The 90 second window was set to ensure that caregivers wouldn't forget to rewash hands if they were interrupted by a page and talked on the phone or left the room after initially washing hands. "A lot of times we are doing things on the fly, and it has increased awareness," says Reed.
"The nice part was that our numbers were better than when we had done observational studies," says Hester, adding that the bigger denominator showed staff members were more compliant that the health system originally thought. "It actually benefited clinicians to get the data back," she says.
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Each year, hundreds of women die in Ghana while giving birth—with most of the deaths caused by complications such as acute hemorrhage, sepsis, pre-eclampsia, obstructed labor, and non-hemorrhagic anemia. While most of these diseases are considered preventable and treatable in the United States, a lack of specialized training make these conditions dangerous.
Last week, three nurses from Ridge Hospital, based in Accra, Ghana, trained at Forsyth Medical Center's Sara Lee Center for Women's Health in Winston-Salem, NC, to learn new ways to treat high risk, pregnant mothers. The Ridge hospital representatives shadowed nurses at the Sara Lee to observe the process from admittance to discharge to learn how to manage obstetrical patients and watch how the staff performs patient assessments, as well as collects and organizes patient data.
"The goal is to help reduce the mother mortality rates and infant mortality rates in Ghana," says Dinah Asante-Mensah, deputy matron for nursing administration at Ridge Hospital. "Mothers shouldn't lose their lives during childbirth, neither should children."
The initiative with Forsyth Medical Center, an affiliate of the Novant Health System, is part of an ongoing exchange with Ghana established in November 2004 by Kybele, Inc., a non profit organization that seeks to improve childbirth conditions worldwide through similar partnerships.
Kybele, Inc. has established a five-year partnership with the Ghana Health Service, and Forsyth Medical Center staff has also visited Ghana as part of the exchange.
"We've been working in Ridge Hospital since January of 2007— that's when the formal relationship began with the Ghana Health Service," says Medge Owen, MD, an obstetric anesthesiologist with Wake Forest University School of Medicine who practices at the Sara Lee Center for Women's Health. "At this point in time it's critical we have the nursing leadership involved at a very high level of this program because nothing can happen in a hospital without good nursing care."
Joining Asante-Mensah on the visit to Sara Lee last week were Rebecca Fofo Larkai, head of the labor ward at Ridge Hospital, and Winifred Gladys Nyarko, head of the obstetrical and gynecology ward.
The three will take the best practices they learned to help try to reach Kybele, Inc.'s goal to reduce by half the number of maternal and neonatal deaths in Ghana by 2011. According to statistics from the UNICEF, maternal mortality in Ghana is 540 deaths per 100,000 live births.
Kybele is also hosting Ghanaian physicians and Ghana Health Service personnel at Wake Forest University, Duke University, and the University of Chapel Hill.
"I think it's the exchange back and forth that is really important, and it's going to allow the program to grow," Owen says. "Even within the first year we've seen a tremendous amount of success and the Ghana Health Service is taking serious note of this program."
Asante-Mensah, agrees, saying that by making site visits to the U.S. hospitals is very important to improve conditions in Ghana, because "seeing is believing" and it is important to view the birthing practices firsthand.
"When we come here and they tell us about how they manage their cases successfully," Asante-Mensah says. "When we come here we are able to ask questions about why things are being done certain ways, and also when they come over there they see why we do things our way. We learn from each other, and you do understand each other better when you go."
The key to this program is sustainability, Owen says: having a plan, monitoring progress periodically, and ensuring the team in Ghana implements and sustains the improvements so that when the program ends the advances that have been made will continue on and set an example for the rest of the country.
"We all should be concerned about healthcare, not only in our own backyard but also what's going on really on a global scale," Owen says. "I think we learn things from each other, and we create equality and partnerships. It's a greater awareness of other cultures, other workplace conditions."
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The World Health Organization kept its pandemic flu alert at the second highest level during a meeting last week, but said that future changes would reflect how severe an outbreak was as well as how widespread. The agency has been weighing how to revamp its pandemic alert scale to reflect both the severity of the flu as well as its geographic spread around the world following criticism that it may have caused undue panic about the new strain whose effects have been mainly mild apart from in Mexico.
Various inappropriate photographs of on-duty nurses at a National Health Service trust have sullied the reputation of the facility. In addition, all the disturbing images were taken as the three hospitals of the Maidstone and Tunbridge Wells NHS Trust were at the center of the worst superbug outbreak in NHS history: More than 1,200 patients were infected in two C. diff outbreaks between 2004 and 2006.
The Australian Medical Association has called on the federal government to develop a contingency plan for public hospitals in case a large number of people drop their private health coverage. The Australian government recently announced changes to private health insurance rebates, and estimated around 25,000 people will drop their coverage as a result. The AMA is encouraging the government to put in place a plan to increase funding to public hospitals so they could cope with the potential extra demand.
Sioux Falls, SD-based Sanford Health has announced that it will construct its first international children's clinic in the Central American nation of Belize. The clinic, expected to open in 2011, will be built on land donated by a hospital in Belize City. Sanford Health will collaborate with the Belize Healthcare Charitable Trust and Belize Natural Energy Trust on the facility.
A piece of Americana is for sale, but it may be the real estate on the outside of the item that will get your attention when it comes to hospital safety education. American Soda Machines of Denver refurbishes old vending equipment that disperses soft drinks. As part of the process, the company also customizes the outer skin of its machines for customers—with themes of sports, animals, and, yes, hospitals.
But given the amount of acronyms and images that safety-related training uses for healthcare workers and patients, one can also imagine this space instead highlighting cough etiquette from the Centers for Disease Control and Prevention or reinforcing the RACE acronym for fire safety (Rescue, Alarm, Confine, and Evacuate/Extinguish).
"I think it's a cool idea," says Terry Jo Gile, MT(ASCP)MA Ed, owner of Safety Lady, LLC, in North Ft. Myers, FL. "Why should Coke or Pepsi get their names splashed all over [the side]?"
Customers prompt the artwork
The vending equipment can be customized however a hospital wants, says Damon Carson, president of American Soda Machines.
"We had several customers inquire about theming a machine into a favorite sports team," Carson says. "So, we decided to customize to multiple themes."
The machine costs $2,695 plus shipping, he says. That's roughly in line with owning some models of modern vending equipment.
While the cost may dissuade you in these belt-tightening times, the value of getting safety information in front of a captive audience also has its proponents.
"Are you taking full advantage of your employees' break times?" asks Steven MacArthur, safety consultant for The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.
For example, while those in the nurses' lounge enjoy a cold beverage, surely it doesn't hurt to remind them not to burn the microwave popcorn and set off the fire alarm. Perhaps there are also future opportunities to wire these themed machines to act as quiz masters for required annual training.
"Maybe you put your money in and answer a safety question before you get your soda," MacArthur says.
Cafeterias would be ideal spots
Joking aside, Gile thinks a customized vending machine would be best used to encourage handwashing among workers, patients, and visitors.
"Handwashing is the No. 1 thing you can do in a hospital to prevent infections," she says. "I think [customization] would be great for vending machines in cafeterias."
The only time she has heard of something close to this idea of customization is in hospitals that use a form of vending machine to dispense scrubs to surgical unit personnel.
Missing surgical scrubs can add up in costs when workers wear them home and then "use them to paint their house over the weekend," Gile says. She's seen vending machines where surgical team members must insert their old scrubs into the machine in order to get new ones dispensed.
Many popular private healthcare plans that cover nearly 100 million Americans will see double-digit rate increases into 2010, according to a national survey of more than 100 health insurers, HMOs, and third-party administrators.
"Although our survey reveals a slight decrease in cost trends since our prior study, there are signs that we're going into another cycle of high trends," says Harvey Sobel, a principal and consulting actuary at Buck Consultants, who directed the survey.
"Health insurers may increase costs in light of the continuing economic downturn and legislation, such as mental health parity and the recent expansion of COBRA," Sobel says. "They may also attempt to increase their prices prior to the implementation of national healthcare reform, including a new public insurance option."
For its 20th National Health Care Trend Survey, Buck analyzed responses from more than 100 health insurers, HMOs, and third-party administrators, and measured the projected average annual increase in employer-sponsored healthcare benefit costs. Insurers providing medical trends for the survey cover about 95 million people.
Costs for the most popular plans continue to increase by more than 10%, and are slightly lower than the trends reported in Buck's most-recent September 2008 survey. Health insurers reported an average prescription drug trend of 10.8%, down 0.6% from the 11.4% reported in the September 2008 survey. This is three percentage points higher than the 7.8% reported by pharmacy benefit managers, who generally do not take any underwriting risk.
Robert Zirkelbach, a spokesman for the industry trade group America's Health Insurance Plans, says health insurance premiums track the cost of medical care.
"As the cost of care goes up, premiums go up accordingly. Government data has shown that to be a consistent trend for the last 20 years," Zirkelbach says, adding that the Buck survey highlights the need to address underlying medical cost drivers.
"The question needs to be 'why are those medical costs going up?'" he says. "We know there are wide variations in practice patterns across the country. New medical technologies are driving costs.
Unfortunately, we don't have good data in this country about which treatments are most effective." Health insurers providing Medicare supplemental plans project an increase of 7.4% excluding prescription drug coverage. This lower trend reflects the impact of federal controls on Medicare fees and the lower increases expected in Medicare deductibles and copays.
Health insurers use trend factors to calculate premium rates, and large self-funded employers use these trend factors to budget their future healthcare costs. In general, trend factors provide for price increases that may result from such variables as inflation, utilization of services, technology, changes in the mix of services, and mandated benefits.
Secaucus, NJ-based Buck Consultants is an independent subsidiary of Affiliated Computer Services, Inc.
