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TRANSCRIPT
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IHI ExpeditionExpedition: Preparing Care Teams for Bundled Payments
Session 5: Care Team Redesign
May 19, 2015
Begins at 1:00 PM
Trisha Frick, MS, RNNick Bassett, MBALucy Savitz, PhD, MBAMolly Bogan, MA
Today’s Host2
Akiera GilbertProject Office Assistant
Institute for Healthcare Improvement
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Phone Connection (Preferred)3
To join by phone:
1) Click on the
“Participants” and “Chat”
icons in the top right
hand side of your
screen.
2) Click the button
on the right hand side of
the screen.
3) A pop-up box will
appear with the option “I
will call in.” Click that
option.
4) Please dial the phone
number, the event
number and your
attendee ID to connect
correctly .
WebEx Quick Reference
• Please use chat to
“All Participants”
for questions
• For technology
issues only, please
chat to “Host”
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Enter Text
Select Chat recipient
Raise your hand
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Chat
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Name and the Organization you represent
Example: Sam Jones, Midwest Health
Please send your message to All Participants
Expedition Director6
Molly Bogan, MA
Director
Institute for Healthcare Improvement
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Expedition Objectives
At the end of this Expedition, participants will be able to:
Describe the benefit of transitioning to a value-based purchasing model
Understand and apply activity-based cost accounting methodology to at least
one care process
Demonstrate examples of how to engage stakeholders in building a bundle
Describe how to customize care team redesign to deliver optimum care
under value-based purchasing
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Today’s Agenda8
Introductions
Session 4 Action Period Assignment Debrief
Care Team Redesign
Action Period Assignment
Closing
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Expedition SessionsSession 1: Volume to Value; Describe the benefit of transitioning Value- Based Purchasing
Lead Faculty: Lucy Savitz & Trisha Frick
Session 2: Getting Started with Building a Care Bundle
Lead Faculty: Trisha Frick & Nick Bassett
Session 3: Collecting Data Using Activity-based Costing
Lead Faculty: Nick Bassett & Lucy Savitz
Session 4: Engaging Stakeholders in Bundle Design
Lead Faculty: Trisha Frick & Nick Bassett
Session 5: Care Team Redesign
Lead Faculty: Trisha Frick & Nick Bassett
Session 6: Case Study: CMS Bundled Payments for Care Improvement Experience
Lead Faculty: Stephanie Calcasola & Trisha Frick
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Action Period Assignment Debrief10
• Build a list of key stakeholders for stakeholder engagement plan.
Share with others using the chat to All Participants
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Chat
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Please chat in one key stakeholder you
identified and a strategy for how to
engage them in building or deploying a
bundle.
Please send your message to All Participants
Faculty12
Lucy Savitz, PhD, MBA
Director of Research and
Education
Intermountain Healthcare
Salt Lake City, Utah
Trisha Frick, MS, RN
Assistant Director of
Managed Care
Johns Hopkins
HealthCare LLC
Glen Burnie, Maryland
Nick Bassett, MBA
Healthcare
Transformation Manager
Intermountain
Healthcare
Salt Lake City, Utah
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Care Team Redesign
Where do you begin?
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• Review each phase of the care cycle: consult, pre-op testing, operation, PACU, inpatient stay, post-discharge follow-up.
• Is the care provided based on evidence-based practice
or “just because” this is the way it has always been done?
• Is each and every level of personnel practicing at the top of their
license?
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Changes to Care Cycles
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• Modified anesthesia protocol to provide spinal anesthesia whenever possible resulting in PT on the day of surgery.
• Pain management: stopped PCA completely. Multimodal pre-emptive analgesia including intra articular joint blocks.
• Other cost savers: no drains, no continuous passive motion, limited foleys.
Utilization of Staff
• Where can staff be utilized differently for increased efficiency?
– Night shift nursing staff get patients out of bed and ready for breakfast.
– Hired scribe for physician documentation during clinic visits.
– Mid-levels utilized in OR instead of 2 residents.
• Are there any places where lower level personnel provide the task?
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Changes to patient services hours
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• Physical therapy staff changed hours to start later in the day and staggered shifts.
• Only anesthesia present to start first case at 7:15. All others scheduled in room at 7:30.
• Block OR time.
Travel Surgery Program Description
• Bundled rate contract with Pacific Business Group on Health representing large national employers (Walmart, Lowe’s & McKesson).
• Requirements of the program is that the patient is approved for surgery without in person consult.
• Requires medical record collection process that is complete and efficient.
• Surgeon is expected to review medical record within 5 days of receiving.
• Uncomplicated patient is to be in surgical city for 7-9 days.
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Changes Necessary to Meet Travel Surgery Program Demands
• Creation of specific list of notes and films necessary to evaluate candidacy.
• Total joint replacement nurse review and assemble medical record to facilitate surgeon review process.
• Surgeons scheduled time for medical chart review.
• Surgeons changed OR days and clinic days to be able minimize number of days in surgical city.
• Travel patients scheduled as first cases to promote discharge early in the day whenever possible.
• Travel patient clinic scheduled early to allow return to home on day of clinic visit.
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Managing the Full Cycle of Care
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• Patient education/expectations pre-operatively.
• What is preventing timely discharge?
• Take home prescriptions.
• Discharge location.
• Managing post op pain and nausea.
• Outpatient physical therapy location identified pre-operatively.
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Identifying Data Needs
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• Cost: OR minutes, anesthesia, supplies (implants & cement) , consult utilization, ICU days, P&L of bundle.
• Quality indicators: length of stay, surgical site infections, wound infections, 30 day re-admissions, return to OR, high cost drug utilization.
• Catastrophic cases? What might be contributing to these?
• Patient satisfaction.
Designing an effective data feedback system
• Regularly scheduled operations meetings.– Formal agenda
– Present data: volume, P&L, successes, challenges.
• Communication at all levels: care team, finance, senior leadership, payor, patients.
• Regularly scheduled full team meetings.– Formal agenda
– Present data: LOS, performance indicators.
– Process: where is the team not making the required time frames?
– Where are there bottlenecks?
– What can be done differently?
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Ongoing Evaluation
• Bundle team and senior leadership– Financial performance monthly, bi-annually, annually.
– Shared savings calculations and reporting.
– Overall evaluation of bundle.
– Are the results worth the risk?
• Contract review– Ask your team for any problem areas.
– Are there any issues from the payor perspective?
– Is this anything we should do differently?
– Are there components that are missing?
– Can billing process be more efficient?
– Are there any terms/requirements influencing patient compliance?
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Questions/Discussion24
Raise your hand
Use the chat
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Action Period Assignment
Build an outline for designing an optimum
care team end-to-end based on data
collected in sessions 1, 2, 3 & 4.
Expedition Communications
• All sessions are recorded
• Materials are sent one day in advance
• Listserv address for session communications:
• To add colleagues, email us at [email protected]
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Session 627
Tuesday, June 2nd, 1:00 – 2:00 PM ET
Case Study: CMS Bundled Payments for Care Improvement Experience
Stephanie Calcasola
MSN, RN-BC
Director of Quality and Medical Management
Baystate Medical Center
Trisha Frick, MS, RN
Assistant Director of Managed Care
Johns Hopkins HealthCare LLC
Thank You!28
Director: Molly Bogan
Akiera Gilbert
Please let us know if you have any questions or
feedback following today’s Expedition webinar.