Planning (strategic, business plans)

What’s Under the Hood? Quick Look at Hospital Expenses

It's helpful to know where hospitals spend their money.  You might see a lot of technology and devices floating around the wards, but to keep the beds full, it's all about FTEs and human capital. Have a look at the figure below: Imagine the C-suite sitting down to make decisions regarding the upcoming annual budget.  While we might focus on the overuse of triple-lumen catheters or a high-risk case and legal costs, the executive decision makers think about personnel.  A hospital will burn approximately two-thirds of its spend on labor.  Medical and Pharma supplies, technology upgrades, keeping the lights on, repairs and maintenance all chip away at the coffers--but it's the employed manpower the first floor needs to think about and follow.  The battles hospital administration become embroiled in with organized labor always make headlines, but it's there leadership may find the greatest savings. The healthcare workforce has grown by leaps…

The Next Hospital Decade: Broken Hips Versus Band-Aid Strips

  I had planned on writing on MACRA and the inability of those who criticize the law to offer up alternatives to fix the flaws.  I got tired of the conclusions from the skeptics: let providers be and they will do the right thing.  That is a recipe for the pendulum to swing too far in one direction.  The "right thing" will wind up costing the Treasury a ton of dough.  History has already born that out. I am one of the skeptics as well, though.  I had no idea how CMS was planning to stitch this whole thing together--and I was waiting for hints from Andy Slavitt, top dog at CMS, based on his testimony last week on the Hill. Well, if you shorted Kleenex stock, pat yourself on the back. You can put your hankies away because it looks like CMS may postpone the start date.  My screed…

AMA: Unbeloved and Overvilified

  CMS just released their proposed MACRA regs (Cliff Notes version), and as you could expect, every specialty society and interested party dug in and critiqued.  The rule runs a thousand pages and will have a substantial effect on the future of provider payment. In case, you have not heard. Each organization will cut their sections of interest out, parse them, synthesize their analysis, and return a long letter to CMS. They will offer the correct paths on which the agency should proceed--lest they go forward uninformed taking down entire blocks of the healthcare system on account of willful neglect and ignorance.  The letters will start with a friendly salutation along the lines of, "We commend the Secretary on her wisdom and hard work....BUT, we have an eensy weensy problem on some issues," and so the turn goes. The inpatient docs will hit the rough patches as they relate to…

Super-Utilizers: Will they be buying or renting beds?

Costs in health care tend to concentrate in the domains of the few (think 80/20 rule).  As it goes for chronically ill community dwellers, the same applies to frequent flyers in the ER.  You may have heard of the term super-utilizers. Those individuals present week after week with innumerable complaints, sometimes pedestrian, sometimes critical--always finding themselves back on the ward for weeks at a time.  As expected, they have weak community support and comorbidities in need of TLC, often requiring services not available in their neighborhoods (mental health and substance abuse counseling come to mind). The local house of worship, community center, or corner bar have limits, and they only offer so much spiritual renewal or sustenance.  We all struggle to find a balance for these folks.  We see them a lot.  And thus, the ER becomes their second home. (more…)

If Your Hospital was The Ritz-Carlton, How High Would Your Patients Rate You?

  I am a skeptic of the physician evaluation component of HCAHPS.  I suspect patients respond to hospital amenities, and better food, bigger TVs, and swankier lobbies have a halo effect—affecting how they assess not just the structural aspects of their care, but how they perceive their caregivers. You probably share my bias.  On an individual level, we can explain stellar assessments easily, because we all have a natural inclination to attribute good report cards to whatever brilliant skills we bring to the bedside.  However, if we receive an appraisal mom would not want to pin to the refrigerator door, we activate our deflector shields and point towards the patient's leaky sink, broken bed, and roommate with the earsplitting screams. When our crosstown rivals reinforce those impressions by citing say,  increased foot traffic post an upgrade ("build it and they will come"), we might be lulled into thinking designer labels…
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