This presentation shows how to remove unnecessary Healthcare Costs using Quality, Safety, and High Reliability Tools.

1. Strategies for …
Removing Millions in
Unnecessary Costs
John Byrnes, MD!
!
Clinical Associate Professor
MSU, College of Human Medicine !
!
Founder & Sr. Partner!
Byrnes Healthcare Group

2. What’s Going On?

3. Many Errors Go Unrecognized
❖ Preventative Care!
❖ 26 of 29 nodes positive!
❖ 2 lesions in the liver!
❖ Illeus diagnosed by nursing ☺!
❖ TPN recommended by nursing ☺!
❖ Couldn’t read doc writing!
❖ Couldn’t read nursing notes!
❖ Couldn’t read signatures!
❖ White boards inconsistent!
❖ Fuzz balls and ventilation screens!
❖ No standard orders!
❖ No care pathways!
❖ Communication btwn caregivers poor!
❖ Who’s the doc?!
❖ Who’s the nurse today?
❖ Fractionated doc coverage!
❖ 3 different nephrologists in 3 days!
❖ Fractionated nursing coverage!
❖ Multiple reassignments during shift!
❖ 3 RN + 1 LPN !
❖ 30 bed oncology unit on weekend!
❖ JB helped put in NG, moving help!
❖ Calls for pain meds!
❖ Often not answered for 30-45 min.!
❖ Restarted PCA pump!
❖ Lasix drip – 7 hours later!
❖ TPN – 24 hours later!
❖ Pressure ulcers/skin breakdown!
❖ Day #4!
❖ SCDs off for unknown period!
❖ Day #3 in ICU, assignment changed at
11 am!
❖ Two patient ID’s - infrequent

4. My Mother
My Grandfather
My Father

5. “Our obligation, to our patients, is one of the
most sacred trusts given to us….”
By our community, our friends, our families, and our patients

6. Findings supported by Classen and Leape. PAE: Preventable Adverse Events
440,000 Deaths per Year “PAEs account for “roughly
one-sixth of all deaths that
occur in the U.S. each year.”
Sources:))James,)J,)“New,)Evidence6Based)Estimate)
of)Patient)Harms)Associated)with)Hospital)Care,”)
Journal(of(Patient(Safety,)September)2013.H
H

7. “Medical Errors May Be the Country’s Third
Leading Cause of Death”
–The Advisory Board Company, Sept. 24, 2013

8. Answer:
High Reliability Organizations
A Culture of SAFETY

9. C-Suite Leaders:
You Hold the
Key
“The culture of a company, is the
behavior of its leaders … You change the
culture of a company by changing the
behavior of its leaders.”!
!
Dick Brown

10. Safety Culture
Ignites Hospital
Turnaround
No harm events in over 835 days!
!
Top 100 Hospital last three years in a row!
!
Before – mired in controversy and almost
closed by the community

11. ELIMINATE DEADLY MEDICAL ERRORS
Using 10 High Reliability Tools

12. PROCESS IMPROVEMENT
Lean, Toyota, Six Sigma

13. Lean QI Initiative - CV Service Line
Cardiac Cath Lab
Savings = $6.7 million!
!
! On time starts!
! Throughput & room turnover!
! Open and unused supplies ($3M)!
! Preference card variation!
! Non indicated add-on procedures!
! Number of stents!
! Appropriateness

14. Medication Administration Process
125 Process Steps Before < 25 Steps After

15. Disclaimer, AKA The Fine Print
All calculations performed by the Director of Decision Support, assorted financial analysts, and
verified by a Chief Financial Officer.!
!
No calculations performed by this doctor person.

16. $68,000,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs

17. IMPACT at One Hospital
Revenue!
$32 Million
Savings!
$36 Million
Total = $68 Million
Hospital Margin
$74 Million
Study on select conditions through November, 2008; Pediatrics, ICUs, Trauma not included.

18. $32 Million Revenue Impact
❖ ABC Health P4P Plan $ 4,274,211!
❖ XYZ P4P Plan 19,663,131!
❖ CMS Market Basket Update* 8,107,477!
❖ TOTAL $ 32,044,819
*Now VBP + >50% upside

19. Eliminating
Complications
Saved $36 M
Study on select conditions through November, 2008; Pediatrics, ICUs, Trauma not included.

20. Average Costs of Common Complications
❖ Decubitus Ulcer! ! ! ! $28,272!
❖ Post-op Deep Wound Infection! $27,814!
❖ Clostridium Difficile Colitis!! $25,401!
❖ Sepsis! ! ! ! ! $23,451!
❖ Reopen Surgical Site! ! ! $19,442!
❖ Venous Thrombosis! ! ! $15,976!
❖ Pulmonary Embolism! ! ! $16,331!
❖ UTI!! ! ! ! ! $ 9,637
Richard Fuller, Elizabeth McCullough, Mona Bao, Richard Averill, Estimating the Costs of
Potentially Preventable Hospital Acquired Complications, Health Care Finance Review,
Summer, 2009, 30:17-­‐‑32

21. DVT $180,000
ARF $820,000
Abcess $75,000
Int. Obstruction $545,000
Acc. Op. Laceration $203,000
Resp. Failure $971,000
Wound Infection $260,000
TOTAL $3,054,000
Physician Leaders Save Money
A Quarter Time
Physician Leader
!
• Episode of Care: Colon Surgery!
!
• 7 Preventable Complications
A small group of physician leaders can remove $ Millions in unnecessary costs

22. Hospital Acquired Infection Rates
Adult Critical Care - 2008 to 2009
MRSA, Acinetobacter, Pseud/Sten/
Serratia, and C. diff Infections
20
15
10
5
0
Jan 08 - Dec 08 Jan 09 - Dec 09
Infection Rate per 1000 Pt. Days
42% Decrease
126 Fewer Patients
126 x $14,000 = $1.8 M

23. Hospital Acquired Infection Rates - 2008 to 2009
A Children’s Hospital
HDVCH HA MRSA, VRE, ESBL/
Amp C, C. diff, and RSV
2
1.5
1
0.5
0
Jan 08 - Dec 08 Jan 09 - Dec 09
Infection Rate per 1000 Pt. Days
46% Decrease
40 Fewer Patients
Combined Results!
166 x $14,000 = $2.3 M

24. Preventing Readmissions - Total Cost of Care
Hysterectomy! ! ! ! 6.7% to 3.8%! ! ! ! $ 42,000!
Hysterectomy CA! ! ! 4.5% to 10.6%! ! ! ! $ 153,000!
Lumbar fusion ! ! 5.4% to 4.2%! ! ! ! $ 830,000!
Peds Chemo ! ! ! 9.9% to 8.3%! ! ! ! $ 685,000!
AMI ! ! ! 12.7% to 8.3%! ! ! ! $2,085,000!
PCI ! ! ! 8.2% to 5.3%! ! ! ! $ 618,000!
EP Ablation !! ! 4.1% to 3.3%! ! ! ! $ 56,000! !
Cholecystectomy ! ! 6.9% to 3.9%! ! ! ! $ 50,000!
TOTAL!! ! ! ! ! ! ! ! ! ! ! ! $4,519,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs

25. Prevent
Readmissions
Majority of Readmissions:!
1. Didn’t fill prescriptions!
2. Didn’t get timely follow-up!
3. Care coordination

26. Opportunity Analysis - 10 Years Later
Clinical QI Can Remove $MILLIONS in Unnecessary Costs
$45,000,000 Remaining Opportunity

27. “Quality and Safety (and their related process
improvements) is the next frontier of cost
management.”
–Joseph J. Fifer, FHFMA, CPA
President & CEO, HFMA

28. Opportunity Analysis
How Much Potential
Savings (Waste)?
❖ Small Multi-Hospital System!
❖ Observed to Expected Complication Rate!
❖ >2,000 Complications!
❖ >$60,000,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs

29. 3 High-Impact Tools
SAFETY - High-Reliability
Save Lives
Save $!
Make $
Clinical QI
Performance
Improvement

30. $68,000,000
$60,000,000
$45,000,000
$4,500,000
$66,800,000
$3,054,000
$2,300,000
$6,700,000
Summary of Savings:
$ Millions
One hospital: cost + additional revenue!
Small hospital system - complications!
Opportunity after 10 years - one hospital!
Readmissions prevented!
Malpractice claim impact of HRO program!
Colon Surgery - 7 Complications!
Hospital Acquired Infections - one hospital!
Cath Lab!
TOTAL $256,354,000

31. Everyday, Remember Why You’re There …
They Entrust Us With Their Lives, Let’s Not Let Them Down !

32. Improving Quality & Safety Together
Resource Page:
John Byrnes MD!
Trainer, Consultant & Keynote Speaker!
!
Founder, Sr. Partner!
Byrnes Healthcare Group!
!
Phone 616-240-9686!
john@johnbyrnesmd.org!
www.johnbyrnesmd.org