Knowledge on the Go

Indirect spending is defined as any purchase or services that are internal or external to a healthcare organization but fall outside of med-surg supplies, pharmacy, physician preference items (PPI), and capital. You might be surprised to learn that indirect spending accounts for up to 30% of a hospital’s total operating expenses.

Today’s guests discuss the current state of indirect spending, its importance in the healthcare space, and some of their success stories. 

Guest speaker:

Hawanya Blakely, MBA

Moderator:

Show Notes:

[02:04] The state of indirect spend within healthcare organizations today.

[03:33] How Rush University Medical Center took a proactive approach to identifying indirect spend opportunities.

[05:01] Why Rush University Medical Center made indirect spending a priority.

[07:51] How leadership sponsorship contributed to their success.

[09:12] Where a healthcare organization should start. 

[10:23] Importance of participating in the Vizient Reducing Variation Indirect Spend Benchmarking Study.

[11:25] Understanding your indirect spending and the number of vendors that you’re using within a specific category.

[12:07] Importance of aligning across various system facilities.

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Early detection of cancer can dramatically increase the efficacy of curative treatment. Unfortunately, early screening tests exist for only a small number of cancers, meaning most are not diagnosed until symptoms arise in the later stages of the disease.

Better cancer screening is, therefore, a major focus area for clinical performance improvement. Marilyn Sherrill talks with Dr. Joe Cummings about a new genomic test that can theoretically screen for more than 50 different types of cancer using a small blood sample, and what the future may hold for this technology.

Guest speaker:

Moderator:

Show Notes:

[01:28] The Grail Galleri liquid biopsy test.

[02:18] Sampling methodology.

[02:55] The analytic process of the Grail Galleri test, and some developmental history.

[04:01] Testing methodology is based on methylation patterns.

[05:36] Results of the clinical studies to-date, and status of ongoing studies.

[08:13] Early adopters include some larger healthcare systems and, potentially, anyone willing to self-pay.

[09:04] Test costs and preliminary cost/benefit anaylsis.

[11:02] Considerations re: payers’ willingness to cover test costs.

[12:09] Looking forward to trial results and potential FDA approval.

[13:05] With many companies doing R&D in the liquid biospy field, the development of competing and complementary tests is to be expected.

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As sepsis continues to be a major cause of death representing a substantial healthcare burden, Vizient hosted a performance improvement collaborative focused on sepsis early recognition. Shannon Hale explores guidelines and best practices with collaborative participant Amy Lorenz of Covenant HealthCare. 

Guest speaker:

Moderator:

Show Notes:

[01:03] Covenant Healthcare identified sepsis fallouts in order to enhance education related to Center for Medicare and Medicaid Services (CMS) guidelines.

[01:59] Covenant created an online reference tool — a sepsis awareness page —to communicate about guideline revisions and fallout areas with all clinical staff.

[03:27] The sepsis awareness page was promoted to educate clinical staff and ensure usage.

[04:08] Executive and physician-driven support strongly enriched the collaboration.

[05:06] Covenant provides sepsis awareness page data monthly.  

[05:40] Lack of education about and awareness of the CMS guidelines has been the greatest challenge.  

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A high reliability organization is an organization that has experienced significant success in avoiding harm within an environment of high complexity and risk. These organizations create a collective state of mindfulness that produces an enhanced ability to discover and correct errors before they escalate into a crisis. Marilyn Sherrill discusses high reliability culture with Dr. Michael Leonard of Safe & Reliable Healthcare and Dr. Gena Futral from Vizient.  

Guest speaker:

Moderator:

Show Notes:

[01:42] Background information about Safe & Reliable Healthcare LLC and culture.

[02:30] Why Vizient has partnered with Safe & Reliable Healthcare LLC.

[03:20] Safe & Reliable Healthcare’s high reliability framework.

[05:13] The synergies between Vizient and Safe & Reliable Healthcare.

[06:38] The importance of culture and why it is a starting point for this work.  

[09:00] Measuring culture: survey results and what that data means.

[10:37] Vizient’s methodology for helping organizations along their high reliability journey, including LENS, Safe & Reliable Healthcare’s management and communication technology.

[15:14] Advice for organizations considering a high reliability journey, and last thoughts.

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Jim Lichauer, Meryl Biksacky, and Conor Hanrahan discuss the strategies Intermountain Healthcare implemented to improve their immune globulin utilization.

Guest speaker:

Conor Hanrahan, PharmD, MS, BCPS, CPHQ

Moderator:

Show Notes:

[01:50] Intermountain Healthcare is a complex system.

[03:19] Challenges included the size and scale of the organization, drug shortages, as well as technology and data capture issues.

[05:30] The development of IG appropriate use guidelines was intricate and enterprise-wide.

[08:21] A medication use evaluation was conducted.  

[10:08] Evaluation of adherence to weight-based dosing strategies produced shocking results.  

[11:41] Surveying stakeholders revealed a lack of awareness of internal guidelines and standards. 

[12:42] A formal policy to optimize IG weight-based dosing is in the process of being approved.

[13:35] Advice for those planning similar strategies includes system-wide collaboration, establishing and monitoring adherence rates, standardization, and quantification of cost savings.

[15:12] Intermountain Healthcare has exciting developments on the horizon.

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In this episode, IU Health Southern Indiana Physician’s Service Line Administrator discuss their experience with the Redesigning Ambulator Care Collaborative. Each participant chose a performance improvement project to address and Elizabeth Thompson shares the rather surprising discovery the team made and the solution that made a difference.

Guest speaker:

Moderator:

Show notes:

[01:17]  IU Health Southern Indiana Physicians choose their improvement project

[02:14]  What prevention was missing—or was it?

[03:01]  What they learned about their data

[03:58]  Solving the code crisis

[05:29]  Pseudo codes

[06:16]  Working with IT

[08:11]  Lessons learned

[09:06]  How the collaborative experience leads to progress

[10:08]  Advice for your journey

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Marilyn Sherrill and her guests, Dr. Matthew Lyon and Dr. Max Bursey, take a deep look at Augusta University Medical Center’s successes and challenges regarding Interhospital transfers.      

Guest speakers:

Max Bursey, DO

Matthew Lyon, MD

Moderator:

Show Notes:

[01:36] Georgia is unique in that it has a large number of rural hospitals, requiring a large number of interhospital transfers for high acuity cases.

[03:50] Telemedicine and ED-based critical care services have aided rural hospital quality of care and decreased the need for transfers.

[05:48] These two services have evolved from intervention in the ED only to a holistic program of care for patients in rural hospitals.

[07:38] The ED ICU service provides inpatient level care to patients waiting on an ICU bed and “short-stay” ICU patients, and works closely with the telemedicine critical care to prevent and manage transfers.

[09:53] Telemedicine interacts with Emtala in ways that allow rural hospitals to admit and keep a broader selection of patients.

[11:13] Challenges have included the need for training providers on the use of telemedicine, and training and staffing ICU-level nurses in the ED ICU and in rural hospitals.

[13:53] Starting slow and adequately training staff are important best practices.

[16:03] Telemedicine isn’t going anywhere and should be utilized fully, and included in the work of the ED.

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As the demand for patient care at home increases, one component driving the move is technology.  In this Knowledge on the Go episode, Dr. Joe Cummings of Vizient and Andrew Rebhan of Sg2 outline what’s connecting clinicians and their patients.  From smartphones to sensors to artificial intelligence, PI Program Director Courtney Furrow-White quizzes our experts on how technology is making a difference in patient care today—and will transform it in the very near future.

Guest speaker:

Andrew Rebhan

Moderator:

Show Notes:

[01:15] There is renewed interest in home care due to affordability and the rise of consumerism.

[02:19] Hospital IT Infrastructure and patient home IT equipment are vital.

[04:02] There is no singular approach when considering patient acuity.

[05:20] Telehealth technology must be customizable and comparable to in-person visits.

[07:29] Digital devices with always-on connectivity provide remote patient monitoring. 

[09:00] Imaging technology can also be achieved in the home. 

[10:25] With home data collection, AI can proceed with the patient. 

[13:09] AI can carry the future of home care into a new world of service.

[18:04] A health system should follow specific strategies to ensure success.

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This week on Sg2 Perspectives, Sg2 Principals Heidi Pandya, MSHA, and Jayme Zage, PhD, join us to discuss all things related to health care at home. Heidi and Jayme start with the current landscape and why health care organizations are evaluating care-at-home services, and then cover how organizations can get started with health-care-at-home programs and prioritize their options. (Hint: stand back and take stock of your strategic imperatives first, then prioritize those strategies and see where care at home fits.)

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Michelle Lewis and Pat Reagan Webster discuss the challenges and successes of Strong Memorial Hospital’s improvement journey with onset C. difficile infection rates.

Guest speaker:

Moderator:

Show Notes:

[01:09] Strong Memorial Hospital had plateaued in its efforts to decrease hospital-onset C. difficile infection rates.

[02:06] Strong’s successful prevention team was diverse and physician-led.

[04:09] Strong’s analysis, using the contextualist model, included brainstorming drivers, blueprinting, and identifying barriers.

[07:06] Interventions were established, monitored, and modified appropriately.

[08:38] COVID continues to cause challenges.  

[09:42] Interventions have proven to be successful, and infection rates have dropped dramatically.

[10:24] Strong made “really significant change in a time when we thought no change was possible.”

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