Contents Operation Improvement Hospital Audit AR & Registration Distressed Hospital Clinical Laboratory Management Operations & Outreach Decision Support Consolidation Disaffiliation Interim Management Information/Knowledge  Systems Merger Analysis DSS Implementation HMO Audit Customer Surveys	Operations Improvement Hospital Audit & Cost Reduction An Indiana hospital, due to declining census and reduced payments needed to significantly cut annual operating expenses by several million dollars. They did not want to have any reductions in patient services.   A multi-disciplined team was put together to audit all clinical and administrative departments to compare workload, staffing and cost structure against national benchmark standards.  Re-engineering took place in several key achieving targeted cost reductions; service level was maintained or improved upon. Accounts Receivable & Registration A large New Jersey inner city medical center needed to get its AR under control. Patient registration, coordination of clinic scheduling, and charity care needed to be examined.   Patient scheduling & coordination of information flows between registration, physician offices and the finance department were studied.  The hospital's information systems related to scheduling, billing and reporting were also examined.  A number of process flow gaps were identified, responsibilities were redefined & established and enhanced management reporting was introduced.  Days in AR was reduced to under 60 days. Distressed Hospital A Washington DC hospital was in significant financial crisis and needed an operational plan to reduce costs.   A multi-disciplined team was put together to audit all clinical & administrative departments examining volumes, staffing and cost structure against national benchmark standards.  Recommendation were made on consolidation and several key areas were re-engineered resulting the achievement cost reductions. Clinical Laboratory Management Laboratory Operation Improvement & Outreach Marketing A large Pennsylvania healthcare system was concerned about the the efficiency of its recently merged laboratory operations.  The costs appeared to be high, service was questionable and the medical staff was sending increasing volumes of their office testing to the national commercial laboratories.   Both an operational & market analysis was performed showing opportunities for cost reduction, service improvement and a significant outreach market opportunity. Operational & marketing initiatives were recommended and implemented.  Within a 2 year period the laboratory went from producing 3.2 to 5.2 billable tests per paid hour.  Their annual test volume went from 1.9 to 3.0 million billable tests; the test increase was related to outreach expansion. Decision Support An acute care Oregon Hospital had laboratory service deliver problems.  The emergency room staff was demanding that a STAT laboratory be built, equipped & staffed in their area.  Additional laboratory staff were being requested due to excess STAT demands.   Daily data extractions from the Cerner LIS were obtained and integrated into a relational datamart; a report writer was used to analyze this information and share the results with the laboratory & emergency room staff.  An initial analysis showed that the laboratory had poor service turn-around and that hospital STAT test orders were at 40% of total testing; normal should be 20 - 25%.  Targeted turn-around times were established and monitored daily. In less that 2 months the request for the STAT laboratory was withdrawn and STAT test orders were down to 25% and service turn-around improved significantly. Consolidation - Multi-Hospital Several large Boston Teaching hospitals wanted to examine the potential consolidation of their laboratories to better understand the logistics, costs, potential savings and political impact.   All participating hospitals were studied to determine test volumes/mix, cost structure, staffing levels/mix/pay scales, service offerings/level, deployed instrumentation, square footage, best practices and geographic proximity.  A core laboratory concept was recommended with an documented annual savings of $8 million. Disaffiliation Two years into a  merger, the participating hospitals of a New England based healthcare system decided to disaffiliate. A for-profit laboratory company jointly owned by the hospitals posed an interesting challenge.   Developed a strategic & operational plan encompassing personnel migration, equipment/capital asset distribution, facility space planning, client transition coordination, redeployment of courier networks, financial impact analysis and information system redesign & integration. Interim Management A California hospital who's Laboratory Director was on an unexpected medical leave of absence needed immediate assistance with a pending CLIA licensing inspection as well as leadership resolving several operational/service related problems.   Provided onsite interim management assisting the client successfully complete a CLIA licensing inspection. Identified service & operational problems related to testing demands, staff scheduling and production workflow. Implemented strategies to correct these problems. Information/Knowledge Systems Merger Analysis Several mid-western hospitals needed to determine the economic benefits of proceeding with a a full asset merger.  In particular they were interested in determining the impact on service lines provided by each merged entity and the resulting scale economies.   Working with an interdisciplinary team, a relational database was developed incorporating service lines, departments, volumes, staffing, staffing mix and "best practice" benchmarks.  Using the data model, developed on-the-fly scenarios that identified optimal service line consolidations and estimated economy of scale savings.  The merger was successfully completed. Decision Support System Implementation A multi hospital New England healthcare system was implementing a Cognos/Microsoft Office decision support system and need assistance on maximizing user acceptance & usage.   A user needs-assessment analysis was performed indicating that end-user baseline knowledge of exiting software tools needed improvement.  The implementation of the decision support system was preceded with intensive user training.  A flexible user interface was recommended & designed to accommodate the skill level of the end user.  The implementation was successful. HMO Audit A university medical center needed to analyze the profitability and effectiveness of its owned HMO.   From financial analysis, owner & HMO management interviews, helped the client identify critical success factors.  Extracted 3 years UB92 & 1500 transaction level detail into a relations database model and performed multi-dimensional analysis to identify utilization and cost saving opportunities. Recommended strategies to optimize utilization and better manage cost. Customer Survey Development & Management A Massachusetts based national HMO wanted to develop, distribute, analyze and manage several on-going JCAHO/HEDIS compliant surveys   Assisted with the development of several survey instruments.  Developed "Patient Satisfaction Tracker" software management system to import, analyze and report survey results.
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