Written by: Isilay Civan MSc, PhDs, LEED AP O+M, as published in the Network, June 2014, vol 22, issue 2
The PPACA seeks to achieve improved quality and reduced costs
in Medicare. As explained in a Medical Construction & Design article by
Benjamin Davenny[1],
previously, at each discharge, Medicare was paying the hospital an operating
base payment along with other payments. Under the PPACA’s value-based
purchasing (VBP) program, the government will now hold a small percentage of
all operating base payments, which will be distributed to hospitals depending
on how they perform on quality measures. Value-based purchasing is budget
neutral; therefore, the incentive money paid to hospitals will be equal to the
amount withheld, and it will be based on how well hospitals perform relative to
each other.
In FY 2013, the VBP performance scores were based 70% on
clinical process measures and 30% on patient experiences. The patient
experience score was/is based on the (standardized and mandatory) Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Up to
80 points on the patient experience score can be achieved from HCAHPS scores
and up to 20 points can be achieved by a consistence score. HCAHPS results
contribute to the performance scores and are posted online at www.hospitalcompare.hhs.gov, as
required by the Deficit Reduction Act of 2005.
Sustainability
and the Hospital Experience
The HCAHPS Survey consists of 32 questions, 7 of which are
demographic and 4 are for screening purposes. The remaining 21 questions
address the patient’s hospital experience, with two HCAHPS questions directly
dealing with the healthcare environment in terms of cleanliness and quietness.
Every challenge can be turned into a unique opportunity. Through a
renewed focus on sustainable practices, lower scores may be improved, giving
hospitals a chance to rank higher. Because the money they receive will be tied
to their score on measurements like HCAHPS survey, the greater their score improvement,
the larger share they may get from the overall pie.
There is also a greater need to do more with less. With
operating budgets declining and focus on the built environment increasing, metrics
and ways for measuring cost-cutting will be more important than ever. According
to the 2013 survey[2]
of Health Facilities Management Magazine subscribers, only 38% include
performance metrics (such as the Environmental Protection Agency (EPA) Energy
Star rating, total waste generation or a recycling rate) in their senior
management dashboards. And only 45% of responding hospitals conducted energy
audits in 2013 — a drop of nearly 5% from 2010. Considering that we cannot
manage what we do not measure, hospitals will need to change their ways — soon.
Free Help
To that end, three American Hospital Association groups (American
Society for Healthcare Engineering, Association for the Healthcare Environment,
and the Association for Healthcare Resource & Materials Management)
collaborated on a website called the Sustainability Roadmap for Hospitals (www.sustainabilityroadmap.org). It
offers free tools and resources showing hospitals how to implement real-world
sustainability projects, enhance existing efforts, and share their
environmental successes with other facilities. The content includes general
information and specific measures for improving a facility's performance,
organized under five tabs: Topics, Drivers, Strategies, Implementation, and
Resources.
One of the reports referenced on the site (from the
Commonwealth Fund[3])
suggests that hospitals can save more than $15 billion in 10 years by
implementing such sustainability programs. Hospitals consume 2.5 times more
energy per square foot than other commercial buildings, spending more than $8.5
billion dollars annually on energy. As a result, the prospect of saving money
on energy costs and reducing reliance on fossil fuels is a huge driver for
undertaking sustainability initiatives. Several other opportunities for
reducing operational costs cited in the article:
·
Reducing
waste costs: The cost of waste disposal, especially disposal of expensive
regulated waste, is a common financial driver. Materials consumption in health
care facilities results in $10 billion annually in waste disposal costs.
Opportunities for cost reduction through smart source reduction and waste
management may be as high 40 to 70 % $4 to $7 billion annually.
·
Reducing
water costs: Hospitals are water-intensive. Today, water is relatively
inexpensive in the United States compared to other parts of the world. (For
example, in 2010 in Spokane, water cost $0.25/100 gallons, in El Paso $0.60,
and in San Diego $1.38, compared to $2.86/100 gallons in Glasgow, Scotland.)
Water prices are predicted to rise around the world and across the United
States. As large water users, hospitals have an opportunity to reduce water use
and improve water quality.
·
Reducing
supply chain costs: Supply chain costs are rising (along with waste,
water, and energy costs). Assessing opportunities to maximize material, supply,
and equipment use can drive down costs and have a positive environmental
impact.
