In this episode, Laurie Jaccard, Founder, President & CEO of Clinical Intelligence & Steven Berger Senior Advisor at Clinical Intelligence, provide a sneak peek into upcoming webinar Clinical Variation Reduction Program Structure presented live on Wednesday, January 15, at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- About Clinical Variation Reduction (CVR)
- Why CVR is important for hospitals to address
- How hospitals can put CVR to good use
- Three overriding benefits and opportunities of CVR
- Structured framework for activating CVR
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Laurie Jaccard and Steven Berger. Laurie Jaccard is the Founder, President, and CEO of Clinical Intelligence, a healthcare consulting firm she established in 2001. With a career that began as a registered nurse, Laurie brings 25 years of experience in clinical operations and care management consulting. Her extensive background in healthcare led her to recognize the need for effective data utilization in hospitals and physician practices, inspiring her to develop ClinView, an interactive analytics platform that integrates data from various sources into a single comprehensive view. Steven Berger is a Senior Advisor for Clinical Intelligence and has 50 years of healthcare financial management and leadership experience. During his first 25 years in the hospital and healthcare industry, he was a hospital financial executive across four hospitals and health systems. Steven has written several articles for leading healthcare magazines in addition to four peer-reviewed books, including Fundamentals of Healthcare Financial Management.
In 2000, he founded Healthcare Insights and created the Insights, Budgeting, Monitoring, and Reporting Software System, which won several Best in KLAS awards. For the last several years, Steven has been a Senior Advisor to Clinical Intelligence, among other pursuits. In this episode, we’re providing a sneak peek into an upcoming webinar, the first in a three-part series by our partner, Clinical Intelligence. The first of which is Clinical Variation Reduction Program Structure that we’re presenting live on Wednesday, January 15th at 1 PM Eastern Time. Welcome, and thank you for joining us, Laurie and Steven.
Steven Berger: Thank you so much.
Kelly: All right. Well, let’s go ahead and jump in today. This first question is for Steven. So, what is clinical variation reduction, aka, CVR?
Steven: Exactly. Well, thank you. CVR, definitionally, is a process for minimizing unwanted variations in clinical practice to improve patient outcomes, enhanced care quality, and reduced healthcare costs. It involves standardizing the process for care standardization to ensure consistency across conditions and sites. Because implementing a standardized process for care standardization is vital for minimizing unwanted variations in clinical practices on a large scale. It’s a vital strategy for achieving significant cost savings in healthcare, providing a rare opportunity to save millions of dollars while maintaining high-quality care. To fully realize its potential, healthcare organizations should not tackle CVR as isolated initiatives. Instead, they need to adopt a coordinated, system-wide approach, ensuring a consistent and standardized process that applies across all conditions and locations.
Kelly: Thank you for that explanation, Steven. This next one is for Laurie. So why is CVR important for hospitals to address?
Laurie Jaccard: Clinical variation is so important for hospitals as it helps standardize the care, as Steve mentioned. It helps ensure consistent and high-quality treatment for all patients. It also reduces unnecessary costs and improves overall efficiency, such as reducing length of stay or excess unwarranted patient days. So, addressing clinical variation at scale is key to unlocking clinical cost savings and capturing contribution margin improvement, also by maintaining quality of care, such as improved mortality, decreased complications, decreased infection rates. So clinical variation is so critical for hospitals to address because there’s such wide variation in physician practice patterns, of course. But are there opportunities to decrease that variability to improve the quality of care and decrease cost? The answer is yes, yes, yes.
Kelly: Wow, it does sound pretty critical. Thank you for that. And I think this one’s for you too, Laurie. How can hospitals put CVR to good use?
Laurie: Clinical variation in hospitals is very instrumental in driving the organizational change, whether it’s enterprise, regional, or specific local hospitals. And in order to identify the variations in care, this would require a very robust analytical function and methodology. This also includes standardizing best practices and engaging clinicians in the process, physician champions to lead the process, team leaders. And it also includes continuous monitoring and development of evidence-based protocols to maintain the high standards of care. So, all this said, a hospital can put clinical variation to good use by requiring a coordinated, systematic approach rather than an initiative-by-initiative approach.
Kelly: That makes a lot of sense, Laurie. Thank you. And this one’s over to Steve. So, what are the three overriding benefits and opportunities of CVR?
Steven: Well, so the three overriding benefits are, one, cost savings, pretty important; two, improving patient outcomes, extremely important; and operational efficiency, which is how you pretty much achieve the other two elements. Listen, I’ve been in hospital finance for 50 years. And cost savings is always at the top of any finance officer’s list, also CEOs and the board. They would like to minimize costs as good as possible without hurting patient care outcomes. So CVR, clinical variation reduction, allows us to understand where the costs are and where the savings may be impacted. The second part is improve patient outcomes. We want the best possible outcomes. There are metrics that we can look at that tell us whether or not we’ve achieved the kind of high outcomes that we’re looking for. Standardized care practices enhances the quality of this care. We can see where we are. We can see where we need to go. And the CVR continues to allow us to take that journey to the improvement. We do that through that third element, operational efficiency, which is helping us to streamline the processes to improve the overall hospital efficiency. This includes throughput. This includes how we actually operate our organization. How are we taking the steps needed to get to where we want to be? And there’s a lot of costs involved there. And as long as we can see those costs and match them up with improved outcomes, we’ve got a big winner.
Kelly: Wow, thank you for sharing those with us. Those are pretty significant benefits. The next question is for Laurie. Is there a structured framework for activating CVR?
Laurie: Absolutely. To expedite the value of clinical variation, this advanced strategy to help with improving quality and decreasing cost, it is extremely helpful for hospitals and healthcare systems to establish a systematic approach to their clinical variation process. And this starts with a vision, defining that vision, the philosophy, the approach, how will we define and measure, how will we structure our governance, who will oversee the clinical variation program? Some hospitals establish a steering committee for this. Some establish the utilization management committee to oversight this or P&T committee with regard to the structure and governance. And then the measurement is so key to establish the data governance and measurement. How are we going to measure clinical variation? Do we have the tools, the source of truth, so we can drill down into that cost structure? Can we drill down past the revenue center? Can we understand the direct cost at the physician level, at the activity code level? The measurement is so critical. So once we have those key components in place, then we can select the project, then we can select the areas of opportunity. And then we start the implementation of the framing, of the improvement, bringing in the literature.
This might include developing protocols such as admission order sets, physician education, staff education, patient family education, patient pathways. There’s a lot of forms of a clinical variation improvement approach. But that design is so critical that we involve physicians, champions, those that are closest to the process, such as specialists and hospitalists and nursing, pharmacists, dieticians, case managers. There are so many key stakeholders involved in the process. But if this process is structured, this process can be very replicable. The timeline it might take for a clinical variation project might be one to three months. It might be four weeks, just depending on the scope of the project. So yes, it’s very vital to have a structured framework. And we’re so excited on January 15th to really focus on the structure of the program. And this is a three-part series where we’ll be focusing on the process as well as the outcomes.
Kelly: Most definitely. And Laurie, what does the structured framework look like?
Laurie: Well, of course, the structured framework must be scalable. It must be repeatable. It must be a performance improvement approach. So, you can incorporate your PDSA, your DMAIC as your performance improvement cycle. But Clinical Intelligence has developed a proprietary approach over the last 25 years, just learning from hundreds of hospitals how to implement this. So, we’re going to share this approach with everyone to really take that away as your roadmap and begin the process of clinical variation. But what it looks like is really a pen-to-paper approach on how we define the opportunity, how we measure the opportunity, how we establish key performance indicators, how we design our improvement, and then finally, feedback the data to providers, stakeholders, and control the process. So it is definitely a performance improvement cycle, and it’s definitely a outcomes-driven approach, but it involves collaboration and data-driven approaches.
Kelly: Yeah, it sounds like it. So, this one’s for Steven. Are there multiple champions within the CVR structure?
Steven: Well, yes, there are. And as Laurie mentioned just a few minutes ago, there are multiple champions, including clinical leaders, administrators, managers, and the frontline staff itself. But here’s the point, the big point. Most of these clinical variation reduction projects will need to be led by clinical leaders, physicians, or key nurse managers and such. So, we need the clinical people on these clinical variation reductions to improve. Again, what are we trying to improve? We’re trying to improve cost savings, patient outcomes, and operational efficiencies. So we need the clinical champions. We need the administrators, the top leaders, but also the middle management, and again, down to the staff. But what is it that we’re really trying to achieve here? Goals. Laurie mentioned metrics. Well, goals are usually set through metrics. Why are they making the goals what they are? How did they get to these goals? Leaders make goals and managers implement the goals.
Clinical variation reduction, CVR, is that process that Laurie just described that allows the leaders to set those goals. Where are we? Where do we want to be? Where do we want to be? That’s also part of the CVR, determining what goals are achievable. Do we want to save X number of dollars? Do we want to save a certain percentage? Do we want to improve outcomes by a certain percentage? Well, where are we now? How should we get to the next 10%, the next 10%? These are what the champions are going to be doing as they’re setting their goals. And then the managers and the staff can go on and achieve them. Some examples of the metrics that we might want to be looking at, for example, within each of these projects, could include average cost per case, patient outcome metrics, complication rates, hospital-acquired conditions. Perhaps it involves excess days per discharge. All of these things are very real. They’re very monitorable. We can understand where they came from, and we can move to improve them. This, in a nutshell, is what CVR will allow healthcare organizations to do.
Laurie: Steve, I wanted to add what you stated as important to driving clinical variation with clinical leaders is the importance of bringing in your finance leaders. There’s just the role of the data integrity and the veracity of the data to be able to drill into the data with confidence and to assess direct costs. Per capita direct cost is really important to clinical variation. Clinical variation can be a really nice layer for your horizontal functional foundational initiatives to layer on a vertical approach, such as a service line focus around clinical variation can be a real compliment to your hospital strategy. So, if you’re already working on throughput or observation management or clinical documentation, those really important foundational strategies, consider layering a clinical variation project to your strategic operational plan, perhaps one study every quarter, which would really greatly enhance your standard care, your outcomes for your hospitals. Plus, it’s really exciting. Physicians, hospitalist leaders, specialists, they’re scientists. They love the data. Engage your physicians. Involve them in the selection of your project to establish the priorities for the hospital. But really, it’s so exciting how a hospital can drive their margin and their quality through clinical variation.
S: Absolutely. And in addition, many hospitals may think they’re doing this. Maybe they’re doing it to some extent. Maybe they’re doing it, or they think they’re doing it to a greater extent. That may be true. But unless they take a very standardized process that we are speaking of, a very standardized process, then they may be missing elements. And so we hope that you’ll join us on January 15th for the first of our three webinars, where we’re going to get into these very detailed elements of how you can get much further along than perhaps you already are.
Kelly: Wonderful. Well, thank you both so much for joining us today, Steven and Laurie, for sharing this great sneak peek into the first in a series of three live webinars that you all, Clinical Intelligence, are providing as part of BESLER’s The Hospital Finance Academy. Part one, Clinical Variation Reduction Program Structure Webinar that you’re presenting live on Wednesday, January 15th at 1 PM Eastern Time. And as a bonus, you can earn CPE. And if you’re interested in learning more about clinical variation reduction, you can join us for part two of their series, Clinical Variation Reduction Program Process, which is going to be presented live on Wednesday, February 5th. And part three, Clinical Variation Reduction Program Outcomes, which is coming to us on March 12th. Both will offer CPE as well. We hope you can join us for all three. You can register for all three on our website now. Thanks again, Steven and Laurie, for all of this great information and sneak peek.
Laurie: Thanks for having us.
Steven: Thank you.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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