The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


Looking for ways to improve the bottom line? Consider your revenue cycle.

By Truven Staff

An efficient revenue cycle has always been an important factor in the success of a healthcare organization. But in today’s complex and dynamic industry, where value-based reimbursement models are becoming the norm, streamlining the flow of money from payers to providers may be more important than ever.

That streamlining is just what Mountain States Health Alliance (MSHA) accomplished. Faced with looming financial challenges, leaders at this Tennessee health system sought a way to reduce expenses, and withstand financial pitfalls for the long term.

By implementing a Lean revenue cycle management (RCM) process, MSHA:

How did do they do it?

MHSA leaders did it through improved communication, transparency and consistency among departments, and the adoption of Lean tools for continuous process improvement.

Since RCM affects every patient in every department, MSHA had to tear down the walls separating the front end (scheduling, registration, financial counseling), the middle (medical records, coding, billing) and the back end (claim drop, liability, accounts receivable).

Daily huddles brought staff members together to discuss key metrics and share information. Progress was tracked on daily improvement boards that were visible to anyone. And Rapid Improvement Events helped staff members get a handle on the interconnectedness of their work, which in turn helped them identify redundancies, reduce variation and waste, and create standards of work.

And the results speak for themselves.

If you’d like more information on how the health system achieved this remarkable result, please reach out to us via our value-based care resource page.


Measuring the potential impact of a new palliative care service line

By Truven Staff

When you discover your mortality rates for stroke, pneumonia and heart failure aren’t where they need to be, what do you do?

The quality team at Carson Tahoe Health, a health system based in northern Nevada and eastern California, recently faced that challenge — and knew they had to answer two key questions: why is this happening and what can we do about it?

After a concentrated chart review, the health system discovered that the majority of patients who died in their care were at the end stages of their diseases.

Recent studies had pointed to the implementation of palliative care as a way to improve patient care and lower mortality rates. So to test the theory in their own environment, Carson Tahoe Health decided to roll out an inpatient care protocol in which hospitalists refer patients with end-of-life issues to a palliative care physician.

Comparing outcomes to determine progress

Using a clinical performance monitoring and benchmarking solution, the quality team was able to analyze several metrics, focusing on heart failure and chronic obstructive pulmonary disease (COPD) diagnosis-related groups in end stages of the diseases.

They tracked two groups of patients: those who participated in the palliative care protocol and those who did not. That way, cost, utilization, readmission, length of stay and other comparisons could be made.

The health system gained some key insights on the value of palliative care:

To see if they could move the dial even further on care improvement, the health system built and analyzed population reports to review the potential return on investment for an outpatient palliative program.

Informing the next step

With the new data and reports in hand, the health system proposed an outpatient palliative care service line to its board of directors, and the board approved it. Now Carson Tahoe Health offers a palliative care/heart failure chronic disease management clinic that sees patients within five days of discharge.

Seeing progress

After implementing the palliative care initiatives, the health system’s 30-day inpatient mortality rates for acute myocardial infarction, heart failure, COPD, pneumonia, stroke and coronary artery bypass graph surgery began trending lower than the national average.

They plan to expand palliative care services to other chronic end-stage disease groupings in the future.

If you’d like more information on how the health system achieved these results, . You can also read the .

Organizational Fibrillation: Studying the Cause of Organizational Malaise

By Truven Staff
Robert Sutter imageWhen I ask my clients how their performance improvement system is working, they often respond that it’s not working well, and they can't seem to make progress on performance improvement projects. Upon further discussion, it becomes clear that these organizations are afflicted with organizational fibrillation with respect to performance improvement.

When the heart is afflicted with fibrillation, the muscle fibers contract rapidly at their own pace and not in coordination with other muscle fibers. As a result the amount of blood pumped to the body is reduced. In other words, there is a lot of heart activity, but reduced heart output.

Many healthcare organizations are in same state with respect to their performance improvement system; there is a lot of activity, but minimal results. This is typically characterized by more performance improvement projects and other projects, such as tasks, being conducted simultaneously than can be supported by the performance improvement project leaders. Hence, they exist in a state of organizational fibrillation.

The causal factors associated with this condition are the lack of two important components of an effective performance improvement system:
1.    A supportive organizational infrastructure
2.    A systematic approach to performance improvement.

Joseph Juran said it best, "All improvement happens project by project and in no other way." This is the beacon guiding the implementation of an effective performance improvement system and the treatment of organizational fibrillation. It means that the key to improving organizational performance is to successfully execute as many performance improvement projects within a given time frame as possible. In order to achieve this, objective organizational defibrillation is required.

Robert Sutter, RN MBA MHA


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