Not even health care is immune to current economic conditions. Hospitals are reducing staff to control their increasing loses. But is this the best strategy?
Sure it’s a good time to reassess staffing levels but reducing staff costs money and hurts morale—critical to patient satisfaction scores. So what else can be done? Some ideas that can save at least a few FTEs:
1. Make sure Medicare is not unnecessarily penalizing you with transfer DRG payment reductions. For example CABG patients sent home too early and with homecare will not earn full payment. Be mindful of Medicare’s expected lengths of stay.
2.Take steps to ensure proper documentation of critical criteria for DRG assignment and avoid DRG downgrading. For example with PTCA patients, documenting the use of drug eluting stents or the presence of major cardiovascular diagnoses is imperative to the correct DRG assignment. Consider modifying the physician operative note to include reminders or create a new document that will trigger proper documentation.
3. Verify that Medicare’s “3-day rule” is being implemented correctly by your automated billing rules. Services unrelated to the inpatient admission do not apply and may be billed separately, thereby increasing revenue.
4. Reduce infections, complications and fall rates (see Falls article, this issue)
Don’t like these tips? There are plenty of other options. You can find new ways to improve profitability by performing methodical and thorough data analyses. Start by assessing the profits and losses on each of your service lines, drilling down to the DRG, physician and even patient levels while looking for patterns.
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Great post!
ReplyDeleteThere are many hospitals & systems out there that have let things like DRG transfers and the 72 hour rule slip out of their sights. As the payor mix and volumes begin changing its time for everyone to go after the low hanging fruit.
In other words, its the prime time to be helping providers in this area.
What do you think about COB issues, particularly with Medicare and related to the MSP questionnaire? Any cash left one the table there?
Enjoying the site!
Nick Dawson
www.nickdawson.net
Nick, thanks for the comment!
ReplyDeleteI'm sure there is opportunity where there is COB. If nothing else, the process alone lends itself to errors and rework.
In addition, many other payers model themselves after Medicare, so you could be looking at very similar reimbursement opportunities, if not more.
Barbara