Optimizing Clinical Equivalencies for Bone and Biologics

Health Care Financial Consultant Clinical Supplies
Through collaboration with physicians and the supply chain team, Pathstone achieved an estimated ~$630K in annual savings.

A ~700 bed hospital in the Southern U.S. was facing financial challenges and tasked Pathstone’s clinical purchased supplies consultants with examining areas of spend that had opportunity to drive benefit. Clinical supplies is typically one of the largest and broadest areas of spend, with items ranging from pennies to thousands of dollars.

For higher cost supplies, there is often opportunity to achieve high savings (e.g., .25% – 50%) through converting to a lower-cost product at another supplier. Bone and biologic items (e.g., allografts, tendons) typically cost in the $1,000s and were identified as having high potential for savings. However, the more complex the supply, the more challenging it may be to convince physicians of clinical equivalency.

To begin, Pathstone wanted to isolate spend on bone and biologic items. The team limited scope to tissues, surgical meshes, and allografts and issued pricing proposals to several suppliers asking them to provide matching products with pricing when applicable. In many cases, suppliers were proposing 50%+ in savings.

The next, and more complex, step was to perform research on product specifications and outcomes to determine clinical equivalency. Pathstone leveraged a clinical research tool that provides a bevy of information with the intent of supporting product and supplier selection.

While the team wanted to supply physicians with all relevant data points, it was important to develop a concise comparative analysis given their busy schedules. The team had the opportunity to present the opportunities to the Chief Medical Officer and the Head of Orthopedics. Pathstone developed a relatively standardized summary view for each of fifteen conversion opportunities, with more supporting data in an appendix to pull from when necessary.

The two physicians were supportive of the potential conversions but needed to hold conversations with end users that have more product specific expertise. At times, physicians can have strong preferences towards specific products for non-clinical reasons (e.g., supplier relationship). Thankfully, there was little concern with Pathstone’s proposed conversions, and any hesitations were addressed with further research.

While physician conversations occurred, the team worked with the supply chain and contracts team to ensure that current contractual arrangements would allow for conversions. Hospitals typically have a web of local contracts and GPO arrangements with high variability of terms, spend requirements, rebates, etc. For GPO contracts, hospitals often have a tiered rebate schedule in which the more the client purchases, the higher effective discount they receive. For suppliers in which the client transitioned away from, Pathstone needed to confirm that potential price increases did not outweigh savings opportunities from converting to a new supplier.

Through collaboration with physicians and the supply chain team, Pathstone achieved an estimated ~$630K in annual savings on ~$1.8M in annual spend. For suppliers in which Pathstone moved significant spend away from, there were negligible rebate implications. Moreover, the team helped the client establish a clear process for future high-cost clinical product conversions, such as orthopedic products. Some conversion opportunities were filed away for a Phase 2 that will be reevaluated after a year.

Importance of Environmental Services (EVS) in Healthcare

Health Care Financial Consultant Environmental Services in Healthcare

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.

Identifying Revenue Leakage in Healthcare

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What Is Revenue Leakage in Healthcare?

Revenue leakage happens when a healthcare practice gives care but does not receive payment for the services it provided. Leakage can occur in a few ways, such as forgotten accounts receivable or missed appeals deadlines for denied claims. It impacts the revenue cycle, preventing businesses from becoming financially viable.

Revenue leakage often goes unnoticed, but its impact can be detrimental to healthcare practices seeking to grow their business and maintain a high standard of care for their patients. The longer providers take to address points of leakage, the less likely they will be to receive any reimbursement for their services.

What Is the Impact of Revenue Leakage?

Healthcare providers must keep up with expenses to secure customer satisfaction and keep their practice in business. Revenue leakage can lead to lower earnings, putting providers at a disadvantage to their competitors.

A lack of revenue will significantly impact a healthcare facility’s ability to maintain several aspects of its organization, including:

  • Staff: Healthcare practices require proper resources to maintain a team with all the talents necessary to meet patient needs, ensure smooth processes and promote detailed organization. Revenue leakage can make hiring and retaining a highly skilled workforce challenging.
  • Quality care: If a provider is experiencing revenue leakage, they may add more services to compensate for the missing revenue. Extra services may decrease a provider’s ability to maintain high-quality care by increasing the likelihood of burnout.
  • Growth: Steady revenue enables organizations to grow their services and meet the needs of an expanding community. Healthcare practices that experience inconsistent income due to leakage may need help to keep up with growth demands.
  • Innovation: Cash flow powers innovation, helping providers maintain a competitive edge. A decrease in revenue will prevent businesses from matching a competitor’s offer, leading to a decline in patients.
  • Business goals: Revenue leakage can inhibit healthcare providers’ ability to meet business goals and objectives. Proper funding is necessary to achieve high standards and goals that drive the business forward.
What Are the Top Causes of Revenue Leakage in Healthcare?

Many forms of leakage are accidental and easy to correct, but they first must be identified. Revenue leakage can come from numerous sources, from issues with a provider’s processes to how patients or payors handle payments.

Some common causes of revenue leakage include:
  • Inaccurate information: Insufficient or incorrect registration data may result in a denied claim or errors in billing. Any changes in a patient’s personal information may also lead to revenue leakage.
  • Unverified insurance coverage: Without a proper review of insurance eligibility or approval, procedures and services may be given without adequate coverage. Inconsistencies with insurance coverage may also come from errors in payor-provider agreements, halting the revenue cycle.
  • Pricing issues: Inadequate pricing may lead to missed revenue opportunities. Prices set too low may undermine services for what they are worth, while prices set too high may drive patients to seek care elsewhere.
  • Unpaid accounts receivable: Sometimes outstanding bills remain unpaid for too long, going unnoticed or becoming lost. The longer an accounts receivable goes unpaid, the less likely providers are to recover any reimbursement.
  • Claims denials and underpayments: Inaccurate information can lead to claim denials and underpayments, slowing the revenue cycle for a healthcare provider. Any delay in addressing these issues with insurance companies can lead to missed appeals deadlines and less revenue for services already given.
  • Unbilled claims: Without a dedicated team to manage claims, practices may experience a variety of problems leading to revenue leakage. Claims require accuracy and consistent follow up ensure all claims are correctly billed.
  • Scheduling issues: Revenue leakage can also result from missed opportunities to receive revenue. These instances include referred patients who have yet to make an appointment or gaps in scheduling that could have been filled to maximize available time and resources.
  • Lost patients: Previous patients who seek another provider for care instead of returning are another form of revenue leakage. Healthcare providers miss out on revenue opportunities when patients feel their needs will be met better elsewhere.
  • Billing errors: Manual input of data may lead to various types of billing errors, decreasing the amount of revenue providers could and should be receiving. Accidental discounts or other inaccuracies in billing will halt the revenue cycle.
  • Unaccounted costs: Administrative costs can sometimes be miscalculated, resulting in underpayment from patients or payors. Incomplete logs of materials and equipment used during treatment or medical procedures performed may also lead to inaccuracies in how much patients or payors are charged.

These forms of leakage are common and usually unintentional, making it challenging to track and manage potential revenue opportunities. Healthcare practices need to ensure careful follow-up to protect vital revenue streams and prevent any leakage.

Revenue management is essential in the healthcare industry. Consistent cash flow enables providers to establish themselves as trustworthy professionals that provide the high-quality care patients seek. Revenue also allows organizations to experience growth and innovation that helps them keep up with competitors and maintain a talented workforce.

Healthcare practices need to ensure they have the funds to support their services and maintain patient satisfaction. Providers have a thin margin of error to work with, making revenue leakage an essential situation to address and resolve if healthcare practices wish to enjoy the benefits of consistent revenue.

Optimizing Outpatient Physical Therapy

Health Care Financial Consultant Outpatient Physical Therapy
Staff turnover decreased resulting in $100k of wage savings.

Management at a local hospital was concerned with operations at an outpatient location providing Physical, Occupational, and Speech Therapy due to an increase in staff turnover and productivity issues, missed appointments, and a growing backlog of patients who needed appointments. Pathstone Partners was asked to assist as part of a broader engagement to develop detailed findings about the current state of operations, establish strategies to increase staff productivity, and reduce patient backlogs and the current 30% patient no-show rate.

Pathstone evaluated several different key areas to determine key strategies and anticipated benefit throughout the engagement.

First, management interviews and department walkthroughs were conducted to collect qualitative and quantitative information about the general management of the department and current pain points. The team learned that there is difficulty scheduling current resources with flexible start and end times, which has led to many FTEs falling short of their full-time status. The team also observed that patient scheduling tends to taper off in the early afternoon, with 1:00 – 3:00pm having the most open appointment times.

Staff schedule reviews and staffing to demand analyses were conducted to further evaluate operational challenges. Findings showed that staffing is not equally allocated throughout the week, PT/PTA ratios vary by day, lunches are scheduled at the same times, and a majority of first shift staff staff generally arrive 30 minutes prior to appointments on any given day. Assessment times are currently scheduled randomly throughout the day, and PTAs are not “first up” for non-assessment scheduling. Furthermore, busy days and non-busy days are currently staffed similarly, creating challenges.

The Pathstone team leveraged this information to make several recommendations to the hospital management team. First, we recommended expanding Saturday hours to both allow staff to work up to their full FTE status and to accommodate the current patient backlog that usually builds on Saturdays.

Additionally, patient scheduling adjustments, weekly (and daily) staffing to demand processes, and skill mix realignment has led to significant improvement for the outpatient facility.

By revising staffing schedules and developing assessment blocks where PTs are available, the facility increased throughput by 10%, and created 6 more appointment slots per week. Double scheduling patients during high no-show times (weekday mornings), adding a 24-hour auto-dialer to remind patients vs. the current 72-hour manual reminder process, and adding a $50 no-show penalty saw an additional 15 appointment slots created per week and reduced the vacancy rate from 30% down to 5%.

As the outpatient facility settles in with these new processes, staff turnover decreased resulting in $100k of wage savings, utilization (+10%), revenue (+10%), and productivity (+15%) all increased, and the hospital system achieved a total financial benefit of $350K.

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.

Cost Reduction Initiatives For Healthcare Organizations

Health Care Financial Consultant 03

Cost Reduction Initiatives

Cutting costs can be tricky, especially when patient health is on the line. Targeting spending less in larger areas like staff, supplies and equipment seems simple. However, these are essential to keeping the hospital running efficiently and delivering a positive patient experience.

Instead, consider the following initiatives as alternative ways to create a successful cost-reduction strategy.

Optimize Revenue Cycle

A healthcare revenue cycle helps organizations stay financially healthy as they provide services for treating patients. Some factors can enhance the revenue cycle and help avoid debt collection. These include:

  • Patient education: Patients should continually be educated on the costs of care, especially early in the treatment. Financially clearing patients early and consistently can help them be prepared and not confused when bills arrive in the mail.
  • Electronic medical billing: Provide online payment opportunities for patients to conveniently and quickly pay their bills.
  • Data analytics: As we mentioned before, data analytics are important in maintaining costs. With this concept, you can get a clearer picture by analyzing your revenue cycle trends.
  • Process updates: Continue to revisit your daily operations to ensure all pieces work smoothly. You can address any issues at the root and adjust strategies where needed to avoid large costs or debt for later maintenance.
Improve Supply Chain

The post-COVID supply chain has greatly improved through enhanced communication opportunities between the medical staff and management. Doctors relaying helpful information on certain products and treatments to management can improve the inventory of adequate medical supplies.

Additionally, regularly evaluate your suppliers. Are they providing quality products at a reasonable price? From here, identify what goods are being transported along the supply chain, including how much of the product is being delivered vs. how much you use between shipments. Knowing what and how much you use can help avoid wasting equipment.

Optimize Information and Digital Technology

Technology continues to advance, and healthcare organizations are beginning to use that to their advantage. Hospitals can utilize technology to create efficiency and cut costs by doing the following:

  • Automate administrative tasks: Doctors spending hours on monotonous administrative tasks can take up more than just time. Technology can make these tasks more cost-effective by automatically importing test results into a patient file, scheduling appointments and providing prescription information to patients.
  • Improve workflow and operations: Technology automation can reduce the risk of human error, saving the hospital from negligence claims. Implementing telehealth can also improve a clinician’s productivity through e-prescription refills and e-visits, allowing the clinician to see more patients.
  • Rethink human resource expenses: Digital applications can analyze labor demands, identify open beds and check equipment status to allow clinicians to focus on patient outcomes.
  • Process digital claims: An automated digital claim processor can assist patients with billing, improving turnaround time and reducing fraudulent claims.
Optimize Labor and Streamline Management Structures

Labor expenses are expensive for hospitals, so discovering where to cut costs in this realm could be very beneficial. You can start by looking over your current medical staffing schedule and administrative positions.

In short, it is about optimizing the right labor in the right departments. Every unit should have a list of necessary tasks and noticeable credentials that need to be fulfilled in each. For example, if nurses are responsible for food delivery in a particular unit, consider hiring a less expensive food tech to pass out trays. Doing so can reduce five nurses to four by eliminating a task from their list that can be handled by another employee.

You can also recognize trends in your organization and adjust the staff. Are there seasons or certain circumstances where patient counts are likely to increase? This process may take some time in the beginning, but it could save you quite a bit of money in the end.

Additionally, for every doctor, there are 16 healthcare workers — and only six are involved in patient care. The other 10 are administrative roles.

Now, these labor and management structures can be simplified. Technology can help streamline a patient’s care and reduce administrative costs but sometimes only leads to workload reduction. Technology in healthcare should streamline these processes instead of creating additional work.

Each administrative position should have a specific role that works for the good of the whole. Let the mundane tasks be taken over by technology, such as scheduling appointments, billing patients, managing patient communications and collecting payments.

Improve Patient Throughput

Now, take a look at your patient flow. Are things moving efficiently? Identifying ways your patient flow can improve is another area of strategic cost reduction.

Consider the following to improve your patient throughput:

  • Enhance collaboration between caregivers across units.
  • Improve communication between a caregiver and patient.
  • Continuously monitor the patient and make good notes.
  • Allow caregivers to spend more time with patients.

Every patient should be seen with the same careful attention in a timely manner. Doing so will improve the patient experience and decrease bottlenecks, reducing delays and ensuring the maximum occupancy for each hospital bed.

Optimize Utilization

Utilization in healthcare defines the usage of products or services within a certain hospital. This is another area where data analytics can be beneficial, as they can accurately assess current operations. Understanding what your hospital uses can help you avoid overtreatment and lower costs while increasing trust.

You can also optimize utilization by encouraging employee feedback. For example, when looking at the data, get a second opinion from employees before deciding what areas are unnecessary. A well-planned feedback system maintains consistent data to take action with, even when you aren’t in a crunch. This system can help your organization stay on top of cutting overall costs.

Introduce a Hospital Asset Management Plan

Hospitals spend a lot on fixed assets, including physical infrastructures like heating, air conditioning, ventilation, plumbing and generators. These assets also include healthcare-specific items like wheelchairs and beds. Instead of reducing the use of these needed items, aim to protect them through a hospital asset management plan.

A hospital asset management plan can help maintain a safe and clean environment in the most cost-effective way possible. Some ways to do this are by tracking your hospital’s most critical equipment, ensuring safety requirements are met and supporting a preventive maintenance approach.

Get the Results You Deserve With Pathstone Partners

At Pathstone Partners, we are committed to providing your company with the right plan to reduce costs. Our healthcare consultants can help you identify, implement and sustain a cost-reduction plan that fits your organization’s exact needs. Contact us today to get started.

How Supply Chain Management Can Reduce Hospital Costs

Health Care Financial Consultant Supply Chain

SCM & Hospitals

Supply chain leaders within healthcare are under immense pressure to reduce cost across their systems. In the US alone, hospitals are estimated to lose $54 billion in net income in 2021.

Robust utilization data is one way that healthcare supply chain leaders can increase their bottom line and improve the revenue management cycle. Dynamic access to “centralized, consumable, and real-time data allow health systems to determine what’s needed, what’s in stock, and the scope of future demand.” Hospital supply chain systems employ data across their system to capture demand, eliminate waste, and avoid redundancy.

Eliminating waste and redundancy across the medical supply chain is just one example. Supply chain knowledge and data can be employed across a health system to achieve price reductions, utilization optimization, and standardization that drive value to the health system.

Does the Healthcare Supply Chain Affect Patient Outcomes?

In today’s value-based care model, health system leaders are required to improve patient outcomes despite the necessity to reduce cost. In particular, supply chain management in the healthcare industry plays a critical role in improving patient outcomes to achieve reimbursement through incentive alignment.

For example, decisions surrounding supply selection solicit feedback from the hospital supply chain teams and clinicians to optimize patient outcomes and source cost-effective supplies. These teams can be aligned through detailed data. Utilization and clinical outcomes data provide the opportunity for medical supply chain teams and clinicians to make decisions that achieve the goals of the health system. Linking supply chain related items such as product standardization to patient outcomes enable these teams to align on the most cost-effective and clinically optimal choice.

What is the Future of the Healthcare Supply Chain?

Supply chain management is a critical function in the healthcare industry. The elimination of unnecessary costs, patient outcome improvement, and increased reimbursement are only a few of the significant benefits optimal supply chain management provides. Emphasis on data collection and employment, incentive alignment, and vendor management are a few avenues that healthcare organizations can utilize to achieve these goals in the future.

At Pathstone Partners, we specialize in helping healthcare systems across several different markets navigate the complexities of their supply chain. With our years of experience in clinical purchased service and supplies, we can assist with everything from supplier contract review to price negotiations.

Contact us online to learn more about our healthcare consulting solutions and how we can help create efficiency in your supply chain.

Cost Reduction Strategies for Healthcare Providers

Health Care Financial Consultant Cost Reduction

Cost Challenges Facing Healthcare Organizations

Hospitals used to be reimbursed at a line-item level, where a charge was only issued with each item used or service provided. That bill was then sent to the patient or insurer, incentivizing procedures and tests.

Now, hospitals are given a certain amount for each diagnosis-related group (DRG). The hospital must then figure out how to best spend that fee while keeping the patient’s overall health status as the priority. Below are three of the most significant risks involved with delaying these strategies.

Lack of Resources or Bandwidth for Strategy Management

When we think of healthcare resources, we paint a picture of physical supplies like gloves, medications or medical kits. As you can imagine, a lack of these resources for healthcare settings can affect the quality of patient care and the work environment for providers. For these reasons, increasing the supply of resources is one of the first places organizations invest extra funds, delaying any plan or initiative.

However, consider extending the needed resources for hospitals to include general knowledge about strategic management — or bandwidth. For the success of cost-reducing plans, teams must have the capacity, energy and motivation to deal with the situation. Understanding your goals and knowing how to implement a strategy can help your organization manage cost reduction.

Decision-Making Process Complexity and Length

Making the final decisions for these strategies can be lengthy and full of multiple levels. Because of this complex process, implementing strategies can be seen as more of a hassle than a help. People and organizations have often pushed a cost-reduction strategy to the wayside because of the many factors involved, including maintaining employee and patient safety.

However, don’t let the lengthy process scare you away from making necessary changes for the betterment of your healthcare organization. Taking the required steps can change this daunting task into a helpful resource to utilize for years to come.

Poor or Inadequate Data for Initiative Support

Data analytics in healthcare are important for categorizing data to use it toward the organization’s operations and services. Poor data organization can add to your costs.

Insufficient data can interfere with patient medical records, increasing potential errors and hindering the patient experience. It may even impact your organization’s security, and data breaches are exceptionally costly.

Take control of your data to best help with the decision-making process. This way, you can pinpoint precisely where cost reductions are needed based on recent data, making initiative support much more efficient.

Take Action

Any organization has several challenges that threaten the success of reducing costs. Overcoming these challenges is vital to ensure we create an environment for patients to heal and thrive. What healthcare organizations decide to implement now can create a sustainable model for the future.

Contact Pathstone Partners today and discover how we can help your margins!

The Value of Supply Chain Management in Healthcare

Pathstone Partners Chicago Health Care Consulting (4)

What is Healthcare Supply Chain Management?

Healthcare supply chain management involves the procurement of resources, the management of supplies, and an interlinked group of processes that are required for healthcare professionals to carry out their operations and increase productivity. Each link in the medical supply chain influences overall cost, patient outcomes, and service efficiency.

The Importance of Supply Chain Management in the Healthcare Industry

COVID-19 related supply chain disruptions across the United States have expedited the need to optimize hospital supply chain management. This is especially true for health systems that aim to provide high-quality care, ensure service availability, reduce cost and boost profitability. Over the course of the past few years, supply chain management in healthcare has become a central focus due to increasing pressures to reduce cost from the pandemic, while improving patient outcomes and reimbursement. Healthcare supply management and optimization within health systems achieve these goals through improved data collection and employment, attentive vendor management, and incentive alignment.

How Does the Healthcare Supply Chain Work?

The healthcare supply chain for healthcare consists of numerous stakeholders. Each one plays a significant role in how the supply chain operates. These stakeholders include:

  • Manufacturers: The manufacturers are the labs, biologists and vaccinologists. They perform the research, development, manufacturing and monitoring. These groups make medical, surgical and pharmaceutical supplies and watch for shortages.
  • Distributors: The logistic partners and wholesale distributors sell, deliver and monitor products while following proper procedures.
  • Providers: Providers include pharmacies, urgent care centers, hospitals, assisted living facilities, dialysis centers and long-term care facilities. These places receive products from the distributors so they can prescribe them to patients. They submit orders to distributors, look for inventory shortages and call in prescription refills.
  • Patients: The patients are the people in the community who use these products or services. They influence the demand for medicines and other products with their unique needs.

Contact Pathstone to discover the critical role of healthcare supply chain management in ensuring the seamless flow of resources and services within the healthcare industry.

What is Revenue Cycle Management (RCM) In Healthcare?

Health Care Financial Consultant 06

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.