A well-managed HM program can positively impact your hospital in many ways, including the length of stay, case mix index, value-based purchasing bonuses, readmission penalties, patient satisfaction, and resource utilization.
As a hospital CEO, the responsibility for maximizing the value of your HM program ultimately falls to you.
Here are five strategies you can engage to increase your program's value and boost ROI through improved clinical quality, care efficiency, and patient experience.
#1: Optimize EM-HM Care Transition
When EM and HM programs fail to work together, patients aren’t the only ones who suffer — so does the hospital.
Longer LWOTs are often the result of conflicts between the two departments, which can lead to lower ED and inpatient experience scores, affecting the hospital's bottom line. When the EM and HM programs work collaboratively for the good of patients, both programs succeed, and the hospital benefits from a highly functioning system.
To optimize EM-HM care transition, schedule a series of meetings with your hospital leadership, including EM and HM department leaders, to talk about ways to open communication lines, agree on EM-HM process standards, and establish mutual goals, accountability, and objective data measures.
The payoff: better EM LWOT rates, EM door-to-doctor times, ED length of stay for admissions, and inpatient length of stay.
#2: Ensure Case Mix Accuracy
HM teams that capture the severity of each case also help align the actual length of stay with CMS’s expected LOS time and rate. For example, if a provider misrepresents acute respiratory failure as simple pneumonia, it can have a significant financial impact.
CMS reimburses simple pneumonia as a 2.9 day LOS and $4,931 payment, significantly less than the 4.9 day LOS and $10,144 payment for acute respiratory failure.
By making certain hospitalists accurately capture the severity of a patient’s illness — that is, documenting the complications and comorbidities that accompany a diagnosis — you ensure that a correct diagnosis-related grouping is assigned, prompting a more error-free case mix index.
#3: Lower Cost per Case with Efficient Resource Utilization, Rounding Practices
HM teams that participate with case management deliver care essential to a patient’s recovery and avoid unnecessary testing or deferring tests and procedures to those that can be administered in ambulatory settings.
Also, daily multidisciplinary team rounds help facilitate the proper utilization of clinical resources and expedite patient progression to lower acuity settings, as necessary.
Your hospitalists can further reduce the cost per case by focusing lab tests and consultations only on scenarios that are clinically appropriate and, whenever possible, using medications listed on the hospital’s formularies.
#4: Improve CMS Values-based Performance
You already know that Medicare payment for services rendered depends on enhanced clinical quality through attention to CMS’s value-based programs.
That's why it's essential your HM program improves performance on measures that reflect quality metrics. That happens when hospitalists thoroughly document increased efficiency, outcomes, and patient experience while minimizing hospital-acquired conditions, mortality, and readmissions.
An HM team that embraces evidence-based practice, standardizes those practices and delivers high-quality customer service can markedly raise reimbursement levels under value-based systems of care.
#5: Reduce LOS
The best way your hospital can grow ROI is to make beds available to admit additional patients. Encourage hospitalists to manage patients well and discharge them as soon as there is no demonstrated need for that bed.
A good HM program will work closely with case management to anticipate discharge needs from the day of admission so that the necessary resources are available when the patient is ready to be released.
Another reason to discharge patients as quickly as possible is that the longer their stay, the higher the chance preventable complications such as DVT, decubitus ulcers, hospital-acquired infections, or functional decline can occur over time.
Three additional strategies you can employ to decrease HM LOS are: balance staffing with patient volume, anticipate the schedule for continuity of care, and make data and feedback available to your providers.
A well-managed HM program focused on quality and outcomes offers a clear ROI for hospitals while also creating loyalty and satisfaction for patients and physicians alike. The ED will perform better and have a more favorable community reputation due to lower LWOT rates and improved throughput metrics.
When admitting a patient, proficient HM programs can assure that documentation supports the appropriate severity of illness for patients, improving the case mix index and reimbursement.
When the patient is ready for discharge, the HM program will minimize avoidable days in the hospital and optimize discharge planning and post-discharge coordination of care.