Strategies for Cost Control amp Collaboration 1 Comanagement Collaboration Governance Model Benchmark Report Case Time Predictive Analytics Agenda Strategies for Net Cost Reduction 3 CoManagement Agreements ID: 768262
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Strategies for Cost Control & Collaboration 1
Co-management Collaboration Governance Model Benchmark ReportCase TimePredictive Analytics Agenda
Strategies for Net Cost Reduction 3
Co-Management Agreements 4
Overview of Co-Management Structure: A Model of Clinical Co-Management 5
Hospital Quality Efficiency Program 6
Bundled Payment Requires Collaborative Governance 7 Strengthen the perioperative governing body to align incentives for all aspects of Perioperative Services Surgical Services Leadership Committee ( SSEC ) Surgical Leadership OR Nursing Leadership Anesthesia Leadership Sr. Hospital Leadership Chaired by Medical Director(s) of Perioperative Services Administration-sponsored Surgery Board of Directors Controls access and operations of OR Sponsors and directs Perioperative team activity
Steering Committee Responsibilities 8
Supply Costs Can Be Controlled 9
Questions to Ask 10
Physicians Scorecard 11
How to Address Outlying Behavior 12
OR Case Time is Very Expensive 13
The Elephant in the OR: Case Time
Case Time Date: Driving Organizational Change 15
Reduce Case Time 16
OR Case Time Variance By Procedure 17
Impact 18
Case Study – East Coast Community Hospital 19
Predictive Analytics in Perioperative Services 20
Why is Efficient Block Scheduling Important? 21 Establishes “draw down” and optimizes room utilization 2.5 FTE/Room Approximately $300,000 Anesthesia cost Reduces costs from having under-utilized rooms Reduces the cost per occupied bed F igure 1. Heatmapping the operating room aids in visualizing peak operating hours and helps to minimize non-productive time.
Effective Block Design The goal is to maximize access for the most productive surgeons Block forecasting correlates physician practice patterns to precisely match demand for block Predictive models also allocate appropriate time for urgent, emergent, and electively scheduled casesDrastically reduces overtime expense and improves throughputMinimizes need for additional resources after hoursHospitals use this schedule to forecast ICU admissions and efficiently manage beds
Designing a Block Schedule by Forecasting Demand 23 Helps to load balance the OR Reduces variance and improves predictability of the daily schedule Improves surgeon access Incorporates physician practice patterns into the model Minimizes interference with clinic schedule Reduces overtime cost Provides “wiggle room”
Scheduling Accuracy is a Critical Component of an Efficient Block Schedule Helps control labor costs Reduces day-to-day variability in the schedule Provides sufficient notice of gaps or complex cases
Scheduling Accuracy, cont. Case Time is non-Gaussian Log-normally distributedSeveral effective approaches How to best handle outliers? Use the expectation value: (with some guidelines)
Case Study - What is the Daily Huddle? H Healthcare U United D Daily (to make)D DecisionsL Leading toE Excellence Recap of previous day Total case review for next days out – PAT and scheduling c ompletion Review of schedule Total number of anesthesia providers to start the day PAT problem review Antibiotics review Review pending action items
Unused Time = 4 hours Unused Time = 3 hours 4 th Case = 1.5 hours Turnover = 1 hour Turnover = 1 hour 2 nd Case = 1.5 hours Turnover = 1 hour 1 st Case = 1.5 hours 3 rd Case = 1.5 hours Flip Room Avg. Duration 1.5 hours Avg. Turnover - 15 minutes Calculating Utilization With a negative turnover: = 1.25 x 4 = 5/8 ‘ unadjusted ’ for flip = 62% Adding 30 min adjusted turnover between each case: = 1.5 x 4 + .5 x 3 = 7.5/8.0 Is the Adj. Util. = 94% Room 1 Room 2 1.25 1.25 1.25 1.25 1.50 .5 1.50 .5 1.50 .5 1.50 Utilized Utilized 27 Case Study - Solution for Room Flipping & Calculation for Adjusted Utilization
Case Study - Impact 28
Case Study – Volume Snapshot 2015 & 2016
Case Study – OR Utilization Snapshot 2015 & 2016
Implementation Checklist
Work Plan 32
Information Collection 33
Physician Scorecards 34
Clinical Redesign 35
Protocol / Clinical Pathway 36
Patient Education 37
Office Staff Education 38
Risk Reduction Tools 39
Cost 40
Implementation Checklist 41
Institution Support Is Key 42
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