steven m. berkowitz, md smb health consulting austin, tx [email protected] 512-415-6095...
TRANSCRIPT
Taking Community Hospitals to the Next Level
Ten Challenges for Rural and Community Hospitals
Steven M. Berkowitz, MDSMB Health ConsultingAustin, [email protected]
This is NOT what I signed up for !!
So What’s New in Health Care Reform?Same old wine in a brand new bottle?
You can always count on Americans to do the right thing… …after they’ve exhausted all the other possibilities !!” Winston Churchill
People do not change until the pain of staying the same…
… exceeds the pain of changing.
Anonymous
What Does the Model Look Like?Form Follows Function
What Does the Model Look Like?Form Follows Function
Decreased payments: VALUE vs volumeSome risk-sharing
Increased demand:Greater volume Aging, chronic
More regulation
Transparency of VALUE:
Clinical Outcomes Patient Satisfaction Cost Effectiveness
Healthier Population
Minimal Variation !!
Some Variation !!
Considerable Variation !!
ALL MARKETS ARE UNIQUE !!
What are the needs of the community that you serve? Quality, accessible, cost-effective care
What are the needs of the physicians? Quality medical care Practice/ economic stability
What are the needs of the hospitals? Quality, accessible, cost-effective care Partnership relationship with the medical staff
What Does the Model Look Like?Form Follows Function
Shared Infrastructure and Governance
Financial Integration
Clinical Integration
Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery
Shared Infrastructure and Governance
Financial Integration
Clinical Integration
X- ABC Community Hospital X
X
X
Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
◦ Enterprise-wide cost reduction◦ Successful Management of Risk
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
Clinical IntegrationThe Road to Population Management
Comm
on Quality G
oals
Comm
on IT PlatformBest Practice Im
plementation
Population Managem
ent
Clinical Integration
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
◦ Enterprise-wide cost reduction◦ Successful management of risk
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
1. Embrace Data Transparency2. Implement Evidence-based practices3. Excel at Pay for Performance
Clinical Integration Imperatives
1. Embrace Data Transparency2. Implement Evidence-based practices3. Excel at Pay for Performance
Clinical Integration Imperatives
The increasingly informed consumer will make health care decisions on the basis of VALUE
Value Based Purchasing
VALUE = Outcomes + Pt Experience
Cost
“What we concluded was that even when hospitals know their performance is not good, that's not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve.”
Judith Hibbard, Health Affairs 2003
Data Transparency
That which is measured, tends to improve.That which is measured publicly, tends to improve faster.
Percent Who Saw and Acted Upon the Information
Choice of Hospitals
0
5
10
15
20
25
30
1996 2000 2004 2006 2008
Saw
Acted
Kaiser Family Foundation, October 2008
Exposure to and Use of Quality Information
2012
Transparency is the best thing that’s happened to quality since antibiotics...
…by decreasing variance and improving results
As transparency matures, it will rewrite the book on:
Who is your competitor?
Data Transparency and Accountability
Stage IThe “other guy”
Stage IIIThe entire nation ?
Stage IVMedical Tourism ??
Incr
easin
g Tra
nspar
ency
Stage IIAll hospitals in the state
System Strategic PlanningWho is Your Competitor…. The role of Transparency
Step 1- Demographic need
Step 2- Financial feasibility
Step 3- Build it and they will come !
Strategic Planning- The Old WayThe Impact of Transparency
Step 1- Demographic need
Step 2- Financial feasibility
Step 3- The need to excel in public data◦ Outcomes ◦ Pt Experience ◦ Cost
Step 4- Only then, will they continue to come !!
Strategic Planning- The New WayThe Impact of Transparency
Step 1- Demographic need
Step 2- Financial feasibility
Step 3- The need to excel in public data◦ Outcomes ◦ Pt Experience ◦ Cost
Step 4- Only then, will they come !!
Strategic Planning- The New WayThe Impact of Transparency
Can you keep the care HERE ?
Challenge #1
Can you keep the care in your community?
Ten Challenges for Rural and Community Hospitals
1. Embrace Data Transparency2. Implement Evidence-based practices3. Excel at Pay for Performance
Clinical Integration Imperatives
Implementing Evidence-Based MedicineWhat Can we Learn from the Airline Industry ?
Where Do We Find the Best Practices ?Examine Your Own Specialty Literature
There will be MORE guidelines in clinical medicine
Guidelines were NEVER intended to apply to all patients and do NOT take the place of individual physician judgment
Expect physicians to occasionally deviate from guidelines in the daily practice of prudent medical care
When so… … DOCUMENT In the medical record that:
The patient was seen and evaluated The options were thoughtfully considered The best clinical judgment was used Discussed with the patient
Guidelines for Guidelines
Don’t DEVIATE from the guidelines !!
Challenge #2
Does your hospital implement best practices in every service line you offer where best practices are available?
Ten Challenges for Rural and Community Hospitals
1. Embrace Data Transparency2. Implement Evidence-based practices3. Excel at Pay for Performance
Clinical Integration Imperatives
CMS Pay for Performance
Core MeasuresHCAHPS
Re-admissionsHospital Acquired Conditions
Meaningful Use
By FY 2017:
5 – 10 % of Total Medicare…
Or more !!
The Evolution of CMS Value Based PurchasingFrom Process Outcomes and Efficiency
Challenge #3
Will your hospital excel at pay for performance, even if your current reimbursement is not at stake??
Ten Challenges for Rural and Community Hospitals
Health Care Information Systems-- We are so far behind !!!
1 Zettabyte =
1,000,000,000,000,000,000,000 bytes
= 10007 bytes = 1021 bytes
The Role of Information Systems
EMR and Evidence Based Order Sets are not just another IT initiative….
…. it is a Clinical Transformation to how we will be practicing better medicine in the future.
The Role of Information Systems
The EMR will do for health care What the assembly line did for manufacturing
The Role of Information Systems
Challenge #4
Will your hospital’s information system be state of the art ?
Ten Challenges for Rural and Community Hospitals
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
◦ Enterprise-wide cost reduction◦ Successful Management of Risk
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
◦ Enterprise-wide cost reduction◦ Successful Management of Risk
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
FFS
Comm
on IT
Pla
tform
FFS
+ In
cent
ives
Bundl
ed P
rodu
cts
Globa
l Cap
Globa
l Cap
+ In
cent
ives
Full
Prem
ium
Financial IntegrationThe Continuum towards Management of Risk
Financial Integration
There will be a focus on Cost Control like we have NEVER seen before in our careers
Enterprise Wide Cost ReductionJob One !!
Health Care Costs Per Capita OECD
Physician
Hospital
Other
Rx
Admin
Today’s Health Care Costs
?????
Post- Reform Health Care Costs
Cost Reductions
Enterprise Wide Cost ReductionJob One !!
Physician
Hospital
Other
Rx
Admin
Today’s Health Care Costs
?????
Post- Reform Health Care Costs
Cost Reductions
Any decrease in health care expenditures is
a pay cut for somebody in health care !!
Enterprise Wide Cost ReductionJob One !!
Maximum opportunity !
MinimalOpportunity
MoreOpportunity
Total Cost of Care- Hospitals
Goal: >20 % Total Cost Reduction
Challenge #5
Can your hospital reduce 20% of your cost basis and be cost-neutral in Medicare?
Ten Challenges for Rural and Community Hospitals
HospitalHospital
Physician Physician
Hospital
Other
Rx
PhysicianPhysician
Hospital
Other
Rx
Admin
Total Health Care Costs
Physician
Hospital
Other
Rx1. Global 2. Bundling
3. Global withIncentives 4. Full Risk Cap
The Successful Management of RiskTypes of Risk Products
Risk = Exclusivity
Levels of Coordinated Systems of Care
Risk = Exclusivity
The greater the risk…
…the greater the reward
Levels of Coordinated Systems of Care
New Roles for the Hospitals
Clinical and Structural ReformThe Icing on a Two Layered Cake
Compensation Reform
Payment Reform
Public Sector
Private Sector
Clinical Reform Structural Reform
Challenge #6
Can your hospital be able to handle some risk in the market; are you strategically thinking about financing and managing as well as delivery of care?
Ten Challenges for Rural and Community Hospitals
Clinical Integration
Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery
Financial Integration
Clinical Integration
Governance/Infrastructure
Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery
Financial Integration
Shared Infrastructure and Governance
Financial Integration
Clinical/ Operational Integration
Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
◦ Enterprise-wide cost reduction◦ Management of risk
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
SystemCommunity
Hospital
Patients !
Tertiary ServicesSpecialistsIT CapabilitiesMgmt ServicesBrandingCapital
Infrastructure- With Whom do you Partner ?Other Hospital Systems
AffiliationIndependent Joint Venture Merge Close Down
Infrastructure- With Whom do you Partner ?Other Hospital Systems
SystemCommunity
Hospital
Patients !
Tertiary ServicesSpecialistsIT CapabilitiesMgmt ServicesBrandingCapital
Infrastructure- With Whom do you Partner ?Other Hospital Systems
What is the LEAST disruptive solutionthat will accomplish your needs
Challenge #7
Are you able to execute on the “least disruptive” option regarding partnerships that best meet your needs?
Ten Challenges for Rural and Community Hospitals
AffiliationIndependent Joint Venture Employ
Physician Network - With Whom do you Partner ?Physician Strategy
Primary Care
Specialty Care
Psych
iatry
Family
Pra
ctice
Pediat
rics
Inter
nal M
edici
ne
Endocrin
ology
Infec
tious D
iseas
e
Rheum
atolo
gy
Neuro
logy
Emer
gency
Med
icine
Nephro
logy
ObGyn
Allerg
y/Im
munolo
gy
Pulmon
ary
Gener
al Surg
ery
Ophthalm
ology
ENT
Patholo
gy
Anesth
esiol
ogy
Urolog
y
Hemat
ology
/Onco
logy
Derm
atolo
gy
Cardiol
ogy
Radiol
ogy
Radiat
ion O
ncolog
y
Gastro
enter
ology
Orthop
edic
Surger
y: G
ener
al
CV Surg
ery
Ophthalm
ology
Neuro
Surg
ery
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
Physician Compensation 2012 MGMAMean Compensation
If you are smart enough to get into medical school…
… you are smart enough to understand this slide.
Challenge #8
Are you strategically addressing your present and future physician needs, particularly primary care?
Ten Challenges for Rural and Community Hospitals
A Final Thought…. 1620- Somewhere in the Atlantic.…
Challenge #9
Do you view your community healthcare (hospital, physicians) as a fragile Mayflower that other people would like to see go away?
Ten Challenges for Rural and Community Hospitals
Opportunity is overlooked by most people because it is dressed in overalls and looks like work.
Thomas Edison
Clinical Integration◦ Embracing data transparency◦ Implementing best practices◦ Excel at Pay for Performance
Financial Integration
◦ Enterprise-wide cost reduction
Hospital Physician Partnership
◦ An aligned, long term collaborative relationship
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and PhysiciansInsights and Actions for Results
1. Keeping the care in your community 2. Implementing best practices 3. Excelling at pay for performance 4. State of the art information system 5. Enterprise-wide cost control 6. Ability to handle some risk in the market 7. Implement a “least disruptive” strategy for Partnership 8. Address your present and future physician needs 9. Implement and protect your “community” health model
Ten Challenges for Rural and Community Hospitals
1. Keeping the care in your community 2. Implementing best practices 3. Excelling at pay for performance 4. State of the art information system 5. Enterprise-wide cost control 6. Ability to handle some risk in the market 7. Implement a “least disruptive” strategy for Partnership 8. Address your present and future physician needs 9. Implement and protect your “community” health model
Challenge #10
Can you meet these in 3-5 years?
Ten Challenges for Rural and Community Hospitals
When you're finished changing, you're finished. Ben Franklin
To the world you may be just one person,But to one person you may just be the world.
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