Budget Cut Survival Skills

Maureen Fitzgerald, NIATx editor, gave me a copy of the last issue of Alcoholism and Drug Abuse Weekly with a note saying “Why don’t you blog about this?”. It was attached to an article on Washington state’s budget proposal to eliminate adult substance abuse treatment funding. My first thought was, “Why would I want to write about more depressing state budget news? Everyone knows about that already.” But as I gave it more thought over the weekend, I decided maybe she was right.

First, Washington is not the first state to propose drastic cuts. Almost every state is facing similar problems and proposing similarly draconian solutions. Providers in Illinois, Maine, and other states have fought off huge cuts in addiction treatment budgets through advocacy and finding other places in state government administrative costs that made more sense to cut. So the first thing to do is know your state budget and get to know your legislative representatives and make sure they know and appreciate you. Good advocacy is your first line of defense.

An equally important second line of defense is preparing for reduced government funding by diversifying revenue streams. Any business that is reliant on a single customer is vulnerable, whether that customer is government or General Motors. Over 70% of people who need treatment have insurance. They either are not seeking treatment or not seeking treatment from you. Many businesses are self-insured. If you can demonstrate positive outcomes and get their employees back to productive employment, they will use you over and over again. These are the obvious sources of new revenue. What are some less obvious sources that you have found?

Another important thing to do is to streamline and automate to reduce costs. This is what NIATx teaches. Maybe you have done a few changes to reduce wait times or increase retention. If you have only partially adopted process improvement or only done a few projects, it’s time to dig in and look at every process at your organization and ask “How can we simplify? Is it possible to automate this and how cheaply can we do that?”

It's hard to think about the second line of defense when you are freaking out about the first. But you can't neglect potential revenue streams or cost reduction if you are going to ride this wave of change in the funding environment. NIATx has developed some resources to help you in these tough budget times, including the NIATx Third-party Billing Guide and new Promising Practices related to increasing reimbursement.

Let us know the creative ways that you have managed funding transitions. I know there is a lot we are missing sitting here in our ivory tower and it would be great if those of you who have been managing budget cuts since 2007 had some words of wisdom for the folks in Washington and other states who may be experiencing their first year of panic.

Data Is Your Friend!

When you're conducting a change project, it's easy to get swept up in the excitement of developing and testing different changes. It's crucial to remember that what you are ultimately seeking is a new process that will not only be a change from the old way of doing things, but an improvement on it.

Through data collection and analysis you can determine whether the change you are testing is actually an improvement, or if it's just a different way to get the same unsatisfactory outcome.

Collecting data may sound like a complex process, but we've developed some resources to help. The How to Collect Data page on the NIATx website is a great resource that includes a step-by-step guide to data collection. And the NIATx Tracking and Measuring Tools provide a set of data collection forms and spreadsheets that help you track, evaluate, and graph your data.

Ready, Aim, Improve

If you plunge into a change project without first defining your aim, you and your team are likely to flounder. It's like setting out on a road trip with no clear idea of your final destination. If you have only a vague notion of where you want to end up, you can waste a lot of time and a lot of gas and may decide to just turn around and go home.

A good aim statement keeps you focused on the process you want to improve. It's something you can return to throughout your project, especially when you and your team find yourselves drifting away from your targeted aim.

A good aim statement is specific. It should answer two questions: What are we trying to accomplish? And how will we know if the change is an improvement?

Here's an example: Reduce no-shows to assessment appointments by 50% from an average no-show rate of 80% to 40% by February 1, 2012.

Remember, the aim statement guides your entire change project.

How has a good aim statement helped you and your teams make progress toward your targeted aim?

Check out the Top Ten List for aim statements from the MD Anderson Cancer Center at the University of Texas: http://www3.mdanderson.org/streams/FullVideoPlayer.cfm?xml=perfImp%2Fconfig%2Fcs138_CFG

Using the walk-through in nursing homes

NIATx is participating in a collaborative research program to help older people live independently and stay in their homes.

Named the Active Aging Research Center, this program is funded through a grant from the federal Agency for Healthcare Research and Quality (AHRQ), whose mission is to improve health care for all Americans.

Key NIATx tools like the walk-through will play an important role in this program. I found the following 2-minute video an interesting example of how one man is using the walk-through to help him design better nursing homes.

http://www.wmtw.com/video/29191411/detail.html

Rapid-Cycle Testing and PDSA Cycles: Not the Same Thing

What does "rapid-cycle testing" mean to you? One of the five NIATx principles, rapid-cycle testing gives change teams a way to try out change ideas to see how they work.

I was at a wrap up session of a learning collaborative last week and one of the participants said, "We did PDSA but we didn't do rapid cycle and I think that was our problem". I think she was right. They did their change projects using a Plan-Do-Study-Act method, but they selected changes that took a long time to complete and measure and did not break them down into "small bites" (her own words).

Have you taken too big a bite in a PDSA Cycle only to find that you weren't doing rapid-cycle change at all? How did you regroup? Coaches, what do you do to help people make sure they are making their change cycles small enough to be done in a rapid-cycle way?