Archives for May 2017

Team Member Spotlight: Dawn Bourne, DNP, RN, FNP-BC

Dawn Bourne, DNP, RN, FNP-BC

In addition to her day-to-day duties as a nurse practitioner in the Department of Family Medicine, Dawn Bourne plays an integral part in two UVAHS programs designed to enhance patient experience throughout treatment at the Medical Center and after discharge.

The first, the Ethics Consult Service at UVAMC, was a natural fit for Dawn to become involved with: Her research and dissertation as a DNP (Doctorate of Nursing Practice) student at UVA School of Nursing was on moral distress in primary care providers. “Ethical issues often arise in patient care when a provider knows the appropriate action to take, but is prevented from taking it because of something outside of their control,” explains Dawn.

As a branch of the Ethics Consult Service, the Moral Distress Consult Service addresses ethical issues that arise which are not specific to one patient. “We meet with the entire team,” says Dawn. “For example, we go to several ICUs on a regular basis and talk about issues that happen in the unit – we try to help troubleshoot what we have the power to change.”

In contrast, individual ethics consults most often involve specific cases and are noted in patient charts, with follow up like other consult services. The issues at hand are generally complex and emotionally charged, such as the withdrawal of life sustaining treatment and surrogate decision maker questions. The service is available 24 hours per day, 365 days per year thanks to the individuals who make up the on-call team: an interdisciplinary group made up of 8-10 consultants including physicians, nurses, a chaplain and social workers. “In many systems, the ethics committee is physician-only”, says Dawn. “It’s really important to UVA that this is an interdisciplinary team because everyone brings something to the table when it comes to these ethically, clinically and socially complex issues.”

Dawn also plays a vital role on the Family Medicine Transitional Care Management team, which follows patients after discharge. Within two days of their leaving the Medical Center, a patient is contacted by a RN Care Coordinator to review their case and tie up any loose ends in preparation for their follow-up visit. “This helps patients understand why their follow-up appointment is important, so they attend more often,” explains Dawn. She adds, “This is a truly collaborative effort because it has formed a more robust bridge between the inpatient and outpatient teams to address all aspects of patient care including social workers and clinical psychologists. There are many social determinants of health that having an interdisciplinary team helps address.”

The success of the team’s efforts are reflected in readmissions data: Between September 2016 and February 2017, 30-day all-cause readmissions were reduced from 31% to 6%.

 

From the CEO’s Desk: Lean Management Update

Brad Haws

We are proud that UPG has led the Health System in using Lean management practices in administrative operations in order to serve as efficient stewards of Health System resources. The following is an update on some important results of those efforts.

  • UPG has had Lean projects in every unit in the past 24 months.
  •  To date, UPG Lean projects have created $2.5M of value for the Health System. 
  • Generated margin in administrative unit in FY2016 and rebated $380K of fees back to clinical units.
  • Last year, UPG was the only organization in the Health System not to add a single FTE. UPG’s FY18 budget continues this trend.
  • Lean Successes include:
    • Zion Crossroads
      • Redesigned scheduling process, reducing rate of errors from 30% to near zero.
      • Reduced referral errors from 30% to near zero so that patient connects with the right physician for their condition the first time.
      • Improved communication between physicians and staff.
    • Life of a Surgical Charge
      • Developed automated OR log in Epic, used by 11 Clinical Departments
        • Estimated increase of $800K/year in collections by adding Accustream to identify missed charges.
        • Time savings of ~960 hours/year.
    • In FY17, Billing and Collections teams have seen a 20% increase in productivity while absorbing a 14% decrease in time processing.
      • Charges and collections are up 8.2%.
      • Timely adjustments are down 60% from $1,217,217 to $481,204.
      • 35 process improvements identified; 33 of which have been implemented.
    • Electronic Enrollment with Medicare, Medicaid and VA.
      • Reduces held charges and increases timely payment
    • Monthly Financial Close Cycle
      • Shortened close cycle from 16th to 10th business day
      • More timely financial statements to the Health System
      • Eliminated waste
      • Team freed up to work on other projects
    • Physician Hiring Platform
      • Creation of a streamlined hiring platform for providers, aligning credentialing and date of hire with ability to bill for services.

Key Messages from Clinical Chairs Committee Meeting May 9, 2017

UPG Interim CFO Beth Allen provided a financial update on revenue and productivity. Financial results from April showed a loss of $2.7M, with work RVUs down significantly. Possible contributing factors include the fact that there were only 20 business days in April, and spring break may have impacted productivity. This trend was similar to the same period in 2016, but because the FY2017 budget was completed before April 2016 the trend was not predicted or reflected in the budget. RVUs are now being monitored on a weekly basis in order to avoid an impact based on Epic training.

The remainder of the meeting was a closed Executive Session with Clinical Chairs and UPG CEO Brad Haws.

Featured Video: Telemedicine at UVA

Featured Physician: Irving L. Kron, M.D.