Knowledge, experience, and innovation are essential tools for revitalizing healthcare and healthcare facilities. These cases are concrete, real-life examples of the growth and improvement potential that can be realized with PDV Health Consulting.
Hospital Growth and Financial Stability
Hospitals in the United States get a significant portion of their income from Managed Care contracts and government programs, which can become an issue when costs rise and reimbursement falls. When rates change and programs are cut, healthcare facilities must have proactive plans in place or they can face big losses. One of Boston’s community hospitals was brought to the brink of closure by this type of financial strain. Signs pleading with visitors, philanthropists, and investors to “Save the Hospital” were posted through the lobbies and halls when they turned to Paul D. Vitale for a financial recovery strategy.
Value-Based Payment & Population Health
In 2005, the State of Massachusetts was experiencing intolerable escalations in Medicaid costs caused by varying social determinants that often led to hospitalization. An analysis showed that these costs were driven in part by frequent unnecessary admissions of dual-eligible geriatric patients who could have remained at home.
Case Study: Hospital Growth and Financial Stability
A situational analysis revealed that by consolidating departments, the hospital could dramatically reduce costs. The next step was to increase revenue. They began to build a new foundation of trust with the community and with their existing medical professionals and hospital personnel. Within the community, they sought out doctors who could help expand their service to fill subspecialty and inpatient beds.
These community doctors were mostly nearing retirement and needed help continuing to run their predominantly Medicare private practices. The doctors were able to focus on patient care and in turn, the hospital benefited from increased revenue and a more varied case mix. These relationships along with the department consolidations initiated a steady financial recovery.
The success of this transformation is that the costs were lowered and the revenue was increased without compromising the quality of comfort and care. After 10 years of partnership with Paul as Senior Director, this community hospital now has the strongest financial stability as one of New England’s prominent public hospitals, as well as the best quality indicators.
Case Study: Value-Based Payment & Population Health
To combat the rising costs and reduce unnecessary hospitalizations, Paul spearheaded a new PACE program, a pay-or-provider program primarily for Medicare and Medicaid seniors who were eligible for nursing home care but preferred to continue living at home. The program has a triple aim: quality results, lower cost per patient, and greater access. If managed carefully, the PACE program can deliver higher-quality outcomes at a lower cost.
Many seniors have been kept out of the hospital by the careful planning and management of the PACE program. Daily services initially included vital exercise, physical therapy, recreation, and two hot meals. Personal hygiene was subsequently added and has greatly increased the overall health and wellbeing of the clients by reducing the occurrence of pneumonia, urinary tract infections, and other diagnoses that often lead to senior hospitalization.
A capitated payment per member per month system allowed for the delivery of higher-quality care at an overall lower cost. The PACE program was not only profitable but also enjoyable, increasing the system’s community standing. It allowed PACE caregivers to provide noticeably better care, giving the seniors of Boston the opportunity to live the best possible lives. The program continues to reduce hospitalizations for seniors and remains financially successful 15 years later.