Improving patient access will be critical to a hospital’s financial performance and patient satisfaction ratings. In our work with hospitals and health systems across the country, we typically see a wait of 30-60 days for patients to see a physician. We recommend the goal should be 3-5 days for a visit, particularly now that numerous options are available for immediate care, such as urgent care centers, retail clinics, and telehealth. In an environment of declining reimbursement, hospitals need to provide better patient access to be competitive and financially successful.

 

The majority of hospitals and health systems employ physician practices, which can be extremely expensive and hurt the bottom line if they are not managed appropriately. There are two primary areas of opportunity to improve physician practice performance. First, it is critical for organizations to deploy the appropriate skill mix within practices to liberate physicians from unnecessary work and allow them to focus on care delivery. This means ensuring that advanced practice providers and other clinicians operate at the top of their licenses, such as using nurse practitioners and physician assistants to deliver more common medical care and having nurses work in areas like infusion therapy and patient triage. Scheduling represents another opportunity and goes hand in hand with patient access. Providers should evaluate current scheduling practices to ensure clear and concise templates, processes, technology and scheduling instructions are in place along with metrics to track progress and promote sustained efficiency.

 

At clients across the country, we see tremendous opportunity in the pharmacy department. The United States spends close to $500 billion on pharmacy costs annually, exceeding over 10% of overall healthcare spending, and these numbers increase every year. Healthcare provider leaders should examine all aspects of their organization’s pharmacy operations to drive peak efficiency and revenues. Providers can optimize pharmacy performance by maximizing 340B programs, improving clinical programs to best in class performance levels, leveraging pharmacy automation, operating a profitable retail pharmacy, and capturing and filling more prescriptions from the owned physician practices and employees.

 

With most health systems now owning physician practices and clinics, a strong outpatient clinical documentation program is critical for both revenue and compliance. Providers should review outpatient coding and documentation processes to ensure the goals of the outpatient CDI program mirror those of the inpatient program: complete, accurate and compliant clinical documentation, coding and billing that 1) accurately reflect patient severity, Risk Adjustment Factor (RAF) scores, the level of service provided and quality of care rendered, and 2) deliver maximum compliant reimbursement. Providers must also account for key differences in the outpatient setting, including significantly higher volumes, shorter timeframes or episodes of care, and multiple code sets, guidelines, claims forms and payment methodologies.

 

Opportunities also abound in inpatient CDI. Hospitals and health systems should assess their CDI programs to make sure they are operating at best practice levels. And if CDI is solely focused on Medicare DRG payers, there is significant opportunity to improve hospital and physician quality profiles by expanding to all DRG payers and, taking it even further, to all payers.

 

Hospitals and health systems have a unique role as both employers and providers of care. Employee health plans that provide resources and incentives for staff to proactively manage their wellness represent opportunities for hospitals to pilot population health initiatives within their organization, improve workforce performance and increase employee satisfaction. Management of chronic diseases like diabetes and asthma and addressing unhealthy behaviors like obesity and smoking can be implemented and yield powerful results. In addition, we recommend hospital health plans direct employees to the organization’s physicians, specialty care providers and pharmacy, which generates additional revenues.

 

While often necessary, change is not easy. The areas above represent opportunities for hospital and health system leaders to seize today to position their organizations for success, boost the bottom line and improve patient experience, regardless of the looming transformation of the healthcare industry.