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How Bundled Payments Change Reimbursement Landscape
Jeff Peters CEO, Surgical Directions
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Agenda How the business of perioperative services is changing Why bundles are here to stay Will bundles change under the new administration How reimbursement changes under bundles How should perioperative services be organized How the role of the OR Business Manager is evolving Case Study New Hanover
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Bundled Payment Covers the Entire Episode of Care
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Hospitals Survival in New Value Based Payment Environment
Bundled Payments Politically Agnostic Essential Competency Hospitals Survival in New Value Based Payment Environment
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Accountable Care Act VS. Repeal
ACA Repeal Increased covered populated Decreased reimbursement Decreased covered populated Not Recovering Decline in reimbursement
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“We can’t solve the problems of healthcare with incremental add-on solutions, we have to change the very structure of how we deliver and think about healthcare” ASA National Meeting 2016— Michael Porter PhD
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Adapting Perioperative Services to a Value Based Model
Cost Outcome Value
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Value Based Payments Now
26% of hospital patients are currently in value based payments Commercial carriers are moving to bundles Humana Tennessee Healthleaders 5/18/2017
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Never Has the Role of OR Business Manager Been More Important
Manage Infrastructure for Entire Surgical Episode (100 days post surgery) Educate Organization on New Paradigm Identify Key Success Factors Provide Information Provide Support
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Key Pillars for Success Under Bundles
Multidisciplinary Steering Committee Daily Huddle Governance Physician Leadership Resources Commitment Cost Quality Patient Satisfaction Surgeon Score Cards Information PAT ERAs Clinical Pathway Post Discharge Clinical Redesign
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Perioperative Organization Needs to Change
OR Director Duties & Details Historical Under Value Based Payment Span of Control Scheduling PAT OR PACU Surgical Floor SICU Title OR Director VP of Surgical Services
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Keys to Success Surgeon Education Metrics Physician Leadership P.I.T.
Anesthesia Information Case Time
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New Hanover Medical Center Case Study
Goal Create strategic alignment between Orthopedic & Colorectal Surgeons Become provider of choice for Orthopedic surgeons and their patients Strategy Surgical Home Co-Management Agreement
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Surgical Home Steering Committee
Member: Surgeon Anesthesia Nursing Responsibility: Clinical Metrics Dashboard Monitor Drive Change Address Issues Organizational Qualitative Redesign Consensus Goals
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Case Volumes – Total Joint Program
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Patient Satisfaction
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First Case On-Time Starts (FCOTS)
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Supply Costs
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Length of Stay
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All Payor Readmission Rate
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Discharge Disposition
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Transfusions
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Bundled Payment Models Demand Standardization to Be Successful
Total Knee Replacement Benchmark* Provider A Provider B Volume 21,966 516 236 Mortality 0.10% 0.00% 0.42% 30 Day Readmissions 3.65% 3.11% 9.79% Complications 10.69% 7.36% 15.25% LOS 3.24 2.75 3.86 Direct Cost per Case $12,041 $11,899 $14,038 Patient Satisfaction Top Decile 92% 86% *Premier Data Set Top Decile When there is large variation in cost and outcomes, organizations are not prepared to offer competitive pricing for bundled payment or take on the financial risk of managing the health outcome of a community
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Total Joint Replacement Colorectal (Open & Lap)
Results Total Joint Replacement Colorectal (Open & Lap) Baseline – FY ’14 Current – Nov ‘15 – Oct ’16 FY ’15 Nov ‘15 – Jan ‘16 Volume 2,180 2,260 50 10 Mortality 0.27% 0% 2.42% Complication 9.99% 6.77% 17.11% Readmission 5.25% 2.13% 13.56% Patient Satisfaction* 78% tile 89% tile 12% tile Under Review LOS 3.34 2.13 7.51 2.5 Cost per Case $12,163 $10,064 $10,219 *Communication with Doctors Source: Premier Items in red are higher than Premier Benchmark Total Joints 2,735 Additional patient days available Joint Readmissions now in line with Medicare penalty threshold Cost per case reduction of $2,099 equates to $4,743,740 in savings Colorectal Based on the provider participating, 50 additional patient days available
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Growth in Orthopedic Volume Increased Financial Performance
Outcome Growth in Orthopedic Volume Increased Financial Performance
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Surgical Directions 541 N. Fairbanks Court Suite 2740 Chicago, IL 60611 T F
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