Presentation by Xavier Vinolas, Cardiologist: Implantable defibrillators and pacemakers at the International Business Festival 2018, 26 June, Exhibition Centre Liverpool

1. STOPandGO
Sustainable Technology for Older People – Get Organised
PPI Pilot project funded by the European Commission
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Sant Pau ICD tender - From devices to Services
Hospital Sant Pau - Spain

2. Who are we?
Hospital Sant Pau
•University Hospital - XX beds — XX physicians
•Budget:
•Population coverage: Sant Pau provides public healthcare services
to the 25% of Barcelona’s Population (400.000)
•Reference hospital in cardiology-arrhythmias for 6 community
hospitals in Catalonia.
•300 catheter ablations/year
•150-170 defibrillators or CRT pacemakers implanted/year
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H S Joan de Reus
H Blanes / Calella
H Igualada
H Mutua Terrassa
H Figueres
H. Manresa

3. • ICD is the treatment for patients at risk of
sudden cardiac death
• High cost devices (10.000 €)
• High technology, and requires control and
reprograming

4. ICD implants Spain- Europe
Sant Pau
Aprox 150 ICDs / year
Budget was 3 milions € / year
Crises
•Spain has ↓50% implant rate than Europe
•Catalunya is below the Spanish Implant rate…. Thus it is
expected an increase!!
During several years of crises the implant rate
was “stable”….
but it is raising afterwards
ICD Spanish
registry 2016

5. Stable budget
BUT
increase in demand

6. ¿What was the Problems we faced and how to solve?
• Increasing & Fluctuation of implants per year.
• Reduction of technical support from industry when prices decreased.
• Limitation of available portfolio of Devices & Brands in a classical Tender with
reduction of prices.
• Make sustainable the increase number of hospitals visits and remote care
controls.
• Need for an IT system integration of all remote care different websites.
….In a scenario of economical crises and reduction of Hospital budget….

7. Mis-alignment of the different actors in “classical” tenders
Industry-Provider
• “Pressure” to implant more.
• No incentivation to offer long duration ICDs.
• No incentivation to take care of complicactions (“recall”).
• Decrease services o “quality” due to price reduction.
• “Closed” IT systems in remote care.
Board of Directors - Administration
• Tenders with price reduction
• Transfer medical decisions to administration
(centralized tenders)
• “Try to limit” implant rate
• Limited interest in the “quality” of devices
• Limit the new and more expensive new tecniques
Physicians
• “Pressure” from patients / referal hospitals.
• Press the hospital directors to increase budget.
• Press the providers to mantain the services.
• His “power” increases if the number of implants
increase
Patient has no
voice!

8. Our procurement at a glance
Value-based procurement:
1.Shifting from device-based to service-based procurement.
2.Risk-sharing
3.Initiate some Payment for outcomes
12.577.460 € of total purchase value (4 years)

9. Our Procurement at a Glance
• Global activity and Activity Fluctuation.
• Stock management.
• Technical Support.
• Remote Care and remote support Center
• IT Systems
• Integration of 2 care levels (University&Comunity hospital)
• Training nurses and Physicians
• Complications Management (extractions)

10. Our procurement at a glance
Patient selection ICD implantation
Device follow up
In-hospital
remote care
ICD replacement
when battery
depletion
complications related to patient disease
(Arrhythmias, infarction, etc..) Treatment
DEVICE MALFUNCTION
Early battery depletion
lead failure
INFECTION
EXTRACTION
Care Pathway

11. Tender
• Global activity and Activity Fluctuation.
• Stock management.
• Technical Support.
• Remote Care and remote support Center
• IT Systems
• Training nurses and Physicians
• Complications Management (extractions)

12. 21
Innovative procurement methods
in our procurement process
H S Joan de Reus
H Blanes / Calella
H Igualada
H Mutua Terrassa
H Figueres
• ICD & CRT implants
• ICD exchange
• Extraction
• Remote follow up
• In hospital follow up
Population based payment for all the interventions
in the care pathway of ICD patients (related to the
ICD implant and follow up)

13. 22
Innovative procurement methods
in our procurement process
Outcome based payments - (3% of total amount)
1.Related to Outcomes in the implantation
2.Related to Remote Control and Support Center
3.Related to reduction in-hospital visits
4.Related Quality of Life patients

14. Hospital Sant Pau
•Tender was adjudicated to a Consortium between Medtronic
& S Jude Medical
•Adjudication —> July 2016
•Contract signature —> 15 september 2016

15. “Technical Table” as the core of the project
Dr Staff 1
Dr Staff 2
Industry 1
Industry 2
Functions
• Devices accepted for implant
• Devices from other companies
• Reviewing and accepting clinical protocols
• Controlling activity
• Defining Quality indicators for outcomes
• Reviewing implementation of IT system
• …
Weekly meetings at the beginning
Monthly meeting at present + extra meetings if needed

16. 1297 Seguimientos presenciales
2687 Transmisiones Remotas. Cada transmisión
remota vale 0,5 puntos
RESULTADOS DEFINITIVOS SANT PAU - PRIMER AÑO - PANEL DEL CONTROL

17. Integración con Mediconnect

18. Current status - Outcome Based Payment
3% of Total Budget With Indicators related to
Remote Care Support Center
Reduction of in Hospitals visits
Patient Satisfaction
Quality of implants and low complication rate

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Impact
#SilverCeremony2018
Some outcomes:
- We are implanting all manufacturers and all
devices
- 95% patients in remote care
- App for empowerment & communication with
Hospital
- 18% Reduction of in Hospital visits
- 30% Reduction of inappropriate shocks

20. OBJETIVOS DE CALIDAD OBJETIVO RESULTADO
A. Indicators related to remote care center
% patients not accepting remote care 5 % 3,33 %
% red Alerts <5% 4.76%
Non programned transmisions <10% 9,20 %
Transmisions generating in hospital visits <20% 4.94%
Reduction of in hospital visits 5 % 9,80 %
E. Reduction of innapropiate shocks
Reducción de las descargas inapropiadas paciente/año
durante la ejecución del contrato.
10 % 29,00 %

21. B. Agreement between transmisionm classification
between remote care support centre & hospital
clasification
Discrepancies in RED or Orange alerts <10% 0.40%
Discrepancy between green alerts <10% 0,00 %
G. Qulity of implants criteria
LV implant success >90% 98,12 %
Infections <3% 0,00 %

22. We have begin with Ritmocore!!!!!
Very ambitious
http://www.ritmocore-ppi.eu

25. Final thoughts
¿Is the Sant Pau Tender perfect?
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