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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Number of Units of RBCs Transfusedper 100 Patient Days at Dixie

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Proportion of all Dixie Patientswith HCT between 21 & 27 Receiving RBC tx

Education does work on doctors

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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