Gerald Biala SCA Senior Vice President of Perioperative Services Matt Kossman SCA Vice President of Perioperative Services Hillary Rosenfeld SCA Director of Perioperative Services The Partner of Choice ID: 775829
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Slide1
Co-Management:Successfully Improving Care Along the Surgical Continuum
Gerald Biala, SCA Senior Vice President of Perioperative Services
Matt Kossman, SCA Vice President of Perioperative Services
Hillary Rosenfeld, SCA Director of Perioperative Services
Slide2The
Partner of Choice
for Leading Health Systems
45+ Health System Partners | 750K+ Surgical Procedures | $1.3+ Billion NPR
Slide3Learning Objectives
Define the basics of co-management agreements
Identify critical success factors in working with co-management arrangements
Demonstrate how co-management agreements are utilized in partnering with physicians to achieve surgical integration
Slide4Shared Decision Making and Management
Many publications/bond rating agencies citing the need for physician engagement
Sg2, Innovation Snapshot: Integrating Physicians, Hospitals and Innovation, Nov 2011
“Clinical culture can be a roadblock to health care innovation, so it is imperative to include physician leaders in innovation activities. These clinical leaders are instrumental in promoting more rapid positive change in organizational culture. Creating culture change among physicians generally plays to the characteristics physicians value in their life and work, including capitalizing on their variety of skills, their role as an expert and having responsibility for significant tasks.”
Becker’s Hospital Review, Top 10 Strategic Initiatives for Hospitals in 2013
7. Explore new physician alignment strategies. Again, this initiative ties in with the move to population health management. Trying out new physician relationship strategies, such as physician-hospital organizations, clinical co-management, ACOs, employment or joint ventures can join hospitals and physicians together on the same platform and can be used to support the population health strategy as well as capture market share. "There are multiple vehicles for alignment. All of them are important and many play a role in the same marketplace.”
Fitch 2014 Outlook: Operational strategies to achieve the lowest possible cost per unit of service can help hospital credit ratings
Moody’s 7/2013: Concerns regarding physician alignment, supply costs, readiness for emphasis on value
Slide5Brief Background and History of Physician Engagement
Slide6Physician Engagement in Management
ClinicalQuality/Safety OutcomesEnforcement of P&PsDisease Specific OutcomesStaff Competency
OperationalUtilization ManagementEfficiency MeasuresCost ManagementSatisfaction Outcomes
StrategicProgram DevelopmentPhysician PreferencesCapital InvestmentProfitable Growth
Effective physician alignment strategies can generate clinical, operational, and strategic improvements to perioperative programs to achieve positive margins on Medicare and increasingly fixed commercial reimbursement.
Medical Chair /Directorships
Co-Management Agreements
Governance Councils
Medical Staff
OR Committees
Slide7Traditional Surgery Physician Alignment Models
Fee for service arrangement with hospitalSingle point of engagement with physicians
Executive Committee with select members blending senior admin and physician leadership Decision making in a voluntary role
A physician group contracted and paid to jointly manage resourcesDecision making authority with responsibility for implementation
Medical Chair/Directorships
Co-Management Agreements
Governance Councils
Oversight for quality of care often extended to management of resourcesAppointed members with limited involvement in final decision making and implementation
Traditional OR Committees
Slide8The Unique Role of a Governance Council
Senior Administration
Governance Council
OR Committee
Hospital strategic planning
Surgical services strategic planningOverall hospital performanceHospital budget
Operational planning and managementPerformance improvement and monitoringRapid response for decision makingDepartment budget
Focus on quality of patient careIdentification of needs for performance improvementInput to governance council
Slide9Co-Management Arrangements
Slide10Common Clinical Co-Management Themes
Align with physicians and grow market share
Seek alternatives to traditional employment models
Build a high-quality, lower-cost delivery model
Implement alternative payment methodologies
Optimize service line performance
Disengaged physicians; non-inclusive decision making process
Decreased focus and loss of interest after agreement signed
Slide11Physician Co-Management Evolution
First Generation Co-Management – Individual
Hospital
A
“First Generation” co-management agreement is specific to one hospital and the participating physiciansResults are contained to the individual hospital and physicians practicing therein
service line leader
First generation co-management is focused on a single specialty or subspecialty goals and often lacks true physician integration extending into overall strategic planning
Single or
M
ultiple
S
pecialties
Slide12Co-Management Roles and Expectations
Shared involvement of management and operations for individual or multiple service lines to achieve surgical integrationAdministrative team partnered with physicians in improving quality and operational indicatorsNecessary clinical services are covered
Purpose is to provide leadership to improve quality and efficiency of careAdministrative services, medical director services, and quality improvement initiativesQuality improvement initiative targets established and compensation at risk based on performance
Hospital
Physicians
Page 12
Surgical continuum
Compensation
Management & Accountability
A hospital/physician alignment strategy
to delivery greater quality and financial value along the surgical continuum of care
Slide13Example Co-Management Structure
Co-Management Agreement
Executive Council
Hospital
Quality
Physician LLC
Medical Director
Efficiency
Operations
Strategy
Finance
Slide14Economics of Co-Management
Limited physician start-up, ~$3K per participant
Physician ROI ~40%
Hospital ROI 25% to 50%
Hospital ROI achieved through benefits of physician alignment:
Population health management
Accountable care organization
Strategic planning/growth
Efficiency improvements
Expense management
Slide15Factors for Successful Co-Management
Transparency and cooperation between all parties
Balance needs of hospital and physician leaders with industry dynamics, evolving business models
Collaborative development of strategic plans
Common language, objectives, and attainable goals
Recognition and acceptance of baseline data
Effective leadership structure and commitment to delivery
Be intuitive
Slide16Implementation Expectations
Program
Maturity
Pre-Signing
First and Second Year
Succeeding Years
Focus
Defining
co-management focus and goals while establishing trust
Organization
and clarity around goals; building successful partnerships between different physician practices and hospital leaders
Program evolution into strategic
areas across multiple sites and specialties
Outcomes
Heavy
investment in establishing structure, data analysis, and setting base line measures
Early results achieved through collaboration and alignment of financial and clinical objectives
Achievement of quantifiable results;
positive ROI
Slide17Co-Management to Achieve Surgical Integration
Slide18Achieving Surgical Integration through Co-Management
Slide19Surgical Integration: Strategic Benefits
Source
:
Harris, Elizonda, & Isdaner. January 2013. “Medicare Bundled Payment: What is it worth to you?”
Healthcare Financial Management Association.
Slide20Surgical Integration: Interdependence Along the Surgical Continuum
Pre-Surgery
Day of Surgery
Post-Surgery
Strategic
PlanningAssemble and lead a multi-disciplinary team of stakeholder sponsors Help replicate capitated episode model with top payersEnhance ancillary network where value gaps exist
Disease ManagementDevelop evidence-based pre-peri-post operative protocols
Utilization ManagementAppropriate pre-op testing and surgical setting to maximize margins
Transition PlanningOptimize site of surgery, post-acute placement
Transition PlanningFinalize post-operative rehab & pain management program
Operational OptimizationThroughput efficiency, costs per case
Transition PlanningDeliver progress notes to surgeon and PCP; coordinate post-acute destination
Care Management1:1 coaching of high-readmission risk patients
Utilization ManagementIdentify and steer to optimized network of rehab partners
Operational OptimizationQuarterly clinical case review of exceptions
Care ManagementMultidisciplinary physician planning and collaboration of pre- & post-surgical care plan
Slide21Physician Co-Management: A Strategy for Surgical Integration
Slide22Physician Co-Management Evolution
Second Generation Co-Management – Multiple Hospitals/Health
System
A
“
Second Generation”
co-management agreement adds to the core by integrating additional hospitals and
physicians to expand the surgical care continuumPatient outcomes and operating efficiencies are optimized through implementation of comprehensive Utilization, Disease, Periop, and Transition management across the entire community as part of the health system surgical integration strategy
ASCs &
HOPDs
Engaging physicians in a second-generation co-management agreement is an ideal
t
actic for surgical population management, ACOs, bundled payment strategies, and
v
alue-based purchasing
Slide23Expanding Co-Management Agreements Across Continuum
Designing third iteration of co-management service agreementEmbed standardized protocols to align resources, costs, and outcomes with contemporary reimbursementEmpower physicians to lead the way in increasing risk capacity to prepare for surgical population managementProactively engage payers and employers to e
Health System
Service Line
Contract
Slide24Case Studies
Slide25Case Study: Florida Hospital – Carrollwood
System Profile
9 OR hospital, heavily focused on orthopedics
Large orthopedics group engaged in clinical co-management agreementMultiple in-efficiencies and disenfranchisement with perioperative leadershipHospital seeking to grow surgery volume and expand market share
ProcessRealignment of co-management with newly developed perioperative governance structure provided integration of initiatives and expanded authorityEducational programs on management process and roles/expectations of physicians, hospital leaders and staffCommittees and task forces established for action OutcomesImproved case on time starts from 36% to 95%Achieved consistent 100% SCIP measures and reduced surgical site infections rates from 2.73% to 0.8%Improved patient satisfaction for four key physician measures from 36th percentile to 90th percentileHospital experienced a 10% increase in surgical case volume as a result of improved schedule management resulting in approval to add 3 additional OR suites
Co-Management Outcomes
Adventist Health System
Slide26Case Study: Genesys Health System
System Profile
450 bed regional medical center
20,000 surgical cases across three operating room sitesEstablished 3 co-management companies with one overall Coordinating CouncilContracting economy with decreasing market share and surgery volumes
ProcessPhysicians engaged to manage perioperative resourcesIntegrated leading management and clinical practiceDeveloped clinician led supply/implant expense managementOutcomesImproved efficiency and quality measures85% OR utilization (from 65%) 20 minute average turnover 95% on-time starts90% or better SCIP scoresReduced labor and implant expensesCoordination of care across continuum for pre-surgical and postoperative care of the diabetic patientActive engagement on Quarterly Strategic Planning with Primary Care Physicians linked to Operational tactics allowing for capturing of surgical cases leaving community
Design and Manage Co-Management Relationships
Ascension
Health
Slide27TriHealth: Integrated Health System
System Profile
Bethesda
North: 17 OR hospitalGood Samaritan: 22 OR hospitalBethesda Surgery Center: 4 OR HOPDCo-management agreement includes >30 physicians managing clinical, operational, business, and quality aspects of surgical hospital/HOPD in conjunction with TriHealth and SCADevelopment of health system wide perioperative council
ProcessLeadership development for transition of new perioperative directorFormation of daily huddle and planning to add cases and consolidate to maximize utilizationStrategic planning related to right case/right location initiative, development of laparoscopic center of excellenceOutcomesImproved efficiency and quality measuresSCIP measures 100%Turnover times <15 minutes25% decrease in instrument repair expenseFirst case on-time starts 88%Implementation of case profitability analytics, scheduling and optimization models, financial and operational benchmarking, and quality best practices
Co-Management
Outcomes
Slide28Q & A
Gerry BialaSVP, Perioperative ServicesSurgical Care Affiliates772-713-3278gerald.biala@scasurgery.comMatt KossmanVP, Perioperative ServicesSurgical Care Affiliates404-617-5734matt.kossman@scasurgery.com
Hillary Rosenfeld
Director, Perioperative Services
Surgical Care Affiliates
276-759-3446
hillary.rosenfeld@scasurgery.com