Pathstone Partners: Giving Back to Make a Difference in 2024

Pathstone Quarterly Newsletter 2024 Year in Review Draft 2024 11 04 Page 7 Image 0002
Our Giving Back Ideology 

At Pathstone Partners, the commitment to improving lives goes beyond healthcare consulting. In 2024, the team embraced its Giving Back ideology through meaningful initiatives that supported vulnerable populations and made a positive impact in the community.

Supporting Global Healthcare with Project CURE

This year, Pathstone held its biannual service event with Project CURE in Chicago. The team came together to sort through medical supplies, prepare shipments, and load containers. As the world’s largest distributor of donated medical relief, Project CURE ensures these supplies reach underserved communities in need of quality healthcare. Pathstone’s efforts directly contributed to this vital mission, helping bridge gaps in global healthcare access.

Spreading Holiday Cheer with Little Brothers Friends of the Elderly

Pathstone partnered with Little Brothers Friends of the Elderly, an organization dedicated to reducing loneliness among older adults. The Pathstone team embraced the holiday spirit, spending hours decorating festive paper bags. These beautifully crafted bags will hold goodie items, delivering joy and companionship to seniors during the holiday season.

A Commitment to Community

Through initiatives like these, Pathstone Partners exemplifies its commitment to making a difference, not just in the healthcare industry but also in the broader community. By giving time and effort to meaningful causes, the team demonstrates how collective action can uplift lives and create lasting impact.

Pathstone Partners is proud to partner with organizations like Project CURE and Little Brothers Friends of the Elderly. These collaborations reflect the company’s dedication to creating a better world, one initiative at a time. Stay tuned for more updates on Pathstone’s community involvement in the coming year!

Pathstone @ Premier Healthcare Conferences in 2024

Confrence 2024
A Year Of Industry Leadership 

In 2024, Pathstone Partners actively participated in several high-profile conferences and events, sharing insights and connecting with industry leaders. These events reinforced Pathstone’s role as a thought leader in healthcare consulting and showcased the team’s innovative approaches to cost savings and operational efficiency.

AHRMM SME Podcast: Elevating Organizational Change

Managing Partner Joseph Jang joined the AHRMM Subject Matter Expert Podcast to discuss strategies for driving organizational change through cost savings. His expertise illuminated actionable ways healthcare organizations can tackle financial challenges while maintaining high standards of patient care.

Health Connect Partners (HCP): Supply Chain Leadership in Dallas

In May, Senior Directors Dan Ehle and Andy Poorman attended the HCP Hospital Supply Chain Conference in Dallas, Texas. The event provided an excellent platform to exchange ideas with supply chain healthcare professionals, exploring cutting-edge solutions for optimizing supply chain operations.

Becker’s Healthcare National Conference: Insights from Chicago

Pathstone Partners played a key role at the Becker’s Healthcare National Conference in Chicago, Illinois, in March. Joseph Jang and Senior Director Colin King connected with healthcare professionals, sharing expertise on tackling challenges in cost management and operational improvements.

IDN Summit: Sharing Expertise in Orlando

At the IDN Summit & Reverse Expo in April, Joseph Jang presented Pathstone’s groundbreaking knowledge on driving hospital cost savings and improving margins. The event, held in Orlando, Florida, emphasized collaborative strategies for overcoming financial pressures in the healthcare sector.

AHRMM Spring Summit: Insights on Transformation Excellence

In April, Joseph Jang represented Pathstone Partners at the AHRMM Spring Summit on Transformation Excellence. He shared valuable insights on how supply chain teams can elevate cost management efforts, driving impactful results for healthcare organizations.

HCP Hospital Supply Chain: Fall Conference in Las Vegas

Capping off the year, Dan Ehle and Andy Poorman attended the HCP Hospital Supply Chain Conference in Las Vegas. The event offered an incredible opportunity to engage with healthcare supply chain leaders, exploring innovative ideas to tackle the industry’s most pressing challenges.

Showing Innovation In A Growing Field

Pathstone Partners’ active presence at these events underscores their dedication to staying at the forefront of healthcare innovation. By participating in discussions with industry leaders, the Pathstone team continues to refine and expand its solutions to meet the evolving needs of healthcare providers.

As Pathstone Partners reflects on the knowledge and connections gained in 2024, the team looks forward to continued collaboration with industry peers and clients. These conferences not only strengthen Pathstone’s commitment to excellence but also inspire new strategies for reducing costs and optimizing operations in healthcare

One of Inc. Magazine’s Fastest-Growing Private Companies in 2024

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Driving Growth Through Dedication

Pathstone Partners, a healthcare consulting firm based in Chicago, Illinois, is proud to announce its recognition by Inc. Magazine as one of the Fastest-Growing Private Companies in the United States for 2024. With an impressive 3-year revenue growth rate of 84%, Pathstone has joined an elite group of organizations celebrated for innovation, impact, and a steadfast commitment to excellence.

Pathstone’s milestone reflects the remarkable achievements of its talented team, which has grown to over 35 professionals dedicated to streamlining operational costs and optimizing healthcare services nationwide. Collaborating with over 250 hospitals across the U.S., Pathstone has achieved more than $500 million in margin improvements, delivering measurable value to healthcare providers of all sizes, from academic health systems to community health organizations.

Transforming Healthcare Operations

Pathstone Partners has built its reputation by offering tailored solutions for both non-labor and labor-related operational challenges, including:

  • Non-labor services: Streamlining laboratory and clinical supplies, purchased services, IT systems, and pharmaceuticals.
  • Labor solutions: Optimizing workforce structures, reducing contract labor costs, managing overtime, and enhancing productivity.

By focusing on creating sustainable cost-saving strategies, Pathstone has become a trusted partner for organizations navigating the complexities of the healthcare industry.

A Commitment to Excellence

Earning a spot among the fastest-growing companies is not just a reflection of financial success—it is a recognition of Pathstone’s ability to adapt, innovate, and create meaningful change for its clients. As Pathstone continues to expand its footprint across the United States, its commitment to empowering healthcare providers remains stronger than ever.

Looking Ahead

Being recognized by Inc. Magazine is a significant accomplishment, but for Pathstone Partners, it’s just the beginning. The firm remains dedicated to its mission of helping healthcare organizations reduce costs, optimize operations, and improve patient outcomes.

As Pathstone continues to grow, the company looks forward to building on this momentum, leveraging its expertise to create even greater value for clients and the healthcare industry as a whole. Together, we are building a brighter future for healthcare, one success story at a time.

What is Revenue Cycle Management (RCM) In Healthcare?

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It is extremely important for RCM in healthcare to run smoothly

Healthcare Revenue Cycle Management (RCM) is the financial process that organizations use to manage the administrative and clinical functions associated with different steps of patient care from start to finish. The process starts when a patient schedules a visit for medical services and finishes when all claims and patient payments have been collected. In summary, revenue cycle management in healthcare serves as the strategy for streamlining processes, ensuring steady collections, and making healthcare providers financially viable.

With RCM in healthcare, the goal is to discover any possible problems in the revenue cycle and solve them before they become a bigger issue. It is extremely important for RCM in healthcare to run smoothly to keep your entire system working properly.

How Does the Revenue Management Process Cycle (RCM) Work in Healthcare?

There are seven main steps in the revenue management cycle for healthcare. These include:

  • Patient eligibility check and insurance authorization
  • Medical coding and billing
  • Claims creation, validation, and submission
  • Error/denial check and correction
  • Statement to patient (EOB and/or bill)
  • Payment collection from patient
  • Continuing data analysis
Why is Revenue Cycle Management (RCM) Important for Healthcare Providers?

While healthcare providers are largely focused on the quality of patient care, there remains a level of concern regarding reimbursement and collections. The process from initial delivery to full payment is complex and implementing effective RCM is essential for to minimize the number of errors, increase the likelihood of payment, avoid aging accounts receivable, and improve overall profitability in health systems. Often there is a significant delay between services and payment collection, making it difficult to see the exact view of cost, spend, and revenue.

Managing revenue is essential for any business and focusing on improving the revenue cycle plays an important role in increasing claims efficiency while reconciling costs against revenues to optimize cash flow. In addition, the healthcare revenue cycle process houses important patient information and data leaks could have substantial legal ramifications. Ultimately, the goal of revenue cycle management in the healthcare industry is to develop a process that helps organizations get paid the full amount for services as quickly as possible by identifying points of friction and resolving them.

Benefits of Focusing on the Revenue Cycle in Your Health System

There are many benefits to efficiently managing your revenue cycle such as improved patient satisfaction, maximized monetary benefit, reduced administrative burden, and simplified processes.

  • Improved Patient Satisfaction: Revenue Cycle Management (RCM) enhances the patients’ experience with the entire hospital billing process through increased transparency in cost of service, added support throughout entire care process, and minimized number of forms for tracking patient data.
  • Reduced Administrative Burden: Revenue cycle management in healthcare serves as the entity for streamlining the processes. Outsourcing and automating the revenue cycle alleviates the administrative burden of the providers, allowing for a greater focus on delivering quality care to patients.
  • Maximized Monetary Benefit: “According to a report from Sage Growth Partners, more than a third of health systems have faced more than $10 million in bad debt annually. The situation is worsening due to unpaid bills and every year up to $125 billion is lost in unpaid and underpaid claims”. Effectively implementing RCM results in lower denial rates, which leads to increased cash flow and faster speed to payment. The process brings accuracy to the system and leaves little room for errors during insurance verification, coding, and claims processing, in turn maximizing collections.
  • Simplified Processes: Successfully managing your revenue cycle drives efficiencies through workflow automation, which improves scheduling processes, coding and billing, and payment processing. Removing the complexities in the workflow leads to improved operational efficiency of the providers, ensuring they meet their revenue targets.

What is Digital Health Technology?

Health Care Financial Consultant Digital Health

The importance of digital health technology

Digital health encompasses the use of various technologies such as such as mobile health (mHealth), health information technology, and telehealth to enhance to overall efficiency between doctors and patients across healthcare systems. The scope of digital health creates opportunities for physicians to gain a holistic view of their patients’ health and for patients to have greater access and ownership to their information.

The importance of digital health technology has increased over time, especially with the COVID-19 pandemic. In addition to increasing access to health information for both providers and patients, digital health also enhances patient-doctor relationships, increases patient disease prevention methods, and creates a shift toward value-based care.

What are the Benefits of Digital Health?

Better Patient-Doctor Relationships

Through digital health, patients can access information about their own health as well as have a stronger relationship with their provider. For example, many hospital systems have digital health portals where patients can message their providers and receive answers back relatively quickly, rather than needing to wait for their next appointment. With digital health portals, patients can also meet with their doctors via video chat, which is especially important during the COVID-19 pandemic. Providers can provide real time updates to their patients regarding lab work and testing all without the patient needing to come into the office.

Improves Access to Information

Using digital health technologies, patients can actively manage their own health and monitor any irregularities that they may experience. Through digital health, patients also have access to information related to the following:

  • Disease prevention
  • Physical therapy
  • Occupational therapy

Having such information at their fingertips allows patients to make more informed decisions about their health.

Promotes Lifestyle Changes Among Patients

The amount of education individuals have access to because of digital health is immense and can lead to lifestyle modifications for patients who may be at risk for common diseases, such as heart disease or diabetes. Physical and occupational therapy can also be achieved through digital health platforms which are paramount to a patient’s recovery.

What Impact Does Digital Health Have on Value-based Care?

Value-based care has been discussed frequently as an alternative to fee for service care. Through digital health technologies, the shift towards value-based care is now being made in the United States.

Value-based care creates a model where providers are rewarded for giving the highest quality care to patients rather than providing care at a lower standard which leads to readmission rates and complications. This type of approach can be used to expand a patient’s care management and ensure that the patient is not suffering because of a lack of quality providers.

Digital health allows for multidisciplinary care management that could be lacking in value-based care. Multidisciplinary care management consists of constant communication between providers, something that digital health has a crucial role in. Digital health technology paired with value-based care gives patients the opportunity to decide for themselves which providers are best equipped to handle their health.

What is the Future of Digital Health?

Digital health is still relatively new in the United States but with continued healthcare services moving towards a digital model, patients will be able to take their care into their own hands. This means that individuals across generations will be more educated about their health and will be able to make informed decisions regarding their own care. Advances in digital health are numerous and the United States will see many more in the future.

As the demand for digital health continues to grow throughout hospitals and healthcare systems, so does the challenges of finding a cost effective solution. At Pathstone Partners, our expert consultants specialize in providing information technology solutions for healthcare systems across several different markets.

From contract negotiations to software rationalization efforts, we take a comprehensive approach to improving outcomes and reducing inefficiencies for health systems. Contact us online to sit down with our experience consultants to learn about our healthcare consulting services how we can help with digital health technology.

 

Guide to Different Types of Healthcare Contracts

Health Care Financial Consultant Contracts

Contracts are the glue holding every operation together within the healthcare industry.

They connect employees and employers, suppliers and buyers, ensuring each party remains protected. Whether dealing with hiring, your supply chain or equipment, contracts can be long and complex and require time and effort to ensure they’re structured in your best interest. Understanding the different types of contracts and how they work is the first step to an effective contract management operation.

Supply Chain Contracts

Healthcare organizations depend on countless materials and products to complete daily tasks. Some of the most common products used throughout healthcare centers and hospitals include syringes, defibrillators, sterilizers, gloves and masks.

You can create supply chain contracts to secure these raw materials, products and services from reliable suppliers. These written agreements guarantee the supplier will provide specified goods or services for a pre-determined period at a fixed cost. They also outline delivery schedules, consequences for failing to adequately buy or supply and termination conditions.

Types of Supply Chain Contracts in Healthcare Facilities

Healthcare professionals use expensive instruments daily, and they might have equipment lease contracts rather than buying items outright. This strategy provides additional flexibility and security to obtain the required tools at a more convenient price. However, there are other solutions healthcare providers might employ to get the resources they need. Common types of supply chain contracts found within healthcare facilities and organizations also include:

  • Purchase orders: A purchase order is a binding contract the buyer produces detailing what they want to purchase from a supplier. This document includes information like quantity, payment terms and delivery.
  • Service agreements: These contracts are lists of all the services a supplier agrees to provide. It also outlines pricing, timelines and the rights afforded to each party.
    Distributor agreements: Distributor agreements are formed between suppliers and merchants. The seller, or distributor, agrees to market and sell specified providers’ products for a fixed fee.
Labor Contracts

Standard labor agreements are legal contracts outlining the terms and conditions of employment at an organization or company. These documents vary by company and position and provide explanations of employee responsibilities and duties, employment terms, compensation and benefits and conditions of termination.

Commonly used labor contracts in every industry include:

  • Union contracts: A single, written agreement between the employer and a group of employees agreed upon using collective bargaining. These documents detail wages, hours and scheduling, time off, working conditions, advancement and more.
  • Non-union contracts: Customized documents that employers and individual employees negotiate. Individual employment agreements state conditions of employment and are often subject to governmental regulations.
  • Independent contractor agreements: Contractors are not employees and agree to perform specific services for a company in return for payment. These contracts outline the scope of work, compensation, deadlines and partnership length.
Special Healthcare Labor Contracts

Labor contracts are required for every employee within your organization. Which one you use depends on their position and union status and must meet all state and federal employment laws. However, there are special circumstances in which you must utilize other contract types, such as hiring a physician.

Many states prohibit medical facilities, like hospitals, from employing physicians directly. Detailed physician employment contracts or independent contractor agreements are often necessary.

They include schedule expectations, wages and benefits, on-call requirements and a restrictive covenant outlining non-compete conditions. If you are hiring for the role of medical director, a separate contract is also required and includes similar information.

Purchased Services Contracts

A lot goes into running and maintaining your healthcare facility. It takes time, effort and money to provide patients with the care and attention they deserve. Partnering with outside companies will ensure your operations are sustainable and run smoothly while saving you money. These partnerships are usually called purchased services and are part of your non-labor spending budget.

Purchased services agreements are the contracts between your organization and outside businesses. They include information regarding contract terms, scope of services, pricing structures and scheduling. Standard outside services many organizations choose to outsource include:

  • Laundry and linen
  • HVAC
  • Marketing
  • Rehabilitation services
  • Specialty equipment
  • Legal services
Types of Purchased Services Medical Contracts

Your healthcare business depends on the services you source from outside businesses and contractors. Outsourcing activities like coding, transcriptions and billing collections require managed services agreements (MSAs) and outsourcing agreements. These examples of healthcare contracts outline the promised service, payment structures, liability protections and timelines. They can also include penalties, fines and exit strategies.

Professional service agreements (PSAs) are another form of purchased services contract that aims to reduce company expenses. Facilities like hospitals often use PSAs to enlist the help of specialized physicians such as anesthesiologists, radiologists, hospitalists and many other professionals.

These professionals remain independent from the business while adhering to a contract tailored to fit the needs of your business or organization in return for payment. You can create them for a single service provider or a whole department, varying in term length, schedule type and responsibilities. These contracts tend to be more complicated, yet they can be extremely powerful when they are done right.

Informational Technology Contracts

As technology has continued to advance, it has become a staple of the healthcare world. Healthcare companies everywhere depend on cutting-edge technology and software to treat patients effectively and deliver reliable services.

Technology contracting is critical to these companies acquiring the resources they need. Most applications, software and information-based technology require licensing agreements detailing necessary fees, the duration of the agreement and prohibited activities.

Examples of Healthcare Informational Technology Contracts

The healthcare industry is extremely reliant on innovative technology to continue meaningful growth. With this, you may see various types of healthcare contracts, including:

  • Software licensing agreements: This is a legally binding contract between your healthcare organization and a technology company permitting the use of specific software. It defines where a purchaser can install the software, how to use it, how much it costs and how a party can terminate it.
  • Software development contracts: These agreements enlist the help of developers to design and implement custom programs and applications to expand business offerings and capabilities. A software development contract offers an overview of the project details and expectations, including the timeline, expectations, budget and other information.
  • Information technology outsourcing (ITO): ITO agreements are legal documents describing all the work to be handled by a third-party partner. You can establish relationships with vendors for infrastructure management, data center services and application development and maintenance.
  • Data use agreements (DUA): Providers use DUAs with patients when transferring protected health information, like limited data sets and identifiable data. This contract establishes both parties’ rights, responsibilities and obligations regarding permitted use, ownership and liability.
  • Application service provider (ASP) agreements: Healthcare companies can work with vendors to obtain the right to use their software or application. Instead of licensing and receiving a copy of the software, organizations rely on vendors to operate and manage the software on their behalf, often charging a usage fee or subscription.
  • Business process outsourcing: Organizations choose to streamline their technological supply chain by subcontracting specific jobs to third-party service providers. Popular online sectors that healthcare facilities create agreements for include finance and accounting, human resources and customer call centers.
Pharmacy Contracts

Drugs and medications are heavily regulated at the state and federal levels. Contractual agreements are used between healthcare organizations and pharmacies to protect each party’s rights and meet legal restrictions.

Pharmacy contracts are legal agreements between pharmacies and healthcare organizations. These detailed documents establish the terms and conditions regarding various operations, including purchasing, dispensing and paying for drugs and related services.

Types of Pharmacy Contracts

Pharmacy contracts will likely vary from pharmacy to pharmacy, and they are heavily dependent on provided services. Essential terms covered within these types of medical contracts include the scope of services, pricing, confidentiality, compliance and termination. Whether you run a pharmacy or work side by side with them, you should be aware of the following contracts you might encounter:

  • Manufacturer rebate agreements: Also known as vendor rebate agreements, these arrangements act as incentives to increase manufacturer sales while offering businesses reduced price points. This contract details the conditions a healthcare organization must meet before they receive a rebate check or future discount.
  • Group purchasing agreements: Specialty healthcare entities and pharmacies can enter into group purchasing organizations to secure supplier discount pricing. Organizations use these agreements to increase their buying power and negotiate with manufacturers, vendors and suppliers.
  • Pharmacy benefit management (PBM) contracts: These documents facilitate the relationship between pharmacy benefit managers and employers, health plans, labor unions, wholesalers and other organizations involved in healthcare. PBM contracts describe the manager’s role in processing and paying prescription drug claims and outline pricing areas and unique exclusions.
Choose Pathstone Partners to Handle Your Healthcare Contracts

Legal contracts come in all shapes and sizes within the healthcare industry, facilitating integral services that businesses and organizations rely on to succeed. Understanding how each operates and how to navigate through each situation accurately is crucial to your growth. It will ensure you’re capable of effectively helping and caring for customers and patients.

Pathstone Partners is devoted to providing your business with a broad spectrum of exceptional healthcare consulting services to manage all your medical contract needs. We have a long history of working with healthcare organizations of all sizes, identifying challenges and capitalizing on opportunities to enhance performance. Our healthcare consultants have unrivaled expertise to oversee contracts across all your business ventures. Get in touch with us to get started today.

The Importance of Information Technology in Healthcare

Health Care Financial Consultant Technology

What is Healthcare IT?

Information technology (IT) plays an important role in the modern world, impacting many industries such as the banking industry and tech industry. Not as widely recognized is the importance of IT in the healthcare industry.

Before delving into the importance of information technology to healthcare, it is necessary to understand what exactly IT refers to in this space. Most commonly, healthcare information technology employs the exchange of health-related data via electronic systems involving the use of digital technology to record, assess, and distribute patient related-data.

Why is IT Important in the Healthcare Industry

The importance of information technology in healthcare is demonstrated when its effective use leads to improvements which medical care providers can bestow upon their patients. Medical care often involves the analysis and decision making of multiple specialists, payors, and the patient and readily available and accessible information is crucial to help inform the patient’s best treatment plan and increase overall efficiency of the health system. It is often difficult to share, access, and maintain consistent information across the many sectors and stakeholders present in medical care. Thus, minimizing the demonstrated gaps of information that present themselves in healthcare financial is where information technology proves instrumental to the industry.

That said, improvements to medical care are limited by the quantity and quality of the information that healthcare providers have on their patients. Insufficient medical information can lead to medical errors that may potentially affect the medical and wellness of patients, payors, and healthcare providers. For example, adverse drug reactions can be linked to insufficient access to medical information and cause over 350,000 hospitalizations and 1.3 million emergency room visits every year in the United States. Therefore, by assisting the delivery of accurate and accessible patient information, supporting shared decision making, establishing networks of social support for patients, and enhancing treatment compliance tracking, IT drastically improves the quality of care provided to patients and avoids the unnecessary costs of medical errors and information gathering.

The Benefits of Establishing a Healthcare IT Infrastructure

IT plays a role in medical data collection and research. By providing researchers with patient data, the development of new treatment options and clinical studies can be conducted.  Additionally, IT eliminates unnecessary processes, such as physical test result interactions and information gathering interchanges using software such as MyChart.

IT also facilitates healthcare providers in the process of remaining compliant with increasingly complex regulatory policies and federal programs. An example is the 340-B Drug Pricing Program, where covered entities must maintain certain statuses and coverage statistics to qualify patients for reduced drug prices. With the development of platforms such as RxStrategies, hospitals and hospital networks can adhere to the strict regulations, minimize the costs of doing so, and maximize the benefit from such programs.

In conclusion, IT has impacted the healthcare industry across the multiple layers and institutions involved in the industry. Patients have benefited from improved medical care, physicians have been able to make better informed decisions, payors have been able to better track their beneficiaries, hospitals have been able to reduce unnecessary costs, and regulatory powers have been able to ensure complex regulation are complied. As information technology continues to develop, so will healthcare.

10 Key Metrics in the Healthcare Industry

Health Care Financial Consultant Metrics

Measurements in the Healthcare Industry

Like any business, hospitals must collect and analyze data about their processes and procedures to streamline operations, improve patient care and avoid overspending. Healthcare performance metrics are essential data points that indicate how efficiently an institution is running and allow hospitals to monitor their quality of care and spending habits.

In this guide, you’ll discover the common healthcare metrics that hospitals and facilities should leverage to provide outstanding patient care and remain as efficient and profitable as possible.

Metric #1: Length of Stay

The average length of stay measures the duration of a patient’s hospital stay from their admittance to discharge. According to the Centers for Disease Control and Prevention (CDC), the average hospital stay in the United States lasts 5.4 days.

Hospitals can track and segment this metric by hours, days, weeks, months or quarters. If desired, they can further categorize length of stay metrics by diagnosis or department. However, most hospitals typically track their average stay length using months or annual quarters as units of measurement.

Stakeholders can use this metric to measure efficiency and financial performance. The longer a patient stays in the hospital, the more their care costs, meaning shorter stays reduce a hospital’s cost per discharge. Post-acute care is also generally less expensive than inpatient care.

Metric #2: Readmission Rates

Patient readmission rate refers to the number of patients readmitted to the same hospital for the same condition after being discharged for less than 30 days. The most recent data from the Healthcare Cost and Utilization Project (HCUP) indicates the average 30-day hospital readmission rate for Medicare patients was 16.9% in 2018.

This metric fluctuates depending on the type of patient and condition. For example, the average 30-day readmission rate for Medicare patients with heart failure in 2018 was 22.9%.

Readmission rates demonstrate a hospital’s quality of care, as a higher hospital readmission rate indicates that care providers likely overlooked complications and prematurely discharged patients.

Hospitals also use readmission rates to measure financial performance, as hospitals with higher readmission rates might not receive full reimbursements from Medicare.

Metric #3: Bed Occupancy Rate

Bed occupancy or bed utilization rate measures the number of occupied hospital beds at any time. This healthcare performance metric helps providers to see the ratio of available beds to those awaiting care. Current data indicates the average national bed occupancy rate in the U.S. was 64.4% in 2019.

Much like a hospital’s readmission rates, bed occupancy rate helps hospitals evaluate their quality of care and financial performance. The higher the bed occupancy rate, the more staff is needed to care for patients. Adequate staffing is paramount, as quality of care could suffer if a hospital is understaffed.

Conversely, if a hospital’s bed occupancy rate is too low, the facility might lose money due to overstaffing and maintenance costs.

Metric #4: Incident Rate

A hospital’s incident rate measures the occurrence of care complications, including issues such as bed sores, infections, reactions or postoperative respiratory failure, hemorrhages, sepsis and pulmonary embolism.

According to a 2018 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG), 25% of Medicare patients experienced harm during a hospital stay. These adverse events included pressure injuries, intraoperative hypotension and respiratory infections, resulting in the need for life-sustaining measures and prolonged hospital stays.

Having a lower incident rate indicates a hospital’s ability to provide high-quality curative care without adverse reactions. Better care also reduces a hospital’s financial losses because it minimizes the need for additional treatment, meaning that this specific performance metric has a substantial impact on other areas of operation.

Metric #5: Average Cost Per Discharge

The average cost per discharge is the median cost per hospital visit for each discharged patient. As with average length of stay, hospitals can segment the average cost per discharge based on diagnosis or department.

Current data indicates that the average cost per discharge for Veterans Affairs Hospitals was $40,763 in 2020. According to the HCUP, the average cost of a common hospital stay in the U.S. in 2017 was $12,100, compared to $11,700 in 2016. Septicemia, osteoarthritis and heart failure were among the most expensive inpatient conditions in the U.S. in 2017.

Hospitalization continues to be one of the most expensive aspects of medical treatment. Tracking the average cost per discharge helps hospitals measure inpatient costs to assess their spending efficiency and monitor areas of overspending. The average cost per discharge metric also showcases where hospitals routinely profit.

Metric #6: Operating Margin

A hospital’s operating margin is its net revenue minus its operating costs. Operating costs include but are not limited to staff salaries, medical equipment, supplies, utilities, liability insurance, treatments, medications, meals and marketing expenses.

According to the American Hospital Association, one report indicates the average operating margin for over 900 U.S. hospitals at the beginning of 2022 was -3.45%, meaning that many U.S. hospitals did not turn a profit early in 2022.

A hospital’s operating margin is an essential healthcare performance metric that demonstrates the institution’s financial health, as a higher operating margin translates to greater profit for the hospital. Higher operating margins also indicate excellent management revenue cycle and patient care.

Metric #7: Inpatient Mortality Rate

Inpatient mortality rate refers to the percentage of patients who die in a hospital’s care. Mortality rates differ based on patient demographics and diagnoses.

For example, a National Health Statistics Report from the CDC asserted that 35% of patients hospitalized for pneumonia in 2016 died during their hospital stay. Other serious conditions, such as congestive heart failure, will naturally involve a higher mortality rate, while more minor issues and illnesses are less likely to result in a patient’s death while under care.

This metric is especially important for informing stakeholders of an institution’s performance because it is an Inpatient Quality Indicator (IQI) demonstrating a hospital’s ability to stabilize and adequately care for patients. Though variation is expected based on patient demographics, higher overall patient mortality rates indicate care deficiencies.

Metric #8: Asset Utilization Rate

A hospital’s asset utilization rate refers to the percentage of time its hospital equipment is in use, with a higher asset utilization rate indicating better performance. That’s because the more a piece of equipment is in use — or the higher the utilization rate — the more the hospital generates revenue from that investment.

A lower utilization rate might mean a hospital has more equipment than is reasonably necessary, hinting at overspending. Without knowing how often a hospital’s staff uses its assets, it’s challenging to budget for or justify equipment expenditures, so this metric is vital for assessing a facility’s financial status.

Metric #9: Patient Satisfaction

Patient satisfaction refers to a patient’s satisfaction with the care and service provided during their hospital stay. Factors that might influence a patient’s satisfaction include staff temperaments, wait time, visit length, technology, facility condition and diagnosis.

According to a 2019 study by the Centers for Medicare and Medicaid Services, only 8% of U.S. hospitals received a 5-star rating on patient experience. In the same study, it was found that the majority of U.S. hospitals receive 3-star ratings.

Why is measuring patient satisfaction important? Patient satisfaction provides actionable feedback and data hospitals can use to improve care and optimize services.

Patient satisfaction also affects the likelihood of a patient recommending a hospital to their loved ones, contributing to its reputation. A positive reputation can bolster a hospital’s bottom line.

Metric #10: Time to Service

Time to service refers to the time it takes a patient to receive care at a hospital, from the first arrival to when they receive healthcare services. This metric also includes the time it takes for a patient to see a physician.

Hospitals can segment time to service based on diagnosis, discipline or department, such as in the case of emergency room (ER) visits. The current time to service for U.S. emergency departments differs by state, with North Dakota having the lowest wait time at 104 minutes as of 2022.

Time to service is an important metric for hospitals to track because it provides information about their ability to provide prompt patient care. Wait times also directly impact patient satisfaction, meaning hospitals can improve their patient satisfaction rates by focusing on improving service times.

Leverage Hospital Performance Metrics With Pathstone Partners

If you’re looking for ways to leverage healthcare performance metrics data to improve your hospital’s operations and finances, consult the experts at Pathstone Partners. We’re a leading healthcare management consulting firm that assists healthcare organizations with developing streamlined operational strategies. We’ll help you identify trends that can enhance your facility’s operations to improve your quality of care and boost your bottom line.

Contact us today to learn more about improving your healthcare organization’s efficiency by analyzing healthcare performance metrics.

Pricing in the Hospital Supply Chain

Health Care Financial Consultant Medical Billing 02

What is Pricing in Healthcare?

Pricing opportunity can be defined as optimizing the price paid for a good or service, which can be achieved through incumbent supplier negotiations or competitive sourcing activities. Accurately identifying pricing opportunities can be challenging due to several variables such as unique product/service specifications, quality, volume, technology advancements, and local market factors. As a result, most benchmarking exercises can leave hospital leaders with misleading perceptions of price competitiveness. Although pricing may be viewed as a straightforward value lever that is routinely reviewed by hospital supply chain, Pathstone finds many hospitals have yet to maximize pricing opportunities in more complex categories such as various clinical and non-clinical purchased services.

Successful implementation of pricing opportunities delivers the following benefits to health systems:
  • Financial benefits ranging 5-25% depending on the category
  • One of the quickest and least disruptive paths to financial improvement
  • More visibility into cost drivers of goods or services
Key Opportunity Indicators

Supplier Relationship Not Reviewed

If your supplier contract has not been evaluated for price competitiveness in the last 3-5 years, this can indicate there may be opportunity. Supplier relationships with hospitals can change over time. Expansions of supplier scope in an organization can be an advantageous leverage point to bring into the pricing negotiations. Furthermore, supplier markets evolve and change the dynamics of how they do business with their hospital clients. Many clinical areas, for example, are impacted by demographic changes (e.g. aging baby boomers), population health challenges (e.g. new diseases) or development of new technology (e.g. telehealth), all of which may affect the demand for certain supplies or services. As a result, continuous vigilance is important.

  • Client Example: In our experience, perfusion services is an example of a complex area that is challenging to identify pricing opportunity for many of our clients. The demand for perfusion services has been growing driven by the increase of open-heart surgeries for an aging population. As a result, many hospitals have seen their perfusion service volumes jump by 30-50% over the last several years. In such situations, Pathstone can help clients evaluate pricing opportunities with current market intelligence across our widespread client base.

Not in-line with Price Benchmarks

One common indicator of opportunity is identifying higher pricing when benchmarked against peers. Utilizing available resources such as group purchasing organizations (GPOs) or databases to perform the benchmarking can provide a good directional perspective on potential pricing value. However, hospitals should proceed with price benchmarking cautiously. Our experience has shown that when hospitals have the ability (often through third-party partnerships) to contextualize and customize benchmarks – this creates the best data and ultimately drives the most value.

  • Client Example: Benchmarking services are anything but straightforward. Pathstone often helps our clients benchmark their services both internally and externally. Pathstone provides external price benchmarks that are contextualized based on the health system’s volume, geography, specific service requirements, and unique operational considerations to determine an accurate and tailored cost savings opportunity.

Hospital Growth and Expansion

Within the healthcare industry, hospital consolidation and integration activity has been increasing. If integration has already occurred or may be imminent for your organization, then it presents a ripe opportunity to re-evaluate pricing for goods and services. Through integration, your volume may change (likely increase) which creates leverage to help drive more competitive pricing.

  • Client Example: Pathstone has worked with hospital systems that have merged, acquired new sites, or expanded service lines. A benefit of any consolidation activity is the ability to combine purchasing activities of two different organizations to create leverage with suppliers. For example, a newly merged health system was using two different dialysis service providers, and in turn, had varying pricing for the same dialysis services. In some cases, hospital sites were even using the same service provider through separate contracts but with very different pricing. Consolidated purchased volumes in the newly merged health system created leverage to negotiate better pricing with the chosen provider.

Prices are Higher than Reimbursement Rates

For certain goods or services where the hospital is receiving reimbursement, it can be a beneficial exercise to compare pricing against reimbursement. If the pricing is significantly higher, this data point can potentially be leveraged in supplier pricing negotiations.

Key Success Factors

Maximize Resources

Hospitals have a variety of resources at their fingertips but determining how best to maximize those resources is challenging. The use of Group Purchasing Organizations (GPOs), market databases, and/or consultants seem to be some of the best options for a hospital to obtain benchmarking information. Appropriate use of this information can create valuable metrics for internal KPI tools to identify opportunities.

“Test” the Market

There are various approaches your organization can take to “test” the market. A competitive process like a Request for Proposal (RFP) or Request for Information (RFI) are common approaches. At times, just the initiation of a competitive process can motivate your suppliers to provide a significant reduction in current pricing in hopes you avoid looking at competitors. However, when going to the market an organization needs to have conducted its initial due diligence on the market and have an appetite for potential supplier conversion

Find the Right Fit

Hospitals often struggle with finding a quality product/service at the right price but also one that fits that organization’s needs. When pursuing price opportunities, it is important to maintain focus on quality. Establishing cross-functional work teams that can evaluate both pricing and quality is key. Additionally, developing service level metrics can help reinforce quality expectations with suppliers. Lower prices don’t always mean it will yield lower quality. Quality can remain the same or improve while pricing decreases as long as the work team maintains focus on this balance.

Benefit your Supplier

Obtaining the most competitive price is usually the result of a mutually beneficial partnership with your supplier. It is important to understand your supplier’s goals and look for ways to benefit your supplier through your relationship while still achieving your financial objectives. Challenge yourself as the customer to provide feedback to your supplier not only on the areas that require improvement but also on the areas in which they have met or exceeded expectations.

The Value of Utilization in the Hospital Supply Chain

Health Care Financial Consultant Supply Chain 02

What is Utilization in Healthcare?

Utilization can be defined as the extent to which hospitals are making use of products or services. Many hospitals have historically focused on savings related to pricing and standardization. However, with seemingly relentless financial pressures and complexities of the healthcare supply chain, utilization opportunities are the next wave to spark interest of savvy hospital executives.

Opportunity for improvement in utilization can exist due to over, under, or improper use of a hospital’s goods, equipment or services. Being able to conduct an accurate assessment of current operations to determine if utilization opportunities exist is a challenge for most hospital leaders due to several factors such as unreliable documentation data and constantly evolving market options for products and services.

Successful implementation of utilization opportunities delivers the following benefits to an organization:
  • Financial benefits ranging 7-15% depending on the category
  • More efficient use of time and resources
  • Discovery of other deep issues within a category, often quality related
Key Opportunity Indicators

Poor Asset Management

In today’s environment, hospitals have a broad mix of assets across the organization. Understanding the true total cost of those assets is a challenge. Total cost of ownership for each asset includes not only the acquisition cost but also ongoing expenses related to maintenance, service and consumables. Furthermore, with hospital service lines experiencing continuous evolution, it’s difficult to maintain current lists of assets, let alone track service and maintenance records. As a result, an organization may find many inefficiencies or low returns on investments when true total cost of ownership is revealed.

  • Client Example: In our experience, clinical engineering often comes up in client discussions as an area to review due to its costly asset acquisitions, large asset inventory, and significant recurring spend on service and maintenance. Optimizing service levels on under-utilized or low-risk devices can drive utilization improvement. As an example, in outsourced maintenance agreements for ultrasounds, there may be significant savings to move from a platinum to silver or bronze support levels when in-house maintenance capabilities exist or sufficient inventory is available to swap out devices as equipment downtime occurs.

High Volume of Add-on Charges

For outsourced services, expenses can mount quickly due to “add on” charges for line items such as over-time, out of scope requests, volume commitment penalties, etc. These situations can result when service requirements were not anticipated when the agreement was created or if an organization experiences operational changes that impact how the services are now used. For these reasons continuous utilization reviews are important.

  • Client Example: Within our client’s clinical purchased services spend, such as dialysis, we discovered a high volume of “delay” charges that increased over several years. This led us to identify an operational bottleneck that was occurring with the patient transport process for treatments performed in the dialysis suite. Once the problem was understood, the transport process was redesigned, resulting in improved patient flow and a significant reduction in delay charges.

Misalignment with Key Performance Indicators (KPIs)

Although the process for determining utilization opportunities does not rely on data alone, using Key Performance Indicators (KPIs) to monitor high level utilization trends is helpful.  KPIs are multi-dimensional, data-driven measurements of key operational data that highlight performance relative to targets and help measure productivity in healthcare organizations. KPIs are a good first place to look for unfavorable utilization trends that may be a symptom of a larger underlying operational issue. We find implementing a KPI reporting tool that ties operational performance to cost can bring more awareness to potential utilization improvement opportunities and ultimately help drive and sustain change.

  • Client Example: Appropriate linen utilization is a common issue for many hospitals, and an opportunity that our clients typically believe exists based on operational practices they witness.  However, determining just how much utilization opportunity there is can be difficult to pinpoint. In our experience, a KPI that effectively measures linen utilization levels, including linen loss, reported in a metric of pounds per adjusted patient day helps our clients identify utilization improvement opportunities.
Key Success Factors

Establish Multi-Disciplinary Teams

Discovering utilization opportunity requires a long-term, multi-faceted approach more complicated than identifying opportunities in pricing or standardization, which are common focuses for traditional value analysis teams. Therefore, it helps to have a dedicated team that understands the nuances of the specific utilization elements. Multi-disciplinary teams including nursing, finance, support services and supply chain are most effective. For many organizations, engaging a third party to determine team composition, establish charters, facilitate initial meetings and help cultivate working relationships on the team, has been very beneficial to expediting efficient and effective utilization projects.

Leverage Multiple Tools and Processes

Identifying utilization opportunities is a comprehensive evaluation process. There is no one tool, process or metric that leads to successful utilization-based initiatives. It is often a combination of many tools that effects sustainable change over the long-term.

Find the Right Change Agent(s)

One of the most difficult aspects to pursuing utilization opportunities is effecting lasting operational changes. Once opportunities are identified and an implementation strategy is defined, an important next step is gaining support of those involved in the operation that change is necessary. An influential leader that can gain organizational support for change – whether it is a change in practices, processes or technologies – is crucial for transformation. Individuals need to feel well supported in the direction the organization is taking, especially when that direction requires change. Success will be elusive without stakeholder buy-in and support.

Improve Continuously

Continuously re-evaluating operations by looking to leading practices inside or outside your organization is important to maintain proper utilization. Take advantage of healthcare industry associations, roundtables and whitepapers that are regularly published to stay aware of key trends. Utilization opportunities, unlike pricing, are not proprietary and can typically be shared through collaborative discussions with peers.