Mercy’s Journey to Excellence; the Role of Benchmarking and Financial and Clinical Analytics Nancy G. Hoffman Executive Director – Financial Operations Analytics Sponsored by EPSi – hosted by John Gragg, COO, EPSi July 2019
Our Legacy Catherine McAuley opened the House of Mercy on Baggot Street in Dublin, Ireland in 1827. She founded the Sisters of Mercy – one of the world's first religious orders not to be cloistered, confined to prayer and quietness within a convent. Instead the Sisters went out into the communities where they lived to feed the hungry, care for the sick and provide education. The Walking Sisters 2
About Mercy 1 Physicians & advanced practice clinicians 2 IBM Watson Health 15 Top Health System for consecutive years: 2016, 2017 & 2018
Our Mission As the Sisters of Mercy before us, we bring to life the healing ministry of Jesus through our compassionate care and exceptional service.
Our Vision We are the people of Mercy Health Ministry. Together, we are pioneering a new model of care. We will relentlessly pursue our goal to get health care right. Everywhere and every way that Mercy serves, we will deliver a transformative health experience.
Our Values Dignity Excellence Justice Service Stewardship
Mercy’s Strategy 2020 …and beyond We believe our long term success, as a health ministry with a strong Catholic- Christian identity, will be tied to differentiated performance and a full realization of our brand. • Implement a consumer-centric operating model to complement our patient-centric care model; • Implement a singular system of care that creates a seamless experience between ambulatory, acute, and virtual care; • Achieve sustainable advantages in quality, service and cost ; • Achieve extraordinary engagement of all 40,000 co-workers and physicians Brand Position: Getting it right. Brand Promise: We’ll change the way you feel about healthcare. 7 |
Mercy Benchmarking • Mercy has long maintained focus on internal performance benchmarking and continuous performance improvement – Financial, operational and quality performance – Over time, vs. targets, and between Mercy-peers – Financial targets relative to budget, with varying degrees of “operational relevance” • We needed an external benchmarking perspective to identify specific quality & cost improvement opportunities & best practices – Costs by functional area – Utilization and outcomes by DRG – Care practices by Physician • We needed to leverage experience and proven practices through knowledge sharing among peers across the country 8 |
Mercy Quality & Financial Performance Benchmarking Program Considers Multiple Dimensions of Performance Operational Costs Financial Compare cost & productivity against peers to identify opportunities in productivity, skill mix, pay scale, non- labor expenses, & supplies Clinical Service Drills to clinical costs per case, ALOS, procedure code & resource Quality Service utilization, & practice variation Quality Integrates cost info with Process of Care and AHRQ measures to identify variation by quality indicator, service line, DRG, or physician 9 |
Mercy Quality & Financial Performance Benchmarking Program Provides Accurate, Transparent & Actionable Information • Rigorous, collaborative data mapping & normalization • Tailored peer groups to ensure meaningful comparisons & credible results. • High-level to very detailed results, so all leaders have analyses meaningful to them. • An integral part of a continuous improvement mindset 10 |
Opportunities into Action 11 |
Opportunities into Action – Operational 12 |
Opportunities into Action – Operational Significant opportunity in Postal/Freight was common theme across our hospitals $10M total opportunity • Multi-disciplinary group pulled together for deep-dive • Driven by courier services • Initially narrowed true opportunity to about half reflected, still very significant • Findings related to management’s low -visibility into expense and subsequent year-over-year growth • Expect about $3M in annual savings from reducing non-essential services now under detailed review 13 |
Opportunities into Action - Clinical 14 |
Opportunities into Action - Clinical 15 |
Opportunities into Action - Clinical 16 |
Opportunities into Action - Clinical – Springfield team assembled, meet 2x weekly • Executive Sponsor – Chief of Critical Care Medicine • Team Lead – VP Quality • Team – Nursing, Care Mgmt, Emergency Dept & Finance leaders – Goal: Identify Septic patients or those at risk as early as possible, and enhance treatment for improved outcomes with lower LOS and cost. – Findings and improvement efforts • Complete clinical pathway review & modification to increase pathway utilization • Focused on education for ED Physicians to increase immediate sepsis dx. • Focused effort with lab, hospitalists & pharmacy to increase turn-around-time from lab test to revised drug orders • Deep-dive comparison of drug utilization with Mercy peers identified lower cost abx with same effectiveness • Patient Logistics & Care Management engage day 1, care and discharge planning – Step-down sooner, reducing ICU days – Focused education with hospitalists regarding earlier discharge, more frequently discharging home to complete IV abx 17 |
Opportunities into Action - Clinical – Used costed patient data to developed “Sepsis Scorecard” • Trend and compare LOS, Drug utilization, other direct costs per case – PI teams formed in each hospital • Comparisons across hospitals and by attending physician • • Physician Executive Sponsor & Quality Leadership Variation in cost identifies variation in care – Ministry Quality & Financial Performance teams engaged • Launched Mercy-wide clinical pathway redesign • Reduce variation and optimize care /cost 18 |
Opportunities into Action - Clinical Initial Results Sepsis identified and treatment delivered earlier, decreasing the volume of Septic Shock and Severe Sepsis, and contributing to decreased ALOS and cost. Sepsis Severity Percentages 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% % Septic Shock % Severe Sepsis % Sepsis 19 |
Opportunities into Action - Clinical Initial Results Average length of stay (ALOS) decreased by 0.72 Sepsis DRG 871 ALOS days, 10.3% 8 7 ALOS 6 Sepsis DRG 871 Total Direct Cost per Case 5 $9,000 $8,000 4 $7,000 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May $6,000 ALOS $5,000 COST $4,000 $3,000 $2,000 $1,000 $0 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Cost per case decreased by $1,089, 15.6% Total Direct Cost 20 |
Reassess Opportunities Consistent Measurement • Key to continuous improvement mindset • Celebrate successes • Identify new opportunities • Accountability for results 21 |
The Journey To Excellence at Mercy Health System • Continue to challenge the status quo. Seek creative ways to bring care to the people who need it most. • Be early adopters and optimize use of new technologies like machine learning and predictive analytics, as a data-driven organization. • Learn & collaborate with peers, inside Mercy and across the industry • Always ensure the right balance between cost, quality and patient experience. 22 |
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