Speaking CFOBringing the Transfer Center Under the Care Management Umbrella

Judy Raimo, Director, Care Management and Patient Service Logistics

Molly Rank, Management Engineer, Performance Improvement

This presentation reflects the views of the presenters and not necessarily those of PeaceHealth.

Honored to be with you today!

43 years in healthcare, 38 within the

same system! 5 years in healthcare, after 14 years

at UL LLC, loving every moment

helping patients!

PeaceHealth Southwest Medical Center

PeaceHealth Mission

We carry on the healing mission of Jesus Christ by promoting

personal and community health, relieving pain and suffering, and

treating each person in a loving and caring way.

PeaceHealth – Rich History and Heritage

▪ Founded by two sisters from the fledgling order of the Sisters of St. Joseph of Peace in August 1890

– They left their New Jersey home on the Atlantic to travel to Washington state, arriving in Fairhaven, now knownas Bellingham

▪ They sold “Annual Hospital Tickets” for $10 each

▪ Possibly the first HMO in the United States to provide healthcare to this new lumber and fishing village

Now a Three-State System

Our Hospital – Southwest Washington

Learning Objectives

At the end of this presentation, you will be able to:

▪ Engage leaders and stakeholders (C-suites & referring

facilities, etc.) to more deeply understand the benefits of a

Transfer Center well-integrated with Care Management

▪ Describe the connection between patient flow, care

coordination and financial outcomes

▪ Identify risk points and implement mitigation strategies before

issues become barriers

To create a model that optimizes patient flow, organizational

structure, culture and language matter …

The question becomes, “How do we get to a culture of yes?”

Why does alignment matter?

▪ Because we need the white space … we need capacity for

movement to enable flow

“Tell me more …” A Humble Inquiry approach

▪ “Humble inquiry is the fine art of drawing someone out,

of asking questions to which you do not already know

the answer, of building a relationship based on curiosity

and interest in the other person.”

– Edgar H. Schein, Humble Inquiry

Examples of the Questions We Have Been Asked

▪ What is the case mix index (CMI) for the transfers we’re

receiving from Centralia, Ocean Beach, Morton?

▪ How does the LOS for patients who transfer compared to

those admitted through Direct Clinic Admissions, ED or Peri-

Op?

▪ How many patients have transferred from other facilities who

went directly to the ICU?

▪ Why did the admission status change after the patient went to

the Operating Room?

PeaceHealth Strategic Values & Priorities

▪ Clinical Safety Initiatives

▪ 5 Rights of patient placement

▪ Discharge milestones

▪ Length of Stay (LOS)

▪ Salaries and wages

▪ EBITDA

▪ Readmission reduction

▪ Integrated Behavioral Health

▪ Community Collaboratives

▪ Private rooms – Patient Engagement Scores

▪ Daily Management System / Unit LOS Goals

▪ Engaging the front line via Kaizens / Lean

“Vector of Metrics” (an IHI concept)

▪ LOS, days and hours– Facility, Unit, Provider, Disposition

▪ Time of discharge

▪ ED2IP (Emergency Department (ED) to Inpatient) times

▪ CMI (Case Mix Index)

▪ Readmissions

▪ LWBS (ED Left Without Being Seen)

▪ Market Share and Payor Mix

▪ Avoidable days, avoidable write-offs (Revenue Cycle)

Are you prepared to answer these questions?

Question?Why is this question

important?

How would you answer?

Where would you get the data?

How many of our transfers from

outside facilities are going

directly to ICU?

• Epic Reporting Workbench

• Central Logic Forefront

• How many total calls / month?

• How many total calls / week?

• How many total calls / day?

• How many total calls / hour of

the day?

• Which hours are heaviest?

• Access Center Manager

• Variance tracking, beyond

what we can capture

electronically

• Central Logic Advanced

Reporting

How much are we reimbursed for

the care provided to the patients

transferred from other facilities?

• Director Patient Financial

Services and Revenue Cycle

• Epic / Financial Reports

Poor patient outcome because

ED stabilization did not occur –

how often does this happen?

We’re taking a new type of call,

“Clinic to ED Concierge.”

How many of these calls can

we handle before caregiver

engagement suffers and we

start to lose patients?

Accepting patients from other

facilities is a financial growth

initiative with a profit margin.

Some of the Tools Supporting the “How”

Central Logic Advanced Reporting ™

Central Logic Advanced Reporting

Central Logic Advanced Reporting

Central Logic Advanced Reporting

Epic – Grand Central Discharge Milestones

Pulsara – Stroke & STEMI early notification

Qventus

Data Presentation in Addition to Epic

▪ Tableau – LOS Process Improvement Data Analysis

LOS: Unit-Specific Performance at Unit Level

Some stories …

Our anecdotes, supporting the need for metrics and measures that can be

operationalized – and personalized to meet our daily needs

Can we move to all private rooms?

▪ Patient satisfaction scores indicated our “quiet at night”

strategies weren’t enough to achieve our goal

▪ Moved to private rooms with

courage

▪ Surprised to discover

unexpected capacity

ED2IP: Visualizing the Facts – Pulling Together

▪ Clarity of expectations between ED

and Inpatient

– How long should it take?

• How long does it really take?

– What does our patient expect?

• What would you expect for your mother?

ED provider enters Bed Request

• This is when patient is dispositioned for admit

• ED RN enters .BEDNEEDS note

Admitting provider enters Order to Admit

Bed Management assigns bed

• Assignment considers .BEDNEEDS

Inpatient RN reviews chart, adds note with .READY

• Inpatient nursing calls ED to ask questions and say “ready for patient!”

Patient is transported to unit

• Inpatient nursing welcomes patient to unit

• Patient is pulled into bed in CareConnect, completing the Bed Request

ED2IP: Meaningful Measures

▪ Not just overall average – but how many times have we beat

our expectations?

ED2IP: Celebrating Collaboration

▪ Build employee excitement, recognition of their efforts!

▪ Achieve spread throughout community

– Training video, using our key workshop participants as patients

and caregivers

The Access Center Team at PHSW

Thank you!

For additional information, please contact Molly Rank

or Priscilla Glovatsky at PeaceHealth Southwest Medical Center

This presentation reflects the views of the presenters and not necessarily those of PeaceHealth.