Sentara Healthcare Case Study

December 11, 2011
iVantage Health

Hospitals can improve their cost position in three ways: lower expenses, increase volume, or both. However, there are countless ways within this conceptual model to accomplish these goals. Key questions include what, where, how much, and why.  iVantage Health Analytics provides a rigorous and comprehensive set of comparative benchmarks and performance management data that helped Sentara Healthcare answer these questions, support their performance improvement programs and improve their cost position on a variety of metrics.

About Sentara Healthcare

Sentara Healthcare is a major Norfolk, VA based not-for-profit health care organization. It employs nearly 400 physicians and operates more than 100 sites, including eight acute care hospitals with a combined total of 1,913 beds. It encompasses ten outpatient care campuses, seven nursing centers, and three assisted living centers. Sentara also provides health coverage plans with 456,000 members, home health and hospice services, physical therapy and rehabilitation services among others ” including Nightingale, the region’s first and only air ambulance system. In addition, Sentara has implemented Sentara eCare, a sophisticated electronic medical record system supporting its hospitals and multiple physician practices. Recently SDI and Modern Healthcare ranked Sentara Healthcare as the top most Integrated Healthcare System in the nation.

The Challenge

Sentara pairs an awareness of fiscal responsibility with the desire to improve quality. This can be a challenge in the current economic climate, with increasingly more attention on controlling expenses and managing resource utilization. eCare specifically addressed the organization’s desire to re-engineer the clinical documentation process with the anticipated outcomes of removing waste and duplication from the system, thus improving productivity and resource utilization.

The Solution

For more than 10 years, Sentara has used iVantage (formerly HMC) data to identify specific opportunities for improvement. Sentara’s Process Improvement Team (management engineers, internal operations consultants, and PI specialists) integrate iVantage reports with other external and internal data into Sentara’s annual PI plan. The PI Plan sets quality and performance goals for management teams at the Sentara facilities and corporate office. To date, Sentara has realized major improvement in transcription, utilization, patient flow, productivity, ED throughput, and Surgical Services throughput, among others.

Current opportunities include improving the documentation process, and Sentara has surpassed expectations with the implementation of eCare. Early implementation (2009 vs. 2011) meant they exceeded the original savings target of $25.5M and are on track to save $40.9M by the end of 2010. Ken Rice, Director of Process Improvement, says: “We relied heavily on process redesign at both the hospital and corporate level, created a disciplined approach by tracking progress through scorecards, and assigned an operational leader to each improvement project to hold them accountable.” He outlined these five items as integral to their success:

  1. Process Redesign: 18 key processes were redesigned by 200 staff members, managers, IT professionals, PI blackbelts
  2. Identify a process owner to establish accountability
  3. Measure progress with monthly results reporting
  4. Set savings goals for facilities; include savings targets in budgets
  5. Commit to being paperless; 85% of medication orders are now on CPOM at Sentara; emphasize document scanning and full bar coding. This has resulted in decreasing the time for medication administration from 132 minutes to 38 minutes on average

The Results

Using iVantage reports and other data, Sentara could pinpoint attainable, realistic objectives such as rolling out eCare. That effort has yielded both tangible cash savings and performance and quality improvement benefits for the system and for individual facilities. In recent benchmark reports, comparing FY 2009 to the previous year:

  • 5 of the 7 hospitals showed 6-15% decreases in cited variance to the external benchmark targets
  • 5 of 7 showed improvement in overall cost position
  • All 7 facilities showed marked improvement in nursing cost/day, both internally & against their respective peer groups
  • Despite the increase in IS investments for eCare, overhead variance decreased in all facilities

In addition, patient volumes have increased at five of the seven facilities, helping to spread fixed costs over a larger base of business. Many ancillary services across the system also showed improved costs/UOS and gained ground on their peers. Lucie D’Amato, Project Director for Performance Improvement, says of 2009, “We’ve been able to document $60M in total cost savings that we loaded into the budget, and we have a goal of an additional $30M for 2010.”
Cost Savings – Current
Improved clinical documentation to reduce denials ” an estimated $12M to date
Improved physician productivity on owned practices ” an estimated $3.4M to date

Cost Savings – Future

  • Review pager utilization system-wide for necessity ” an estimated $1M savings
  • Review clinical engineering contracts for elimination of duplicate contracts, improve monitoring of maintenance records – $1M goal
  • Review the need for internal brochures in a paperless world
  • Re-size the IT budget now that eCare is almost complete

Process Enhancements:

  • Eliminated duplicate lab testing between hospitals & MD owned practice offices
  • Redesigned the medical case management model to reduce LOS; made model consistent across facilities
  • Targeted supply chain efforts toward standardized pricing & contract compliance

Quality Improvements

  • AHRQ patient safety indicators suggest improvement as well.
  • 4 of 7 facilities reside in Quadrant 1, demonstrating low cost associated with high quality versus their peers
  • 5 facilities improved their internal quality positions
  • All 7 Sentara facilities showed lower off-quality cases and dollar variances

Sentara Leigh Hospital (SLH) has enjoyed particular success related to quality. They saw their adjusted admissions rise 4.6% between 2008 and 2009. Cost per adjusted admission improved 6.1% after years of increases ranging from 1% – 5%. Cited variance decreased 13% over the same time period, with marked improvements in Support Services, Ancillaries, and Nursing. Cited variance for off-quality cases improved by 19%, giving SLH the third best overall quality position in their peer group, combined with the fourth best cost position. Lastly, they realized much lower incident rates for decubitis ulcers and post-operative sepsis, among AHRQ patient safety indicators. These results earned Sentara Leigh Hospital an Honorable Mention in the 2010 HMC Quality Awards program.

iVantage Takeaway

Sentara is starting to reap the benefits of years of planning and investment in systems infrastructure, as well as the hard work from staff, management, and clinicians. This commitment to using effective data systems and PI tools, such as HMC’s benchmarking program, is converging to create the synergies necessary to manage costs, improve quality, and grow the business.

In 2010, three Sentara hospitals earned high marks in HMC’s Top Performer awards. All iVantage clients were scored on the following dimensions:

  • Overall Cost per Adjusted Admission in the best TM½ of their peer group
  • Cost per Adjusted Admission improved from previous year’s benchmark
  • Cited savings potential decreased versus previous year’s benchmark
  • Overall AHRQ Patient Safety Quality score in best TM½ of their peer group
  • Cost vs. Quality performance in the upper left quadrant of the peer matrix (i.e., low cost & high quality)
  • Off-quality savings potential decreased versus the previous year
  • Overall HCAHPS Patient Satisfaction score in upper TM½ of their peer group
  • Profitability greater than 5%

Sentara Virginia Beach General Hospital and Sentara Leigh Hospital achieved Top Performer status. Sentara Viriginia Beach General Hospital and Sentara Obici Hospital were most improved in the HMC Partnership.

Congratulations to Sentara as they continue their mission to provide the highest quality, most effective healthcare in its market.

About iVantage Health Analytics

iVantage is the leading provider of actionable performance benchmarking, encompassing quality, cost, productivity, patient satisfaction, span of control, best practices, and dashboards. iVantage enables hospital managers to achieve their full potential for excellence. For further information, visit our website at http://www.iVantageHealth.com