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

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

3. 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

4. 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

5. Getting Started

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

7. 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

8. Identification of Project Lead
Navigation
Nurse Champion
Business Lead
IT Resource

9. Collect Quality Baseline Data
DVT
SSI
LOS

10. Collect Patient Satisfaction Baseline
HCAP
Patient Satisfaction Survey

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

12. Define Best Practice Review Literature Finance Quality
Patient Satisfaction
Quality
Finance

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

14. 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

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

16. ERAs Protocol
Fluids
Narcotics
Temperature Control
Surgical Technique

17. Post Surgical
Pain Management
Early Ambulation
Clinical Milestones

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

19. Post-Op Monitoring
Rehab Status
Physician Follow-Up

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

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

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

23. Surgical Directions
541 N. Fairbanks Court
Suite 2740
Chicago, IL 60611
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