AZHIMS Clinical Throughput November I7TH, 2006 Presented By John C. Lincoln Hospital

1. AZHIMS Clinical ThroughputNovember I7TH, 2006Presented ByJohn C. Lincoln Hospital

2. Clinical Efficiency Using Electronic Tools Maren Sharpsteen, RN, BSN, MFT, CMAC Clinical Director of Care Management John C. Lincoln Hospital North Mountain Phoenix, AZ

3. Hospital Case Managers: Care managers and financial managers Impacts quality of care for patients Ensures payer source reimbursement at optimal level for level of care Manages optimal throughput Manages safe discharge/ensures continuity of care Plays pivotal role in ensuring payer contracts are aligned with appropriate clinical care Does anyone here have a close relationship with your case management department. We are relied upon for these major functions. Does anyone here have a close relationship with your case management department. We are relied upon for these major functions.

4. Technological Barriers to Effective Patient management Lack of integrated data to determine effectiveness of quality care Healthcare lags in technology � numerous manual tasks still exist No credible post acute vendor data is available Increasing amounts of patient information with little or no connectivity

5. Needs Assessment Throughput issues: 2004 � 2006 Hospital LOS increased from 3.5 to 4.2 Fewer than 15% are discharged before noon Decreased patient satisfaction with discharge when delayed Medicare ALOS went from 4.2 by 3rd quarter in 2004 to 4.6 in 3rd quarter 2006

6. Needs AssessmentDischarges by Noon

7. Average Length of Stay

8. Average Length of StayMedicare

9. Needs Assessment Capacity Issues: winter months Increase in time it takes to discharge Typical demand for hospital beds increase from November, peak in Feb, drop in May Increase in patient ED wait time Increase in patients leaving before being seen

10. Needs Assessment Capacity Issues: winter months LOS increases from 3.9 to 4.5 in peak months Elective surgeries cancelled Diversion for trauma cases Lower patient satisfaction scores

11. Admissions Jan - April Admissions have gone downAdmissions have gone down

12. Bed Days Jan - April Bed days have gone upBed days have gone up

13. Summer Months Admits Admits increasedAdmits increased

14. Summer Months Bed Days Bed days increasedBed days increased

15. Root Cause AnalysisInternal Timely discharge of patients by physicians Increased need for post acute care Ordering and obtaining test results Change in patient status Communication challenges Manual and time consuming communication systems

16. Root Cause AnalysisExternal 3-4 hours to find skilled nursing facility, Home Health,LTC, DME Nursing shortage in post acute care Phoenix has an increasing population Dependency on vendors to communicate back in timely fashion TALK ABOUT SPECIFICS OF HHC, DMETALK ABOUT SPECIFICS OF HHC, DME

17. Root Cause AnalysisExternal Seasonal influx of people Finding care outside of area or state Retirees/elderly � stay more than 10 days, will need post-acute care Increasing complex discharge needs TALK ABOUT SPECIFICS OF HHC, DMETALK ABOUT SPECIFICS OF HHC, DME

18. Complex Road to Discharge No real-time transparency of SNF bed availability; discharge planners forced to make individual inquiries Lack of standardized process complicates coordination between hospital and post � acute facilities Social workers influenced by marketing from post-acute placement reps; placing patients based on personal relationships with facilities Separate paper-based forms must be completed for each area facility. (True North Advisory board)

19. John C. Lincoln Savings Analysis

20. John C. Lincoln Savings Analysis

21. John C. Lincoln Savings Analysis

22. Manual Processes Cost Hospitals Revenue 60% patients need post acute care - 25 % of Case Management and Social Work time spent on clerical work

23. Current processes for discharge Waiting for return calls: 30 � 60 min Scheduling liaison visits: 2 � 3 hours Calling facilities, payers, transport: 20 � 40 min Calling for DME, supplies, and O2: 10 � 20 min Waiting for payer authorization: 2 � 3 hours Calling to confirm placement: 2- 3 hours

24. Researching throughput solutions The Advisory Board: Washington D.C End of patient stay impacts the next patient�s stay Sicker patients and quicker turnaround times Capital budget constraints mean there is limited ability to add beds

25. Understanding Financial Impact Delay in discharge = delay in admission of new patient Dead Bed Time Unnecessary Days = potential for denial Less time for staff time to do timely and quality Utilization Management/Review

26. Understanding Financial Impact Physician and patient satisfaction � who will be attracted to your hospital Staff satisfaction = turnover Readmission Costs

27. Use of Web-based software for discharge planning 3 � 5 hours per SNF referral to an average 30 min Onus is on the vendor/provider to drive the discharge process Competition is created due to first come first serve: drawing line in sand Documented communications for referrals that are reportable Keep competition from trolling for patients Changes �the he said she said� Keep competition from trolling for patients Changes �the he said she said�

28. Use of Web-based software for discharge planning Improvement relationships with vendors by providing data Shifting clerical time to clinical time: more time with patients and families More time for quality oversight Keep competition from trolling for patients Changes �the he said she said� Keep competition from trolling for patients Changes �the he said she said�

29. Staff Efficiency Data based on staff self � reporting of 1.5 hours a day spent on faxing, calling, and copying: 15 CM FTE x 1.5 = 22.5/day x 5 = 112.5/week x 52 weeks = 5850 hours a year = 2.8 FTEs 10.5 SW FTE x 1.5 = 15.75/day x 5 = 78.75/week x 52 = 4095 hours a year = 2 FTEs Total 38.25 hours a day x 5 = 191.25/week x 52 = 9945 9945 / 2080 = 4.8 FTE

30. Staff Efficiency Data based on staff self � reporting of 1.5 hours a day spent on faxing, calling, and copying: One FTE for Faxing = 1 x 8hr/day = 40 x 52 = 2080 = 12,025 hours Total =12,025 hours year for faxing and calling vendors Costs: CM salary at $31/hour = 64, 480/year x 2.8 FTE�s = $180,544 SW salary at $25/hour = $52,000/year x 2 FTE�s = $104,000 Add one Clerical Salary at $16/hour = $33,280 Total: $317,824 spent on inefficient and time-consuming tasks

31. Improving Efficiency Estimated time to create a referral based ECIN�s assessment of JCL NM process: Saved time will go from 40 min per case to 7.5 min per case Hands on clerical pieceHands on clerical piece

32. Improving Efficiency CM and SW estimated time for faxing and calling = 40 min per case Average number of HHC referrals and SNF referrals per CM/SW per day = 3 3 x 25.5 x 7 = 53 cases per week per CM/SW x 40 min = 21,420 min or 357 hours per week referral and transfer set � up time 53 cases x 7.5 min x 7 = 2782 or 46 hours a week 311 hours saved a week in referrals time or 7 FTES for CM/SW

33. Outcomes: Micro Analysis (Reports supplied by ECIN) Based on standard reports of Referral and Placement Summary; Placement Summary; Provider Performance Results; Processing Time Report

34. Vendor Reports

35. Vendor Reports

36. Patient Intervention Reports

37. Potential for Improvement 17% improvement in discharge referral time 20 % improvement in Turnaround time from referral to acceptance 18 % fewer FTEs used for clerical work

38. Impact on Throughput Case Example: late week discharge to post-acute care SNF scenario 67 year old Mrs. Smith admitted on Monday with broken hip. Had surgery on Wedesday with intention to send to subacute rehab by weekend. Placement was not organized by Friday as the SNF facilities had not returned any phone calls.

39. Facilities Using Discharge Technology Examples of ECIN�s Outcomes in several health care networks and hospitals across the country

40. Facility I

41. Facility 2

42. Facility 3

43. Facility 4

44. Improved Data/Reporting Monitors provider performance Ability to see referrals and trends of acceptance Turn-around times for acceptance Readmission rates

45. References (2006) Breakthrough Capacity Management: An Improved Approach to Managing Capacity. True North, Annual CIO Business Summit. The Advisory Board, Washington, D.C. (2006) Discharge Planning Process Review Business Case Analysis Proposal for John C. Lincoln Health System. ExtendedCare Professional� (ECIN)

46. References Shefter, Susan M., MSW, LCSW. Workflow Technology: The New Frontier, How to overcome the Barriers and Joing the Future. Case Management. Jan/Feb 2006, Vol 1, p.37 Tome, Jeanine M., A Future of Case Management: Will Technology be the Key to Linking Clinical and Business Expertise? Presentation for ECIN, Oct 26th, 2006