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Case study: Uncovering performance improvement opportunities faster

3M client saved $1.5 million just three months after implementation

  • Hospital graphic

    Health system profile

    Location: Southeastern United States
    Type: Not-for-profit, teaching hospital with five affiliated hospitals in the region, offering multidisciplinary care to a 12-county area
    Beds: 499
    Annual revenue: $3.5 billion

    *Because of client confidentiality, this case study does not identify the organization by name. The snapshot description is accurate, and the facts and figures reported as results are true to 3M findings; only the institution’s name has been altered for privacy reasons.

The challenge

  • Hospital leadership at the organization knew it needed to improve operational performance by specifically shortening length-of-stay (LOS) in a clinically appropriate manner. Located in the urban center of a mid-sized city, the organization cares for a disproportionate share of publicly funded or uninsured patients compared to its competition in the market.

    Between financial pressures, accreditation concerns and quality objectives, the organization needed to find a solution. Leadership identified the following challenges and objectives:


    • Improve quality outcome metrics and reduce performance penalties and litigation
    • Grow and maintain market and financial position
    • Reduce unnecessary care and cost variation
    • Increase operational efficiency and align clinicians with evidence-based practices
    • Prepare for at-risk, value-based care contracts


The solution: Data insights with actionable intelligence

  • The organization’s leaders recognized they needed a deep and highly specific understanding of their organizational performance to tackle these challenges and meet their objectives. The organization expanded upon its 14-year relationship with 3M Health Information Systems (3M) and add the 3M performance improvement platform.

    The 3M performance improvement platform combines decades of coding and risk-adjustment methodology and experience from 3M with the data-processing power of Verily, a subsidiary of Alphabet Inc. (formerly Google Life Sciences).

The opportunity: $2.9 million in preventable excess LOS

  • The 3M team looked at the organization across multiple performance measures and uncovered three specific 3M™ All Patient Refined Diagnosis Related Group (APR-DRG) codes that encompassed the largest opportunity for performance improvement: hip fractures, lower limb traumas and amputations. The orthopedic surgery service line presented an opportunity to improve average length of stay (ALOS) with a potential financial impact of $2.9 million in savings and enhanced internal revenue.

The 3M approach: End-to-end analysis

  • 3M’s analytics and professional consulting services team was led by a physician, a seasoned engagement leader, four clinical transformation consultants (one physician, three nurses) and a project manager. The 3M team attacked the organization’s operational problems by considering coding, clinical documentation integrity (CDI), throughput/workflow opportunities, alignment with best practices and utilization of supplies and drugs.

    The 3M team soon eliminated factors such as coding and CDI, quickly identified the true root causes and implemented sustainable performance improvement for long-term, impactful results. By aligning with the hospital’s existing 3M data monitoring software, the 3M team addressed these areas:

    • Targeted chart reviews: Two critical issues emerged in the clinical workflow for limb amputation that resulted in a rigorous care process improvement for the targeted 3M APR-DRG code.
    • Coding reviews: Another 3M APR-DRG code’s severity of illness (SOI) level revealed an opportunity to improve and optimize the care process.
    • 3M data monitoring: from its series of dashboards and drill-down reports, the analysis displayed benchmarked opportunities in the capture rates of complications and comorbidities (CCs) and major complications and comorbidities (MCCs), as well as in potential revenue and case mix index opportunities.
    • Appropriate post-acute care placement: The 3M team worked with post-acute care facilities to reduce readmissions and drive appropriate patient placement, resulting in more revenue and better patient outcomes.

    Once root causes and solutions had been identified and back-end issues resolved, the 3M team worked with the organization to improve patient handoff communications between service lines and care team members; begin discharge planning and insurance authorization early; and introduce social workers into the care process sooner.

The opportunity list: Overcoming excessive LOS

  • Together, the 3M team and the organization selected the performance improvement projects from the opportunity list that would best combat the excessive LOS rates and improve throughput. These priorities emerged:

    • Anesthesiologists and orthopedic surgeons needed to improve their coordination of pre- and peri-operative patient pain management
    • Physical therapy and nursing teams needed to achieve earlier post-operative patient mobility
    • Sixty percent of the chart reviews should target specific 3M APR-DRGs and SOI levels and problematic records quickly escalated to the coding team
    • Orthopedic surgeons needed to adopt a single, streamlined post-operative order set to facilitate earlier patient mobilization
    • Social workers needed to drive an accelerated discharge process and reduce barriers to expedited post-acute placement

The results: Reduced LOS

  • Just three months after the implementation and on-site 3M advisory services, the organization reduced ALOS overall by 0.77 days and on the orthopedic surgery service line alone by 0.75 days—a 15 percent reduction—during a period when the organization’s case mix index also increased by 0.27.

Three months post-implementation, the organization saw impressive results

  • Reductions

    • 5% in volume of patients transferred to acute rehabilitation
    • 1.7 days in LOS for patients discharged to rehabilitation units
    • 1 day in LOS for patients discharged to skilled nursing facilities
    • 0.9 days in LOS for patients discharged to long-term acute care
    • $1.5 million in variable costs
    • 0.77 days ALOS
    • 364 excess LOS days
    • Clinical care variation across orthopedic surgery and cardiology service lines
  • Increases

    • 0.27 in case mix index
    • Alignment with evidence-based practices
    • Improved relationships between physicians, accrediting agencies and community partners

“3M said they would do all the heavy lifting and have lived up to that promise. Our executive team continues to be impressed with the talent the 3M team commits to our organization and how efficient and comprehensive they are at getting to the cause of our problems.”

executive vice president, not-for-profit, teaching hospital

Improvements realized faster with the 3M™ Performance Matrix Platform

  • To take on a project of this size and scope can be overwhelming, but the not-for-profit, teaching hospital and the 3M team were committed to deploying the data and using performance analytics methodologies to quickly identify the root causes. 3M PMx helps organizations achieve long-lasting, sustainable performance improvement across clinical, financial and quality measures.

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  • *3M and 360 Encompass are trademarks of 3M Company. The International Statistical Classification of Diseases and Related Health Problems—Tenth Revision (ICD-10) is copyrighted by the World Health Organization, Geneva, Switzerland 1992–2008.