Cost cutting, quality not mutually exclusive

Increase patient satisfaction and save money

Cutting costs in order to remain profitable even though reimbursement levels may be shrinking means cutting quality. Right?

Wrong, say several experts who have found ways to cut costs and preserve, even improve, quality within their centers.

"Most people assume that cutting costs means a cut in quality, but what really happens in a good process is that you focus on what is important to providing the service," says Vicki A. Lucas, PhD, RNC, vice president of women's services at Helix Health/Medlantic Health Systems in Lutherville, MD.

When payers began reimbursing for only a 24-hour length of stay (LOS) for normal deliveries a few years ago, Lucas' department looked carefully at what could be cut without compromising quality.

"We realized that when we had several days to teach the mother, we taught everything to every mother," says Lucas.

Now, the mothers are given an educational checklist at a prenatal visit with their obstetrician. The form asks the mothers what topics they want nurses to teach them during their hospital stay. Copies of the form go to both the postpartum nurses and the nursery nurses, so the mother's teaching can be individualized to her specific needs, explains Lucas.

The key to a success is to make your cost- containment efforts an ongoing process that is proactive rather than reactive, explains Lucas. Before making any cost cutting decisions, ask yourself what excess costs can be cut without cutting quality of service or patient satisfaction, Lucas advises.

A number of strategies can help a women's center manager control costs without reducing quality, says Lucas.

· Look carefully at staffing.

"Salaries represent 60% of your costs," says Lucas. She recommends flex staffing as an excellent way to control staff costs as long as you are vigilant about monitoring census and staff levels constantly. (For other staff cost-containment tips, see p. 125.) Before making changes in the way you staff, conduct time-and-motion studies and gather empirical data based on accepted standards of care, says Lucas. You want to make sure that any changes you make don't affect quality and that your staff understands this stance.

· Look at other ways to deliver services.

A shortened LOS for obstetrics means looking closely at the education component, says Joyce Benjamin, RN, MSN, director of women's and children's services for Scottsdale (AZ) Healthcare.

"Many of our mothers are staying only 24 hours, so we started a program in the fall of 1996 to provide follow-up teaching and examination of the mother and baby within a 48-hour period," says Benjamin.

While the mother is still in the hospital, she is offered a free visit to the Family Support Center one to three days after her discharge. The one-hour visit with a nurse includes a physical exam of the mother and the baby. Questions about the mother's care for herself, infant care, and breastfeeding are answered at this time. Potential problems can be detected early, explains Benjamin. This early follow-up enables the women's center to keep LOS down and prevents readmissions due to a baby's problems such as jaundice, dehydration, or weight loss.

"We are fortunate that we can still offer this as a free service," admits Benjamin. "But even if we have to charge for it in the future, we know it will be less expensive than home health visits."

· Educate staff.

Another key to ensuring successful cost containment is to make sure your staff understand why you have implemented certain changes, says Ann L. Ropp, RN, vice president of services for women and children at St. Luke's Shawnee Mission Health System in Kansas City, MO.

The best way to demonstrate that quality is not compromised is to use good data that evaluate not only cost but quality of care as defined by accepted standards and patient satisfaction, says Benjamin.

"We share our information with nurses, utilization review and case managers, and physicians," she says.

· Standardize supplies, forms, and equipment.

Using standard protocols or critical pathways to determine which supplies, medications, or lab tests will be provided is a good way to make sure you get your money's worth. But look at standardization when you purchase equipment, as well, says Ropp. When her organization looked at fetal monitoring equipment for the seven facilities in the health care system, the decision to purchase the same equipment for all seven was made for several reasons.

"Not only did we negotiate a better price from the equipment vendor, but we will save money because our biomedical department and our information systems department can easily support the equipment for all facilities without extra training or resources," says Ropp.

Whether purchasing equipment or evaluating staff levels, the most important thing is to start with accurate data, says Benjamin. "We look at costs, patient satisfaction ratings, outcomes," she says. "We make sure we have accurate data before we make changes, and we make sure our changes will provide better management of patient care and better patient satisfaction even as we reduce costs."