LIVE WEBCAST PRESENTED ON FEBRUARY 27, 2014 · For more information, please contact us at: 75 Sylvan Street, Suite A-101, Danvers, MA 01923. Attendance at the webcast is restricted

1

LIVE WEBCAST PRESENTED ON FEBRUARY 27, 2014

2

Copyright Information

Copyright © 2014 HCPro, a division of BLR.

The “Orthopedics Service Line Success: Physician Engagement, Efficiency, and Quality” materials package is published by HCPro, a division of BLR. For more information, please contact us at: 75 Sylvan Street, Suite A-101, Danvers, MA 01923.

Attendance at the webcast is restricted to employees, consultants, and members of the medical staff of the Licensee. The webcast materials are intended solely for use in conjunction with the associated HCPro webcast. The Licensee may make copies of these materials for internal use by attendees of the webcast only. All such copies must bear the following legend: Dissemination of any information in these materials or the webcast to any party other than the Licensee or its employees is strictly prohibited.

In our materials, we strive to provide our audience with useful and timely information. The live webcast will follow the enclosed agenda. Occasionally, our speakers will refer to the enclosed materials. We have noticed that non-HCPro webcast materials often follow the speakers’ presentations bullet-by-bullet and page-by-page. However, because our presentations are less rigid and rely more on speaker interaction, we do not include each speaker’s entire presentation. The enclosed materials contain helpful resources, forms, crosswalks, policies, charts, and graphs. We hope that you will find this information useful in the future.

Although every precaution has been taken in the preparation of these materials, the publisher and speaker assume no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein. Advice given is general, and attendees and readers of the materials should consult professional counsel for specific legal, ethical, or clinical questions.

HCPro, a division of BLR, is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks; the Accreditation Council for Graduate Medical Education, which owns the ACGME trademark; or the Accreditation Association for Ambulatory Health Care (AAAHC).

3

We will begin shortly!

If you are not hearing music or you are experiencing any technical

difficulties, please contact our help desk at 888/364-8804.


4


5

Presented by:

James D. Holstine, DO

• Board certified Orthopedic Surgeon in active practice for 11 years

• System Quality director Orthopedics Peacehealth

• Medical Director Joint replacement center Geriatric fracture center

• Advisory board Marshall Steele\Stryker performance solutions

6

Presented by:

Marshall Steele, MD

• Medical Director

• Stryker Performance Solutions

• Orthopedic Surgeon

• Anne Arundel Medical Center, Annapolis, Md. (1977-2008)

• Founder Orthopedic Sports Medicine Center (22 surgeons)

• Former Medical Director

• Operating Room (1992-2005)

• Surgical Business Development (1995-2008)

• Founder, Marshall | Steele

• Author

7

Objectives

• Upcoming challenges, opportunities in orthopedics

• Six primary influencers of orthopedic service line success

• Leadership models and alignment strategies

• How to successfully implement, sustain, and improve

• Lessons learned

8

What Are the Upcoming Challenges/Opportunities?

• Economics

• Knowsumerism

• Competition

• Affordable Care Act

9

Economics

Economy, lower reimbursementslead to hospital layoffs

10

• Scientific Revolution – Evidence-based

• Information Revolution – Internet

• Transparency Revolution – Fueled by Knowsumers

11

The Importance of Patient Expectations in Predicting Functional Outcomes After Total Joint ArthoplastyN Mahomed, M Liang, E Cook, L Daltroy, P Fortin, A Fossel, J Katz. The Journal of Rheumatology2002; 29:6.

Patient Expectations vs. Provider Expectations

Knowsumerism

12

Fierce Competition

• Local

• Regional

• National

• International

13

Affordable Care ActSubspecialty Focused

13

14

15

RiskThe Big Shift

16

How Do We NegotiateThis Transition?

17

OrthopedicsGreat Place to Start

18

Why?

19

20

Orthopedics as a StrategicPlatform for Change

21

The FutureManaging the Continuum

21

22

How Do You LeverageThis Opportunity?

Orthopedic Service Line

Multidisciplinary Group of Clinicians andNon-Clinicians Organizing Care Around a

Particular Patient Condition

Integrated Practice Units

Harvard Business Review, October 2013 Porter and Lee.

23

Destination Centersby Subspecialty

• Joints

• Spine

• Fracture Care

• Sports Medicine

• Hand/Upper Extremity

• Foot/Ankle

• Pediatrics

24

Surgeon

Hospital

Co-Ownership

Co-Management

Traditional Model Destination Center

How Do We Get Clinical/Financial Integration?

25

Delivery SystemPatient-Centered

Performance Culture

Measurement, Benchmarking Hospital and Patient Reported

InnovationContinuous

Improvement

Your WHY

AlignmentPeople

6 Key Elements of aSuccessful Service Line

Structure

26

Physician Leadership Models:Pros and Cons

• Informal Involvement of Physicians

• Subspecialty Medical Director

• Orthopedic Medical Director

27

Subspecialty Medical Director

Administrator Program Coordinator/Navigator

Suggested Subspecialty Structure

28


Performance Culture



Improvement

Your WHY

AlignmentPeople


Structure

29

How Do I Create Alignment With All Physicians?

• Common Enemy/Vision – Your WHY

• Co-Management Agreements

• Employment

• Shared Risk – Bundled Payments

30

Mutual Defined Success

• Extraordinary Patient Satisfaction

• Proven Quality

• Lowest Costs

• Aligned Physicians and Staff

• Fantastic Reputation

• Volume

31

In the Direct Contract Model physicians provide oversight, they are not active managers.

Source: Safriet and Blau.8

Service Line Co-ManagementDirect Contract Model

32

Requirements

• Governance and Organizational Structure

• Co-Management Services, Roles, and Responsibilities

• Physician Participation Criteria

• Performance Standards, including benchmarks and time frames

• Co-Management Compensation

33

Range for participating physicians is 2%-6% of service line revenues

Compensation

34

Savings Distribution–An ExampleBundled Payments

Original Reimbursement : $20,000 Total cost of care for a Total Knee Replacement

$19,600

$

Actual Cost:$20,000 -$1,000 in savings

$19,000

$1,000

$600

Per Case to Physician – 125%

of typical fee ($1,200 per case is

typical)

$300 $300

Savings

$400

Target Price

2% Discount

Total Cost Savings: $1,000Savings from cost reduction

Net Savings Per Case: $600 $1,000 (savings) —$400 (discount)

1

Discount to Medicare:

$400

Target Price:

$19,600

2

3

4

4

35

EMPLOYMENT

36


Performance Culture



Improvement

Your WHY

AlignmentPeople


Structure

37

Patient Awareness / Trust

Community Service

3 Distinct Phases Phase 1: Education, Awareness, Preparation

38

Brochures• Joint• Spine• Fracture Guidebooks

• Joint• Spine• Fracture

Provide Multiple Tools for Community:Patients, PCPs, Family, Specialists

Seminars, PCPs, Specialists, Patients

39

Preparation/ Care

Phase 2:The Hospital Experience

40

Clinical Tools, Templates,Best PracticesPreoperative 30-Day Process

Ticket for Surgery

41

• On Time Starts

• Throughput

• Costs

• Patient Outcomes

• Dedicated Teams

• Block Schedule

• Balanced Daily/Weekly Vols.

• Anesthesia Protocols

Focus is Patient Safety,Physician and Staff Efficiency

Incorporate Safe and Efficient Operating Room

42

Expert Dedicated Team

43

Clinical Tools, Templates,Best Practices

Inpatient Scripted Daily Care Routine

Standardized Order Sets

44

Wellness and Teaching Culture

Group Physical Therapy

“Transition Class”

Preoperative Class

45

Post Hospital CareManagement

Growth Challenges

Phase 3: RehabilitationMeasurement & Monitoring

46

Continuous Innovation

• Feedback

- Nurse Callbacks

- Outpatient Rehab

- Reunion Luncheons

• Clinical Case Conferences

• Benchmarking Best Practices

• Performance Improvement Team

*Exercise Programs are designed to allow healthcare professionals to select appropriate exercises for their patients. The programs should be provided to a patient only upon recommendation of the patient’s physician and should be accompanied by instructions based on the patient’s particular medical needs. Patients should use the programs only under the supervision of a physician or physical therapist.

47


Performance Culture



Improvement

Your WHY

AlignmentPeople


Structure

48

CLINICALComplication Rate

- Surgical Site Infection

- Urinary Tract Infection

- PE Rate

- DVT Rate

- Hematoma

- Blood Transfusions

Readmission Rate

OPERATIONALCase Volume

Length of Stay

Discharge Disposition

- % Home

- % Subacute

- % Acute Rehab

- % Other

FINANCIALContribution Margin

- Direct Costs

- Implant Costs

Reimbursement

- % Commercial Insurance

- % Medicare

- % Medicaid

- % Other

OPERATING ROOM

Duration Accuracy

Prep Time

Surgery Time

Exit Time

PACU Time

SATISFACTIONOverall Satisfaction

Likelihood to Recommend

FUNCTIONALSF – WOMAC

Knee Society

Harris Hip

Measure What Matters

49

Easy to Read Dashboards

50

Internal ImprovementClinical

• Benchmarks

• Quarterly trends

• Effects of case mix shifts

51

Financial Example

52

Drill Down to Causes

53

• Who is the best practice in the group?• How can we standardize our results?

Share Comparison Data

54

Hospital ABC

Surgeon Scorecards

MetricJan –Mar 11

Apr –Jun 11

Jul –Sep 11

Oct –Dec 10

12 MonthAverage RHM Avg. M|S Avg.

LOS 3.52 3.12 2.81 2.76 3.01 3.09 2.97

Discharge to Home 74% 65% 81% 79% 75% 75% 74%

Blood Transfusion Rate 26% 23% 27% 18% 23% 26% 17%

Distance Walked 346 198 282 266 270 270 329

Flexion 83 80 88 95 87 86 91

Extension 4 6 3 4 4 4 4Primary Knee Implant Cost $5,947 $5,238 $4,914 $4,959 $5,251 $5,184 -

Primary Hip Implant Cost $6,516 $7,257 $6,154 $7,418 $7,039 $6,779 -

Surgery Time 96 94 93 104 98 104 93

ProcedureJan –Mar 11

Apr –Jun 11

Jul –Sep 11

Oct –Dec 10

12 Month Total

RMH Total Volume

Surgeon % of Total Vol.

Primary Knee 16 17 13 22 68 140 49%

Primary Hip 5 9 9 14 37 76 49%

Revision Knee 2 4 2 8 10 80%

Revision Hip - - - - - 8 -

Total 23 26 26 38 113 234 48%

55

Surgery Postop Survey

AggregateReports

6-12 Months

PatientResults

0

5

10

15

20

25

30

35

40

45

50

Pre‐op 6 week 3 months 6 months 1 year 2 years

T

o

t

a

l

S

c

o

r

e

Reduced WOMAC Scores

0

5

10

15

20

25

30

35

40

45

50

Pre‐op 6 week 3 months 6 months 1 year 2 years

T

o

t

a

l

S

c

o

r

e

Reduced WOMAC Scores

PreopSurvey

Marketing Materials

Patient Reported Outcomes

• Did the intervention succeed?

• Are the patients satisfied?

56

Industry Validated Surveys

Area Survey # of Questions Who Completes

Reduced WOMAC 12 Patient

Knee Society Score (KSS) 7 clinician, 3 patient Patient and Clinician


Harris Hip 10 clinician, 4 patient Patient and Clinician

Oswestry Disability Index (ODI) 10 Patient

Back Pain Visual Analog Scale (VAS) 1 Patient

Neck Disability Index (NDI) 10 Patient

Neck Pain Visual Analog Scale (VAS) 1 Patient

Osteoarthritis of the Knee

Osteoarthritis of the Hip

Low Back Pain

Neck Pain

Area Survey # of Questions Who Completes


Knee Society Score (KSS) 7 clinician, 3 patient Patient and Clinician


Harris Hip 10 clinician, 4 patient Patient and Clinician

Oswestry Disability Index (ODI) 10 Patient

Back Pain Visual Analog Scale (VAS) 1 Patient

Neck Disability Index (NDI) 10 Patient

Neck Pain Visual Analog Scale (VAS) 1 Patient

Osteoarthritis of the Knee

Osteoarthritis of the Hip

Low Back Pain

Neck Pain

57

Patient Reported Outcomes

58

Communicate Results

• Referring Physicians

• Insurance Companies

• Public

• Employers

• Hospital Employees

Performance Management

59


Performance Culture



Improvement

Your WHY

AlignmentPeople


Structure

60

Service Line Performance Team

•

60

Physical Therapy

Nursing

Anesthesia

Surgeons

Operating Room

Finance

IndependentPractitioners

Case Management

Surgeons Nursing

Administration Finance

Anesthesia Dietary

Physical Therapy Marketing

Operating Room Strategy

Preadmission Public Relations

Case Management Housekeeping

Surgeon Office Staff

Performance Improvement Team

61


Performance Culture



Improvement

Your WHY

AlignmentPeople


Structure

62

“Success as a doctor was not singularlydependent on hard work or my individual skill.

Culture and the systems it influences andcreates can have a larger influence on patient outcomes.”

63

High Performance Culture

• Focuses on WHY

• Embraces Reality

• Empowered Front Line

• Self-Motivated

• Sees and Speaks Up

• Transparent

• Healthy Dissatisfaction

• Simple and Relevant

• Encourages Vulnerability

64

4 A’sWhere Should You Start on Your Journey?

Assess

Architect

Assemble

Assure

6.7

6.7

6.3

6.3

6.2 5.6

5.4

5.3

4.8

Expertise andFocus

Evidence BasedStandardization

Measurmentand

Transparency

Service LineStructure

SafetyCollaboration /Alignment

ContinuousImprovement

Efficiency

Continuum ofCare

Baseline Process of Care Scores

7 6 5 4 3 2 1 0

7

7

7

7

5

3

3

1

0

0

Mortality

Complications

Surgical Site

Infections

Patient

ReportedOutcomes

DischargeDisposition

BloodTransfusions

Length Of Stay

Readmissions

Fall Rate

Patient

Satisfaction

Results ‐ Baseline Scores

7 6 5 4 3 2 1 0

How do you compare?

65

Next

Project plan

Gannt Chart

Assess

Architect

Assemble

Assure

66

Finally

Assess

Architect

Assemble

Assure

67

Lessons Learned

• Effective physician, staff leadership is essential

• Experts – faster, better, less expensively

• Variability – enemy of quality

• Transparency speeds improvement

68

Lessons Learned

• Culture trumps process any day, any time

• People and relationships are Culture

• All challenges should be looked at as partnerships and not directives

• Hyper vigilance is required for communication and program oversight, you are only just beginning at all stages of a project

• In times of conflict or disagreement always think about what’s the right decision for the patient

• Never give up

69

Questions & Answers

James D. Holstine, DO PeaceHealth St. Joseph

Medical CenterBellingham, Wash.

Marshall Steele, MDOrthopedic Surgery

Medical Director Stryker Performance Solutions

Chicago

70

Thank you for attending!

For more information on programs HCPro offers, please visit

http://www.hcmarketplace.com.

Click here to receive 20% off Orthopedics and Spine: Innovative Strategies for Service Line Success, Second Edition:

http://hcmarketplace.com/orthopedics-and-spine-strategies-for-superior-service-line-performance.

Enter EB315847 in the Discount Code field at checkout and select ‘Apply Code’ to receive the 20% discount.

Written by an entire team of orthopedic and spine service line experts including Marshall K. Steele, MD, this book will help maximize the orthopedic service line's success.

71

This concludes today’s program.

Please do not close your browser. When the presentation ends youwill be automatically redirected

to the post-event survey.

Certificate of Attendance

_________________________________________________________________________________________________________________________________________________

attended

“Orthopedics Service Line Success: Physician Engagement, Efficiency, and Quality”

a 90‐minute webcast on

February 27, 2014

Elizabeth Petersen Vice President, Healthcare HCPro, a division of BLR

75 Sylvan Street, Suite A‐101, Danvers, MA 01923

Documents

LIVE WEBCAST PRESENTED ON FEBRUARY 27, 2014 · For more information, please contact us at: 75 Sylvan Street, Suite A-101, Danvers, MA 01923. Attendance at the webcast is restricted