Presentation Transcript

1. MGMA 2013 Annual Conference Physician Leadership Strategies: Alignment with Hospitals for Healthcare Reform
2. Introductions Colleen Vetere, Vice President RN with 25 years of healthcare experience to include critical care delivery, quality management & operations Experienced healthcare consultant focusing on supply chain & clinical improvement processes Holds a Masters Degree in Public Health with a focus on data management David Hermann, Vice President 18 years in healthcare operations, finance and IT MBA with focus on strategy and operations Manager of Strategic Services, Mount Sinai Medical Center of Florida Experience includes supply chain operations, supply chain strategy, business intelligence, e-commerce, inventory management, value analysis programs, and development of regional purchasing alliances
3. Learning Objectives Articulate the financial impact of bundled payments on all stakeholders Describe key metrics used to better align with payers and providers Identify strategies to help lead alignment efforts with your hospital
4. CMS - from Fee For Service Volume Model Transition to…..Value – High Quality/ Low Cost
5. Healthcare Reform Imperatives Reduce your cost – manage to Medicare reimbursement Focus on areas of greatest risk Chronic disease management Procedural cases with high volume, high cost Migrate from fee-for-service to fee-for-quality Chase margin, not revenue Strategic use of your resources Align incentives for physicians, hospitals, non-acute providers Preparation for ACO, medical home, bundled payments Value Based Purchasing Episodes of care / continuum of care Choose your partners wisely *Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09
6. Engaging Physicians in Clinical Resource Utilization Efforts Keys to Success Position physician champions to lead clinical initiatives Clinical leadership and accountability Engage physicians early in the process Present the Case for Change with credible data Profile physician utilization by service/product Frame the discussion in clinical terms Ask key questions, then listen Measure changes and report back Identify barriers to participation Don’t confuse employment with alignment
7. Measure Medicare Losses by “Top 5” Populations Top Chronic Disease Populations Top Bundled Populations
8. Variable Cost by Physician: MSDRG 193 Sample
9. MSDRG 193—Physician Utilization Traditional resource utilization review Evidenced-based protocols or based on better outcomes Increasingly driven by risk-based payor arrangements
10. Merging clinical and financial outcomes Clinical Financial Data Warehouse Order Set and Plan of CareTemplates Update Process - Metrics Included Assign Costs and Baseline All Existing Templates Cost, Quality, Compliance Metrics DSS Plan/ Organize Customize Templates Review/ Approve EMR Deploy Baseline Analytics Assign Costs MMIS/SCIS Change Management Permeates Process Billing
11. Determine the cost of best-practice care
12. Leadership Strategies Paid medical director position Paid for participation in committees Co-management agreements Shared savings Gainsharing Employment

13. Telling stories with data

14. Assembling the data

15. Key linkages
16. Key linkages
17. Clinical, demographic and payment files Spend files
18. Spend files Item description Quantity Units of measure Acquisition price Physician Patient code, account or identifier
19. Clinical, demographic and payment files Patient code, account or identifier Physician Demographics Patient diagnoses and treatments LOS Outcomes Expected reimbursement Actual reimbursement Hospital-centric today but this will expand in the future
20. Implant logs (if appropriate) Patient code, account or identifier Physician Components for implants
21. EHR and OR modules Patient code, account or identifier Physician More detailed procedure descriptions than ICD-9 Open/close time BMI Anesthesia risk score Antibiotic prophylaxis

22. Data quality

23. A common challenge… The Supply Chain department performs an analysis on primary joint implants Data presented to physicians at the Orthopedics department meeting A physician catches an error in the data and dominates the discussion by destroying the credibility of the analysis The message of “we must work together to reduce costs” is lost Credibility of Supply Chain and its cost-control initiatives is damaged
24. Results Loss of credibility Loss of opportunity to create a partnership with physicians Loss of savings opportunity At the time of the analysis For the period after the analysis spent regaining credibility Loss of resources spent in performing the analysis (time, money, labor, etc)
25. Unvalidated variability in data collection Caused when an end-user freely types a value that should be standardized:
26. Other data quality challenges Unverified required values Use of non-standard entries or values Unstructured free-text fields
27. Future directions with clinical data We want American registry data but we have some major hurdles: Labor prohibitive Cost prohibitive Comparative effectiveness research

28. Conclusion

29. Conclusion Individual physicians’ practice patterns will be reviewed and analyzed In aggregate Along the continuum Align incentives for physicians, hospitals, non-acute providers Preparation for ACO, medical home, bundled payments Value Based Purchasing Episodes of care / Continuum of care Choose your partners wisely
30. Q&A