The first step is to understand your position. One of the things that can be very harmful is when a hospital tries to shave costs in an area where they are already efficient. That can be detrimental to both the hospital and patients.
The first critical pieice is to understand a hospital’s performance and find the places where they have an opportunity to reduce costs.
Once you find an area with room for approvement the next step is to identify what is driving that difference, That allows a hospital to determine how to approach the problem.
Is it a physican preference issue? A lot of care is determined by the physican’s protocol. When evaluating cost, are there phsycians that have a more efficient cost protocol than others?
Are you forgetting charges? Sometimes losses can be explained by something as simple as overlooking charges. For example, the presence of a charge for an injection, but not the needle, can compound quickly. These are great problems to find, because they are easily solved.
On a supply side, do phsycian’s prefer to use certain supplies that may be more expensive. There may be an alternative that is less costly. In some cases, this alternative has simply never been communicated to the phsycians, who continue to use the supplies they’re familiar with.
Certain physicans prefer to practice a specific way. They may want a complete set of lab tests upfront, while another may be more selective in their testing. These different courses of treatment can change a hospital’s cost structure.
Utilization is the use of a service. How many lab tests are being done. If you come in for pain and a doctor runs bloodwork. She may choose to be very selective in the test, while other may run multiple tests. That physician will show a higher cost of care.
Cost per unit is the cost of individual supplies. If the second physician in our example runs 3 tests at $50, while the first runs a single test for $50, cutting down on the number of tests may not actually positively affect cost.
This is one reason why it’s so important to analyze data thoroughly and from multiple angles. Although the answer may seem simple initially, it may be more complicated.
Enhanced market share often means increased volume. That allows hospitals to spread their costs around. For example, if you have to maintain a CT machine, but it’s only used by two patients, you’re going to lose money at that machine. Increasing your volume on the machine will help pay for maintaining it.
On the revenue side, it give you the opportunity to gain more revenue but it also gives you a stronger position with payers. A hospital with high market share has something to negotiate with when sitting down with payers.
You can increase market share through marketing or attaching well-known names to the facility. Of course, talented physicians with good reputations will increase volume. If the hospital is known for high quality it will drive people to the hospital.
Pricing will always play a factor with volume. If a hospital is known for being expensive, especially for certain procedures, patients will look elsewhere for treatment.
On the other hand, if a hospital is known for being cheap a patient may not trust them for a complicated procedure.
Plant age is important because of the utility of the equipment and the usability, but it’s also important because of perception. If a community perceives a hospital as being outdated they may look elsewhere for their care.
Hospitals are trying to be reasonable with expecations and their ability to upgrade. The equipment that a hospital purchases today will be more expensive in five years, most likely. From a planning perspective, a hospital must remain profitable so that it can reinvest in those assets. Not only will they need to repurchase equipment as it breaks or is outdated, but the new equipment will likely be more expensive.
Even non-profit hospitals have to maintain a profit in order to continue providing the best care. Non-profit does not mean no profit. They have to remain mindful of their fixed assets.
Charge Capture and Coding
You don’t want to leave any money on the table. If you’ve performed the service you don’t want to leave anything on the table. The first step to this is identifying when things have been missed. There isn’t an organization out there that doesn’t have some charge capture issues. No one is immune.
That being the case, you need to identify where. We can help hospitals recognize when one service is connected to another. For example, if you run a lab test you need to get the blood out of the patient. If we see a test that requires a blood draw, but not a charge for a blood draw, we know there is a charge capture issue there.
The flipside of that are charges that show up by accident, like a test that wasn’t actually run. This can be an issue with audits, as well as being required to pay the money back.