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A journey toward the Rep-less OR
- 1. July 2, 2015 A Journey Towards the Rep-less OR © Intralign 2015
- 2. Bending the Cost Curve • Alignment of surgeons and hospitals; clinical and operational goals • Integration of tools and strategies in TJA to enhance transparency and accountability • Change management – Strength and capability to affect lasting, sustained change Intralign’s Innovative Vision © Intralign 2015
- 3. Aligning Clinical and Operational Goals Combining Clinical Staffing with Efficiency Enhancements Increase throughput and quality while reducing cost Address operational and clinical concerns simultaneously Enable substantial and sustained transformation © Intralign 2015
- 4. Addressing Drivers of OR Costs Rectifying Operational and Clinical Inefficiencies Hospital Cost Drivers • Implant Cost • Cutting Accessories • Cement Accessories • PAT and SPD • Environmental Protection • Patient-Specific Cutting Blocks • Navigation • Device Complexity Process transformation and supply chain solutions add efficiencies. Highly qualified clinical staff increases throughput, reduces costs and increases quality.
- 5. Focus on Orthopaedic Care • Implants contribute considerably to the cost of orthopaedic care delivery • SG&A costs of the major manufactures driver of higher implant costs Key Driver is Implant Cost R & D 6% Tax 4% Selling and admin 42%Cost of goods 29% Net income 10% Other 9% Orthopaedic Implant Cost Components According to a 2007 study by the American Academy of Orthopaedic Surgeons (AAOS), Total Hip Replacement and Total Knee Replacement procedures will grow 174% and 673% respectively over the next 20 years. © Intralign 2015
- 6. The Role of the Sales Rep • Lack of price transparency and rep presence leads to unnecessary up-sell • Rep or multiple reps in OR slows room turnover • Clinical support provided by the rep is not free – charged through hefty SG&A implant cost Influencing the Cost of Orthopaedic Implants The result: Loss of control, reduced efficiency and higher supply costs. © Intralign 2015
- 7. Barriers to Going Rep-less Intralign Addresses these Key Issues Device rep relationship with clinicians Intralign addresses these barriers and helps the hospital move toward a Rep-less solution. Sourcing specialized clinical support with device knowledge Managing inventory and implant complexity Interrupted back table and surgical episode processes Transitioning Physicians and staff to new model © Intralign 2015
- 8. Going Rep-less Intralign enables the hospital to journey towards a Rep-less solution Objective evaluation of technology opportunities Intralign’s Rep-less model addresses the elements needed to regain control. Empowered surgical team with device & clinical knowledge Improved process flow across the episode of care Cultural shift with alignment of clinical and operational stakeholders © Intralign 2015
- 9. Intralign’s Rep-less Journey Every hospital is unique. Intralign’s Rep-less model combines assessment with clinical and operational tools to get to an optimized surgical episode. Aligning Clinical and Operational Goals © Intralign 2015
- 10. Intralign’s Rep-less Assessment Intralign takes the hospital through a collaborative process of identifying opportunities for process improvement and prioritizing high impact process transformation initiatives Methodology Rep Value Mapping Rep-less Model Recommendations Gap Analysis Roadmap Initiatives © Intralign 2015
- 11. What does the rep do in our facility? Rep Value Mapping © Intralign 2015
- 12. Can our facility go rep-less? Gap Analysis Methodology © Intralign 2015
- 13. What initiatives do we need to take? Rep-less Recommendations All surgeons are not involved in the design of the program Purchasing and replenishment process is inefficient High implant costs threaten service line profitability Problem Specialized clinical support is lacking in OR Intralign Alignment & Commitment: Brings clinical and operational stakeholders together to identify mutually agreeable goals Intralign Process Transformation: Combines best practice research with human-centered design to transform inefficient processes Intralign Value-Based (Generic) Technology: Access to generic implants reduces costs and increases efficiency while maintaining clinical quality Intralign Solution Intralign Intra-Operative Support: Highly-trained surgeon extenders fill the “rep gap”, increasing efficiency and throughput © Intralign 2015
- 14. How do we get to rep-less? © Intralign 2015 Roadmap Initiatives Heavy dependence on device rep for inventory management and training of surgical team. Redesign inventory and set management process, and train personnel. Improve overall surgical team performance for efficiency, staffing consistency, reduced variation, and improved outcomes. Launch rep-less model and improve clinical outcomes while reducing costs. Achieve control of the surgical process without relying on the rep. Assess Current State Design Future State Achieve Future State
- 15. Thank You For more information about Intralign’s Rep-less model go to www.intralign.com
Editor's Notes
- From the beginning of our process when Intralign was founded, our critical mission has been to better align clinical and operational interests at the hospital (i.e., the surgeon vs. the administration, for example) by integrating clinical and process tools and present this within a framework of change management that works.
- This combination of clinical and operational initiatives have allowed us to help hospitals increase throughput while delivering the same or better quality care. It has also allowed our partner hospitals to significantly reduce costs and to sustain these improvements over time. While there are several staffing companies in the market that offer similar services as ours – and several consulting firms that offer very expensive advice, our focus has been on substantial and sustainable changes. Our initial focus has been the Orthopedic space, where many hospitals are struggling to remain profitable and efficient in the light of payment reform and increasing patient populations. However, our clinical staff as well as our operational staff are competent across service lines.
- Intralign Savings Clinical staff payroll Up to 40% increased throughput 20 to 30% procedure time reduction Infection rate reduction Value-based (Generic) technology up to half the cost Standardizing the instrument trays so there are less instruments – only those used 80-90% of the time and peel packs for other instruments- this saves nursing, central sterile processing time, reduction of tray weight/ reduction of injuries and overuse to move trays , wear and tear on instruments – fewer replacement costs – less time to open decontaminate and wash instruments….. Up to date preference lists or sets keeps waste down – example our SFAs know their surgeon uses a certain method to close the wound – so instead of the circulator putting every method for skin closure (sutures, staple gun, various dressings ) only the used items will be opened, Only using antibiotic cement when indicated Kan Ban system for supply replenishing Methods for capturing and educating staff about each materials costs
- Insert VA study
- Intralign’s Rep-less solution Readiness assessment shows the hospital’s roadmap to a Rep-less solution Intralign surgeon extenders reduce dependency of the Rep in the OR Process transformation optimizes the surgical episode Supply chain services introduce value-based (generic) technologies to reduce costs and complexity Every hospital is different. We begin with a pre-assessment that identifies the unique characteristics, challenges and opportunities at the individual hospital . We look at what it takes to get to a Rep-less model, determine the gaps and suggest change initiatives. However, before any such initiatives are launched, we work with the hospital to ensure alignment among key stakeholders – so that everybody gets to ‘own‘’ the project and buy into its conditions. Following this, our three programs are launched to create clinical and operational improvements. Some of these action-steps have immediate or very shot term effect. Utilizing our clinical resources can create massive savings month to month, and we have in the past identified very simple process improvement steps that create immediate savings or other efficiency results.
- Provide current rep value map to see what your rep is currently doing for you Gap analysis – using CTSIs Rep-less model recommendations Pathway of initiatives to reduce rep dependency
- [From Monmouth proposal] This spaghetti map demonstrates the movement of direct support and ancillary staff during the course of one total knee replacement procedure. In this case, the operatory door was opened 42 times for various reasons – missing equipment, supplies, phone calls…etc