Transcript Tiered Approach to Robotic Surgery: Improving Utilization

Symposium on Delivery Science:
Evolution & Application
A focus on:
• The boundaries of Delivery Science
• Tools and expertise for success in patient care in the reformed health system
• The role of supply chain in new models of innovation
• Meeting the dual demands for clinical and economic integration
A panel from academia, practice, and the supplier community including:
• Amol Navathe, M.D., Ph.D., Co-Editor, Health Care: The Journal of Delivery Science and Innovation
• Keith Lindor, M.D., Executive Vice Provost and Dean, College of Health Solutions, ASU
• Terry Loftus, M.D., MBA, Medical Director of Surgical Services and Clinical Resources, Banner
Health
• Michael Nagel, MBA, President and CEO, Vomaris Innovations
• Natalia Wilson, M.D., MPH, Co-Director Health Sector Supply Chain Research Consortium, ASU
The Science of Healthcare Delivery:
Moving Beyond Theory
Terry Loftus, MD, MBA, FACS
Medical Director
Surgical Services & Clinical Resources
Banner Health, Phoenix, Arizona
Agenda
• Challenges
– Volume to Value
– Transition from High Cost to Low Cost Centers
– The Great Migration
• Approaches
–
–
–
–
–
Contracting
Utilization
Physician Support
Clinical Practice
Patient Safety
CHALLENGES
Volume to Value
High Cost to Low Cost Centers
Home Care
Quality of Life
Comfortable
Independent,
setting
Healthy Living
Chronic Disease
Cost
Management
Effective
Residential Care
Assisted Living
Skilled Nursing
Facility
Acute Care
Specialty
Clinic
Community
Hospital
ICU
$1
$10
Source: IBM ‘Connected Health’ Solution, 2011
$100
$1000
Cost of Care / Day
$10,000
The Great Migration
Inpatient Surgery Cases
Acute Care Facilities
70.0%
61.4%
60.8%
51.9%
60.0%
48.9%
46.7%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2010
2011
2012
2013
2014
Contracting
VALUE ANALYSIS PROGRAM
VAP: EVAR/ELGs
Vendor A
Vendor B
Vendor C
Vendor D
Value Analysis Teams
• EVAR/ELGs*
• Synthetic Mesh*
• Biological Mesh*
– Hernia & Breast Reconstruction
•
•
•
•
Spinal Implants
Ortho-biologics
Heart Valves
Urinary Incontinence
Value Analysis Savings
2013 Value Analysis
EVAR
Synthetic Mesh
Biological Mesh
$867K Total Savings
$106,617
$556,990
1
$203,392
$203,392
$556,990
$556,990
2
3
Utilization
ORAL RINSE IN THE ICU
CHG Oral Care Case Study
• Critical Care Discipline Team identified a
variance in supply usage (Q2 vs Q4)
• Worked with Supply Chain to reviewed
literature to identify best practice (Q4)
• Team standardized practice across system and
reduced costs
• System savings $129K (cut in half)
Utilization
REPROCESSING
Reprocessing
Reprocessing Savings
45.4% increase from 2012
to 2013 -> $ 2M Savings
(All -> $4.9M Savings)
Perioperative + Surgery Centers
$300,000
$250,000
$200,000
2012
$150,000
2013
$100,000
$50,000
$Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Utilization
ALL HANDS ON DECK
Aligning Strategies
Preventing new non-value added spend just as
critical as reducing current non-value added spend
Daily CHG Patient Hygiene Case Study
• Care Management and Supply Chain teamed with
Infection Prevention
– Care Mgt narrowed scope of patient population
– Supply Chain lower cost alternative identified and
contracted
• Potential $1M+ spend down to $300K
Physician Support
ENERGY DEVICE
ADHESION BARRIER
Ortho CCG Recommendation
$255,570
Savings
OB/Gyn CCG: Adhesion Barriers
--OB Clinical Practice*
changed to eliminate
adhesion barriers
--Supply cost was reduced
by nearly $1 million annually
*Edwards RK, et al. Obstet Gynecol. 2014; 123: 919,923-928.
Clinical Practice
BOWEL SURGERY
TOTAL KNEE ARTHROPLASTY
Clinical Practice Metrics
• Bowel Surgery
– Key Process Steps:
• Early & frequent activity: ambulating 3 or more times on POD #1
• Early alimentation: a minimum of 200cc of liquids on POD #1
• Total Knee Arthroplasty
– Key Process Steps:
• Early activity: mobilizing patient out of the bed, either to a chair,
standing at the bedside or ambulating any distance on POD #0
• Avoidance of continuous urinary catheter: no use of a continuous
urinary catheter during their hospital stay
Accelerating Adoption & Sustaining the Gains
Outcomes
Bowel Surgery Outcomes*
Complications
Gastrointestinal
Reduction
-27.8%
-30.2%
Ileus
-29.8%
Pulmonary
-34.4%
30-day Readmission
TKA Outcomes**
-17.5%
Reduction
Complications
-10.5%
Cost ($1000) mean
-9.7%
30-day Readmission
-18.8%
LOS
-7.6%
* Loftus T, Stelton S, Efaw BW, Bloomstone J. A system wide care pathway for enhanced recovery
after bowel surgery focusing on alimentation and ambulation reduces complications and
readmissions. J. Healthcare Quality. 2014 Feb 20 (Epub ahead of print).
** Loftus T, Agee C, Jaffe R, Tao J, Jacofsky D. A simplified pathway for total knee arthroplasty
improves outcomes J. Knee Surg. 2013 Nov 14 (Epub ahead of print).
$3M
Savings
Patient Safety
SAFE SURGERY PROGRAM
Patient Safety & SRE
• Safe Surgery Program
– Implemented in 22 acute and 8 ASC OR’s
– Results
• Increase in days between SRE:
• Reduction in SRE:
• Est. 10 year cost avoidance:
121%
52%
$5,565,523
Questions