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Jennifer Wolfe-Pearce

Health Care

You’re Worth Your Weight in Gold

Now prove it

Published: Tuesday, October 26, 2010 - 05:00

It is no secret that the health care industry is undergoing revolutionary changes. Are you responding by re-evaluating your approach to process improvement? In a world where doing more work with fewer resources is the norm rather than the exception, now is the right time to update your own work processes and ensure your projects provide quantifiable value to your organization.

Health care reform will create significant challenges and unparalleled opportunities for health care quality professionals, but managing limited resources will be necessary for success. Developing synergistic relationships with your peers in finance will ensure that process improvement projects meet not only quality goals but financial objectives as well.

Developing collaborative relationships with finance

Historically the clinical and financial functions have not been well integrated within health care. This is changing rapidly as government initiatives such as pay-for-performance are implemented. The interdependencies between cost and quality will increase under the pressures of health care reform. It is imperative that you have a close working relationship with your finance peers.

Just as quality professionals are not always comfortable analyzing financial statements, finance professionals typically aren’t comfortable evaluating clinical outcomes. This creates an opportunity for sharing and learning from both areas with the outcome of optimal decision making, benefiting the organization as a whole.

There are ways the bottom line can be affected that may not be evident unless finance is consulted. One example is Medicare’s Postacute Transfer policy, better known as transfer diagnosis-related groups (DRGs). Under this rule, patients who fall into one of the 273 affected DRGs and are transferred to another facility or receive home health care within three days are subject to reduced reimbursement if their length of stay is less than Medicare’s Geometric Mean Length of Stay. While quality professionals generally aren’t familiar with the complexities of payment policies, it is imperative that they be factored into PI activities. Adding a financial representative to your team can assist with understanding the financial impact of your planned process improvement activities.

In addition to avoiding pitfalls, engaging a financial peer can help you quantify the bottom-line value of your projects. Process improvement activities inherently make positive contributions to the bottom line and this is important to demonstrate. Your quality department should be seen as a financial asset, not a nonrevenue-producing cost center. The best way to promulgate that information is to attach financial value to your work and share that information, early and often.

The value proposition

When we make purchases in our personal lives, we consider costs and benefits. Choosing process improvement initiatives should follow the same consideration. The value of the project equals the benefits your organization receives minus the costs. When that value is positive, the activity has a return on investment.

Working with finance early in the development of your value proposition has many benefits. By vetting your proposition before you present it to your leadership, you will learn what financial considerations surround your project. You may also find that discussing your proposal with peers from the finance department in advance helps them understand your perspective and may provide you with an ally in the process of securing or maintaining resources.

Now is the right time to rethink how you prioritize your process improvement projects. Get comfortable applying dollar figures to your work and including cost in your project selection process. Taking these important steps now will protect your quality department and your own career. Be sure to share your value so your organization is acutely aware that you are a critical part of not only excellent patient care but also the organization’s financial viability.

This article first appeared in the October issue of the National Association for Healthcare Quality’s NAHQ e-news.


About The Author

Jennifer Wolfe-Pearce

Jennifer Wolfe-Pearce is consultant of quality outcomes at Scottsdale Healthcare, in Scottsdale, Arizona. She is a registered nurse, and has a bachelor’s degree and a
master’s degree in business administration.