My name is Michelle Wood and I am the Director of Operations for the Accreditation Field Staff. And I want to introduce Mercedez Scott. She is the Director of Institute Planning and Program Management at Lehigh Valley Health Network. And she's responsible for data integrity and using data to make informed decisions for the benefit of patient care and strategic initiatives related to the cardiovascular service line at Lehigh Valley Health Network. So I think you're in for a good session and welcome to Keeping Registries and Accreditation a Focus with Limited Resources. Thank you, Michelle. I appreciate the opportunity to be up here today. And obviously, we all have the same problem, right? We're all sitting here thinking about how poor, desperately poor, our hospitals are, and trying to figure out exactly how we're going to do this with absolutely nothing, right? So as Michelle said, I am Mercedez Scott, and I am Director for Institute Planning and Program Management at Lehigh Valley Health Network, specifically for the Heart and Vascular Institute. Our flagship is in Allentown, Pennsylvania. And if you haven't heard of that, it is 100% because our only reference is probably that Billy Joel song. So that is us. And actually, he was talking about Bethlehem down the street from us. So OK, oh, well. So this is us. We are a 12-hospital system in Northeast Pennsylvania. And we sit in that corner triangle in between New York City and Philadelphia. We sit on a major artery in between making that triangle. So we see lots and lots of traffic coming through. But also, we span about 20 counties between Pennsylvania and New Jersey, covering all kinds of urban, suburban, rural life. So we see a lot of people coming through with all kinds of different backgrounds. So it's really important when we talk about what we're addressing in our community needs. So this is me. I play Danny DeVito in the Matilda 1996 film. But also, my other half of my job is playing Sybil Trelawney. So I do half of my job trying to convince everybody to buy that used car, basically. Do what you need to do. Here's the information. Go ahead and buy the car. And the other half of my time sitting there divining my tea leaves, trying to figure out what's going to happen in health care next, which is almost impossible. So that's me. If you're looking for my LinkedIn page, that's what it looks like. OK, so we're going to start here. I don't really need to say any more. This is 2020. Everybody knows what it was like. We were there. It was vividly awful for everyone. But those of you who can appreciate numbers the way that I do, if you have that data geek thing on your thing, that's me. So I'll kind of go through the numbers and just illustrate a fraction of what the impact of COVID-19 had on the health care system. So this is terrible, right? We know what it felt like to be there. But this is exactly what it comes down to in numbers. More than 334,000 clinicians left that workforce, right? 117,000 of those were physicians. 32% of nurses planned to leave the field altogether or just retire. They were done, right? And that comes down to 54% of workers leaving health care altogether, health care, pharma, all of it, leaving that industry and never coming back. That means that for every six people looking for a job, there are 10 open spots. So today, that means that hospitals are hemorrhaging, right? We all know this. Nationwide, we're facing operation margins that continue to fall while drug expenses and length of stays increase by record amounts. Even scarier, in 2022, we saw the closure of 19 hospitals. And today, more than 200 hospitals More than 200 hospitals are in immediate risk of closing, not to mention 631 rural hospitals who are hanging on by a financial thread. They have low financial reserves and high dependence on nonpatient service revenues just to survive and are at immediate risk of closure. That's more than 29% of the nation's rural hospitals who are already serving demographics of people who have not great access to care because of where they are. It's hard to get there. And as we know, just when we're talking about our STEMIs, time is muscle. You can't get there, and now you've closed that hospital. So you've got a lot to do, a lot to do. So what does all this mean for the future of health care? Well, this is it, right? Are we destined for this chaotic carnival ride where we're just not sure what's going? There's risk around every single corner. It seems that way. But in reality, we just have to shift our perspective, right? So it's not just quality sitting on the part of the roller coaster waiting for us to fall out of the roller coaster. We're the whole roller coaster, right? We have to apply that kind of mentality. It's time for us to just collectively sit down and throw everything in and say, here, this is what we're gonna do. We're gonna fix your bottom line, even though you 100% don't believe we can. So Ben Franklin once said that bitterness of poor quality remains long after the sweetness of low price is forgotten. That brings true in everything, right? But more so in health care. What we don't realize, that's what we really need to bring attention to. So where do we begin? What do we need to do to ensure that we're working with resources that we have while investing where we can so that we can have a strong cardiovascular quality program? We've got three pieces to the puzzle to guide us on this journey. The first step in our quest is getting everyone to understand what we already know, right? And that is the value of our cardiovascular registries and accreditations. They're not just data repositories, right? They're these living, breathing tools that we need to use every single day to prove what we're doing, right? But also what the rest of the country is doing and beyond that. We're gonna use that information and we're gonna use that to ensure that everyone comprehends what we know, what we live and breathe every single day. The immense value of cardiac registries, essentially, right? We're gonna use that to show everybody what we know, right? We're not just talking about our docs. We're talking about every single person that comes in contact with the CV world. The second piece of that is storytelling and I'm not talking about like the kind that your toddler tells you, it's a different, this is like data storytelling, right? We're not here to tell lies. We might embezzle a little bit of the truth, but we're here to kind of, we're gonna tell them a little bit more, right? But we're gonna use the data to do that and to do that, we need lots of pieces of data and everyone's sitting here thinking, I don't have the time to do that. I'm too busy in the charts, right? But it's gonna be a long-term investment, right? So we're gonna put together all of our tools that the ACC provides us with. We're gonna take some of our other tools that we need to use from our homegrown information and we're gonna put that together to create a wonderful, beautiful playbook that they can't say no to. The last part is leadership's role and they definitely have a role here, right? They're the ones that are gonna say no the minute we come back to them and say, this is what we need, but we're gonna change their minds because we're gonna show them what they need to see to be able to say, you're right, there's money here. Which sadly, that's kind of what they care about, right? So in 1962, President John F. Kennedy visited NASA as America was racing towards the moon and it was there that he came across a custodian with a mop in his hand. I'm sure some of you have heard this story already. And when asked what his job was there at NASA, the custodian said, I'm not mopping floors, I'm putting a man on the moon. This unknown man, he just embodied that spirit that we need in quality. So what we're talking about really here is changing the culture of our organizations. It was Kennedy who kind of just simplified it all, right? He put it into four simple steps to make Neil Armstrong's one small step come to fruition. Kennedy just reduced the number of NASA's aspirations to one, we're getting that man to the moon, that's it, one, right? He shifted from the aspirational vision to a concrete objective. And then he communicated those milestones and made the abstract more tangible. And so in doing that, from custodian to astronaut, everyone was on board with the mission. Transformation in culture of organizations has to focus on quality. We have to shift that from quantity to quality. A lot of organizations are in that process. It is a lengthy, difficult process, but it's still something that we have to continue to push for. It's complex and it takes, on average, seven years to see that change come, right? But I think that's why we're here, right? We're here to try to figure out how we're gonna make that shift happen so that we can keep that in the forefront of everybody's mind. So in 2008, the Harvard Business Review emphasized the importance of breaking big changes into manageable chunks to gain buy-in. This philosophy aligns perfectly with our journey towards quality-focused culture. Here are the six contributors that we're gonna talk about today to change that culture, not only to keep quality registries and accreditation at the forefront, but also to provide the building blocks for showcasing our return on investment. So number one is education and training. This one is straightforward, right? We do this all day, every day. We organize training sessions and workshops and healthcare, to educate healthcare professionals and staff about the purpose and benefits of registries and accreditations. The question I have, though, is who are we doing this for, right? Is it just our team? Are we expanded beyond that? Think about who we're educating and training. I was just talking to one of our quality specialists this morning and she came back to me and she's like, well, why aren't we doing this? That's what we need. We need everybody at the table saying, we forgot to educate that guy, right? Or the new doc just started. He's gonna be trouble. Let's make sure that we go talk to him, right? Number two is quality improvement. Again, something we all do, but what we need to do is make sure that we're highlighting those essential tools that come with the registries, and then augmenting them with what's important in your own organization, because you're gonna have those goals, right? You're gonna have people in your leadership positions who are saying, okay, well, I don't care what mortality looks like. I wanna focus on this, right? So making sure that we're pulling all of that together and we're working continuously to improve that. Number three is benchmarking. We have so many wonderful tools built into the NCDR registries. Making sure that we're using them and showing our providers what their performance compares to a national average. My personal favorite, what it is against each other. I love to pit that dissent amongst them and just be like, but that guy's doing better, right? And then number four is feedback. Feedback, by establishing those feedback mechanisms that allows our teams to work with leadership and see what the impact of their cases are. We allow them to see how they contribute to registries and accreditation efforts, fostering a sense of ownership and pride. It's really fun. I love this one. You can't get better than feedback, right? And then you hang it up on the wall and you're like, hey, he only got the star, where's your star, right? And then they fight, because they're cardiologists, what else can they do? Okay, so I use, oftentimes, so we use feedback for our STEMI program. That was the first where we started it. It's what everybody does, right? We had this requirement of 48 hours to return their feedback. So they get that, they have to turn around their times. And then leadership gets the blurb as well, right? So it's not just going to the cath lab. It's not just going to the ED. It's not just going to EMS. It's going to everybody. Everybody's got a claim in it. And then, much to the chagrin of my cardiac quality specialist, they come back and they're wondering, great, leadership has questions for me. I'm like, that's good, right? Let's own this and let's show them that you know what you're doing and that they can get to know who you are, right? So that's a good thing. Number five is clinical relevance. It's not only important from a guideline perspective, but ensuring that we're current in terms of best practices and stuff like that. But what I love about the tools that the ACC provides is that, inevitably, the docs start to argue, right? And they're just like, well, they do it this way. I'm like, no, they don't. No, we all follow the same ones, right? I had a guy, an EP doc, come up to me, and I saw the shudder grow across the room when I said EP. But I had an EP doc come up to me, and he was like, I have a question. I think you're doing it wrong. And my quality specialist was like, no, no. Here's the definition straight from the book. And he's like, well, I'm going to contact NCDR. And she was like, here's the phone number. Enjoy. Right? It's what it's about. We know what we're talking about. They don't. It's okay, fine. We're going to get them to understand one day. I'm sure of it. And the last one is transparency. Transparency is 100% my soapbox. It's all I talk about all day. They hate it. It's fine. I like it. So what's important about transparency is making sure that we're not hiding. We're not hiding it, right? Everybody needs to know what's good, what's bad, what we're working on today. Are there a lot of measures? Yeah, there's a lot of measures. We're not going to try to hide them at all. We're still going to bring the important ones to the top, but we're still going to talk about the other ones as well. Once we do that, then they start talking, and then they start talking to their friends, and they bring it in. That's how that change in culture really starts to happen. So we've got those six contributors to culture change. I think the most important tidbit I can add about those things is that once you have made sure that you're enacting all of those things, that you track it, right? Now you're like, okay, that's one more thing to track. I already track everything, but here's the importance of it, right? You're going to take all of this information. You're going to say, I met with Dr. X 15 times in the past two months. Nothing has changed. And then you're going to take it to leadership, and you're going to be like, you need to do something about Dr. X, right? It sounds kind of crass, right, that we're doing it like that, but it has worked tremendously for us because now my physician-in-chief sits back and says, okay, they're not getting paid until they do this, right? We do the same thing with coding. We're not paying the bills until they fix the codes, right? So it's about tracking what you're doing, one, to cover yourself, right? But it's also a great tool to kind of show what everybody else is doing and just keep that transparent, right? This guy's putting in the work, but that one's not. And your tracking can be like anything. It can be fancy. You can use like a red cap, or if you want to be like super duper old school, go ahead, dig out like an access database, whatever you want to do. You can use an Excel, like you can use paper for all I care. It doesn't matter, just track it. Like mobile X marks, it don't matter. It's as long as everybody knows that we're watching you. We'll do that all day. So Mark Twain once wisely said, the data is like garbage. You'd better know what you're going to do with it before you collect it. And let's be honest, we don't do a great job with that. We just collect and collect and collect, really little hoarders. So we understand like why we participate in registries, but it's equally crucial to ensure that our staff and our providers and administrators grasp the potential of that data, right? These registries aren't like digital records just sitting there, right? Like we've got it. It's collective wisdom sitting here ready for us to use. We better use it. All right, so here's our mission. It's really, really easy. We just need to convince our cardiovascular colleagues that our registries and accreditations are our compass, that they show us the way when the path is ahead and uncertain, and that they are the source of evidence-based decision-making, guiding us towards the best possible care for our patients. They're going to help us understand that it's not just about the present, it's also about the past, and that our registries are basically time machines. They allow us to recognize all of our patterns in patient care and to fine-tune our approaches and make our continuous improvements. So how do we do that? Well, we're going to delve into the top four areas related to patient outcomes that are going to effectively demonstrate our return on investment in quality. So I break it down into three different sections. We're going to talk about the first one that's going to be quality-based key performance indicators or KPIs, as everybody likes to refer to them with their jargon. So here's the top four areas related to patient outcomes that are going to help us demonstrate our return on investment. So mortality rates, complication rates, readmission rates, and oddly enough, our patient and colleague satisfaction. They're going to fall into this category. All of these metrics focus on quality for the most part with the added bonus of what happens when the patient leaves your four walls, which is also incredibly important when we talk about the care of our patient. Incorporating all of these care transitions and positive patient experiences and trust into our quality care provided along with ensuring our staff is appropriately resourced and cared for well, that is going to be Part 1. A majority of this information you can get straight from the QR code on our website. This information you can get straight out of your outcomes reports from your registries and your accreditations. You can combine that with what's already in your in-house resources, hopefully, if you can have a decent IT system that can pull them out. And then you're basically going to combine them together and then you're going to get your first KPI report, right? Everybody's got like tons of KPI reports, right? But we're building a new one. Here's Section 2. These are our financial KPIs. Here we need things like our average charge per encounter, our average variable cost per encounter, our average net revenue per encounter, and then our average variable contribution margin per encounter. That one's my favorite, the VCM, because we know. We know what we're going to make off of procedures, right? As long as we have that, we know what our volumes are, we know what the contribution margin is. That's already like money. They're ready to go. Okay, here's our last section. We're going to combine quality and financial together and we're going to take a look at our total claims-based costs. If you have access to that data, not everybody does. At LVHN, we have our own insurance company and so we have access to all of our attributed lives. So we know exactly what we're making in terms of claims. We're going to take a look at our average claims cost per episode and then we're going to take a look at the cost by readmission DRG and the cost of readmission by days. All of that is huge money left on the table all of the time. Okay. This is a snapshot of what they allowed me to show you of one of our dashboards. So this is our chest pain clinical pathway, and here we do exactly that. We take those KPIs that we just talked about, that we sat down with leadership with, and we said, what are our goals, right? What are the goals within the registry that we need to focus on? We take a look at all of the patient outcomes, the financial outcomes, and we put them all together, and we come up with a dashboard like this. This allows us to effectively review real-time what is happening within the network, good or bad. It's out there on a server, live, refreshed, every single day. They take a look at it, and they know exactly what's happening. So here, all the way at the very top, tiny little font, because it's super huge, but you can see all of the goals that we have, including internal goals related to MACE, but also goals related to our accreditation standards and according to the registries. And then as we move forward, or across I should say, we have goals related to readmissions, related to the cost of those readmissions. And then the payer side of it as well. This one is our AMI dashboard. Do the same thing here. They have the same kind of—all of our dashboards have the same look and feel to them as a network standard. But the content varies, of course. It's based on who our medical lead is and what they're looking for. So here we're looking at accreditation metrics, specifically the ones that we've got there are ED arrival, it's a first EKG, and door-in-door-out times. This is all of our hospitals. So we have the ability to slice and dice by each facility, get a better look at what's going on. And then from there we can slice into the breakdowns that make up those variables. So here my quality specialists can also determine what our readmissions look like, if there's a trend and cause, who that is. Sometimes that's the case. And then how much that's costing us, and if we are projecting a penalty as well from CMS. You know, because you've got to use this one instead of CMS, which is like 45 years old. So we take all of that, and we've got our top four outcomes based on quality cost savings, right? The first one is going to be accreditation and payer recognition. It's not really fair, right? It says like, my beautiful graph says that it's low in cost savings. But it's really not. All four of these are high in terms of cost savings. But you've got to put it on a graph, right? So the main groups here represent showing the impact that they have. The first one, like I said, accreditation and payer recognition. Apart from the clear benefit of improved patient outcomes and standardized clinical pathways, accreditation and payer recognition lead to substantial cost savings by increased patient volumes and improving reimbursement rates. There's also lots of payer relationships that you can create that's also going to save you lots of money there. The second one is risk mitigation and legal protection, not one that we always think about. But it's true, right? We reduce our risk, and suddenly we see a lot less of those lawsuits that sometimes come through the door. They can yield substantial cost savings just by avoiding those settlements and liabilities. The third is efficient resource utilization which allows for optimization of operations while maintaining or enhancing care quality. It leads to substantial cost savings by reducing operational expense and by minimizing waste. This we know because we oftentimes work in very lean teams to begin with, right? How many of you are like, I'm the captain of my rowboat, right? You know, so if we can prove that we need more resources and that it doesn't cost as much as they seem to think that it will, that this is the way to kind of go about that. The last is reduced complications of readmissions which strategically is the most important because it directly impacts patient outcomes and quality of care. It also yields significant cost savings by reducing treatment expenses and hospital stays. All of these have a high potential for cost savings, but their strategic importance might vary depending on your organization. But in practice, they really should be considered as integral components of the Comprehensive Cardiovascular Quality Program because they all collectively contribute to improved patient care and financial stability. So we've got the team on board. That was easy, right? All right. We've got the data telling us the story. Again, that was super easy because everyone has great technology teams within their organization that can pull off a dashboard in two days. Okay. So the last one that we need to do is to understand the return on investment, right? So we're about to go talk to the bosses. That's what we're going to do. We're going to go tell them, like, this is our plan. We've got the money. This is how we're going to do it. So here it is right in front of us from the former U.S. Deputy Attorney General Paul McNulty who once said that if you think compliance is expensive, try noncompliance. Truer words, I swear, have never been said, never, right? So how are we going to do it? We're going to make them an offer they can't resist. We've got four of those offers, the four different scenarios. So here's scenario one. This is I feel like we've all been there. This is all too familiar. One that everybody has played countless times, countless times, right? Okay. So picture this, right? Your supervisor walks into your office and drops the bombshell, right? Our readmission rates are on the rise. Something needs to be done. You're like, what can we do? You're going to give me some resources. Like, yes, absolutely, right? It's like the hunger game. So like, yeah, I volunteer you as tribute, right? So that's where we are. It's the hunger games, wonderful. So that's it. You're the tribute. So it's a situation that many of us can relate to, no doubt about it, right? And this is the dynamic world of healthcare. This is what we're living in. The challenge is real, but we have the commitment. We know how to do it. We're going to do it, right? We're going to start by taking our return of investment. It breaks down into two major categories. That's how our calculation works, right? The first one is going to be our investment costs. This one is going to be no investment, minimal resources, high costs, right? We've got no registries. We've got no accreditation. This is our training and our education. No. Nope. Process improvement initiatives, we're going to give you maybe a quarter of an FTE. That's it. That's it. They already exist. You don't get a new one. That's the person who's already sitting there. But they can help you out sometimes. Maybe give you some tips on how you're going to go and talk to the person about training. That's it. Data collection and reporting systems, you get to use what Bill Gates has given you, and that's it. That's it. You've got your Microsoft package. Good luck. There's some YouTubes out there for you. And technology, what is that, right? The queue. We're waiting on optimization, right? It's going to be about six years, so yeah. So that's it. What is our investment cost? Bare bones, $25,000, that's it. Is it blown out of proportion? Maybe not. Maybe not. It's maybe not an exaggeration. We oftentimes really are working with nothing, right? Just what we have. So here are our financial benefits. Same. Because we put nothing in, we're getting nothing out, right? We don't have reduced complications. Now we're paying this, you know, three-quarters of a million-dollar fee because of all of the complication rates that we have. Reduced readmissions. What's that? We failed. We failed. For every single readmission, it's about $12,500, every single one of them, right? So now we're looking at maybe $400,000, something like that, and that's on average nationwide. There's your CMS penalty. If you're lucky, you don't have a huge program. We were talking about maybe $70,000. Revenue increased from payer contracts. Nope. Resource inefficiency. Yeah, yeah. Absolutely. We're wasting all of our time. A hundred percent. There's another quarter of a million. So what have we spent? We have lost over $2.5 million. Oh, I forgot about that. about this one, legal and liability costs. There's another $200,000, and patient satisfaction. That one, that one's huge, right? We didn't help you. We're not coming back, and guess what? Neither is the rest of our family, right? We know that women are the medical decision makers of their family, and they get it done, right? Guess what? I had to wait in the ER for 18 hours. We're not going back, right? All right, here's your calculation. We're gonna put it in our calculator, and we will take a look at the financial benefits, and then we're gonna subtract the investments from that. We divide that by the investments, and that's how we get our ROI, right? So here, it's pretty clear. We have lost way more than what we put in, right? And our return on investment is negative 10,000%. This isn't even like really like, can't even say this, right? I had to put in $25,000, it's really, we work with $0, right? But I can't divide by zero because math, whatever, okay. Okay. All right, let's make it a little better, right? We'll get a little bit of something. Here's scenario two. We got a modest investment in registries and accreditations, so we're gonna take part in just Cath PCI and just Chest Pain MI. We're just giving you two. We're gonna do it at two facilities. It's gonna cost us, I don't know, like $30,000. We're throwing numbers out here. We're gonna take part in Chest Pain Accreditation as well. Those same two facilities, that's another $20,000. We're just doing annual basis, right? Training and Education, we're gonna give you 20,000, a little bit less, right? We're still just gonna rely on that one person that we already have in our house. Process Improvement Initiatives. Here's, we're gonna give you some more, right? Now we're talking about maybe one FTE if we're lucky. Process Improvement Initiatives for $75,000. Data Collection and Reporting Systems, still Bill Gates. Technology, no, we still don't have that, for a total of $145,000. That's not much at all, right? That's one year. That's no one's salary, right? We were talking about like maybe two, three people out of that, that's not a lot of money, not a lot. In the grand scheme of things. Our benefits though, because we put into it, are gonna look a whole lot better. Now, we've reduced our complications, we're saving about $100,000. We've reduced our readmission rates, sort of, not really, right? We're at $0, because of that, we still have our penalty, because that takes a lot of work. We're working on it though. Your revenue increase from your payer contracts, we still don't quite have that. We're still putting the work in. But, we're gonna estimate about 100 new patient visits, because we've changed our complications, and now the word is out there, and everybody understands. On average, it's about $400,000, just for those 100 new patients, which is a lot of patients, don't get me wrong. All right, so we've got a total of 63, $630,000. Man, these are all out of order today. So you're surprised. All right, so patient brand recognition and market share increase. That 1% sounds like it's nothing, but in terms of market share, it's huge, right? When we talk about market share, if you've got 3% gain, you moved a mountain, right? So 1% is substantial. It's still gonna get you at least $200,000, if not more, depending on what your market looks like, and what your patient demographic looks like as well. Okay, so let's put it into our calculator again. We'll do the math, and now we've got an investment gain, that investment gain of $485,000, and a super positive ROI of 334%. We did nothing, we did nothing, but our ROI is incredibly positive, right? I'm blessed to work with a physician-in-chief who's like, well, if I just had this much money, I would say yes, right? Not everyone has that, I get that, but show them those numbers and what you're making, like definitely we can support adding a few more resources to the plan. Okay, scenario three, a little bit better, slightly more significant investment resulting in a substantial financial benefit, right? So it's all about what you put into the equation like we talked about, right? We're gonna cut it back, we're just gonna do one, so we're small, right? We're gonna do cath PCI and a chest pain MI for about 15. Here's our chest pain accreditation at one facility, 10,000. Here's our training and education, only 10,000. Here's our process improvement initiatives, still got 75,000, that's our one FTE essentially. Data collection and reporting systems, we're still not putting anything into that. Here's our technology, still nothing, so we've got a total of only $110,000. Even less, right? All right, so we're gonna total up all of our financial benefits from putting in that hard work and focusing on what we did. And yeah, we're divining from the future, but still, we're gonna just try. Still haven't gotten rid of that penalty, that one's a hard one, takes years to get rid of. Here's your total, $820,000, right? Put them together, and you've got an investment gain of $710,000, and a return on investment of 645%, still even higher, right? Here's the last one. This one I think is the most, to be fair, it's the most accurate, right? At least it is for my system, it could be different for everybody else, but we're just gonna talk about our costs, right? We're talking about one facility still. And what I do in this kind of situation, because like I said, we're, I count the ones that have cardiac involvement, we are about nine facilities, right? We'll take out the children's and everybody else, they don't care. All right, so when we talk about all those guys, I'm just gonna multiply everything, right? This is just one, I'm gonna multiply it now by every single one of those facilities, and I'm just gonna multiply it by every single one of those facilities, and now I have an even bigger number to send back to them, right? So those are investment costs. Here are our financial benefits. We're still using national averages here, but at the end of the day, now we've got a financial benefit of 1.7, almost 8, really, if we're rounding up, because we're going to be generous, million dollars. So what's our return on investment look like now? We've got an investment gain of $1.6 million, we didn't do much, $1.6 million and an ROI of almost 1,600%. I don't really feel like we're stretching the truth. How many of you are doing that? You've got one or two registries, you've got one accreditation, but we just didn't take the information, we didn't put it onto a platform, we didn't say this is what we got out of what we did, and then we didn't shove it back in their face and say, hey, look, we did it, we won. So that's my recommendation to you, right? Once you've got all your KPIs figured out, what those costs are, what the benefits are, you put them down into your ROI, use the Google machine, figure out what those national averages are, make sure you cite it, because they're going to ask, right? And you say, here, here are the numbers, this is what it works out to. If we just did these things, I could save you this much money. And that's how it starts. We started with just accrediting one site, God willing. By the next year, we will have five for chest pain, and we take part in 11 registries times at least three of our campuses. We started very small in that number and have just moved and moved and moved and moved, mostly because I'm really good at nagging, but still. So this is what they get. That's what they want, right? There's Scrooge McDuck diving in the money pit. That's what it is. It's just about demonstrating your investment in quality and your registries and your accreditations, right? It's not just checking that box for compliance. It's not just saying, yes, we submit to the state because we have to. It's not just saying that we participate in the registry because the state mandates it or whatever it might be, right? So arm yourself with your data, be transparent about your costs and your benefits, and try to create those dashboards to really bring focus and light to what is going on in quality. That is the easiest way to get everybody on board, and the people who don't want to join the party, they're going to get pushed out because that's what happens, right? Everybody's like, I'm winning. I'm doing so great, right? And the other guy's like, well, no, it's all wrong. I have it in my black book. I know it's wrong, right? And you're like, no, it's not, right? It's right here. It's black and white. So lastly, in the immortal words of the great philosopher Aristotle, quality is not an act, it is a habit. So with unwavering dedication and your newfound arsenal of insights, you can march forward with an extended, irresistible offer to your leadership, one that distinctly underscores the tangible benefits of quality-focused healthcare paradigm. That's it. It's simple. Go home and do it. You're like, no. I can't. Thank you. Thank you very much, Mercedes. We have slated the next few minutes to have some meet the author time. So Mercedes will be available over here on the side to speak with any of you that want to spend some time with her. A lot of information there. And I'm sure overwhelming to a lot of you that have not seen that kind of work put into spreadsheets and that type of thing to be able to present to your leadership. But she had to start somewhere, so I know she's got some good information to share with you guys. Yeah. Sometimes you just make it up, too. You just go like this. They never know. Thank you. And again, join her over there if you have questions.

Mercedez Scott

data

patient care

financial challenges

quality-focused

leadership

culture change

ROI