Hospitals tightening the screws on operations
CHICAGO – With state Medicaid program cutbacks and reduced Medicare reimbursement rates looming, hospitals are looking to control costs in labor management.
While managing labor costs is always an issue whenever margins go down, hospitals are focusing on targeted strategies, said Paul Osborne, managing director of Huron Consulting Group.
Hospitals are controlling the hiring process by targeting hiring freezes and labor productivity analysis, Osborne said. While there's still a nursing shortage, hospitals want to make sure their staffing is in line with their peers.
Many hospitals are scrutinizing management - not just the rank-and-file staff – throughout their system, including departments that don't have direct contact with patients, for potential cutbacks, said Osborne.
Administrators of health systems that have acquired new hospitals are reassessing their operating model versus their holding model. If the corporate structure has grown more than a system's patient volume, expect downsizing, Osborne said.
"You have to better integrate your corporate functions - human resources, materials management, marketing," he said.
Hospitals are also taking a look at services that they outsource, such as food and environment, and bringing them in-house to manage, said Osborne. Services are also being examined more closely. If a service, such as dialysis, isn't profitable, administrators may decide to close the program.
This practice of cherry-picking services will be a "tough call" for systems that are not-for-profit or faith-based, Osborne said.
A large number of hospitals have shut down their capital expenditures, said Christopher Drummond, managing director for Huron Consulting Group's Health and Education segment. If they are implementing new technologies, the return on investment must be realized much sooner than in the past.
Hospitals that executed well on their healthcare information technology implementations are reaping the benefits of automation over manual processes, Osborne said. Healthcare IT systems that capture coding and clinical documentation correctly will enable hospitals to pay employees correctly.
Hospital staff is being trained to be more diligent about collecting co-pays and deductibles during patient registration. Osborne said such training needs to be in place in order to collect revenue upfront.
Increasingly, hospitals are asking for help - from consulting firms, vendor partners and even the community, said Drummond.
While the details of the HITECH Act are still being clarified, Osborne noted that industry discussions are emerging over how hospitals can receive some of the stimulus funding. WellSpring Partners, a Huron Consulting Group practice, is seeing such discussions commence, and reaching out to its current clients for assistance.
Even hospitals with healthy bottom lines are focusing on efficiency because of the "fear of the unknown," said Osborne.
"We've always seen hospitals shutting down," he said. "Whether there's going to be an increase, we don't know."
Volume 113, Issue 1, Supplement 1, Pages 67-79 (8 July 2002)
Pathogenesis of bacteriuria and infection in the spinal cord injured patient
Mike B Siroky, MD
Spinal cord injury (SCI) produces profound alterations in lower urinary tract function. Incontinence, elevated intravesical pressure, reflux, stones, and neurological obstruction, commonly found in the spinal cord-injured population, increase the risk of urinary infection. The overall rate of urinary infection in SCI patient is about 2.5 episodes per patient per year. Despite improved methods of treatment, urinary tract morbidity still ranks as the second leading cause of death in the SCI patient.
SCI removes the ability of the pontine micturition center and higher centers in the brain to inhibit, control, or coordinate the activity of the vesicourethral unit. As a result, a patient with complete quadriplegia is typically unaware of bladder activity. Bladder contraction is accompanied by vesicosphincter dyssynergia instead of sphincter relaxation.
It is widely accepted that intermittent catheterization, when compared with indwelling catheters, reduces the risk of urinary tract infection (UTI) in SCI patients and is the preferred method of bladder drainage in this patient population. Attempts at eliminating bacteriuria associated with indwelling or intermittent catheters have generally been unsuccessful. There is now appreciation of the fact that a creeping adherent biofilm of bacteria frequently ascends through the luminal and external surfaces of an indwelling catheter, often within 8 to 24 hours, leading to bacterial adherence to the bladder surface and correlating with symptomatic infection. The use of antimicrobial agents to clear or prevent bacteriuria in patients on indwelling or intermittent catheterization has had mixed success. Treatment for asymptomatic bacteriuria in SCI patients remains controversial. SCI patients with symptomatic urinary infections should be treated with the most specific, narrowest spectrum antibiotics available for the shortest possible time. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated urinary infections in the general population. Characteristics of the quinolones make them well suited to treating UTI in the SCI patient.
a Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA
b Department of Urology, Boston Veterans Administration Healthcare System, Boston, Massachusetts, USA