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MEDTRONIC OUTCOMES PLEDGE PROGRAMVALUE-BASED HEALTHCARE STARTS WITH IMPROVING OUTCOMES
DECEMBER 14, 2016
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TODAY’S PANELISTS
Cori Johnson Maegley, BS, MS, MBA
Director of Clinical and Portfolio Sales and Outcomes Pledge Program Director
Medtronic
Mary Jo Valentine, MSN, RN, OCN
Director of Nursing Professional Development and Magnet Program Director
Methodist Hospitals
Jeff Ollis, MD
Cardiac Anesthesiologist
Parkwest Medical Center
MEDTRONIC MISSION
ALLEVIATE PAINRESTORE HEALTHEXTEND LIFE
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Our broad portfolio of solutions spans the continuum of care to support minimally-invasive treatment by reducing complications and accelerating patient recovery.
PATIENT MONITORING & RECOVERY (PMR)
IDENTIFYEARLIER
INTERVENEEARLIER
TREAT EFFECTIVELY
IMPROVE OUTCOMES
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INTRODUCING THE MEDTRONIC OUTCOMES PLEDGE PROGRAM
VALUE-BASED HEALTHCARE STARTS WITH IMPROVING OUTCOMES
MEDTRONIC OUTCOMESPLEDGEPROGRAM
FACILITIES PARTICIPATING IN THE PHASES OF THE PROGRAM WILL COLLABORATE WITH MEDTRONIC TO TARGET…
OPTION 1
20% Reduction In events related to respiratory compromise on the medical surgical floor
When implementing a program using Microstream® Capnography for adult patients receiving sedatives and/or opioids/PCA on the Medical Surgical Floor.
OPTION 2
20% Reduction In cardiac surgical complications associated with Major Morbidity and Operative Mortality
When implementing a program using INVOS™ Regional Oximetry for adult cardiac surgery patients
Med Surg Operating Room
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OPTION #1: RESPIRATORY COMPROMISEMICROSTREAM CAPNOGRAPHY
“Respiratory Compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death, but in which specific interventions (continuous monitoring and therapies) might prevent or mitigate decompensation.”
- Respiratory Compromise Institutewww.respiratorycompromise.org
Common, Costly and Deadly: • Nearly 30% of post-operative patients and
approximately 7% of all Medicare patients1
• Patients with respiratory compromise that originates on the medical surgical floor are 29 times more likely to die compared to those in other areas of the hospital.2
• Cost projected to exceed $37 billion by 2019.3
1. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population. 2019. Abstract presented at Academy Health Congress, June 2011.
2. Kelley SD, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012;40(12)-764.
3. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population. 2019. Abstract presented at Academy Health Congress, June 2011.
Name: Amanda AbbiehlAge: 18Diagnosis: Severe pain from throat infectionMonitoring: Intermittent SpO2 and vitalswww.promisetoamanda.org/amandas-story
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End-tidal carbon dioxide (etCO2):
Noninvasive continuous measurement of CO2 concentration
Helps clinicians detect signs of respiratory compromise earlier, so they may intervene sooner
Normal range: 35-45mmHg*
*http://globalrph.com/abg_analysis.htm
MICROSTREAM™ CAPNOGRAPHY
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Program Targeted Goal
OPTION #1:MEDICAL SURGICAL FLOOR
Respiratory Compromise*
20% Reduction
* For purposes of this program, Respiratory Compromise is defined as respiratory arrest, insufficiency or failure as assessed by the following four metrics: Code Blue Incidents, Naloxone Reversal Agent Administrations, Unplanned Intubations due to Respiratory Compromise, and Intensive Care Unit (ICU) Transfer from the Medical Surgical floor.
** *Adult patients receiving sedatives and/or opioids/PCA on the Medical Surgical Floor
Total# of Adverse Events
Code Blue Incidents +
Naloxone Reversal Agent Administration
+Unplanned Intubations
+ICU transfers from GCF
# of Qualifying Patients*
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OUTCOMES PLEDGE PROGRAM STRUCTURERESPIRATORY COMPROMISE
REBATE: If program requirements met, but outcomes not achieved
50% rebate on Microstream® capnography sampling lines
TIME REQUIRED: Measurement Period
12 months (maintain in Years 2-5)
PLEDGE: 20% Reduction in adverse events
Respiratory Compromise
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OPTION #2: MAJOR MORBIDITY AND OPERATIVE MORTALITYINVOS REGIONAL OXIMETRY
Cerebral Desaturation is Common, Costly and Debilitating:
• 60-75% of high risk cardiac surgery patients experience cerebral desaturation1
• CABG patients with prolonged desaturation have 3x greater risk for prolonged hospital stay>6 days,2 costing up to $31,0003
• CABG surgery patients with prolonged desaturation have higher rates of MMOM than CABG patients without prolonged desaturation4
The INVOS™ system provides real-time monitoring of changes in regional oxygen saturation (rSO2) of blood in the brain or other body tissues beneath the sensor for effective oxygen monitoring in adults.
1. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. Available online 18 June 2013, ISSN 1053-0770.
2. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87(1):36-44.
3. Cleveland Clinic Patient Price Information List. 16-CCC-237.4. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth
Analg. 2007;104(1):51-58
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Program Targeted Goal
OPTION #2:OPERATING ROOM
Major Morbidity and Operative Mortality (MMOM)*
20% Reduction
* Major Morbidity and Operative Mortality is a composite endpoint defined as having one or more of the following six complications: permanent stroke, reoperation for any reason, renal failure, prolonged ventilation > 24 hours, mediastinitis or death (per STS version 2.81).
** Adult Cardiac Surgery patients.
Cardiac Surgical Patients Exhibiting MMOM*
# Qualifying Patients**
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OUTCOMES PLEDGE PROGRAM STRUCTUREMAJOR MORBIDITY AND OPERATIVE MORTALITY
REBATE: If program requirements met, but outcomes not achieved
50% rebate on INVOS Consumables
TIME REQUIRED: Measurement Period
12 months (maintain in Years 2-5)
PLEDGE: 20% Reduction in adverse events
Major Morbidity and Operative Mortality (MMOM)
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EXPECTATIONS OF PARTICIPATING CUSTOMERSOUTCOMES PLEDGE PROGRAM REQUIREMENTS
Measurement & Reporting1
• Identify appropriate Clinical Sponsor and Program Manager• Provide 24 month historical aggregated baseline data• Kickoff Meeting and regular progress check-ins during implementation• Quarterly Outcomes Review with Medtronic
Protocol2 • Adopt clinical protocol(s) governing use of applicable technology on qualifying patients• Draft written protocol and approve via standard hospital processImplement Technology3 • Ensure necessary equipment is ordered and installed • Ensure consumables are ordered and stocked Training & Education4
• Training required for all Staff Members on participating units• Online Module and Live Training required for at least 80% of staff• Documentation and quarterly attestations required, to ensure
training requirements are maintained
Implementation Period
• Establish baseline measurement
• Create policy/protocol
• Implement technology
• Train relevant staff
Measurement Period
• Quarterly outcome reviews
• Ongoing training and education to maintain required competency
Maintenance / Expansion
• Maintain outcomes improvements
• Expand program to other facilities within a system
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OUTCOMES PLEDGE PROGRAMIMPLEMENTATION APPROACH
~ 90 days 12 months Years 2-5
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OUTCOMES PLEDGE PROGRAM METRICS & REPORTINGDASHBOARD OVERVIEW
Clinical Outcomes Financial Outcomes
SPEAKER:
Option 1 -Respiratory Compromise
Mary Jo Valentine, MSN, RN, OCNDirector of Nursing Professional DevelopmentMethodist HospitalsGary and Merrillville, Indiana
SPEAKER:
Option 2 -Major Morbidity & Operative Mortality
Jeff Ollis, M.D.Cardiac AnesthesiologistParkwest Medical CenterKnoxville, Tennessee
Q&A
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