System’s standardization helps contain costs
Project integrates 20 outpatient clinics
When Janet Brooks, RPT, was hired three years ago as outpatient coordinator at Health Midwest, an 11-hospital system in Kansas City, MO, she faced the challenge of standardizing services at more than 20 outpatient clinic locations. One goal was to contain costs for the system while improving the product line to offer better and consistent services at a variety of locations.
"I didn’t come in as an administrator and just look at costs. We recognized that if we could integrate the system, it would affect costs in the long run," Brooks says. (For details on how the system saves $500,000 a year on salaries by hiring paraprofessionals, see story, p. 12.)
One of Brooks’ first jobs was standardizing services among the sites in the system, each of which had its own way of doing things. Staff created standardized documentation tools, such as evaluation forms and progress notes, but they went well beyond the usual standardization and came up with standardized clinical procedures and a staff training program. Every therapist in the system now measures range of motion the same way, for example. "We got into minute detail on the standardization. We felt it was important that we were truly consistent across the system. There wasn’t necessarily any right way of doing things; we just all had to agree to do things the Health Midwest way," Brooks says.
Standardizing the treatment and documentation process has made it easier to get staff to fill vacancies in other facilities, she says. "It’s not so threatening or difficult for them to go from one facility to another because they feel like they are still at home."
By meeting bimonthly, the directors at all the outpatient centers know each other and feel comfortable calling each other for help in filling a temporary vacancy or to offer staff to other centers when the caseload drops, Brooks says.
A consolidated educational program, which brings speakers to Kansas City instead of sending staff to conferences, has saved money and given a boost to efforts to standardize treatment, she says. With more than 100 professional and paraprofessional staff on the outpatient side alone, it made more sense for the health system to hold its own seminars rather than sending a few staff out of town for courses. The education program is coordinated by one of the clinic directors.
Education focuses on outcomes
"We tried to offer classes we felt we needed the most in terms of our business and improving clinical outcomes," Brooks says. For instance, almost all outpatient orthopedic physical therapists have attended 100 hours of training in Maitland manual therapy. The occupational therapists have attended specialty classes for treating lymphedema. Members of the physical therapy staff developed and taught a course on lumbar exercises to the physical therapy assistants and certified athletic trainers on the staff.
"The education program has helped bring staff together from all our facilities. It’s helped bond a group of people who didn’t know each other three years ago," Brooks says.
Having staff get together from throughout the system has helped them learn what resources are available at the different locations and helped move patients through the system effectively, she says. Only two clinics offer work hardening, for instance, but in the past, therapists from other facilities didn’t regularly refer patients to the work hardening program.
"Now they see all the facilities are part of their program, and they are very at ease with making referrals," Brooks says.
She expects ties among staff at all facilities to become more important as the system moves toward eliminating duplication.
Cutting back on inventory
The system also has saved money by standardizing supplies ordered and cutting down on stocking supplies that patients can get from other sources. "We came to the consensus that we could not be a supply house for rehab equipment. We couldn’t stock all options for all of our patients. There are people out in the community who already do that," Brooks says.
Among the items Health MidWest no longer stocks are knee braces, ankle braces, neck rolls, special pillows for the bed, and special support pillows for the car.
Some insurance providers won’t automatically approve payment for these items, Brooks adds. "Reimbursement gets tricky, depending on the insurer, and it got to the point that we were essentially giving out some of the equipment for free."
The staff at each facility assembled a list of what supplies they felt should be stocked. The administration went through the lists, none of which were the same, and determined which items the facilities had to stock and which ones patients could get in the community. The facilities still stock some commonly used items, such as crutches.
The staff also made a list of supply houses and vendors where patients could get the items they need in the community. Because patients often must pay for these items out of their own pockets, it’s usually cheaper for them to get them directly from the supplier, Brooks says. [Editor’s note: Janet Brooks may be reached at (816) 276-7227.]
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