You can't manage what you don't measure: that seems to be the mantra of every hospital executive, as electronic data systems increasingly help hospitals track data on quality measures, patient satisfaction and revenue. Here five hospital leaders discuss ten statistics every hospital should track.
1. Quality measures, such as infection rates, patient falls and overall mortality. CMS requires hospitals measure a variety of quality statistics, including hospital-acquired infection rates, associated diseases and readmissions. Kathy Young, CEO of St. Joseph Hospital in Kokomo, Ind., says hospital administrators should keep their eye on those core measures and identify several that the hospital needs to improve upon or watch for. "We watch our patient fall rates to make sure we improve our performance if our rates get too high," she says. Looking at statistics on quality measures might not be possible more than once a month because the data is not available, but Ms. Young says hospitals should still talk over patient safety issues every day.
In order to keep patient safety issues front and center, her hospital holds a "daily huddle" where staff members discuss upcoming or potential safety issues as well as mistakes that have happened in the past 24 hours. This "daily huddle" means that patient safety problems are not forgotten over the course of a week or a month, and hospital administrators and department heads have a good idea of the hospital's strengths and weaknesses. If you hold a regular meeting to discuss patient safety issues, you won't be surprised when you look at monthly data and find your hospital is underperforming in certain areas.
2. Patient census statistics. As well as calculating revenue and collections, your hospital should track patient census statistics to determine when you experience the biggest patient load and when that load drops off, says John Fontanetta, MD, chairman of the emergency department at Clara Maass Medical Center in Belleville, N.J. His experience in the emergency department has taught him that patient satisfaction drops off steeply when the number of patients outmatches the number of available beds. By tracking your patient census and reviewing it on a daily basis, you can determine which departments are overburdened, which times of year are the busiest and which departments are seeing a declining stream of patients.
Ms. Young says she watches inpatient census and surgery volume every day, but she also regularly watches for changes in the number of cases for an individual physician. "If I see any changes in that number, I want to pick that up right away and follow up," she says. "If you don't get in contact immediately, somebody might be mad at you for months and you wouldn't know about it."
3. Discharged not final billed claims. If your hospital has a claim that's been discharged and clear-coded but it hasn't arrived at the payor yet, there is something wrong with the claim that means it's not clearing the edits. If you aren't tracking DNFB claims, you won't be able to research why your hospital never received payment and how your billing department is submitting flawed claims. The status of DNFB claims should be reviewed every day to ensure billers and collectors know the status of the hospital's payments. Hospitals can also make sure they have a linkage to the payor, so that when the payor receives the file, they notify the hospital of the claim's status. Over-time statistics on DNFB claims can be reviewed less regularly — for example, every month — to get a "big picture" look at how many claims are being processed incorrectly.
Your hospital should also track claims that are hung up with the payor, says Steve Mooney, president of revenue cycle solutions at Conifer Health Solutions. "Once the bill has left the hospital, a lot of hospitals stop paying attention to it," he says. "I think we're going to see a lot more focus on those neglected claims."
1. Point-of-service cash collections. Point of service collections are defined as the collection of the portion of the bill that is the responsibility of the patient prior to the provision of service, which could mean payment is received before the procedure or on the day of the procedure. In order to note where your hospital is losing money, you need to know how much you collect from the patient on a monthly basis and how much of that is collected on point of service. Data on point-of-service cash collections should be reviewed monthly so your hospital can regularly examine and adjust its collections policy if necessary.
"There's a big initiative to contact a patient as soon as they are scheduled to find out if they are insured, who their insurance company is and whether their procedure is covered by insurance," says Mr. Mooney. "You want to determine the co-pay and deductible and call the patient beforehand to ask if they'd like to pay in advance or at the hospital." By calling the patient several days before the procedure, you set up an expectation that they will pay the claim when they arrive at the hospital, Mr. Mooney says.
2. Percentage of charity care. Tracking your hospital's percentage of charity care differs depending on non-profit or for-profit status. Non-profit hospitals have to provide a certain amount of charity care, and in order to qualify for funding, they must identify charity care cases and track the data. "It's very important for tax status to capture that population," Mr. Mooney says. "You want to triage the financial ability of a patient to pay as soon as possible. We have a tool that looks at every patient who comes through the doors of the hospital and looks at their credit report and looks at census bureau data and tries to figure out their propensity to pay."
If your hospital is for-profit, you should track your percentage of charity care and review it monthly to determine how you can route uninsured, non-emergency patients to other facilities. If your emergency department is frequently used to treat non-life-threatening situations, your hospital might talk to uninsured patients about using local clinics. For uninsured patients who are using the emergency room for real emergencies, your hospital can talk to patients about how to qualify for Medicaid. "A lot of patients who don't have insurance today use emergency rooms," Mr. Mooney says. "If it's an emergency, you can use a financial counselor once the patient is through the ER to talk about Medicaid, how to get food stamps in their community and how to improve their lifestyle in general."
3. Percentage of budget spent for each department. Every department should schedule a regular review of its budget and spending to figure out where your hospital is spending the most money, says Faye Deich, chief operating officer at Sacred Heart Hospital in Eau Claire, Wis. "During a cost saving initiative, we put together diverse groups of people to look at various department budgets. This helped to train department leaders and others within the organization to think about cost management," she says. "Our goal was to find out if we could use different supplies at a lower cost, or if we should be negotiating harder with vendor contracts." She says by reviewing the budgets on a departmental level, the hospital found it was renting wheelchairs when it had the resources to buy them.
She recommends asking each department team to achieve a specific target based on their team's sum portion of total hospital expenses. It's a lot harder to see where you're potentially wasting money from the macro level. If you get down to the nitty-gritty details of each department, you may find — like Ms. Deich did — that you can save several thousand dollars a year just by switching your brand of garbage bags.
4. Door-to-discharge times. Dr. Fontanetta says tracking door-to-discharge times — the amount of time a hospital visit takes from the moment the patient walks in the door to the moment they are discharged — is essential to determine where your bottlenecks exist. Especially in the emergency department, he says, hand-offs happen so quickly that providers may not be aware of the time a patient spent sitting around the waiting room. He says an EMR is extremely helpful in tracking a statistic like door-to-discharge times because it allows your staff members to look at data on a rolling basis. "You can only imagine how hard it would be to track those times manually," he says. "You would need four to five FTEs on the project, and you wouldn't be as accurate as an EMR."
With a quality EMR, Dr. Fontanetta says you should be able to break up your door-to-discharge times into different sections to determine where bottlenecks occur. You should look at door-to-triage time, triage-to-room time, room-to-doctor time, doctor-to-order time and order-to-decision for discharge time within the overall time the patient spends in the hospital. "If you find out your times are high, you can drill down on that and find exactly where the problem is," he says.
Dr. Fontanetta says once you have information on your door-to-discharge times, you should compare your hospital to other similar hospitals. You won't know how your wait times and procedure times measure up if you don't compare the data to other hospitals on a quarterly basis.
5. Patient satisfaction scores. If you want to gauge efficiency, comfort and quality in your hospital, ask your patients. Ms. Deich says her hospital looks at patient satisfaction rates on a weekly and monthly basis to get a sense of why patients are dissatisfied and how they can improve. "We know it's not statistically significant to look at scores on a weekly basis, and we don't go jumping off in a certain direction based on one weekly score, but it gives you an idea of how things are looking," she says. "We're shooting for the top decile as our target, so we're trying to set a pretty high bar."
She says administrators review patient satisfaction scores from a third-party company on a weekly basis to identify immediate issues and then review again on a monthly basis to make decisions about policy changes.
Dave Veillette, president and CEO of Cancer Treatment Centers of America at Western Regional Medicine Center in Goodyear, Ariz., recommends asking customers to rate how likely they are to recommend a particular hospital service. Your hospital can effectively gauge patient satisfaction by asking, "Would you recommend this service to a family member?" Ms. Deich and Mr. Veillette both also recommend soliciting patient feedback through daily rounds and sharing that information at regular department meetings. Not all patient satisfaction indicators will be statistics, they say. By soliciting and sharing anecdotal evidence about patient experience, your hospital can get feedback on problems that may not fit on a "0-9 satisfaction level" survey.
1. Colleague satisfaction scores. Your hospital should do an annual colleague satisfaction survey that asks each staff member for input on the hospital's policies and practices, strategic direction, staff communication and other topics. Once you have the results of that survey, share them with your colleagues and form tangible solutions for several common complaints. Ms. Deich says she gives a presentation to the staff on the feedback the hospital received and the hospital's priorities following the colleague satisfaction survey each year.
In order to keep up with colleague complaints and concerns, Ms. Deich says her hospital also issues a "pulse survey" with 10 or 12 questions every quarter. "We want to get a sense of how our colleagues feel about working here and the respect level between staff members," she says.
2. Market share and service line development. As well as regularly monitoring statistics on revenue, your hospital should look at market share and service line development on a monthly basis to determine how you should increase your market share or develop or expand more profitable service lines. Comparing your revenue from each service line with the costs associated with that line can tell you which lines are profitable and should be expanded, and which lines are no longer profitable and might be discontinued. This research can be combined with research in your community to determine which lines best fit the health needs of the surrounding area. If your hospital is in an area with several competing hospitals and clinics, review your market share quarterly to determine where you are losing customers and how you can increase your attractiveness to potential patients.
Your hospital should look at information on community demographics and illness rates on a quarterly — or, if the information is not available that regularly, yearly — basis to evaluate whether you are offering the right services. For example, a community where many residents suffer from heart disease should have a robust cardiology service line.
Daily
1. Quality measures, such as infection rates, patient falls and overall mortality. CMS requires hospitals measure a variety of quality statistics, including hospital-acquired infection rates, associated diseases and readmissions. Kathy Young, CEO of St. Joseph Hospital in Kokomo, Ind., says hospital administrators should keep their eye on those core measures and identify several that the hospital needs to improve upon or watch for. "We watch our patient fall rates to make sure we improve our performance if our rates get too high," she says. Looking at statistics on quality measures might not be possible more than once a month because the data is not available, but Ms. Young says hospitals should still talk over patient safety issues every day.
In order to keep patient safety issues front and center, her hospital holds a "daily huddle" where staff members discuss upcoming or potential safety issues as well as mistakes that have happened in the past 24 hours. This "daily huddle" means that patient safety problems are not forgotten over the course of a week or a month, and hospital administrators and department heads have a good idea of the hospital's strengths and weaknesses. If you hold a regular meeting to discuss patient safety issues, you won't be surprised when you look at monthly data and find your hospital is underperforming in certain areas.
2. Patient census statistics. As well as calculating revenue and collections, your hospital should track patient census statistics to determine when you experience the biggest patient load and when that load drops off, says John Fontanetta, MD, chairman of the emergency department at Clara Maass Medical Center in Belleville, N.J. His experience in the emergency department has taught him that patient satisfaction drops off steeply when the number of patients outmatches the number of available beds. By tracking your patient census and reviewing it on a daily basis, you can determine which departments are overburdened, which times of year are the busiest and which departments are seeing a declining stream of patients.
Ms. Young says she watches inpatient census and surgery volume every day, but she also regularly watches for changes in the number of cases for an individual physician. "If I see any changes in that number, I want to pick that up right away and follow up," she says. "If you don't get in contact immediately, somebody might be mad at you for months and you wouldn't know about it."
3. Discharged not final billed claims. If your hospital has a claim that's been discharged and clear-coded but it hasn't arrived at the payor yet, there is something wrong with the claim that means it's not clearing the edits. If you aren't tracking DNFB claims, you won't be able to research why your hospital never received payment and how your billing department is submitting flawed claims. The status of DNFB claims should be reviewed every day to ensure billers and collectors know the status of the hospital's payments. Hospitals can also make sure they have a linkage to the payor, so that when the payor receives the file, they notify the hospital of the claim's status. Over-time statistics on DNFB claims can be reviewed less regularly — for example, every month — to get a "big picture" look at how many claims are being processed incorrectly.
Your hospital should also track claims that are hung up with the payor, says Steve Mooney, president of revenue cycle solutions at Conifer Health Solutions. "Once the bill has left the hospital, a lot of hospitals stop paying attention to it," he says. "I think we're going to see a lot more focus on those neglected claims."
Monthly
1. Point-of-service cash collections. Point of service collections are defined as the collection of the portion of the bill that is the responsibility of the patient prior to the provision of service, which could mean payment is received before the procedure or on the day of the procedure. In order to note where your hospital is losing money, you need to know how much you collect from the patient on a monthly basis and how much of that is collected on point of service. Data on point-of-service cash collections should be reviewed monthly so your hospital can regularly examine and adjust its collections policy if necessary.
"There's a big initiative to contact a patient as soon as they are scheduled to find out if they are insured, who their insurance company is and whether their procedure is covered by insurance," says Mr. Mooney. "You want to determine the co-pay and deductible and call the patient beforehand to ask if they'd like to pay in advance or at the hospital." By calling the patient several days before the procedure, you set up an expectation that they will pay the claim when they arrive at the hospital, Mr. Mooney says.
2. Percentage of charity care. Tracking your hospital's percentage of charity care differs depending on non-profit or for-profit status. Non-profit hospitals have to provide a certain amount of charity care, and in order to qualify for funding, they must identify charity care cases and track the data. "It's very important for tax status to capture that population," Mr. Mooney says. "You want to triage the financial ability of a patient to pay as soon as possible. We have a tool that looks at every patient who comes through the doors of the hospital and looks at their credit report and looks at census bureau data and tries to figure out their propensity to pay."
If your hospital is for-profit, you should track your percentage of charity care and review it monthly to determine how you can route uninsured, non-emergency patients to other facilities. If your emergency department is frequently used to treat non-life-threatening situations, your hospital might talk to uninsured patients about using local clinics. For uninsured patients who are using the emergency room for real emergencies, your hospital can talk to patients about how to qualify for Medicaid. "A lot of patients who don't have insurance today use emergency rooms," Mr. Mooney says. "If it's an emergency, you can use a financial counselor once the patient is through the ER to talk about Medicaid, how to get food stamps in their community and how to improve their lifestyle in general."
3. Percentage of budget spent for each department. Every department should schedule a regular review of its budget and spending to figure out where your hospital is spending the most money, says Faye Deich, chief operating officer at Sacred Heart Hospital in Eau Claire, Wis. "During a cost saving initiative, we put together diverse groups of people to look at various department budgets. This helped to train department leaders and others within the organization to think about cost management," she says. "Our goal was to find out if we could use different supplies at a lower cost, or if we should be negotiating harder with vendor contracts." She says by reviewing the budgets on a departmental level, the hospital found it was renting wheelchairs when it had the resources to buy them.
She recommends asking each department team to achieve a specific target based on their team's sum portion of total hospital expenses. It's a lot harder to see where you're potentially wasting money from the macro level. If you get down to the nitty-gritty details of each department, you may find — like Ms. Deich did — that you can save several thousand dollars a year just by switching your brand of garbage bags.
4. Door-to-discharge times. Dr. Fontanetta says tracking door-to-discharge times — the amount of time a hospital visit takes from the moment the patient walks in the door to the moment they are discharged — is essential to determine where your bottlenecks exist. Especially in the emergency department, he says, hand-offs happen so quickly that providers may not be aware of the time a patient spent sitting around the waiting room. He says an EMR is extremely helpful in tracking a statistic like door-to-discharge times because it allows your staff members to look at data on a rolling basis. "You can only imagine how hard it would be to track those times manually," he says. "You would need four to five FTEs on the project, and you wouldn't be as accurate as an EMR."
With a quality EMR, Dr. Fontanetta says you should be able to break up your door-to-discharge times into different sections to determine where bottlenecks occur. You should look at door-to-triage time, triage-to-room time, room-to-doctor time, doctor-to-order time and order-to-decision for discharge time within the overall time the patient spends in the hospital. "If you find out your times are high, you can drill down on that and find exactly where the problem is," he says.
Dr. Fontanetta says once you have information on your door-to-discharge times, you should compare your hospital to other similar hospitals. You won't know how your wait times and procedure times measure up if you don't compare the data to other hospitals on a quarterly basis.
5. Patient satisfaction scores. If you want to gauge efficiency, comfort and quality in your hospital, ask your patients. Ms. Deich says her hospital looks at patient satisfaction rates on a weekly and monthly basis to get a sense of why patients are dissatisfied and how they can improve. "We know it's not statistically significant to look at scores on a weekly basis, and we don't go jumping off in a certain direction based on one weekly score, but it gives you an idea of how things are looking," she says. "We're shooting for the top decile as our target, so we're trying to set a pretty high bar."
She says administrators review patient satisfaction scores from a third-party company on a weekly basis to identify immediate issues and then review again on a monthly basis to make decisions about policy changes.
Dave Veillette, president and CEO of Cancer Treatment Centers of America at Western Regional Medicine Center in Goodyear, Ariz., recommends asking customers to rate how likely they are to recommend a particular hospital service. Your hospital can effectively gauge patient satisfaction by asking, "Would you recommend this service to a family member?" Ms. Deich and Mr. Veillette both also recommend soliciting patient feedback through daily rounds and sharing that information at regular department meetings. Not all patient satisfaction indicators will be statistics, they say. By soliciting and sharing anecdotal evidence about patient experience, your hospital can get feedback on problems that may not fit on a "0-9 satisfaction level" survey.
Annually
1. Colleague satisfaction scores. Your hospital should do an annual colleague satisfaction survey that asks each staff member for input on the hospital's policies and practices, strategic direction, staff communication and other topics. Once you have the results of that survey, share them with your colleagues and form tangible solutions for several common complaints. Ms. Deich says she gives a presentation to the staff on the feedback the hospital received and the hospital's priorities following the colleague satisfaction survey each year.
In order to keep up with colleague complaints and concerns, Ms. Deich says her hospital also issues a "pulse survey" with 10 or 12 questions every quarter. "We want to get a sense of how our colleagues feel about working here and the respect level between staff members," she says.
2. Market share and service line development. As well as regularly monitoring statistics on revenue, your hospital should look at market share and service line development on a monthly basis to determine how you should increase your market share or develop or expand more profitable service lines. Comparing your revenue from each service line with the costs associated with that line can tell you which lines are profitable and should be expanded, and which lines are no longer profitable and might be discontinued. This research can be combined with research in your community to determine which lines best fit the health needs of the surrounding area. If your hospital is in an area with several competing hospitals and clinics, review your market share quarterly to determine where you are losing customers and how you can increase your attractiveness to potential patients.
Your hospital should look at information on community demographics and illness rates on a quarterly — or, if the information is not available that regularly, yearly — basis to evaluate whether you are offering the right services. For example, a community where many residents suffer from heart disease should have a robust cardiology service line.