university of michigan pathology staff presentation february 6, 2009 presented by: doug strong,...
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University of MichiganPathology Staff Presentation
February 6, 2009
Presented by:
Doug Strong, Director & CEO, UMHHC
Benefit to the Community
Balance of Excellence
12/11/08
Financial Success
Preparing for the Future
Benefit to the
Community
Quality and Safety
Employer of Choice
Provider of Choice
3
Financial Success
• Solid Overall Financial Position
• Weakening Operating Performance
Financial Success
Note: FY07 – FY09 margins have been restated due to accounting changes.
HHC Net Assets
0.0
500.0
1,000.0
1,500.0
2,000.0
2,500.0
FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09DecYTD
$s
in
Mil
lio
ns
Net Assets OPEB
HHC Operating Margin Trend
0.0%1.0%2.0%3.0%4.0%5.0%6.0%
FY04 FY05 FY06 FY07 FY08 FY09 DecYTD
Margin Goal Actual Margin FY08 w/out OPEB
4
HHC PAYER MIX BASED ON CHARGES (with Margin %)
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
FY03 FY04 FY05 FY06 FY07 FY08
Blues/MCare
Medicare
Commercial
Medicaid/Uninsured
-.63% 2.10% 2.79% 7.14%
8.26%8.75%
.20% -0.08%-0.02% -4.40%
-13.71% -23.88%
17.46%24.69%
35.18%35.86%
34.87%-41.84%
-18.68%-25.23% -39.80%
-46.25%-39.52% 35.75%
UMHS Payer Mix Trends by Major Payer Category
UMHS Margin Trends by Public/Private Payer Category
HHC MARGIN PERCENT BY PRIVATE vs. PUBLIC/UNINSURED
-5.2%
-7.5%
-17.3%
-21.8%
6.4%
11.0%
13.7%
18.3% 18.3% 18.2%
2.3%
4.5%5.8% 5.9%
4.2%
-8.4%
-29.7%
1.4%
-30.0%
-20.0%
-10.0%
0.0%
10.0%
20.0%
FY03 FY04 FY05 FY06 FY07 FY08
Private Payers
Overall
Public Payers/Uninsured
2008 Gross Charges
$1,829 M
$1,567 M
$3,396 M
5
Outpatient Activity Projected to Grow Faster Than Inpatient
INPATIENT AND OUTPATIENT "CASES"
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
7
Financial Success: Pathology
Total Charges
Path Charges as a % of Total Charges
FY07 12.9%FY08 12.0%YTD Dec FY09 11.7%
8
Quality and Safety
• Finalist in AHA-McKesson Quest for Quality Prize Competition, 2008
• Goal to be known as Safest Hospital in the Country
• Growing national reputation for quality and safety
• Leader in many Michigan quality improvement
collaboratives
• Michigan Quality System
Quality & Safety
9
Quality and Safety: Catheter Associated Bloodstream Infection Rate
Trendline
Data includes: NICU, TICU, CCMU, SICU, CICU, TBICU, PICU, PCTU
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Jan-07
Mar-07
May-07
Jul-07
Sep-07
Nov-07
Jan-08
Mar-08
May-08
Jul-08
Sep-08
Nov-08
Rat
e p
er 1
000
cath
eter
day
s
10
Quality and Safety: Ventilator Associated Pneumonia
Data includes: NICU, TICU, CCMU, SICU, CICU, TBICU
Trendline
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Jan-07
Mar-07
May-07
Jul-07
Sep-07
Nov-07
Jan-08
Mar-08
May-08
Jul-08
Sep-08
Nov-08
Rat
e p
er 1
000
ven
tila
tor
day
s
11
Quality and Safety: Surgical Site Infection Rates
Inpatient procedures include: Cardiac Surgery, Peds Cardiac Surgery, C-Section, Ortho Spinal fusions, total hip arthroplasty, total knee arthroplasty, VP shunts, Peds VP shunts, Breast reduction, Colectomy, Craniotomy, and Peds Spinal fusion.
Outpatient procedures include: KEC Ophthy, LSC & EAA
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Jan-07
Mar-07
May-07
Jul-07
Sep-07
Nov-07
Jan-08
Mar-08
May-08
Jul-08
Sep-08
Nov-08
Rat
e p
er 1
00 p
roce
du
res
Trendline
Trendline
12
Quality and Safety: Pathology
Avg=3.28
UCL=3.73
LCL=2.83
2.53
2.73
2.93
3.13
3.33
3.53
3.73
3.93
4.13
4.33
Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08
Mean
TA
T (
days)
Lead (“Turnaround”) Time for All AP Patients Affected by August 2007 Project
Anatomic Pathology
13
Quality and Safety: Pathology
Sample Turn-Around Time (TAT)Percentage of Time TAT not met
August 2007 - December 2008
05
101520253035
Aug OctDec
Feb Apr Ju
nAug Oct
Dec
Aug 07 - Dec 08
Per
cen
tag
e o
f ti
me
TA
T
no
t m
et
RT - 2 hrs IP Stats - 45 mins
OP Stats - 45 mins Total Stats - 60 mins
Chemistry Lab
Target 5% or
less
14
Provider of Choice
• Consistent increase in activity
• Improving patient satisfaction scores
• Strong HCAPS scores
• Improving referring physician satisfaction
Provider of Choice
15
Target: Patient satisfaction mean scores on “care experience” at or above 90
Provider of Choice: Target/Results
Index based on 12-month
rolling average
Charge-Weighted Index including UH, Women's, CVC, Mott/Holden, Ambulatory, and ED
80
81
82
83
84
85
86
87
88
89
90
Jan-04
Apr-04
Jul-04
Oct-04
Jan-05
Apr-05
Jul-05
Oct-05
Jan-06
Apr-06
Jul-06
Oct-06
Jan-07
Apr-07
Jul-07
Oct-07
Jan-08
Apr-08
Jul-08
Oct-08
We
igh
ted
In
de
x
88.1
16
Provider of Choice: HCAHPS Scores
Source: Hospital Compare, August 2008 release
HCAHPS
Discharges from October 2006 to September 2007
UMHS National
(N = 2,578)
COTH Hospitals
(N = 218)
Median 75th Percentile
Median 75th Percentile
How do patients rate the hospital overall?
Patients who gave a rating of 9 or 10 (high)
71% 63% 69% 63% 68%
Would patients recommend the hospital to friends and family?
YES, patients would definitely recommend the hospital
78% 68% 74% 70% 76%
17
Summary Measures of Referring Physicians' Attitudes toward UMHS, 2006 vs. 2008
72.0
80.6
78.777.2
84.984.0
65
70
75
80
85
90
Q17. Your overallexperiences referring
patients to UMHS
Q19. Likelihood to continuereferring patients to UMHS
Q20. Likelihood torecommend UMHS to peers
for their patients
Mea
n S
core
In
dex
(0-
100
Ran
ge,
100
= B
est
Po
ssib
le)
2006
2008
2006: n=10242008: n=1124
Interyear differences are statistically significant at 95% level of confidence
Provider of Choice: Referring Physician Satisfaction
18
Provider of Choice: Pathology
Mlabs Total ChargesFY06 $23,209,575
FY07 $29,639,777
FY08 $28,547,310
19
Employer of Choice
• Successful recruitment and retention,
especially faculty and nurses
• No change in staff satisfaction scores
Employer of Choice
20
Employer of Choice: Successful Nurse Recruitment and Retention
2,517 2,667 2,8683,143 3,292
2,312
0
500
1,000
1,500
2,000
2,500
3,000
3,500
FY04 FY05 FY06 FY07 FY08 FY09
Data reflects all nurses at UMHS (both UMPNC and MVN)
UMHS – Nursing FTEs
21
Target: Employee satisfaction scores will improve by 10%
Employer of Choice: Employee Satisfaction
Mean Score based on 7 point scale
Prior to 2005, scores based on 5 point scale
69.9 70.070.4 70.3
64
66
68
70
72
74
76
78
80
2005 2006 2007 2008
Willin
gn
es
s t
o R
ec
om
me
nd
De
pa
rtm
en
t (M
ea
n S
co
re)
UMHHC Employees’ willingness to recommend department
22
Employer of Choice: Pathology
Pathology Employee Engagement Survey Results
Q36. Willingness to recommend work area to someone looking for a good place to work
•May 2007
•Mean Score = 61.5
•N = 275
•March 2008
•Mean Score = 59.8
•N = 527
23
Benefit to the Community
0
50
100
150
200
250
300
Charity Care &Bad Debt
Unpaid cost ofgovernmentprograms
(Federal, State ,Local)
SubsidizedHealth Services
Programs forthe community
Support ofresearch and
educationmissions
Total
Co
ntr
ibu
tio
n i
n $
Mil
lio
ns
MHA FY06
MHA FY07
10% increase
12% increase
14% increase
37% increase
17% increase
8% increase
Community Benefit using MHA methodology
Benefit to the
Community
24
Benefit to the Community: Pathology
• Pathology Family Charity• Calendar 2007, raised funds to provide $1,000 checks during the holiday season to
31 needy families referred to us by UMHS social workers• Calendar 2008, despite harder economic times, pathology provided, 33 $1,000
checks!
• Pathology sponsored American Red Cross Blood Drive• This year, sponsored a blood drive that generated 66 units of blood, well above our
goal of 58 units. Many of the donors were Pathology employees.
• Laboratory Services provided to Small Community Organizations• Provide laboratory services to numerous small University affiliated organizations and
other community groups where there is no profit margin to justify participation. Where possible, patients insurance is billed, but absent insurance services are provided gratis or at a dramatically discounted cost. Groups supported include:
• Regional Alliance for Healthy Schools (Formerly Health Place 101). 4 schools• University of Michigan Nurse managed Clinics or Related Groups. 7 entities• Washtenaw Community Support & Treatment Services (formerly Washtenaw Co.
Mental Health)
25
Preparing for the Future
• CareLink
• Restructuring of FGP
• New Ambulatory Care Model
• Facility Expansion
• Strategic Facilities Planning
• Destination Programs
• Administrative Integration
Preparing for the Future
26
Preparing for the Future: Pathology
• Replacement and expansion of clinical laboratories
• Expansion of research space
27
Summary of Strategic Positioning
• Focus on mission balance and synergies
• Quality of patient care is differentiator
• Quality of GME is differentiator
• Geographic diversification of sources of patients
• Geographic diversification of location of care provided
• Modify go-it-alone approach
• Increase clinical research disproportionately
• Physical resources will not be the major barrier
• More unified decision-making/prioritization
• Culture of collaboration
Relation to Scope of VisionStrategic Emphasis Depends on
Scope of VisionArea Current Scope of Vision Future Scope of Vision?
Research Education Patient Care
Research Education Patient Care
Local
SE MI
MI
96% MI
Midwest U.S.
U.S.
Global? ? ?
Degree of change will vary by service based on current scope
29
Conclusion
• Strength and progress in most areas
• Financial results need to improve
• Building well for the future
Employer of Choice
Preparing for the Future
Benefit to the Community
Provider of Choice
Quality and
Safety
Financial Success
Financial Success
Preparing for the Future
Benefit to the
Community
Quality and Safety
Employer of Choice
Provider of Choice
30
Appendix
31
Major Factors Influencing Operating Margin
Expense per case
Revenue per case
Activity
Operating
Margin
32
Overall Strategic Questions
1. How large should each of our missions be? What is optimal balance among them?
2. What quality and cost/value positioning will succeed? How can we best demonstrate value?
3. What should be our areas of strategic focus (geography, severity, specialty)?
4. Should UMHS continue a centralized strategy for inpatient beds in Ann Arbor or geographic dispersion of beds?
5. Should UMHS continue “go-it-alone” strategy?
33
Overall Strategic Questions
6. Given planned growth, what alternative models of care are necessary to support it?
7. What strategies of workforce planning should we use to be employer of choice and to recruit and retain best faculty and staff?
8. What emphasis should be placed on clinical research and how can it be nurtured?
9. What emphasis should be placed on innovation and how can it be nurtured?
10. What actions should we take to best prepare for the future (given assumed certainties and uncertainties)?
34
Benefit to the Community
Balance of Excellence• Successful physician and nurse recruitment and retention• Commitment to improve staff satisfaction scores
• Consistent increase in activity
• Improving patient satisfaction scores
• Strong HCAHPS scores
• AHA McKesson Quest for Quality Prize Finalist
• Growing national reputation
• Michigan Quality System
• CareLink (CPOE)• Restructuring of FGP• New Ambulatory Care model• Facility Expansion• Destination Programs
• Solid overall financial position• Weakening operating performance
• Direct patient care for uninsured and underinsured
• Community health programs/services
Financial Success
Preparing for the Future
Benefit to the
Community
Quality and Safety
Employer of Choice
Provider of Choice
35
Michigan Quality System
A uniform process improvement approach to create value from the customer’s perspective by enhancing:
Quality Safety Efficiency Appropriateness Service
Major Areas of Focus
1. Improve access and maximize capacity in all our patient care areas 2. Enhance clinical quality and safety performance 3. Enhance key workforce planning strategies 4. Increase parking and transportation options for employees 5. Improve ambulatory care experience in partnership with the Faculty Group Practice 6. Provide the Ideal Patient Experience
Targets/Results
SERVICE: Patient satisfaction mean scores on “care experience” at or above 90 FINANCIAL: Operating margin at 3% or better QUALITY CARE: Quality and safety measures at or above the 90th percentile of select benchmarks ACADEMIC: All Graduate Medical Education programs will have five-year accreditation; 10% annual increase in clinical
PEOPLE: Faculty/employee satisfaction scores will improve by 10% COMMUNITY: Partner with the community to improve the health of the population
U
MH
HC
Goa
ls a
nd
Ob
ject
ives
Ideal Patient
Experience
Ideal Clinical Practice
Experience
Ideal Faculty and Staff
Experience
research funding
36*Hospital Acquired Infections include: SSI, ICU-Acquired Infections (BSI, VRE), hand hygiene
(C.Diff)
Major Areas of Focus
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