MEDHOST seeks financial improvement through more efficient throughput
LAS VEGAS – It's often said that the emergency department is the "front door" of the hospital. And recent years have seen more people than ever making their way through that entry.
"ED volumes have skyrocketed over the past two years, while the number of EDs has stayed consistent," said Craig Herrod, president and CEO of Addison, Texas-based MEDHOST, in an interview at HIMSS12 last month.
And not only are patient volumes 10 to 12 percent higher, patients' acuity level is higher, too. Compounding that? Decreasing compensation across the board. "For the first time since the early '90s you're seeing the gap between private payer and government payer at an all time [high]," said Herrod. Those Medicaid patients can be costly for cash-strapped hospitals.
With healthcare reform looming, it's a probability that hospitals will soon be seeing EDs inundated even more so. A decade ago, the numbers were "12 percent of ED patients admitted, 38 percent of admitted came from ED," said Herrod. Now, across our customer base, its 17 percent of ED patients getting admitted, and 60 percent of admitted patients start in the ED." In certain underserved areas, those numbers could be as high as 30 and 90 percent, respectively.
MEDHOST develops a suite of products meant to "make EDs tremendously more efficient," he said. "It doesn't really matter what size hospital you are, it's all the same issues."
Its Web-based OpCenter tool aims to give hospital execs a view of their entire facility – offering real-time data about which patients are coming in and which are waiting to go home. That "30,000-foot view looking down into the ED," says MEDHOST product manager Robin Hill, gives the C-suite information that can help optimize resource utilization for more efficient throughput.
MEDHOST HD, meanwhile, is a decision support tool that's also aimed at executives. Aggregating data from both the emergency department information system and the inpatient hospital information systems, it can alert decision-makers when patients are in observation status longer than indicated, occupying higher acuity beds or exceeding their reimbursed length of stay.
In short, it lets a hospital know when it's "providing care at one level when [it] should be providing care at another level," said Hill.
At HIMSS12, meaningful use Stage 2 was the talk of the exhibit floor. But it was less of a concern to MEDHOST executives. "When you listen to CEOs, and what their biggest issues are," said Herrod, meaningful use surely has its place. "But number one is, 'How the heck do I get more revenue in here? Somehow, some way?'"
In hospitals nowadays, "opportunity for new revenue is not great – but also at the same time, your ability to cut cost is not great, either."
That’s certainly the case at Good Shepherd Medical Center in Longview, Texas, said Ron Short, the hospitals' vice president of operations.
"As with most ED’s across the country," he said, "we have been challenged with increasing volumes, increased patient acuity, increasing numbers of patients without funding, increasing numbers of patients without primary care physicians, the perpetual challenge of unfunded patients using ED as primary care, increasing surgical and direct admission volumes that compete for inpatient bed space in our hospital, poorly executed inpatient discharge planning to facilitate inpatient bed availability, and declining reimbursements."
Indeed, since Good Shepherd’s implementation of MEDHOST 2005, the ED volume at Good Shepherd has "increased 20 percent," said Short. The volume of patients admitted from the ED has grown 37 percent in the same time frame. “The volume of patients without a primary care physician has reached levels as high as 30,000 patient visits per year."
But MEDHOST has helped. "The technology allows us to display our ED and inpatient statuses for all clinical staff to see," he said. "Visibility creates accountability. Our admissions department uses the technology to predict and prepare for patient placements well in advance of the actual admission orders being written. The admissions department also works with the staffing office to ensure the proper number and mix of clinical staff so our units are prepared to care for the patients coming to them."
Moreover, he said, "we can look at each individual milestone of our admission processes to see where bottlenecks exist, and work to systematically address these as they arise, both in the immediate term and over the longer term. MEDHOST has given us real-time access to information that before was manually counted and tracked, and we can be significantly more agile to address problem areas than we could before MEDHOST implementation."
The firm's technologies, said Short, have helped make it so "the increased volume has been positive for our bottom line, as we have been able to accommodate the additional volume without increases in our left without being seen rate (LWBS) and no ambulance diversion since April 2008. We are keeping patients in our system that used to leave. This is financially beneficial for our hospital and clearly is better for our patients and community."
Of course, "reducing the volume of patients that leave your ED is one of the most effective ways to increase a hospital’s revenue," he added. "Being able to reduce length of stay in a hospital’s inpatient units makes beds available more quickly and reduces the time that patients must board in the ED. The net impact of these improvements are financial but also positively impact patient experience, which will ultimately be reflected in a hospital’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and impact the hospital’s reimbursement from CMS.
