Asset Stewardship and the Board's 3 for Understanding and Improving Operational Efficiency

Asset stewardship has long been a key board responsibility. As fiduciaries of a health care organization’s assets, governing boards are required to act in the best interest of the organization, ensuring that resources are used in a reasonable, appropriate and legally accountable way to meet community health care needs. However, ensuring the best use of the organization’s human, financial, physical and other resources is becoming more complex. Today’s hospitals face conflicting pressures that call for boards to effectively balance stewardship of existing assets with the need for appropriately investing in new resources to meet future challenges.

Capacity that falls short of demand for care and service, declining reimbursement from key payers, an expanding uninsured population and increasing consumer choice are just a few of the trends that make asset stewardship a challenging, yet critical, governance responsibility. To adequately discharge this responsibility, today’s boards need information and tools to help them understand how effectively existing assets are being used. With this knowledge, boards can then act as prudent fiduciaries, authorizing strategic investments in the additional resources their organizations need to meet their missions while assuring existing resources and investments are optimized.

The core business of hospitals is delivering care. Efficient, effective patient fl ow is the engine that drives optimal care delivery and supports achievement of strategic goals, such as strong financial performance, high quality care, patient satisfaction and operational excellence. The goal of efficient and effective patient fl ow is not to move patients through their hospital stay more quickly. It is to deliver the appropriate care to a patient at the right time and in the right setting. This assures quality services, positive outcomes and best use of health care resources.

The Health Care Operating Cycle™ (figure in the attachment) can help boards understand where existing assets are primarily deployed in hospitals. The Cycle identifies the processes health care organizations conduct to help patients gain access to care, provide needed care and services, and realize associated revenue. Ensuring that assets are being most productively utilized to support patient access and service delivery processes maximizes the margin hospitals can achieve from revenue realization, building a solid foundation for long-term success.

The Cycle begins with “Patient Access”. This includes processes involved in managing demand, patient arrival and referral, service scheduling, securing financial sponsorship, and coordination of activities on the day of service. Next, “Service Delivery” involves placing patients, case management, care coordination, utilization management, capturing all charges associated with a patient’s care, transitioning patients throughout their stay and discharge, and preparing a room to receive the next patient. “Revenue Realization” includes activities such as care and service pricing, contracting, coding and documentation of care and services delivered, billing and follow-up, managing payment discrepancies and account resolution.

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