IMPERATIVE:
Management of Non-Emergent Patients
CASE STUDY:
Southern Regional Medical Center
ATLANTA, GEORGIA... Like hospitals all over the US, the Emergency Department at Southern Regional Medical Center is suffering from an increased utilization of emergency services by both emergent and non-emergent patients. Southern Regional’s ED has 39 staffed beds serving the Southern Crescent of Metropolitan Atlanta. SRMC is the sole provider in this predominantly urban area. The population in their primary service area has grown by almost 50% in the last 10 years. From 2004 to 2006, there has been an 8.5% -rise in visits, an average of one patient arriving to the ED every 6.5 minutes. By 2015, the total of emergent and urgent visits to the ED is expected to increase 16% while the uninsured and underinsured percent of the population likewise continues to increase. The impact on the hospital was an increasing volume of non-emergent patients (Triage levels 4 &5), an increasing volume of self-pay patients, decreasing reimbursement, inadequate co-pay collections and mental health hold issues. The realization was that the hospital needed to change its model of care.
To facilitate the change, Southern Regional’s administration staff enlisted the help of Compirion Healthcare Solutions, a Milwaukee-based consulting firm. According to Senior Vice President of Operations, Mary Kay Gardenier who championed the project, Compirion was chosen for their unique multi-disciplinary approach to their methodology, the focus of their past projects and because they were very hands-onCompirion was chosen for several reasons; the unique multi-disciplinary approach to their methodology; the focus of their past projects, which aligned well with Southern Regional’s objectives; and because they were very hands-on, consulting in the ED environment. Compirion sent a team of two to work with the hospital team, which consisted of the Chief Nursing Officers, Medical Directors, the CFO, and a representative from each department touched by the ED. Compirion was to work under hospital direction, helping them develop tools and processes in order to effect permanent change.
The primary project objective was to redirect the non-emergency patients to a setting more appropriate to the level of care they required while staying within regulatory agency guidelines. This would allow the ER to get back to its original intent —treating the seriously injured. Other objectives were to increase total net income to a set goal, improve patient flow, improve utilization, decrease ED turnaround time to 3 hours or less, and improve employee and patient satisfaction.
The Compirion’s key initiatives were to improve community care clinic interface/utilization, increase co-pay collections, and address mental health holds. In order to ensure progress, the Compirion team began by creating a daily dashboard. The dashboard allowed them to compare current performance to past performance as well as analyze data on a daily basis.
Next Compirion developed a medical screening examination to correctly and appropriately assess all patients who were triaged as Level 4 and Level 5 Acuity. The Compirion team then worked with local government and regulatory agencies to set up guidelines for determining which patients in these categories could be referred to a primary care physician, a community care clinic, a community based clinic, or minimally treated and released. Levels 1-3 and some Level 4’s were routed directly back to the ED. The impact of this reduction has a potential savings to the hospital of $511,000 annuallyThe result was a 7,300 annual reduction in Level 4 and 5 non-emergent patients with the potential of reaching an annual reduction of 13,000. The impact of this reduction has a potential savings to the hospital of $511,000 annually. This had a welcome side effect of decreasing ED turnaround time and overall medical length of stay.
Increasing co-pay collections began by improving the payer mix by evaluating the history of paramedics serving the hospital. Next the Compirion team worked with the hospital staff to establish a concept for all patients to understand the value of the services provided. A goal was set to achieve co-pay collections of $60,000 per month. The result of these actions was a jump in collections from $39,000 per month to $56,000 within 5 months and climbing.
To address the final challenges, improving patient flow, throughput and overall length of stay, they looked at setting up a safe, convenient location for mental health patients to be held prior to disposition. Next they began establishing an STD/wound management clinic where qualified RN’s could medically screen these patients and refer them to the proper resources. In the event of patients requiring suture removal, they can now be treated in the new suture removal clinic that will help eliminate volume from the ED and improve utilization of resources. Currently these projects are in process.
Their unique methodology is behaviorally focused and resulted in facilitating change in hospital leadership which had the greatest impact of allAlong with the improvements in revenue, the Compirion project resulted in an increase in point-of-service collections by 32%, a 52% decrease in door-to-room time, a decrease in treatment-to-disposition of 12%, a decrease of 20% in overall length of stay and a 40% reduction in left without treatment. According to Gardenier, what impressed her the most with the Compirion team was “…their high degree of commitment to the project. Their unique methodology is behaviorally focused and resulted in facilitating change in hospital leadership which had the greatest impact of all.”
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