One focus of every hospital case management department or utilization management team is patient length of stay (LOS). Hospitals get paid by Medicare and most Medicaid and third party payers based on a formula that includes a number of elements. The formula is specific to categories of diagnoses referred to as Diagnosis Related Groups (DRG¿s). The payment for the DRG¿s are predetermined and the amount doesn¿t change regardless of the cost of care. The only way for hospitals to make a profit is to provide care for the patient in a manner that is medically appropriate and gets the patient well…mehr
One focus of every hospital case management department or utilization management team is patient length of stay (LOS). Hospitals get paid by Medicare and most Medicaid and third party payers based on a formula that includes a number of elements. The formula is specific to categories of diagnoses referred to as Diagnosis Related Groups (DRG¿s). The payment for the DRG¿s are predetermined and the amount doesn¿t change regardless of the cost of care. The only way for hospitals to make a profit is to provide care for the patient in a manner that is medically appropriate and gets the patient well enough to get safely out of the hospital, but at the same time keeping costs below the amount of the DRG payment. If costs exceed the payment, then the hospital will lose money on that patient. For hospitals to know how they¿re doing, they need a standard for comparison. Medicare generally tracks and reports length of stay as a "Geometric Mean Length of Stay" or GMLOS which uses a statistical application that is calculated by multiplying all of the lengths of stay and then taking the nth root of that number (where n=number of patients). Most hospitals measure their own length of stay as an "Average Length of Stay" or ALOS which is a simple arithmetic mean or average. This book focuses on the next generation of initiatives to improve LOS (length of stay) performance in hospitals. In the last 20 years many organizations have significantly improved the management of labor and non-labor expenses. The new frontier of expense reduction initiatives is in the utilization of clinical services. A one day reduction in LOS in a 500-bed facility represents about $1.5M per month in savings. This book showcases the most innovative solutions that have been implemented in the industry to reduce LOS to the proverbial GMLOS. This book also provides easy, practical solutions that will reduce LOS within 120 days.Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Ali Birjandi is currently VP of Performance Improvement at CHRISTUS Trinity Mother Frances Health System. He is an accomplished leader with significant career progression culminating in a senior management positions in a nationally recognized 2.5 billion dollar multi-facility integrated delivery system. His expertise is in the ability to develop enterprise-wide performance improvement strategies and assist business unit leaders in converting them into tactical action plans. He was formerly the COO Palm Beach Garden Tenet Hospital, VP of Operations Improvement ProMedica Health System and Director of Business Process Improvement Carle Clinic and Hospital. He holds an MBA and an MHA from the University of Florida. He holds the CPHIMS certification from HIMSS and a ASQ Six Sigma Black Belt.
Inhaltsangabe
Preface Chapter 1: Importance of LOS and how to measure it Many organizations don t understand the impact of LOS in an organization. Additionally, most organizations don t know how to measure LOS appropriately. Understanding the nuances of what should be and not be included in the measure is critical to knowing how to manage it. * Defining LOS as an opportunity * Common methods of measuring LOS and GLMOS * What items should be included and excluded from the measure * Common mistakes in measuring LOS Chapter 2: How to create the infrastructure to roll out the changes Organizations require significant infrastructure in order to roll out a sustainable LOS program in their organizations. Building all the components from the ground up is critical to get the organization firing on all cylinders to keep LOS down. * Developing the steering committee * Developing the working group * Developing the teams * Developing the meeting schedules and project tracking Chapter 3: Negotiating with payors to improve approvals If the payers are not cooperating or you are not negotiating well, the organization will never achieve GMLOS. Knowing what to ask for is critical and getting it into the contract even more so. * Collecting performance indicators for approvals * Setting the required standards for approvals * Meeting with the payors * Negotiating the contracts Chapter 4: Utilizing hospitalist to manage "inlier" patients The utilization of hospitalist is critical because an organization has control over them. For the first time the priority of an organization can be part of play in getting LOS down to GMLOS. * What are inliers and how to identify them * Significance of managing inliers * Utilization of hospitalist in managing inliers * Specific information required to manage the hospitalists for LOS Chapter 5: Setting up post-acute care services to manage "outlier" patients The most expensive place to treat the patient is in the acute care setting. Any other location will by default be less costly. Knowing clinically when to transition the patient to the right level of care is critical. * What are outlier patients and how to identify them * Significance of managing outliers * Negotiating with post-acute care services * Setting up communication forms with post-acute care facilities Chapter 6: New innovative reports for managing ALOS and its process A new level of performance requires newer innovative reports. Reports showing utilization patterns of providers, LOS broken down by inliers and outliers, discharge patterns, and operator discharge times are critical to managing every aspect of the discharge. * New processes require new reporting * How to use these reports * Troubleshooting LOS using reports * Ranking opportunities using reports Chapter 7: Inter-disciplinary review structure that provides the most benefits Daily reviews are critical to keep tabs on the patient s condition. The escalation is critical to enable the IDR to function effectively. * Do you have all the right people at the table? * What is the expectation of the team? * When and where are they meeting? * Creating an escalation process. Chapter 8: Getting the benefits of reducing LOS It s one thing to reduce LOS but it needs to work in conjunction with labor and non-labor to get the benefits. For the department is not staffing to volumes the cost structure will change. * What does LOS mean to resources * Metrics to track for benefits (labor and non-labor) * Tracking readmissions to make sure LOS is not pushing too hard * Quantifying avoidable days Chapter 9: LOS management is a perpetual process Sustainability for LOS requires constant vigilance. Infrastructure that is constantly monitoring the metric is critical. These metrics need to be monitored in conjunction with reciprocating metrics such as 30 day re-admissions to make sure LOS is not decreased at the expense of patient condition. * What happens when the team disbands * Components that need to be in place for CQI process * Monitoring at each level of management * Making it part of the culture Chapter 10: Leadership drives culture and results through proper communication The most critical part of the book is making sure you have the right leadership in place. What are the characteristics of a good leadership that can drive the culture. * The value of strong leadership * The communication methodology
Preface Chapter 1: Importance of LOS and how to measure it Many organizations don t understand the impact of LOS in an organization. Additionally, most organizations don t know how to measure LOS appropriately. Understanding the nuances of what should be and not be included in the measure is critical to knowing how to manage it. * Defining LOS as an opportunity * Common methods of measuring LOS and GLMOS * What items should be included and excluded from the measure * Common mistakes in measuring LOS Chapter 2: How to create the infrastructure to roll out the changes Organizations require significant infrastructure in order to roll out a sustainable LOS program in their organizations. Building all the components from the ground up is critical to get the organization firing on all cylinders to keep LOS down. * Developing the steering committee * Developing the working group * Developing the teams * Developing the meeting schedules and project tracking Chapter 3: Negotiating with payors to improve approvals If the payers are not cooperating or you are not negotiating well, the organization will never achieve GMLOS. Knowing what to ask for is critical and getting it into the contract even more so. * Collecting performance indicators for approvals * Setting the required standards for approvals * Meeting with the payors * Negotiating the contracts Chapter 4: Utilizing hospitalist to manage "inlier" patients The utilization of hospitalist is critical because an organization has control over them. For the first time the priority of an organization can be part of play in getting LOS down to GMLOS. * What are inliers and how to identify them * Significance of managing inliers * Utilization of hospitalist in managing inliers * Specific information required to manage the hospitalists for LOS Chapter 5: Setting up post-acute care services to manage "outlier" patients The most expensive place to treat the patient is in the acute care setting. Any other location will by default be less costly. Knowing clinically when to transition the patient to the right level of care is critical. * What are outlier patients and how to identify them * Significance of managing outliers * Negotiating with post-acute care services * Setting up communication forms with post-acute care facilities Chapter 6: New innovative reports for managing ALOS and its process A new level of performance requires newer innovative reports. Reports showing utilization patterns of providers, LOS broken down by inliers and outliers, discharge patterns, and operator discharge times are critical to managing every aspect of the discharge. * New processes require new reporting * How to use these reports * Troubleshooting LOS using reports * Ranking opportunities using reports Chapter 7: Inter-disciplinary review structure that provides the most benefits Daily reviews are critical to keep tabs on the patient s condition. The escalation is critical to enable the IDR to function effectively. * Do you have all the right people at the table? * What is the expectation of the team? * When and where are they meeting? * Creating an escalation process. Chapter 8: Getting the benefits of reducing LOS It s one thing to reduce LOS but it needs to work in conjunction with labor and non-labor to get the benefits. For the department is not staffing to volumes the cost structure will change. * What does LOS mean to resources * Metrics to track for benefits (labor and non-labor) * Tracking readmissions to make sure LOS is not pushing too hard * Quantifying avoidable days Chapter 9: LOS management is a perpetual process Sustainability for LOS requires constant vigilance. Infrastructure that is constantly monitoring the metric is critical. These metrics need to be monitored in conjunction with reciprocating metrics such as 30 day re-admissions to make sure LOS is not decreased at the expense of patient condition. * What happens when the team disbands * Components that need to be in place for CQI process * Monitoring at each level of management * Making it part of the culture Chapter 10: Leadership drives culture and results through proper communication The most critical part of the book is making sure you have the right leadership in place. What are the characteristics of a good leadership that can drive the culture. * The value of strong leadership * The communication methodology
Es gelten unsere Allgemeinen Geschäftsbedingungen: www.buecher.de/agb
Impressum
www.buecher.de ist ein Internetauftritt der buecher.de internetstores GmbH
Geschäftsführung: Monica Sawhney | Roland Kölbl | Günter Hilger
Sitz der Gesellschaft: Batheyer Straße 115 - 117, 58099 Hagen
Postanschrift: Bürgermeister-Wegele-Str. 12, 86167 Augsburg
Amtsgericht Hagen HRB 13257
Steuernummer: 321/5800/1497
USt-IdNr: DE450055826
