CEO SUMMARY: In Philadelphia, Jefferson Health was looking for new revenue streams to help financial performance during the pandemic. It determined a strong opportunity existed by establishing a patient blood management program that included better anemia treatment options and utilized clinical lab test data.
BY IMPROVING BLOOD AND ANEMIA MANAGEMENT, the opportunity exists to measurably improve patient care, cut costs by a meaningful amount and even generate a new source of revenue for the hospital. In Philadelphia, this was the strategy pursued by administration and the clinical laboratory team at 18-hospital Jefferson Health.
Since the outbreak began, Jefferson has struggled with high numbers of SARS-CoV-2 cases in the community and the financial consequences of the pandemic. Hospital executives knew financial recovery would be driven by several operating initiatives.
“Coming out of COVID-19, the health system is under pressure. Revenues are down, margins are tight,” explained Chris Tomlinson, Enterprise Vice President of Clinical Lab/Pathology and Radiology/ Imaging at Jefferson Health. “It’s like getting punch drunk as an old boxer: You keep taking these hits; COVID-19 surges, blood shortages, staffing shortages, and supply chain disruptions.
“The health system was looking for opportunities that could drive revenue, cut costs, and decrease length of stay,” he added. “As one of its key operating initiatives, Jefferson settled on blood and anemia management to improve the bottom line as well as clinical outcomes.”
Successful patient blood management implementation requires a multidisciplinary effort within a hospital or health system. However, the hospital’s clinical laboratory and the blood bank can act as the starting point for these projects, Tomlinson told The Dark Report.
Labs Can Help Their Hospitals
“Lab managers need to get out of their comfort zones as lab leaders if they are to positively impact length of stay and trigger cost savings coming out of the COVID-19 pandemic,” he explained. “Blood utilization is not comfortable for all lab leaders. That’s not really the discipline studied by these leaders. But the lab team can initiate clinical collaborations, start a project, engage resources from different parts of the organization—such as quality and safety or the medical staff— and position the lab as leading high-value change.
“Hospital and health system labs don’t often get viewed that way,” he added. “They get viewed as providing just lab operations, but not providing additional value—such as impacting length of stay.”
With its patient blood management program, Jefferson targeted two areas:
- Transfusion: The goal is to save $2.6 million in blood acquisition costs over three years by reducing unnecessary, excessive, or avoidable transfusions.
- Anemia: The goal is to achieve $8.3 million in additional revenue and savings by improving surgical outcomes, reducing hospital patient length of stay, and increasing outpatient anemia treatment revenue.
Project Launched in 2021
The project started in 2021 after some starts and stops due to the COVID-19 pandemic. The timing ironically ended up working well, because the nation’s blood supply shortage made the transfusion and anemia projects more urgent.
“You need to change utilization quickly in the middle of blood shortage, and the shortage created a sense of urgency that definitely helped us,” Tomlinson observed.
Jefferson Health—which has 18 hospitals within its system and performs 11 million diagnostic tests annually—rolled out a set of meaningful clinical metrics and scorecards to identify all areas of opportunity and measure progress with anemia management and blood utilization reform.
“Our strategy on blood was to create visibility across the health system and post the metrics of every division,” Tomlinson said. “We wanted everybody accountable, we wanted every physician to be tracked among their peers, and every division to be tracked among its specialties and all of that against industry leading benchmarks.”
The goal of a comprehensive patient blood management program—including anemia oversight—is to optimize care of the patients’ own blood and only use transfusion when appropriate, said Joe Thomas, Vice President of Strategic Partnerships at Accumen, a healthcare consulting firm in Scottsdale, Ariz.
Accumen worked with Jefferson on its patient blood management initiative, including providing clinical analytics and anemia management software.
“It is expected that most organizations will probably see a combined 20% increase in the utilization and cost of blood over the next three years,” Thomas noted. “That is what the national trends tell us. So, for many of those hospitals and health systems that already spend millions of dollars a year on blood, this will be a massive hit. The opportunity isn’t price reduction, it is to improve utilization.”
Thomas and Tomlinson spoke at the Executive War College on Laboratory and Pathology Management in April. Their session was titled, “Anemia as An Opportunity to Add Value.”
Anemia can be exacerbated by blood loss during surgery. In those situations, a transfusion is a common response. However, the journal JAMA Internal Medicine noted in January 2018 that transfusion was one of the five most overused procedures in U.S. hospitals. Unnecessary transfusions and related practices also expose patients to the threat of serious reactions and infections.
Lab’s Role in Anemia Fixes
One noteworthy element in the Jefferson Health project to improve clinical services associated with blood products was to elevate the awareness of anemia as a factor in patient care. For example, when Jefferson Health looked at past cases of 32 non-emergency, high-blood-loss surgical procedures, it determined 39% of those patients were anemic prior to surgery.
By addressing anemic patients before a procedure, a health system can reduce the need for transfusions during or after a procedure while improving clinical recovery.
Laboratories play an important role in early anemia intervention via various blood-related tests; for example, to determine hemoglobin and iron levels.
Precautions for anemic patients prior to surgery include vitamin B12 supplements and iron infusions offered on an outpatient basis. Both steps can improve red blood cell counts and reduce the risk of transfusion during a procedure.
A snapshot from one division within Jefferson Health—which includes a large academic medical center—showed the financial and length-of-stay impacts from an anemia management program from July 2021 through March 2022:
- Outpatient infusion revenue (after costs) earned $100,000.
- Reduced length-of-stay costs for anemic patients equaled $25,000 per month.
- Average hospital length-of-stay reduction for patients in the anemia management program was 1.08 days.
- The best reductions were seen in bowel, spine, and high-risk orthopedic surgery.
Tomlinson expects those figures to grow past their initial amounts once the patient blood management program is optimized in the coming two years. In addition, the entire health system achieved blood utilization savings (acquisition cost only) of $2.9 million in over 18 months.
“Payback from this clinical program comes with revenue from anemia infusions, as well as reducing length of stay on the back-end that saves additional costs—and these benefits are in addition to savings in blood costs,” he said. “If length of stay is shortened by one day for an anemic patient prior to surgery, those are huge savings when multiplied over and over again.”
Labs Leading Change
For lab directors and pathologists who want to lead change, whether with a blood management program or other endeavor, Tomlinson said to study benchmarks first.
“Find some benchmarks, either in your peer group or some of the larger lab or hospital associations,” he suggested.
“Whatever benchmark your organization uses, see where you’re at and determine the opportunity. Start with what the opportunity is and ask whether the effort will bring meaningful results.”
Contact Chris Tomlinson at Christopher.Tomlinson@jefferson.edu; Joe Thomas at email@example.com.
Jefferson’s COVID-19 Testing Success at Airport May Lead to Other Diagnostic Tests
IN OFFERING AIRPORT TESTING FOR SARS-COV-2, Jefferson Health leaders made an assumption, only to discover the reality was different—in a good way.
In late 2020, Philadelphia International Airport asked the health system to set up a COVID-19 testing station onsite to aid with travelers who needed a test result before flying to meet destination requirements. This station also helped the airport open air routes with other countries where testing was a prerequisite.
“We thought it would be a boutique service,” said Chris Tomlinson, Enterprise Vice President of Clinical Lab/Pathology and Radiology/Imaging at Jefferson Health.
Instead, far more people than expected took advantage of the service for the polymerase chain reaction tests (rapid antigen tests were also offered). Tomlinson played The Dark Report a video clip showing the testing line extending down a corridor of a terminal. It resembled a throng of people waiting to get through airport security.
The testing volumes at Philadelphia International remain high. Jefferson’s lab leaders are contemplating how to build on that success by offering additional diagnostic tests, telehealth, and other healthcare services at the airport as more of a permanent walk-through clinic for travelers.
That point should not be lost on other innovative clinical labs—if testing success occurs in one area, look at other options that use the same processes or locations, particularly if convenience is a factor.