Mark J. Ott, M.D.Surgical Services Medical Director
Intermountain Healthcare
Improving Surgical Quality While Reducing the Cost
Disclosures
• I’m an American• I’m a Utahn• I’m employed by Intermountain Healthcare
• I’m a surgeon• I’m a member of The Church of Jesus Christ of
Latter‐Day Saints (Mormon)
What is the most important NSQIP variable that we track?
• Mortality?• Morbidity?
• SSI’s?• DVT/PE?• Cardiac?
• Or is it something else that we aren’t even measuring?
How will you decide where to eatin Salt Lake City?
• Where to eat? • Italian: Cucina Toscana (~$60) vs. Cinegrill (~$15)• Buffet: Chuck‐A‐Rama ($12) vs. The Roof ($39)
How will you decide what to do that is truly unique in Salt Lake City?
• What to do that is uniquely Utahn?• Olympic Bobsled ($60) 1 mile, 15 turns, 4G, 70 mph• Kennecott Copper Tour ($5/car)• Temple Square (free)
Intensive Behavioral
Clinical Support Services
Oncology
Intensive Pediatrics
Cardiovascular
Intensive Medicine
Women and Newborns
Surgical Services
Contribution Margin
Inpatient Outpatient
*Contribution Margin = (Insurance Payments + Other Payments) - Variable Cost
Contribution Margin* By Clinical Program Inpatient and Outpatient Accounts 2011
Lymphoma/Leukemia (Onc)Urology Procedures-Prostatectomy (Surg)
Nephrology (IM)Infectious Disease except Pulmonary (Beh)
Endocrine and Metabolic Disorders (IM)Appendectomy (Surg)
Miscellaneous FXs/Procedures (NMS)Psychoses (Beh)
FXs/Procedures UE (NMS)Other GI (IM)Trauma (IM)
Urology Procedures-Kidney Ureter Bladder and UrethraIntracranial Surgical Procedures (Peds)
Liver and Billiary Procedures (Surg)Knee Procedures (except total joints) (NMS)
Congestive Heart Failure (CV)Fx/Other Procedures-Pelvis Hip and Thigh (NMS)
Intracranial Surgical Procedures (NMS)Head Trauma (NMS)
Other Major Chest Surgery (CV)Pulmonary (Peds)
Vascular (CV)Benign Gyn Conditions (WN)
CABG & Other Major Non-valve (CV)Rehab and Post Surgical Care (CSS)
Nervous System (IM)Valves (CV)
Arrhythmias & Pacemakers (CV)Adult ICU (Tracheostomy Respiratory Failure ARDS) (IM)
Chemotherapy and Bone Marrow Transplant (Onc)Abnormal Newborn Level 3b (Peds)Bowel Disorders and Surgery (Surg)
Pulmonary (IM)Dx & Tx Cardiology (CV)
Normal Newborn (WN)Infectious Disease except Pulmonary (IM)
UnassignedDisorders of the Spine (NMS)
Major Joint Replacement-Hip and Knee (NMS)Abnormal Newborn Level 3a (WN)
Labor and Delivery (WN)
Contribution Margin
*Contribution Margin = (Insurance Payments + Other Payments) - Variable Cost
Contribution Margin* By Clinical Work ProcessTop 40 Inpatient Work Processes 2011
Value = Quality/Cost
• Life after a total pancreatectomy• Creon 24 ($3.20/pill)• Viokase 16 (purchased from Canada) (60 cents for two
pills)• High Potency Pancreatin (OTC enzyme pills) by Now
Pharmaceutical in Glen Ellyn, Illinois (15 cents for 3 pills) • The cost savings is $7,000/year.
• “I've experienced less flatulence, (which Tomi certainly appreciates), darker stools with more structure, and less stomach and digestive upset than I had been having with the Creon or the Viokase.”
“MAINTAINING THE STATUS QUO IN AMERICAN HEALTHCARE IS NOT AN OPTION...”
• Medical technology and new therapies continue to proliferate — but often with little evidence of the comparative effectiveness and risks of new treatments.
• Those who ultimately pay for healthcare —government, businesses, patients, and consumers in general — are reaching the limits of their ability to pay for healthcare.
“It’s about better healthcare at a lower cost”
“It’s about better healthcare at a lower cost”
Do we want to deliver Quality or Value?
• NSQIP could evolve into an organization that not only delivers quality improvement, but helps its members to deliver the highest quality patient care at a reasonable cost.
Bone Cement Mixing Accessory AnalysisOEM Stryker Biomet Zimmer DePuy S&N
Price $52 $172 $63 $123 $305Market Share 62% 18% 14% 3% 3%# of surgeons representing
80%
20 10 6 1 8
Mfg Catalog #
206‐15 418200, 417200 00‐5049‐001‐00 5401‐98‐000 121010
Predominant Facility
ALL TOSH AVH, LDSH TOSH USR
Total Spend for this category in 2011 was $457,000
Stryker 80% commit savingsFAC BIOMET DEPUY S&N STRYKER ZIMMER Grand Total
ALTA VIEW $5,561 $200 $4 $2,586 $8,351AMERICAN FORK $257 $103 $320 $680BEAR RIVER $593 $593CASSIA $2,079 $163 $2,242DIXIE $4,798 $2,477 $7,275HEBER VALLEY $52 $52INTERMOUNTAIN MED CT $9,890 $1,069 $808 $120 $11,886LDSH $2,095 $6,582 $8,677LOGAN $695 $695MCKAY DEE $17,075 $3,023 $2,949 $23,047PARK CITY MED CTR $367 $976 $1,343PRIMARY $257 $257RIVERTON HOSPITAL $1,540 $30 $1,570TOSH $33,284 $3,738 $0 $60 $37,082UTAH VALLEY $1,454 $6,596 $559 $8,610VALLEY VIEW $553 $553Grand Total $69,910 $5,375 $16,599 $11,680 $9,348 $112,912
Stryker 80% commit savingsFAC BIOMET DEPUY S&N STRYKER ZIMMER Grand Total
ALTA VIEW $5,561 $200 $4 $2,586 $8,351AMERICAN FORK $257 $103 $320 $680BEAR RIVER $593 $593CASSIA $2,079 $163 $2,242DIXIE $4,798 $2,477 $7,275HEBER VALLEY $52 $52INTERMOUNTAIN MED CT $9,890 $1,069 $808 $120 $11,886LDSH $2,095 $6,582 $8,677LOGAN $695 $695MCKAY DEE $17,075 $3,023 $2,949 $23,047PARK CITY MED CTR $367 $976 $1,343PRIMARY $257 $257RIVERTON HOSPITAL $1,540 $30 $1,570TOSH $33,284 $3,738 $0 $60 $37,082UTAH VALLEY $1,454 $6,596 $559 $8,610VALLEY VIEW $553 $553Grand Total $69,910 $5,375 $16,599 $11,680 $9,348 $112,912
ICD9_PRCDR_LONG_DSC
FIRST_NM
LAST_NM
Cost of LDR Spine ROI‐A Anterior Lumbar Plate &
Device
Contracted Price for all other
Anterior Lumbar Plate & Devices
Total Cost for this Patient (Account)
Case Duration for this Patient
in minutes
LOS for this Patient in hours
Average Cost for Patient with this ICD9
Avg Case Duration for this ICD9 in minutes
Avg Patient LOS ICD9 in
hoursLUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 19,103.78 147 76 $ 20,854.59 244 92 LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 22,305.18 170 103LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 20,399.35 167 79LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 21,825.52 196 53LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 29,361.95 223 53LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 18,389.01 157 79LUM/SAC FUS ANT, ANT TEC Bob $ 8,780.00 $ 5,000.00 $ 18,897.80 164 54LUM/SAC FUS ANT, ANT TEC Kim $ 8,780.00 $ 5,000.00 $ 20,833.72 189 83
$ 21,389.54 176.63 72.50
A surgeon requests an exception for the more expensive system that he uses to do an Anterior Lumbosacral Fusion procedure –
Should he and his vendor be granted an exception?
MDCS Financials
Cochrane review:author’s conclusion on triggers
“In patients who do not have advanced coronary artery disease, blood transfusion can probably be withheld in the presence of Hgb as low as 7 g/dL or a Hct of 21%.”
Blood Utilization“Houston, we have a problem”
Blood Transfusion Trends in our System
Intermountain HealthcareBlood Utilization
• Cross matched RBC Units transfused – 39,567• Total of all blood products transfused – 69,743• Total of all discarded products – 6,286
• RBC – 3,128• Plasma – 1,391• Platelets – 1,101• Cryoprecipitate ‐ 757
• Total Transfusion reactions ‐ 222
Current Intermountain Healthcare PRBC Transfusion Indication
Recommendations
Pilot a stripped down version of the model
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022008
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112008
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Number of Units of RBCs Transfusedper 100 Patient Days at Dixie
Starting to see a change in behavior
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Proportion of all Dixie Patientswith HCT > 27 Receiving RBC tx
Starting to see a change in behavior
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Proportion of all Dixie Patientswith HCT between 21 & 27 Receiving RBC tx
Education does work on doctors
22.50
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Average Pre‐tx HCT per Transfusion EpisodeAll Patients Receiving RBCs at Dixie
To Do List for MD Education
• Review and agree upon transfusion indications.• Integrate new transfusions indications into current
processes for ordering blood• Educate those that enter blood orders about new
transfusions indications and that if there is no transfusion indication call the physician back for an appropriate indication• This is problematic and a possible source of
conflict between staff and physicians
To Do List for the Facilities and Hospital Staff
• Automate process for ordering, receiving, verifying, and transfusing blood products• Bar code scanners• Blood bank processes• Computer order entry changes
• Education• Nursing staff• Blood bank• Operations officers
2008 2009 2010 2011 2012 ANNLZD
Units of Blood (PRBC) 43,428 41,591 40,437 39,451 38,238
Change in Units of Blood ‐1837 ‐1154 ‐986 ‐1213
Patient Charge / unit $ 961 $ 1,070 $ 1,082 $ 1,073
Hospital Cost from ARC $ 245 $ 316 $ 308 $ 343
Charge Reduction $ 1,765,438 $ 1,234,559 $ 1,066,458 $ 1,301,341
Cost Reduction $ 450,217 $ 364,378 $ 303,350 $ 416,597
What can happen with a new transfusion process & education!
Devices Reprocessed by Facility
Facility General Ortho Non-Invasive
Alta View Harmonic Scalpels Tourniquet Cuffs, Shavers, ArthroWands SCD Sleeves
American Fork Harmonic Scalpels Trocars
Tourniquet Cuffs, Shavers, ArthroWands, Saw Blades SCD Sleeves
Dixie Harmonic Scalpels Tourniquet Cuffs, Saw Blades Ortho Burs SCD Sleeves
IMED Harmonics Scalpels Clip Appliers Tourniquet Cuffs SCD Sleeves
LDS Harmonic Scalpels Tourniquet Cuffs SCD Sleeves
McKay Tourniquet Cuffs SCD Sleeves
TOSH Tourniquet Cuffs SCD Sleeves
Utah Valley Harmonic Scalpels Tourniquet Cuffs, ArthroWands, Saw Blades, Ortho Burs SCD Sleeves
Intermountain Healthcare Reprocessing Data Fiscal 2011-2012
• Savings YTD= $1,700,000 • Target = $2,000,011
• Devices Diverted from Landfill YTD= 101,805 devices• Red Bag Waste Diverted = 73,000 lbs.
• Carbon Footprint Savings = 43,965 lbs. of CO2
Cost Comparison Examples
5 mm Optical Trocars for Laparoscopic Surgery
Ethicon B5LT
$110.93
Applied CTR03$35.27
CovidienONB5STF
$32.85
Negotiating Endomechanical Purchasing Agreements
• Historical debacle 7 years previously• Cost driven initiative• Limited physician input in the decision making process
• Current strategy for contract negotiation• Assemble a team of interested physicians from around
the system to make the decision (facility leads)• Add in an additional vendor to put pressure on the two
primary vendors to improve their bid competiveness (no real intent to use the third vendor from the outset)
General Surgery Product Review Committee
Dr. Rob PriceDr. Jay BishoffDr. Scott PutmanDr. Richard RasmussenDr. Scott ReesDr. William PeughDr. Allen AndersonDr. Ed HashimotoDr. Tae KimDr. Robert MoesingerDr. Jeffrey ArringtonDr. Ryan LewisDr. Grant CarterDr. Douglas BarnhartDr. Mark Ott
Chair, IMCIMCIMCUtah ValleyUtah ValleyAmerican ForkLoganAlta ViewLDSMcKay DeeMcKay DeeDixie Regional Medical CenterDixie Regional Medical CenterPrimary Children’s Medical CenterSurgical Services Medical Director
Products Evaluated• Trochars
• Verres Needles• Graspers• Scissors
Applied Medical Product Evaluation
Procedure data by Facility General SurgeryProcedure IMED Dixie Utah Valley Alta View LDSH Logan Mckay Dee Riverton American Fork PCMC Grand TotalLap Chole 29 13 20 20 15 16 9 1 9 1 133Lap Appy 5 2 4 1 3 2 2 1 1 21Lap Nissen 3 3 2 1 1 10Lap Inguinal Hernia 3 1 5 9Lap Colectomy 2 2 4DX Lap 2 1 1 4Lap Bilateral Inguinal Hernia 2 2 4Lap Chole/Appy 3 3Inc. Hernia 3 3Lap Gastrectomy 3 3Lap Ventral Hernia 2 2Lap Esophogectomy 2 2Lap Liver Cyst 1 1Lap Asst. Colon Resec. 1 1Lap Band Removal 1 1Lap Donor Nephr. 1 1LGB 1 1NUSS Procedure 1 1Lap LAR 1 1Port Place 1 1Lap Lysis of Adhesion 1 1Lap Hernia 1 1Lap Sigmoid (Hand‐Assisted) 1 1Lap Ilesostomy 1 1Lft VAT/ Wedge Resection 1 1Lap Ilesostomy T/D 1 1HALS Colectomy 1 1Lap Incisional Hernia 1 1Band removal 1 1Lap Gtube Placement 1 1
49 30 38 25 25 20 9 4 13 3 216
Procedure IMED Dixie Utah Valley Alta View LDSH Logan Mckay Dee Riverton American Fork PCMC Grand TotalLap Chole 29 13 20 20 15 16 9 1 9 1 133Lap Appy 5 2 4 1 3 2 2 1 1 21Lap Nissen 3 3 2 1 1 10Lap Inguinal Hernia 3 1 5 9Lap Colectomy 2 2 4DX Lap 2 1 1 4Lap Bilateral Inguinal Hernia 2 2 4Lap Chole/Appy 3 3Inc. Hernia 3 3Lap Gastrectomy 3 3Lap Ventral Hernia 2 2Lap Esophogectomy 2 2Lap Liver Cyst 1 1Lap Asst. Colon Resec. 1 1Lap Band Removal 1 1Lap Donor Nephr. 1 1LGB 1 1NUSS Procedure 1 1Lap LAR 1 1Port Place 1 1Lap Lysis of Adhesion 1 1Lap Hernia 1 1Lap Sigmoid (Hand‐Assisted) 1 1Lap Ilesostomy 1 1Lft VAT/ Wedge Resection 1 1Lap Ilesostomy T/D 1 1HALS Colectomy 1 1Lap Incisional Hernia 1 1Band removal 1 1Lap Gtube Placement 1 1
49 30 38 25 25 20 9 4 13 3 216
Procedure data by Facility Gynecologic Surgery
Procedure Dixie Mckay Dee Alta View Riverton LDSH IMED Logan Utah Valley American Fork Grand TotalLAVH 11 2 3 2 6 2 26DX Lap 6 5 1 2 1 15Lap Tubal Ligation 4 3 1 2 1 11Lap Hysterectomy 3 1 4 8Lap Cystectomy 3 4 7TLH 2 2 2 6Lap Diagnostic 3 1 2 6Lap BSO 3 1 1 5Robot Hysterectomy 3 1 4Diagnostic Lap 3 3Dx. Lap ‐ Cystectomy 1 1 2Laparoscopy 2 2Robot Myomectomy 1 1LSH 1 1Lap Oophorectomy 1 1Lap Removal of IUD 1 1DX Lap, LSO 1 1Lap Oopherectomy 1 1Lap Hysterectomy ‐ BSO 1 1TLH/opened 1 1Hysterectomy 1 1Lap LSO 1 1
21 15 15 12 12 11 8 8 3 105
Procedure Dixie Mckay Dee Alta View Riverton LDSH IMED Logan Utah Valley American Fork Grand TotalLAVH 11 2 3 2 6 2 26DX Lap 6 5 1 2 1 15Lap Tubal Ligation 4 3 1 2 1 11Lap Hysterectomy 3 1 4 8Lap Cystectomy 3 4 7TLH 2 2 2 6Lap Diagnostic 3 1 2 6Lap BSO 3 1 1 5Robot Hysterectomy 3 1 4Diagnostic Lap 3 3Dx. Lap ‐ Cystectomy 1 1 2Laparoscopy 2 2Robot Myomectomy 1 1LSH 1 1Lap Oophorectomy 1 1Lap Removal of IUD 1 1DX Lap, LSO 1 1Lap Oopherectomy 1 1Lap Hysterectomy ‐ BSO 1 1TLH/opened 1 1Hysterectomy 1 1Lap LSO 1 1
21 15 15 12 12 11 8 8 3 105
Procedure data by FacilityUrologic and Bariatric Surgery
Specialty Procedure IMED LDSH Mckay Dee Grand TotalURO Robot Asst. Prostate 11 11
Lap Left Nephrectomy 1 1Robot Prostatectomy 1 1Lap Radical Nephrectomy 1 1Lap Retroperitoneal 1 1
URO Total 14 1 15Bari LGB 2 2
Bari Total 2 2
Specialty Procedure IMED LDSH Mckay Dee Grand TotalURO Robot Asst. Prostate 11 11
Lap Left Nephrectomy 1 1Robot Prostatectomy 1 1Lap Radical Nephrectomy 1 1Lap Retroperitoneal 1 1
URO Total 14 1 15Bari LGB 2 2
Bari Total 2 2
Product Quality
Product Acceptability
Applied Medical Surgeon Approval
3 Disapprove
10 Neutral
117 Approve
•1 no for grasper•1 no for trochar (GYN)•1 no from initial procedure, later approved
Endomechanical bid response summary and vendor selection
General Surgery
Committee
Savings Opportunity
*Intermountain leadership has approved a physician engagement incentive of 30% of savings for this project
Scenario Scenario Description Current SpendProjected Spend
Potential Savings
Potential Rebate Savings
Potential Savings with rebates
1 Covidien preferred (80% Endo, 75% Trochar), Ethicon secondary 13,344,883$ 12,168,397$ 1,246,486$ 688,484$ 1,934,970$ 2 Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (100%) secondary 13,344,883$ 10,334,945$ 3,079,938$ 688,484$ 3,768,422$ 3 Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (80%) secondary 13,344,883$ 10,730,324$ 2,684,559$ 688,484$ 3,373,043$ 4 Ethicon 80% preferred for Endo & Trocars 13,344,883$ 13,815,543$ (470,660)$ ‐$ (470,660)$ 5 Covidien 80% preferred for Endo; Applied Medical preferred for Trocars Tier 2 13,344,883$ 11,047,877$ 2,297,006$ 189,421$ 2,486,427$ 6 Ethicon 80% preferred for Endo; Applied Medical preferred for Trocars Tier 2 13,344,883$ 11,109,673$ 2,235,210$ 330,000$ 2,565,210$
Scenario Scenario Description Current SpendProjected Spend
Potential Savings
Potential Rebate Savings
Potential Savings with rebates
1 Covidien preferred (80% Endo, 75% Trochar), Ethicon secondary 13,344,883$ 12,168,397$ 1,246,486$ 688,484$ 1,934,970$ 2 Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (100%) secondary 13,344,883$ 10,334,945$ 3,079,938$ 688,484$ 3,768,422$ 3 Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (80%) secondary 13,344,883$ 10,730,324$ 2,684,559$ 688,484$ 3,373,043$ 4 Ethicon 80% preferred for Endo & Trocars 13,344,883$ 13,815,543$ (470,660)$ ‐$ (470,660)$ 5 Covidien 80% preferred for Endo; Applied Medical preferred for Trocars Tier 2 13,344,883$ 11,047,877$ 2,297,006$ 189,421$ 2,486,427$ 6 Ethicon 80% preferred for Endo; Applied Medical preferred for Trocars Tier 2 13,344,883$ 11,109,673$ 2,235,210$ 330,000$ 2,565,210$
• Same assumptions as Scenario #1• In addition, savings is based on converting 100% of the below items as marked to Applied
Scenario 2Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (100%) secondary
Current Spend $13,344,883Projected Spend $10,334,945Potential Savings $3,079,938Potential Rebate $688,484Potential Savings with rebates $3,768,422
Scenario 2Covidien preferred (80% Endo, 75% Trochar), Ethicon/Applied (100%) secondary
Current Spend $13,344,883Projected Spend $10,334,945Potential Savings $3,079,938Potential Rebate $688,484Potential Savings with rebates $3,768,422
Scenario #2 savings & assumptions
Endo Trochars Item Description UsageCB5LT SLEEVE TROCAR XCEL 5MM LONG CB5LT 6/BX 6,804 B11LT TROCAR XCEL BLADELESS LONG 11MM B11LT 1,908 B12LT TROCAR XCEL 12MM BLADELESS LONG B12LT 1,566 H12LP TROCAR XCEL 12MM BLUNT TIP H12LP 6/BX 1,253 D5LT TROCAR XCEL DILATING 5MM D5LT JNJ 834 D11LT TROCAR XCEL DILATING 11MM D11LT JNJ 751 D12LT TROCAR XCEL DILATING 12MM DIA 100MM 6/BX 380 CB12LT SLEEVE TROCAR 12MM XCEL LONG CB12LT 222 B8LT TROCAR BLADELESS STBLTY SLEEVE 8MM X 100 126
POUCH POUCH ENDO SPECIMEN RETRIEVAL 10MM 6/BX 1,350 Move as much to Applied as possible (UVRMC)5BB GRASPER BABCOCK 5MM 5BB 6/BX 366 Move as much to Applied or Covidien as
possible (VVMC, AVH, IMED) 5 doc's make up 85%
UV120 NEEDLE VERRES 120MM HI FLOW UV120 12/BX 1,572 Move as much to Covidien as possible (IMED, 511NT TROCAR ENDOPATH DIALATING 10/11MM 511NT 72 Move as much to Covidien as possible (LDS, 3 512NT TROCAR ENDOPATH DIALATING 10/12MM 72 Move as much to Covidien as possible (IMED, 4 B5LT TROCAR XCEL 5MM BLADELESS LONG B5LT 6/BX 8,949 Move as much to Applied as possible
Items to convert
Move 2,000 units to Covidien, as much else
to Applied
Endo Trochars Item Description UsageCB5LT SLEEVE TROCAR XCEL 5MM LONG CB5LT 6/BX 6,804 B11LT TROCAR XCEL BLADELESS LONG 11MM B11LT 1,908 B12LT TROCAR XCEL 12MM BLADELESS LONG B12LT 1,566 H12LP TROCAR XCEL 12MM BLUNT TIP H12LP 6/BX 1,253 D5LT TROCAR XCEL DILATING 5MM D5LT JNJ 834 D11LT TROCAR XCEL DILATING 11MM D11LT JNJ 751 D12LT TROCAR XCEL DILATING 12MM DIA 100MM 6/BX 380 CB12LT SLEEVE TROCAR 12MM XCEL LONG CB12LT 222 B8LT TROCAR BLADELESS STBLTY SLEEVE 8MM X 100 126
POUCH POUCH ENDO SPECIMEN RETRIEVAL 10MM 6/BX 1,350 Move as much to Applied as possible (UVRMC)5BB GRASPER BABCOCK 5MM 5BB 6/BX 366 Move as much to Applied or Covidien as
possible (VVMC, AVH, IMED) 5 doc's make up 85%
UV120 NEEDLE VERRES 120MM HI FLOW UV120 12/BX 1,572 Move as much to Covidien as possible (IMED, 511NT TROCAR ENDOPATH DIALATING 10/11MM 511NT 72 Move as much to Covidien as possible (LDS, 3 512NT TROCAR ENDOPATH DIALATING 10/12MM 72 Move as much to Covidien as possible (IMED, 4 B5LT TROCAR XCEL 5MM BLADELESS LONG B5LT 6/BX 8,949 Move as much to Applied as possible
Items to convert
Move 2,000 units to Covidien, as much else
to Applied
Timeline
11/01/2010 – Start Applied Medical trial with select surgeons11/01/2010 – Send out RFP11/15/2010 – Receive bids back11/24/2010 – Committee meeting (Review bid responses)12/01/2010 – Second round of negotiation12/03/2010 – Begin expanded evaluation of Applied Medical01/21/2011 – Finish expanded evaluation and compile feedback forms02/02/2011 – Committee meeting (Review feedback and bid responses)02/07/2011 – Communicate with facilities and develop implementation plan03/01/2011 – Load new pricing
What could NSQIP potentially help healthcare systems do?
•Reduce waste and cost•SCO partnered initiatives
Endomechanical purchasing agreements (~$5.4 M) Orthopedic implants (~$18.7 M)Third party scope repairs (immediate annual savings ~$23K, potential annual savings with full conversion ~ $475K)Sterile Reprocessing of Single Use Items (SUD) (~$2 M)Instrument tracking ($2 M projected)Cost per case real time data for surgeons ($30 M projected)
•Carry out quality research•MDCS
Alvimopan•Biologics for ventral hernia repair•SPRING research and publications
What could NSQIP also help healthcare systems potentially do?
• Garner local, regional , and national media attention• High Value Health Collaborative Innovation Team (Intermountain Healthcare, Geisinger, Cleveland Clinic, Denver Health, Dartmouth‐Hitchcock, Mayo Clinic) Total Knee Replacement Project
Keys to a Successful Value Program
• Physician & Nursing leadership and support is critical• Need the expertise of a Supply Chain Organization (SCO) that
gathers the data, negotiates the contracts, and talks to other healthcare organizations to learn best practice
• Need a healthcare organization that is willing to pay doctors for their time be involved in negotiations and trial different products.
• Need volume to have leverage
Value = Quality/Cost
• 479 out of ~5,000 hospitals in the United States participate in NSQIP• 2 out of 23 hospitals in the Intermountain
Healthcare system participate in NSQIP• Yearly cost for participation fee and SCR
including benefits = ~$120,000 ‐ $150,000• Why aren’t more hospitals participating in NSQIP?
• It is clearly the premier surgical quality initiative in North America
• Could it be that hospital administrators don’t see the value?
Hotel Hospital
Source: Costs of Care Teaching Value Project