Client Profile:
A 330-bed Mid-Atlantic health system
Challenge:
Under the Global Budget Revenue model, hospital revenue must fall within 5% of the cap budget or face a CMS penalty. At a large health system in Maryland, revenue fell 7% under the hospital global cap budget in fiscal year 2015. To fall within budget, the hospital had to address several areas, including a readmission rate of over 23%, to meet quality measures and budgetary requirements.
Solution:
After an assessment to determine root causes of the shortfall, our strategic planning team worked with the hospital to balance patient mix and coordinate care to reduce readmissions. The team worked to align the staff (nurses, physicians, and administration) goals and work flow, implement multi-disciplinary rounding, and closely monitor costs of care. Multi-disciplinary rounding ensured patients received optimal care, and as a result, patients transitioned out of the hospital sooner.
In addition, the team improved relationships and communication with post-acute care providers to monitor patient conditions after discharge.
Results:
Within three months, the health system’s 30-day readmission rate was reduced from 23% to less than 7% due to better care planning, coordination, and referral relationships. The system was able to provide better care and lower costs for Maryland patients, while obtaining adequate financial reimbursement.
By working in concert to optimize patient outcomes, monitor key revenue-driving areas, and adjust frequently to meet budget goals, the health system achieved a 6% closure on the global cap budget, placing the hospital within 2% of budget. These adjustments saved the health system over $1 million in CMS penalties.