“To measure improvement achieved through process changes intended to better manage LOS, it is important to utilize a consistent and accurate cost accounting approach to determine the components of your daily costs, including bed costs, ancillary testing and services, pharmacy and supplies as well as improvements, and this measurement should be customized to meet the needs of each organization,” H&HN says.
Hospitals are mining big data in intensive-care units to try to get better outcomes.
The Wall Street Journal reports:
“The big-data approach being tested by some hospitals … sifts through years of medical records and information from multiple sources—including data sets that may never have been linked in a single analysis before—to find correlations no one knew existed, and thus discover more trouble spots and more potential solutions.”
“First-time hospital meaningful users who began the attestation process in 2015 can attest anytime between now and August 14. Previously, hospitals participating for the first time were required to wait until Jan. 1, 2016 to attest due to system changes.
“Those hospitals choosing to attest this summer must attest to stage 1 meaningful use requirements that were set in place in the beginning of 2014. They will not be able to attest to the new, revised meaningful use requirements that were announced for the 2015 through 2017 time frame.”
Chris Powell is managing editor of the Journal Inquirer, in Manchester, Conn.
Get sick enough to go to the hospital in Connecticut and you inevitably fall into a web of political deception and corruption.
It’s not just the cost-shifting and concealment that government long has imposed by requiring hospitals to treat the indigent for free, recovering those costs by charging more to paying patients and their insurers, a policy that taxes serious illness and converts hospitals into tax collectors.
In recent years the scheme has grown. Lately state government has been taxing hospitals directly. At first this taxation of hospitals was undertaken in the name of obtaining higher medical reimbursements from the federal government, reimbursements that were to be passed along to the hospitals themselves.
But then state government started keeping the reimbursements for itself, spending the money on other things. Thus the hidden state tax on serious illness grew and, with it, the function of hospitals as tax collectors.
So the public blames rising medical costs on hospitals and insurance companies, not the sneaky elected officials also responsible. State government long has used a similarly dishonest system with electric utilities, requiring them to provide service to the indigent for free and to recover the expense by charging paying customers extra. This policy drives up electricity bills and turns utilities into tax collectors as well, but again elected officials escape the blame; instead it falls on the utilities.
Some state legislators seem to have noticed such policy only recently, but at a General Assembly hearing in February, Gov. Dan Malloy’s budget director, Ben Barnes, was remarkably candid about it. Asked why state government is taxing hospitals, Barnes replied by quoting the career criminal Willie Sutton. When Sutton was asked why he robbed bank, he replied: “That’s where the money is.”
It’s funny that Democrats who purport to sympathize with working people countenance secret sales taxes on the necessities of life. At least these taxes should be shown plainly on hospital and electric bills just as sales taxes are shown on other bills.
Of course, the Democrats’ expressions of concern for working people are just for show. Their main concern is only to feed the machine of government, particularly to sustain the compensation of government’s employees, their party’s base.
Hence Connecticut has not only gotten these secret taxes on serious illness and electricity but soon will have more gambling, on account of provisions in the state budget just passed by the Democratic majorities in the General Assembly – “satellite” casinos to divert the state’s gamblers from new casinos out of state, and the casino game keno, to be installed on computer terminals in bars, more mechanisms for taxing the working class and poor.
Still, state government isn’t the only one exploiting hospitals. They also are being exploited by their own executives, who claim salaries in the hundreds of thousands and even millions of dollars.
While Hartford Hospital has begun laying off hundreds of employees at its facilities around the state, Journal Inquirer Staff Writer Don Michak reports that the hospital recently paid bonuses ranging from $45,000 to $498,000 to 16 executives who were already earning between $300,000 and $2.1 million a year.
Defending such salaries, hospitals say they need to compete for top talent in the market. But just as it is the biggest purchaser of higher education, government makes the market in medical care, too, and government could control excessive salaries in both college and hospital administration any time it wanted to by conditioning its purchases on salary restraint.
While the Malloy administration has injected itself into a hundred trivial things without ever managing to stop the collapse of state government’s finances, it still hasn’t gotten around to the excessive college and hospital executive salaries that state government pays for.
In an essay that ran on The Philadelphia Inquirer’s Web site, he says “I was disappointed to see headlines about high hospital charges dominating the media coverage of cost data released this month.
“The headlines attracted public attention. But they may distract us from a more important discussion about why we Americans spend so much on healthcare but are so unhealthy.
“Many factors are driving this sad reality, but high hospital charges are not chief among them.”
His piece details what he sees as the main contributing factors in the wide differences in hospital charges.
Among the things that should promote such ties, she lists:
• “Value-based payments are prompting hospitals to work more closely with post-acute providers.
• “Hospitals face Medicare penalties for high readmission rates.
• “Establishing narrow networks of post-acute partners can encourage providers to improve quality of care.
• “Tactics for improving care between acute and post-acute partners include ‘warm handoffs’ that involve actual conversations, not just the exchange of paperwork, between clinicians on both sites.
• “New staffing models, including the use of SNFists {nursing-home specialist worker} and nurse care navigators, are gaining ground.”
She discusses, among other things:
Selection of the right ”first setting”
Standardization across the continuum of care
Longitudinal CARE planning
Nurse care navigators
It discusses physician-alignment problems, finding seeking the right mix of payers, how to distribute shared savings, finding the right physician leaders and integrating with physician practices.
The WSJ explains:
“Medicare allows hospitals to collect for such patients based on the actual costs of treating them. But because hospitals don’t provide cost data until many months after patients are treated, the government has to estimate costs using a formula that relies heavily on list prices.
”When prices rise faster than actual costs, the government overpays. Medicare can seek to claw back overpayments when it gets fresher information about costs, but it rarely does, hospital records show.”
”A Wall Street Journal analysis of Medicare claims data and financial filings from medical facilities shows that many hospitals increased prices faster than costs rose, affecting outlier payments.”
Labor ratio — a hospital’s total labor costs divided by total revenue — “should be the most important metric you use in doing your budget every year,” Berger told a session at the American College of Healthcare Executives 2015 Congress.
Labor is hospitals’ largest expense, and each incremental improvement in the labor ratio goes straight to the bottom line, he notes. And many hospitals can improve, considering the wide variation in performance on this metric.
Mr. Berger said that the median labor ratio for U.S. hospitals is 55 percent, but the highest and lowest performers can vary by 20 percentage points. “Best practice is about 45 percent,” he said.
He said that many rely on full-time-equivalent per occupied bed to benchmark productivity, but this metric fails to account for FTE and contract labor costs, said Mr. Berger.
He says that hospitals should keep young workers in the know about leadership opportunities, and everyone aware of the need to seek out talents that the current administration, led by older people, may lack. And he discusses in a Q&A how to get along with a staff many of whose older members might be dismissive of a young leader.
He ranks among his biggest successes so far readmission rates that have dropped to 35 percent from as low as 12 percent and a 30 percent rise in outpatient surgery over the past few years driven by new service lines.
Tejeda told H&HN that youthful hospital execs should play into the stereotype that they’ll be energetic and enthusiastic.
“That’s one of the preconceptions that should be taken advantage of. Allow yourself to be dynamic. Allow yourself to have that energy and enthusiasm. People will feel it. They will want it. People who have been at the hospital for a long time have wonderful ideas that need to be implemented, but they haven’t had that spark. They haven’t had someone who is the impetus to get things done. If they see that you have that energy, they will latch on and together you can accomplish wonderful things.”
