For our charge capture, we looked at our documentation—was it solid? And we did coding audits. There was really no magic to finding cost savings, but it did take a lot of discipline and focus. You have to get the low-hanging fruit but you also want to be sure you'll get sustainable performance.
[VISN 11] also has a decreasing number of veterans with third-party insurance. Since we don't score charity care, uncompensated care, and bad debt the way it can be done in the private sector, we need to compensate for that. For us it's part of our mission to help these vets, so if our [insurance earnings] are decreasing, we have to maximize what we get from the basic insurance.
When we get a budget increase, we need to show how we used that. Did we see more veterans? Then we need to show how many more veterans the system was accessible to. How did we improve our quality and patient satisfaction, and how many more new programs did we create? We measure the outcomes at the back end of our scorecard to see how much further we are stretching our dollars. We measure our margin not in margins … but look at the real value equation of access to care and quality versus cost.
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Although the VA has a unique set of circumstances surrounding funding, the fundamental challenges that VA facilities face are the same as in the private sector, Finegan says. "We have physician relation issues, access to capital, and getting the data," he says. "And our leadership is also looking to improve patient flow, quality, and safety while seeing some standard, good ol' fashioned savings. Healthcare is, in my mind, the ultimate unsolvable problem, and it will keep explorers like me in challenges for our entire career. But that's what makes it truly exciting."