Healthcare Financial Management Association

1. Healthcare Financial Management Association Healthcare Reform

2. During a Boring Lecture

3. Overview of Finger Lakes Health What are Some of the Problems in Healthcare that we are Attempting to Solve Success Stories The Real Problems Agenda

4. Not All Hospitals Are Created Equal

5. Ontario, Seneca, Wayne & Yates Counties

6. Continuum • Acute Care • LTC • (Assisted living & more independent housing) • Dementia • Respite • Adult Day Care • Transportation • Independent Housing • Transitional Care Program • Meals on Wheels • Outpatient Rehab • Durable Medical Equipment • Home Lab Draw • Care Management • Acute Rehab Unit • Life Line • Rehab Services • College of Nursing

7. Acute Care Stroke Center Spine Center Dialysis Ambulatory Surgery Center Sleep Lab Joint Center

8. FLH Medical, P.C. • Specialties • Internal Medicine • Family Medicine • Orthopedic • Psychiatry • Physiatrist

9. Urgent Care (4)Draw Stations (11)

10. Affordable Care ActDelivery Systems • Structures • ACO • Medical Homes • Risk Based Reimbursement • Payment Change • Value Based • Bundle • Shared Saving

11. Are You Weathering the Storm?

12. The Goal: The Best Care

13. Baby Family Elderly

14. Root Causes of the Current Very Expensive Healthcare in the US • Communication • Silos • Volume driven payment structure • Technology (not evidence based) • Pharmaceuticals • Implant Manufacturers • Professional Salaries

15. Lean Organization • Management Restructuring (Flatter) • Value Stream Mapping • Better Contract Management • GPO • Productivity and Efficiency • Toyota, Six Sigma

16. Primary Physician VS Care Coordinators (Coaches) Specialists Visiting Nurses Emergency Room Radiologist Pharmacy Anesthesia Communication

17. Communication • Employment Interview • Governance • College of Nursing

18. Ingredients Providers (Primary Care) Specialist and Other Providers Care Management EMR, Scorecards Communication Patient Centered Medical Home (Level 3) Accountable Care Organization Commitment to Education

19. Partnership • The Case for Collaboration or Disintegration • Physicians and Hospitals • Communities and Hospitals

20. Partnership Disease Specific Program Prevention Education Reduce Variation

21. Areas of Focus Disease Management Education in Prevention High School Graduation Reduce Waste and Expense in Clinical Areas e.g. Surgery Antibiotic Stewardship Hypertension Diabetes

22. Delivery of CareReengineer Work Responsibilities • Primary Physician Coordinates the Care • 1 MD: 50 Patients/Day

23. Physician Incentives for Quality Metrics Since 2005 Outpatient Blood Pressure DM Vaccination Inpatient • Core Measures • Antibiotic Stewardship • Patient Satisfaction • Referring Physician Satisfaction

24. How are we doing? Hospital Value Purchasing, our Next Change in Base Operating DRG Payment Amount +0.0217745965 Readmission Rate: 10.1% Vaccination Rates: 90%, 93% Antibiotic Stewardship: 11% cost reduction Blood Transfusion Initiative: 4% cost reduction Orthopedic Implants: 9% cost reduction

25. Average time spent in the ED before being seen by a provider Average time spent in the ED from arrival to discharge 2010 41 min 2012 27 min State 36 min National 30 min 2010 150 min 2012 134 min State 155 min National 140 min Emergency Room Wait Times

26. Emergency Room Wait Times 2010 6 hrs 2 min 2012 4 hrs 20 min State 6 hrs 6 min National 4 hrs 37 min • Average time spent in ED from arrival to time of admission

27. Lets Solve The Problems Prevention End of Life Pharmaceutical Implants Manufacturer

28. Are We Ever Going to Address Our Culture? Quality Compassion/Dignity • Silver Bullet • Warehouse VS.

29. It isn’t About Weathering The Storm, It’s About Learning To Dance In The Rain