Co ontrolling Dev vice an Imp nd plant C Costs

BAC CKGROU UND

Cardi iac,orthopedic,andspin nalimplantsareoneoft themostimportantmed dical innov vationsofth heera.Continuedadvancementsinm materialsan nddesign,co oupledwith anag gingdemographiclivingphysicallyac ctivelifestyles,isexpect tedtoincrea asethe dema andforthese eimplantsa atadoubled digitratefor rtheforesee eablefuture. .Although theA AmericanAca ademyofOr rthopedicSu urgeonsrepo ortsthatthe epopulationofpeople aged65andolde erstillreceiv vesthelions sshareofkn neeandhipi implants,the enumberof f suchproceduresperformedonyoungeradultscontinuestogrow weachyear.

WHA IS TH BUSIN AT HE NESS PRO OBLEM?

High dollarimpla antstypically yrepresentt theorganiza ationssingle elargestexp pensefor cardiology,ortho opedic,ands spinalprocedures.Inso omeinstitutionsthesepurchasescan n excee ed70percen ntofthetotalsupplyexpenditure.Ifleftunchecked,curren nt proje ectionsindica atetheycou uldincreasesupplyandr relatedexpe ensesforhospitalsfrom anav verageof30percenttom morethan5 50percentoftotalopera atingexpens sesby2015. Often n,theperson nmakingthe epurchasing gdecisionfo orthesedevi icesisthein ndividual Surge eon.Surgeo onsdecisionsarefreque entlybasedo onfactorsno otrelatedto ocostthat mayreflecttheirpersonalex xperiencean ndfamiliarity ywithapart ticularprodu uct,their asses ssmentsofaparticularp patientsinte erests,aswe ellastheirre elationshipswith manu ufacturersrepresentativ ves.Thisma ayleadtoad disconnectb betweenthehospitals costc containment tgoalsandt thephysician nspreferen nces(PPIs).A Arecentsurv veyofone hund dredhospital lsrevealedt thatthepricesforthesa amedevicem mayrangeb between $2,00 00and$9,00 00.Infact,onehospitalintheNewY YorkCityare eapaid$8,00 00more thanthatpaidby yacompetitorforthesa ameartificialhipdevice. . Medi icarespercasepaymen ntbasisusing gdiagnosisr relatedgrou ups(DRGs)is sintendedto o cover ralltheserv vicesprovide edbytheho ospital,includ dingthecostofdevicesusedin surge ery.Butwhilepricesfordeviceshavebeenincre easing,Medi icaresperc case paym mentsforsom mesurgicala admissionsh havebeendecreasing.T Toillustrate, manu ufacturersp pricesforart tificialknees sandhipsha aveincreasedanaverage eof8 perce entperyear.Atthesametime,Med dicarespercasepaymentstohospitalsforsome inthisgroupfellbymoretha an9percent toverafive yearperiod. Thisd dilemmaisn notlostonp policymakers s,andtheMedicalPaym mentAdvisory Comm mission(MedPAC),estab blishedtoad dviseCongre essonissues saffectingth heMedicare e progr ram,hasadd dressedthechallengeso ofpricingfor rexpensiveitemssucha asstents, pacem makers,and dimplants.M MembersofMedPACrec cognizethatitisnotfeasiblefor Medi icare(orpriv vatehealthp plans)toend dorseaparticulardevice e,especiallywhen thera apeuticequiv valentsarea available,asthiswouldbeseenasil llegallyenteringthe

practiceofmedicine.Instead,MedPAChasrecommendedthathospitalswork aggressivelywiththeirmedicalstaffstostandardizetheiruseofmedicaldevicesandto securelargerdiscountsfromsuppliers.

HOW ARE HOSPITALS APPROACHING THE PROBLEM?

Anumberofinstitutionshavealreadyinitiatedprojectsattemptingtoprovidesome levelofcontroltothesupplycostsassociatedwithOrthopedic,CardiacandSpinal Surgeries.Theseprojectstakeonanumberofdifferentformsbutoftencontainthe followingsteps: DataCollectionandAnalysisAggregatetheinformationnecessarytoanalyzeimplant usagepatternsandvariationsincostsforsimilarprocedures.Thisinformationrequires consolidatinginformationfromseveralsourcessuchasbilling,costaccounting, materials,clinicalandpossiblyothersystems. BenchmarktoExternalDataCompareyourdatatoNationalandRegionaldatato determinethesizeoftheproblemandalsoestablishabasisofunderstandingwithother peopleinsidetheorganization. InvolveKeyStaffMembersShareinformationwithmedicaldirectors,highvolume deviceusers,andphysicianswhoarerespectedleadersinthehealthsystem,togettheir buyin.Oftenthesearethepeoplethatarespeakingtothesuppliers.Ifthesuppliers recognizetheyareawareofthecostsitcanbeeasiertochangeprice.Somehospitals haveformedservicelineprofitabilitycommitteestoapproachtheproblemfromacross functionalperspective. CometoConsensusonaPreferredSupplierListAtsomepoint,allcontractsare volumebased.Identifyopportunitiesforreducingthenumberofimplantdevice options,Suppliersandcontractsasameansofreducingperunitcosts. MonitortheProcessContinuetomonitorcontractcompliance,costtrendsandquality andsafetyinformationtoensurethatobjectivesarebeingmetandasawaytoidentify additionalopportunitiestoimprove. OngoingEvaluationofNewSuppliersandDevicesCreateaprocesstoapprovenew devicesastheybecomeavailablewhennecessaryandbeneficial.Chargingapremium fornewdevicesthatarentincludedonacontractisoneofthewaysthatsupplierscan subvertcontractterms.However,technologiesconstantlyevolveandusingnewdevices maybeappropriateinmanycases.Maintainingphysiciansupportandgivingthe physiciancommunityownershipandresponsibilityinthisprocessiscriticaltoachieving results.

HOW CAN DI HELP?

AtthecoreofanyProjectthatattemptstoaddressthisproblemisanInformation Systemthat: Collectsdatarelatedtothesecases. Integratesandtransformsthedataintoactionableinformationandreports. Sharesthisinformationwithkeymembersoftheprojectteam.

DimensionalInsightwillworkwithyourhealthcareorganizationtocreateagroupof regularlyscheduledelectronicfeedsfromyoursourcesystems.Thesefeedswould include: CaseLevelAdmitandDischarge,Financial(Charges,Costs,Payments),and DemographicInformation ChargeDetailChargeItems,RevenueCodes,Quantities,ChargesandCosts PurchasingCaselevelimplantpurchases BenchmarkingExpectedMortality,Complications,ReadmissionsandLengths ofStay PatientSatisfactionSurveyResponsesrelatedtothehospitalstay SurgerySurgeryStartandStopTimes,Preop,IntraopandPostop CoreMeasureCaseLevelinformationrelatedtocompliancetoSCIPMeasures. ThesefeedswillthenbeintegratedandpresentedusingourInteractivePortal TechnologyallowingyourorganizationtoanalyzeandmonitorImplantusagewithinthe System.Werecognizethatsomeinstitutionsmaynotbeabletocreateelectronicfeeds inalltheseareassothePortalwillincludeanInputfunctionthatwillallowyouto directlyenterinformationwhenrequired. ThePortalwillsupportAnalysisinthefollowingAreas: Utilization HistoricalreportingthatletsyouanalyzeCaseVolumes,TotalCostsperCase,Supply CostsperCase,andLengthsofStaybyEntity,ProcedureGroup,ImplantSupplier, FinancialClass,PayerandSurgeon.Thesereportswillhelpnarrowdownyourlistof suppliersbyansweringthefollowingquestions: WhatImplantsarebeingusedinyourProcedures? WhichSurgeonsareperformingthemostProceduresandwhatImplantsarethey using? HowisImplantSelectionimpactingCostandProfitabilitypercase? HowdoyourCostsperCasevarybetweenEntities? HowdoyourCostsperCasecomparetobenchmarkdata? HowdoreimbursementsvarybetweenPayersfortheseProcedures?

OnceaPreferredSupplierlistisestablishedtheutilizationreportscanbeusedto monitorcomplianceandinsureprojectobjectivesarebeingmet. QualityandOutcomes OngoingreportingtohelpyouanalyzetheimpactofImplantSupplierselectiononsome ofyourkeyOutcomesMeasures.Thisincludes: ProcedureTimes,LengthofStay,MortalityRates SurgicalCareImprovementProjectCoreMeasureCompliance(SCIP) PatientSatisfaction ReadmissionRates ExceptionReporting ProvidevisibilitytoCaseswhereImplantSupplyChargesfallbelowaminimumamount fortheassociatedDRG.Thiscanhelpspotinvalidchargeitems,missingchargesand codingerrors. Thereportswillsupportdrilldowncapabilitytotheindividualcaselevel.Ifyouarea multihospitalHealthSystem,andhaveinstitutedaCorporatePatientIdentifier,then thePortalwillallowforasingleviewofPatientinformationacrossalllocations. ThePortalcomeswithaflexiblelayerofsecuritythatallowsyoutocustomizeviewsfor differentmembersoftheProjectTeamandcontroltheirlevelofinteraction.Team memberscanbeconfiguredwiththreedifferentlevelsofinteraction: CasualUsersUserscanviewreports,filterinformationusingpredefined dropdownboxes,andprintitordownloadthecontentsintoMicrosoftExcelTM. TheseneedsaremetentirelywithintheDivePortinterface. GeneralUsersIntendedforbusinessuserswhorequireaccesstoreportsand graphswiththeabilitytoperformjobspecificanalysis.Thisleveloffunctionality isdeliveredviatheWebandprovidesaccesstoreportsandchartswithinPortal interface,orusingourzerofootprint,browserbasedanalysisclient. PowerUsersIntendedfordeveloperswhorequireahighlevelofanalytical capability.Theseusersaccesspowerfulclientinterfacesanddevelopmenttools forcreatinganddeliveringreportinganddataanalysisapplicationstothe enterprise. Arecontractedproductsbeingused? Howdocontractbuycasescomparenoncontractcases? Arepaymentsinlinewithcostsandlevelofcare? Arecostgoalsbeingmet?