Archive for 'May 2016'

    The Supply Chain: A Gold Mine for Succeeding in Value-Based Payments?

    May 25, 2016 9:23 AM

    Value-based payments are, essentially, a capped fee. So to succeed with a value-based payment model, it’s about how efficiently and effectively you can deliver care within that capped fee that determines if you can maintain a profitable health system.


    Since supply chain expenses are 40%1 of a typical health system’s cost structure—and the fastest-growing of all areas of spend—it’s a primary target for rooting out cost and inefficiencies. But using fewer widgets is not always an option when delivering care, and only applying pressure on suppliers to lower the unit price of those widgets won’t yield the savings necessary to succeed in the future.


    By viewing your supply chain as an area for strategic, organization-wide improvements, you’ll be much more effective than those who approach the supply chain as simply a transactional mechanism.


    How do you use your supply chain as a strategic asset? It starts with focusing on the interaction between your supply chain and clinical functions, so you can gather cohesive data on a per patient, per episode of care, and per disease state basis.


    At Mercy Health System, we’ve married our EMR with a number of other data sources to look at our cost to serve per physician, per procedure, per patient, per location and per day. Once you have that data, you can begin to have intelligent conversations about variations in clinical care that are driving up the cost of care. Through the partnership between clinician leadership and the supply chain, a provider can execute upon strategies to minimize the unnecessary costs associated with that variation, and can focus on ways to maximize patient outcomes.


    Based on conversations I’ve had with peers in the industry, very few health systems have these capabilities today. But all see this as the future state to move toward.


    Health systems need to build up their capabilities in marrying supply chain and clinical data, to handle value-based payment structures like CMS’ joint replacement program (a game-changer, in my opinion). This is clearly the first example of what will become a flood of capitated payment strategies coming out of CMS. When other procedures start to get bundled, it’s a big risk to the financial viability of health systems if their clinical and supply chain data is not properly linked and available for analysis. 


    There are two places of value that your healthcare suppliers can bring to this equation:


    1. Creating products that demonstrate the ability to lower the clinical cost of care, ideally by providing better outcomes at lower costs. Those products must be wrapped in clinical data showing superiority to previous products, and a healthcare economics story justifying its payment.

    2. Sharing registries of data with providers. Registries allow the sharing of data across the country to show the nuances of care and how individual products can affect an outcome—and this is a role that a supplier is well positioned to do. By providing that data and potentially creating an ecosystem where providers can interact on the data, a supplier can empower a productive debate on proper clinical care and elevate itself from a vendor to a peer in the discussion on how to best care for a set patient population.

      Team-based decision-making is what drives this strategy. Our approach at Mercy has always been a very integrated approach where we have clinicians, administration, and supply chain all come together to make unified decisions on product categories. “What are we going to do?” “How are we going to do it?” “Which manufacturer do we want to do business with and which do we exclude from the system?” And so forth. 


      The supply chain will be a gold mine for success in value-based payments for those who can align it with their system’s clinical strategies and invest in the analytics to understand the opportunities underfoot.

      Scott Alexander is Vice President of Sourcing, Innovation & Marketing for ROi. Scott’s team works on identifying, developing, and commercializing innovative solutions to supply chain-related issues that reduce the total cost of care for ROi customers. 




    How One Facility’s Ventilator Wean Rate Went From 45% to 70%

    May 20, 2016 8:19 AM

    Several years ago our team was asked to establish a protocol for prolonged mechanical ventilation. Our unit at DeKalb Medical in Georgia specializes in mechanical ventilation. Patients receive physical, occupational, speech and nutritional therapies as well as pain management and help with anxiety. A weaning protocol was developed and approved by our medical staff.


    The goal was to wean appropriate patients from the ventilator in 15 days.  When we started the protocol, we had a wean rate of 45% — 5% below the national average. Today, after more than a decade with the protocol in place, our wean rate is about 70%. How did we do this? 


    First, we educated ourselves on how best to work with these patients. We learned about the important components that need to come together — both from a clinical standpoint and a human caring view — to best wean these patients. We also applied for a disease-specific Respiratory Failure On a Ventilator for Weaning certification. We have held this certification since 2006.


    We work with patients who have undergone a severe trauma, so patients come to our unit sedated, malnourished, and unconscious. Long Term Acute Care (LTAC) units need to meet certain criteria, but our protocol sought to address issues beyond that like feeding and progressive mobility —  things to make the patient’s success most likely.


    Key to our success was determining when patients reach their highest level of function. We give them a couple days to rest after reaching our unit. But we make it a point to help patients wean from the ventilator every day. Treating their pain and anxiety is also crucial, but we want patients alert and able to participate in their own care as best as they can. Involving family in care has improved success, too. It really takes a village to wean patients from prolonged mechanical ventilation.


    Under our protocol, we carefully track patient success. We meet daily on the status of the patients in our 44-bed unit, and physicians join us weekly for multidisciplinary case reviews. The doctors often tell us they are amazed by patients’ progress in the unit, and that they never expected some of them to wean — especially in just 15 days.


    Our team of 24 employees is passionate and dedicated. The respiratory therapists in the unit are happy with their jobs — and they stay with us for a long time. High employee satisfaction helps us maintain high standards of quality and clinical efficiency. 


    DiAnn Larson, RRT, is the Respiratory Manager in the Respiratory Care Services group of DeKalb Medical, Long Term Acute Care at Downtown Decatur, Georgia.

    Fighting to Mandate Smoke Evacuation

    May 4, 2016 10:06 AM

    Ulmer has been fighting to regulate electrosurgical smoke since 1996. She and others who shared her concerns formed a coalition. They contacted smoke evacuation manufacturers, the National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety & Health Administration (OSHA). Ulmer also contacted AORN and the AORN Foundation to host round table discussions on surgical smoke. The meeting brought together representatives from the American Society of Anesthesiologists, American College of Surgeons, American Nurses Association, and the Joint Commission.


    Ulmer and others worked introduce a bill into Congress. The bill was assigned a number and attached to the omnibus reconciliation bill. The bill made it all the way to budget reconciliation, and then it was eliminated before the bill passed.

    Other efforts
    In the early 2000s, a relationship developed between AORN, OSHA, and the Joint Commission, and the Joint Commission included smoke evacuation in its accreditation surveys. Also in the early 2000s, Ulmer served on an AORN smoke task force that put together the AORN Position Statement on Surgical Smoke and Bio-Aerosols.

    Hope for the future
    What the International Council on Surgical Plume is trying to do now is what needs to be done, says Ulmer. The Council is working together to look at new evidence and develop a plan on how to get smoke evacuation uniformly implemented.

    One option would be to lobby the Joint Commission to implement stricter standards for smoke evacuation, like they do for fire safety, says Ulmer. “If we could get that focus from them on smoke, that would change the landscape,” she says.

    Another option would be to go to Washington, DC, again after the 2016 election because that would allow 4 years to work a bill through the legislative process.

    “It‘s a very complex issue and very involved, and I think that is why more hasn’t been done,” says Ulmer. “The number of people it affects is small compared to cigarette smokers; there is still no direct proof that illness is caused by the smoke; and smoke evacuation is going to cost hospitals money,” she says.

    Ulmer is on the board of directors of the International Council on Surgical Plume and a member of the Society of American Gastrointestinal and Endoscopic Surgeons Fundamental Use of Surgical Energy (FUSE) committee that developed the FUSE educational program study materials to certify an individual has the fundamental knowledge for the safe use of surgical energy-based devices.

    Ulmer says she volunteers to work with these groups because she would like to see regulations in her lifetime mandating surgical smoke evacuation so that the young people who are in the OR now don’t have to worry about the health effects of breathing surgical smoke.

    Tips for ensuring mandatory smoke evacuation
    “The accomplishments to date are an excellent example of what diverse groups working together can do, says Ulmer, but we must keep fighting.”

    She gave the following tips for moving mandatory smoke evacuation forward:

    • Make the decision to evacuate smoke
    • Identify champions
    • Use a team approach: Surgeons, perioperative staff, anesthesia personnel, risk managers, occupational health, infection control, and administration
    • Investigate smoke systems
    • Develop smoke policies
    • Educate to evacuate
    • Evaluate compliance

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