How one struggling hospital is on track to save $18M
The Camden Clark Medical Center in Parkersburg, West Virginia, had a serious financial problem. It had been cited for regularly having "poor operating performance" and was posting operating losses of more than $6 million and $15 million in 2012 and 2013, respectively.
But after bringing in a consulting firm that helped change care its management processes and optimize its IT systems, the hospital is now on track for an $18 million improvement by year's end.
It wasn't just one issue that set the stage for CCMC's poor financial performance. There were health system-hospital integration factors (CCMC recently joined West Virginia United Health System). There were factors related to bad payer mix. There were locational factors, making it difficult to find qualified employees in the area. And some of the hospital's processes needed serious reworking.
Enter Accenture, which the hospital retained starting in October 2014 to help with care management shortcomings, and overhaul its employee physician group and IT optimization.
"This project was a lot of process work, and some people and some IT," Doug Pedersen, managing director of healthcare providers at Accenture Strategy, told Healthcare IT News. "But you have to touch all of them. It's always better to (be) comprehensive across the system."
If you go in and just focus on one area, he points points out, sometimes you fix that one area, but it negatively impacts another.
One of the biggest deficiencies the Accenture team identified was around care management processes that impacted length of patient stays: the hospital's average LOS was higher than the national average of 4.8 days. So they started implementing daily unit huddles, said Pedersen.
These huddles brought together case managers, the Accenture team, nurses, physicians on call in that part of the hospital to actually all look at what was happening with certain patients, "so that everyone was clear what needed to happen," he said.
Then they started what he described as an "outlier management meeting" – that is, looking at the patients who had been in the hospital for more than five days and figuring out what they needed to do to discharge them.
A common problem with patient discharges, Pedersen said, is not that the hospital isn't ready to discharge them – it's that the patient doesn't have a ride, or beds aren't available at a nursing facility.
Part of improving this involved working with and better optimizing the hospital's bed management system, he said.
The hospital started to organize it so patients who were going to be discharged first were at the bottom of the list on a board at the nursing station. If a clinician's name was on the top of the list, it meant they're the one whose patient is being discharged latest in the day.
Thus, the sentiment would be, "Oh, wow, I don't want to be at the top of the list, so what can I do to get this done? Do I just need to go track down the missing lab, figure out what's going with radiology?" said Pedersen.
"The choreography of getting the patient to leave the hospital is tricky," he added. "Unless you are really structured in your processes and in your IT systems so you can keep track of those things, it's really easy for a couple patients to just get lost in the shuffle, and all of a sudden they're there another day."
The so-called Navigator Program developed at CCMC focused on transitioning these patients out of the hospitals: "Making sure they had rides available, making sure that their family members knew," improving the overall care coordination process, said Pedersen.
In addition to the pre-discharge process tweaks, the initiative also implemented a post-discharge follow-up process which staff helped schedule follow-up appointments with primary care physicians.
Another piece of it all, as Pedersen explained, was around centralizing the hospital's scheduling. This involved more effectively utilizing CCMC's Allscripts system to have one group of people schedule across 15 physicians.
This IT optimization and care management work combined with some serious initiatives with revenue cycle management has the hospital poised for an $18 million improvement by the end of 2015, he said.
The hospital's employee physician group is currently losing about $12 million, but officials expect that number will decrease to $6 million or $7 million. There's still work that needs to be done, said Pedersen, specifically around revenue cycle and selling off one of the hospitals. But an $18 million improvement is a darn good start.