Cost & quality quarterly journal : CQ最新文献

The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the annual budget of +10.3 million; Recruited 10 new podiatrists and increased the volume of cases brought to Northwest Region facilities by surgical specialists. This added 100 cases in 1996, and is projected to add 500 cases in 1997. A 14.5 percent reduction in the cost of operating the Surgical Services was achieved. This was accompanied by enhanced staff morale, physician satisfaction and a higher quality of patient care.

It is not anticipated that the demand for physician credentialing information will lessen. Organizations will have to become more cost-efficient in the way that the credentialing process is managed. The use of a uniform application and the emergence of CVOs can help streamline the process. Additional methods for implementing cost reductions and avoiding duplication of efforts in the area of physician credentialing will result as competition increases in the managed care arena.

Managed care systems have traditionally found ER management issues difficult to address. Patients view these facilities as points of consistent, easy, and reliable care. Providers see these facilities as necessary off load points from busy practices for problems whose intensity or complexity would overwhelm their office work flow. Emergency Department physicians understand their roles as nondiscriminate passive recipients of all patient flow through their facilities. These same providers also recognize a huge liability potential for both missed diagnosis and for perceived inadequate/unsafe treatment plans such as non-hospitalization when hospitalization was needed.

Managed care and capitation will become increasingly familiar in the Central Valley of California as managed care arrangements capture more of the marketshare. This type of healthcare environment presents a myriad of opportunities for case management to affect quality and cost outcomes within healthcare organizations. Assessment skills (clinical outcomes), client-provider relationship (member satisfaction), and resource coordination (cost containment) are three key elements underlying the role of the case manager, making the role components congruent with the needs of a managed care population. As payers continue to mandate outcomes measurement, case management beyond the walls or outside the inpatient setting is a technique that will increasingly be used to document that the diverse needs of high-risk patients are met.