Operations Efficiency through

Physician Engagement

Kevin Gilroy, MD Internal Medicine, Lead Hospitalist Associate Program Director, Internal Medicine Residency Program

GHS Leadership Team Meeting March 16, 2011

•  Department of Medicine DRG Project: – Goals:

•  Improve Operational Efficiency •  Cost Reduction

– Via: •  Standardized Care •  Evidence-based focus •  Identification of Process barriers •  Physician Engagement and Ownership

The Culture of Engagement

•  Top 12 DRGs identified for cost savings opportunity –  Congestive Heart Failure –  Sepsis –  Pneumonia –  Renal Failure –  Stroke –  Acute Pancreatitis –  Urinary Tract Infection –  GI Bleed –  Diabetes –  Overdose –  Respiratory Failure with Tracheostomy –  Acute Leukemia

The Culture of Engagement

•  Multidisciplinary Physician Team created for each DRG –  Hospitalist with Subspecialist(s)

•  Physician owned / affiliated (majority) •  Private (GI, Hem/Onc, Nephrology)

•  Individual DRG Team education, data overview, goal setting

•  Random sample of 25 charts reviewed by each team •  Business Intelligence utilized for further data drill down •  Opportunities identified; Action plans later created

The Culture of Engagement

•  DRG Team Review: –  Physician opportunity / ownership issues identified: Prime Focus!

•  “Taking care of our own backyard” drilled home –  Non-Physician opportunities identified: Secondary

•  DRG specific and common themes identified

•  Action Plans created to address major issues identified –  Physician-specific opportunities - Priority –  System specific opportunity recommendations –  Timelines created –  Follow-up data reviewed

The Culture of Engagement

•  Physician ownership issues (examples): –  Documentation integrity opportunities

•  Physician lack of understanding coding world

–  Sepsis management delays –  Plavix procedural delays –  Lack of aggressive management / resuscitation:

•  Pancreatitis •  Sepsis

–  Lack of antibiotic stewardship –  Lack of evidence-based standardization for

•  Pancreatitis •  Sepsis •  PNM •  CVA •  CHF

The Culture of Engagement

•  Non-Physician issues (examples): –  Reactive Case Management / Social Work –  Coding discrepancies / Separation from clinical world –  Sepsis management delays

•  Nursing education and training in ER •  Transport delays •  ICU bed availability

–  Contaminated blood culture results –  Data management

•  Lack of Physician-specific utilization •  Lack of Service-focused patient / data assignment

–  Limited Behavioral Patient Bed access / State resources –  Lack of coordinated post acute care assessment / transition

The Culture of Engagement

The Culture of Engagement

The Culture of Engagement

•  Benefits outside of cost savings –  Transparent focus on Physician Improvement / practice opportunities –  Highlighting “our” unexplained Physician practice variation

•  Acceptance of its existence and detriment to our Patients and System •  Taking ownership to create the solutions

–  Linking a strong bottom line to enhancing Physician support for patient care –  Physician access and education on Data management and capability –  Shared focus / unified goal of the Department

•  Relationship building between Divisions •  Fostering a “Team” atmosphere

–  Physician education regarding System operations / processes of care –  Physician education regarding Payment methods and System solvency –  Highlighting Physician responsibility and ownership for financial success

•  Equal / equivalent to Quality care •  Everyday practice focus among Divisions

–  Fostering Physician creativity in streamlining / maximizing operational efficiency

–  Physicians and System = One in the same!

The Culture of Engagement

•  Reasons for success –  Administrative support of Physician-led System

•  An organizational culture change •  Physician buy-in increasing

–  Administrative Leadership •  Transparent, accountable, engaged, accessible, workforce Leadership and

development

–  Physician owned / aligned Medical Staff (majority) –  Administrative resource support behind project

•  Business Intelligence: Janet Thompson and Renee Tollison (phenomenal)

–  Department Chair Leadership and Focus •  IM Leadership biweekly Meetings / Education

–  Economic downturn –  Local Competition –  Clarity of Healthcare Reform landscape: Keys to survival and

success

The Culture of Engagement

•  Future opportunities / needs assessment –  Improved data collection and management

•  Transparent Physician performance with real-time feedback •  Access to office based EMRs

–  Clinical IT decisional support systems •  Gains to date based on Education / awareness alone: short half-life

–  Case Management development –  More nimble Pharmacy and Therapeutics committee

•  More real-time Formulary efficacy and cost evaluation / adjustment

–  Antibiotic stewardship development / growth •  High cost / Highly utilized medications •  LOS opportunity

–  Continued Medical Staff involvement / engagement / ownership

The Culture of Engagement