Step by Step Approach for Implementation & Sustainability of the Bundled Payment Model Jeff Peters CEO, Surgical Directions

Agenda Step by Step Approach Expected Problems How to Address these Problems

Step by Step Approach Develop Institutional & Surgical Databases 1 Create Collaborative Governance Bodies 2 Support & Maintain Mentoring Physician Environment 3 Execute Training & Mentoring for Clinical Staff 4 Identify System-Wide Support To Achieve Financial & Tech Outcomes 5

Common Problems Lack of Physician Engagement Ineffective Physician Leadership Lack of IT Support Time Required to Assemble Information Non-Compliant Surgeons (Joint Costs, Supplies, Discharge to Rehab) Socioeconomic Challenging Populations Lack of Institutional Support & Navigation

Getting Started

Select Medical Director Define Goals Select Medical Director Select Steering Committee Surgeon Anesthesiologist Nursing Administration IT

Select Project Team Surgeon Anesthesia Lead Lead Care Manager Post Op Pharmacy Project Manager Administration Anesthesia Nurse Executive Navigation OR Business Manager Hospitalist IT PT Post Discharge

Identification of Project Lead Navigation Nurse Champion Business Lead IT Resource

Collect Quality Baseline Data DVT SSI LOS

Collect Patient Satisfaction Baseline HCAP Patient Satisfaction Survey

Collect Financial Baseline Data Cost per Stay Surgeon Cost Anesthesia Cost Post Discharge

Define Best Practice Review Literature Finance Quality Patient Satisfaction Quality Finance

Cost Quality Hospital LOS Surgeon DVT Anesthesia SSI Supplies Observe Current State Cost Hospital Surgeon Anesthesia Supplies Discharge Quality LOS DVT SSI Readmissions

Develop Protocols & Clinical Pathways Surgical Checklist Risk Screening Form Management of Abnormal Tests Protocols to Manage Co-morbidities Cardiac Depression Diabetes Pacemaker ICD Management Smoking Medication

Pre-Surgical Instruction Patient Education How to Prepare What to Expect NPO Status

ERAs Protocol Fluids Narcotics Temperature Control Surgical Technique

Post Surgical Pain Management Early Ambulation Clinical Milestones

How to Handle Questions Discharge Planning PT How to Handle Questions Home

Post-Op Monitoring Rehab Status Physician Follow-Up

Sources of Information Hospital Cost Physician Cost Facility PT Tests ER Visits

Develop Institution & Surgeon Score Cards Where Do We Get The Information? Who Produces The Score Cards?

How to Use The Information Who Identifies & Meets with Outlying Surgeons? Where Do We Have Organizational Opportunity?

Surgical Directions 541 N. Fairbanks Court Suite 2740 Chicago, IL 60611 T 312.870.5600 F 312.870.5601 www.SurgicalDirections.com