Welcome to Module 8, Session 3 of the Cardiovascular Program Coordinator Course. This module is financial management with content provided by Beverly Fuari-Libsey, Ginger Beesbrock, and Keri Morris. In this session, we will cover the last item, Value Proposition of Accreditation or Certification. Let's focus on cath lab processes. Accreditation avoidance is imperative. Lack of defined same-day discharge processes allow issues to occur that could be avoided if practices were clearly identified and implemented during the time the patient is being prepared for a planned procedure and then continue through discharge. Identifying the appropriate location for the patient. Being familiar with inpatient versus outpatient criteria is extremely important for cost avoidance and patient satisfaction. Having defined pre-procedural screening and discharge planning are important to avoid health care related issues that can complicate the procedure. Establishing a clear discharge plan for the patient and family is essential to avoid any delays or concerns that need to be addressed prior to sending the patient home. The use of the radial approach has also proven to have less incidence of complications compared to the femoral approach that is used more frequently in the United States when compared with other countries. Radial approach has proven to be less costly if the procedure proceeds without issues. Continuing with the cath lab cost avoidance strategy, we need to understand the potential cost savings. One key area is femoral access procedures that require an overnight stay. Literature shows the rate of adoption of transradial access has doubled in the U.S. over the last eight years to approximately 40%. Transradial access reduces the risk of patient complications, things like decreased bleeding events. It facilitates quicker discharge, thus improving your length of stay, increases patient mobility, and reduces the total cost of care. To this end, leaders must identify meaningful strategies that align around the health care provider satisfaction and improved patient outcomes. In cath labs, having sound cost avoidance strategies is imperative, as well as understanding the cost involved with the procedures. It is essential to work with your finance department to determine what your cost per case is. Here is an example provided from Cath Lab Digest in August 2017. The cost per case for an inpatient PCI was just over $17,000. The facility involved identified 32 cases for review. If the procedure would have been performed using a transradial access and same-day discharge, on average, the cost would have been almost $3,700 less than a femoral approach requiring an overnight stay. In summary, using the information provided and an assumption that the hospital performs 1,000 PCIs per year, and the hospital adopted a transradial access in 30% of those procedures and adopted a same-day discharge protocol, on average, they would save $1,000,000 annually related to operational efficiencies. Another key area of focus is on the impact from complications. Let's drill down into how complications can impact costs of care for the patients and missed revenue, not to mention patient safety and satisfaction. Say you wish to identify the impact of reducing cath lab complications. You can start this initiative at addressing the lack of a defined pre-procedural screening that could result in the following acute kidney injury, bleeding events, increased vascular site access injury. These all produce a trickle down effect. Let's look at this. So the average cost of one day in the hospital is around $2,500. If the patient has a complication and say would need to stay four additional days, the cost escalates to $10,000. If your facility has only reimbursed $20,000 and you have increased costs due to complications, you can see where this reduces your margin for this patient encounter. Let's continue with the impact train of thought. A lack of standardization equates to dollars lost for hospitals, also setting them up for more risk if a deviation from usual practices occur. The impact is not in there. Due to the lack of documented processes and policies, this can also have a trickle down effect that can lead to duplication and variation in processes. As we discussed previously, variations in care can lead to poor outcomes, death, and an increase in the cost of litigation and final settlements. The lack of complete documentation by healthcare team members also consumes a great deal of time when hospitals are preparing for regulatory inspections required to maintain your state licensure and payment from CMS and other private insurances. If processes are disorganized and variation exists between multiple disciplines and staff, oftentimes there is duplication of effort. Just as a reminder, the clinical members of your team are probably the biggest expense for your hospital. You will want to eliminate any overlap of duties. One example is follow-up phone calls to patients following a procedure. In some instance, we found that multiple departments are making calls to the same patient using unnecessary resources and manpower, and this can become a patient dissatisfier when answering similar questions multiple times. This is not an optimal process when striving to improve patient care and satisfaction. Another aspect we want to look at is the cost avoidance in electrophysiology or EP. There are several goals with this type of project. First is navigating the pressure from physicians to offer a variety of devices and supplies while balancing the needs of the patient. The difference between the cost of the device or supplies and procedural reimbursement can be upwards of thousands of dollars per case. Interaction between physicians and purchasing allows each to understand the impact of products and pricing upon the financial viability of the program. Second, it is critical to have the appropriate staff in the room to monitor and care for these patients during the procedure, which in many cases can take four to eight hours. And then it is also key to having well-defined inventory processes to balance physician preference with patient needs. And then not to be forgotten is a more efficient supply chain to control the cost of required supplies. It is critical to identify supplies with a short shelf life to avoid loss due to expiration dates and minimize time by the clinical staff tasked with inventory management. EPs have access to more resources than ever before, and maintaining appropriate supply levels while navigating unnecessary product outdates becomes a high priority. Navigating supplies and devices while balancing the needs of the patient is demanding. As supported in EP accreditation, it is vital to have a defined process in which the EP lab director and manager is actively involved in supply management, working in concert with hospital purchasing representatives. A defined inventory process is one that balances the needs of the patient with the preferences of the physician while maintaining adequate inventory and avoiding unnecessary outdates to effectively manage this resource. There is significant value in cost of supplies needed to support the operations of an EP lab. The most challenging is the inventory, especially related to physician preferences for various devices. There should be a well-defined process for determining how physicians' requests are processed and who are the individuals involved in making the operational decisions clinically and financially. There should be a cost analysis performed to determine if the reimbursement for the procedure covers the supply cost requested and identify in what situations the organization is willing to take a loss. Remember, your main goal is to maintain your margins to sustain the organization moving forward. As addressed in accreditation, we assist you in defining the inventory process and balancing the needs of the patients and physician preferences. The impact in the long term is that EP procedures can have the potential to generate financial loss. For leaders of the organization, hardwired policies and procedures must be in place to ensure a positive bottom line. Two additional impacts that need to be considered are hard and soft costs. In hard costs, studies have shown that there is an estimated $5 billion in hidden costs in the supply chain for high value medical devices and implants, with 7 to 10% of those products likely to expire on the shelf. These statistics alone should get your attention due to the significant impact it can have on your profit margins. In soft costs, it has been determined that nurses spend as much as 30% of their time looking for the correct product on the shelf to prepare for a room setup. It is very clear that having organized and well-established policies and procedures are key to avoiding unnecessary costs and wasted time for staff. According to a 2017 survey for Cardinal Health Hospital staff and decision makers, better hospital supply chain management leads to better quality of care and supports patient safety. 25% of hospital staff have seen or heard of an expired product being used on a patient, while 18% have seen or heard of a patient being harmed due to a lack of necessary supplies. The survey also found physicians and nurses currently spending nearly 20% of their work week on supply chain and inventory management. Better management of high-cost products is imperative to control cost in the procedural areas of your hospital. This is reflected in more efficiencies developed in your supply chain management. These increased efficiencies allow for additional time dedicated to ongoing education of staff with a focus on new procedures and the use of new equipment and supplies. Additional time can be spent on research in various aspects of the procedural areas, and most importantly, more focused time on patient care to ensure improved patient outcomes and better patient, staff, and physician satisfaction. In conclusion, as you move forward and use accreditation products in achieving the goals of your strategic plans, we aim to support the financial health of your organization. Remember, it is important to assess your current performance and target areas for improvement. Assess and define the standards of care you are using in your guideline-driven medical therapies and hospital-specific protocols. It is imperative that you secure executive commitment and engage your physicians to provide the support you need for success. Continue to utilize patient-centric multidisciplinary teams when developing new processes and reviewing data for continuous improvement. Do not forget to factor in the costs to provide that care. This will demand you also engage the financial executive at your hospital to provide the support you need to access financial data. Research supports positive return on investment and the next frontier of cost-saving opportunities lies in labor, care protocols and process to deliver care, supplies, and contracts. Our sincere hope is that you find this presentation helpful as you navigate the financial component of delivering the best care in today's challenging health care environment.

cath lab processes

same-day discharge processes

radial approach

complications

inventory management