The intersection of quality and finance

In the first part of our conversation with Money Atwal, who is both CFO and CIO at Hilo Medical Center in Hilo, Hawaii, he told us about how he and his team were digging into hospital operations. In the second half of that conversation, he talks about the intersection of quality, finance and technology.

[See also: Hawaiian CFO digs deep to mine revenue.]

Q. How are quality and finance correlated?

Atwal: Quality drives our reimbursement. For example, take length of stay. If you have a severe case of pneumonia, the benchmark from the Centers for Medicare & Medicaid Services is about 3.1 days. We’re finding in our experience that it is four days. We now have the analytics to dive into the data by patient, by provider and look for a specific reason for the difference in length of stay. Is there an outlier that’s causing the longer length of stay? Is it across the board? What is the cost of them pulled in from the cost accounting system? Are the problem areas in a specific unit, a floor? Did they come in from the ER? Both clinicians and our financial folks are using the analytics.

Q. How does physician documentation fit in with that scenario?

Atwal: For example, are we at four days because we haven’t gotten the physician to document appropriately enough, and is it just coded at that level? What we have to do now is review and analyze that data. In some cases, it may be the time the physician put in a discharge order. Maybe this provider always puts it in at 5 p.m. instead of 2 p.m. Then it becomes an easy conversation – ‘We notice you are discharging your patients at 5 p.m. That requires us to keep them an extra day and discharge them in the morning.’ 

The system we have has all the quality, financial and cost data along with the associated medical record system. We have a data repository with analytic folks in the backend that help extract that data and see the benchmarks. We’re giving the data more to physicians as a discussion point. If we’re going to ask a physician to change, they are going to want to see the data and the reason to change. 

Q. How are physicians and employees handling these system changes?

Atwal: Our employees have invested much time and money. Our employed physicians and community physicians – we’ve disrupted their workflow from what they originally had. These technology projects are challenging. There is a lot of compromising and give and take, and our doctors have been a tremendous partner in this give and take. Early on, it did take more time to order medications; it did take more time to document; it did take more time to review results. It took education, working with them and asking them what they liked and didn’t and involving them. Partnering with a technology company with the right expertise for your hospital is very important.