Prior to 2016, leadership and staff at Winona Health — an independent, rural health care system in southeast Minnesota — identified workflow improvement opportunities for their medication charging process.
They dealt with multiple chargemasters where pharmacy drug costs differed across departments. This resulted in a mismatched relationship between patient charges and medication costs, meaning clinicians and pharmacists were unable to understand the total cost of care.
Through a close relationship between Winona Health and Cerner ITWorks℠, staff implemented a new medication pricing process, using PharmNet®, in October 2016.
"With this implementation, we can easily see what our usages and expenses are for each department," said Tami Ekern, PharmD, RPh, director of pharmacy. "This helps the pharmacy better control inventory and drug expenses."
As of August 2017, Winona Health staff experienced a decrease in total drug costs by $226,000, or a 5.5 percent change.1.
"Using Winona Health's CSI (Continuous System Improvement) tools, the team focused on improving documentation, mitigating financial risk, and improving safety," said Kathleen Lanik, vice president, quality and safety.
Having integrated PharmNet with Cerner Patient Accounting, Winona Health began tracking the downstream impacts at billing. The number of claims that were identified in the claims scrubber as missing national drug code decreased by 83 percent.
"When it came to our discharged not final billed charges, with our previous system, our billers had to mine accounts to see why there was a no charge for a patient service," said Audrey Pronschinske, director of revenue cycle. "Now that the information is more transparent, our time management has improved.
"Leveraging information technology (IT) to make our revenue cycle system work better allows us to shift our resources to other projects."
An informaticist audits the charges and if a medication is not charted properly, they can go to the clinician to correct the issue. The billing, coding and clinical teams are working together to identify missed charges and improperly documented medications.
"We are now able to enter one order for the duration of the patient's treatment instead of one on each separate encounter," said Jill Ender, PharmD, BCPS, informatics pharmacist. "This leads to smaller opportunity for errors and frees up time for our pharmacists to do more patient care activities."
As they look to the future, leadership plans to implement a similar ordering system for their supply chain management. Additionally, they want to utilize the technology for barcode scanning, improved workflows and reduced laboratory errors.
"Total trust in our vendors means we are successful," said Robin Hoeg, vice president, inpatient and senior services.
"Working side-by-side with Cerner ITWorks to continuously improve the way we work on these newer systems is what allows Winona Health to remain independent throughout these implementations. It has never been 'We are Winona, and they are Cerner.' We are one team."
1 From $4,087,761 in July 2016 to $3,861,634 in July 2017
2 From 287 errors in October 2016 to 48 in April 2018