A federally-financed program developed at the University of Michigan has produced a system that could save billions of dollars a year in hospital costs, according to U.S. officials.
The system, adopted in May here by Greater Southeast Community Hospital, has enabled the hospital to increase its occupancy rate, reduce waiting lists, improve the quality of care and effectively cut costs, according to Greater Southeast administrators.
If the program, called the Admissions Scheduling and Control System, is a good a hospital administrators and federal officials say it is, it could provide a major tool for busy hospitals to handle more patients without expanding and for hospitals with high vacancy rates to close unneeded beds and reduce costs.
Far from being a revolutionary new concept, the Admissions Scheduling and Control System adapts for hospitals, the techniques used for years by private industry. These techniques called operations research developed during World War II to allow American and English defense forces to get the maximum use out of a limited number of planes hunting German submarines.
The purpose of the new system is to give a hospital a more stable patient population y reducing as much as possible fluctuations in the patient census by scheduling elective surgical and medical patients for admission at times when the hospital is being relatively under-used.
Hospital care accounts for roughly 40 per cent of the $139 billion spent last year for medical care in this country and is the largest single item on te national medical bill.
Health, Education and Welfare Secretary Joseph A. Califano Jr. repeatedly has criticized the hospital industry for engaging in wasteful, inefficient practices. In an effort to control rising pital casts, President Carter, against the vehement objection of the American Hospital Association and the American Medical Association, has asked Congress to impose a limit of roughly 9 per cent on the annual increase in revenues that a hospital may receive.
Although the techniques involved in the admission scheduling system are relatively simple and well-known in the business world, it has been only recently that hospitals have come under pressure to find ways to minimize their costs and increase their efficiency.
Officials at Greater Southeast, which invested about $17,000 to have the system developed by a concultant estimate that it will save the hospital more than $750,000 a year. The hospital more than $750,000 a year. The hospital, at no additional cost according to administrators there, has been able to increase its occupancy rate from 88 per cent to 91 per cent. The savings to the hospital from the more efficient use of existing resources and personnel is about $6 a day per patient.
At the same time, Greater Southeast has been able to guarantee patients classified as "urgent" for surgical procedures that they will be operated on within 72 hours. Previously, Patients sometimes faced a two-week waiting period as emergency patients preempted space.
Hospital administrators generally consider an occupancy rate of about 85 per cent to be the optimum. Since that figure represents an average, the actual patient population may fluctuate widely. Greater Southeast has calculated that daily emergency admissions over the 21-day period vary from a low of about nine patients to a high of more than 35.
The trick for a crowded hospital like Greater Southeast is to find a way to bring in more nonemergency patients while still maintaining enough empty beds to accommodate the less predictable emergency admissions that will be coming in.
The admissions scheduling system also can be used to help hospitals close unneeded beds, possibly aiding in the reduction of a 100,000-bed surplus in the United States that is costing more than an estimated $1 billion a year.
Another product of the system, according to Greater Southeast administrators, is that they have been able to reduce cancelations for surgeries due to overcrowding from three a month to one every eight weeks, a reduction of 81 per cent.
Besides Greater Southeast, the system has been introduced at about a dozen hospitals in Michigan.Administrators in three separate hospitals describe teh system and their results in enthusiastic terms when interviewed. According to Barry M. Spero, executive director of the 250-bed Bon Secours HOspital in Grosse Pointe, Mich., "We're very, very pleased with it."
The problem Greater Southeast faced was accommodating its medical and surgical staff's demands for beds at the same time that the hospital was being denied permission to expand. Physicians were either sending their urgent patients elsewhere or bringing them in an emergency patients, thereby aggravating the problem.
"We were really too busy to handle it all," said Donald Rippert, Greater Southeast's finance director. About a year ago, Rippert heard a presentation given by Walton Hancock, an industrial engineers from the University of Michigan and the developer of the Admission Scheduling and Control System.
"What this said to us," Rippert said of the system, "was that maybe we can handle it. We really don't have to push more beds."
Hancock had developed the system at the university's Bureau of Hospital Administration. He took two years worth of information about admission practices and hospital census figures from Greater Southeast, and constructed a "simulator" - in effect a hospital in a computer. The simulator incorporated goals of a more stable patient population that Greater Southeast's administrators wanted to achieve.
From this procedure, Hancock was able to come up with rules for admission as well as suggestions for changing some practices.
For example, plastic surgery - generally non-urgent procedures that can be performed when time and space permits - was shifted to the weekend when the operating room and beds were available. Certain gynecological procedures of an elective, rather than urgent or emergency nature, also were shifted to the weekend since administrators knew that the patients would be out of the hospital before the Monday-Tuesday crunch began.
Those changes, combined with rules which differ for each day of the week about when and how many surgical patients to admit, have alowed Greater Southeast to increase its occupany and still allow for the less predictable emergency admissions that it must be able to accommodate.
Hospitals employing the system do not need a computer, although a computer is needed to construct it. What hospitals do need is information about their past admission and occupancy pratices so that a system can be constructed. And they need personnel with training sophisticated enough to allow them to monitor the system and make adjustments in it as experience is gained.
According to David Trites, chief of the health care instutions and financing branch of HEW's National Center for Health Services Research, the "vast majority" of American hospitals could use the system. Implementing the admissions scheduling system along with some related programs could save "billions" annually, Trites said.
One of the potential problems a hospital can encounter in installing the system is opposition from the rmedical staff. The solution at Greater Southeast, according to Tony Strande, director of system development, was simply to begin using the new system. "We didn't twist any arms," Strande said. "We just did it and afterwards told everybody how wonderful it was. And by then it really was."