1. Psh PERIOPERATIVE SURGICAL HOME
R. Matt Schantz, MD
MARCH 17, 2018

2. PSH is a team approach to patient centered perioperative care
R. Matt Schantz, MD
MARCH 17, 2018

3. THE LARGEST INDEPENDENT PHYSICIAN GROUP IN SOUTHWEST OHIO
R. Matt Schantz, MD
MARCH 17, 2018

4. Patient Story
R. Matt Schantz, MD
MARCH 17, 2018

5. What is the PSH?
The PSH is a patient-centered, physician-led interdisciplinary, and team-based system of coordinated patient care
Spans the entire experience from decision of the need for any invasive procedure—surgical, diagnostic, or therapeutic—to discharge from the acute-care facility and beyond
R. Matt Schantz, MD
MARCH 17, 2018

6. What is the goal?
The goal of the PSH is to enhance value and help achieve the Triple Aim: a better patient experience, better health care, and lower costs.
R. Matt Schantz, MD
MARCH 17, 2018

7. ASA Perioperative Surgical Home
R. Matt Schantz, MD
MARCH 17, 2018

8. Create Consistent Seamless Care
Patient-Centered Medical
Home Team
Perioperative Surgical
Home Process
R. Matt Schantz, MD
MARCH 17, 2018

9. Why now ?? “opportunities” to improve
Perioperative care plans are variable and fragmented = “Silos” of care
The decision of the need for surgery or an invasive procedure often disconnects patients from their usual medical care
Patients may experience lapses in care, duplication of tests, and preventable harm
Costs rise, complications might occur, team members frustrated, patient and family endure a low quality of care experience
Communication lapses in transition from surgery to medical home
R. Matt Schantz, MD
MARCH 17, 2018

10. benefits Early Patient Engagement and concierge treatment
Reduce patient confusion – unified message and instructions
“Prehabilitation” -Identify High Risk Patients and optimize surgical preparation
Reduce practice variability through best practice protocols
Improve efficiency, outcomes and cost savings will follow
R. Matt Schantz, MD
MARCH 17, 2018

11. Value based payments
HR2: Medicare Acess and CHIP reauthorization act (MACRA) of 2015
30% of Medicare payments
value-based in 2016
50% by 2018
Private payers are shifting
R. Matt Schantz, MD
MARCH 17, 2018

12. What is Anesthesiology’s Role?
Natural evolution in practice and continuum of care from anesthesiologist inside OR to perioperative physician
Already expert in:
Preoperative evaluation
Management of intraoperative and PACU care
Critical care and pain medicine
Application of knowledge, skills and experience to all perioperative care
R. Matt Schantz, MD
MARCH 17, 2018

13. An anesthesiologist’s perspective…
“From the anesthesiologist’s perspective, we, as anesthesiologists, have to understand that we are physicians, that our practice of medicine should not be limited solely to the intraoperative period. We have to step up to the plate and say that we are perioperative physicians so that we can help optimize patients preoperatively, reduce variability intraoperatively, and help surgeons with the medical management of patients postoperatively to reduce the likelihood of readmissions and shorten the length of stay. We are capable of doing these things, and we need to step up to the plate and actually do them.”
Zeev Kain, MD, MBA—chair of the department of anesthesiology & perioperative medicine and associate dean for clinical operations for UC Irvine Health
R. Matt Schantz, MD
MARCH 17, 2018

14. A surgeon’s perspective..
“From my perspective as a surgeon, it streamlines my work. I don’t have to waste time or resources on things that I’m not proficient in. I have other team members and stakeholders who are better in different parts of the process of caring for the patient and taking that responsibility. So I have more time and resources to do what I know to do best—see my patients in clinics, perform surgeries, and take care of patients.”
~Ran Schwarzkopf, MD
Assistant clinical professor of orthopaedic surgery, University of California, Irvine (UC Irvine)
R. Matt Schantz, MD
MARCH 17, 2018

15. Premier’s Perioperative Surgical Home (PSH) Learning Collaborative
Bethesda North was accepted into Premier’s 2-yr PSH Learning Collaborative
Benefits of the Learning Collaborative
Peer-to-peer networking and sharing of learning opportunities
Access to subject matter experts in key PSH and population health topics
Tools and resources to support a successful implementation and optimization of a PSH program
R. Matt Schantz, MD
MARCH 17, 2018

16. PSH Learning Collaborative Core Group Members
R. Matt Schantz, MD
MARCH 17, 2018

17. TSOC Trihealth surgical optimization center
COLO-RECTAL PILOT
R. Matt Schantz, MD
MARCH 17, 2018

18. Pilot Elective Inpatient Colorectal patient population (baseline data)
MS-DRG: ICD 9 codes 329, 330, 331
Total (BN+GSH) cases 369 (April March 2016)
Readmissions %
Complications – 11.92
Mortality - .81%
Average LOS – 4.38 days
R. Matt Schantz, MD
MARCH 17, 2018

19. Outcomes for PSH pilot to achieve
Decrease in LOS
Increase the percentage of patients going home versus SNF
Decrease in complications
Decrease in re-admissions
Decrease in overall costs
Decrease in pharmacy, lab and radiology costs
Improve the patient experience with perioperative service
R. Matt Schantz, MD
MARCH 17, 2018

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MARCH 17, 2018

21. Preoperative Phase of Care
Admission through centralized portal
Early preadmission evaluation
Patient information gathered in a systematic and standardized manner
“Prehabilitation”
Triage and patient screening
Multidisciplinary collaboration
R. Matt Schantz, MD
MARCH 17, 2018

22. Intraoperative Phase of Care
Integrated pain management
Fast track process
Individualized fluid management
Processes to ensure on time starts
Efficiency through predictability~information sharing
Scheduling initiatives to minimize cancellations and increase efficency.
R. Matt Schantz, MD
MARCH 17, 2018

23. Postoperative Phase of Care
Pain management plan of care
Early mobilization by physical therapy as well as acute and rehabilitative care
Care coordination from postop to home
Discharge protocols
Improved partnerships with family/caretaker.
R. Matt Schantz, MD
MARCH 17, 2018

24. TSOC Beginnings June, 2016
R. Matt Schantz, MD
MARCH 17, 2018

25. TSOC Beginnings August, 2016
R. Matt Schantz, MD
MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

33. Recovery Rm/Anesthesia Order Set
The surgeon places the OSA order set for the IP floor.
R. Matt Schantz, MD
MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

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MARCH 17, 2018

38. TSOC Beginnings October,2016 Colo-rectal Pathway
R. Matt Schantz, MD

39. TSOC Beginnings October,2016 Colo-rectal Pathway
R. Matt Schantz, MD
MARCH 17, 2018

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MARCH 17, 2018

41. TriHealth Surgical Optimization Center (TSOC)
TriHealth Surgical Optimization Center (TSOC) new paradigm in patient care
Is a patient centered, team based model of care that guides the patient from the decision of the need for surgery through 90 days post discharge
Provides a care pathway for the patient with clinical processes and protocols throughout the episode of care
Aligns with the triple aim to reduce cost and clinical variability while improving clinical outcomes
R. Matt Schantz, MD
MARCH 17, 2018

42. CORE GROUP Matt Schantz, MD Dave Kirkpatrick, MD Mary Pat Gilligan
Anesthesia
Surgeons
Executive Director of Perioperative Nursing
Manager of IT Applications
TSOC Administrator
Matt Schantz, MD
Dave Kirkpatrick, MD
Mary Pat Gilligan
Diana Smith
Julie Sheedy
Tom Elsass, MD
Hamza Guend, MD
R. Matt Schantz, MD
MARCH 17, 2018

43. TSOC Accomplishments TSOC registry (Surgery specific)
8 optimization pathways
3 intra-op pathways
TSOC Nurse Navigators (reach out to patients within 48h of referral)
EPIC orders and outcome documentation
TSOC Nurse Practitioners (Review, place orders and can complete H&P’s on patients without PCP)
SSI (documentation and reports built)
TSOC Administrator
Discharge Care Guide (follows patient pre through 90-days post discharge)
PCP involvement (Optimization phase and discharge phase)
Patient satisfaction surveys on day 2 and day 30
R. Matt Schantz, MD
MARCH 17, 2018

44. Data Definitions Date range: Mar ‘17-Dec’17
MS-DRGs: 329, 330, & 331 only
Avg Direct Cost: TriHealth
Quality Outcomes: Premier QualityAdvisor, risk-adjusted
R. Matt Schantz, MD
MARCH 17, 2018

45. Benefit? Outcomes Cost O/E Volume Avg Dir Cost LOS 30-Day Readmits*
Complications
Mortality
CY16
592
$11,693
1.20
1.49
1.24
1.75
TSOC
169
$11,083
0.81
1.15
1.27
1.70
Benefit?
$610/patient
1,059 less days
15 less readmits
15 more patients w/complication
1 less death
*excludes Dec’17 patients
R. Matt Schantz, MD
MARCH 17, 2018

46. R. Matt Schantz, MD
MARCH 17, 2018

47. Tsoc – What’s next?
Expanding service lines – total joints, urogynecology, robotics
Physician Director
Definitive data collection and communication
Refinement of roles and processes to make addition of new service lines easier
MAKE THE PERIOPERATIVE SURGICAL HOME THE STANDARD OF CARE FOR ALL PATIENTS HAVING SURGERY AT TRIHEALTH!
R. Matt Schantz, MD
MARCH 17, 2018

48. Psh key words to remember
Optimize
Standardize
Communicate
Patient Centered!
R. Matt Schantz, MD

49. R. Matt Schantz, MD
MARCH 17, 2018