Case Study

QHR Health Client Success Story: Clinical Resource Management

Challenge

A nonprofit 200-bed hospital in the Midwest wanted to improve revenue, outcomes and the patient experience.

QHR Health Solutions

The hospital engaged QHR Health’s Clinical Resource Management services to help identify and solve inefficiencies along the care continuum that drive up total costs, reduce reimbursement, create poor utilization, increase unnecessary lengths of stay, and impact inappropriate levels of care. In six weeks, the QHR team conducted a thorough assessment of patient throughput, operations and care management. The assessment focused on:

  • Level of Care: Review of ICU, PCU, Med/Surg utilization and transfers out to understand potential level of care opportunity.
  • ‘Transfers Out: Analysis of transfers to understand those that could have potentially stayed inhouse.
  • Length of Stay: Validation of initial length of stay (LOS) issues; outline excess days opportunity compared to geometric mean length of stay (GMLOS).
  • Status Management: Evaluate current process and data for initial status placement and status management.
  • Departmental Opportunities: Evaluate case management, inpatient nursing, revenue cycle, health information management, hospitalists and emergency department opportunities.

The assessment revealed the opportunity for $2 million in additional annual revenue due to diversion and appropriate status management.

Results

In October 2020, the hospital partnered with QHR Health to achieve the goal of patients in the right status, level of care and an appropriate length of stay and quality care. QHR Health’s Clinical Resource Management assessment identified a high rate of observation status patients: nearly 40 percent of the hospital’s patients compared to a recommended level of 22 percent. Year to date through August 31, 2021, realized revenue due to a reduction in observation status patients is nearly $391,000. Annualized additional revenue is $586,000.

The assessment showed approximately 12 patients per month were transferred outside of the community due to unavailable beds (rather than clinical complexity). From February through August 2021, the hospital reduced patient transfers out, achieving $782,000 in additional revenue. Annualized additional revenue is $1.34 Million.

Client Quote

“Our partnership with QHR Health Clinical Resource Management is a triple win. We’ve implemented changes that improve the experience of the patients we care for, allow more patients to receive care within the community, and enable us to realize millions more in revenue.”
C-Level Executive
Midwestern Hospital

To learn more about QHR Health Clinical Resource Management, visit: https://qhr.com/solutions/clinical-consulting-services.