Resource management education for staff can significantly change old habits without a major outlay of dollars. If your staff still think resource management is the job of the utilization manager and not theirs, it's time to change this attitude. At department staff meetings provide inservice presentations about resource management. Each employee should know how they personally impact the cost-efficiency of health care services and what they can do to minimize lost revenue due to poor utilization. Employees must understand the goals of utilization management and their individual role in making sure that:

• only appropriate patient care services are delivered
• services are provided in the most appropriate care setting
• the facility receives payment for services rendered
• less than optimal patient care outcomes and/or system inefficiencies are reduced

Both clinical and non-clinical staff should receive education about the facilities' utilization management goals and how staff impact the organization's ability to achieve these goals. Share reimbursement data with the staff — helping them to understand how payment schemes are changing and the impact of new per diem or capitated reimbursement contracts.

Utilization management education must also include the physicians. Sharing charge and reimbursement data with physicians helps them to appreciate the impact of their ordering pen. Show them how their practice compares to that of their peers. Comparative cost reports provided to physicians on a regular basis can heighten their awareness about charges. If physicians don't know their practices differ from those of their peers, they can hardly be expected to change! Even if you only have access to charge data, not cost data, that's OK. Comparing charge data internally is valid.

Another way to reduce unnecessarily long lengths of stay is to educate physicians regarding post-hospital patient care options. Until a few years ago heavy care patients could not be managed in skilled facilities or by home health agencies. Physicians still laboring under the misconception that heavy care patients must be hospitalized should be educated in the wide variety of out-of-hospital treatment options available today. To ensure physicians are up-to-date in their knowledge of non-acute service availability, case management staff should make regular presentations at medical staff meetings. Similar awareness training should be provided to physicians' office personnel.

Testing algorithms/standards and stop orders are another quick-fix likely to yield significant reductions in unnecessary costs. Of course, medical staff approval is necessary, but once standards and stop orders such as the following are in place, inappropriate testing can be reduced.

• Urine culture and sensitivity performed only if urinalysis shows more than 8 white blood cells per high power field
• All orders for repeat white blood counts written less than 72 hours after a normal white blood count will not be carried out (Exception: orders from critical care or pediatric unit)
• All orders for MRI must be approved by medical director prior to completion of test
• Open-ended orders for repeat EKGs shall be re-evaluated every 48 hours (automatic stop order placed at 48 hours)
• Medical director approval is required for all routine mammograms, screening colonoscopies and foot care ordered for inpatients.

Studies of appropriateness, performed by the utilization management or quality management committee can pin-point areas of unnecessary utilization. You may find that many common tests are ordered without clear indications for medical necessity. Share that data with your physicians and staff. If you find you have variations in patterns of patient care without corresponding improvements in patient outcomes, a number of other quick-fix solutions can be implemented. For example, through collaboration and consensus physicians and other clinicians can reduce inventory costs for high price items such as prostheses, specialized equipment and drugs. By maintaining only a few items in inventory, rather than a vast array of choices, hospital costs can go down.

If excessive hospital costs are due to process breakdowns, not the physician's order pen, form a performance improvement team of those involved in the problem process. Even small system failures can negatively impact the cost of health care services! The team can identify ways to improve the system and design an action plan specific to the root cause of the problem. Many system problems, such as those listed below, can be resolved without an extensive case management and/or clinical path implementation strategy.

• Equipment not available the same day ordered

• Dietary delivered meal to patient who was not on oral intake

• Dietary failed delivery of ordered diet advance

• Dietician visit not performed as ordered

• Pathology microscopic interpretation not available the day after biopsy

• Lab test not available the day after drawn

• EKG/EEG not performed the same day as ordered

• Drug or bowel prep not given as required by procedures

• Surgery not performed the day requested due to scheduling problems in operating room

Designing and implementing more structured resource management strategies requires time and money. The addition of one case manager can add $50,00 or more to the hospital's staffing budget. The development and implementation of clinical paths requires physician and staff time and this translates into dollars. For example, Stanford University Medical Center reportedly spent $21,350 for the knee replacement surgery clinical path that they developed in 1995. If you have immediate utilization problems, don't overlook many of the quick fix solutions that can be easily implemented right now. You may find that significant over-utilization and cost-inefficiencies can be easily and swiftly resolved with just a few well-conceived action plans! As these solutions are yielding positive results, you can be designing and implementing longer-term actions such as case management and clinical pathways.

The book Mastering Path-Based Patient Care provides an overview of clinical paths, a longer-term resource management solution. In this book you'll discover how to design and implement pathways that will meet the needs of your unique patient populations. To learn more about this publication, visit the Brown-Spath and Associates' web site: http://www.brownspath.com or call (503) 357-9185.

© 1998 Brown-Spath & Associates.

To Learn More: Patrice L. Spath is available for presentations on health care quality and resource management topics. She can be reached (503) 357-9185; email: Patrice@brownspath.com. Address comments or correspondence to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116.

[ Home | Products | Services | Free On-Line Resources | Upcoming Workshops ]
[ Web Links | Contact Us | Search ]