Application of Analytics to DNFB Improvement Effort Continues to Deliver Impressive Results

Financial challenges rank as the number one issue hospitals face, and hospital CEOs are always looking for opportunities to boost revenue through improved reimbursement. Managing discharged not final billed (DNFB) cases, where bills remain incomplete due to coding or documentation gaps, is one important way hospitals can improve financial performance. However, without analytics to support efforts, meeting a target for DNFB improvement remains a serious challenge.
Thibodaux Regional Medical Center, a 180-bed community hospital in Louisiana, invested in analytics and resources to improve their DNFB rates. By expanding the use of analytics to every aspect of the work, the hospital transformed financial improvement efforts with impressive results.
While some organizations struggle to sustain hard-won financial improvements, two years after Thibodaux Regional launched its initial DNFB improvement effort, it has sustained the initial outcomes, and further reduced AR days by 27.5 percent, while achieving these additional improvements:

$1 million in additional annual reimbursement, attributable to improvements in the accuracy of clinical documentation and CMI.
66.7 percent relative reduction in DNFB dollars, significantly improving cash flow.

Using Data to Spotlight Variation and Transform Total Joint Care

Total Hip (THA) and Total Knee (TKA) Arthroplasty are the most prevalent surgeries for Medicare patients, numbering over 400,000 cases in 2014, costing more than seven billion dollars annually for the hospitalization alone. Today, more than seven million Americans have hip or knee implants, and the number is rising. Furthermore, substantial variation in the cost per case has raised questions about the quality of care. At Thibodaux Regional Medical Center, total joint replacement for hips and knees emerged as one of the top two cost-driving clinical areas with variation in care processes.
To address this, Thibodaux Regional maintained its focus on the IHI Triple Aim while developing organizational and clinical strategies to transform the care of patients undergoing THA and TKA. It commissioned a Care Transformation Orthopedic Team that set multiple outcome goals. Among its many efforts, the team established standard care processes, created an educational program, redesigned order sets and workflows, and deployed a joint replacement analytics application.
Thibodaux Regional reduced variability and decreased costs significantly while maintaining high levels of patient satisfaction:

76.5 percent relative reduction in complication rate for total hip and total knee replacement.
38.5 percent relative reduction in LOS for patients with total hip replacements.
23.3 percent relative reduction in LOS for patients with total knee replacement.
$815,103 cost savings, achieved in less than two years.

Labor and Delivery Transformations Lower Costs and Improve Care

One in three women delivers via cesarean in the U.S., and more than 90 percent of them have repeat operations in subsequent deliveries. Despite numerous evidence-based guidelines and established best practices for labor and delivery, clinical care varies widely for many practices. Labor and delivery care varied at Thibodaux Regional Medical Center, causing the organization to look for ways to standardize care.
To better understand variations in care, and opportunities to reduce its cost, the labor and delivery care transformation team at Thibodaux Regional used the Health Catalyst Labor and Delivery Advanced Application as well as the Financial Management Explorer application, which integrates data from billing and costing, and creates snapshots of current financial metrics.
Informing and educating providers with provider-specific data in conjunction with redesigned workflow, standardized supplies, and new, standardized protocols enabled the labor and delivery care transformation team at Thibodaux Regional to experience cost savings and improved outcomes, including:

24.4 percent relative reduction in the cost of care for uncomplicated vaginal delivery. Projected annual cost savings of $266,067.
22 percent relative reduction in the cost of care for cesarean deliveries. Projected annual cost savings of $346,856.

How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience.
Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.
Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.
Thibodaux’s efforts are driving measurable improvements in the hospital’s inpatient admission process, including:

55 percent reduction in average inpatient admission time
Ranked 99th percentile for patient experience

How One Hospital Took the Pain Out of Getting Paid

A hospital’s core mission is to provide the best care possible. To continue to do so, however, hospitals must be paid promptly. Discharged not final billed (DNFB) cases—where bills remain incomplete due to coding or documentation gaps—represent an ongoing challenge for hospitals around the country.
Thibodaux Regional Medical Center, like other hospitals, faces a myriad of new government regulations that have made hospital bill collection efforts more onerous. Its leaders recognized their inadequate manual DNFB process left hospital staff overburdened and put at risk the necessary cash flow to best serve patients.
The hospital automated and streamlined this process to relieve the burden on physicians, provide an integrated view of data, optimize visibility and workflow, and reduce the need to “downcode” reimbursements due to missing documentation. The hospital leveraged analytics to provide actionable feedback to continuously improve the process.
Thibodaux has already achieved significant improvements to cash flow and operational efficiency:

44.4 percent improvement in delinquency rate
8.2 days reduction in A/R days
70.5 percent decrease in the number of billhold accounts outstanding
50 percent decrease in physician portion of DNFB dollars
97 percent improvement in operational efficiency

The Improvement Methodology From Thibodaux That TJC Calls “Best Practice”

Thibodaux Regional Medical Center has always excelled in delivering quality care to its patients, but a fundamental tenet of its culture is continuous improvement.
Driving that continuous improvement is a methodology The Joint Commission called “best practice in how to use data and get physicians engaged.” This quality improvement methodology centers around a three-systems care transformation model that includes best-practice care protocols, analytics, and rapid time-to-value analytics application development and frontline clinician adoption.

Keys to Successful Quality Improvement: A CEO’s Perspective

We believe healthcare is undergoing a transformation and that CEOs need to promote a culture of dialogue and adaptive learning to drive continuous quality improvement. Thirty years ago Greg Stock, CEO of Thibodaux Regional Medical Center, was seated in a healthcare conference when he heard a presenter say, “Thirty percent of clinical care is waste.” These words triggered something in Stock that sent him down a relentless path to transforming healthcare in his community.
Learn how Stock is leading and sustaining outcomes by establishing a culture of quality with an adaptive leadership style, engaging physicians, and using analytics, best practices and adoption processes that work.

Saving Lives with Best Practices and Improvements in Sepsis Care

Every year, severe sepsis impacts more than 1 million Americans, and an estimated 25 percent die from the condition. Thibodaux Regional Medical Center is committed to driving and keeping its sepsis mortality rate to less than have the national average. How is this health system achieving these outcomes? Thibodaux formed a sepsis improvement team charged with reducing sepsis mortality and lowering costs while improving the patient experience. The team implemented best-practice care protocols, an analytics system, and an adoption approach that engaged clinicians using education and data. Backed by executive leadership and guided by clear goals, the sepsis improvement initiative has achieved impressive results in just six months that include a decrease in sepsis mortality rate to half of the national average, a 3 percent reduction in average variable cost, a reduction in LOS in the ICU by one day, and a 7 percent improvement in patient satisfaction.