transitioning value analysis teams to total value of care...2015/12/04  · 12/9/15 1 transitioning...

26
12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and overall improvement potential to advance to total value of care by service line Explain cost reduction strategies beyond supply pricing and standardization Compare financial value to cost savings from operational improvements Learning Objectives

Upload: others

Post on 03-Aug-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

1  

Transitioning Value Analysis Teams to Total Value of Care

 Assess value analysis structure and overall improvement potential to advance to total value of care by service line  Explain cost reduction strategies beyond supply pricing and standardization  Compare financial value to cost savings from operational improvements

Learning Objectives

Page 2: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

2  

VHA’s Clinical Quality Value Analysis

  A consistent decision-making process   Interdisciplinary involvement   Support by engaged executives   Involved physician champions

Clinical Quality Value Analysis (CQVA)

An organized approach to decisions about products and services and their associated practices in the context of safety, quality and cost effective patient care that includes:

Applied consistently across the organization

Decision-making platform C

linical and physician preference Su

pplie

s an

d se

rvic

es

Clinical Quality Value Analysis Continuum

No Process New Product Team

Value Analysis Novice

Value Analysis Intermediate

Value Analysis Transformation

 No formal process  Purchases driven by

demand  Minimal criteria

 Process and team focused on review of new products

 Suppliers initiate new product entry and have frequent unregulated access to clinical areas

 Customer service to requestor

 Often rubber stamp of approval

 Process is led by supply chain

 Vendor management policy is developed to govern supplier access to clinical areas

  Limited Development of objective, non-financial criteria

 Commodity and clinical preference product conversions

 High volume of new product requests

 Process is led by supply chain and clinicians

 Supply chain uses market pricing benchmarks to obtain best financial value

 Reduce or eliminate waste

 Objective data used to -  Ensure new

products add value

-  Reduce variety of products

  Integration of appropriate use for clinical preference products

 Develop forum for new technology assessment

  Integration with Performance Improvement

Limited strategies for savings

Pricing and limited standardization

Conversion, utilization and

standardization

Total value across care continuum

Value Analysis Advanced

 Multi-disciplinary teams use supply chain, clinical, financial and operational data across acute care continuum

 Outcomes data drives balanced decision making ˗  EMR ˗  MMS ˗  National Metrics ˗  Protocols ˗  Evidence

  Integration of appropriate use for physician preference products

Total value in acute care

 Community based, post acute and acute providers as well as patient and family caregivers collaborate to determine appropriate care and product use that results in improved patient engagement

  Long term outcomes data drive supply chain, clinical, financial and operational decision making

 Alignment of process drives seamless care -  Patient access, flow

and care coordination

Pricing only

Greater Physician Involvement

Page 3: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

3  

Characteristics

  Focus on cost and standardization within a department or procedural area.

  Membership is multi-disciplinary structure by department or clinical practice area.

  Team Leader reports initiatives completed, savings achieved and pipeline opportunities.

  Physician participation with supply chain in Value Analysis to review products and cost savings opportunities.

  Analysis of products and services through the eyes of a patient and spans pre, acute and post acute care.

  Membership is across internal and external departments and services that support the service line.

  Service line director provides dashboard of service line business review.

  Physicians co-chair teams who analyze cost, quality and outcomes.

  Teams review practice variation along service line and implement evidence based best practice.

Traditional Value Analysis Advanced Value Analysis

Moving from Hospital Inc. to Health Company Inc. Hospital centric System of Care focused

Compete via size, scale consolidation, outcomes

Volume growth

Actively managing: Physician employment Physician incentives Supply chain metrics

Focusing on: Driving volumes Meaningful use

EMR install

Success = inpatient growth

Quality and value

Compete via care coordination price, service, connectivity,

outcomes

Actively managing: High risk populations Physician alignment

Redesigned value analysis Cost per case metrics

Focusing on: Integrated care management, clinical data across continuum,

post acute care network

Success = Connected lives and shared risk

Payment changes drive

model changes

Page 4: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

4  

  Consistent methodology that considers evidence, strategy, business development and risk to the organization and patient.

  Accountability for team activities are achieved at the VP level

  Cost of Care evaluated versus cost of products

  Reimbursement, payor mix and outcomes are critical factors for decision-making.

  Establishes solid infrastructure of subject matter experts to analyze complex cost and procedural data

  Facilitates an environment for swift adjustments to market conditions.

  Ensures decisions are being made from a holistic point of view.

  Link products and practice with outcomes

  Increased transparency and opportunity for physicians to lead changes to their practice.

  Robust teams have ability to support bundled payment analysis

Benefits of Service Line Structure

Bundled Payments

Simplify the buying process

Shop for quality and convenience

Best price

Patients’ own unique needs

Workforce involved

High variable cost

RETAIL

HEALTHCARE

Page 5: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

5  

  Opportunity to align incentives across providers to deliver coordinated and efficient care.

  ASCs can market their all-inclusive bundled procedures to consumers, creating new ambulatory opportunities in the market and threats to hospitals that are unprepared to compete on price and service.

  One upfront price for all services in an episode of care vs individual, variable and sometimes opaque prices for each discrete service needed.

  Consumers, Employers and Payors will have ability to shop around for services based on quality, experience and price transparency. Online services such as MediBid will allow patients to receive transparent price bids from providers, similar to Priceline for travel.

Bundled Payments – What is coming?

Shift from Supply Savings to Operational Improvements

65%

30%

5%

Pricing Process improvement Utilization

2014 and 2015 performance is baseline for future shift in operational improvements

Page 6: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

6  

Success Factors

  Build an efficient service line based value analysis structure to address cost, quality and outcomes across the continuum of care.

  Align physician incentives to ensure they work together to reduce variability and achieve positive outcomes.

  Create a laser-focused perioperative process that mitigates infections and other adverse events, efficiently utilizes OR time, and standardizes supply and device utilization.

  Coordinate and align incentives with high-quality post-acute providers to reduce potentially avoidable complications and readmissions.

How to we get there?

Revise Value Analysis Team Structure and Process to support a Service Line approach to understanding Total Value of Care.   Highly visible governance with Senior Executive oversight.   Goals are aligned with clinical, financial and operational objectives.   ACO will move certain DRG’s to a bundled payment structure.   Multidisciplinary service line teams co-chaired by VP Executive Sponsor and Physician, facilitated by Team Leader, and team membership to include those disciplines and services that support service line success.   Expand team skills to synthesize data from various clinical and financial sources to address utilization and clinical variation.   Develop service line dashboards to identify, track and trend opportunities and re-measure implemented projects.   Address new product entry parameters and develop triage criteria to route initiatives.   Establish regular channels of strategic communication.

Migration of Teams to Total Cost of Care

Page 7: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

7  

Example of Current State Value Analysis Team Structure

Value Analysis Steering

Committee

Peri-Op VAT

Patient Care VAT

Cardio-Imaging

VAT

Support Services

VAT

Admin VAT

Value Analysis Coordinator

Future State Service Line Structure

Value Analysis Steering

Committee

Ortho/ Spine

Service Line

C-V Service

Line

Patient Care Team

Support Services Team

Women / Children Service

Line

Surgical Services

Oncology Service

Line

OPS

New Technology and Innovation

Ass

essm

ent

Implem

entation

Ancillary Services Team

Service Line Teams

Physician Co-Leadership

Value Analysis Coordinator

Page 8: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

8  

Incorporate New Technology and Innovation Physician and executive led new technology and innovation committee

•  Triage •  Research •  Cost

analysis •  Objective

summary

SLT Assessment

•  Review findings •  Peer review •  Decision

New technology and innovation •  Implementation

plan •  Monitor outcomes

SLT Implementation

Supports capital, strategic planning, purchasing, IT and service lines

Team Leadership and Governance

  Executive Sponsor – VP or Service Line Leader

  Physician Co-leader

  Team Leader – Department Manager or Business Manager

Service Line Committee Structure

Page 9: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

9  

Service Line Committee Structure Membership to include all disciplines that interact with a patient throughout the course of their care both inside and outside the hospital.   Contract Managers

  Department Managers

  Nursing Staff

  Case Management

  Quality

  Education

  Radiology

  Laboratory

  Pharmacy

  Finance

  IT

  Reimbursement

  Biomed

  Clinicians –  WOCN –  ICP

  Physician Offices

  Home Health

  Rehab

  Clinics

Achieve accountability at VP level

  Review financial reports compared to goals and budgets.

  Agenda for monthly Steering Committee –  Volume and profitability

–  Accomplishments and pipeline: supply, clinical, operational and financial improvements

–  Impact on cost per case

–  Declined initiatives and rationale

–  Remove siloes to enhance transitions of care

–  Identify barriers

Accountability

Page 10: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

10  

Support services –  Controllable costs per adjusted admission

Patient care –  CMI adjusted variable cost per case for all medical DRGs

Surgical services –  Surgical CMI adjusted supply cost per case

Ancillary services –  Contribution margin percentage

Cardiovascular, oncology, women’s, ortho and spine –  Contribution margin percentage

Goal Measurement for New Teams

  New products, technology, services and capital

  Evidence based consistent methodology

  Consider utilization, variation, consumption, need and waste

  Use financial discipline for decision-making

  Consider alternative payment models

  Include transitions of care, LOS and readmissions and post acute care

  Physician co-leader not just for messaging to physicians

Functions of New Service Line Value Analysis Teams

Page 11: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

11  

Exploring Cost per Case

  Dr. Newtech has requested to trial an optical trocar for laparoscopic hysterectomy.

  He learned about it from a colleague at another hospital.

  The hospital is 80% standardized with Applied Medical and 20% Covidien.

  The new trocar is more costly than the current product and from a different vendor.

Physician Preference Item Request

Page 12: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

12  

Product Application How is it used?

Bladeless Trocars • Separates fibers versus cutting tissue • Reduces risk of tissue/organ injury

Blunt Trocar • Hasson – Uses a cut down technique-safer for the umbilical area • Balloon Tip – Inflates a balloon to prevent trocar from slipping out

Optical Trocar • Blade that cuts with a visual guide for placement • Reduces risk of injury to tissue and organs

Reposable Trocar • Allows hospitals to reuse some of the parts to save expenses • Obturators and cannulas are reusable

Various Surgical Approaches for Hysterectomy What procedure will Dr Newtech use this for?

Abdominal Hysterectomy

Vaginal Hysterectomy

Laparoscopic Hysterectomy

  Laparoscopic Total Hysterectomy

  Laparoscopic Supracervical Hysterectomy

  Laparoscopic Assisted Vaginal Hysterectomy

  Robotic Approach

Page 13: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

13  

Total Laparoscopic Hysterectomy

CPT 6841 DRG 742-743 Avg. LOS 1.58 days* Avg. reimbursement

§  With CC/MCC $8031 §  Without CC/MCC $5240

§  Less intraoperative bleeding §  Shorter hospital stay §  Faster recovery §  Lower infection rates

  The Surgical Services Value Analysis Team (or Women’s Health Service Line Team) will coordinate the DRG review for cost savings opportunities and practice variation.

  Patient population will be normalized to include only patients discharged to home. Oncology patients are excluded.

  The data to be analyzed will include: –  Clinical application and properties of trocars –  Trocar cost analysis and contracts –  Physician trocar practice and preferences –  DRG profitability by physician –  Variable cost of OR supplies and ancillary services –  Quality and safety measures for Laparoscopic Hysterectomy –  Clinical evidence based practice and leading practices

Project Scope

Page 14: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

14  

Be prepared with accurate, in-depth clinical and financial data

–  By procedure and physician

  Quality of outcomes

  Utilization patterns and compliance with care protocols

  Cost of care

Understand variation

–  Over time

–  By facility

–  By physician

The Importance of Data-driven Decisions

Case Study Goals

Value Analysis

Improve Outcomes

Manage Cost

Reduce Variation

Page 15: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

15  

Stakeholders

Supply Chain Analysis

Trocar Utilization and Contracts

Page 16: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

16  

Summary of All Trocar Usage

VENDOR CAT # ANNUAL USAGE

COST / EA SPEND

Applied Medical

12 SKUs 4774

$20 - $62 $130,262

Covidien 4 SKUs 300 $73 - $121 $30,272

Applied Medical is prime vendor at 80% with Covidien at 20%.

Cost Impact of Request

Current State • Applied Medical Hasson Trocar

COR47 • 12mm x 100mm • 180 / year • $30.96 • $5,573 annual spend

Future State • Ethicon Optical Bladed Trocar

B11LTH – off contract • 11mm x 100mm • 180 / year • $205.79 • $37,042 annual spend

Dr. Newtech did 180 Laparoscopic Hysterectomies last year Conversion increases procedural cost by $174.83 per case. Conversion increases hospital spend by $31,469 annually.

Page 17: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

17  

Trocar Vendor Cross-Reference Current  Trocar  Volume   Applied  Medical   Covidien   Ethicon  

Descrip9on   Mfg   Cat#   U/M   Order  Cost   Qty   Cost/EA   Spend   Cat  #   Cost/EA   Spend   Cat  #    Cost/EA      Spend     Cat  #   Cost/EA   Spend  

TROCAR  SET  5MM  X  55  Dual  Pack   Applied  Medical   CTR14   Bx/10   $280.00   40    $        28.00    $11,200.00   CTR14    $        28.00    $11,200.00   NBFCA5SH    $        41.36      $        16,544.00    B5ST    $        48.74    $19,496.00  

TROCAR,  BLUNT,  BALLOON                        11  X  100MM   Applied  Medical   CFR33   Bx/6   $198.08   3    $        33.01    $594.24   CFR33    $        33.01    $594.18   NB11STF    $        36.29      $                    653.22    B11LT    $        58.94    $1,060.92  

TROCAR,  BLUNT,  BALLOON                        12  X  130MM   Applied  Medical   C0R50   Bx/6   $180.00   18    $        30.00    $3,240.00   C0R50    $        30.00    $3,240.00   No  match        $              3,240.00    No  match       $3,240.00  

TROCAR,  HASSON  12  X  100MM   Applied  Medical   C0R47   Bx/6   $185.76   172    $        30.96    $31,950.72   C0R47    $        30.96    $31,950.72   NB12STF    $        36.29      $        37,451.28    H12LP    $        76.70    $79,154.40  

TROCAR,  OPTICAL,  BLADELESS,  Fios  12  X  100MM   Applied  Medical   CFF73   Bx/6   $180.00   61    $        30.00    $10,980.00   CFF73    $        30.00    $10,980.00   No  match        $        10,980.00    No  match       $10,980.00  

TROCAR,  OPTICAL,  BLADELESS,  Fios  5  X  100MM   Applied  Medical   CFF03   Bx/6   $120.00   60    $        20.00    $7,200.00   CFF03    $        20.00    $7,200.00   NB5STF    $        42.32      $        15,235.20    B5LP    $        34.51    $12,423.60  

TROCAR,  OPTICAL,  BLADELESS,  THREADED  12  X  100MM   Applied  Medical   CTR73   Bx/6   $185.76   145    $        30.96    $26,935.20   CTR73    $        30.96    $26,935.20   NB12STF    $        36.29      $        31,572.30    B12LT    $        45.67    $39,732.90  

TROCAR,  OPTICAL,  BLADELESS,  THREADED  12  X  150MM   Applied  Medical   CTF71   Bx/6   $180.00   15    $        30.00    $2,700.00   CTF71    $        30.00    $2,700.00   NB12LGF    $        52.65      $              4,738.50    B12XT    $        70.44    $6,339.60  

TROCAR,  OPTICAL,  BLADELESS,  THREADED  5  X  100MM   Applied  Medical   CTR03   Bx/6   $123.84   225    $        20.64    $27,864.00   CTR03    $        20.64    $27,864.00   NB5STF    $        42.32      $        57,132.00    B5LT    $        34.51    $46,588.50  

TROCAR,  OPTICAL,  BLADELESS,  THREADED  5  X  150MM   Applied  Medical   CTF01   Bx/6   $120.00   8    $        20.00    $960.00   CTF01    $        20.00    $960.00   NB5LGF    $        42.32      $              2,031.36    2B5LT    $        45.00    $2,160.00  

TROCAR,  OPTICAL,  BLADELESS,  THREADED  8  X  100MM   Applied  Medical   COQ19   Bx/6   $120.00   6    $        20.00    $720.00   COQ19    $        20.00    $720.00   NB8STF    $        38.01      $              1,368.36    B8LT    $        40.38    $1,453.68  

TROCAR,  OPTICAL,  BLADLESS,  THREADED  15X100MM     Applied  Medical   C0R37   Bx/6   $369.87   16    $        61.65    $5,917.92   C0R37    $        61.65    $5,918.40   VS101015

P    $        66.36      $              6,370.56    B15LT    $    116.86    $11,218.56  

 TROCAR,  VERSAPORT,  BLADELESS  12MM    W/  FIXATIO     Covidien   NB12STF   Bx/6   $725.22   25    $    120.87    $18,130.50   CFF73    $        30.00    $4,500.00   NB12STF    $    120.87      $        18,130.50    B12LT    $        45.67    $6,850.50  

 TROCAR,  VERSAPORT,  BLADELESS  5MM    W/  FIXATIO     Covidien   NB5STF   Bx/6   $598.44   6    $        99.74    $3,590.64   CTR03    $        20.64    $743.04   NB5STF    $        99.74      $              3,590.64    B5LT    $        34.51    $1,242.36  

 TROCAR,  VERSAPORT,  BLADELESS  8MM    W/  FIXATIO     Covidien   NB8STF   Bx/6   $550.02   2    $        91.67    $1,100.04   COQ19    $        20.00    $240.00   NB8STF    $        91.67      $              1,100.04    B8LT    $        40.38    $484.56  

 TROCAR,  VERSAPORT,  V2  5MM  TROCAR     Covidien   179094   Bx/3   $219.15   34    $        73.05    $7,451.10   CTR03    $        20.64    $2,105.28   179094    $        73.05      $              7,451.10    D5LT    $        34.51    $3,520.02  

Total Spend $160,534.36   $137,850.82    $    217,589.06     $245,945.60  

Price Benchmarking

Company Name Product Description HCO Price 10% 25% 50% 75% 90% Price IndexCovidien  TROCAR,  VERSAPORT,  V2  5MM  TROCAR   73.05$           111.88$   112.86$   116.13$   118.50$   118.50$   06.5Applied  Medical TROCAR,  HASSON  12  X  100MM 177.84$     152.06$   159.21$   186.00$   284.97$   408.50$   38.2Applied  Medical TROCAR,  BLUNT,  BALLOON  12  X  130MM 180.00$     155.79$   168.00$   192.00$   298.92$   426.12$   35.0Applied  Medical TROCAR,  BLUNT,  BALLOON  11MM  X  100MM 198.08$     186.83$   191.65$   198.08$   198.08$   204.02$   50.0Applied  Medical TROCAR,  OPTICAL,  BLADELESS,  Fios  12  X  100MM 180.00$     174.00$   186.00$   197.18$   209.39$   257.71$   15.5Covidien  TROCAR,  VERSAPORT,  BLADELESS  12MM    W/  FIXATIO   120.87$     131.89$   133.98$   148.14$   207.35$   213.30$   9.1Covidien  TROCAR,  VERSAPORT,  BLADELESS  5MM    W/  FIXATIO   99.74$           123.99$   127.56$   154.75$   186.66$   192.00$   8.04

Page 18: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

18  

Utilization and Variation

Practice Variation and DRG Profitability

Total Laparoscopic Hysterectomy

Page 19: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

19  

Physician Preferences for Trocars Laparoscopic Hysterectomy

Qty Price Qty Price Qty Price Qty Price Qty Price Qty Price TROCAR, Bladeless w/fixation 12 X 100MM Covidien NB12STF 120.87$ 1 120.87$ 1 120.87$ TROCAR Kit FiOS Optical Z-Thread 12 X 100MM Applied Medical CTF73 30.96$ 1 30.96$ 1 30.96$

TROCAR Hasson 12 X 100MM Applied Medical COR47 30.96$ 1 30.96$ 1 30.96$

SLEEVE THREADED 5MM Applied Medical CTS02 8.77$ 2 17.54$ 1 8.77$ 2 17.54$ 1 8.77$ 2 17.54$ 2 17.54$ TROCAR Kit Advanced Fixation 5 X 100MM Applied Medical CTF03 20.64$ 1 20.64$ 1 20.64$ 1 20.64$ 1 20.64$ 1 20.64$ 1 20.64$

159.05$ 60.37$ 159.05$ 60.37$ 69.14$ 69.14$ TROCAR COST PER CASE

Description Vendor Catalog # Cost Each

Dr. A Dr. B Dr. C Dr. D Dr. E Dr. Newtech

Evaluating DRG 742-743 Data Physician Profitability

Physician # Cases Avg LOS

Avg Cost Avg Pmt CMI

Dr A 118 2.57 $9,481 $9,619 1.10

Dr B 91 2.35 $8,263 $7,875 1.10

Dr C 100 2.25 $6,440 $6,288 1.03

Dr D 82 2.29 $6,972 $6,136 1.02

Dr E 79 2.82 $7,212 $10,346 1.10

Dr Newtech

180 2.82 $6,869 $6,577 1.04

2011 UHC National Data ALOS = 1.58 Reimbursement: $5,240 - $8,031 (with CC/MCC)

Page 20: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

20  

Evaluating DRG 742-743 Data Variation in Practice – Ancillary Services

Physician Avg Anes

Avg Lab

Avg Rad

Avg Pharm

Avg Supp

Avg OR

Dr A $57 $448 $54 $1,067 $650 $3,682

Dr B $244 $240 $67 $316 $1,016 $3,034

Dr C $73 $148 $59 $392 $1,842 $2,530

Dr D $84 $317 $63 $500 $628 $3,425

Dr E $195 $252 $66 $572 $1,353 $2,390

Dr Newtech

$128 $247 $46 $574 $1,587 $2,284

"In God we trust. All others bring data.“

William Edward Deming

Page 21: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

21  

Clinical Practice

What is our practice? What are our outcomes? How can we improve?

70% 45%

20% 10%

30%

30%

30% 25%

25%

30% 40%

20% 25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CMS Value-Based Purchasing Program

Preparing for Shift in CMS Payment Incentives CMS continues to shift emphasis towards Outcomes and Efficiency away from Clinical Process Domains

FY2013 1.0%

FY2014 1.25%

FY2015 1.50%

FY2016 1.750%

FY2017 2.0%

  Clinical   HCAHPS   Outcomes   Efficiency

Page 22: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

22  

Clinical Benchmarking Data

Clinical – Performance and improvement rates are around the 50th percentile as compared to other hospitals in the system.

Clinical - This view compares your hospital to other hospitals in your region.

Sample Hospital

Surgical Care Improvement Project

Page 23: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

23  

Clinical Benchmarking Data Core Measures Associated with DRG 742-743

Analysis of Current Clinical Practice

Normothermia

Prophylactic Antibiotics

Pre-Operative Testing

Urinary Catheter Removal

Page 24: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

24  

  Determine current compliance to core measures.

  Understand the significance of compliance.

  Review current literature for recommendations to improve practice.

  Review blueprints.

  Determine best practices.

  Compare best practices against your current order sets and policies.

  Implement change and support with education and training.

Improving Outcomes

Hierarchy of Research and Evidence

Systematic Review/Meta-Analysis - summary of the comprehensive medical literature and critical appraisal of individual studies

Randomized Controlled Trials - experimental, prospective study in which participants are selected randomly and followed over time Cohort Studies - observational, prospective or retrospective; involves two groups (cohorts) of patients, one that received the exposure of interest, and one that did not Case Control Studies - observational, retrospective; involves identifying patients who have the outcome of interest (cases) and control patients Case Series/Reports- report on a series of patients with an outcome of interest; no control group is involved. Expert Opinion- clinical experience, expertise, and judgment

Page 25: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

25  

Healthcare Resources

  Value analysis manager/director or clinical resource

  High functioning value analysis process (Intermediate Level)

  Strong physician and executive leaders as change agents

  Timely cost accounting and other actionable data

  Consistent and timely communications

  Finance and supply chain liaisons for each team

  Change goals from supply based savings to cost per case savings

Lessons Learned – Must Haves

Page 26: Transitioning Value Analysis Teams to Total Value of Care...2015/12/04  · 12/9/15 1 Transitioning Value Analysis Teams to Total Value of Care Assess value analysis structure and

12/9/15  

26  

Contact Susan Hogan [email protected] for more information.