IHI Expedition Expedition: Preparing Care Teams for Bundled Payments - PDF document

5/18/2015 May 19, 2015 Begins at 1:00 PM IHI Expedition Expedition: Preparing Care Teams for Bundled Payments Session 5: Care Team Redesign Trisha Frick, MS, RN Nick Bassett, MBA Lucy Savitz, PhD, MBA Molly Bogan, MA Today’s Host 2 Akiera Gilbert Project Office Assistant Institute for Healthcare Improvement 1

5/18/2015 3 Phone Connection (Preferred) To join by phone : 1) Click on the “Participants” and “Chat” icons in the top right hand side of your screen. 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number , the event number and your attendee ID to connect correctly . 4 WebEx Quick Reference • Please use chat to “ All Participants ” for questions Raise your hand • For technology issues only, please chat to “ Host ” Select Chat recipient Enter Text 2

5/18/2015 Chat 5 Name and the Organization you represent Example: Sam Jones, Midwest Health Please send your message to All Participants 5 6 Expedition Director Molly Bogan, MA Director Institute for Healthcare Improvement 3

5/18/2015 7 Expedition Objectives At the end of this Expedition, participants will be able to: Describe the benefit of transitioning to a value-based purchasing model Understand and apply activity-based cost accounting methodology to at least one care process Demonstrate examples of how to engage stakeholders in building a bundle Describe how to customize care team redesign to deliver optimum care under value-based purchasing Today’s Agenda 8  Introductions  Session 4 Action Period Assignment Debrief  Care Team Redesign  Action Period Assignment  Closing 4

5/18/2015 9 Expedition Sessions Session 1: Volume to Value; Describe the benefit of transitioning Value- Based Purchasing Lead Faculty: Lucy Savitz & Trisha Frick Session 2: Getting Started with Building a Care Bundle Lead Faculty: Trisha Frick & Nick Bassett Session 3: Collecting Data Using Activity-based Costing Lead Faculty: Nick Bassett & Lucy Savitz Session 4: Engaging Stakeholders in Bundle Design Lead Faculty: Trisha Frick & Nick Bassett Session 5: Care Team Redesign Lead Faculty: Trisha Frick & Nick Bassett Session 6: Case Study: CMS Bundled Payments for Care Improvement Experience Lead Faculty: Stephanie Calcasola & Trisha Frick 10 Action Period Assignment Debrief • Build a list of key stakeholders for stakeholder engagement plan. Share with others using the chat to All Participants 5

5/18/2015 Chat 11 Please chat in one key stakeholder you identified and a strategy for how to engage them in building or deploying a bundle. Please send your message to All Participants 11 12 Faculty Nick Bassett, MBA Trisha Frick, MS, RN Lucy Savitz, PhD, MBA Healthcare Assistant Director of Director of Research and Transformation Manager Managed Care Education Intermountain Johns Hopkins Intermountain Healthcare Healthcare HealthCare LLC Salt Lake City, Utah Salt Lake City, Utah Glen Burnie, Maryland 6

5/18/2015 Care Team Redesign Where do you begin? • Review each phase of the care cycle: consult, pre-op testing, operation, PACU, inpatient stay, post-discharge follow-up. • Is the care provided based on evidence-based practice or “just because” this is the way it has always been done? • Is each and every level of personnel practicing at the top of their license? 14 7

5/18/2015 Changes to Care Cycles • Modified anesthesia protocol to provide spinal anesthesia whenever possible resulting in PT on the day of surgery. • Pain management: stopped PCA completely. Multimodal pre-emptive analgesia including intra articular joint blocks. • Other cost savers: no drains, no continuous passive motion, limited foleys. 15 Utilization of Staff • Where can staff be utilized differently for increased efficiency? – Night shift nursing staff get patients out of bed and ready for breakfast. – Hired scribe for physician documentation during clinic visits. – Mid-levels utilized in OR instead of 2 residents. • Are there any places where lower level personnel provide the task? 16 8

5/18/2015 Changes to patient services hours • Physical therapy staff changed hours to start later in the day and staggered shifts. • Only anesthesia present to start first case at 7:15. All others scheduled in room at 7:30. • Block OR time. 17 Travel Surgery Program Description • Bundled rate contract with Pacific Business Group on Health representing large national employers (Walmart, Lowe’s & McKesson). • Requirements of the program is that the patient is approved for surgery without in person consult. • Requires medical record collection process that is complete and efficient. • Surgeon is expected to review medical record within 5 days of receiving. • Uncomplicated patient is to be in surgical city for 7-9 days. 18 9

5/18/2015 Changes Necessary to Meet Travel Surgery Program Demands • Creation of specific list of notes and films necessary to evaluate candidacy. • Total joint replacement nurse review and assemble medical record to facilitate surgeon review process. • Surgeons scheduled time for medical chart review. • Surgeons changed OR days and clinic days to be able minimize number of days in surgical city. • Travel patients scheduled as first cases to promote discharge early in the day whenever possible. • Travel patient clinic scheduled early to allow return to home on day of clinic visit. 19 Managing the Full Cycle of Care • Patient education/expectations pre-operatively. • What is preventing timely discharge? • Take home prescriptions. • Discharge location. • Managing post op pain and nausea. • Outpatient physical therapy location identified pre-operatively. 20 10

5/18/2015 Identifying Data Needs • Cost: OR minutes, anesthesia, supplies (implants & cement) , consult utilization, ICU days, P&L of bundle. • Quality indicators: length of stay, surgical site infections, wound infections, 30 day re-admissions, return to OR, high cost drug utilization. • Catastrophic cases? What might be contributing to these? • Patient satisfaction. 21 Designing an effective data feedback system • Regularly scheduled operations meetings. – Formal agenda – Present data: volume, P&L, successes, challenges. • Communication at all levels: care team, finance, senior leadership, payor, patients. • Regularly scheduled full team meetings. – Formal agenda – Present data: LOS, performance indicators. – Process: where is the team not making the required time frames? – Where are there bottlenecks? – What can be done differently? 22 11

5/18/2015 Ongoing Evaluation • Bundle team and senior leadership – Financial performance monthly, bi-annually, annually. – Shared savings calculations and reporting. – Overall evaluation of bundle. – Are the results worth the risk? • Contract review – Ask your team for any problem areas. – Are there any issues from the payor perspective? – Is this anything we should do differently? – Are there components that are missing? – Can billing process be more efficient? – Are there any terms/requirements influencing patient compliance? 23 24 Questions/Discussion Raise your hand Use the chat 12

5/18/2015 Action Period Assignment Build an outline for designing an optimum care team end-to-end based on data collected in sessions 1, 2, 3 & 4. 26 Expedition Communications • All sessions are recorded • Materials are sent one day in advance • Listserv address for session communications: bundledpaymentexp@ls.ihi.org • To add colleagues, email us at info@ihi.org 13

5/18/2015 27 Session 6 Case Study: CMS Bundled Payments for Care Improvement Experience Trisha Frick, MS, RN Stephanie Calcasola Assistant Director of Managed Care MSN, RN-BC Johns Hopkins HealthCare LLC Director of Quality and Medical Management Baystate Medical Center Tuesday, June 2 nd , 1:00 – 2:00 PM ET Thank You! 28 Please let us know if you have any questions or feedback following today’s Expedition webinar. Director: Molly Bogan Akiera Gilbert mbogan@ihi.org agilbert@ihi.org 14