Long Beach Memorial

Measurement, Management and Sharing

from MetricsDouglas Garland, MD

Orthopedics & Rheumatology Conference

October 2015

Long Beach Memorial

3 Key Questions

• What’s Lacking In Hospitals Today?

• Why Should You Manage From Hospital Metrics?

• What You Need to Measure That You Don’t Measure Today?

Long Beach Memorial

250 Orthopedic Programs ImplementedBuilding Blocks of Superior Performance

Leadership TeamAccountabilityStrategy

Teamwork / Collaboration

Staff-Generated SolutionsStrive for PerfectionTransparency

SatisfactionClinical Operational

Functional Outcomes Financial

Education/ Teaching/ LearningCoordinated Care (PCP, Specialist) Pre Intervention Readiness Efficiencies (PreOp, OR, Unit)

Cutting Edge TechnologyDedicated Facilities

Standardized Care System

Ongoing Improvement & Innovation Marketing / Public Service

Patient / Family Empowerment

Physician Specialized Staff Access

Long Beach MemorialWhat’s Lacking in Hospitals?

Collaboration Amongst all Roles

•Aligned Incentives / Empowered Physicians

•Specialization / Teamwork

Therapist

Long Beach MemorialWhat’s Lacking in Hospitals?

Structure to Boost Performance

•Service Line Leadership Structure

•Written Goals / Specific Performance Metrics

•Specific Expectations and Responsibilities

Long Beach MemorialWhat’s Lacking in Hospitals?

Culture of Change

• Perfection Instead of Better Than Average

• Transparency Instead of Secrecy

• Focusing on Outputs Instead of Inputs

• Innovation Instead of “what’s always worked”

• Staff Empowerment Instead of “just following orders”

• Personality Instead of Faceless Institution

Long Beach Memorial

Effective/Efficient Patient-Focused Processes• Continuum of Care Focus• Primary Care Support and Collaboration• Community Service and Education • Effective Risk Management and Preparation• Efficient Operating Rooms • Organized Consistent Delivery System• Extraordinary Patient / Family Experience• Constant Innovation From Patient / Family Feedback

What’s Lacking in Hospitals?

Long Beach MemorialWhat’s Lacking in Hospitals?

Results

•Hospital Reported Outcomes, Benchmarked, Best Practice

• Clinical• Financial• Operational

•Patient Reported Outcomes

•Management From Metrics

Long Beach Memorial

• Do Your Staff and Physicians Have Hospital Reported Clinical, Operational and Financial Data At Their Fingertips?

• Do You Benchmark That Data With Other Hospitals To Understand Best Practices?

• Do You Use That Data For Ongoing Improvement?

Ask Yourself…

Long Beach Memorial

Financial, Clinical Success Tied To Effective Management

Service Line DevelopmentDestination Centers of Superior Performance® Joint Replacement

Inpatient Spine

Geriatric Fracture

The program is focused on the episode of care from the patient’s perspective:•AccessCommunity OutreachPrimary Care/Physician Office

•Non-Operative Care

•Operative CarePreadmission/OR/Inpatient Care/ Discharge

•Inpatient Care

•Post Hospital CarePost Discharge/Transition Care CoordinationMeasurement of Outcomes

Long Beach MemorialKeys to Measuring

• Choose Vital Few Relevant Metrics

• Easy To Understand

• Drill Down To Specific Details

• Analyze Multiple Ways

• Trend and Benchmark Against Best Practice

• Take Action

• Results Can Be Communicated

To Important Stakeholders

Long Beach Memorial

Our programs focus on improving clinical, operational, financial and satisfaction metrics that include:

• Discharge Home• Complication Rate• Blood Transfusions• Readmissions• Flexion/Extension• Distance Walked

• Discharge Home• Complication Rate• Blood Transfusions• Readmissions• Flexion/Extension• Distance Walked

ClinicalClinical

• Case Duration• Scheduling Accuracy• Prep Time• Surgery Time• Exit Time• PACU Time

• Case Duration• Scheduling Accuracy• Prep Time• Surgery Time• Exit Time• PACU Time

Operating RoomOperating Room

• Reimbursement• Contribution Margin• Commercial Payor (%)• Direct Cost• Implant Cost

• Reimbursement• Contribution Margin• Commercial Payor (%)• Direct Cost• Implant Cost

FinancialFinancial

• Patient Satisfaction• Likely to Refer• Patient Satisfaction• Likely to Refer

SatisfactionSatisfaction

• Volume• Lengthy of Stay• Discharge Disposition

• Volume• Lengthy of Stay• Discharge Disposition

OperationalOperational

Choose Just a Vital Few Metrics

Long Beach Memorial

Extract Data Into Comprehensive Dashboard

Long Beach MemorialSelect the Measure to Improve

Long Beach Memorial

Drill Down and Analyze – 80 Different Ways

Long Beach Memorial

• Promote Top Performers

• Tier Networks Based on Cost and Quality

• Put the Risk on the Providers

• Tie Reimbursement to Results

Payers Testing Different Options

Long Beach Memorial Bundled Payments

Acute Care Episode (ACE Project)• Hospital Gives Medicare a Discount• Hospital Receives Entire Payment Part A & B• Patient and Physicians Get a Cut of the Savings

Extended ACE• Will Also Include Rehabilitation

Long Beach Memorial

Share Results – Primary Care Physicians & Insurers

Long Beach Memorial Patient Reported Outcomes

Long Beach Memorial

Thank You

Any Questions?