A CMOs Perspective How can I get housestaff to think about valuebased clinical medicine using outcomes data Can outcomes data be used to incorporate a culture of quality improvement into surgical training ID: 500811
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Slide1
Intersection of Surgical Outcomes and Medical Education A CMO’s Perspective
How can I get housestaff to think about value-based clinical medicine using outcomes data? Can outcomes data be used to incorporate a culture of quality improvement into surgical training?Slide2
Medical EducationMy CFO’s Perspective
Declining hospital margins Inefficiencies in the care model Declining GME funds Growing emphasis on education over service
Time away for didactics, simulation
“Explain to me again why I would rather pay for a resident than a PA or NP” Slide3
Congress should authorize the Secretary to change Medicare’s funding of graduate medical education (GME)
to support the workforce skills needed in a delivery system that reduces cost growth while maintaining or improving quality.
The indirect medical education (IME) payments
above the empirically justified amount should be removed from the IME adjustment and that sum
would be used to fund the new performance-based GME program.
To allow time for the development of standards, the new performance-based GME program should begin in three years
(October 2013)
.
Slide4
Value-Based Residency Training and Reimbursement:CMMI Project Proposal
PI: Joel Katz MDHypothesis: A new model of hospital reimbursement can improve: 1) Metrics of health status among patients cared for by trainees 2) Attainment and utilization of competencies directly related to value (quality per unit cost) and lead to more cost-efficient investments in physicians in trainingSlide5
Direction Of Health Reform Is Uncertain....
Global Capitation
Fee for Service
P4P
Medical Home
Bundled Payments
Adapted from Dr. James Mongan presentation 5/26/2009
Level of financial risk borne by provider
Level of financial risk borne by
payor
...but all models involve performance measurement and accountabilitySlide6
Bundled ProceduresSurgeon-specific Metrics
M&M LOS Readmission rates Use of home care, PT, SNF, rehab Cost data
Access
Patient satisfaction
Compliance with standardized pathway
Site of careSlide7
Procedure Cost Assessment
7
MD
Cases
CMI
Total
OR
Time
Team
Supplies
Implants
Recovery
Pharm
Rad
Other
A
237
3.63
$7,572
$1,029
$2,652
$2,779
$1,113
$6
$18
$1,204
B
91
3.85
$8,965
$1,715
$3,086
$3,025
$1,140
$29
$39
$1,522
C 904.37$10,392 $1,668 $4,106 $3,455 $1,163 $11 $46 $1,508 D763.96$8,661 $1,498 $2,550 $3,625 $988 $6 $80 $1,423 E 563.7$8,084 $1,265 $2,680 $2,920 $1,219 $6 $76 $1,251 F 463.82$11,457 $1,838 $2,570 $5,821 $1,228 $22 $360 $1,800 G 293.97$8,822 $1,802 $2,789 $3,210 $1,022 $4 $43 $1,545 H 263.78$11,543 $1,490 $3,514 $5,456 $1,082 $10 $229 $1,462 I 193.53$8,047 $1,498 $2,319 $3,269 $961 $206 $16 $1,312
Average Direct Cost per Inpatient DischargeTotal Knee Replacement - OR Related Costs - FY11Slide8
Surgeon-specific Metrics
The Next Generation?Slide9
Porter ME.
NEJM
2012Slide10
QPID
Appropriate Procedure Order
: Evidence Based Guidelines
>50% Stenosis as determined by ultrasound or angiogram and symptomatic
Print Personalized Consent
Schedule Surgery
>80% Stenosis as determined by ultrasound or angiogram and asymptomatic
Patient has received a decision aid
Complex case (write exception below)
Risk Calculator:
If guideline criteria not met, but patient still requires surgery, add justification here
Procedure Decision Support
Carotid Stenosis
Risk of Mortality 1.6%
Morbidity or Mortality 17.0%
Long Length of Stay 7.7%
Short Length of Stay 38.4%
Permanent Stroke 1.1%
Prolonged Ventilation 8.2%
DSW Infection 0.4%
Renal Failure 7.6%
Reoperation 6.7%
Print Personalized Consent
Schedule Surgery
Carotid Stenosis Therapy
Step 1: Indications with exceptions
Step 2: Perioperative risk assessment
Step 3: Shared decision making
Step 4: OutputsSlide11Slide12
How do we prepare our residents for what’s coming? Make outcomes analysis routine
Give them the tools to improve eg. CPIP, Lean, Toyota Emphasize appropriateness eg. clinic, advanced care planning, palliative care Teach them some finance analysis and accounting Team training and leadership skills
Patient experience trainingSlide13
The future ain’t what it used to be.
Y. Berra
Y. Berra