Learning centers can be cost-effective

Prove worth through tracking

Learning centers or labs that provide individual teaching opportunities on various health care topics and skills needed for a safe hospital discharge have been proven cost-effective.

According to Nancy Goldstein, MPH, patient education program manager at University of Minnesota Medical Center, Fairview in Minneapolis, when the Patient Learning Center opened in 1987, it was able to bill insurance companies for reimbursement. However, with managed care currently covering so many patients, this is no longer possible because the companies pay the hospital a set fee for services.

Although the learning center no longer receives funds that directly cover the teaching costs, it has proven cost-effective because of the dollars it saves elsewhere.

"When we received reimbursement, we were able to pay for ourselves. We no longer receive reimbursement for this service due to managed care and how reimbursement is handled. The program does save the institution dollars as demonstrated by our research. We have relied on our research findings and performance improvement [PI] data to demonstrate that it is a cost-effective program," says Goldstein.

One study showed a reduction in readmissions for reinsertion or complications with central lines. Another study demonstrated an increase in compliance with a home monitoring device for lung transplant patients.

PI data regarding joint replacement pre-op classes showed a half-day reduction (from a three-day hospital stay) for people who attended the classes.

In a study that looked at discharge planning and included anecdotal feedback from inpatient and home care staff, the staff members said it took half as long to prepare patients for discharge if they went to the Patient Learning Center.

Goldstein has a budget for the center that includes staffing and supplies. The budget is based on her projections for the coming year, and she submits it to administration annually.

The cost to run the patient learning center at University of Wisconsin Hospital and Clinics in Madison is included in the organizationwide budget for the patient and family education department. The hospital covers salaries and other expenses such as printing, office supplies, and building rental, reports Zeena Engelke, RN, MS, patient education manager.

"I submit an annual budget in February just like all other hospital managers and directors. Monthly, I receive department operating expense reports, which reflect our expenses and revenues. The reports also tally the number and variety of sessions provided [i.e., 60 minutes diabetes, 30 minutes Peds ENT pre-op, etc]. This allows us to track growth at the various sites and/or troubleshoot any negative variances," she explains.

Although day-to-day operational expenses are part of the budget, any special projects are funded by grant money. For example, grant money was used to create a box of materials, called a pain kit, filled with items to decrease pain and anxiety.

Engelke says the Friends of University of Wisconsin Hospital and Clinics have been very generous. They provided $15,000 in start-up funds in 1995 and recently gave $50,000 for special projects. Also, the center received $8,000 as part of the Quality through Safety grant program at UWHC.

It is important to prove the worth of the learning center in terms of its clinical value, says Engelke.

"When you consistently provide services that help the patient care delivery to be more efficient or effective, you become an undeniable service. Support from nursing colleagues and other disciplines becomes hugely helpful in articulating your worth to the organization," says Engelke.