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					        ICJR Hip and Knee Course
     Practice Management Symposium
Future Requirement of Orthopaedic Groups

        How Do Physicians Win?
       ICJR Hip and Knee Course
    Practice Management Symposium
          How Do Physicians Win?


• Leadership

• Technology

• Affiliations

• Differentiation
              ICJR Hip and Knee Course
           Practice Management Symposium

                     How Do Physicians Win?
• Leadership:
  – Strategic Thinking (Market /
    Business)

  – “Seat at the Table” of ACO (Demand
    It)

  – MSK Service Line Co-Management
    (Hospital / ACO)

  – Progressive Actions: Quality
    Program; Bundled Payments

  – Market Coverage (“Hub and Spoke” –
    Community)
           ICJR Hip and Knee Course
        Practice Management Symposium

                  How Do Physicians Win?
• Technology:
  – Electronic Medical Records
     (Data Exchange)

  – Sophisticated Billing System
     (Cash is King)

  – Business Intelligence System
     (Dashboard / Integration)

  – Clinical Research Database
     (Outcomes)
             ICJR Hip and Knee Course
          Practice Management Symposium

                  How Do Physicians Win?
• Affiliations:

  – Other Medical Groups
    (Quality / Strategic)

  – Hospital Systems (Financially
    Sound)

  – University (Academic)

  – ACO (Market Coverage)
          ICJR Hip and Knee Course
       Practice Management Symposium
               How Do Physicians Win?

                In a Nut Shell!

• Differentiation:

          Differentiation in Quality and
          Service; and a Responsible
                Approach to Cost.
        ICJR Hip and Knee Course
     Practice Management Symposium

               Differentiation

• Quality Initiatives

• Service Initiatives

• Cost Initiatives
   ICJR Hip and Knee Course
Practice Management Symposium




      Quality Initiatives

“Provide Quality and Measure”
           ICJR Hip and Knee Course
        Practice Management Symposium

        Differentiation
       Quality Initiatives

• Hospital Value Based Purchasing
  (VBP)

• Physician Quality Reporting
  System (PQRS)

• External / Internal Reporting
  Systems
         ICJR Hip and Knee Course
      Practice Management Symposium
                       Differentiation
                    Quality Initiatives
• External / Internal Reporting Systems

  -Hospital Compare - HHS – (External)
     -Process of Care (SCIP)
     -Outcome of Care (Mortality/Readmission)
     -Use of Imaging (Safety/Screening)
     -Hospital Experience (HCAHPS)
     -Medicare Volume / Payment
         Pennsylvania Health Care Quality Alliance (PHCQA)

                                    Surgical Care and Infection Prevention (Overall)
Measures how often hospitals are performing recommended tasks. The column highlighted in yellow is the benchmark to which
     the hospital is compared. The red numbers indicate when the hospital is performing the task at a rate lower than the
                                                  benchmarked PA rate.


                              TJUH
                         (Including JHN                                                                         Top 10%
Core Measures              & Methodist)   Riddle   Nazareth   Lankenau   Bryn Mawr     BCSH         PA Rate     Nationally
Beta Blocker During
the Perioperative
Period                        97%          93%       93%        95%        98%          N/A           93%         100%
Prohylactic Antibiotic
within 1 hour of
incision                      98%         100%       99%        99%        99%          N/A           97%         100%


Appropriate Antibiotic        98%          97%       99%        98%        99%          N/A           98%         100%
Prophylactic
Antibiotic
discontinued within
24 hours                      97%          95%       98%        98%        100%         N/A           95%          99%
Urinary Catheter
removal within two
days of surgery               97%         100%       92%        97%        100%         N/A           94%         100%

VTE Ordered prior to
surgery                       98%          91%       96%        97%        100%         N/A           96%         100%

VTE Received within
24 hours of surgery           97%          90%       95%        94%        100%         N/A           95%         100%
            ICJR Hip and Knee Course
         Practice Management Symposium
                     Differentiation
                  Quality Initiatives

• External / Internal Reporting Systems
  – HealthGrades / Vitals MD (External)
     • Hospital Rating Systems
     • Risk Adjusted Data
     • Primarily Joints/Spine
              ICJR Hip and Knee Course
           Practice Management Symposium
                           Differentiation
                       Quality Initiatives
• External / Internal Reporting Systems
  – Outcomes Database – OBERD (Internal)
     • Functional Outcomes
     • Integrated with Operations
     • Patient Questionnaire; Specialty Questionnaire
     • Validated Instruments
         (SF12; SF 36; Harris Hip Score; HOOS)
     • Comparative Analysis
         (Transparency)
     • Future: Patient Satisfaction; Patient Education; Integrate Data
       Sources
                ICJR Hip and Knee Course
             Practice Management Symposium
                        Differentiation
                    Quality Initiatives

• External / Internal Reporting Systems
  – HealthGrades Quality Engagements:
     •   Consistent, Reporting Data (Risk Adjusted)
     •   Process Assessment / Standardization
     •   Currently MedPar; Future: All Payor
     •   Report at Hospital, Group, Surgeon, Procedure Level
             ICJR Hip and Knee Course
          Practice Management Symposium
                    Differentiation
                 Quality Initiatives

• External / Internal Reporting Systems
  – HealthGrades Quality Engagements: (contd.)
     • Benchmarking: Local, Regional, National
     • Hospital Ranking – All RI Hospitals
     • Complication Rate / Type; Volume; LOS; Charges;
       Readmission Rates; Mortality
   ICJR Hip and Knee Course
Practice Management Symposium

       Differentiation

    Service Initiatives
            ICJR Hip and Knee Course
         Practice Management Symposium

                 Differentiation

             Service Initiatives

•   Patient Mapping
•   Physician / Employee Training
•   Referring Physician Relations
•   Measure / Monitor Satisfaction
              ICJR Hip and Knee Course
           Practice Management Symposium

                    Differentiation

Service:
  – Patient Mapping:
     • ID Protocols / Metrics – each “Contact Point”
     • Call Center Stats (Calls, Wait Time, Abandon Rate)
     • Wait Time / Time with Physician / Communication
     • Hospital Connectivity for Surgical Scheduling
     • Post-Op “Customer Follow-Up” – Call; Notes
             ICJR Hip and Knee Course
          Practice Management Symposium

                  Differentiation

Service: (contd.)
  – Physician / Employee Training
     • Orientation (Physician / Staff)
     • Formal Customer Service Training (Staff)
     • Professional Appearance
     • Bed Side Manner (Physician and Staff)
     • Scripting Protocols
     • Complaint Management Feedback / Monitoring
Report of each person
              ICJR Hip and Knee Course
           Practice Management Symposium

                    Differentiation

Service: (contd.)
  – Referring Physician Relations:
     • Communication (Calls / Quick Fax)
     • Dictation / Report Submission (Timely)
     • Return Patient to Referring Physician
     • Referral Development Marketing Reps.
              ICJR Hip and Knee Course
           Practice Management Symposium

                   Differentiation

Service: (contd.)
  – Measure / Monitor Satisfaction:
         –HCAHPS (CMS)
         –Insurance Companies
         –Press Ganey
         –HealthGrades
         –Internally Generated Survey (OBERD)
                                               Hospital Compare
 HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national survey that asks patients about their experiences during a recent
 hospital stay. Use the results shown here to compare hospitals based on ten important hospital quality topics


                                                                                                                                      PA         National
                               Nazareth     Lankenau       TJUH       Methodist      Riddle    Bryn Mawr AtlantiCare      BCSH      Average      Average
Patients who reported that
their nurses "Always"
communicated well.               71%           78%          77%          N/A          77%         78%          75%         N/A        75%          76%
Patients who reported that
their doctors "Always"
communicated well.               74%           81%          76%          N/A          77%         76%          75%         N/A        78%          80%


Patients who reported that
they "Always" received help
as soon as they wanted.          57%           58%          66%          N/A          65%         62%          58%         N/A        63%          64%
Patients who reported that
their pain was "Always" well
controlled.                      64%           70%          69%          N/A          70%         70%          67%         N/A        68%          69%

Patients who reported that
staff "Always" explained
about medicines before
giving it to them.               54%           60%          61%          N/A          59%         59%          62%         N/A        59%          60%
Patients who reported that
their room and bathroom
were "Always" clean.             72%           64%          65%          N/A          62%         64%          65%         N/A        70%          71%


Patients who reported that
the area around their room
was "Always" quiet at night.     52%           47%          50%          N/A          45%         45%          51%         N/A        50%          58%
 RED = Lower than PA State and National Average
 PURPLE = Lower than National, but equal to, or higher than PA State Average
 Data Last updated 12-11-2010
       ICJR Hip and Knee Course
    Practice Management Symposium


          Cost Initiatives

“Ultimate Driver of Healthcare Reform”
            ICJR Hip and Knee Course
         Practice Management Symposium


                 Differentiation

• Cost Initiative:

  – Practice (FTE’s; Malpractice; Supplies)
  – Hospital (LOS; OR; R&B; Implant Supplies, etc.)
  – Episode of Care / Bundled Payment
             ICJR Hip and Knee Course
          Practice Management Symposium
                          Summary

                        Takeaways!

• Healthcare Market is Changing

• Outstanding Leadership Opportunities (Physicians)

• Understand Value Based Purchasing (Cornerstone ACA)

• Physicians – Help Drive Change Process – Don’t be a Result
  of Change
Thank You

				
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posted:1/24/2013
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