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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. Franc e: Organization for Economic Co-operation
and Development and IRDES (Institute for Researc h and Information in
Health Ec onomics), 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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