Christiana also has improved patient data collection by service line. Quality metrics for every line is easily accessible and transparent to physicians, motivating them to improve, Nevin said. “We are driven around performance.”
Meanwhile, Advocate Lutheran General Hospital in Park Ridge, Ill., opened its Advocate Heart Institute clinic in 2015 to tackle cardiology costs. The clinic includes treatment for heart failure and chest pain patients. In a process integrated with the hospital, patients who come to the emergency department complaining of chest pain will be directed to the clinic if they don't require emergent care. This helps prevent unnecessary trips to the ED, said Dr. Leo Kelly, vice president of medical management for the hospital.
The readmission rate for heart failure patients at Lutheran General is 17.9%, which is lower than the 18.9% heart failure readmission rate for the highest-rated hospitals in the Crimson database, an Advisory Board Co. service used by Lutheran General that includes data from 800 hospitals. According to Truven's analysis, cardiology costs per patient discharge were $11,295 among the 100 Top facilities in 2014 compared with $11,725 among the peer group.
“We're making sure patients have the right resources at the right places at the right time,” said Barbara Weber, the hospital's chief operating officer. The 638-bed hospital has been on Truven's 100 Top Hospitals list 17 times.
Advocate Health Care, Lutheran's parent system, has also cut drug costs systemwide by developing a central service center for pharmaceuticals. Instead of buying prepackaged drugs, Advocate packages their meds—which they buy in bulk—at the centralized facility. The efforts have saved $2.1 million this year, Weber said.
Pharmaceutical spending was also the target of a cost-cutting initiative taken up by four-hospital Tanner Health System in Carrollton, Ga. The system set out to decrease drug spending in service lines that use medications the most, such as cardiology, infectious disease, oncology and surgery. Clinicians implemented evidence-based solutions to cut drug spending, such as opting for less expensive medications when appropriate or placing restrictions on ordering. The efforts have saved Tanner about $700,000 annually, said Carol Crews, Tanner's chief financial officer. Truven has recognized the health system four times in its annual 15 Top Health Systems list.
At Chesterfield, Mo.-based Mercy—which made Truven's 15 Top Health Systems list for the first time this year—physicians in the same service line meet to discuss specific initiatives, aiming to improve quality and also pare costs, said Shannon Sock, CFO of the 45-hospital system. For example, cardiologists teamed up on strategies to cut spending on preference items such as stents and pacemakers.
“To achieve the level of performance that is required, you really need all key stakeholders working in the same direction,” Sock said. “We need our physicians focused on the same objectives around quality and cost.”