Courtesy : www.managedhealthcareexecutive.com
Green healthcare faclilities
From Recycling and waste management programs to nontoxic paint and permeable pavement, hospitals across the country are implementing green initiatives to produce healthier environments for patients and staff, which they say saves not only energy, but money.
Among several provider facilities going green is Stony Brook University Hospital, in Stony Book, N.Y., which recently signed an agreement with the U.S. Environmental Protection Agency (EPA). The agreement outlines energy and water conservation, waste management and the use of environmentally friendly products, and the hospital is currently auditing areas to reduce energy consumption.
“A hospital is unique in that it’s a structure that operates 24/7,” says Andrew Bellina, EPA program coordinator, “So, there are opportunities for powering down in many areas of the hospital that do not impact the people that are working or the care of the patients.”
In addition, the hospital is taking on a number of initiatives designed to reuse materials and reduce material waste. For example, staff has eliminated the blue, disposable wrapping used for sanitary operating tools, says Bellina. Tools now arrive in reusable containers.
However, he notes, the hospital has to evaluate recycling from a practical standpoint while also maintaining strict accreditation standards. Even so, recycling at the hospital increased by about 420 tons in 2007 and 2008, and it is expected to be higher this year.
“It significantly affects your carbon footprint when you recycle waste instead of just throwing it out, because you don’t go through the actual mining, the treatment, the procurement, the manufacturing and the transportation,” he says. “You’re cutting all that out.”
Water conservation is another important aspect of the agreement struck with the EPA. Bellina notes water supply costs recently increased 20% in New York City. He predicts water shortages in as many as 36 states in the next three to five years.
The hospital is looking to conserve water in two ways. First, captured storm water can be reused for non-contact functions, such as watering lawns and landscaping. Second, he says, it will be important to reduce demand for water. The hospital is monitoring water use with equipment that limits water flow and reduces total use.
Going green will definitely show a return on investment in the long run, and in most cases, produce immediate savings, Bellina says.
“Five years ago it [going green] would have cost you money, and the payback would be seven, 10 or 12 years, but now there are immediate cost savings. For example, recycling is an immediate cost saver,” he says, “And you reap the economic benefits through the lifetime of the structure after that.”
Determining effects on the quality of care is not as easy, he says, but he postulates that once the hospital’s energy audits are complete and the air handling is upgraded to a more efficient mix of outdoor and indoor air, the quality of air will improve within the hospital. Better air means better health, especially for those who need respiratory care.
EAST CAROLINA HEART INSTITUTE
The structure has only been open for a year, but was built with energy efficiency in mind, according to Brian Floyd, executive director of the Heart Institute. It also contains recycled materials in the carpet as well as in bathroom, kitchen and ceiling tile.
Natural lighting is one feature that overlaps in the green movement and healthy hospital movement. An effort was made to light the Institute with large windows in patient rooms, physician work areas, waiting rooms, lobbies and cafes.
“Many studies show that people recover faster when they have access to sunlight, and we want to make people as comfortable as possible and acclimate them to the day and night cycles so they can heal faster,” Floyd says.
It also requires less energy to light the facility during the day. With the help of sensors, artificial lighting turns on only when someone is in the room and dims when natural light levels are adequate.
The utility plant powering the Institute operates on energy efficient air conditioning chillers, high-efficiency electric motors and variable-speed pumping and air flow systems, according to Floyd.
The monthly electricity expenses at the Heart Institute have averaged 30 cents per square foot, or $142,000 per month, since opening in January 2009, according to James Ryals, Media Specialist for the Heart Institute and Pitt County Memorial Hospital. To compare, over the same period, monthly electricity expenses in the main hospital have averaged 45 cents per square foot, or $533,000 per month. The main hospital was built in 1977, and is twice as big as the Heart Institute, says Ryals.
“The per-square-foot figures are a better basis for comparison than the monthly totals,” he says. “It’s safe to say that, with the efficiency measures we’ve taken, our power expenses at the Heart Institute are roughly 33% lower than the main hospital.”
Certain intangible cost savings, such as worker productivity, are harder to define, says Floyd, but he has noticed that retention of staff is higher and length of patient stays are shorter.
How To Remedy the Healthcare Hiring Crisis
November 18, 2022
Thad Price
Job candidates need to be shown that the workplace is flexible and set up to accommodate their individual needs.
If the pandemic showed us one thing, it’s that essential. workers. matter.
But as healthcare workers quit in droves, qualified candidates are slipping through the cracks.
With the current U.S. unemployment rate at 3.7%, the reality is we’re not short of people. We’re short of staff. So, where are they and how can we meet the needs of today’s healthcare professionals?
Discover your candidates’ wants and remedy the staffing crisis with these pro tips.
Encourage workers to show up for themselves
For years, workers have been led to disregard self-care for work. Physicians, nurses, and other healthcare professionals are a prime example of this as they are pressed to assume the responsibility for patients over themselves. They’re trained to prioritize others, no matter the cost — and that they don’t have the luxury of saying “no.” This can have a damaging effect not only with burnout, but the trajectory of their career.
Tammie Chang, M.D., in her article, “My Burnout Nearly Cost Me Everything. Now I Help Other Physicians Overcome It,” which was posted on the Harvard Business Review website, shares that healthcare providers “must show up for [them]selves before [they] can do right by others. Setting healthy boundaries around your time and energy is what will allow you to deliver the best care to your patients.” According to Chang, establishing these boundaries means guarding five key areas in your life: your emotional, physical, social, professional, and societal self.
Show applicants that your workplace is set-up for individuality, where their “yes” means “yes” and “no” means “no.” Because no job is worth sacrificing their well-being.
Don’t let candidates slip through the cracks
Plenty of traditional job platforms promise to plaster your jobs across the Web for a fixed price. Which sounds great; you know exactly how much you’ll be paying. But do you know what you’re paying for and where it’s going?
Let’s say there are two billboards off the highway. Option 1 has worked well in the past, is nicely priced and relatively low risk. But recent on-going construction has obstructed the view.
Option 2 hasn’t been used but is highly visible in a high traffic area. Which would you choose?
Option 1 may have worked well in the past, but it’s not the prime real estate it once was – making the investment fall flat. The real ROI lies with option 2, the board that is converting now. Ultimately, if your job posts aren’t following sites, they’re wedged between the same construction, debris and lack of visibility.
The moral of the story? Positioning is key to job advertising. And knowing where to market may be what sets your organization apart from the competition.
Compare traditional versus programmatic advertising and decide which is the best fit for you. After all, you want results, not holes in your wallet.
Traditional job advertising allows you to have a fixed budget while using old job data to inform decisions as to where to post your jobs. The only downside is traditional doesn’t track how your job posts are performing on each site nor do they target job seekers. So, when your budget is declining, your job bids become scarce and can become lost in the sea of the internet.
Programmatic job advertising takes a profile-driven data approach. It monitors candidate behavior to match the right job seeker to your job listing. It then tracks which sites are gaining the right traffic, turning bids up on the sites that are working and turning them down on the sites that are not. While your budget may not be fixed, it still delivers even higher caliber candidates due to artificially intelligent targeting.
Peek into your candidate’s mind
Put yourself in the mind of your candidate.
What do they want? What worries them? What makes them tick?
Many are mulling over salary and job security as inflation grows in today’s marketplace. They’re looking for jobs with flexibility, growth and security to settle the score of a teeter-tottering economy. If you position your jobs to accommodate these concerns, you’ll attract top talent and end circular hiring processes.
Consider these key benefits:
Flexibility
Unfortunately, medical staff can’t always deal with crises remotely. But according to Steelcase, CADRE, and HKS, “flexibility, especially scalability and modifiability, allows organizations to respond efficiently to emergent needs and delivery modes.” In addition, 72% of research respondents “felt that flexibility did not necessarily equate to a higher cost. The key was to incorporate flexibility as an operational strategy (…) as there is a growing market for telehealth and desire for more controlled scheduling.”
Instead of one-time bonuses or better benefits, take advantage of this booming telehealth industry via controlled shifts and remote opportunities. Healthcare extends far beyond the physician’s office and highlights the work-life balance your candidates crave.
Pay higher wages
As inflation runs rampant through the American economy, flexibility and higher wages are far more attractive than promised bonuses or benefits. Data from a Talroo Healthcare Report stated that 62% of healthcare job seekers said that higher pay would increase their likelihood of accepting an offer, while 53% said that flexibility was their top deciding factor.
In the same study,80% of job seekers were more likely to apply for a job with a transparent salary range. With workers fearing mass layoffs in an uncertain financial landscape, posting salary range puts their mind at ease. To stay competitive, offer at or above market wages and be upfront with your salary expectations.
The cost of vacancy vs. the cost to hire
When short-staffed and under stress, hiring can come at a high price – so, let’s break down the costs.
To better understand ROI when hiring and determining salary, compare these 3 metrics:
Cost of vacancy
While it varies by industry, the cost of vacancy (COV) can be estimated by dividing company revenue per employee by number of annual workdays. This gives you the average revenue produced by an employee daily.
Just note that it’s difficult to measure the negative impact open roles have on productivity. It adds to burnout by disintegrating team morale, which makes it even harder to tie a monetary value to these metrics.
Cost of a bad hire
The U.S. Department of Labor puts the cost of a bad hire at up to 30% of the employee’s first year wages. That means, if you hire an employee for $70,000 a year, the employer expense could be as high as $21,000. These factors include lost productivity and damage to your reputation as a quality care provider.
Cost to hire
According to the Brandon Hall Group, “the average cost to hire an essential worker is $340, and for organizations with 1,000 employees or less, the cost is $670.”
How to gain and retain your healthcare workers
Smart Job Titles are groundbreaking in the talent marketplace, allowing you to use recruitment analytics to check your job’s reach along with the best-performing job titles and descriptions. You also have the power to track your job posting progress, edit the description and manage budget. These titles give you the ability to vet and select candidates from the get-go and ensure you reach top talent fast.
If you want great hires, don’t simply set their sights on the “now”, but instill a vision for tomorrow. Staff training is a powerful retention tool in healthcare. So, for positions that don’t require certifications, offer in-house training or sponsor higher education. By positioning your organization as a place of learning, you’ll ease burnout all while filling the skills gap. With the freedom to move vertically and linearly, your culture will instill hope – reminding staff why they dedicated their lives to medicine in the first place.
Thad Price is the CEO of Talroo in Austin, Texas.
Bundled Payment Program Cost CMS $279 Million: JAMA Study
October 28, 2022
Peter Wehrwein
The program reduced per-episode spending as intended, the researchers found. But those savings were offset by bonuses paid to hospitals for beating financial benchmarks, leading to a net loss.
One of CMS’s signature value-based care programs wound up costing rather saving CMS money, according to results of a study published this week in JAMA.
Although the results can be interpreted in different ways, the study may put a dent in the reputation of value-based care and its promise as a way to rein in U.S. healthcare spending while also keeping the quality of care high.
The study by Sukruth A. Shashikumar of the Washington University School of Medicine in St. Louis and his colleagues showed that Bundled Payments for Care Improvement Advanced (BPCI-A) was associated with a $279 million increase in Medicare spending.
The program did achieve reduce per-episode spending as intended to the tune of $175 per episode, which tallied up to $75 million across nearly 430,000 episodes of care during the first two years of the program, according to the researchers’ calculations. But that savings in Medicare spending on clinical care was more than offset by the $762 million in the bonuses that CMS paid out to the hospitals participating in the program for beating the financial targets for those episodes.
CMS also assessed $408 million in financial penalties on hospitals that exceeded financial benchmarks, according to the figures reported in the JAMA. The bonuses exceeded the penalties by approximately $354 million, so the net financial result of the program was a cost of $279 million (the net payments of $354 million minus the $75 million in savings).
Shashikumar and his colleagues highlighted another finding: BPCI-A payments were skewed in favor of hospitals with a greater proportion of patients in poverty and from racial and minority groups, and those receiving Disproportionate Share Hospital payments.
An accompanying editorial by Joshua Liao, M.D., M.Sc., of University of Washington School of Medicine in Seattle and Amol Navathe, M.D., Ph.D., of the University of Pennsylvania in Philadelphia, said that “acknowledging net losses may reflect investments in more equitable participation” in the bundled payment program. “Ultimately,” wrote Liao and Navathe, “the priority of reducing spending through payment models must be balanced by the priority of combating structural inequities.”
Liao and Navathe also argue against emphasizing net losses when the BPCI-A was associated with changes in healthcare practices that reduced spending on healthcare. Benchmarks for episodes of care are difficult to set, they said, because the costs of episodes of care are volatile and influenced by factors such as the price of infused drugs.
Shashikumar and his colleagues say their results show that the target prices used by CMS are “not true counterfactuals.” They also mention the difficulty of prospectively determining target prices and recommending using Bayesian statistical methods to set them.
Another explanation for the net losses from the researchers is that the hospitals that saw higher price targets (which they believed they could beat) were more likely to participate in the program.
The findings in JAMA were based on calculations of payments made to 694 hospitals who volunteered to participate BPCI-A. The first two years of the program covered the period from Oct. 1, 2018, through Dec. 31, 2019.
BPCI-A sets up payments for 29 different kinds of episodes, ranging from myocardial infarction (heart attacks) to back and neck spinal fusions to urinary tract infections. According to Shashikumar and his colleagues, the most selected episode among the participating hospitals was congestive health failure, followed by sepsis and simple pneumonia and respiratory tract infection. The intent is to encourage cost-effective care by setting a target price for these episodes of care and then paying hospitals bonuses if they spend less than the target. Other value-based programs are based on patients rather than episodes of care.
The researchers calculated BPCI-A’s effect on per-episode spending by comparing spending differences between 2013 and 2019.
After the first two model years, the BPCI-A program was put on hold by CMS in 2020 because of the COVID-19 pandemic. The target prices were modified for the fourth year of the program, which covers 2021, but results from that year are not available yet for study, according to Shashikumar and his co-authors.
