Page 22 - Modern Healthcare (January 2020)

Three
health
systems
tackle
waste
Bellin Health
For Bellin Health, a
member of the Institute for
Healthcare Improvement
Leadership Alliance since
its inception six years
ago, the checklist woke
up leaders to the issue of
diagnostic errors, said Jim
Dietsche, chief operating
and financial officer of the
Green Bay, Wis.-based
system.
Eliminating diagnostic
errors can save the
healthcare system about
$100 billion a year through
avoiding unneeded testing,
wrong treatments and
litigation costs, according to
the alliance.
Each year, Bellin sets a
goal of spending about
$6 million to $8 million
less than the previous year
through waste reduction.
The goal is maintaining
Bellin’s operating margin at
around 4%.
Frontline staff are
encouraged to come
up with solutions where
waste can be reduced in
their departments. Once
physicians became a part of
alternative payment models
that showed them their cost
and quality data regularly,
they got more interested.
20 Modern Healthcare | January 27, 2020
Northwell Health
Frontline staff are also driving the battle against waste at Northwell Health.
For instance, the 12-bed surgical intensive-care unit at Lenox Hill Hospital
in New York is working on cutting spending broadly across the unit by being
transparent about how much services and supplies cost. Now, the 20 most-
expensive supplies in the supply closet are labeled with their price. The idea
is to encourage staff to be more conscious about how many supplies they
take at a time, perhaps taking just one catheter instead of three now that
they see the price, said Dr. Daniel Baker, medical director of Lenox Hill. They
are still acquiring data to calculate the initiative’s impact.
The work on the unit regarding Tylenol is leading to cost savings. After
laying out the price differences between intravenous Tylenol, which averages
about $30 per use, compared with 5 cents to 30 cents for the pill form, staff
educated themselves about appropriate use of IV Tylenol. They found they
were using it when it wasn’t necessary, such as when a patient has a fever.
Since September, they have decreased the use of IV Tylenol, leading to
roughly $730 in savings each week.
Baker said he’s working on how Lenox Hill can spread the lessons the
surgical ICU has learned to other units.
Northwell typically starts small on new initiatives to see how well they
work before using them broadly, said Dr. Mark Jarrett, chief quality officer
for the system.
Pricing assistance
A Northwell Health surgical unit saved an estimated $730 a week in part
by disclosing prices on the IV and pill forms of Tylenol
Cost IV Tylenol: $30 per use, on average
Pill form of Tylenol: 5 cents to 30 cents per use
Change BEFORE: Average of 42 doses of IV Tylenol a week
AFTER: Average of 14 does of IV Tylenol a week
Source: Northwell Health data on Lenox Hill Hospital’s 12-bed surgical ICU
Providence
Scaling practices that work is the hardest part about working on waste,
said Dr. Joanne Roberts, chief value officer at Renton, Wash.-based
Providence, which has 51 hospitals.
Rather than calling it waste, Providence calls it variation. The work
involves finding ways to standardize care more. One way is by having
centers of excellence perform highly complex procedures instead of at
sites across the system.
Roberts said there is evidence that patient outcomes will be better, and
it will also bring down costs because all the resources for those services
can be centrally located. It may also show perhaps too many doctors have
been hired for a procedure, she said.
Providence didn’t estimate what the cost savings would be for the work,
but Roberts said the system is starting with heart surgeries to see how
it goes.
“Ten to 15 years ago the most lucrative thing a hospital could do
was heart surgery. It’s not true anymore,” she said. “Many of our heart
programs actually lose money just because reimbursement has slowly
changed and care models have changed.”