Doylestown Health's approach to Utilization Review

Doylestown’s journey: Eliminating wasted time to gain job satisfaction and 7X ROI

Mary Beth Mitchell knew there was a better way to approach Utilization Review (UR) at Doylestown Health and investigated a more efficient option. Three years and over 7X ROI later, her team’s investment in XSOLIS’ CORTEX data-driven UR solution has more than paid for itself.

As the Senior Executive Director, Care Transformation Strategies for Doylestown Hospital, she oversees a 270-bed facility with four full-time employees, admitting and discharging an average of 50 patients a day.

Chief among the list of concerns for her team: “It’s hard to find staff and cover them when they’re off, and you can never really have enough staff when the patients are getting more complex,” said Mary Beth. “It’s more critical that you dive into charts, which are also more complex to go through.”

The before-state for her UR team while using legacy solutions looked something like this:

Nurses began their day by going from one end of the floor to the other, or one chart to the next in their payer groupings.
UR documentation throughout the day was tricky — and subjective at best — because with traditional criteria, the patient doesn’t always fit squarely into checkboxes. This led to a fair amount of guesswork to “make the boxes turn green.”
A nurse may find a chart at 3:00 that they should have reviewed at 8:00, but they didn’t have a system to help prompt them toward this prioritization.
At the very end of their day, a nurse may have realized he or she needed to flip certain patients to inpatient (IP), when they had been in an observation status (OBS) all day. Getting in touch with a physician to change the status was challenging at the end of everyone’s workday.
The volume of charts to review caused aggregate delays as nursing shifts changed, because hospital ERs get busier on certain days, with Monday morning bringing retrospective reviews to cover as well.

The customized financial analysis that XSOLIS performed for Mary Beth during the sales process confirmed to her: “There was really no downside in looking at options to do things more efficiently and effectively.”

Doylestown adopted CORTEX in early 2019, which provided a more efficient way of reviewing a chart — and planning your day — from the onset.

“When you walk in first thing in the morning, you can see the cases that you need to do something about right away,” she said. “The focused priority is a huge benefit and a great way to start your day.”

Mary Beth describes receiving real-time information as “nurses having their own personal assistants,” because the CORTEX platform continuously reads the chart to offer opportunities that someone might have otherwise missed during the course of their day.

Doylestown experienced improvements in several areas in just the first three to six months:

OBS Rate
Doylestown began with a 16.7% OBS rate before CORTEX, which reduced to 14% within the first six months after go-live. This marks a 20% improvement, which has continued through the life of the partnership
OBS to IP Conversion Rate
Doylestown began with a 24.2% OBS to IP conversion rate, which increased to 33.2% within the first six months. This marks a 37.2% improvement
Exception Rate
The exception rate is an XSOLIS specific metric which identifies observation discharges with a length of stay 2+ midnights and a Max Care Level Score >75, indicating potential missed opportunities for conversion. During the first six months, the exception rate also went down, from 28.8% to 17.6%, marking a 37.2% improvement.
ROI
The customized financial impact analysis reassured Mary Beth CORTEX was worth a closer look and turned out to be on the conservative side. In the first six months, Doylestown was able to see a 4.6X return on their investment.

It was the fastest and smoothest go-live I’ve probably done. The support and knowledge of the XSOLIS team cannot be understated. They were onsite for a couple of weeks to ensure our success, and three years later, we still meet every other week,” said Mary Beth.

“We continue to give feedback on things that could further enhance the technology, and we see those changes made quickly. There are no cookie-cutter solutions out there, so XSOLIS’ service has really made the difference over time.”

Fine-tuning the advanced reporting capabilities — including with staff productivity reports that are not available via any other solutions — and constantly seeking improved processes for Doylestown has continued to pay off.

Three years in, their return on investment is currently around 7.23X ROI.

“Not only has the platform paid for itself, but it has obviously exceeded our expectations with reimbursement dollars as well as staff and clinical efficiencies,” said Mary Beth. “In the last year, we increased our bed capacity by 40 beds. I recently had a half-time nurse resign that I will not have to replace.”

In the wake of nursing shortages that continue to plague the healthcare industry, one could say that such efficiencies better enable Doylestown to “weather the storm.”

It can be difficult to change technology tools for a team who is used to doing UR a certain way. And in Doylestown’s case, Mary Beth was able to eliminate the use of other screening criteria, forgoing a hybrid approach to go “all-in” on XSOLIS.

She looks to her team’s feedback to assess the risks taken and changes made:

“My staff say they feel like they’re actually using their clinical expertise now, so we’ve eliminated the wasted time for them, replacing it with more job satisfaction. They’re not just combing through a chart, looking for a statement that will help them turn a box green anymore.”

But it goes beyond the efficiency. “The review consistency is just as important,” she said. “Being able to review with this level of automation is so much better than the manual approach we used in the past.”

'No Downside in Looking for a Better Way' to Do UR

Doylestown’s journey: Eliminating wasted time to gain job satisfaction and 7X ROI