Why Optimizing Productivity in the PFT Lab Matter$

Transcription

1 Why Optimizing Productivity in the PFT Lab Matter$ Matt O Brien MS, RRT, RPFT, FAARC FOCUS Spring 2018

2 Disclosures / Conflicts I am from Wisconsin. I have do not have any conflicts of interest related to this presentation. I have done education related work sponsored by MGC, Vyaire, Methapharm and ERT. Our pulmonary lab uses a variety of pulmonary function equipment.

3 Objectives Overview of the fiscal climate in most hospitals. Factors shaping this new reality. What is the health of your pulmonary / respiratory department? Finding efficiencies in capitol and operating expenses. Keep your job

4 Fiscal Climate Change Solid profit margins Adding services and staff Expansion Flattening profit margins Concern over costs and reimbursement Securing partnerships for market share Negative profit margins Consolidating services and reducing staff Exploring all strategies to stop the bleeding

5 My hospitals story The CFO warning margin Nov

6 The fiscal climate is not localized

7 Factors causing the new reality in healthcare An aging population Declining reimbursement Increased consumable costs Labor inefficiencies Poor management decisions

8 Declining Reimbursement Estimates Medicaid 15 cents Medicare 40 cents HMO 60 cents Private Commercial: 80 cents/dollar. Per Michael Buhl CFO-University of Wisconsin Hospital

9 Reimbursement: Who are your customers? Adult lab Pediatric lab West Clinic Typical day: approx. ~1/3 Medicare insured Five years from now 3/4? Baby boomers will turn 65 at a rate of 10,000/day for 18 years. AARP

10 Hospital Based Pulmonary Labs Relies on a cooperative/symbiotic relationship with physician groups. Pulmonary Nutrition Transplant Allergy/ Asthma Outside referrals Hospitals PFT Labs receive requests from a wide variety of sources. Pediatrics Oncology PFT Lab GI Surgery Cardiology Research

11 PFT Lab Economics Capitol equipment: >$5K Lifespan of ~8 years Older equipment can have a higher repair cost PFT Lab Multiple PFT vendors MGC, Vyaire, Nspire, ndd, Morgan, Ganshorn, Cosmed Small to large footprint for equipment Myriad of factors to consider: ease of use, reliability, reputation.

12 Specialized capitol equipment Before purchasing consider Is it FDA approved? Verify a billable CPT code exists. Does it support patient care? Will clinicians order it? Purchase with physician research funds, grants or donations.

13 PFT Lab Consumable Costs What is your cost per test? Filters Nose clips Sample lines Gas cylinders (disposable ED?) Gowns, gloves, masks Blood gas kits QC supplies Sample bags Masks Flow sensors Cleaning supplies Rental fees (tanks)

14 Service contracts Insurance policies to keep your equipment running. Do you have multiple PFT systems or only one? Try to negotiate in a favorable rate for service contracts when you purchase new equipment. Do you have quality biomedical support? (consider vendor training) Consider parts only service contracts. Preventive maintenance as needed / visits verses contracts. Does the vendor require an annual license fee?

15 Physician ordering practices PFT Lab Demand / volume may be going up..while reimbursement is going down.what to do? Encourage clinicians to only order what they need. Complete, Full, Formal PFTs Eval and perform appropriate testing Spiro Lung volumes / LCI DLCO Spiro pre/post BD Flow volume loop Methacholine/EIB/VO2/6MWT Metabolic Impulse oscillometry pre/post Airway resistance pre/post HAST / Shunt / RMF

16 Problems with fixed PFT profiles Often results in unneeded testing Drives up insurer costs $$$$ Increased co-insurance costs for the patient $$$$ Restricts available slots for patient testing Sorry we are scheduling out 3 weeks Can result in factory approach to testing rather than connecting with the patient to best assess the issue

17 Workflows in the PFT Lab Educate staff, allow them to modify workflows when indicated. Call when an order is inappropriate. Be an advocate for the patient.

18 Quality Assurance is still a must Quality checks apply to more than just the data. PFT biologic data in range? PFT simulator data in range? Data posting in EMR? Billing posted correctly? MD interpretations completed in a timely manner? Staff competencies up to date?

19 Spectrum of PFT testing offered Top revenue producing tests: Spirometry Lung volumes Diffusion capacity Post bronchodilator testing Can you afford to offer every specialized test? VO2 max Infant testing Can you afford to offer testing for every research protocol? LCI Spiro during CTs What specialized testing can we offer that has low entry costs? Methacholine / Mannitol / EIB Breath hydrogen testing FENO HAST / Shunt

20 Duplication of services Blood gas analysis: Core lab, PICU, NICU, ORs, PFT? Quality control, training, maintenance, reagents $$$ Cardiopulmonary exercise testing PFT adult and peds, Cardiology, Sports medicine Spirometry PFT, Allergy, Women s Health, off-site clinics

21 Supporting multi-disciplinary clinics Most multi-disciplinary clinics are poorly managed. Generally not an effective use of PFT staff time. Consider clinic volumes and prioritize who sees these patients first. Adult ALS clinic Adult MS clinic Pediatric muscle clinic Peds evening allergy clinic Adult severe asthma clinic Pediatric aerodigestive clinic Consider staggering arrival of clinic personnel.

22 Staffing considerations Flexing staff off as needed to reduce cost Stager lunch breaks Early testing or evening testing options More cross training of staff More part time positions as the PFT/RT workforce ages Request researchers fund some percentage of your staff FTE.

23 Productivity Metrics Various methods Procedure counts RVUs (Relative value units) Statistical counts PFT visit: patient satisfaction measures Add statistical counts for procedures you don t bill for. ABG puncture (if lab charges) Pulse oximetry Flow volume loop when bronchodilators were performed. Airway resistance (bodybox) Supine spirometry Patient teaching Research time

24 Strategies to optimize productivity Add a Testing System Given Capitol $$$$$...adding volume capability is crucial Adding volume capability is crucial. Allows you to meet peak demands. Back up if a system is down. Volume increases justify FTE increases. Second Spirometry system? Body box with DLCO capability? Alternative FRC method?

25 Strategies to optimize productivity Educate and challenge staff Pulmonary staff should be willing to learn new skills. Incentivize earning NBRC credentials Vendor sponsored training. FOCUS, AARC, ATS and State Society meetings. Encourage research projects.

26 Strategies to optimize productivity Market Your Lab Let clinicians know what's new. An ed newsletter is a simple way to get the message out. Encourage fellows and residents to attend a rotation in the lab. Demo testing at monthly education meetings. LCI New Methacholine testing Eucapnic challenge New research capability New GLI spiro predicteds New GLI DLCO predicteds Expanded hours of operation

27 Strategies to optimize productivity Network with Peers AARConnect Join the Diagnostics specialty section Post a question Contact peers directly Respiratory Care Journal AARC Times Call Other Labs Affiliates Friends Competition

28 What can vendors do to help? Two year new equipment warranty. Reduce the price of service contracts. Integrate a basic EMR interface software in the purchase of a system. Develop new testing sequences for screening patients. Develop more mobile Spiro, DLCO, LCI platforms. Make a biodegradable PFT filter.

29 Summary / Future Pulmonary / Respiratory departments need to continue to evaluate productivity and minimize expenses. Specialized testing may become more consolidated. Vendor help will be needed to help us adapt to this fiscal climate change. Matt O Brien MS, RRT, RPFT, FAARC mobrien@uwhealth.org

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