Mercy, a 2016 HIMSS Davies Enterprise Award winner currently has approximately 40 evidence-based and standardized clinical pathways representing care of patients in an inpatient setting for 29 different procedures or conditions. They have spent a decade optimizing their electronic health record (EHR) system, its processes, and navigating patient data for better cost and outcomes. Through the use of evidence-based protocols configured in their electronic health records (EHR), Mercy was able to reduce cost, improve quality of care, improve patient outcomes and improve reimbursements.
Mercy | Davies Enterprise Award
Mercy recognized that a large portion of the waste in health care can be contributed to failures in care delivery, care coordination, and overtreatment. Mercy was not achieving a healthy contribution margin in several communities on the top 15 diagnosis related groups (DRG) for patients in which reimbursement was received based upon bundled payment such as Medicare and Medicaid patients. Heart failure was a condition that the mortality rate for patients was at the national rate of 6% prior to implementation of the pathway.
The goal was to improve quality of care through standardization for selected patient populations and achieve a savings in direct variable cost per case through the process of standardizing and improving care. In comparing the patients that were on the pathway to those that were not on the pathway for individual conditions reveal that direct variable cost per case is lower in most conditions and
those with higher costs for patients on pathway reveal improvements in mortality reduction.
Pneumonia is another condition that the actual mortality rate for patients was at the national rate, ranging between 4-5% prior to implementation of the pathway. A key aspect of the Pneumonia pathway order set were the elements included to expedite the delivery of antibiotics. Again, the goal was to improve quality of care through standardization for selected patient populations and achieve a savings in direct variable cost per case through the process of standardizing and improving care.
The door-to-antibiotic time for patients on the pathway is approximately three hours less than patients that are not on the pathway. The door-to-antibiotic time for patients on the pathway is approximately one hour less when compared to the baseline patient population.
Comparison of patients that were on the pathway to those that were not on the pathway for individual conditions reveal that direct variable cost per case is lower in most conditions and those with higher costs for patients on pathway reveal improvements in mortality reduction.
Mercy recognized several patterns in the care continuum, quality metrics, and payment denials indicating that medical documentation was not accurately reflecting the sickness of their patients or the quality of their care. After closer review of patient records, they confirmed that the patterns were the result of inaccurate documentation. While the aim was accurate documentation, Mercy’s medical documentation specialists (MDS) program also helped to improve patient care.
By bringing together people, process, and technology, Mercy was able to implement a solution that provides accurate documentation in an efficient and timely manner, standardizes workflows with best practices, and provides actionable data to enhance communication with physicians. The MDS Operational Analytic Tool and the Secondary Diagnosis Report provides MDS users a standardized workflow process across the organization.
The new standard process has increased productivity from 10 to 25 charts per day and promoted accurate clinical documentation throughout the medical record thanks to complaint methodologies.
To support Mercy’s strategic goals related to cost, service and quality, and help Mercy pioneer a new model of care while balancing financial pressures due to changes in reimbursement, perioperative leaders set out to find new ways of monitoring, measuring comparing and improving the cost and delivery of surgical procedures while increasing patient satisfaction and creating an exceptional.
The data provided in the perioperative dashboard is automatic and takes just seconds, saving Mercy’s perioperative services team approximately 2,300 man-hours a month for each of Mercy’s locations, a total estimated to be around 30,000 hours a year of manual effort saved.
What used to take 2,300 man hours a month, now takes 10 minutes. With analytics at their fingertips, and needing only minutes to identify expense and get all the comparative details to eliminate variance, improve quality and lower cost, Mercy achieved a total savings of $9.42 million across perioperative departments for all surgical procedures.