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Published byAlan Watkins Modified over 6 years ago
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Re-engineering Cardiac Catheterization at Cornell Medical Center
$8M deficit in 1997 $5M surplus in 2000 1997 Balanced Budget Act average 20% reduction in reimbursements Objective: Do more procedures without adding expenses! 8M in the summer of 1997 5M in the black in the summer of 2000 Average 20% reduction in reimbursements, higher for many big ticket items. Build-out of three new cath labs, acquisition of several new pieces of imaging, opening of two off-site facilities, renovation of waiting room.
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The Rules of the Game: Competitive Industry – lots of providers in the NY Metro Area 1997 Balanced Budget Act reduced reimbursements by 20% on average HIPPA – Health Insurance Portability and Privacy Act of constrained options for managing information and monitoring Billing requirements for specific information (Medicare, private) Institutional constraints on salary, bonus Social and cultural position of physicians, nurses, techs, secretaries, administrators
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Physicians had all the decision rights
The Problem: Physicians had all the decision rights Secretaries lacked specific information about schedules Pre-op and lab lacked decision rights No communication at all with billing (no accountability) Everything on paper No standardized procedures for scheduling Physicians had decision rights over everything Billing had accountability but no information or authority
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Scheduling Pre-op Procedure Billing
Specific Knowledge (costly to transfer) Patient anxiety Scheduling difficulties (e.g. transportation) Patient status Updated lab, bed, staffing schedules Emergencies Patient status Equipment status (including inventory) Procedures Contract requirements Coding requirements Paper records and lack of accountability made these costly Cannot monitor secretary interactions – to frequent, time, cannot record due to patient confidentiality Schedules used to be specific knowledge prior to computerization! Much of the insurance requirements used to be specific knowledge too Paper medical records made it more costly to transfer all types of information! General Knowledge (NOT costly to transfer) Insurance Demographics (name, etc.) Lab schedule, MD & Staff schedules Pre-op procedures Lab procedures (what happened in the lab)
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Insurer & Vendor Contracts Billing Procedures Lab procedures
MORE types of goods Secretarial Support Waiting rooms Inventory Insurer & Vendor Contracts Billing Procedures Lab procedures Chart from p. 645 with overlay picture examples from the hospital Electronic Medical Record Billing Systems Scheduling Systems Cath Lab Pre & post-op beds Medical Records Inventory
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Decision Rights Monitoring Incentives Patient Scheduling
Periodic reviews Trouble-shooting Monthly service awards Annual raises Patient clearance Day-of schedules Staff schedules Periodic reviews Trouble shooting M&M meetings Monthly service awards Annual raises Procedures Equipment Staff schedules Periodic reviews Trouble shooting M&M meetings Weekly inventory Specific compensation contracts based on productivity Billing codes Question team members Daily reconciliation Monthly audits Billers on site! Productivity bonuses Promotion Administrative staff can schedule without checking with doctors first. Doctors responsible for updating on-line schedule Pre-op nurses have final call on patient readiness – do not have to check with doctors first Charge nurse has final call on daily schedule, Administrator resolves conflicts Techs and doctors have total autonomy in the lab. They are expected to know the insurance requirements (automated) and manage inventory Billers have final call on billing codes – do not have to check with doctors Administrator has final call on overhead, scheduling conflicts, performance reviews Overtime Scheduling conflicts Insurance contracts Budgets Annual reviews Trouble shooting Monthly & annual reports Annual raises Career advancement
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2. Visibility, horse trading and trust-building
Implementation A Crisis never hurts… 1997 Balanced Budget Act Budget Act has teaching hospitals awash in red ink 2. Visibility, horse trading and trust-building 3. Employee training and turn-over 4. New Technology
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Summary We were forced to do more with less, which means we needed to be FASTER and more EFFICIENT. Speed and Efficiency required a dispersion of decision rights and new information technology to transform specific knowledge into general knowledge. Crisis, personality and persistence.
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