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Fall 2009


The Cost-Cutting Approach To Healthcare Reform

John M. Kunysz
FACHE, Chief Operating Officer, Quantum Clinical Navigation Systemâ„¢ , Charlotte, NC

You cannot open a newspaper or turn on the television today without hearing about healthcare reform and healthcare quality. The driving force behind healthcare reform is that it is currently 18.4% of our gross domestic product. Despite the amount of money being spent on healthcare, hospitals and practices alike are concerned with what may happen to already diminishing margins and therefore are looking to decrease costs.

Quantum CNS Continuum of Care

Quantum Clinical Navigation System™ has been quietly working in the background for more than twelve years providing proof of quality and helping hospitals, physicians and practices decrease costs and implement pay for performance models.

By capturing 50 perioperative indicators Quantum CNS can measure numerous types of outcomes:

  1. Efficiency measures such as case delays and cancelations;
  2. Practitioner performance, including measuring complications or incidents and answering the following two questions:
    • Which doctor is not performing according to best practices or industry guidelines for evidence based medicine?
    • How can we mentor the doctor to become a better practitioner?
  3. Critical quality indicators that assist in meeting JCAHO standards, SCIP initiatives and PFP initiatives. Quantum CNS also produces reports that allow clients to measure the CQI data by location, physician and comparative benchmarks. Numerous best practices have been instituted based on CQI results;
  4. Patient satisfaction through patient satisfaction surveys administered after surgery or once the patient has returned home, and
  5. CQI data captured throughout the continuum of care: patient check in, holding room, operating room, post-op, hospital floor, home, and reported back to the physician, surgeon and hospital.

Southeast Anesthesiology Consultants, the founding company of Quantum CNS, has been using the system since its creation. “We wanted to be able to measure, analyze and continuously improve our processes and performance,” said Dr. Richard Gilbert, President and CEO of Southeast Anesthesiology Consultants and Quantum CNS.

Quantum is designed to flow naturally with the patient care models already in use throughout physician groups and hospitals. Unlike expensive healthcare IT systems which force clinicians to bear the burden of cumbersome interfaces and extra steps, Quantum CNS provides a very high “return on clinician time” in addition to the standard “return on investment” model.

One example of the way Quantum CNS’s real time reporting helped Southeast Anesthesiology Consultants occurred in their Obstetrics Anesthesiology division. One of SAC’s physicians always received patient satisfaction scores of 98% or better. A few months ago, for no particular reason, this physician’s score began to drop dramatically. In less than two weeks he went from patient satisfaction scores of 99% to scores below 70%. Because of the real time reporting that this physician’s hospital chief received, SAC was able to quickly intervene, discuss the results with the physician and see immediate improvement with the scores rebounding to 99% in a matter of days. “It was remarkable,” commented John Kunysz, COO of Quantum CNS, “This particular physician’s scores dropped dramatically and then rebounded in less than 24 hours due to the data Quantum provides on a real time basis.” Actions like this have kept SAC’s overall patient satisfaction 98% or better for over five years. This kind of real time reporting and immediate focused intervention is not possible with most traditional QA programs using retrospective chart review.

Another way that Quantum CNS’s reporting data is invaluable for physicians and hospitals is that it can aid in payer negotiations. Instead of having to rely on payer data, SAC can proudly showcase their own data, prove that they are able to beat all national benchmarks and ultimately use it as a tool to negotiate better reimbursement rates.

Finally, Quantum Clinical Navigation System aids in cost reduction. If you were to achieve the level of benchmarks that Southeast Anesthesiology Consultants can achieve with antibiotic administration, lowering of myocardial infarction and stroke incidences nationwide the United States would save more than $5 billion in healthcare expenses each year. (See “Proper Antibiotic Administration Savings”, inset) These cost savings would allow hospitals and practices to begin implementing expensive technology, such as EMR systems, and could lessen the burden of healthcare reform on an already weak economy.

John M. Kunysz, FACHE, is a licensed CPA formerly with Pricewaterhouse Coopers and KPMG. He received his MBA from the University of California, Los Angeles, and Bachelor of Science degree from San Diego State University. For additional information regarding Quantum Clinical Navigation System visit www.quantumcns.com or call 1.800.354.3568.