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Thoracic and Cardiovascular Surgery
Annual OutcomesReport
September 29, 2018
Edward Soltesz, MD MPHStaff SurgeonSurgical Director, Kaufman Center for Heart FailureDirector, Cardiac Surgery Affiliate Programs
CCF Affiliation program extends nationally with broad membership profile
MedStar
CC Florida
Sequoia Hospital
Piedmont Heart
Valley HealthSt. Luke’s
Froedtert
St. Francis Medical Center
Kings Daughters
Susquehanna Health
Rochester
Cleveland Clinic
Metro
Fisher Titus
Ashtabula
Lake West
Boston Children’s
Cleveland Clinic Heart & Vascular Affiliation drives value in four key areas
Quality & Reporting
Cost Containment
Clinical Care Delivery
ProgrammaticGrowth
Optimize quality infrastructure for reporting and improving quality outcomes
Gain strategic insights and tools to maximize and differentiate local and regional brand
Eliminate waste and excess spending across care delivery processes, ancillary services, and supply chain
Enhance and expand care delivery across the cardiovascular service line
Quality & Reporting –Highlights
6
• 3-Star Mitral Valve Replacement and Repair (MVRR) Rating
• Sequoia Outcomes Book
• Quality & Registry documentation improvement and support
• Quarterly Quality Meetings – Cardiac Surgery and Cardiovascular Medicine– Focused metric review and sharing of best practice to improve quality outcomes
• Education and conferences– Monthly Cardiac Registry Webinars – 3-day Cardiac Registry Boot Camp
Clinical Care Delivery – Highlights
• Annual clinical assessments & recommendations reports
• Mortality reviews and discussion during quality meetings
• Echo Over-reads• Sharing of best practices: processes, policies, protocols, education materials
• Education and conferences– Monthly Cleveland Clinic Nursing Grand Rounds – Cleveland Clinic ECMO Support Training – Cleveland Clinic Cath, EP, and Echo Conference
• Collaborative Projects with Continuous Improvement team: Operating Room & SPD Project
Cost Containment – Highlights
• Continuous improvement efficiencies initiated in Cath & EP Labs– Opportunity related to scheduling of cases, case start times, and physician
accountability to arrive on time– Cath Lab and procedural area to conduct workflow analysis by Cleveland
Clinic continuous improvement team
• Cath & EP Lab scheduling project and onsite assessment
• Initiated billing and coding documentation improvement assessment– Claims based quality measure analysis of CMS Hospital Specific Reports
(HSRs) for specific CMS Pay for Performance Programs
Programmatic Growth – Highlights
• Branding and Marketing– Promotion of physicians/ speaking engagements – Mitral Valve surgery market assessment
• Patient Experience assessment and best practices
• Physician Recruitment support
• Direct to Employer (DTE) Quality Profile development
• Education and conferences– Samson Global Leadership Academy – Cleveland Clinic Marketing Intensive – Patient Experience Summit – Cleveland Clinic Payment Innovation Summit– Alliance and Affiliate Cardiology and Cardiac Surgery Retreat
23%
10%
41%
26%
Sequoia Adult Cardiovascular Surgery
0
100
200
300
Category 1
2017 Cardiac Operations(N = 208)
Combined Valve
Isolated Valve
Other
Isolated CABG
Annual Volumes
2013 2014 2015 2016 2017
18%
22%
20%
21%
9%
10%
Cleveland Clinic Adult Cardiovascular Surgery
0
1000
2000
3000
4000
5000
Category 1
2017 Cardiac Operations(N = 4,586)
Combined Valve
Isolated Valve
Other
Isolated CABG
Aorta
PercutaneousValve
Annual Volumes
2012 2013 2014 2015 2016 2017
4
STS Quality Star Ratings
Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database
Conclusion: Sequoia is above average for CABG, AVR, and AVR + CABG star rated domains, low volume preventing 3-Star Rating.
90%
91%
92%
93%
94%
95%
96%
97%
98%
99%
Sequoia Cleveland ClinicNEOH
National NetworkAggregate
Sequoia Cleveland ClinicNEOH
National NetworkAggregate
Sequoia Cleveland ClinicNEOH
National NetworkAggregate
Isolated CABG(2017)
Isolated AVR(2016 - 2017)
CABG + AVR(2015 - 2017)
Quality Rating Overall % STS 50th %ile STS 90th %ile
STS Cardiac Surgery
Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database
0%
2%
4%
6%
8%
2013 2014 2015 2016 2017
CABG Risk-Adjusted Operative Mortality
Sequoia Cleveland Clinic NEOH STS Expected
JANUARY 2013 – DECEMBER 2017
STS Cardiac Surgery
Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database
JANUARY 2013 – DECEMBER 2017
0%
2%
4%
6%
8%
2013 2014 2015 2016 2017
AVR Risk-Adjusted Operative Mortality
Sequoia Cleveland Clinic NEOH STS Expected
STS Cardiac Surgery
Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database
JANUARY 2013 – DECEMBER 2017
0%
2%
4%
6%
8%
10%
2013 2014 2015 2016 2017
AVR+CABG Risk-Adjusted Operative Mortality
Sequoia Cleveland Clinic NEOH STS Expected
Importance of Volume for Star Ranking
All information contained in this document is proprietary and confidential. 18
CCF
Sequoia
STS AVR Composite Scores
STS CABG Composite Rating Across Affiliates/Alliances
All information contained in this document is proprietary and confidential. 19
STS AVR Composite Rating Across Affiliates/Alliances
All information contained in this document is proprietary and confidential. 20
STS AVR+CABG Composite Rating Across Affiliates/Alliances
All information contained in this document is proprietary and confidential. 21
STS MVR/MVr Composite Rating Across Affiliates/Alliances
All information contained in this document is proprietary and confidential. 22
STS MVR/MVr+CABG Composite Rating Across Affliates/Alliances
All information contained in this document is proprietary and confidential. 23
Sequoia Value is Driven Through…
• Experience with the most complex patients
• Highest quality outcomes
• High patient satisfaction
• Reduced long-term cost of care
• Improved long-term quality of life
• Shortened return to work time