Hospitals and health systems across the country have stepped up in unprecedented ways to meet the challenges of COVID-19. They expanded intensive care capacity, developed COVID-19 units, and ramped up testing efforts as physicians and other health care workers continue to treat hundreds of thousands of Americans suffering from this virus.
This historic response comes with a massive price tag. Between March 1 and June 30, hospitals and health systems have experienced $202.6 billion in losses, or an average of $50.7 billion per month, according to the American Hospital Association. Many hospitals and health systems are looking to reduce expenses to offset their financial losses due to COVID-19.
Michigan Medicine (the University of Michigan’s Health System and Medical School) is among them. Michigan Medicine faced a projected $400 million dollar shortfall in funds due to expenses related to treating COVID-19 patients; reducing inpatient admissions to free up hospital beds; postponing ambulatory visits until new safety procedures were implemented; experiencing increased costs of care with procedures to lower transmission risks; and rapidly expanding the use of telemedicine visits, where possible, noted R. Van Harrison, PhD, Professor of Learning Health Sciences at the University of Michigan Medical School and a public member of the American Board of Physical Medicine and Rehabilitation’s Board of Directors.
In May, Michigan Medicine froze staff hiring, released all temporary personnel, projected that up to 1,400 employees would be laid off in the next two months, temporarily stopped construction of a new hospital, restricted travel, and reduced all permanent employee’s compensation by 10 percent for the next year (by eliminating the match to retirement accounts), he explained. In June, all the health system’s corporate support programs were scrutinized. They were deemed to being essential to providing care, recommended to continue because of high return on investment (ROI), put on hold for two years, or ended.
As Co-lead of the Michigan Medicine Maintenance of Certification Program at Michigan Medicine, Dr. Harrison was responsible for demonstrating the value of the program. An ABMS Portfolio Program Sponsor since 2011, QI activities at Michigan Medicine are often aligned with national priorities for improving health care, for example, decreasing infections in hospitalized patients with peripherally inserted central catheters as well as improving vaccination rates and decreasing risk for falls for ambulatory care patients. Other QI activities are aimed at local priorities, such as developing pathways to assure prompt, high quality care for infants hospitalized with fever and helping primary care physicians use modifications to the electronic health record system to improve the quality and efficiency of visit notes.
In a four-page report, Dr. Harrison detailed several direct, indirect, and intangible benefits of being an ABMS Portfolio Program Sponsor. By multiplying the number of physicians receiving continuing certification credit by the hours saved per physician by the cost of physician time, he demonstrated that the program has a high ROI. Specifically, $175,000 in expenses yields $900,000 worth of savings in physician time and work overload.
The program also:
- Provides continuing certification credit to about 250 Michigan Medicine physicians annually.
- Aligns the interests of Michigan Medicine physicians with the institution’s quality improvement (QI) priorities.
- Encourages Michigan Medicine QI leaders to develop longer term programs of QI activities.
- Offers continuing certification credit annually for about 100 community physicians who are engaged in activities related to Michigan Medicine.
Looking ahead, annual participation in the ABMS Portfolio Program by Michigan Medicine physicians is expected to increase by 50 to 100 physicians as the subspecialty divisions in Internal Medicine participate more systematically. The additional physician participation translates into an extra $187,500 to $375,000 savings in physician time. Discussions are underway with Mid-Michigan Health, an affiliate of Michigan Medicine, to offer continuing certification credit to its physicians as well. Being able to make this offer to strategic partners is an asset, Dr. Harrison said.
While the program was viewed as highly valued, it did not go unscathed. The scope of activities being performed was narrowed to only those central to the program and the program’s budget was reduced by one-third to $115,000.
Going through the financial review and recovery process reminded Dr. Harrison of the importance of getting the right people at the table. “In difficult financial times, people making decisions are likely to be influenced by their personal experience with continuing certification requirements,” he said. “In institutions where the final decision-maker has not personally benefited from the ABMS Portfolio Program, the decision to cease being a Sponsor may seem intuitively reasonable, even when presented with data about the benefit for other specialties,” he said. Additionally, some leaders are so focused on eliminating direct expenses on the institution’s budget that they are less concerned that this action will increase physicians’ personal workload.
Being an ABMS Portfolio Program Sponsor benefits some specialties more than others, Dr. Harrison noted. For example, physicians certified in Family Medicine, Internal Medicine, and Pediatrics have the most frequent opportunities for documented participation in QI activities to count toward continuing certification. Michigan Medicine requires that its physicians be certified as a condition of employment, and more than half of them are in these three specialties. The Chief Quality Officer, who is a general internist, is a staunch supporter of the program.
ABMS Portfolio Program Sponsors who find themselves looking to offset their financial losses due to COVID-19 will likely be faced with tough decisions. It’s imperative that they solicit input from individuals who have personally benefited from the program and who understand its true value, Dr. Harrison said.
If you need assistance in making the financial case for participating in the Portfolio Program, please contact Teena Nelson.
Read more Portfolio Program Sponsor Spotlights