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ORTHOPAEDIC SERVICES AT METHODIST WEST HOSPITAL. Presented by: Dr. Stephen Taylor, President West Hospital Ortho Co-Management Laurie M. Johnson, RN Executive Director - Orthopaedics. Total Joint Replacement (TJR) has been the most effective treatment for advanced arthritis since the 1970’s

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Orthopaedic services at methodist west hospital

ORTHOPAEDICSERVICESATMETHODISTWESTHOSPITAL

Presented by:

Dr. Stephen Taylor, President

West Hospital Ortho Co-Management

Laurie M. Johnson, RN

Executive Director - Orthopaedics


Total Joint Replacement (TJR) has been the most effective treatment for advanced arthritis since the 1970’s

Goal of TJR → Quality Results

Relieve Pain

Restore Function

Long Lasting (>25 years)

Avoid Complications

More than 700,000 TJR’s are currently performed each year


INCREASING DEMAND FOR treatment for advanced arthritis since the 1970’s

TOTAL JOINT REPLACEMENT

Increasing senior population

Greater desire for active lifestyle

Greater acceptance of TJR by population

700% increase in TJR in the next 20 years


INCREASED DEMAND FOR TJR treatment for advanced arthritis since the 1970’s

Success Requires:

Adequate physician supply

More efficient care process

Care process must emphasize VALUE

QUALITY

COST

VALUE =


VALUE IN TOTAL JOINT REPLACEMENT treatment for advanced arthritis since the 1970’s

Reality:

Healthcare dollars spent

must be controlled and

appropriately allocated

Allocation must be determined by value of product or service

In TJR we must maintain and improve quality, but we must also control costs


IOWA HEALTH-DES MOINES COMMITMENT treatment for advanced arthritis since the 1970’s

IH-DM committed to meet the increased patient need for TJR

Current facilities at IMMC couldn’t meet growing demand for OR’s and patient beds

  • MWH was designed to emphasize orthopaedic

  • total joint care dedicating 4 of the 6 OR’s and 50% of the patient beds


MWH ORTHOPAEDIC SERVICES treatment for advanced arthritis since the 1970’s

Focused, specialized care

Mutual project between IH-DM and Des Moines Orthopaedic Surgeons, PC

Aligned incentives of both organizations to improve QUALITY and VALUE for our patients

“Co-Management” organization was formed to manage the entire process


WEST HOSPITAL ORTHOPAEDIC CO-MANAGEMENT COMPANY, LLC treatment for advanced arthritis since the 1970’s

The WHOCC oversees the entireorthopaedic service line at MWH emphasizing quality, patient safety & convenience, efficiency and cost containment

Equal representation from IH-DM & DMOS

Medical Director from DMOS


WHOCC BUSINESS MODEL treatment for advanced arthritis since the 1970’s

WHOCC GOVERNING BOARD

•Oversees all committee activities

•Reviews & approves meeting minutes

•Makes final decisions


WEST HOSPITAL ORTHOPAEDIC treatment for advanced arthritis since the 1970’s

CO-MANAGEMENT COMPANY

Initial project was to interview and select the following key personnel:

Orthopaedic service-line Executive Director

Inpatient department Nurse Manager

Surgical Services department Nurse Manager

Physical Therapy department Manager

All personnel are employees of IH-DM


WHOCC TEAM REVIEWS treatment for advanced arthritis since the 1970’s

AND SETS ALL PROCESSES

All physicians expected to comply at MWH

No significant exceptions are allowed

All physicians are invited and encouraged to participate in the process


STANDARDIZED, UNIFORM treatment for advanced arthritis since the 1970’s

PROCESSES AND PROCEDURES

Rationale: Repetitive, focused process and procedures maximizes efficiency and minimizes the risk of error or oversight.

Examples:

OR nurses comfortable working with any surgeon due to standardized draping, supplies and instructions

Nursing unit care doesn’t vary by physician (common pain management regimen, blood transfusion protocol, dressing, etc…)

One standard Physical and Occupational therapy regimen for all surgeons that can be tailored to the individual needs of each patient


EXAMPLES OF UNIFORM PROCESSES treatment for advanced arthritis since the 1970’s

CREATED AND IMPLEMENTED BY WHOCC

Pre-op medical clearance request form

Standardized scheduling process and form

Pre-op orders

Regional anesthesia

Demand matching of implants

Comprehensive uniform post-op orders, including pre-emptive multi-modal pain management

Uniform activity and physical therapy goals


WHOCC ACTIVITIES treatment for advanced arthritis since the 1970’s

VALUE IN TJR

New techniques, equipment and implants must be critically evaluated by hospital and physicians

Those new techniques or implants that add cost without significant improvement in quality should be avoided

QUALITY

COST

VALUE =


EVALUATION OF NEW TECHNIQUES AND SURGICAL PRODUCTS treatment for advanced arthritis since the 1970’s


EVALUATION PROCESS EXAMPLES treatment for advanced arthritis since the 1970’s

Floseal→ deny (evidence didn’t support)

V-lock suture → confirm (all use)

Participated in ‘Draping Boot Camp’ to streamline, trial and standardize surgical drapes → confirm (all use)

Surgical prep (Chloraprep) → confirm (all use)

Eliminated many trays by developing common instrument sets for all physicians by procedure → confirm (all use)

Covaderm Surgical Dressing → future trial

Cold therapy/DVT wrap → future trial


WHOCC PHYSICIAN COMPENSATION treatment for advanced arthritis since the 1970’s

Base Management Fee

Hourly at Fair Market Value

Incentives

Quality of service

Operational efficiency

Financial/budgetary

New program development


INCENTIVE COMPENSATION DEVELOPMENT treatment for advanced arthritis since the 1970’s


2010 incentives

  • Quality of Service treatment for advanced arthritis since the 1970’s(50%)

  • SCIP Core Measures

  • Patient Satisfaction

  • Demand Matching

  • Operational Efficiency (20%)

  • On-time starts

  • OR turnaround time

2010 INCENTIVES

  • Financial/Budgetary(20%)

  • Length of Stay

  • Cost per Case

  • New Program

  • Development (10%)

  • Expanded Patient Education


2011 incentives

  • Quality of Service treatment for advanced arthritis since the 1970’s(50%)

  • SCIP Core Measures

  • Patient Satisfaction

  • Demand Matching

  • Financial/Budgetary(30%)

  • Cost per case (Goal – 4%↓)

  • Vendor negotiations for

  • spinal implants

2011 INCENTIVES

  • New Program Development (20%)

  • Hip and Knee scoring

  • Infection rates (within 60 days)

  • Readmission rate (within 30 days)

  • Revision rate (within 1 year)


Incentive structure
INCENTIVE STRUCTURE treatment for advanced arthritis since the 1970’s


VENDOR NEGOTIATIONS treatment for advanced arthritis since the 1970’s

All implants placed in category based on technology

Cemented femoral stem

Tapered non-cemented stem

Revision stem

Each category included “substantially similar” implants

Target price established by WHOCC

All vendors allowed to participate


VENDOR NEGOTIATIONS, treatment for advanced arthritis since the 1970’s

continued…

Implants that meet target price for each category become “preferred” and permitted to use at MWH

Use of outliers is strongly discouraged

In a few select categories competitive bidding utilized – only one implant from single vendor allowed

eg. Modular revision femoral stem (one vendor, one price for all components)

eg. Revision segmental hinged knee


DEMAND MATCHING treatment for advanced arthritis since the 1970’s

All implants categorized by

Quality Level and Cost

A Level – Lowest cost

B Level – Intermediate cost

C Level – High cost


DEMAND MATCHING cont… treatment for advanced arthritis since the 1970’s

Three Patient Variables Considered

Patient Age

Patient Health

Patient EXPECTED activity level


Scanned copy of form here

(scanned copy of form here) treatment for advanced arthritis since the 1970’s


DEMAND MATCHING cont… treatment for advanced arthritis since the 1970’s

>90% Compliance expected

Results are reported by

Individual Physician

All Physicians

Transparency is a great motivator!


WHOCC - SUMMARY treatment for advanced arthritis since the 1970’s

Aligned incentives of hospital and surgeons that are required for success

Emphasis on Quality and Cost = Value

Recognize importance and contribution of ALL team members:

•Surgical Techs & Nurses •Therapists

•Patient Care Facilitators •Patient Care Techs

•Management Staff •Physicians

Ultimate winners:

•Patients •All team members


WEST HOSPITAL ORTHOPAEDIC treatment for advanced arthritis since the 1970’s

CO-MANAGEMENT COMPANY

OUR COMPANY

Is COMMITTED to

FRESH THINKING

and

INNOVATIVE CARE

THAT ADDS VALUE


Whocc metric results

WHOCC treatment for advanced arthritis since the 1970’s

METRIC RESULTS

QUALITY

COST

VALUE =


Data collection
DATA COLLECTION treatment for advanced arthritis since the 1970’s

  • Information received monthly from various systems

    • Finance • Purchasing

    • ORSOS • Clinical Quality

  • Review, calculate and report Incentive Metric data monthly to Executive Committee

  • Determine if there is other data outside of the metrics that needs to be reported

    • On-time starts, turnover times, and Average Length of Stay (ALOS) are not part of the 2011 metrics, but continue to be monitored monthly for significant changes

    • Volume and cost data from broken, lost and (not) found instruments in Central Sterile is reported to the Executive Committee & the staff each month

    • The cost of implants that are opened but unused are reported in conjunction with the demand-matching metrics


Data collection continued
DATA COLLECTION continued… treatment for advanced arthritis since the 1970’s

  • Whenever possible, total volumes are reviewed rather than randomized selections

    • 100% of all total joint procedures are reviewed for correct implants

    • Over 90% of all eligible patients are included in the SCIP Core Measure

      data review

    • In addition to the overall patient

      satisfaction score, each physician’s

      scores are calculated and reported

    • Direct variable cost-per-case is

      reported/reviewed by surgeon

  • All data is presented as an

    overall score and also by

    each physician and procedure

    Transparency has been a key motivator for physician change


2010 goal treatment for advanced arthritis since the 1970’s

3.45 days


2010 goal treatment for advanced arthritis since the 1970’s

$8,196

2011 goal

$7,939


Summary
SUMMARY treatment for advanced arthritis since the 1970’s

  • DO recognize that consistent, substantiated data is a key factor in engaging the physicians and staff to achieve success

  • DON’T underestimate the value of immersing yourself in the details

  • DO plan to be in this ‘for the long haul’

    • Success doesn’t happen overnight

  • DON’T hesitate to build relationships with people who can help you

    • The advantage of a large organization is that many people are there to assist, but you may have to search for them

  • DOcommunicate results regularly with front-line staff

    • They will be very engaged in the process

    • They can have a big impact on achieving positive outcomes

    • DON’T overlook the small successes

      • These are most important when things are progressing slowly

        DOcelebrate every milestone along the way, and DON’T forget to have fun!


Questions
QUESTIONS? treatment for advanced arthritis since the 1970’s


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