Issue link: https://beckershealthcare.uberflip.com/i/324690
14 One of things we are doing to address that is shortly after I got here, we started a revenue integrity committee. Once a month, a multidisciplinary committee that is led by the director of patient financial services, but also di- rectors of case management, managed care, ancillary directors, and we work through a lot of billing issues with denials, coding issues as a result of internal audits. That's something we've really worked on this year. RR: In the revenue cycle, it's the ever-changing rules of Medicare. No matter how well you bill or code, you're going to get less reimbursement. But if you bill the old way, it'll be considered incorrect. You have to quantify that and adjust your budget accordingly. For cost accounting, we're too small to have full-blown cost accounting system. We have a hybrid system. It's critical to know your costs and know where you're making money on certain DRGs. Most hospitals need to break even on Medicare today. When commercial insurers start paying less and less, you're not going to be around [without breaking even on Medicare]. Q: What are innovative supply chain measures aimed at control- ling costs? How do physician preference items, vendor creden- tialing and other areas fit in? GE: Three years ago, we exited from one healthcare system for our purchas- ing and supply chain. We had to rebuild it. We then signed an agreement with Yale New Haven (Conn.) Health System where we utilize their supply chain services. We have access to Yale's pricing now. We're a $160 million organiza- tion, and that's a $2 billion system. So we've realized $1 million or more in savings on that piece alone. We have a lot of service and vendor contracts. I went through and renegoti- ated every material contract. I said, "You have to cut what we're paying." We got about 75 percent of vendors that came back with price cuts. We leveraged the changes in healthcare and cuts in government reimbursement. DN: We're probably a little more fortunate, as we are part of a system. Within our GPO, our physicians get to be on the selection committee. So we get one to two physicians from our hospital…to look at supplies as mandated for the facility. That's a big plus and hasn't been happening in past. We have a fiscal responsibility committee that gets together on a monthly basis to review all new products. We have a multidisciplinary committee of all our major care directors, from the OR to nursing, to look at new supplies, surgical packs. Then we go back to vendors under the GPO to make sure they meet the needs and quality. With physician credentialing, every hospital within our system has done their own credentialing with its medical staff. We're putting together a cen- tral credentialing office. I'm in western Wisconsin with two facilities here. The eastern division has three other facilities. We're going to consolidate the credentialing process so we have a central office for all our facilities. We still have an FTE onsite at each facility because you have to have interactions with physicians, but we can still consolidate into a central credentialing office. RR: We actually are part of an informal consortium of hospitals, even though we're independent. The independent hospitals in Oregon have gotten together and specifically have gotten together to look at physician preference items. That tends to work really well for implants. The hardest thing, though, is to make sure your physicians don't feel like they are get- ting dictated. If you can show them [items are] clinically the same and that outcomes are better or as good as what they had, they are generally pretty interested and wiling to help. They are cooperative and know they are not here if we are not here. This has helped because vendors don't care about one hospital as much as seven or so hospitals coming together. It's pretty unique and pretty cool how we've all come together and share our informa- tion for the good of the whole. It's not easy, but if you keep at it, you can achieve substantial savings. Q: How do you plan on handling the increasing budgetary and regulatory compliance pressures? For example, how do you en- sure savings in staff credentialing, staff training and visitor man- agement without compromising those processes? GE: We understand the nature of compliance, quality and education, and we still allocate a portion of the budget to those areas. We can't go back and let staff and providers lose ground and become ineffective or dangerous. It's something that we don't cut. We try to manage it and are doing it appro- priately. We still think it's vitally important we stay up on new regulations, technologies and therapies, because that's what makes us good. DN: Staff credentialing is handled a lot by our HR folks. From a staff training perspective, we have brought in some key instructors…so we can train nurses and staff. Because we're close enough to the Twin Cities, we are fortunate to get folks to make that hour drive and provide those types of services. But we have had to tighten down the budget on travel and education expenses. RR: We have trouble with that being a smaller hospital. We don't have over- head, and everybody helps in the compliance area. We aren't part of chain where we can call corporate to deal with compliance. We try to do it more by committee, help each other out and farm it out when necessary. I don't know if that's typical, but I think smaller places have to do it that way. n "Payers are always adept at finding ways of not paying." — George Eighmy, CFO of Bristol Hospital At IntelliCentrics, our sole purpose is to protect the health and safety of your patients and staff. Our Reptrax™ system has quickly be- come the industry standard for vendor credentialing. Now, we're introducing staff credentialing, medical and nonmedical staff training, and visitor management solutions that further simplify the world of regulatory compliance and drive even more costs out of healthcare.