A Volume To Value Ortho Service Line Model

A Volume to Value
Service Line Model
November 16, 2016
William E. Munley
Vice President of Orthopedics, General Surgery & Professional Services

Goals of Presentation
• Model applicable to all service lines.
• Model that transitions from volume to value.
• Volume and Value are not necessarily mutually exclusive
• The sky is not falling.

• Bon Secours operates 19 acute-care hospitals, 1 psychiatric hospital, 5 nursing
care facilities, 4 assisted living facilities, and 14 home care and hospice programs
in 7 states.
…About Us

• St. Francis downtown
– 10 IP operating suites / 8 OP operating suites
– 202 Acute care beds
– 19 Inpatient Rehab Beds
– 27 ICU / CCU / CVICU
– 248 Total Beds
• St. Francis eastside
– 8 operating suites
– 52 acute care beds
– 35 LDRP
– 6 ICU Beds
– 93 Total Beds
…About Us

Service Line Management
OthersAncillariesSurgeryNursing

OthersAncillariesSurgeryNursing

• Program development
• Enhanced teamwork
• Increased volumes
• Increased market share
• Increased quality
• Streamlined costs & efficiencies
• Value
• Positioning for healthcare reform
Benefits of Service Line Structure

Orthopedics is becoming a specialty within a specialty
• Foot & Ankle
• Fracture Care
• Hand & Upper Extremity
• Joint Replacement
• Medical Ortho
• Spine
• Sports Medicine

Orthopedic, Spine & Rehab Services
DYAD
Leader:
Dr. Baumgarten
Orthopedic
Chair:
Dr. VanPelt
Joint Camp
Drs. Kavolus
& Ridgeway
SFE OFC
Dr. O’Boyle
SFD
Sports
Med. &
O/P Ortho
Dr.
Baumgarten
SFD / SFE
O/P Rehab
Dr. Schwartz
SFD / SFE /
Millennium
& 4 satellites
Other
Orthopedics
Wound
Healing
Center
Dr. Melissa
Richardson
SFE
Inpatient
Rehab
Center
Dr. Choe
SFD
Foot &
Ankle
SFD / SFE
Spine
Program
Dr. Bucci
SFD

Future
Vision
Identify
Future
Positioning/Regional
COE
Future Vision
Quality /Outcomes/Value
Future Vision Peripherals /
Innovation
Future Vision COE’s
Centers of Excellence
Orthopedic Programs
Orthopedic Services
Quality/Outcomes
Service/Satisfaction
Volume/Market
Share/Growth
Cost
Munley Healthcare Consulting, LLC
Bon Secours St. Francis Health System Orthopedic Service Line
Vision Statement
We are committed to excellence as the
high-quality patient-centered provider
of choice for regional orthopedic and
spine services.

• Majority of hospitals in the country (about 50% ) do not have formalized
orthopedic programs.
• They deliver services and perform procedures only.
• We have a few services like this which we would like to take to the next level (i.e.
Foot & Ankle).
Orthopedic Services

Orthopedic Programs
• Another 25% of Hospitals delivering orthopedic service have organized programs.
• No formal programs before 2004 at St Francis.
• We have formalized a Shoulder Program, and initiated components of an
Osteoporosis Program complete with Bone Health Navigator.

• Fewer still (20% - 25%) have developed Centers of Excellence or are able to go to
the next level
• We developed Center’s of Excellence in Joint Replacement (Joint Camp 2004), Hip
Fracture (Osteoporotic Fracture Center 2007), Sports Medicine (2008), and Spine
Care Center (2010)
• Center of Excellence Differentiation

We have differentiated our COEs through menus for success:
• Joint Camp
• Spine Care Center
• OFC
• Sports Medicine

Joint Camp Menu for Success
1. Medical Director / Physician
Champion
2. Hip & Knee Pain Seminars
3. Focus on Wellness
4. “Prehab”
5. Early Discharge Planning
6. Multidisciplinary Team
7. Regular Team Meetings
8. Dedicated Program Manager
9. Dedicated Unit
10. Direct Admission into Room
11. Group Therapy
Green:
Advertising/Promotion
Red: Differentiators

12. Coach Program
13. Clinical Pathway & Standardized Orders
14. Comprehensive Educational Information for
Patients & Families
15. Rise & Shine Greeting Program
16. Newsletters
17. Graduation Ceremony
18. Dashboard Development
19. Annual Reunion
Green: Advertising/Promotion
Blue: Promotional materials
Purple: Outcomes

20. Physician “Buy In”
21. Dedicated, Consistent OR, Nursing & Therapy
Staff
22. Flip Flop OR’s for high-volume surgeons
23. 1:5 Nurse-to-Patient Ratio
Green: Advertising /
Promotion
Dr. Stephen
Ridgeway
Joint Camp
Medical Director
Dr. Christopher
Kavolus
Orthopedic Medical
Director

Spine Care Center Menu for Success
1. Focus on Wellness
2. “Prehab”
3. Early Discharge Planning
6. Coach Program

Spine Care Center Menu for Success
7. Clinical Pathway & Standardized Orders
8. Comprehensive Educational Information for Patients &
Families
11. Dedicated, Consistent OR, Nursing & Therapy Staff
12. Designated Unit
13. Community Seminars
Purple: Outcomes

Spine Triage Center
• Initial consults with Physiatrists
• Primary Care Musculoskeletal Physician
• PCP/Network Referral
• RN Spine Navigator
• Specialty Network

St. Francis OFC
(Osteoporotic Fracture Center)

St. Francis OFC Menu for Success
1. Medical Director / Physician
Champion
2. OFC Coordinator
3. Streamlined Evaluation and admission
process
4. Admission by Hospitalist
5. Clinical Pathway and Standardized
Orders
7. Reserved O.R. time 5 days/week

St. Francis OFC Menu for Success
9. Dedicated Beds
10. Dedicated / Specially trained OR, Nursing & Therapy staff
11. Aggressive Therapy
12. Early D/C Planning
13. Patient / Family Education
16. Administrative Support
Purple: Outcomes

Primary Target Audience
Injury-Prone Weekend Warrior/Baby Boomer
Secondary Target Audience
Student Athletes
Strategies
–Pursue high injury risk weekend warriors/baby boomer sports leagues
–Increase awareness at public events focusing on multiple sporting
venues utilizing our community-based ATC’s, sports medicine
coordinators, and physician network.
–Provide Athletic Trainer Programs on-site to organizations
Sports Medicine Menu for Success

– Participate in non-traditional community events that
promote health and wellness
– Sponsorships
– Promote HURT Line
– Provide Effective Materials for Events
– Develop a Comprehensive Marketing & Sales Package
– Incorporate with other St. Francis system-wide events

– Track Clubs
– Mud Runs
– Adult Basketball Leagues
– Cycling Events
– Tennis Clubs
– Triathlons
– Volleyball
– Swimming Clubs
– Adult Soccer
– Lacrosse Leagues
– Corporate Leagues
– Rugby
– Sports Clubs
– Hiking Clubs
– Ballet
– Senior Centers
– YMCA / YWCA
• Pursue Injury Prone Weekend Warriors/ Baby-boomer Sports Leagues
utilizing our community based ATC / Sports Medicine Coordinators and
Physician Network

• Provide athletic trainer programs onsite to Organizations
– Bob Jones University
– Easley High School
– Powdersville High School
– Wren High School
– Shannon Forest High School
– CESA Youth Soccer
– Greenville Swamp Rabbits

• Participate in non-traditional community events that promote health
and wellness
– Health Fairs
– Sports Performance Challenge in collaboration with D-1.
– Publish injury prevention articles/training kits
– Community educational programs
– Develop pre-season tune-up and/or post-event injury clinics

• Established Major Sponsorships
– Clemson
– Greenville Drive
– Greenville Road Warriors
– Downtown cycling classic
– GO Magazine
– Mud Run
– Wheels for Meals
– Track Clubs
– Tennis Tournaments
– Soccer Leagues
– Cycling Events
– Golf Tournaments
– Universities

Future
Vision
Identify
Future
COE
Future Vision
Innovation
Orthopedic Programs
Orthopedic Services
Quality/Outcomes
Volume/Market
Share/Growth
Cost
Vision Statement
spine services.

Service Line Pillars
(central to future vision for orthopedics)
Service & Satisfaction have been outstanding:
• 99th percentile for Orthopedist Satisfaction
• 4.84/5.00 Gallup Patient Satisfaction 3rd Floor Ortho SFE
• 4.73/5.00 Gallup Patient Satisfaction 7th Floor Ortho/Spine SFD
• 3.79/4.00 HCAHPS Grand Mean 3rd Floor Ortho SFE $
• 3.67/4.00 HCAHPS Grand Mean 7th Floor Ortho/Spine SFD $
• 4.76/5.00 Gallup Employee Engagement

Future
Vision
Identify
Future
COE
Future Vision
Innovation
Orthopedic Programs
Orthopedic Services
Quality/Outcomes
Cost
Vision Statement
spine services.
Volume/MarketShare
Growth

Volume/Market Share Growth:
• Most Joint Replacements and Shoulder Replacements performed
in South Carolina
• Performed over 9,000 orthopedic surgical procedures in FY16.
Market Share:
• 40% Spine Care
• 49% Hip Fx. Care
• 51% Outpatient Ortho (knee, shoulder)
• 65% Joint Replacement

Future
Vision
Identify
Future
COE
Future Vision
Innovation
Orthopedic Programs
Orthopedic Services
Quality/Outcomes
Vision Statement
spine services.
Volume/MarketShare
Growth
Cost

Cost:
• Shorter Length of Stay
• Reduced O.R. Times
• Reduced Variation in Practice Patterns
• Lowest implant costs in BSHSI
• Lowest cost MS-DRGs in the Upstate as per American Hospital Directory
• Monitor MSPB (including SNF placements)

Comparative Data for Medicare Patients
Total Joint Replacement and Joint Revisions
Hospital
Medicare
Inpatients ALOS
Average
Charges
Average
Payment
Average
Cost
St. Francis 718 3.4 $51,284 $11,492 $13,587
Spartanburg Regional 335 5.1 $48,966 $14,257 $15,673
Patewood Memorial Hospital 247 2.9 $40,525 $11,154 $16,927
Self Regional 242 3.8 $66,863 $14,082 $19,375
AnMed 224 5.1 $75,421 $13,608 $36,559
Greenville Memorial Hospital 73 6.4 $63,012 $16,984 $34,864
Hillcrest Hospital 57 3.8 $50,183 $13,172 $31,095
Village at Pelham 26 3.9 $42,880 $10,112 $42,125
MS-DRGs 469, 470: Major Joint Replacement or Reattachment of Lower Extremity w/MCC and
w/o MCC
MS-DRGs 466, 467, 468: Revision of Hip or Knee Replacement w/CC, w/MCC, and w/o CC/MCC
Hospital
Medicare
Inpatients ALOS
Average
Charges
Average
Payment
Average
Cost
Spartanburg Regional 49 5.6 $67,283 $18,761 $24,071
St. Francis 36 3.8 $86,362 $16,377 $22,270
Patewood Memorial Hospital 16 3.4 $55,442 $14,058 $22,290
Data is for Medicare inpatients only- year ending 9/30/09
Source: American Hospital Directory

Future
Vision
Identify
Future
COE
Future Vision
Innovation
Orthopedic Programs
Orthopedic Services
Vision Statement
spine services.
Volume/MarketShare
Growth
Cost
Quality/
Outcomes

Quality/Outcomes:
• Premier top 10% Joint Replacement Quality and Cost
• Delta Care Chex/Comparion top 5% for Overall Orthopedic Surgery
• Becker’s Top 100 Orthopedic Hospitals Award
• Joint Commission DSC for Total Hip & Total Knee Replacement
• BCBS Preferred Distinction Center+ for Quality and Cost for Joint Replacement Surgery and
Spine Surgery
• Aetna Institutes of Quality (IOQ) for Joint Replacement & Spine Surgery
• United Healthcare Specialty Center Designation for Joint Replacement & Spine Surgery
• Sg2 National Best Practice for Fracture Care
• Synthes Corporation Preferred Show Site for Fracture Care
• America’s Best Hospitals for Orthopedics-Women’s Choice Award 2013
• Consumer Reports Highest Rated Hospitals for Knee Surgery 2014
• Consumer Reports Highest Rated Hospitals for Hip Surgery 2014, 2016

HealthGrades
• America’s 100 Best Hospitals for Orthopedic Surgery, 6 years in a row (2012-2017)
• Top 5% in the Nation for Overall Orthopedic Surgery, 6 years in a row (2012-2017)
• Ranked #1 in SC for Overall Orthopedic Services (2012-2013, 2016-2017)
• 5-Star in Knee Replacement, 15 years in a row (2003-2017)
• 5-Star for Hip Fracture Treatment, 6 years in a row (2012-2017)
• 5-Star for Back Surgery, 2 years in a row (2013-2014)
• Service Excellence Award for Joint Replacement (2011-2014, 2016-2017)

QUALITY
• Mortality • Infections • Readmission Rate • PE • DVT • Dural Tears • Patient Falls • CMS/VBP Indicators
• Clinical Pathway Usage • Time between ER Arrival to Surgery in < 12 hrs. & < 24 hrs. • Time b/w ER Arrival
to Floor < 4.5 hrs. Complications: Delirium, Ileus, Pneumonia, Renal Failure, Respiratory Failure, UTI
SERVICE
• On-time starts for 1st case • Turnover time • Surgery Block Utilization • Patient Satisfaction
• Cancellations w/in 24 hours
OUTCOMES
• Pain level • Functional level • Return to Work • Return to Former Activities • Maintain Independent Living
FINANCIAL
• Implant Cost • Total Cost • Volume • LOS • Wasted Implants • MSPB
MISC.
• Seminars / Screenings • Percent of Patients D/C to Home
Dashboard

QUALITY
• Mortality • Infections • Readmission Rate • PE • DVT • Dural Tears • Patient Falls • CMS/VBP Indicators
to Floor < 4.5 hrs. Complications: Delirium, Ileus, Pneumonia, Renal Failure, Respiratory Failure, UTI
SERVICE
• On-time starts for 1st case • Turnover time • Surgery Block Utilization
• Patient Satisfaction
OUTCOMES
FINANCIAL
• Implant Cost • Volume • LOS • Wasted Implants • MSPB
• Total Cost $
MISC.
•Seminars / Screenings • Percent of Patients D/C to Home
Dashboard

QUALITY
• Mortality • Readmission Rate • PE • DVT • Dural Tears • CMS/VBP Indicators
to Floor < 4.5 hrs.
• Infections $ • Patient Falls $
• Complications: Delirium, Ileus, Pneumonia, Renal Failure, Respiratory Failure, UTI
SERVICE
OUTCOMES
FINANCIAL
MISC.
Dashboard

QUALITY
• Mortality • Infections • Readmission Rate • PE • DVT • Dural Tears • Patient Falls
• CMS/VBP Indicators $
• Clinical Pathway Usage • Maintain Independent Living • Time between ER Arrival to Surgery in < 12 hrs. & <
24 hrs. • Time b/w ER Arrival to Floor < 4.5 hrs. Complications: Delirium, Ilius, Pneumonia, Renal Failure,
Respiratory Failure, UTI
SERVICE
OUTCOMES
• Pain level • Functional level • Return to Work • Return to Former Activities
FINANCIAL
• Implant Cost • Total Cost • Volume • LOS • Wasted Implants • MSPB $
MISC.
Dashboard

QUALITY
• Mortality • Infections • Readmission Rate • PE • DVT • Dural Tears • Patient Falls • CMS/VBP Indicators •
Clinical Pathway Usage • Maintain Independent Living • Time between ER Arrival to Surgery in < 12 hrs. & <
24 hrs. • Time b/w ER Arrival to Floor < 4.5 hrs. Complications: Delirium, Ileus, Pneumonia, Renal Failure,
Respiratory Failure, UTI
SERVICE
OUTCOMES
• Pain level • Functional level • Return to Work • Return to Former Activities
FINANCIAL
MISC.
•Seminars / Screenings • Percent of Patients D/C to Home
Dashboard

QUALITY
• Mortality • Infections • Readmission Rate • PE • DVT • Dural Tears • Patient Falls • CMS/VBP
Indicators • Clinical Pathway Usage • Time between ER Arrival to Surgery in < 12 hrs. & < 24 hrs.
• Time b/w ER Arrival to Floor < 4.5 hrs.
• Complications: Delirium, Ileus, Pneumonia, Renal Failure, Respiratory Failure, UTI $
SERVICE
OUTCOMES
• Pain level • Functional level • Return to Work • Return to Former Activities • Maintain
Independent Living
FINANCIAL
MISC.
Dashboard

QUALITY
• Mortality $ • Readmission Rate $
• Infections • PE • DVT • Dural Tears • Patient Falls • CMS/VBP Indicators • Clinical Pathway Usage
• Time between ER Arrival to Surgery in < 12 hrs. & < 24 hrs. • Time b/w ER Arrival to Floor < 4.5 hrs.
• Complications: Delirium, Ileus, Pneumonia, Renal Failure, Respiratory Failure, UTI
SERVICE
• On-time starts for 1st case • Turnover time • Surgery Block Utilization
• Patient Satisfaction • Cancellations w/in 24 hours
OUTCOMES
• Pain level • Functional level • Return to Work • Return to Former Activities • Maintain Independent
Living
FINANCIAL
MISC.
Dashboard

• Foot & Ankle
• Osteoporosis
• Shoulder Replacement
Future Vision

Da Vinci Robot
St. Francis Millennium St. Francis
Outpatient Center

• Dr. Marc Tanner - Hand (2012)
• Dr. Shay Koch - Sports Medicine (2013)
• Dr. Dylan Watson - Joint Replacement Surgeon (2015)
• Pain Management Physician (2017)
• Foot & Ankle (2017)
• Hand Surgeon (2017)
Specialist Recruitment

• Investigate and maintain new government regulations/coding
• Prepare operationally for new reimbursement strategies
• Maintain & improve efficiencies (on-time starts, turnover time, etc.)
• Improve consistency, ability, experience and training with OR staff and possibly
Anesthesia/Hospitalists
• Site visits to other premier programs
Operating Excellence

• Concentrate on patient-centered coordination of care
• Continued task force meetings
• Program element upgrades, protocol updates, continued differentiation
• Maintain and further develop dashboards and benchmarks (re-admission rates,
quality, return to community, return to work, pain levels, return the functional
activities, etc.)
Operating Excellence

• Identified as having one of the
most comprehensive and
diversified orthopedic marketing
plans by Innovator’s Studio
(Chicago 2010)
• Current & future strategies
Service Line Focused Marketing

Patient / Family Items
Tee Shirt Coach’s Guide Coffee Cup Bag

Hip & Knee Pain Seminars
• Bi–Monthly at St. Francis Eastside
• Participation in Community Events

HealthGrades
5-Star in Hip
Replacement
5-Star in Knee
Replacement
5-Star in Total
Joint Replacement

Spine Marketing Efforts
• Brochure
• Community Seminars
• Website
• Peripheral Materials

OFC Marketing Efforts
• EMS
• Community Outreach
– Seminars
– Churches
– Senior Centers
– Assisted Living
• SNF
– Inservices
– OFC Coordinator
•Development of
Osteoporosis Program
•Peripheral Materials
•HealthGrades
•Media Coverage

“Take me to St. Francis” Brochure

• HURT Line (864-675-HURT)
• Outpatient surgical patient T-shirts with “Life is a Sport” theme
• Program ads – High Schools, Furman, North Greenville
• Faith characters and associated ads, magnets, giveaways
• Comprehensive website
• Program literature and other peripheral materials
• GO Magazine
• Message on hold
• Webinars
• Banners
• E-newsletter
• Collaborative events with corporate partners
• DVD through Clemson Sponsorship
• Community Service Announcements
• Success stories postcards
• Sales Package
• Sponsorships
• “Not all athletes wear jerseys” campaign
St. Francis Marketing Department Responds to
Sports Medicine!

Team Sponsorships
Greenville High Rugby
CESA
Greenville Griffins
Adult Rugby League

• Secondary Audience – Student Athletes

St. Francis Combine Challenge
Awards Ceremony 12/07
St. Francis Sports Performance Challenge
Awards Ceremony 5/08

The Word is Out
2009 – 2016
• Becker’s Hospital Conference: Chicago, IL
• HealthLeaders Media Magazine
• IHI Conference: Nashville, TN
• ACI Conference: Dallas, TX
• HCPro Webinar on Joint Replacements
• Marshall Steele Summits: Chicago / Orlanda
• HCPro Webinar on Service Line Marketing
• Marshall Steele Book
• Sg2 Webinar on Hip Fracture
• Bon Secours Health System: Richmond, VA
• Chief Marketing Officers’ Innovator’s Studio: Chicago, IL
• Sg2 Conference, San Francisco, CA
• Stryker Performance Solutions, San Antonio, TX
• SharePoint HealthGrades Symposium: Miami, FL
• Sg2 Executive Summit: Washington, DC
• HealthGrades Webinar on Volume to Value
• OrthoServiceLine.com
• Wall Street Journal Article-Hip Fractures

• The key is a combined effort marketing the overall identity/co-
branding while not losing the current marketing strategies of the
individual centers of excellence
• Communicate the quality accolades, differentiators, outcomes,
and value to:
1. The public
2. Business community
3. Third-party insurers
4. BSMG & other physicians
• Emphasize Regional Presence
Future Marketing

• SC MedTransTech Program (Clemson Biomedical Engineering Research)
• Latest Technology
– New cervical cages
– Patient specific knees
– Patient specific hips
– Ankle replacements
Future Vision for
Peripherals/Innovation

• Quality / Outcomes / Value will be the “Tip of the Spear” for differentiation
• Quality / Outcomes / Value will be the future of marketing and steerage
• Mid-Level Practitioner in Preassessment for Joint Replacement and Spine
• Potential Outcomes Tracking:
– SF 12, Lower Extremity Functional Scale, DASH, Oswestry, Stryker
Performance Management & Outcomes
– OBERD or similar tool for outpatient orthopedic surgery
– Create outcomes measures, track, and publish
Future Vision
Quality/Outcomes/Value

• Bundling
• Episodic Care
• Aetna & BCBS
• Industry
• Workers Comp
• Preferred Insurance Steerage
• Surgical Tourism (i.e. BridgeHealth)
• ACOs
Future Vision / Positioning
for Regional Center of Excellence

The Experts Say…
Sg2 -- Marshall Steele & Associates -- HealthGrades -- Premier
“The vision of most orthopedic hospital programs is to become where St. Francis is now.”
“Most hospitals that have orthopedic services dream to be where St. Francis is currently,
and your future plan is visionary.”
“St. Francis is at the top and is one of the best programs in the country, and your model
takes you even further.”
“The Future Vision for the Orthopedics & Spine Service Line at St. Francis is one of the most
clear, concise visions we have ever seen.”

Vision in a Nutshell
• Maintain and seek continuous operational improvement in our current COE
programs: Joint Camp; OFC; Spine Care Center; Sports Medicine
• Manage current and future programs and services around the four service line
pillars:
Quality/Outcomes; Service/Satisfaction; Volume/Market Share
Growth; and Cost
• Develop future COE programs in Foot & Ankle, Osteoporosis, and Shoulder
Replacement
• Implement outcome measures in both inpatient/outpatient surgery

• Focus efforts around Patient Centered Coordination of Care and Transition of Care
• Package our product to become preferred provider (Bundling, Episodic Care,
ACOs, Industry, Centers of Distinction, Preferred Insurance Sites, and Surgical
Tourism)
• Create Overall Umbrella Identity and Co-branding
• Market new identity and co-branding utilizing a unified strategy while maintaining
marketing for individuals subspecialties. Quality, Outcomes, Differentiation &
Value are the “tip of the spear.”
Vision in a Nutshell

Thank you for your attention.
William E. Munley
Vice President of Orthopedics, General Surgery
& Professional Services
Bon Secours St. Francis Health System
Bill_Munley@bshsi.org
(864) 449-3386

115
Streamlining Orthopedic Patient Pathways
www.wellbe.me/CJR

A Volume To Value Ortho Service Line Model

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