Post on 06-Mar-2020
OR Optimization:Right-Sizing to the Future
BETTY JO ROCCHIO, RN, BSN,
CRNA, MS
VICE PRESIDENT
PERIOPERATIVE PERFORMANCE
ACCELERATION
MATTHEW MENTEL,
CMRP,MHA, MBA
EXECUTIVE DIRECTOR
INTEGRATED PERFORMANCE
SOLUTIONS
Mercy Demographics
$2,093,276,868Perioperative Revenue
$351,487,571Perioperative Spend
$1,741,789,297Periop Contributing Margin
35Facilities
259OR Rooms
210,000Periop Procedures
FYJuly - June
Five Dimensions
of Excellence
Financial
•Retained Surgical items
•Wrong Site Surgery
•Surgical Site Infections
•Minimize distractions
•Satisfaction with waiting times
•Raising OP Surgery Satisfaction
Scores
•Supplies
•Labor
•Overhead/Resources
Triple Aim for Perioperative
Fiscal Year Comparison Perioperative
OperationsFY15 FY14
Periop Locations 35 33
OR Suites 259 232
OR Cases 135,833 125,474
• Inpatient 36,822 35,935
• Outpatient 99,011 89,539
Surgeons 2,602 2,580
• Integrated 1,705 1,650
• Non-Integrated 897 930
Co-Workers 1,768 1,769
• RN 1,033 1,030
• Technical 468 465
• Ancillary Clinical 99 101
• Clerical Support 168 173
Revenue $2,093,276,868 $2,207,931,239
Supplies $253,724,844 $257,820,021
Labor $97,762,727 $100,303,743
Supply Chain Challenges
FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20
FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20
Rev/Case Supply/Case Labor/Case
Impact to
Supply/Case and
Labor/Case
Why is this so important right now?
Perioperative
Services
Reimbursement
shifts
Long-term
viability
High revenue
but also high cost
to deliver care
Impact on margin
contribution are
significant
“What got us here will
not get us to the
Triple Aim!”
Value For Surgery
Appropriate surgical solutions:
▫ Matching clinical need, which includes costs and efficiencies
New world:
▫ Penalties based on Medicare spending and Value Based Purchasing
Business bottom line:
▫ Managing cost of supplies, labor, and overhead
Revenue
Center
Cost
Center
TODAY TOMORROW
Mercy Expense Breakout (Top 14)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
9.8%
3.9%
1.8%
$1.2 BILLION
spend in top 5 categories
Representing
34.6% of Expense
Steps to Success
Assess Current State: Business & clinical environment
Identify Challenges/Barriers: Financial & operational
Clearly Outline Opportunity: Identify & quantify projected benefits
Establish Future State: Standardization & Lean Processing
Alignment: Organizational mission and culture
Communicate & Engage: People – Process – Technology
Define Success: Performance metrics
OR Optimization Goals
Improve OR inventory management
Eliminate patient safety risk surrounding product expiration
Improve execution on product recalls & expiry
Improve workflow in the OR
Leverage the benefits of Unique Device Identifier (UDI)
Appropriately document product information
Improve cost per case accuracy
Supply Chain Challenges
Reimbursement
Inventory
Management
Process and
Workflow
• Healthcare cost
• Patient safety
• Patient satisfaction
• Charge Capture
• Inventory availability
• Multiple product locations
• Inventory value & valuation
• Preference card accuracy
• Recognizing consumption on demand
• Management of expired product
• Management of product recalls
• Product Documentation
• Product tied to Patient tied to Outcome
Supply Chain Opportunities
Reimbursement
Inventory Management
Process and Workflow
• Improved charge capture
• Improved patient outcomes
• Comparative effectiveness/outcome based
analytics
• Inventory as an asset-valuation
• Inventory expense reduction
• Preference cards accuracy/
maintenance/optimization
• Inventory visibility and standardization
• Redesigned, clinically-driven workflows
• UDI and risk visibility
• Instrument and equipment tracking
• Tissue tracking and regulatory compliance
Five Dimensions of Excellence
Clinical Excellence
▫ Inventory Visibility
▫ Preference Card Management
▫ Workflow
▫ Regulatory/Risk Management
Cultural Excellence
▫ Transformative to our OR and Materials
Cultures
Community Excellence
▫ More accurate EMR information
▫ More Accurate Patient Billing Data and Cost
Stewardship Excellence
▫ Improved Visibility to Expenses
▫ Efficiency in Labor Utilization and Productivity
Opportunities for Solutions▫ Metrics to drive results
defined/measured/tracked/reported
▫ Variation Reduction
▫ Automation of Process Work
▫ Optimization at local and system levels
▫ Organized clinical solutions for
procedural workflows (People Work)
Variation
Automation
Optimizatio
n
Clinical
Solution
Metrics
CLINICALLY LED OPERATIONALLY DRIVEN
People Process Technology
Process Redefinition
Right patient, right
procedure, right supplies,
right time….every time.
Patient-centered to improve
care and flow through the OR with awareness of financial impacts to
the delivery of consistent or improved
outcomes
CLINICALLY LED
People Process Technology
Automation
of replenishment
$4.8K
Reduction
in cycle counts
$167K
Improving
clinical user satisfaction
Survey
Ability to
optimally manage owned vs. consigned
inventory
Realizing unrecognized
inventory assets
$2.4M
Improving
inventory utilization
$4.7M
Optimizing
charge capture
$13M
Improving
Preference card accuracy
$459K
Defining Success Through Resource Management
CLINICALLY LED OPERATIONALLY DRIVEN
QUESTIONS? Thank you