PowerPoint Presentation - Methodist Hospital

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					MARC BOOM, M.D.
JUNE 15, 2010
HOUSTON, TEXAS




                  The Methodist Hospital Update:
                       QUARTELY MEDICAL STAFF MEETING




                                                        1
Accolades

  • Dr. Laura Morrison has been
    selected as the winner of the AAMC
    Humanism in Medicine Award by
    the medical students and has been
    submitted as a candidate for the
    national award, which will be
    presented this fall.

  • Drs. Eugene Alford, Brian Butler
    and James Musser won the Houston
    Business Journal’s Health Care
    Heroes Award in their respective
    categories.




                                         2
Accolades

  • The Houston Surgical Society named
    Dr. George Noon as the 2010 Houston
    Distinguished Surgeon.




  • Dr. Alberto Ayala received the Koss Medal for
    career achievements in Urological
    Pathology. This is the highest recognition by
    the urologic pathologists.




                                                    3
Health Care Reform




                     4
Health Care Spending
      Two Key Failings of Our Health Care System

                                       Health Care Spending as Percentage
                                                    of GDP




                               OECD Health Data 2008. France: Organization for Economic Co-operation
                               and Development and IRDES (Institute for Research and Information in
                               Health Economics), 2008. (No authors given.) Robert Wood Johnson
                               Foundation, June 2009.

                                                                                                  5
Health Care Reform



   • Cost - $940 billion over 10 years
      • Medicaid and CHIP expansion
      • Insurance subsidies
      • Small employer tax cuts




                                         6
Impact on Hospitals



                 Reduces                                             Reduces
                 Medicare                Reduces
                                                                     Medicare
                 payments by             Medicare
                                                                     payments by
                 0.1%                    payment by 0.3%
                                                                     0.2%

    2010            2011        2012         2013          2014            2015
                               Reduces                 Reduces inpatient
   RAC programs
                               Medicare                and outpatient
   expanded to                                         hospital payment
                               payments by
   include audits                                      by 0.2%
                               0.1%

   Reduces
   Medicare
   payments by
   0.25%


                                                                              7
The “Shrinking” Dollar




                         8
In fact, it’s already happening…

  Monday, April 19, 2010….


     Proposed CMS rule decreases FY 2011
                   hospital
              payments by 0.1%
  • Expected cut to an inflationary update would amount to a $3.7
    billion hit for our nation’s hospitals

  • CMS
     • Attempt to recoup payments from the industry for inaccurate
       coding practices

                                                                     9
Our Economy




              10
TMH Net Income




                       5%
                      Margin




                 11
                                                  -
                                                      100
                                                            200
                                                                  300
                                                                        400
                                                                              500




          (500)
                  (400)
                          (300)
                                  (200)
                                          (100)
     Jan-00
     Apr-00
     Jul-00
     Oct-00
                                                                                                                                  Volumes


     Jan-01
     Apr-01
     Jul-01
     Oct-01
     Jan-02
     Apr-02
     Jul-02
     Oct-02
     Jan-03
     Apr-03
     Jul-03
     Oct-03
     Jan-04
     Apr-04
     Jul-04
     Oct-04
     Jan-05
     Apr-05
     Jul-05
     Oct-05
                                                                                                    2000 - 2010




     Jan-06
     Apr-06
                                                                                                Patient Admission




     Jul-06
     Oct-06
     Jan-07
     Apr-07
     Jul-07
     Oct-07
     Jan-08
     Apr-08
                                                                                    Month over month/ Year over Year Comparison




     Jul-08
     Oct-08
     Jan-09
     Apr-09
     Jul-09
12




     Oct-09
     Jan-10
     Apr-10
Realization Rate

                              2010 Realization Rate
   45%
                 41.63%
   40%

   35%

   30%

   25%

   20%
                                     16.10%
   15%

   10%
                                                 7.00%
    5%                                                      3.85%

    0%
         Managed Care/ Commercial   Government   Self Pay   Other




                                                                    13
Action Plan

                  What are we doing about it?

    •   25 out of 241 cost centers over budget
    •   Decrease overtime use to less than 3%
    •   Improve efficiencies in labor and non-labor
    •   Reduce average length of stay to top decile of UHC
    •   Opportunity for physician growth
    •   Align strategy throughout TMHS




                                                             14
        How best can we work together?

• Length of Stay
• Efficiency/Utilization




                                         15
2010 ALOS Metrics
                                          UHC TMH AVERAGE LENGTH OF STAY INDICES
                                                  (Total Inpatient Population; August 2009 UHC Risk Model)
 1.13




                                                                                                                                                                                     0.97


6.75          6.62          6.53
                                                        6.18          6.16          6.17                                          6.20                                      6.22
       5.97          5.94          5.84
                                          6.10
                                                 5.77          5.89          5.86          5.85
                                                                                                  6.11 5.95   6.05 6.07    5.96                 6.03          6.03   5.96          5.95 6.12   5.95
                                                                                                                                         5.70          5.72




2007-1         2007-2       2007-3        2007-4        2008-1        2008-2        2008-3        2008-4      2009-1       2009-2        2009-3        2009-4        2010-1        Apr 2010 May 2010
                                                                                                                                                                                              Prelim
                                                                                                                                                                                            (6/7/2010)


                     Mean LOS (Obs)                 Mean LOS (Exp)                  LOS Index              Target = 1.00             Q1 2010 Top Decile = 0.91 (n=91)                Trend (LOS)



                                                                                                                                                  External
              Performance Measure                                      TMH Q4 2009                            TMH Q1 2010                        Benchmark                          Source

   ALOS Observed/Expected Index                                   0.95 ** (77th Percentile)              0.96 ** (72nd Percentile)                     1.00                           UHC
                             ** lower than UHC expected value, highly significant (p = < 0.01)                                                   Source: UHC Clinical Data Base, as of 6/2/2010       16
Length of Stay Activities: Updates


       Goal: Improve processes to insure appropriate patient
                throughput across continuum of care


   Why all the effort??

   •   Improve safety
   •   Enhance patients and family experience
   •   Expedite patient discharge
   •   Optimize hospital capacity
   •   Eliminate unnecessary delays in treatment, testing
   •   Reduce readmission rate


                                                            17
Length of Stay Activities: Updates
                     Current Initiatives Underway
 •    Collaborative effort with Department Chairs, Physician staff, and Executive
     team in identification of patient populations requiring focused efforts
     regarding throughput

 •    Daily Multidisciplinary rounds with entire care team and Executives to
     identify individual patient plans of care and discharge needs

 •   Implementation of weekend processes that assure patient transfer/discharge:
     on site case management, social work, operations administrators and NP’s

 •   Improved utilization of community SNF, LTAC networks and Home
     Healthcare

 •   Implementation of Admission Status Protocol: July, 2010
      • Improve compliance with Medicare and Medicaid regulations
      • Appropriate status of patient given by case management on admission


                                                                               18
2010 Mortality Metrics
                                                                UHC TMH MORTALITY INDICES
                                                  (Total Inpatient Population; August 2009 UHC Risk Model)

0.92




                                                                                                                                                                                            0.60


                                                                                                                        3.26           3.21                                        3.30          3.29
                                                               2.98                        2.99          3.00                                          2.98          3.11
       2.92          2.84          2.88          2.89                        2.79
2.70          2.64                        2.56                                                    2.60
                                                        2.50                        2.46
                            2.36                                                                                 2.34           2.20                          2.09          2.08
                                                                      2.05                                                                      1.98                                      1.98
                                                                                                                                                                                                        1.78




2007-1         2007-2       2007-3        2007-4        2008-1        2008-2        2008-3        2008-4          2009-1        2009-2           2009-3       2009-4        2010-1        Apr 2010 May 2010
                                                                                                                                                                                                     Prelim
                                                                                                                                                                                                   (6/7/2010)


                     % Deaths (Obs)                % Deaths (Exp)               Mortality Index                 Target = 1.00                 Q1 2010 Top Decile = 0.64 (n=91)               Trend (LOS)



                                                                                                                                                         External
              Performance Measure                                      TMH Q4 2009                                TMH Q1 2010                           Benchmark                          Source

 Mortality Observed/Expected Index                                0.68 ** (92nd Percentile)                0.63 ** (91st Percentile)                          1.00                           UHC
                             ** lower than UHC expected value, highly significant (p = < 0.01)                                                          Source: UHC Clinical Data Base, as of 6/2/2010         19
2010 Readmission Metrics
                        UHC TMH PERCENT 30-DAY RELATED READMISSIONS
                                    (Total Inpatient Population; August 2009 UHC Risk Model)
  6.08




                                                                                                                                                                5.24



                                                   53                                                                                                           53

                                                                                                                                 46

               39           38
                                                                                         36                                                    35
                                                              31                                     30
                                       29
                                                                                                                   27
   21                                                                       21




 2007-1      2007-2       2007-3     2007-4      2008-1     2008-2        2008-3       2008-4      2009-1       2009-2        2009-3        2009-4        2010-1
 (n = 88)    (n = 88)    (n = 88)    (n = 88)    (n = 91)   (n = 91)      (n = 91)     (n = 91)    (n = 91)     (n = 91)      (n = 91)      (n = 91)      (n = 91)

“n” = Number of hospitals in compare group

                TMH Percentile         % 30 Day Readmit            UHC Top Quartile           UHC Top Decile            Trend (% 30 Day Readmit)


                                                                                                                External
         Performance Measure                       TMH Q4 2009                        TMH Q1 2010              Benchmark                     Source
                                                                                                                UHC 25th
  30-Day Related Readmissions                   5.94% (35th Percentile)          5.24% (53rd Percentile)        Percentile                     UHC
                                                                                                               Source: UHC Clinical Data Base, as of 6/2/2010        20
LOS vs. Bed Availability

                LOS vs. Satisfaction with the Availability of Beds
   7.0                                                         4.5



            6.78

                                                       4.16

   6.5                                                         4.0
                            6.4
                                         3.9

                                                       6.25          LOS
                            3.7                                      Availability of beds
                                         6.11
   6.0                                                         3.5



            3.28



   5.5                                                         3.0
         2007            2008         2009      2010 May YTD


                                                                                     21
Radiology Utilization

                                Trends
   • Inpatients having “the Methodist workup” for the convenience of
   the patient “since they are here, let’s get a xxx done”
        •For example: Patient being transferred back to Beaumont and is
        due for a biopsy there soon and attending has it done before they
        leave

   • Inpatient has diagnosis unrelated to cancer and something
   suspicious is found on a scan
       •Physician orders a whole diagnostic workup for the possible
       cancer while patient is still an inpatient
   • Multiple echoes, peripheral vascular studies, and chest x-rays being
   done during the same inpatient stay

   • Currently we are reviewing order sets for unnecessary labs,
   imaging, etc.

   •Reimbursed according to bundled payment or MS-DRG
                                                                            22
The Methodist Hospital
  Research Institute




                         23
Research Institute

 • Thank you
    • A special thank you to Dr. Lieberman – retiring June 30, 2010

 • TMHRI President and CEO Search Update
    • Search committee composed of clinical, scientific and executive
      leadership
    • Excellent local and national candidates

 • Chair of Pathology Search
    • Excellent local and national candidates




                                                                      24
TMHRI Building Update


 The building is nearly complete; investigators and their
   staff will begin moving into office and lab space this
   summer. The 440,000 sq. ft. facility includes:
    • Cyclotron in the basement
    • State of the art auditorium and pre-function space
      on the second floor
    • MITIE facility on the fifth floor
    • Four lab floors (two shell) – enough space for 90
      investigators
    • Inter-connective lounge between lab floors
    • A connecting corridor to The Methodist Hospital

                                                            25
TMHRI




        26
Lobby




        27
Auditorium




             28
Other News




             29
Residency Graduation


                         June 18th 7 p.m.
                          Crain Garden
     • 5th TMH Residency Graduation
     • 69 Graduates

     First graduating class:
     • 5 graduates from the Internal Medicine program
     • 1 graduate from the OB/GYN program (entire program at TMH)
     • 1 graduate from the Breast Imaging program (non ACGME)
     • 1 graduate from the Minimally Invasive Gynecological
     program (non ACGME)


                                                            30
Residency Programs


 • 168 TMH residents

 • 23 ACGME-accredited
   Residency Programs

 • More than 200 residents from
   other medical schools
 • More than 300 physicians with
   Weill Cornell faculty
   appointments

 • Residents cover Pathology,
   Neurosurgery, OB/Gyn,
   General Surgery, Plastic
   Surgery, Family Medicine and
   more
    • Cardiovascular disease (2010)

                                      31
New Fellowships


  • The Accreditation Council for Graduate Medical Education (ACGME)
    has accredited a fellowship in Molecular Genetic Pathology.
     • This single fellow program will begin training on July 1, 2010
     • The Program Director is Dr. Federico Monzon

  • The ACGME also has accredited the HLA (Pathology) Fellowship
    Program.
     • This program has the distinction of being the first program of its
       kind in the United States and is paired with UT M. D. Anderson
       Cancer Center.
     • The Methodist program will train pathology physicians and M.D.
       Anderson will train PhD applicants to become HLA experts and
       laboratory directors.
     • The program director is Dr. David Bernard and the Associate PD is
       Dr. Geoffrey Land.

                                                                       32
  CPOE
                                                                                      ORIGINAL
                                                                                     COMPLETION
TODAY                        2010                                                                    2011                                              2012

      5/18         6/8              9/21        11/15            1/18      3/8     3/22      5/18       7/12        9/3       10/25      12/13                 4/30
     MSLH         MSLH              TMH        MWHH              TMH MWH           MWH       TMH        TMH        TMH        TMH        TMH                  MethOD
     Initial     Hospital         Functional   Opening         Functional Initial Hospital Functional Functional Functional Functional Functional             Upgrade
    Group         Wide              Unit 1     & CPOE            Unit 2 Group      Wide      Unit 3     Unit 4     Unit 5     Unit 6     Unit 7               Go-Live
    Go-Live      Go-Live           Go-Live     Go-Live          Go-Live Go-Live Go-Live Go-Live        Go-Live    Go-Live Go-Live       Go-Live



        May    Jun   Jul    Aug     Sep   Oct    Nov     Dec     Jan   Feb   Mar   Apr   May   Jun   Jul    Aug   Sep   Oct   Nov   Dec   Jan    Feb   Mar    Apr




    Sugar Land



                              West Houston



                                                                    Willowbrook



                                                                             Main Campus                                                    MethOD Upgrade
                                                                                                                                                (ARRA Readiness)
                                                                                                                                                         33
NextGen E.H.R

                           • Pre-built clinical templates and workflow for
                             accurate, standardized documentation and access

                           • Disease management templates capture discrete data
                             at the point of care to meet clinical reporting
                             guidelines for pay-for-performance programs

                           • ePrescribing & Medication Management Module

Benefits
•Access patient records instantly – anytime, anywhere

•Improve medication management protocols

•Integrate scheduling and admissions tasks in one system

•Improve financial, clinical and administrative reporting

•Receive TMHS and national lab (Quest and LabCorp)
results electronically, seamlessly linked to the patient
                                                                           34
record
TMHS Pricing

                                        Monthly Cost   Physician Cost with
                                                       50% TMHS Subsidy
      Electronic Health             $721.97            $360.98
      Record
      (EHR)1
      Electronic Practice           $290               $290
      Management
      (EPM)
      EHR/EPM                       $1,011.97          $650.98
      Combined

                                        Monthly Cost   Physician Cost with
                                                       50% TMHS Subsidy
      Implementation                $3,955             $1,977
      Fee
      1Cost   decreases with larger practices

                                                                             35
Physician Opinion Survey 2010
                            Physician Engagement Trend
          4.50
          4.45
                                                                  4.45
          4.40
          4.35                              4.37       4.37
          4.30
                                  4.30
          4.25       4.24
          4.20
          4.15
          4.10
                  2005         2007      2008        2009       2010

Engagement Composite Questions:
• I would recommend The Methodist Hospital to family and friends who need
   care.
• Overall, The Methodist Hospital provides high-quality care and service.
• The Methodist Hospital makes every effort to deliver safe, error-free care to
   patients.
• Overall, I am satisfied working with The Methodist Hospital.
• If I am practicing medicine three years from now, I am confident that I will be
                                                                                    36
   practicing at The Methodist Hospital.
37

				
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