4. Clinically Integrated Network
Einstein Medical
Center Philadelphia
(533 acute beds)
Einstein Medical
Center
Montgomery
(171 acute beds)
Einstein Medical
Center Elkins Park
(66 acute beds)
Moss Rehab
Integrated in
inpatient facilities
13 ambulatory
centers
Four hospital
partnership
programs
10 ambulatory
sites across
region,
with more sites
planned;
31 primary care
sites
5. Health Network Statistics
Total Revenue $1.1B
Licensed Beds 995
Employees 8,500
Fellows and Residents 410
Employed Physicians 535
Independent Physicians 668
Admissions 43,000
Outpatient/MD Practice Visits 1.4M
Emergency Department Visits 158,000
Academic Components
ACGME Programs 23
Fellows and Residents 410
Tertiary and Quaternary Clinical Capabilities
Trauma Level Level I
NICU Level Level III
7. Einstein Healthcare Network
Department of Orthopedics
• 13 Employed Orthopedic Surgeons
• Orthopedic Offices located at all 3 Hospitals as well as several outpatient sites
• Blue Distinction Center for both Hip & Knee Replacement as well as Spine Surgery
• Procedures are done across all 3 Acute Care Hospitals
• Majority of Total Hip & Knee Replacement Volume is done by 5 Surgeons
• Majority of Spine Surgery is done by 3 Surgeons
8. Einstein Healthcare Network
2015 Procedural Volumes
• Primary Knees: 440
• Revision Knees: 75
• Primary Hips: 276
• Revision Hips: 61
• Shoulders & Elbows: 20
• Joint Replacement Procedures Total: 872
• Single Manufacturer for Total Joints
• Single Manufacturer for Spinal Fusion
9. Single Manufacturer Model
How we got there, and Held the Gains
• Formal Request for Proposal (RFP) Process
• Financial Proposals
• Oral Presentations
• Detailed Review of each Manufacturers Clinical Technology and Philosophy
• Review of each Manufacturers Future Product Pipelines
• Process took approximately a full year
• All surgeons fully participated and then voted
• Dynamic Leadership by Hospital Administration to engage the Department to Initiate Change
• Strong Leadership by Chairman of Orthopedics in support of the change to one vendor
• Ongoing Support by Chairman of Orthopedics to continue Single Manufacturer for 8+ years
• Established Process for New Product Requests to run through Surgical Value Analysis Committee
10. Single Manufacturer Model
Operational Advantages
• Economics:
• Due to 100% Market-share commitment we have very aggressive invoice pricing
• Also have manufacturer rebate program for maintenance as well as growth
• Pricing regularly benchmarked by ECRI and IMS as well as GPO confirms best in class
• Purchasing/Supply Chain Operational Efficiencies
• Line Item Component Pricing
• Revision Procedures Pricing Advantage
• 5600 Total Joint Implant SKU’s in Lawson (Recently Added 5000 SKU due to Vendor Merger)
• 1730 Spine Implant SKU’s in Lawson
• Less Items to Update when price changes are negotiated (Lawson, Cerner, Siemens)
• Less Manufacturer Sales Reps proposing New Technology
11. Single Manufacturer Model
Operational Advantages
• Operating Room Efficiencies
• Training: OR Nurses know the trays and instruments and can immediately tell if
anything is missing
• Procedural Interoperative flow: Due to standardization cases run more smoothly
• Interoperative EMR Documentation & Patient Charges: More streamlined and
less choices in Cerner
• Less “Bill Only” to Manage
• Manufacturer Rep Labor: 1-2 reps on-site every day assisting
• Procedure Planning: One rep to call for questions
• Relationships: Stronger relationships built with manufacturer catch Add-On
cases more quickly
12. Single Manufacturer Model
Operational Advantages
• Sterile Processing Department Efficiencies
• Instrument Tray Usage is More Predictable
• Standardized Tray Issue Process
(Typically 6-7 Trays for a Total Knee/Hip Procedure)
• Missing Instruments are Diminished
• Fewer Loaner Trays are Delivered; Back-up Trays are
on-site
• Less Trays are Wrapped, Not Used, Unwrapped,
Picked Up, Returned following week
• Less Storage Space Required for Trays
13. Single Manufacturer Model
Inventory/Storage Advantages
• Less Implant Inventory to Keep On Hand (Consignment)
• Only One Manufacturer vs Many
• Less Consignment Inventory Agreements to Manage
• PAR Levels
• Cycle Counts with Reps (Semi-Annual Physical Inventory)
• Expiration Dating Checks
14. Information Systems
Structure and Interoperability/Interfaces
• Lawson Purchasing/Contracts System – Cerner Millenium ORIS – Siemens Patient Billing System
• Bi-directional Interface Between Lawson & Cerner
• Lawson sends all new item master additions
• Lawson sends all existing item changes
• (Lawson Item #, mfg name, mfg cat #, vendor cat #, Description, UOM, price)
• Cerner sends supply usage (Currently not using this data)
• Cerner uses Lawson Item # on Preference Cards and Pick Lists
• Cerner Interface with Siemens Patient Billing System
• Cerner sends Supply Usage by Patient by Procedure using CDM # to Siemens
• Accurate Cost Per Procedure Reporting by Physician
• Minimize “Free Text” Charges
• Current OR Lawson Item Master Percentage > 95%
15. Systems Integration
Interface Diagram
Cerner Millenium
OR Information
System
OR Room 1
OR Room 1
OR Room 1
Documented Supplies
and Implants Used
Lawson Perpetual
Inventory Location
(IC12)
Usage Transactions
Lawson Perpetual
Inventory Location
(IC12)
Reduce Stock on Hand
Stock below
Reorder Point?
Lawson reorders
more inventory up
to stock level (MAX)
Yes
Wait for additional
Usage transactions
No
Goods Received
Increase Stock On Hand
Lawson PAR
Location (IC81)
Non-Documented
(Non-Billable)
Supplies Used
Cerner-Lawson Inventory Model
Inventory
Manager uses
Handheld
scanner to
count stock
Stock on hand
below PAR
Lawson creates
Requisition
Yes
WaitNo
Goods received
No
Transactions
pass from
Cerner to
Lawson
