Proposed: improve efficiency, reimbursement and LOS through better utilization of inpatient imaging procedures

In recent years, most hospitals have gone through several rounds of cost cutting initiatives. While it is necessary and prudent to closely monitor operating costs and staff utilization, the focus needs to shift from cutting cost to increasing revenue. This study examines the potential financial benefit of performing diagnostic imaging procedures that are ordered on inpatients the day of, or the day prior to discharge as outpatient exams, following discharge. While this analysis focuses on revenue enhancement, it will not lose site of the fact that patient safety and quality clinical care always come first. We selected three imaging modalities for study: CT, MR and nuclear cardiology. These modalities are unique because of their expensive nature, length of time to complete, and limited availability. Also, they typically yield the highest reimbursement per procedure when compared to other diagnostic imaging procedures. Yearly volume at North Shore University Hospital for CT, MR and nuclear cardiology studies performed on the day of or day before discharge is projected to be 1,120 studies. Sixty-two percent of the total is generated by nuclear stress tests, 34 percent by CT, and only 6 percent is related to MR. On an annual basis, approximately $840,800 in hospital charges will be generated for inpatient procedures performed on the day of or one day before discharge. Implementing change is a difficult and complicated process. The following are among many factors that must be carefully considered: physician education, consensus building, patient care guidelines, ongoing performance improvement activities and scheduling. This study focused on a small aspect of inpatient procedure utilization and identified reimbursement to the hospital. The most significant finding of this project relates to the fact that of the 323 CT and MR studies performed, 83 percent of the findings were positive, and the patients were still discharged. That fact further supports the concept of performing studies ordered on the day of or one day prior to discharge as outpatient procedures.