OUTLINE
• Traditional scheduling and the advanced
access at a primary care clinic
• Uncertainties that should be considered when
patients are scheduled
• Decisions that need to be made for designing an
appointment system
• Practice on using the panel size calculator
•Emerging Trends in Primary Care:
ACS NSQIP Best Practices Case studies volume 2 July 2010mart1971
This case study describes how Advocate Good Samaritan Hospital in Downers Grove, Illinois used an interdisciplinary team and Failure Mode and Effects Analysis (FMEA) process to address high outlier results for postoperative renal failure outcomes identified through their participation in ACS NSQIP. The team identified five areas for improvement in preoperative testing, bowel preparation instructions, fluid management in surgical holding, documentation of fluid intake and output, and surgeon communication. Changes were implemented including improved bowel preparation and hydration education, preoperative renal testing and standardized fluid orders for colorectal patients, and communication enhancements. These efforts resulted in a reduction of their observed to expected ratio for renal failure from 2.89 initially to 0.85 in their
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
Advanced Process Simulation Methodology To Plan Facility RenovationAlexander Kolker
This document summarizes a case study on using simulation modeling to plan for a surgical suite renovation at Children's Hospital of Wisconsin. The hospital needed to increase surgical capacity to meet growing demand. A project team used simulation to evaluate options for allocating operating rooms and beds across services. Their model found that separating gastroenterology and pulmonary services into their own area with 2-3 procedure rooms and 8-11 beds would best meet goals of minimizing wait times while staying within budget. The renovation is projected to increase patient satisfaction and yield a positive return on investment within 15 years. Ongoing simulation will evaluate the new process over time.
In the United States, current best practices for potential victims of stroke focus on the goals of rapid EMS triage of, transport to and treatment at Primary Stroke Centers. This session will address the following questions:
-What is the best EMS Stroke Care Model to accomplish this?
-Is there only one “Best Model”?
-How do models compare with other systems in neighboring states and elsewhere in the U.S.?
-What aspects of these other models might be adapted by EMS care systems to improve stroke care?
An Innovative “Patient First” Vaccination Clinic DesignKaiNexus
Presented by Dr. Joy Dobson, Senior Physician Consultant at 3sHealth in Saskatchewan, Canada
Learning Objectives:
Become familiar with a “care comes to the client” concept as applied in Canadian vaccination clinics
Use lean concepts embedded in a “Patient First” model to improve value in clinics of any size
We know there will be many innovative practices shared that will have application possibilities across borders and outside of vaccination work and settings. We hope you can join us!
1. The memorandum summarizes a review of medical records for a client who suffered a closed head injury and vertebral fracture in a 2011 motor vehicle accident.
2. The client was admitted to WakeMed hospital and diagnosed with a closed head injury with severe concussive symptoms and a C6 spinous process fracture, which did not require surgery.
3. Neuropsychological testing a few months post-accident found no significant cognitive deficits, though the client reports ongoing difficulties with mathematical calculations compared to her pre-injury abilities.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
ACS NSQIP Best Practices Case studies volume 2 July 2010mart1971
This case study describes how Advocate Good Samaritan Hospital in Downers Grove, Illinois used an interdisciplinary team and Failure Mode and Effects Analysis (FMEA) process to address high outlier results for postoperative renal failure outcomes identified through their participation in ACS NSQIP. The team identified five areas for improvement in preoperative testing, bowel preparation instructions, fluid management in surgical holding, documentation of fluid intake and output, and surgeon communication. Changes were implemented including improved bowel preparation and hydration education, preoperative renal testing and standardized fluid orders for colorectal patients, and communication enhancements. These efforts resulted in a reduction of their observed to expected ratio for renal failure from 2.89 initially to 0.85 in their
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
Advanced Process Simulation Methodology To Plan Facility RenovationAlexander Kolker
This document summarizes a case study on using simulation modeling to plan for a surgical suite renovation at Children's Hospital of Wisconsin. The hospital needed to increase surgical capacity to meet growing demand. A project team used simulation to evaluate options for allocating operating rooms and beds across services. Their model found that separating gastroenterology and pulmonary services into their own area with 2-3 procedure rooms and 8-11 beds would best meet goals of minimizing wait times while staying within budget. The renovation is projected to increase patient satisfaction and yield a positive return on investment within 15 years. Ongoing simulation will evaluate the new process over time.
In the United States, current best practices for potential victims of stroke focus on the goals of rapid EMS triage of, transport to and treatment at Primary Stroke Centers. This session will address the following questions:
-What is the best EMS Stroke Care Model to accomplish this?
-Is there only one “Best Model”?
-How do models compare with other systems in neighboring states and elsewhere in the U.S.?
-What aspects of these other models might be adapted by EMS care systems to improve stroke care?
An Innovative “Patient First” Vaccination Clinic DesignKaiNexus
Presented by Dr. Joy Dobson, Senior Physician Consultant at 3sHealth in Saskatchewan, Canada
Learning Objectives:
Become familiar with a “care comes to the client” concept as applied in Canadian vaccination clinics
Use lean concepts embedded in a “Patient First” model to improve value in clinics of any size
We know there will be many innovative practices shared that will have application possibilities across borders and outside of vaccination work and settings. We hope you can join us!
1. The memorandum summarizes a review of medical records for a client who suffered a closed head injury and vertebral fracture in a 2011 motor vehicle accident.
2. The client was admitted to WakeMed hospital and diagnosed with a closed head injury with severe concussive symptoms and a C6 spinous process fracture, which did not require surgery.
3. Neuropsychological testing a few months post-accident found no significant cognitive deficits, though the client reports ongoing difficulties with mathematical calculations compared to her pre-injury abilities.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
The document describes a PDSA cycle to improve communication of clinic delays at an orthopedic faculty clinic. The clinic was experiencing unpredictable wait times due to variations in patient arrival times and service times. A standalone whiteboard was purchased to display information about clinic name, provider availability status, and delays. Front staff agreed to update the board daily. The goal was to improve communication of delays, provider availability, and the Press Ganey score on information about delays by 15%. Measurements like the Press Ganey score and staff/patient feedback would be used to monitor the change over 6 and 12 months.
The document discusses using discrete event simulation (DES) to analyze capacity and plan renovations for a hospital's surgical suite. It provides an example where DES was used to simulate different scenarios for renovating the Children's Hospital of Wisconsin's surgical facilities. The simulation analyzed patient wait times and resource needs under each scenario. The output recommended scenario 3 and reallocating beds to meet performance criteria for wait times.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
This document discusses value stream management in healthcare. It provides an overview of value stream mapping, including creating current state maps to identify waste and future state maps to design improved processes. Key aspects covered include selecting value streams, mapping process and information flows, setting metrics, and developing implementation plans. Maintaining value stream management through a manager, visual controls, and continuous improvement is emphasized.
Creating Data-driven Strategies to Improve Hospital Outcomes_Oct 16th 2014Lana Cabral
The document discusses strategies for using data to improve hospital outcomes through case management. It provides objectives for a training which include connecting case management efforts to key metrics, establishing frameworks for evaluating processes and outcomes, and developing governance around high-quality data and accountability. The document also outlines characteristics of leading and challenged case management programs, categories and examples of data to monitor, and components of an analytics framework including assessing information needs, designing future states, building tools, and generating reports and dashboards.
Simulation modeling of pre/post bed needs for an Interventional PlatformSIMUL8 Corporation
Architect Frank Zilm discusses how simulation software was used to explore the implementation of an interventional platform concept, integrating surgery, cardiac procedures, interventional radiology and endoscopy services, at Saint Louis University Hospital.
A presentation by Dr Imran Waheed, Consultant Psychiatrist, on strategies to reduce the length of stay of psychiatric inpatients. Delivered in Birmingham, UK in July 2010.
Designing Machine Learning Driven Clinical Decision Support ToolsQian Yang
CHI'16 Paper Presented by Qian Yang from Carnegie Mellon University. The presentation describes a field study investigating how to design better machine-learning-driven systems in support of better LVAD (left-ventricular assist device, the "heart pump") implant decision.
Patient safety is the most important thing in any hospital. Everyday, every hospital staff do their best to ensure no harm to any patient in the hospital. The root cause of every patient safety incident is primarily due to poor, ineffective or lack of communication. This is communication between the hospital staff as well as between hospital staff and their patients.
How do you effectively address the communication problem? The healthcare industry has learned from the aviation industry. Taking a flight has been safer than being in the operating theater or ICU of a hospital. The airline industry, following major crashes, have managed to make air travel the safest thing to do. Key safety-related domains that emerged in the airline industry and adapted by healthcare included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture. SBAR is one of the practices adapted from the airline industryas well.
Introduction to SBAR for effective communication in hospital. Ineffective communication is the root cause of all errors, adverse incidences in hospital. Structured communication between personnel helps reduce this root cause.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
Tricks of the trade: Turn Around Your Slow-Enrolling TrialImperial CRS
Common factors behind slow enrollment
Creating a plan of attack
Setting realistic expectations
Getting management on board
Energizing sites and other stakeholders
Execution and performance tracking
Building a Better Regional Anesthesia Note (on paper or in an EHR)John Gerancher
The author, JC Gerancher MD discusses the principals that add value to an electronic (EHR) or paper regional anesthesia note. See also:
http://www.raadvantages.com/wp-content/uploads/Helping-Patients-Understand.pdf
This document provides a toolkit for public hospitals to improve patient access to acute care services. It outlines a process for hospitals to plan improvements, which includes identifying problems, reviewing performance data, engaging clinicians, understanding current systems, determining goals, implementing changes, analyzing results, and communicating changes. The toolkit compiles strategies from various sources that have been shown to improve patient flow, though the evidence level varies. It is intended to help hospitals redesign processes to provide safe, efficient, and timely patient-centered care.
This document discusses various frameworks for optimizing healthcare staffing levels with variable patient demand. It begins by outlining different approaches including the newsvendor framework, linear optimization, and discrete event simulation. The newsvendor framework is then explained in more detail, showing how to calculate optimal staffing levels by balancing the costs of over- and under-staffing based on historical demand data. Key points are that the optimal level may be higher or lower than the average depending on costs, and it provides a trade-off between having too many or too few nurses on staff at a given time.
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
The summaries discuss challenges emergency room doctors face with the increased number of insured patients under the Affordable Care Act and difficulties those patients experience accessing primary care. The summaries also note concerns about how quickly the legislation was implemented and issues that have arisen in Massachusetts with a similar law, such as increased emergency room visits and longer wait times for care. Congress is urged to work on implementation details to ensure the reform plan works as intended.
This document discusses a quality improvement project aimed at reducing emergency room wait times. A team of 3 nurses will lead the project. They plan to research current best practices for minimizing wait times and improving the patient experience in the ER. Options may include adjustments to staffing, facility layout, or patient flow. The team will evaluate several proposals before testing a new approach. Their goals are to enhance patient satisfaction, safety, and hospital reimbursement by addressing long wait times in the ER.
This document discusses strategies that hospitals have used to improve patient throughput and bed management. It describes how hospitals such as the University of Rochester Medical Center, University Hospital in San Antonio, Stony Brook University Hospital, Ingalls Health System, and Mississippi Baptist Medical Center implemented solutions like expanding observation units, adding bed czars, adopting full capacity protocols, and investing in bed management software. These changes helped reduce emergency department wait times, free up beds more quickly, and improve overall patient flow and capacity management.
Staffing with variable demand in healthcare settingsAlexander Kolker
Outline
Main Concept and Some Definitions.
The “newsvendor” framework approach.
Staffing a nursing unit with variable census (demand)
Linear optimization framework approach.
Minimizing staffing cost subject to variable constraints
Discrete event simulation framework approach.
Staffing a unit with cross-trained staff
Key Points and Conclusions
The document discusses the Out-Patient Department (OPD) of hospitals. It defines the OPD as the "window" of the hospital that provides a wide range of treatments, diagnostic tests, and minor surgeries. This has reduced the need for prolonged hospital stays. The OPD plays an important role as the entry point for healthcare delivery and helps filter which patients need in-patient admission. It also provides training facilities. The typical OPD workflow involves registration, waiting to see a doctor, tests if needed, consultation, and discharge or admission. Design considerations for the OPD include space for patients, administrative areas, clinical areas, diagnostics, and minor procedures. Challenges mentioned include long wait times, lack of
The document describes a PDSA cycle to improve communication of clinic delays at an orthopedic faculty clinic. The clinic was experiencing unpredictable wait times due to variations in patient arrival times and service times. A standalone whiteboard was purchased to display information about clinic name, provider availability status, and delays. Front staff agreed to update the board daily. The goal was to improve communication of delays, provider availability, and the Press Ganey score on information about delays by 15%. Measurements like the Press Ganey score and staff/patient feedback would be used to monitor the change over 6 and 12 months.
The document discusses using discrete event simulation (DES) to analyze capacity and plan renovations for a hospital's surgical suite. It provides an example where DES was used to simulate different scenarios for renovating the Children's Hospital of Wisconsin's surgical facilities. The simulation analyzed patient wait times and resource needs under each scenario. The output recommended scenario 3 and reallocating beds to meet performance criteria for wait times.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
This document discusses value stream management in healthcare. It provides an overview of value stream mapping, including creating current state maps to identify waste and future state maps to design improved processes. Key aspects covered include selecting value streams, mapping process and information flows, setting metrics, and developing implementation plans. Maintaining value stream management through a manager, visual controls, and continuous improvement is emphasized.
Creating Data-driven Strategies to Improve Hospital Outcomes_Oct 16th 2014Lana Cabral
The document discusses strategies for using data to improve hospital outcomes through case management. It provides objectives for a training which include connecting case management efforts to key metrics, establishing frameworks for evaluating processes and outcomes, and developing governance around high-quality data and accountability. The document also outlines characteristics of leading and challenged case management programs, categories and examples of data to monitor, and components of an analytics framework including assessing information needs, designing future states, building tools, and generating reports and dashboards.
Simulation modeling of pre/post bed needs for an Interventional PlatformSIMUL8 Corporation
Architect Frank Zilm discusses how simulation software was used to explore the implementation of an interventional platform concept, integrating surgery, cardiac procedures, interventional radiology and endoscopy services, at Saint Louis University Hospital.
A presentation by Dr Imran Waheed, Consultant Psychiatrist, on strategies to reduce the length of stay of psychiatric inpatients. Delivered in Birmingham, UK in July 2010.
Designing Machine Learning Driven Clinical Decision Support ToolsQian Yang
CHI'16 Paper Presented by Qian Yang from Carnegie Mellon University. The presentation describes a field study investigating how to design better machine-learning-driven systems in support of better LVAD (left-ventricular assist device, the "heart pump") implant decision.
Patient safety is the most important thing in any hospital. Everyday, every hospital staff do their best to ensure no harm to any patient in the hospital. The root cause of every patient safety incident is primarily due to poor, ineffective or lack of communication. This is communication between the hospital staff as well as between hospital staff and their patients.
How do you effectively address the communication problem? The healthcare industry has learned from the aviation industry. Taking a flight has been safer than being in the operating theater or ICU of a hospital. The airline industry, following major crashes, have managed to make air travel the safest thing to do. Key safety-related domains that emerged in the airline industry and adapted by healthcare included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture. SBAR is one of the practices adapted from the airline industryas well.
Introduction to SBAR for effective communication in hospital. Ineffective communication is the root cause of all errors, adverse incidences in hospital. Structured communication between personnel helps reduce this root cause.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
Tricks of the trade: Turn Around Your Slow-Enrolling TrialImperial CRS
Common factors behind slow enrollment
Creating a plan of attack
Setting realistic expectations
Getting management on board
Energizing sites and other stakeholders
Execution and performance tracking
Building a Better Regional Anesthesia Note (on paper or in an EHR)John Gerancher
The author, JC Gerancher MD discusses the principals that add value to an electronic (EHR) or paper regional anesthesia note. See also:
http://www.raadvantages.com/wp-content/uploads/Helping-Patients-Understand.pdf
This document provides a toolkit for public hospitals to improve patient access to acute care services. It outlines a process for hospitals to plan improvements, which includes identifying problems, reviewing performance data, engaging clinicians, understanding current systems, determining goals, implementing changes, analyzing results, and communicating changes. The toolkit compiles strategies from various sources that have been shown to improve patient flow, though the evidence level varies. It is intended to help hospitals redesign processes to provide safe, efficient, and timely patient-centered care.
This document discusses various frameworks for optimizing healthcare staffing levels with variable patient demand. It begins by outlining different approaches including the newsvendor framework, linear optimization, and discrete event simulation. The newsvendor framework is then explained in more detail, showing how to calculate optimal staffing levels by balancing the costs of over- and under-staffing based on historical demand data. Key points are that the optimal level may be higher or lower than the average depending on costs, and it provides a trade-off between having too many or too few nurses on staff at a given time.
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
The summaries discuss challenges emergency room doctors face with the increased number of insured patients under the Affordable Care Act and difficulties those patients experience accessing primary care. The summaries also note concerns about how quickly the legislation was implemented and issues that have arisen in Massachusetts with a similar law, such as increased emergency room visits and longer wait times for care. Congress is urged to work on implementation details to ensure the reform plan works as intended.
This document discusses a quality improvement project aimed at reducing emergency room wait times. A team of 3 nurses will lead the project. They plan to research current best practices for minimizing wait times and improving the patient experience in the ER. Options may include adjustments to staffing, facility layout, or patient flow. The team will evaluate several proposals before testing a new approach. Their goals are to enhance patient satisfaction, safety, and hospital reimbursement by addressing long wait times in the ER.
This document discusses strategies that hospitals have used to improve patient throughput and bed management. It describes how hospitals such as the University of Rochester Medical Center, University Hospital in San Antonio, Stony Brook University Hospital, Ingalls Health System, and Mississippi Baptist Medical Center implemented solutions like expanding observation units, adding bed czars, adopting full capacity protocols, and investing in bed management software. These changes helped reduce emergency department wait times, free up beds more quickly, and improve overall patient flow and capacity management.
Staffing with variable demand in healthcare settingsAlexander Kolker
Outline
Main Concept and Some Definitions.
The “newsvendor” framework approach.
Staffing a nursing unit with variable census (demand)
Linear optimization framework approach.
Minimizing staffing cost subject to variable constraints
Discrete event simulation framework approach.
Staffing a unit with cross-trained staff
Key Points and Conclusions
The document discusses the Out-Patient Department (OPD) of hospitals. It defines the OPD as the "window" of the hospital that provides a wide range of treatments, diagnostic tests, and minor surgeries. This has reduced the need for prolonged hospital stays. The OPD plays an important role as the entry point for healthcare delivery and helps filter which patients need in-patient admission. It also provides training facilities. The typical OPD workflow involves registration, waiting to see a doctor, tests if needed, consultation, and discharge or admission. Design considerations for the OPD include space for patients, administrative areas, clinical areas, diagnostics, and minor procedures. Challenges mentioned include long wait times, lack of
Staffing Decision-Making Using Simulation ModelingAlexander Kolker
The use of Management Engineering methodology for
staffing decision-making.
• Part 1 - Quality and Cost: Outpatient Flu Clinic.
• Part 2 - Quality and Cost : Optimal PACU Nursing
Staffing.
• Summary of Fundamental Management Engineering
The document discusses strategies to reduce congestion in emergency departments (EDs) through increased patient involvement and addressing gaps in service. It identifies four key gaps: listening, planning, service delivery, and communications. Recommendations include actively listening to patients, involving them in care planning and policy changes, designing the ED for efficiency, ensuring appropriate staffing and resource allocation, educating patients on proper ED use, and strengthening communication between EDs, primary care providers, and patients. The overall aim is to close gaps and improve the patient experience through a coordinated, patient-centered approach.
What if you knew a bed crisis was going to happen before it happened? Could you do something to reduce its impact?
View the slides for the webinar and find out about our new Bed Management simulation tool that could save millions for your organization. Bed.P.A.C. can help prevent delays and ED boarding time, reduce length of stay, and ensure patients get the best care.
Understand what healthcare analytics is.
Identify the 5-stage Analytics Program Lifecycle (APL).
Understand how data analytics can be used in healthcare.
Check it on Experfy: https://www.experfy.com/training/courses/introduction-to-healthcare-analytics.
Ward Handover enables a more efficient handover of patients between shifts enabling a more effective patient discharge process. The solution is split into two parts, based around 6PM's CareSolutions database:
Ward Handover System:
A proven ward handover application which enables clinical staff to maximize their care time whilst delivering a single view of the patient by allowing them to enter the discharge notes into a single location that may be accessed by all clinical teams involved in the patient's care – including doctors, ward nurses, specialist nurses and Allied health Professionals. The system therefore allows predictability of bed utilization to maximize their occupancy and assists the bed management team in proactive assessment whilst reducing overall costs of related activities.
Patient Discharge Reporting:
The second part of the solution is real time reporting. The solution takes feeds from the Trust's CRS application every 15 minutes regarding patient status and predicted discharge dates which is then used to create a number of reports for ward staff regarding the workload and patient status. These reports can then be viewed either by ward staff or by consultants.
Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 1-3, 2017 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Children's Mercy Patient Progression Hub - HIT December 2023KC Digital Drive
These slides were presented at the December 2023 meeting of the KC Digital Drive Health Innovation Team.
This presentation focuses on Children's Mercy's innovative use of data. Bill Saltmarsh, MBA, Vice President and Chief Data Officer says, "We are using data to create value for our patients, their families, and our community. We believe that the key to delivering that value is contingent upon our ability to capture, safeguard, and derive novel insights from our data. It is also contingent upon our ability to take advantage of advanced analytical methods and technologies, including the use of Artificial Intelligence. One example of this type of innovation is our Patient Progression Hub which is enabling us to improve the connected care experience for our patients by consistently providing the right information to the right people and the right time."
Bill leads the Data Intelligence Team for Children's Mercy, which includes groups such as Data Science, Clinical Reporting and Analytics, Data Platform Engineering, and Data Governance. Before joining Children's Mercy in March of 2023, he led data teams at ResMed and Pluralsight.
Brief overview of how queueing models can be be linked with big data initiatives to more accurately forecast demand
and revenues, improve care delivery pathways, plan resources and assess new projects.
Similar to Primary care clinics-managing physician patient panels (20)
The purpose of this presentation is providing an overview of the main approaches in using big data: data focus vs. business analytics focus. The following topics will be covered:
- Why getting data should not be a starting point in business analytics, and why more data not always result in more accurate predictions
- The simulation analytics methodology in comparison to machine learning and data science approach
- Examples of two business cases:
(i) Healthcare: Pediatric Triage in a Severe Pandemic-Maximizing Population Survival by Establishing Admission Thresholds
(ii) Banking & Finance: Analysis of the staffing and utilization of a team of mutual fund analysts for timely producing ‘buy-sell’ reports
Many resources discuss machine learning and data analytics from a technology deployment perspective. From the business standpoint, however, the real value of analytics is in the methodology for solving some systemic holistic problems, rather than a specific technology or platform.
In this presentation, the focus is shifted from the technology deployment to the analytics methodology for solving some holistic business problems. Two examples will be covered in detail:
(i) Analysis of the performance and the optimal staffing of a team of doctors, nurses, and technicians for a large local hospital unit using discrete event simulation with a live demonstration. This simulation methodology is not included in most Machine Learning algorithms libraries.
(ii) Identifying a few factors (or variables) that contribute most to the financial outcome of a local hospital using principal component decomposition (PCD) of the large observational dataset of population demographic and disease prevalence.
DEA is a technique that measures the efficiency of decision-making units (DMUs) that use multiple inputs to produce multiple outputs. It defines an efficiency score for each DMU as a weighted sum of outputs divided by a weighted sum of inputs, with all scores restricted to a range of 0 to 1. DEA calculates efficiency scores by choosing input/output weights that maximize each DMU's score, presenting it in the best possible light relative to its peers. Strengths of DEA include its ability to handle multiple inputs/outputs without assuming a functional form and directly compare DMUs against peers or combinations of peers.
This document describes a study conducted at Froedtert Hospital to develop a predictive model of emergency department operations and the effect of patient length of stay on ED diversion. The study analyzed patient length of stay data, developed an ED simulation model, and used the model to test scenarios with different upper limits on length of stay. The model predicted that ED diversion could be reduced to around 0.5% by limiting discharged patients' length of stay to 5 hours and admitted patients' length of stay to 6 hours.
This document describes using process modeling simulation to analyze the effect of daily leveling of elective surgeries on ICU diversion rates at a hospital. The simulation models the patient flow through different units like the ICU, OR, and ED. Currently, elective surgeries are scheduled without considering ICU capacity, leading to periods of high utilization and ICU diversion. The simulation analyzes scenarios where elective case limits are set each day, smoothing out utilization across days and reducing ICU diversion times. Initial results show imposing daily caps of 5 cases for one unit and 4 for another reduces scheduling variability by around 20-28% compared to the current practice.
This document provides an outline and overview of a course on healthcare administration and delivery systems. It discusses the following key points:
- The course will introduce quantitative decision-making methods in healthcare management and apply techniques like forecasting, optimization, and simulation to address challenges in the healthcare system.
- Traditional management has relied on intuition but incorporating quantitative methods can help address problems in a systematic way.
- The roles and responsibilities of healthcare managers have become more visible and important given issues around costs, access, and quality in the system.
- A background in both healthcare and business administration is valuable for medical and health services managers.
This document provides details about a graduate course on healthcare administration and delivery systems, including its objectives, topics, assignments, and evaluation criteria. The course uses lectures, discussions, and exercises to teach students how to apply quantitative techniques like forecasting, optimization, simulation, and analytics to decision-making in healthcare. The goal is to help students develop skills in using data-driven methods for planning, managing, and evaluating healthcare programs and organizations. The course meets weekly and includes a midterm and final exam that evaluate students' problem-solving abilities and understanding of operational challenges in healthcare settings.
The document discusses data science, data analytics, and their application in hospital operations management. It states that data science and analytics strive to transform raw data into actionable business decisions using quantitative methods. Various types of analytics are described like descriptive, predictive, and prescriptive analytics. Examples of applying different analytical methods to common business problems in healthcare are provided, such as using simulation for capacity planning and optimization for resource allocation. The key is integrating analytics into decision-making processes to create value for customers.
This document discusses using management engineering principles to analyze healthcare delivery systems. It provides an example analysis of a hospital system modeled as interdependent subsystems, including the emergency department, intensive care unit, operating rooms, and nursing units. Simulation of the mathematical model revealed important relationships between the subsystems that could inform management decisions. The conclusion advocates using objective data analysis and simulation rather than subjective opinions alone for healthcare management decisions.
Effect Of Interdependency On Hospital Wide Patient FlowAlexander Kolker
This document discusses using simulation modeling to analyze the impact of interdependencies between key departments in a hospital system, including the emergency department (ED), intensive care unit (ICU), operating rooms (OR), and nursing units. It summarizes how modeling each department individually can identify factors influencing performance, such as patient length of stay in the ED and scheduling of elective surgeries in the ICU. The document also provides examples of operational performance criteria used to evaluate the OR and potential simulation models analyzing the impact of changes like adding OR capacity.
1) The Child Protection Center (CPC) evaluated children who may have been abused and aimed to reduce patient wait times which were perceived to be due to staff shortages.
2) A discrete event simulation model was developed to analyze current patient flow and identify bottlenecks. It found the sexual abuse exam room and medical assistants were causing most delays.
3) The best scenario found was adding 0.6 full-time equivalent medical assistant in the afternoon and changing the exam room configuration to one exam room and two sexual abuse exam rooms. This significantly reduced total patient wait times.
SHS_ASQ 2010 Conference: Poster The Use of Simulation for Surgical Expansion ...Alexander Kolker
Children's Hospital of Wisconsin is planning a major expansion and renovation of its surgical suite to increase capacity. Computer simulation models were developed to analyze three expansion scenarios and determine the optimal design. Model 3 was selected as the best option, as it would separate gastroenterology and pulmonary services into their own area with 2-3 procedure rooms and 8-11 pre/postoperative beds, while meeting all performance criteria for patient wait times and OR utilization through 2013. The simulations accounted for patient volume flow, limited system capacity, and the balance needed between these factors for efficient patient throughput.
SHS ASQ 2010 Conference Presentation: Hospital System Patient FlowAlexander Kolker
The document discusses using systems engineering principles to improve healthcare delivery. It describes modeling a hospital as interconnected subsystems like the emergency department, intensive care unit, operating rooms, and medical units. The emergency department is analyzed in depth as a case study. A simulation model of patient flow through the emergency department is created to predict how limiting patient length of stay would reduce times when the emergency department must be closed to new patients due to capacity issues. The document advocates applying mathematical modeling and analysis to make more informed management decisions compared to traditional intuitive approaches.
Here is a high-level layout of the PACU simulation model:
- Inputs:
- Historical daily OR schedule with planned start/end times of surgeries
- Distributions of surgery durations
- Distributions of PACU length of stay for different surgery types
- Process:
- Simulate surgeries based on schedule and duration distributions
- Patients enter PACU after surgery based on OR schedule
- Patients spend time in PACU based on PACU length of stay distributions
- Patients discharge from PACU over time
- Outputs:
- PACU census (number of patients) tracked over time
- Staffing requirements calculated to maintain target nurse-to-patient ratios
The model simulates patient flows
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
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TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
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Healthy Eating Habits:
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Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Primary care clinics-managing physician patient panels
1. Session 6
Primary Care Clinics &
Managing Physicians’ Patient Panel Size:
Advanced Access and Reducing Delays in
Primary Care Clinics
Alexander Kolker. All rights reserved 1
2. OUTLINE
• Traditional scheduling and the advanced
access at a primary care clinic
• Uncertainties that should be considered when
patients are scheduled
• Decisions that need to be made for designing an
appointment system
• Practice on using the panel size calculator
•Emerging Trends in Primary Care:
•Team Care
•Patient-Centered Medical Home
• Five main payment modelsAlexander Kolker. All rights reserved 2
3. Primary Care and Advanced Access
• For most patients, their primary care physician is their major access
point to care
• Yet, primary care practices often have long waits for appointments and
may have difficulty in accommodating patients with urgent problems
• Some primary care practices have adopted a patient scheduling
approach known as advanced access
•In a “traditional” system each physician’s daily schedule is booked in
advance, and some fixed number of appointment slots are held open for
urgent cases
•The Institute of Medicine has reported “timeliness” as one of six key
“aims for improvement” in its major report of quality of care
“Crossing the Quality Chasm: A New Health System for the 21-st
Century”, 2001. IOM, Washington, DC, 2001.
Alexander Kolker. All rights reserved 3
4. • The advanced access approach offers every patient a
same-day appointment, regardless of the urgency of
the problem
• However, advanced access can only work if patient
demand for visits and physician capacity to see
patients are “in balance”
Main Points to discuss
• What constitutes an appropriate balance ?
• What is a “manageable” patient panel size ?
Alexander Kolker. All rights reserved 4
5. Question:
If the demand for appointments is equal on average
to the number of available appointment slots,
do you expect no backlogs and no wait time for
appointments?
Alexander Kolker. All rights reserved 5
6. •A fundamental feature of patient demand for primary care is
its random nature: the actual number of patients requesting
care on any particular day will vary around the average daily
value, sometimes substantially
•It is this inherent randomness that makes it difficult to
answer the questions such as:
“How large a patient panel size can be served by a given
physician practice?”
• Because of this variability, making supply and demand equal
on average would create chronic backlogs for care and wait
for appointments that would likely get longer and longer
The Need for “Safety” Capacity
Alexander Kolker. All rights reserved 6
7. Alexander Kolker. All rights reserved
To illustrate, suppose that 10 daily appointments are
scheduled in the clinic.
Demand for appointments is:
about 50% of time 9 appointments are requested
(demand is 9),
and another 50% of time 11 appointments are requested
(demand is 11),
i.e. the average demand is 10 appointments
7
8. Alexander Kolker. All rights reserved 8
(Green, Savin, Murray, 2007. The Joint Commission Journal on Quality & Patient
Safety.)
9. But ……
Isn’t it seems logical to assume that “bad” days with the demand of 11
will be balanced out by “good” days with only 9 patients demand ?
So, why doesn’t this balancing out happen?
The answer is:
When patient demand is less than the appointment capacity, the extra
service capacity cannot be transferred to the next day to serve future
patient demand; therefore it is lost.
On the other hand, on the “bad” days, when patient demand exceeds
service capacity, the un-served demand does not disappear, and it has
to be satisfied in the future.
Therefore “good” days cannot clear the backlog created by the equal
number of “bad” days. Alexander Kolker. All rights reserved 9
10. Key points:
• The average daily demand for appointments must be
strictly less than the maximum appointment capacity.
• There must be some safety capacity relative to demand.
• Safety capacity (the amount of capacity in excess of
average demand) serves as a hedge against demand
variability.
• Without safety capacity a practice will be unable to offer
timely access to care.
Alexander Kolker. All rights reserved 10
11. Finding the Right Balance Between Supply and Demand
Question:
How much safety capacity does any specific practice need?
Answer:
This depends primarily on the desired overflow frequency
level—the percentage of days when demand exceeds the
number of appointment slots for that day.
In the example illustrated above, the overflow frequency is
50%.
The lower the overflow frequency level, the easier it will be to
offer the same-day appointment
Alexander Kolker. All rights reserved 11
12. •Decreasing the overflow frequency can only be
accomplished by increasing the safety capacity
(good for patients – higher chance for the same
day appointment).
•However, more safety capacity also means
more idle physician time
(bad for physicians – loss of revenue).
Alexander Kolker. All rights reserved 12
13. •So, the “right” level of safety capacity for an office
must be determined by the trade-off between:
(i) the revenue associated with seeing more patients
and
(ii) the amount of overtime the practice is willing to
undertake to keep patient delays minimal.
•To evaluate the possible trade-offs, it is necessary to
establish the relationship between:
• safety capacity
• patient panel size
• overflow frequency Alexander Kolker. All rights reserved 13
14. Patient panel size is the major determinant of demand and
the prime lever for achieving the right balance between
supply and demand.
Finding the Right Panel Size (Savin, S., In: Patient Flow: Reducing
Delay in Healthcare Delivery. Ed. R. Hall, Springer, 2006)
Establishing an appropriate panel size for the existing practice
includes the following 6 steps:
1. Identifying the current panel size
2. Estimating the daily visit rate per patient
3. Fixing the number of daily appointment slots
4. Calculating the current overflow frequency
5. Setting the target overflow frequency
6. Computing the panel size based on the target flowAlexander Kolker. All rights reserved 14
15. 1. The panel size N
It will be most accurately estimated by calculating the
total number of distinct patients seen by a physician (or
requests for appointments) in the last 18 months.
2. The daily visit rate
r = A/(N * T)
Here, A is the number of patient appointments / requests for T work
days (determined from examination of the appointment log).
For example, consider a general practice with a current panel size
N = 2500 patients and A = 6500 office visits during the last 18 months
(T = 315 days).
For this practice, r =6500/ (2500*315)= 0.0082 visits/day per patient.
This is the average over a long period of time. It can over- or
underestimate the actual demand over any short-term period.Alexander Kolker. All rights reserved 15
16. 3.Establishing the Target Number of Daily Appointment Slots.
The average daily supply of appointment slots, C, is determined by the
average length of an appointment slot and the average daily number of
hours devoted to direct patient care.
For example, if a physician spends an average of 6 hours per day in
patient care and appointments are scheduled 20 minutes apart, the
daily scheduled appointment capacity is
C = 6 hours × 3 appointments/hour = 18 appointments.
4. CALCULATING THE OVERFLOW FREQUENCY- Use the online calculator
(info on the next slide…. )
Let current and the desired future (recommended) panel size be 2500;
18 appointment slots; 5 days/week; 50 weeks annually (2 weeks off).
For this example, the overflow frequency is 10%, and appointment
capacity utilization is 74% (for the number of weekly visits 90)Alexander Kolker. All rights reserved 16
17. Panel size online calculator link:
You will have to register:
create you own user name and password
http://www.panelsizer.com/wps/panelsizer.aspx
Alexander Kolker. All rights reserved 17
18. Panel Sizes (Capacity Utilizations %) for Different Parameter Values
(from Green et al, 2007, page 217)
Overtime Frequency # of overtime days per week
40% 2
20% 1
10% 0.5 (1 in 2 wks)
5% 0.25 (1 in 4 wks)
Overflow
frequency
Daily
Appointments
slots=24
Daily
Appointment
slots=20
5% 2321 (73%) 1879 (70%)
10% 2515 (79%) 2053 (77%)
20% 2765 (86%) 2279 (85%)
Alexander Kolker. All rights reserved 18
19. Key Points
•Ensuring timely access to medical care is an important goal
for any physician practice
•Advanced access is a way of achieving this goal
•The variability inherent in the demand and delivery of care
makes it difficult to determine patient panel size or,
conversely, physician practice size by using guesswork or
intuition.
• Quantitative models help to take into account the
unavoidable variability of patient demand.
Alexander Kolker. All rights reserved 19
20. • Traditional scheduling systems:
– Long times until next appointment
– High no-show rates
– Double/triple booking—queues form
• Advanced access:
– Patients seen the same day as requested
– Reduces no-show rate
– Better continuity of care
Alexander Kolker. All rights reserved 20
21. • PanelSizer™ is a tool that diagnoses the degree of
mismatch between the needs of patients and the
capacity of physicians
• Based on that diagnosis, it then recommends the
size of the patient panel consistent with the goal of
providing the same-day appointments for most
patients
• Thus, the environment is created in which patient
satisfaction and revenue generation go hand-in-hand
Alexander Kolker. All rights reserved 21
22. Alexander Kolker. All rights reserved 22
Ozen et al, 2013, 16(2), 101-118. Healthcare Management Science
Journal. THE IMPACT OF CASE MIX ON TIMELY ACCESS TO APPOINTMENTS IN A
PRIMARY CARE GROUP PRACTICE
Abstract
At the heart of the practice of primary care is the concept of a physician panel. A panel
refers to the set of patients for whose long term, holistic care the physician is
responsible. A physician's appointment burden is determined by the size and
composition of the panel.
The overflow frequency, or the probability that the demand exceeds the capacity, is a
measure of access.
The problem of minimizing the maximum overflow for a multi-physician practice is
formulated as a non-linear integer programming problem. This optimization framework
helps a practice: 1) quantify the imbalances across physicians due to the variation in
case mix and panel size, and 2) determine how panels can be altered in the Ieast
disruptive way to improve access.
An important advantage of this approach is that it can be implemented in an Excel
Spreadsheet and used for panel management decisions.
23. Emerging Trends in Primary Care
Team Care
•PCP reimbursement is less than most other
specialties
•This discourages many physicians from careers in
primary care
•As a result, many practices are using support staff,
such as Physician Assistants (PA) and Nurse
Practitioners (NP) to fill the void
• Primary care teams start playing a central role
Alexander Kolker. All rights reserved 23
25. (Team care cont.)
•While a patient’s PCP remains a main point of
contact and coordinate the care, the patient might
be seen by other clinicians in the team
•This pooling of the team’s capacity helps to better
absorb fluctuations in demand, as well as direct care
based on acuity of the case
•Patient appointment scheduling in primary care has
to consider this team aspect rather than focusing
primarily on physicians
Alexander Kolker. All rights reserved 25
26. Patient-Centered Medical Home (PCMH)
•An approach to primary care that facilitates partnership
between individual patients, their PCP and the patient’s
family
•The PCMH attempts to counter the increasing fragmentation
and a lack of coordination of care between various providers
•Each patient will have a PCP who will also coordinate and will
stay informed of the patient’s care across the other parts of
the system: subspecialties, hospitals, health agencies and
nursing homes
•The PCMH model will use extensively IT and EHR to achieve
this level of coordinationAlexander Kolker. All rights reserved 26
27. (PCMH cont.)
•Currently, physician reimbursement is based on the number
of visits
•In PCMH model, ‘face-to-face’ visits will be complemented
by visits to other team members, such as LNP and PA
•Some exchanges may happen over e-mails and phone calls
•The reimbursement will have to account for ‘non-visit’ care
time
•This creates a number of operational questions since
‘capacity’ of a clinic now assumes a flexible form rather than
being centered solely on physician visits
Alexander Kolker. All rights reserved 27
28. Summary of payment models
The goal of payment models is to change the way
physicians, hospitals, and other care providers are paid in
order to provide higher quality at lower costs, i.e. to
improve value.
There are 5 main payment models:
1. Fee-for-Service
Alexander Kolker. All rights reserved 28
•Policymakers and Payers have grown increasingly frustrated
with fee-for-service payment system.
•Fee-for-service rewards volumes and encourages silos and
fragmentation of care.
•Several provisions of 2010 healthcare reform legislation seek
to shift provider payments to value-based approaches that
encourage quality improvement and cost reduction
29. Fee-for-Service (cont.)
Yet, this payment model has some advantages:
The types of care that are best suited for fee-for-service
payment model:
•emergency and trauma care
•elective procedures that are not covered by insurance
Alexander Kolker. All rights reserved 29
30. Summary of payment models (cont.)
2. Pay for coordination
The types of care best suited for pay for coordination are:
• primary care management and care coordination for patients with
chronic conditions,
• and care coordination for healthy patients who are at risk for
chronic illness.
Alexander Kolker. All rights reserved 30
The typical example of this model is the medical or health care home
model.
The medical home receives a monthly payment in exchange for the
delivery of care coordination services that are not otherwise provided
and reimbursed.
31. Summary of payment models (cont.)
3. Pay for performance
This model has actually become Pay for Compliance
The types of care that are best suited for pay for
coordination are:
•services for which metrics already exist including
management of some chronic conditions (e.g. diabetes,
asthma, heart failure)
•certain surgeries
Alexander Kolker. All rights reserved 31
32. 4. Episode or Bundled Payments
The types of care best-suited for episode or
bundled payments are:
• obstetric/maternity care
• transplants
• joint replacement surgery
• other general surgeries
• pacemaker/ICD implantation
• and some other ambulatory diagnostic or
therapeutic procedures.
Alexander Kolker. All rights reserved 32
Summary of payment models (cont.)
33. 5. Comprehensive Care/Total Cost of Care Payments
• Practice with improved flexibility for providers in
terms of care delivery
• Practice with greater potential for innovation in
delivery design
• Practice with improved incentive for providers who
serve a particular population to collaborate with
each other
Alexander Kolker. All rights reserved 33
The types of care best-suited for this model are:
Summary of payment models (cont.)
Provides a single risk-adjusted payment for the full
range of health care services needed by a specified
group of patients for a fixed period of time.
34. Alexander Kolker. All rights reserved 34
•There is no ‘silver bullet’ among the options
•No single payment model is appropriate for all types
of care or applicable in all settings, practice types, and
geographic locations
Overall take-away for payment models:
35. Next session 7
‘Fair’ Costs and Payoff Distributions among
cooperating providers.
Introduction into Game Theory and the concept of
the Shapley Value.
Reading Assignments:
Kolker, chapter 6
Alexander Kolker. All rights reserved 35