In the past, hospital administrators managed the facility and its finances, while leaving management of medical care to the clinical side, says Brent James, M.D., chief quality officer at Intermountain Healthcare.
With the advent of accountable care organizations and other new care delivery and payment initiatives, administration must take full management responsibility for clinical delivery, he contends. “That’s a transition the whole industry is going through.”
Back in the old says, chief financial officers were accountable for financials--that was the measure of success. How, they have to transition to a strategy that makes clinical quality the core competency of the organization, James says.
At a session at 2:45 p.m. on June 25 during the Health Care Financial Management Association’s National Institute, “Clinical Transformation and Increasing Value,” James will explain Intermountain’s ongoing initiative, started in 1995, to use data to support clinical transformation across the delivery system.
It starts with changing the culture and collecting, analyzing and learning from the huge amounts of data collected in health care facilities. James pioneered the standardization of clinical care through collecting and analyzing data on treatment protocols and the early results were stunning.
Intermountain initially identified 1,400 clinical processes in 1995 and found that 104 processes accounted for 95 percent of all care delivery volume. Further, the biggest care delivery volume came from pregnancy, labor and delivery (11 percent), and management of ischemic heart disease (10 percent). By the end of 1996, James had better management of 21 percent of the business from two of 1,400 processes.
That helped seal the deal for moving to a new approach to clinical transformation, which twice had previously been tried and failed, with vice presidents in charge leaving the organization. “A lot of money was sent down the toilet with pretty good people sent down the road.” Those early efforts had assumed that using existing financial data sets would produce answers to make clinical decisions, a mind-set that still exists today, he contends. “It’s called ‘availability phenomena’ and it’s very common. It wasn’t so much the wrong data as not enough of the right data.”
And that was a challenge for Intermountain in the mid-1990s as the organization learned it was missing up to one-half of the data needed to fully support the pregnancy/labor/delivery process. That led to a board of director’s 1998 decision to create a management system, which including hiring medical directors, to ensure the proper data was collected and used.
Now in 2012, clinical transformation is an initiative all organizations need to master, and quickly, James warns. The federal government is in serious financial trouble and a lot of the problem comes from health care.
There is an unavoidable consequence coming with draconian reimbursement cuts on the near horizon. All new health reform payment systems, he notes, put providers at risk for the cost of care, but only one-third of CFOs really understand what is coming and what is needed. “If the others haven’t mastered it, they’d better soon.”
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