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
2
3
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
4
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
5
BPCI Started Program April, 2015
Total Joint Replacements: DRG 469 & DRG 470
6
HOW DID WE DO?
7
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
8
Average Episode Cost
Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)
9
$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
10
Average NPRA per Patient
Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)
11
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)
12
% 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)
13
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)
14
% 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)
15
% 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)
16
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)
17
SNF - Avg Cost Per Patient
Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)
18
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)
19
90-Day Readmissions
Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)
20
Readmission Trends
Source: Porter CMS Reconciliation Data; 1/1/2013 – 3/31/2016; (BPCI Patients Only)
21
HOW DID WE DO IT?
22
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
23
Our RN Care Coordinators
24
Care Coordination Goals
• Prepare Patients for Efficient Discharge
• Front-Load Discharge Planning
• Promote use of Preferred Partners
• Extend Patient Management Post-Discharge
25
Role of Care Coordinator
26
Bending the Cost Curve
27
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
28
SNF Metrics
29
SNF Dashboard
30
WHAT ARE OUR LESSONS LEARNED?
LESSONS LEARNED
31
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
32
33
Understanding Stakeholders
34
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
35
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.
36
Discussion
What questions would you ask your stakeholders to elicit feedback and understanding?
3 minutes
37
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?
38
QUESTIONS
39
Kristen Daley, Director – Value Based Programs [email protected], 303-765-6486
Ryan Walker, Director – Lean Leadership Institute
[email protected], 303-715-1137
Recommended
