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Psh PERIOPERATIVE SURGICAL HOME
R. Matt Schantz, MD MARCH 17, 2018
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PSH is a team approach to patient centered perioperative care
R. Matt Schantz, MD MARCH 17, 2018
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THE LARGEST INDEPENDENT PHYSICIAN GROUP IN SOUTHWEST OHIO
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Patient Story R. Matt Schantz, MD MARCH 17, 2018
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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
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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
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ASA Perioperative Surgical Home
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Create Consistent Seamless Care
Patient-Centered Medical Home Team Perioperative Surgical Home Process R. Matt Schantz, MD MARCH 17, 2018
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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
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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
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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
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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
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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
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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
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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
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PSH Learning Collaborative Core Group Members
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TSOC Trihealth surgical optimization center
COLO-RECTAL PILOT R. Matt Schantz, MD MARCH 17, 2018
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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
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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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R. Matt Schantz, MD MARCH 17, 2018
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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
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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
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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
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TSOC Beginnings June, 2016 R. Matt Schantz, MD MARCH 17, 2018
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TSOC Beginnings August, 2016
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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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TSOC Beginnings October,2016 Colo-rectal Pathway
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TSOC Beginnings October,2016 Colo-rectal Pathway
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R. Matt Schantz, MD MARCH 17, 2018
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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
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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
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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
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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
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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
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R. Matt Schantz, MD MARCH 17, 2018
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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
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Psh key words to remember
Optimize Standardize Communicate Patient Centered! R. Matt Schantz, MD
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R. Matt Schantz, MD MARCH 17, 2018
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