Blog, The Hospital Finance Podcast®

Part 2-Clinical Variation Reduction Program Process Webinar [PODCAST]

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In this episode, Laurie Jaccard, Founder, President & CEO of Clinical Intelligence & Steven Berger Senior Advisor at Clinical Intelligence, provide a sneak peek into upcoming webinar Clinical Variation Reduction Program Process, presented live on Wednesday, February 5, at 1 PM ET. 

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Highlights of this episode include:

  • The tools/technologies that are used to monitor and assess the effectiveness of CVR initiatives
  • Why is it important to have confidence in your costs to study clinical variation
  • The steps that are involved in the initial data analysis for CVR
  • How to identify and prioritize clinical variations to address
  •  Best practices that should be standardized across conditions and sites
  • How hospitals can balance standardization with the need for individualized patient care
  • How to measure the success of CVR initiatives in terms of patient outcomes and cost savings

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Laurie Jaccard and Steven Berger.

Laurie Jaccard is the founder, president, and CEO of Clinical Intelligence, a healthcare consulting firm she established in 2001. With a career that began as a registered nurse, Laurie brings 25 years of experience in clinical operations and care management consulting. Her extensive background in healthcare led her to recognize the need for effective data utilization in hospitals and physician practices, inspiring her to develop ClinView, an interactive analytics platform that integrates data from various sources into a single comprehensive view.

Steven Berger is a senior advisor for Clinical Intelligence and has 50 years of healthcare financial management and leadership experience. During his first 25 years in the hospital and healthcare industry, he was a hospital financial executive across four hospitals and health systems. Steven has written several articles for leading healthcare magazines in addition to four peer-reviewed books, including Fundamentals of Healthcare Financial Management. In 2000, he founded Healthcare Insights and created the Insights Budgeting, Monitoring, and Reporting Software System, which won several best-in-class awards. For the last several years, Steven has been a senior advisor to Clinical Intelligence, among other pursuits.

In this episode, we’re providing a sneak peek into an upcoming webinar, the second in a three-part series by our partner, Clinical Intelligence, Clinical Variation Reduction Program Process that we’re presenting live on Wednesday, February 5th at 1 PM, Eastern Time. Welcome and thank you for joining us again, Laurie and Steve.

Steven Berger: Thank you so much, Kelly. We are delighted. Laurie and I are delighted to be with you today. Let me give you a little introduction, or the listeners a little introduction on what we’re about to talk about through this clinical variation reduction process. We really wanted the audience to know that implementing a standardized process for care standardization is vital for minimizing unwanted variations in clinical practices on a large scale. Very important. So clinical variation reduction, or CVR, is a vital strategy for achieving significant cost savings in healthcare, providing a rare opportunity to save millions of dollars while maintaining high-quality care. Obviously, that’s the golden goose that we want to achieve. To fully realize its potential, healthcare organizations should not tackle CVR alone in isolation. Instead, they need to adopt a coordinated system-wide approach, ensuring a consistent and standardized process that applies across all conditions and locations, because every one of those is unique. Establishing an effective structure and process are vital to realizing sustainable outcomes. And as you all know, we have three-part series here. The first part, which was a podcast and also a webinar was on structure. This second part is on process. And the third part, part three, next month, will be on outcomes.

Kelly: Thank you for that introduction, Steven. Well, let’s go ahead and jump in today. So, what tools or technologies are used to monitor and assess the effectiveness of CVR initiatives? Steve, I think this one’s over to you.

Steven: Yeah, I’ll take it. Well, healthcare is a high touch and a high-tech industry, amazingly. So much operations are developed through the people and the technology. So, the tools and technology used for CVR include electronic health records or electronic medical records, EHR, EMR, clinical decision support systems, which many of you hospitals will have through a variety of areas, data analytic platforms, and performance dashboards for monitoring outcomes. We will certainly be talking about the performance dashboards a bit in our second webinar and certainly a lot more in our third webinar on outcomes. These tools help track the adherence to standardized practices and measure outcomes.

Kelly: Thank you very much for providing that for us, Steve. And Steve, this one’s for you too. So why is it important to have confidence in your costs to study clinical variation?

Steven: Well, clinical variation, of course, what we’re looking to do is reduce any negative issues on the clinical side and also where possible reduce costs. It’s a win-win if we can do this in a very well-structured environment. So, we need to know our cost. We will also need to understand our clinical outcomes. So having confidence in our cost accounting is crucial to studying this CVR because it ensures a more reasonable measurement of discrete costs, not the solid big costs in your general ledger, but how we understand our costs down at the charge-based level so that we can roll them back up into meaningful categories. It helps to identify the key expense drivers and enables informed decision-making. That’s really important. By allowing for effective benchmarking against industry standards, it aids in efficient resource allocation, and it forces transparency and accountability within the organization. Really important. How do you know where you’re going if you don’t know where you’ve been? How do you know why you want to go where you want to go if you don’t have benchmarks to rely upon to decide what your goal should be? So that’s why it’s important to understand our costs at this discrete level. The foundation is essential for prioritizing interventions that yield significant cost savings and quality improvements in patient care.

Kelly: Those are great questions to ask, Steve. That made a lot of sense to me. Laurie, we’re going to be over to you now. What steps are involved in the initial data analysis for CVR?

Laurie Jaccard: The key objective of the initial data analysis for clinical variation is to collect, model, and review clinical and financial data. This process aims to identify practice patterns and variations in care practices, helping to pinpoint areas where improvements can be made to enhance patient outcomes and operational efficiency. There are several initial steps in the initial data analysis process to study clinical variation. First, we start by collecting and reviewing the patient level and charge level data. This can be obtained from the finance department, working very closely with finance and quality. Bringing these disparate data sets together, we can organize the data into a business intelligence platform to visualize the data, to drill, to thin slice into the data. And this allows us to correlate various patient outcomes data, direct costs, payment data, and other resource utilization that needs to be analyzed. So ultimately, the goal is to identify practice pattern variations that are unwarranted, not driven by the unique attributes of different patients. Every patient has individual needs, individual comorbidities, and complexities. But we’re trying to identify unwarranted variation in care. And so, by analyzing these data, we can pinpoint where the variations occur. And during our part two webinar on February 5th, Steve and I will be sharing many examples of various metrics and analytical processes to improve care management and utilization, and so for your takeaway and use within your own facilities.

Kelly: That should be really helpful. Thank you, Laurie. Steve, so how do you identify and prioritize clinical variations to address?

Steven: Well, of course, that’s a really good question. How do we know what we want to do? Where do we want to go? How do we decide where we want to go? So clinical variations can be identified through data analysis, benchmarking, which I mentioned earlier, against best practices, and feedback from physicians, clinicians, nurses, and all of your ancillary support staff, radiology, cardiology, laboratory, all of those should have input into this. But ultimately, prioritization is based on factors such as goals established by the organization’s leadership to determine the impact on patient outcomes, cost implications, and the feasibility of standardizing the practices. So, this is a top-down approach generally. We need the leadership buy-in. Without it, clinical variation reduction processes will fail. We need the leadership to support the initiative as well as be used to break down any roadblocks that might be out there. And leadership is a number of categories, CEOs, COOs, if you have a chief operating officer, CFOs, chief medical officer, CMO, chief nursing officer, CNO. You have the CIO, the chief information officer, along with a number of other leaders, top leaders, first level, second level, third level that will help to set the goals using benchmarking and the organization’s understanding of its own people.

Kelly: Wow, that sounds pretty impressive. Thank you for sharing that. Let’s talk best practices now. So, what best practices should be standardized across conditions and sites? And Laurie, I think this one’s yours.

Laurie: Thanks, Kelly. The key objective here is ensuring uniformity in care delivery. To achieve this uniformity in care delivery, providers and multiple disciplines, i.e., nursing, dietary, pharmacists, therapies, case managers, and the like are standardizing best practices within their enterprise, within their hospitals, within their episodes of care across all sites, ideally. This may be the use of evidence-based treatment protocols, such as for asthma management, sepsis care, myocardial infarction, heart failure, total joint replacements. The list goes on and on. These clinical guidelines may include admission order sets, physician order sets to help really drive quality of care in a standardized approach. Ensuring that this care is tailored to the individual needs of patients is really important. This may include structured patient pathways or staff and patient education. All of this said, the evidence that is published in the literature from reputable sources really direct and guide the development of these tools that are deployed in the organization. And many times these tools are embedded in the computerized physician order entry system. Again, these best practices are tailored to specific conditions and applied consistently across all sites to ensure that patients receive the high quality care regardless of where they’re treated.

So ultimately, the key objective is to ensure uniformity in care delivery. This is so powerful. It takes over seven years to translate evidence into practice. But if teams can build these evidence-based order sets and protocols, guidelines, then we can ensure standardized care is being delivered and we should move the needle on improving the decrease in variation and improving the quality of care.

Kelly: I just love when people share best practices with us. Thanks, Laurie. And Laurie, how can hospitals balance standardization with the need for individualized patient care?

Laurie: That’s another great question, Kelly. Standardizing workflow in healthcare can certainly lead to improved patient outcomes and operational efficiency, as I mentioned. However, it really ensures and requires careful planning and management to overcome challenges. Some challenges that we need to be aware of in trying to implement best practice standardized care and standardized workflow. Some challenges may impede implementation, including the resistance to change, to ensure that we have a change model and acceleration model. This oftentimes we can see cultural barriers. They may include training needs or requirements that can hinder adoption of these best practice protocols. If your organization is complex and fragmented and you have fragmented data systems, this really could cause some real barriers to be able to study the data and make standardization very difficult without data. It’s hard to improve what we don’t measure. We also might have some financial limitations, staffing issues. And the takeaway here is that the protocols, again, must be adaptable to the individual patient needs and evolving evidence. So many times the organizations get excited to build a protocol, an order set, a patient pathway, or education, but then fail to review that information on a routine basis. And so therefore, there would be outdated information and evidence.

So, balancing all this standardization with individualized care, it really involves that protocols as a foundation, but it also involves that really important, valuable data used to identify the variation and measure the improvement. And so this approach will ensure consistency without compromising personal care.

Kelly: Sure, yeah, that makes a lot of sense, Laurie. Steve, how do you measure the success of CVR initiatives in terms of patient outcomes and cost savings?

Steven: Sure. Well, as Laurie just said, the organization is building a number of their own protocols and they need to because otherwise without formal protocols, how can you have some standardization? We need standardization despite the fact that every patient is an individual. That goes without saying. But we can measure success by tracking key performance indicators such as patient outcomes, mortality rates, readmission rates, all of which already exist in the organization, by the way, because Medicare has been demanding it for almost 25 years. So, it’s out there, as well as cost savings, which could include reduced lengths of stay, lower resource utilization, and also adherence to standardized protocols. Having said that, that is why, as I said earlier, understanding costs at a discrete level is so important, which I’ll call cost accounting. And there’s many different shades of cost accounting. They all work in their own way. It’s all good. If you have something that’s uniform and standard through cost accounting, then everything will make sense in any case. But we need that kind of thing. And we will need something like the finance division to be the scorekeeper on these cost savings around these protocols that have been developed. And now we want to see them achieved, again, with costs attached.

So again, finance division as scorekeeper. Everybody has to agree to what the results will look like. And of course, the results are a factor of how the process moves through. So, we want to start with what was our goal? Let’s call it cost, or we can call it patient outcomes, but let’s just stick with costs for a minute. What did we expect to achieve and what did we achieve? And again, finance would do that kind of thing.

Kelly: Wonderful. Thank you so much, Steve. Thank you both for joining us, Steve and Laurie, and for sharing this great sneak peek into the second in a series of three live webinars that you’re providing as part of BESLER’s The Hospital Finance Academy. This one coming up, part two, Clinical Variation Reduction Program Process Webinar that you’re presenting live on Wednesday, February 5th at 1 PM, Eastern Time. And as a bonus, you can earn CPE. Thank you so much.

Laurie: Thanks, Kelly.

Steven: Thank you.

Kelly: And if you’re interested in learning more about clinical variation reduction, check out part one of their series, Clinical Variation Reduction Program Structure, available now on demand on our website, and the upcoming part 3, Clinical Variation Reduction Program Outcomes, coming live on March 12, 2025.. You don’t want to miss this series, watch or register for these sessions on our website now. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

 

If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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