I couldn't leave the previous post on return on investment as a stand alone. I'd like to connect the dots to enhance your thinking around this topic.
If you invest in measuring and managing quality, what changes? Is there a return on your investment? I believe if you truly embrace providing quality, and hit quality targets related to effectiveness and efficiency, there are changes that affect your clinicians, your patients/clients and your business. There are mixed changes: both positive and negative. To be successful, I advise that you take time to understand the changes so you can be ready for them and have a strategy to address what I believe could be a negative change if you aren't prepared for it.
I took the same image that was in the previous post and enhanced it to provide details as to what may change (for good or for bad).
If you'd like a PDF of the image, you may download it here.
Most focus on the financial impact when discussing return on investment. Let's focus on a positive scenario. Your clinicians and staff full-heartedly embrace measuring and managing quality. Let's face it, with almost anything new you implement, there will be a cost: definitely a training cost and nowadays a subscription level of a cost. We live in a subscription based world. If you are designing something in-house, you may have consultant, legal, engineering, and/or technology fees, you may need new equipment or hardware, you'll have an investment in time and effort drawing and designing whatever it is you want, you'll have multiple meetings with the design team, you'll have multiple trials and errors, and you'll have time invested in creating reports. If what is designed does not have an auto feature, you'll continue to have time invested in creating reports at the frequency you desire. So either way, when implementing a quality focus into practice, you will incur cost.
Let's move forward in the scenario. Everyone has been trained and you are embarking on a measuring and managing quality journey. What changes? At some point, you'll set a quality standard to meet. Hopefully, this entails providing the most effective and efficient care. How will this affect your practice?
Since your practice revolves around patients/clients, let's take a look at the effect the change will have on them. They will need to do a bit more work with regard to responding to patient reported outcome assessments. If you accomplish your quality goals, your patients/clients end their episode of care sooner. They also end their episode with a higher level of function. This is great for them, isn't it? Depending on how you manage quality and the level of reports that are used during an episode of care, there is also a potential for your patients/clients to be more engaged in their care. And maybe, just maybe, you'll gain increased positive word of mouth in your community about your clinicians and services.
Now let's take a look at the effect it may have on your practice. Again, I'll focus on the scenario where measuring and managing quality is whole heartedly accepted and implemented. You are now creating a culture of quality. During the implementation period and in the early stages, you may lose employees. Once the culture of quality is established, any new employee will automatically be on board because quality expectations will be communicated prior to hiring. This may increase employee retention and reduce costs associated with recruiting team members. Meetings may change from a total productivity perspective of units/visit to the level of quality achieved and how to achieve consistent high quality. There will be additional time spent assuring completed data is acquired for every episode of care. Communication with other medical providers outside your business/department may change to where the focus of care is the level of effectiveness and efficiency of services provided, especially in written reports. This will reduce vague reports of how the patient is changing with services. You will be able to very easily know if the quality of your services are conforming to your quality expectations. Performance evaluations change to where, with the right system, objective data on the quality of services is front and center in the discussion. You will eliminate wasted spending on unnecessary continuing education dollars and can target continuing education on non-conforming quality levels. If patients are engaged enough in their care, you may see a reduction in your cancel/no show rate. At the same time, you may see that patients complete their anticipated visits for their episode of care. This obviously results in increased revenue.
The resource area is where there are some odd twists. Right now, in a fee for service payment model, the more efficient you are, financial loss occurs because of a reduction in the visits/episode component. Your new issue: the need for a higher volume of referrals to offset the faster turn around time due to shorter episodes of care. If you are doing well in this area, you should see a trend where you begin having substantially more initial evaluations occurring in a calendar year. Since you need this to occur to maintain financial viability, what can you do? This is where incentive payments come into the picture. Can you negotiate a new payment model with a key payer? This is also where you begin evaluating the various networks available to you. Can you convince them, with your data on your outcomes, to be the first choice for their patients/clients? You also need to give your patients/clients ways to help them with their word of mouth evangelization of your clinicians/practice. Your marketing efforts have a different twist to them to help individuals in your community to choose you. "Individuals" mean: physicians, citizens in your community, payers, other businesses in your community - actually anyone who meets the description of your "best" customer.
As you can see, there can be a financial return in investment, especially if you are aware of how measuring and managing outcomes affects your practice. To really achieve the financial aspect, you need to consistently build relationships and be focused on increasing the number of new evaluations/year to offset the reduction in visits/episode of care.
Can you think of anything I have missed?
Judy Holder always enjoys speaking to anyone interested in measuring and managing outcomes.
Until next time,