Managing Patients for Performance under BPCI Total Hip … · Managing Patients for Performance...

Managing Patients for Performance under BPCI Total

Hip and Knee Replacements

Kristen Daley, Director – Value Based Programs Ryan Walker, Director – Lean Leadership Institute

DISCLOSURES

Kristen Daley - None

Ryan Walker - None

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Agenda

TOPIC SPEAKER

How did we do? Kristen Daley

How did we do it? Kristen Daley

What are our lessons learned? Kristen Daley Ryan Walker

Stakeholder Analysis - Discussion Ryan Walker

Q&A Kristen Daley Ryan Walker

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Porter Adventist Hospital

• Employed Total Joint Replacement Practice – Dr Doug Dennis, Dr Todd Miner,

Dr Raymond Kim, Dr Charlie Yang, Dr Jason Jennings

– 2,200 Total Joint Replacement Cases per Year

– 85% Primary, 15% Revision

• Located in Denver, Colorado (Part of the Centura Health System)

• 368-Bed Hospital Facility, Level-3 Trauma

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BPCI Started Program April, 2015

Total Joint Replacements: DRG 469 & DRG 470

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HOW DID WE DO?

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Volume

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

BPCI Program Start

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Average Episode Cost

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

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$1,995

$938

Average Episode Cost

7.9% reduction in total average episodic cost

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

53% reduction in SNF average episodic cost

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Average NPRA per Patient

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

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Acute Length of Stay

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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% of Patients by ALOS

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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Discharge Dispositions

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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% Discharged to SNF

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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% Discharged SNF by Surgeon

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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SNF - Length of Stay

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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SNF - Avg Cost Per Patient

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

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30-Day Readmissions

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; and Internally Collected Data; 4/1/2016 – 12/31/2016 (BPCI Patients Only)

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90-Day Readmissions

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

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Readmission Trends

Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)

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HOW DID WE DO IT?

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Key Elements Driving Results

• Established Care Coordination Program

• Developed Post-Acute Care Partnerships

• Improved Joint Education Coaching & Compliance

• Perioperative Clinic - Risk Assessment & Medical Optimization

• Standardized Pain Management & PT Protocols

• Employed Physicians Under Co-Management

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Our RN Care Coordinators

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Care Coordination Goals

• Prepare Patients for Efficient Discharge

• Front-Load Discharge Planning

• Promote use of Preferred Partners

• Extend Patient Management Post-Discharge

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Role of Care Coordinator

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Bending the Cost Curve

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Critical Partnerships

• Engage with Post Acute Care Facilities (PAC)

• Develop Metrics to Track Partner Performance

• Align and Share Clinical Knowledge with PAC Providers

• Consistent Presence of Care Coordinators at Post Acute Care Facilities

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SNF Metrics

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SNF Dashboard

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WHAT ARE OUR LESSONS LEARNED?

LESSONS LEARNED

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Be Payer Agnostic

Resources for Data Analysis

Surgeon & Admin

Champions are Critical

Program Incentives vs. Compensation

Embrace Process

Improvement

Have A Tolerance for Failure

Be Innovative

Engage Stakeholders

Early

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Understanding Stakeholders

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Joint Replacement Bundle - Stakeholder Analysis

Key Stakeholder

(Name or Role)

Level of Support or Resistance

Reasons for Level of Support or Resistance

Goal for Level of Support

Strategy for Dealing with Resistance

Strong Reservation

Moderate Reservation

Neutral Moderately Supportive

Strongly Supportive

Joint Replacement Bundle - Stakeholder Analysis

Key Stakeholder

(Name or Role)

Level of Support or Resistance Reasons

for Level of Support or Resistance

Goal for Level

of Support

Strategy for Dealing

with Resistance

Strong Reservation

Moderate Reservation

Neutral Moderately Supportive

Strongly Supportive

Stakeholder Analysis

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Stakeholder Analysis

Joint Replacement Bundle - Stakeholder Analysis

Key Stakeholder

(Name or Role)

Level of Support or Resistance

Reasons for Level of Support or Resistance

Goal for Level of Support

Strategy for Dealing with Resistance

Strong Reservation

Moderate Reservation

Neutral Moderately Supportive

Strongly Supportive

Director of Orthopedics X

Understand this is the direction that healthcare is headed and we must learn to operate in a value-based world.

Strongly Supportive. N/A

Surgeon A X

Believes this program is all about money and asks clinicians to compromise care.

Strongly Supportive.

Research and provide studies on best practice and effectiveness of bundled programs to positively influence patient outcomes.

Surgeon B X

Saw a presentation at a conference about the benefits of bundled programs resulting in better outcomes for patients!

Strongly Supportive.

Leverage supportive attitude of Surgeon B to share findings with Surgeon A.

Case Management X

I hear this involves care coordination - that's our job and we do it really well!

Neutral.

Work with Case Management leadership and Care Coordination resources to establish shared expectations and better understand roles.

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Discussion

What questions would you ask your stakeholders to elicit feedback and understanding?

3 minutes

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Other Stakeholder Questions

What have you heard about CJR? (BPCI)

What is your impression of the program?

In your opinion, what does success look like for this program?

What do you feel are the greatest opportunities?

What are your greatest concerns regarding this program?

Do you support moving forward with efforts to implement?

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QUESTIONS

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Kristen Daley, Director – Value Based Programs kristendaley@centura.org, 303-765-6486

Ryan Walker, Director – Lean Leadership Institute

ryanwalker@centura.org, 303-715-1137