Fairview name of facility

1
Fairview CV Service Line Assessment and Premier
Service Line Solutions Fairview Southdale
Hospital Minneapolis, MN
2
Presenters
Fairview Southdale
Premier
Susan Mullaney Vice President Cardiac,
Radiology, Imaging, Perioperative
Services MJ Swanson Director, CV
Services Chris Meyers-Janda System Vice
President Supply Chain
John Johnston Region Vice President Dawn
Terry Senior Clinical Associate, CV
Services Brian Duggan Principal
3
Presentation Overview

• Fairview Southdale Heart, Stroke
  and Vascular Center overview
• Premier Service Line Solutions
• Action Plan and Results

Fairview Southdale Hospital
4
(No Transcript)
5
Premier Engagement

• Value Proposition
• Holistic, clinical focus physicians nurses
  engaged
• Tailored to FSHs specific needs
• Well organized executed process
• IDd significant opportunities concrete action
  plan
• Mindshift device negotiations
• Built on strong hospital-physician relationship

Fairview Southdale Hospital
6
Heart, Stroke and Vascular Center

• Top decile performance CMS Demonstration Project
  AMI, HF
• Solucient Top 100 Hospital Award for
  Cardiovascular Services
• Certified as a nationally recognized Primary
  Stroke Center
• Blue Cross Blue Shield National Cardiac Center of
  Excellence
• HealthGrades 2006 Cardiac and Stroke Excellence
  Award
• IHI spotlight for Primary Angioplasty program
• JCAHO Vascular Program certification goal 2007

Fairview Southdale Hospital
7
Twin Cities Market

• 4 competitor heart hospitals opened since 2000
• Managed care lower reimbursement
• Consolidation of CV specialists, hospitals, and
  primary care
• Highest level of cardiac care nationally

8
Background

• 2001
• Distressed center
• Fractious relationship with specialists
• Low employee morale
• Financial performance struggling

9
Background

• Re-organize CV services FOCUS
• Joint venture
• Financial performance EP, Cath Labs

10

11
Background

• JV Goals
• Top-ranking regional cardiac program
• Strategic coverage of key geographic locations
• Highly efficient, effective operations
  infrastructure
• Outstanding service patients and referring
  physicians
• Strong financial performance reinvestment in
  the program

12
(No Transcript)
13
Background

• Financial Performance
• Team effort
• Operations Physicians - SCM
• Cardiac Cath Lab device prices and utilization
• EP Lab device prices and utilization
• Revenue management

14
Fairview Southdale Hospital Cardiology Performance
15
Fairview System Financial Performance

16
2005

• Current State
• Best practice operations
• Superior financial performance
• Pride in clinical excellence
• Strong physician hospital partnership

17
Premier Service Line Solutions

• Why Engage?
• Fresh look
• Maintain strong position, gains going forward
• CMS proposed payment rules for Cardiovascular
  Services

18

535
536
19

20
Service Line Solutions

• Comprehensive Management of Your
• Most Strategic Clinical Programs

21
New strategies for managing key service lines
Revenue
Outcomes

• Coding and documentation
• Charge Master
• Bill Accuracy
• Managed Care rates
• Pay for Performance
• Market Share

• Avoidable complications
• Avoidable mortality
• Avoidable readmissions
• Costs associated with poor quality

Expense
Physician Engagement

• Implant pricing and utilization
• Length of Stay
• Ancillary tests
• Pharmaceuticals
• New technology

• Their local market preferences
• Data they want
• Linking them to operating performance

22
Service Line Solutionsintegrating data to
improve performance
Ancillary Supply Utilization
23
Service Line Solutions Approach
Scope
Data Sources

• Patient population primarily cardiac cath-related
  procedures
• Percutaneous coronary interventions
• Cardiac rhythm management devices
• Acute Myocardial Infarction
• Heart Failure
• Excluded
• CABG
• Peripheral Interventions

• Witt and Cath Source cath lab information
  system
• PCI data
• CRM data
• Mat Con materials management information system
• Supply costs
• TSI and Administrative database clinical and
  financial system
• Patient billing and coding records
• Clinical performance measures
• DRG payor data
• Kronos payroll system
• Cath Lab and Heart Center labor cost data
• Site visits and interviews

24
Service Line Solutions Clinical and Utilization
Analysis

• Outcomes
• Complications
• Length of Stay
• Readmissions
• Mortality
• Utilization
• Lab, Pharmacy, Diagnostic Imaging
• Room and nurse ratio intensity
• Labor and staffing

25
Labor cost opportunity Cath lab
Peer median
Peer 1st quartile
Fairview
Average monthly volume Worked FTEs (Fairview
volume) Worked hours per unit Potential worked
FTE savings Potential labor dollar
impact Overtime percentage Potential overtime
FTE savings Potential overtime premium impact
231
17.1 Worked FTEs 12.81 hours/unit 9.3
15.2 Worked FTEs 11.37 hours/unit 1.9
FTEs 120,766 3.9 1.0 FTEs 32,110
14.9 Worked FTEs 11.15 hours/unit 2.2
FTEs 139,262 1.9 1.4 FTEs 44,388
Total potential savings 152,877 183,650
26
Service Line Solutions Implant and Supply
Utilization Analysis

• Reimbursement
• Cost as a percent of reimbursement targets
• Benchmark to national averages
• Individual physician average costs
• Contract and utilization analysis
• Premier contract value
• Financial opportunity
• Utilization practices

27
Average Device Cost and Reimbursement
28
Hospital and Physician Engagement
Tremendous strides have been made in building the
culture building the relationships. The
interview results validate this as well as
include recommendations to further strengthen the
relationship and the culture. These
recommendations are summarized
Communication
Readiness to Change
Strategy

• The Hospital is seen as becoming more proactive
  in embracing change at times, balance of
  quality versus finance an issue
• Speed of implementation and communication were
  noted as largest barriers to change
• MSA is working to align incentives to implement
  changes based upon common goals for the program

• Communication between key Hospital and physician
  leaders frequent and effective however, channels
  outside of these individuals are limited and not
  as effective
• A need for a communication strategy was noted to
  streamline messages and target all physicians

• Both Physicians and Hospital Leadership indicated
  that the outreach programs are effective but more
  could be done to facilitate the access to
  Fairview from these various locales and the
  experience once the patient is in the system.
• The need for a defined, collaborative strategic
  growth plan, taking into consideration physician
  capacity issues was noted.

29
Fairview Southdale HospitalSummary of Service
Line Opportunities
Difficulty
High
Low
1

16 cases
16 cases
Avoidable Complications
2
Charge validation analysis
8,000
7,200
2
Cath Lab staffing analysis
153,000
184,000
2
138,000
124,200
Lab/phlebotomy cost and utilization analysis
3
Lab/UA costs and utilization analysis
7,200
6,500
3
Pharmacy costs and utilization analysis
237,000
237,000
3
LOS/Room and board analysis
2,594,000
2,334,600
3
782,000
38,500
CRM price and utilization analyses
3
PCI price and utilization analyses
612,000
31,000
Total Margin Improvement Opportunity
4,562,200
2,932,000
30
Fairview Health Services Supply Chain Contract
Negotiation Process

• Discovery and Goal Setting
• Work with multidisciplinary team to define
  customer needs and financial goals.
• Listen to their perspective what works, what
  doesnt and how can we improve.
• Discuss upcoming initiatives so we can coordinate
  our efforts.
• Request for Proposal (RFP) sent to
  team-identified top suppliers
• Allowed for consistent and timely communication
• Clearly described Fairviews expectations and
  qualifiers
• Presented each supplier with QA opportunities.
• RFP Response Evaluation
• Supply Chain created scenarios and evaluated each
  opportunity with multi-disciplinary team.
• Physician driven multi-disciplinary team
  participated in supplier negotiations.

31
Fairview Health Services Supply Chain Contract
Negotiation Timeline

• December 2005
• Identified contracts that were scheduled to
  expire in Q1 of 2006.
• Analyzed data and identified cost savings
  opportunities.
• January
• Met with multi-disciplinary team
• Met with Premier regarding their findings from
  Fairview Southdale Hospital Service Line
  Assessment Results.
• February
• Sent RFP out on February 3, 2006. Due date for
  responses was February 17, 2006.
• Analyzed RFP responses and shared them with the
  team.
• March
• Held CRM Vendor negotiations.
• Awarded selected CRM suppliers.
• April
• Finalized CRM contracts.
• Held PCI/DES Vendor negotiations
• May-June
• Awarded selected PCI/DES supplier.
• Finalized PCI/DES contracts.

32
Contract Negotiations Results

• Created system-ness by achieving physician
  input and participation from both the academic
  facility and our community based facility.
• Achieved an open access market that allows
  physicians to focus on clinical need rather than
  contract compliance.
• Reduced line-item costs by roughly 15.
• Implemented a stoplight tool that provides
  physicians with device cost information.

33
Fairview Southdale CRM Stoplight Product
Selection Grid Example

34
Fairview Southdale CRM Implant Cost Reduction

35
PI Continued Assessing at a Deeper LevelHeart
Center

• Premiers work INTEGRATED with work already in
  progress in the CV Service Line
• so here is the rest of the story

36
Fairview Southdale CV Services Performance
Improvement (PI) Strategy

• Just Do It
• Plan-Do-Check-Act (PDCA)
• Primary Strategy for Clinical PI
• Congestive Heart Failure Care Process
• Six Sigma PI
• DMAIC
• DMADV
• Lean
• Currently using tools

37
Fairview Southdale CV Services 2004-2005
Performance Improvement (PI) Projects

• 5S Heart Center
• 5S Cath Lab and Care Suites
• Interventional Radiology/Cardiology
  Coding/Billing
• Medlearn Audit October 2005 NO TRENDS!! Best
  Practice
• Cardiovascular Surgery Process of Care
• Other PI Projects
• Transport of Patients
• RN Orientation
• Nursing Service Delivery
• Patient Placement Guide
• Defined Clusters/Lanes of care (Medical,
  Surgical, Critical Care)
• Stroke Process
• Care Suites Admission to ready for CT Exam
• Carotid Endarterectomy Process of Care

38
PI Continued DMAICCLEARLY DEFINE THE PROBLEM
VALUE ADD FROM PREMIER

• Assessment Results Labor Utilization
• For the Jan-Nov period, Fairview Southdale
  operates at a Worked Hours per Unit significantly
  higher than peer facilities.
• Assessment Results Overtime
• Fairview Southdale operates at a higher Overtime
  Rate than peer facilities, as compared to both
  median and quartile performance.

39
PI Continued DMAICMEASURE the current status
Heart Center Opportunity Summary (Jan 2 Nov 20)

1. As a percentage of paid hours paid hours
based on worked hours plus 10 benefit hours.
Time period Jan 2, 2005 Nov 20,
2005
40
PI Continued DMAIC Analyze Why?

• Lack of Clear Expectations by Leadership
• Overtime
• Implementation of e-time
• Nursing was SIGNIFICANTLY under hired
• Cant See the problem when it is happening!
• Indirect time what not hired
• Dramatic increase in volume

INTEGRATION OF PREMIER VALUE ADD
41
PI Continued DMAIC Analyze Why?

• Worked Hours per Unit
• Transition to increase FTEs
• Agency use was excessive
• Staff worked over hired hours
• Excessive Sick Time
• Excessive use of sitters
• Orientation process
• Grid changes in 2005
• Definition of CICU care (historical)
• Care defined by location vs. level of care

INTEGRATION OF PREMIER VALUE ADD
42
PI Continued DMAIC Improve

• Leaders increased leadership
• Physicians
• Organizational Leaders at all levels including
  frontline
• Implementation of e-time (Kronos timekeeping)
• INDIVIDUAL FACTORS
• Letter to all employees from President of Care
  System
• Report created to employee level detail
• Understand individual work patterns
• Employee Counseling implemented
• Concurrent Documentation
• Re-evaluate work agreements
• Implemented Visual Control where possible
• LOA, Sick Time, Incidental Overtime
• In Development Real Time visual control

43
PI Continued DMAIC Improve

• Nursing was SIGNIFICANTLY under hired
• Hired for Indirect time LOA, Sick, Education
• 187 RNs were hired in 2005 (Hospital-wide)
• 292 Orientations
• Extensive orientation took place on the Heart
  Center
• Transition to increase FTEs
• Bit the bullet!

44
PI Continued DMAIC Improve

• Excessive use of sitters
• Standards established for sitter use
• Orientation process
• Implemented Calendar for visual control to manage
  number of days of orientation and see number of
  days required for Preceptor
• Unit educators managed the process more closely
• Management Oversight improved
• More timely decisions reemployee job fit

45
PI Continued DMAIC Improve CONTINUOUSLY

• Improve (DMAIC)
• Maximize throughput by using cluster concept
• Flexible patient placement
• Grid changes in 2005
• Defined financial sweet spot for Units
• Evaluating acuity models
• Developing visual tracking tool to see status
  at all times
• Implementation by December 2006
• Understand Levels of Care vs. Location of Care
• Merging Management structure for CICU and ICU
• Develop plan to gain understanding and implement
  strategies

46
PI Continued DMAIC Control Agency Hours per
Pay Period

Control DMAIC
47
PI Continued DMAIC Control Hours of Sitter
Use per Pay Period

48
PI Continued DMAIC Control Fairview
Southdale NursingOvertime Hours per Month

49
PI Continued DMAIC Control Heart Center
Overtime Hours per Month

50
Premier Service Line Solutions

• Value Proposition
• Holistic, clinical focus physicians nurses
  engage
• Tailored to FSHs specific needs
• Well organized executed process
• IDd significant opportunities concrete action
  plan
• Mindshift device negotiations
• Built on strong hospital-physician relationship
• THANK YOU!