What is Standardization in Healthcare?

Standardization can be defined as the extent to which hospitals are making use of the same products, services and processes. Due to the sheer number of suppliers and products available in the market combined with a diverse array of end-user preferences, hospital leaders often find they have a variety of similar products and services being used across the organization.

Standardization delivers the following benefits to an organization:

• Financial benefits ranging 15 – 30% depending on the category
• Leveraging system purchasing power
• Improved consistency of service levels across the organization
• Improved patient care and access

Key Opportunity Indicators

Supplier Fragmentation

The use of multiple suppliers providing similar products and services may be a strong indicator for standardization opportunities. A closer review may reveal differences in both pricing and quality amongst the suppliers.

• Client Example: Pathstone worked with a large health system that used multiple suppliers for over the phone interpretive services. By consolidating its supplier base through a competitive bid process, the client was able to leverage the health system buying power to negotiate market competitive prices and save over 25% in annual costs.

Product Fragmentation

The use of multiple products or services that fulfill a similar need can be another indicator of potential standardization opportunities. Different end-user preferences are a key contributing factor to product fragmentation, which can lead to varying price points for similar products and services. A thorough review of purchase orders or supplier invoice data can be a good starting point to understand the degree of product fragmentation.

• Client Example: Pathstone recently reviewed print services for a client and discovered over 40 different copier models being used across the organization, resulting in variable device leases and cost per page rates. A deeper analysis showed over half of the devices had similar functionality but were billed at different rates. By standardizing devices, the client was able to achieve significant savings.

Incomplete Category Definition

An incomplete understanding of a total product or service category due to extensive fragmentation can lead to missed opportunities to take advantage of key supplier relationships. If there is a narrow view of a category and its scope, it can significantly restrict the hospital’s leverage in negotiating key supplier contracts.

• Client Example: Revisiting our previous example, the key driver behind the client’s fragmented supplier base was its decision to allocate business based on the type of interpretive services, such as in-person, over the phone and video interpretation services. Pathstone worked collaboratively with the client to identify suppliers with capabilities for all types of services, thereby generating more leverage for negotiations with existing and new suppliers.

Varying Service Levels

Disparate service level expectations across departments or facilities may also suggest opportunities to achieve cost or service efficiencies. This is often an overlooked identifier but can drive more consistent service delivery at a lower cost overall.

• Client Example: In the same example as mentioned above, Pathstone discovered varying break/fix Service Level Agreements (SLAs) for the copiers across departments, resulting in inconsistent service and higher staffing costs due to the vendor’s inability to implement standardized practices. By standardizing and aligning break/fix SLAs with actual needs, the client was able to not only reduce costs but also improve service levels by optimizing staff deployment based on the “density” of areas (the volume and devices at a certain location).

Key Success Factors

Utilize a Data-Driven Process

High-performing organizations remain disciplined in utilizing data as a foundation to identify opportunities for change. Since standardization requires a change in end-user preferences for suppliers, products and services, data is crucial for an objective approach to arrive at the best solution. Without the use of data, organizations may resort to anecdotal information that will not drive optimal results.

Increase Knowledge of Complex Categories

Understanding the strengths and weaknesses of suppliers, products and services enables organizations to select the best solution that meets internal objectives. By conducting market due diligence, organizations can evaluate a wide range of options considered by their peers. Partnering with third party consultants such as Pathstone may be beneficial to access market intelligence and provide assistance in determining what change is truly best-in-class and beneficial to the organization.

Engage Key Stakeholders Early

Any standardization initiative that does not have support and buy-in from key stakeholders is bound to fail over the long-term. A strong leadership team that participates in initial decision making and ongoing management is essential to reduce costs and improve service levels. When working with clients on standardization initiatives, Pathstone proactively identifies champions that can engage end-users and hold them accountable. By doing so, initiative benefits can be sustained over the long term.

What is Clinical Documentation Improvement (CDI) in Healthcare?

Clinical documentation improvement (CDI) aims to represent a patient’s clinical status into coded data. This data is then used for medical research, quality reporting, financial reimbursement, public health data, and disease tracking/trending. By enhancing clinical documentation, medical data collection, reporting, and digital health technology, hospitals will improve their cost efficiency, thus maximizing their revenue and increasing productivity in their organization.

Why Are Clinical Documentation Improvements Important?

With the increasing complexity of medicine and healthcare, there is great importance of capturing data accurately for further analysis. Physicians spend about six hours per day performing data entry into patient records, which includes clinical documentation. These administrative tasks detract providers from focusing on patient care, which is what they are trained on. Physician education typically doesn’t include payer rules for clinical documentation, or other factors that influence a hospital’s revenue.

Moreover, physicians typically don’t prioritize improvements in clinical documentation, and consider it to take away time from providing patient care. The implementation of physician advisors, or clinically experienced professionals, can act as a bridge between healthcare providers and other staff to support clinical documentation improvements.

What Are the Challenges of CDI?

While implementing CDI can improve hospital revenue and efficiency, you should account for potential pitfalls. When creating a CDI program, consider the following:

• Technology issues: Some outdated technology may make communication and reporting more challenging. While implementing a CDI plan, there may be necessary technology updates as well.
• Conflicting information: Some client intake charts may have duplicate or conflicting data with their patient records. CDI can help remove and prevent unnecessary reporting.
• Physician engagement: After the CDI system implementation, physicians must comply with new standards and communicate as necessary.

While you may face these challenges, the overall impact on patient well-being makes CDI necessary for many individual healthcare practices. As employees address the individual challenges, they’ll create a trickle effect that enhances all aspects of the hospital system.

Benefits of Clinical Documentation Improvements

There are several benefits to implementing clinical documentation improvement within your health system. The main advantages of CDI include:

• Reduced Claim Denials: Insurance companies can deny a patient’s request for healthcare coverage due to ineligibility, lack of detail, late submission, missing information, and more. With enhancements in clinical documentation, claims will be thoroughly completed on time, which reduces the chances of a patient’s claim being denied.
• Lower Physician Queries: Improved clinical documentation will also decrease physician queries, by ensuring the Current Procedural Terminology (CPT) and Classification of Diseases (ICD) codes are precise based on physician notes.
• Improves Communication: Lastly, CDI strengthens communication not only for the patient and provider, but for everyone who accesses the patient’s charts, specifically billing companies. Clinical documentation improvement keeps both the healthcare provider and billing company on the same page regarding the patient’s healthcare, so they will better care for the patient. Payers continue to push for CDI and accurate clinical data not only to tie financial reimbursement to value, but to consequently improve care quality overall.

A 2016 Black Book Market Research survey found that nearly 90% of hospitals that implemented CDI earned at least $1.5M more in healthcare revenue and claims reimbursement, showing a clear benefit for hospital revenue.

Improved Documentation and Performance

CDI also advances patient care. When a patient’s record is accurate detailed, healthcare professionals can create more personalized treatment plans. Better documentation not only improves patient care, but also provider performance. The Heritage Valley Health System in Pennsylvania found that better CDI reduced their predicted mortality by 27%, showing clear and tangible benefits. With better clinical documentation, healthcare providers can more easily identify and correct gaps in care. This comprehensive data allows providers to catch a potential complication before it arises, therefore improving patient safety and shortening hospital stays.

Different Types of CDI Metrics

Knowing which key healthcare metrics to look for will help you understand how your system works and where to make adjustments. If you want to analyze trends and gaps, Pathstone Partners will assist as you interpret and visualize the data.

Review Rate

The review rate accounts for how many documents the CDI team reviews in a given time. This metric helps administrative staff measure productivity within any organization. You can break this number down by timeframe and assign quantitative goals to each CDI team member.

Query Rate

The query rate is the number of queries per the number of reviews. This number helps leaders notice how their team handles documentation and manages communications.

Response Rate

This rate represents how often staff is responding to queries. You can see which groups are struggling to respond and offer guidance and education to improve this rate.

Response Time

Your response time is how long it takes physicians to respond to queries once they receive them. You might consider setting a standard response time goal across all teams. Reaching this goal will improve communication and ensure patient needs are met quickly.

Case Mix Index (CMI)

The CMI is the average relative weight of all diagnosis-related groups (DRGs) within a hospital. This number determines how sick patients are at any hospital and helps staff calculate payments to meet demand. You should monitor this number monthly and compare it to similar institutions with the same services.

Need Help With Clinical Documentation Improvement?

As a leading healthcare management consulting firm, Pathstone Partners can help with CDI in any facility. We work with your team and offer strategies and software that improve performance across the board.

Whether you want to implement a new CDI program or refresh your policies, we can find a custom solution for your facility. Contact us today to learn more about our CDI consulting capabilities!

What Are Environmental Services in Healthcare?

A key challenge that health systems face involves healing patients in an environment in which many illnesses are highly transmissible. Environmental services (EVS), which is defined as all cleaning services that take place in healthcare settings, performs the vital service of protecting patients, visitors, and staff from infectious pathogens. While proper cleaning of clinical spaces has a direct impact on patient health outcomes, the perception of clean in non-clinical areas significantly influences patient satisfaction scores.

Why Are Environmental Services Important in Hospitals?

Patient outcomes are directly influenced by the performance of EVS while in the hospital. Hospital-acquired infections (HAIs) affect roughly 1 in 31 hospital patients and 1 in 43 nursing home residents in the United States, their impact becoming more pronounced with the rise of antibiotic-resistant bacteria.

Further, HAIs represent a significant expense to hospitals at over $9.8B annually. HAIs represent a considerable challenge to EVS systems, as not all pathogens can be eliminated using the same cleaners and methods. C. diff, a common hospital-acquired bacterium, forms spores on surfaces and cannot be sterilized with bleach alone. In order for EVS to minimize the impact of HAIs on the health system, EVS staff must understand the nuances of cleaning patient care areas relative to non-hospital janitorial work.

Environmental services personnel are integral to the success of the health systems they serve because of the effect their work has on patient satisfaction. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is issued to recent hospital patients nationwide as a means to evaluate and compare hospital performance across systems. Included in HCAHPS are questions related to the quality of the hospital environment, which includes how patients perceive the cleanliness of the hospital. As a result, EVS must ensure that both clinical and non-clinical areas are pathogen free to prevent HAI transmission and appear clean to the naked eye to bolster HCAHPS scores.

What is the Role of EVS Staff in Hospitals?

Efficiency and employee education are key factors that influence the success of an EVS department. EVS staff must be efficient in cleaning rooms post discharge to make room for new admissions, but too much emphasis placed on turnaround time may result in insufficient disinfection.

Further, employees must understand their role in combating HAIs not only for the benefit of patient outcomes and satisfaction, but also to mitigate their financial impact on the system. A successful EVS department is an essential component of a successful health system, as EVS plays a key role in helping hospitals achieve their primary objective of treating patients and preventing infection.