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LAURA O’DONNELL: The human resource role is great in creating and establishing and
maintaining the budget. The biggest ticket item, I think for most organizations, is payroll. It’s the
human resource factor, so we have a major role. There are tools that we develop here where
we’re able to manage that on a daily basis, a monthly basis. Where I might go to the president
and say we’ve got certain trends happening. We can redirect the ship immediately.
I’m happy to say with those tools our personal costs have always been under budget, and where
we have not used agency, and that we have maintained our overtime, which then makes us more
successful. We have more money to put back into capital, we have more money to give people
raises. Because we’re trying to manage to the day to day. I know here we have a major role, and a
major role in the tools and the functions to manage that cost every day.
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DEANA STOUT: Costs are rising and reimbursement’s not. And there’s a lot of pressure to
improve efficiencies. I agree that there’s always areas for improvement, but finding those
efficiencies quick enough to deal with the pressures of the lower reimbursement is a huge
challenge.
By now, most health care organizations, I think, have gotten the low-hanging fruit. The things
that are easy to find have been found. And reimbursement is still not going up as fast as expense
inflation. So trying to find ways to be more efficient and survive in this kind of an economy is a
real challenge.
But it’s also the patient aspect. And dealing with how to get our community the health care
services it needs. Knowing that the number of under-insured and uninsured in that population is
growing. We do have a Charity Care Policy and every patient is eligible to take advantage of
that, assuming that they meet the criteria. So as you might imagine, that number has grown over
time. So we take a very hard look at it every year and we budget accordingly. It’s not a piece that
we scale back on. We’re here for the community, and if those patients need us, then we’re going
to find a way to fund it. Employees and managers get behind that. And they’re with us. They
want to be more efficient, too, so that we don’t have to scale back that line item. So it is
powerful.
| uninsured clearly fall under our Charity Care guidelines, so they’ll be granted Charity Care per
our policy. But it’s really almost that middle income group, when they have the more complex
illnesses, that I’m most concerned about, in making sure that they have access to care, and the
financial resources to get the care that they need. Because they don’t as easily fall into the
Charity Care guidelines, because their income is over the limit. But at the same time, some of
them have some very expensive medical needs.
We do have a have policy where we do inform patients of their expected copays and
coinsurance. And sometimes, even though we offer them financial assistance, and payment
plans, and whatever, the number does scare them. And they’ll say, I’m going to defer health care
services right now. We hate to hear that, but at the same time, the patient also needs to
understand that they make get a bill in the mail. So it’s that middle income group that I worry
about the most.
We are in a process of going more and more electronic, which once you’re past the learning
curve, I think does make life easier. And I think it improves accuracy, which improves patient
care. And improves billing and collections. So from a financial standpoint, I think it’s made a
huge difference, but still has the potential, once we go electronic with the physicians, I think can
make even a bigger difference.
And in particular physician documentation, and making sure that we’re able to code accurately
for billing, and can capture everything that we need to capture from the financial standpoint. And
then of course, having all of that information available real time to the clinicians makes a huge
difference from a quality standpoint.
We are part of a bigger system, so some of the compensation decisions are a challenge, because
we can’t make those on our own, like we would if we were a stand-alone hospital. So that gets a
little bit more challenging, because we sometimes need to fall in line with the rest of the system.
So for instance, if there’s a position that three of our sister hospitals are struggling to hire into,
our retain into, but it’s not a problem for us, then we may need to increase our rates across the
board. So there’s a little bit of a dynamic there that is somewhat out of our control, as it relates to
rates.
I mean, for the most part, I play a role in making sure that any new investments in human
resources make sense financially. And that we understand the cost benefit. We can’t always pay
for them through other means, but at least we know what a new investment is, and have a
conscious decision that it’s a strategic investment that we need to make. But then also making
sure that the resources that are in place are used in the most efficient way possible, looking at
productivity. So making sure that we are managing the resources that we have efficiently.
The bed management system is a system that we recently implemented. It was all a part of our
patient flow initiative. What we saw was that the majority of our admissions come in through the
emergency room. And the emergency room was really clogging up and we were hitting
roadblocks in getting patients through, and on the floor quick enough. So we invested in what we
call the patient logistics center, which was a concept– and was also, a very good display of team
work, where each of the divisions really bought into the concept of the patient logistics center.
So we staff the center with some patient transporters. Nurses were transporting patients to the
floors when they were admitted. And a bed management system so that we could see real time
which beds were available, which ones had monitoring capabilities. A lot of the patients coming
from the ED need to have a monitored bed. And really helped the patient flow and improved
throughput through the ED, so we didn’t get bottlenecked in the ED waiting for a patient needing
a bed.
This is the bed board that we recently implemented. And it really is the control unit for
everything that goes on in the hospital. This is sort of the hub of all the patient activity if they
move throughout the acute care operation. This is really important to the hospital, because it
really impacts all of our main focus areas. And also in finance, as we deal with patient
throughput, and getting the patients through the system. Making sure that we’re as efficient as we
can. It has some benefits there, as well. Which then, of course, allows us to grow our volume. So
it really impacts all the areas that we focus on at the hospital.
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There’s obviously a big push towards computerized physician order entry and electronic medical
records. Here at MedStar, we’re just getting started on that journey. We’re not fully electronic in
our records. But obviously, the financing of that, how organizations– particular standalone
organizations– we have the benefit of being part of a larger system, and the funding that goes
with that to be able to afford these technologies. But some of the standalone organizations are
going to have great challenges in being able to implement those effectively, even with the
reimbursement that’s available as part of the health reform.
Data is great, but it’s how you use the data. And one of the critical challenges that we face as an
industry is utilization, and how do we get the best possible outcomes with the least possible cost
generated? And we all know that the United States has 16% to 18% of GDP dedicated to health
care, a lot of it in waste. It doesn’t really contribute to the outcomes that we’re looking for. So
we’ve got to find a way to limit the lab tests and the imaging that’s done to make decisions. And
data is going to help us do that. Our IT systems help us to pull data that looks at physician
utilization by diagnostic-related group, by DRG or by condition. And by drilling down on that,
we can determine, even with outcomes data, who’s at the forefront and who’s lagging behind.
And share that data, and help them to understand that perhaps there’s testing that’s going on that
isn’t necessarily beneficial or contributing to an outcome that we’re trying to achieve.
But getting the data from the point that it comes out of the information systems to the point
where it’s actually actionable is a great challenge as well.

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