This article, written by Lee Ann Odom, Principal and Director of PYA’s Performance Transformation Services, was originally published by Chief Healthcare Executive and reprinted with permission.
How an academic medical center manages patient movement and transitions of care can impact the organization’s finances.
For some healthcare leaders, spring means the budgeting process for the upcoming fiscal year is well under way.
As operational leaders consider all of the inputs related to developing the operating budget, one of the most impactful components is volume.
Many different levers can be used to fine-tune a budget, and robust patient volume is critically important to each facility’s financial health. As I reminisce about my experiences preparing operating budgets, I hear the words frequently said by a chief financial officer colleague, “Volume cures all woes.”
While volume is certainly a lever that can balance the bottom line, how an academic medical center manages patient volume, particularly patient movement and transitions of care, will ultimately drive overall institutional financial health.
Heads in beds
Academic medical centers care for many high-acuity patients who are transferred for a higher level of care. Because of an academic medical center’s multi-mission model (clinical care, education, and research), it is positioned to deliver very specialized and complex treatments.
Many academic medical centers have a “say yes” philosophy to accept inbound patient transfers, which results in significant volume. That inbound volume, coupled with patient volume from busy emergency and surgical departments, often leads to high occupancy. High occupancy is financially beneficial when the right patients are in the right beds at the right time, but low-acuity patients in AMC beds produce the opposite effect.
Having the wrong patients in academic medical center beds requires a significantly higher cost structure to support the institution’s multi-mission model, challenging its efficiency proposition.
Volume vs. value
To shift focus from volume to value, health system organizations should strive to have the right patients in the right beds by exploring value enablers: patient flow, patient movement, and transitions of care across the continuum. These enablers can be prioritized and apply to both single- and multi-site organizations, including academic medical centers.
Patient flow
Getting the right (high-acuity) patient in the right bed in the context of a single site can involve patient flow challenges such as emergency room boarding, specific bed type availability, and diagnostic testing availability.
Hospitals, including AMCs, should assess the situation by asking key questions:
- How often are patients in a higher-resourced bed than necessary?
- How often are ICU patients waiting for a step-down bed?
And while some staffing can be acuity adjusted, the overall fixed infrastructure expense remains. How often are observation-status patients placed on the general medical floor and become part of that floor’s routine: multidisciplinary rounds daily versus clinical decision rounds every two hours? Length of stay can quickly escalate from hours into days.
In the scenarios described above, hospitals have high volume but compromised efficiency.
Patient movement in the multi-site environment
Getting the right patient in the right bed in a multi-site environment includes pairing the patient’s needs with the most appropriate care site. Many multi-site organizations excel at expediting the transfer of critically ill patients to the academic medical center or high-acuity care site; however, it is not uncommon for AMC sites to receive placement requests for low-acuity patients.
Low-acuity patients do not require the complex infrastructure of an AMC nor justify the associated expense structure. Careful assessment of each transfer request is a multifactorial process.
In addition to understanding the patient’s medical needs, being aware of the services available at the requesting site is just as important. AMCs should probe to identify how the care plan will change as a result of the transfer. This may require a physician-to-physician conversation (between the requesting physician and the potential accepting physician or transfer center physician leader) and is worth the investment of time. Unnecessary patient movement and high-acuity bed utilization are costly.
Transitions of care
Optimizing transitions of care across the continuum enables proper patient placement: getting the right patient to the right bed at the right time. Efficient transitions require hardwired, reliable multidisciplinary communication pathways, tools and technology, and clear escalation protocols that include physician leadership.
Many organizations are beginning to use transfer center operations, sometimes referred to as “mission control centers,” to escalate patient flow and patient movement delays in addition to the more traditional role of expediting the movement of high-acuity patients.
Putting the scenarios into practice
Using some of the scenarios mentioned, let’s consider the patient waiting for imaging, perhaps an MRI. Is there a hardwired escalation path to determine if that test is necessary while the patient is occupying an inpatient bed, or can the MRI be done as an outpatient?
Consider the academic medical center with low-acuity patients occupying extensively resourced beds. Does the AMC have a protocol or escalation path when capacity is constrained to decant low-acuity patients by leveraging transfer center/mission control processes and communication pathways?
Think about the transition from inpatient to a subacute nursing facility (SNF), which is often a source of delay and unnecessary occupancy of an inpatient bed. When an SNF bed is not readily available, does the patient simply occupy a hospital bed while waiting, or does the hospital have a process to continually assess the patient’s status to determine if an alternate level of care is appropriate?
Chasing volume for the sake of volume, in the absence of optimizing efficiency, will not support long-term financial health. Instead, hospitals, particularly academic medical centers, should leverage and enhance transfer center scope and processes to optimize efficiency and improve financial results.
Chief Healthcare Executive is a publication of MJH Life Sciences, the largest privately held medical media company in North America, and shares best practices, cutting-edge solutions, and innovative thinking. Read the article in Chief Healthcare Executive.
PYA’s experts can help academic medical centers, hospitals, and health systems strategically manage volume to reach sustainable operations.
