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Reduce healthcare costs without sacrificing quality and flexibility

Article by Rebecca Flink, RN, BSN, MHA; MGMA Connection
March 2014


Ask most medical group leaders what their biggest challenge is and the answer is likely to be “taking the cost out of quality healthcare.” In fact, that was the No. 1 challenge in the MGMA “Medical Practice Today: What members have to say” research published in the July 2013 issue of the magazine (mgma.org/virtualconnection). To accomplish that feat, retain quality and improve patient satisfaction requires flexible solutions. Some healthcare professionals, including a group at a major outpatient center for West Virginia University (WVU) Healthcare, are using operational prototyping (OP). It allows teams to identify strategies, processes and physical spaces that work best for their practices and can be standardized in all locations.

The health system, an integrated healthcare provider in Morgantown, W.V., and a large system of clinics in the Midwest implemented OP 15 years ago, and professionals continue to repurpose their clinic space without gutting it every time.

OP is a process, not a manual or a piece of software, that encourages professionals to design spaces with efficiency and patient satisfaction in mind. It is a method of determining a unique set of best practices established by key personnel and team members who are mindful of cultural differences and population management challenges. The resulting standards become part of a manual, and they are incorporated into every organizational change, whether it is architectural design, space planning or staff interaction.

“Designing the medical office environment to address current objectives isn't easy,” says Jeffrey Milburn, MBA, CMPE, independently contracted consultant, MGMA Health Care Consulting Group.

“Organizations tend to fall into three general categories regarding planning. Some never develop a planning process and are basically only reactive to the environment. Others develop a plan every year and promptly shelve it to focus on more current issues. This is comparable to building an annual budget and never using it during the year. The third category is the organization using a formal process, regardless of the methodology, as a tool to develop goals and objectives, assign responsibility and frequently measure and report progress. It’s the organization developing and using the planning process that sees the greatest return on its resource investment.”

When using OP, professionals develop unique strategies,processes, methodologies and best practices for each system to contend with changing healthcare demand, reimbursement rate cuts, EHR mandates and limitations of existing facilities. These issues require reliable data to support decisions regarding optimal physician mix, projected revenues and expenses, and future real estate requirements as well as the best ways to gain efficiencies and improve staff interaction. Professionals who have used OP say the process helped them satisfy patient expectations, reduce expenses and ensure long-term viability of their practices.

How it works
The first step is to schedule a meeting of the OP team to envision how a practice wants to deliver care. The number of team members and their level of involvement will vary with each organization based on its management style, culture, size and structure, and where and how OP is to be implemented. Team representatives could include an administrator, a physician, a clinician, information technology (IT) and administrative support. Your team can then assess how the practice operates and ask pertinent questions, some of which might be:
  • Does the practice have an efficient EHR system?
  • How does staff manage supplies?
  • How does staff run labs?
  • Where are computers needed?
  • Is it preferable to have registration at a kiosk or a station?
Once executive leadership and the OP team buy in to the concept, the OP process begins, including determining and designing models. Through the process, your practice can:
  • Reduce capital requirements
  • Establish a consistent model of care and optimize its delivery
  • Create a consistent, quality patient experience
  • Develop efficient, flexible environments
  • Set group purchasing standards
  • Optimize the flow of space and processes
  • Support and solidify recognizable brand identity
  • Effectively implement and integrate technology
  • Improve staff interaction
  • Gain efficiencies throughout the practice
  • Standardize but with flexibility, adaptability, replicability and modular capability
OP in action
WVU, a 531-bed tertiary care center that serves as the primary teaching destination for the university’s medical schools and University Health Associates (UHA), the state’s largest multispecialty physician and dental group practice, recently completed an OP project. UHA leadership and WVU executives approved the use of the OP process to examine anticipated functions and components of a new facility, including operations modeling, standard facility pod development and development services.

During their planning for a 100,000-square-foot ambulatory care center (ACC) they used the process to:
  • Ensure that the ACC operations were community-based, with a user-friendly, consistent caregiver environment, flexibility and adaptability to change, and delivered exceptional care
  • Develop a more standardized model of care that allowed good interaction between staff, physicians and residents
  • Provide patients with easy access to physicians and diagnostic services outside the main campus
  • Build one health center with a replicable group practice module
  • Maximize exam room usage when physicians perform surgery or take days off
Professionals who have used operational prototyping say the process helped them satisfy patient expectations, reduce expenses and ensure long-term viability of their practices.

The process helped the team meet goals while keeping costs under control, says Kim Trimble, MPA, director of practice operations, WVU. “It incorporates flexibility into everything we’re doing, making our rooms more accommodating for multiple patient and physician types, and more cross-functional in their purpose,” she adds. Due to the success, the team is applying OP elements to its supply management process to incorporate a more efficient and effective computer-based supply system.

“The process sets us apart from our competition and is something we can apply across our practice in a multitude of ways. The investment we've made in OP today will be a value-add tomorrow,” Trimble explains.

They defined and refined standard modules of patient flow, IT, telecommunications, capital procurement, including equipment and furniture, and supply management. These teams and leadership were instrumental in creating a prototype that has been replicated for many years. And the key to that success is the flexibility of the model. It is important to recognize that there will be unknown operational challenges as you plan for the future. For example, you might need to use a room for exams today and tomorrow it will be repurposed for diabetes education or as a mini conference room.

Rebecca Flink, RN, BSN, MHA, is Practice Leader within Hammes Company’s Advisory Services. She is located in Brookfield, Wisconsin and can be reached at rflink@hammesco.com.


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