Maximizing Post-Acute Value by Leveraging the Physician's Role Susan Quirk, MBA, president, Susan Douglass and Associates, Colorado Springs, Colo.

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1 Maximizing Post-Acute Value by Leveraging the Physician's Role Susan Quirk, MBA, president, Susan Douglass and Associates, Colorado Springs, Colo.; and Mike Soisson, senior vice president, Vibra Healthcare, Mechanicsburg, Pa.

2 Maximizing Post Acute Value By Leveraging the Physician s Role Pre Session Tool Susan D. Douglass President Susan Douglass and Associates LLC Mike Soisson Senior Vice President, Development Vibra Healthcare

3 Tool Overview What It Takes A collective, intentional effort A refocused mindset (for most) What We Know Post acute levels Scorecard metrics What We Have Learned The key challenge 2

4 What It Takes

5 Maximizing Value Requires A Focused Effort Reinforce the success by celebrating successes, reward as defined and look for next opportunities Deliver on agreed to expectations in all communications and interactions; measure progress monthly and reward annually. REINFORCE DELIVER Executives, Employed, Affiliated, Contract Physicians ALIGN Select 2-3 manageable goals; develop a shared savings plan as appropriate. LISTEN DEFINE What does post acute care mean to each of us and our patients; what works well, what are our challenges, what are our opportunities? Understand our marketplace and the various post acute options; work together to develop a mutually beneficial plan for successfully working across this extended continuum of care.

6 With A Reoriented Mindset (for most)

7 What We Know

8 Metrics of Most Prevalent Post Acute Care Settings Long Term Acute Care Hospital (LTACH) Inpatient Rehab Facility (IRF) Skilled Nursing Facility (SNF) Clinical Acute care & generally stable Medically stable; showing functional Medically stable; sub-acute. with ongoing medical complications. improvement. Not ready for home but probable. Need daily physician coverage (often Will be able to tolerate 3 hours of Transition to home or LTC. 2 or more specialists) therapy/day soon. Less intense rehab Post Surgical complications Neuro; ortho; debility Completion of pharmacy program Vent pts w potential to wean Wounds/infections Requires 3 day acute care hospital Too debilitated for rehab but w potential qualifying stay prior to admission Dialysis High Pharmacy Discharge Expected LOS 20+ days Expected LOS days Expected LOS days Expected Discharge to Home (50-60%); Expected Discharge to Home (75%); Expected Discharge to home (50-60%); Rehab (10%); SNF (10%); LTC (10-20%); SNF (10%); LTC (15%) LTC (30-40%) death (10-20%) Costs SW&B $450 - $500 PPD $400 - $450 PPD $250 PPD Pharmacy $80 - $100 PPD $50 - $60 PPD < $40 PPD Other Ancillary $80 - $100 PPD $40 - $50 PPD $50 PPD Total DIRECT $800 - $1000 PPD $650 - $750 PPD $300 - $400 PPD Reimbursement Per discharge $40,000 $17,000 Per Day $1,600 $1,300 $150 - $450 Medical Staff Multiple physicians attending + Consults Physical Med & Rehab (PM&R) Internal Medicine and rare consult - Medicine; Pulmonary; Infectious Disease; - Medicine; neurology; Pulmonary - podiatry; cardiology; etc. GI; Nephrology; etc. Attending and consults daily Attending daily; consults as needed Attended as needed with recertification visit once every 30 days

9 What We Know We must identify the facilities in our market which meet our collective success scenarios ( i.e. patient, hospital and physician) These may or may not be owned by our healthcare system. We must understand the quality of care delivered. Monthly scorecards are an excellent tool. We must learn the key scorecard measures to focus on. For most it is: Thirty day readmission rate. Percent discharged to home/previous setting. Illustrative examples of best practice scorecards will be part of our presentation at the conference. Core measures. Risk/safety. Financial. 8

10 What We Have Learned

11 The Key Challenge Fragmentation of care is one of the most critical flaws in today s healthcare delivery system today. Timely communication can improve patient outcomes, quality, timeliness of care, reduce cost of care, and reduce length of stay. Effective communication will be even more important in the future as metrics ( quality of care, HCAHPS, cost of care, readmissions) become more transparent and bundled payments a reality among: Referring physicians and consultants. ER physicians and hospitalists. Hospitalists at the end of shift. All physicians who discharge to another facility.

12 What We Have Learned Performing our best against metrics requires collaboration and alignment in two ways plus consistent communication. First, physician to physician. Regardless of affiliation ( i.e. contract, academic, employed or independent) Second, among administration, physician, nurses, case manager, pharmacy, patient and family. Communication must be consistent to effect quality of care and outcomes. Meetings, phone, verbal, written, electronic. Improving in key areas is essential. We have no time for unproductive activities. We need to set priorities and establish accountabilities. This includes formalizing some effective informal processes. 11

13 What We Have Learned Maximizing value in the post acute arena requires: Setting clear intertwined, manageable goals, having necessary resources, discussing challenges openly and measuring progress regularly towards goals is key. Recognizing the need to help stay focused and on track. Understanding the skills required to enhance our abilities to influence and work through others (perhaps not taught in medical school). Supporting each other is key. We cannot do this alone. We can mutually be successful if we work together to meet mutual goals. Fellow physicians, hospital. A rewards focused compensation program often aids to focus and motivate behaviors. 12

14 Questions? See You at the Conference!