Why do we need to improve value?

Transcription

1 Value Improvement

2 Why do we need to improve value? Clinics Physician Compensation Ambulatory Surgery Center Genomic Medicine BCHO Ambulatory Affiliate Partnerships International Medicine Weill Neuroscience Institute Proton Therapy New Hospital at Parnassus PCMB Digital Innovation Cancer Regionalization Infusion Services 2

3 UCSF Key Cost Drivers UCSF Health FY18 Operating Budget: $4.2B 3

4 UCSF Health Value Improvement Plan Value Improvement ($ in millions) Entity Bud `17 Bud `18 `19 `20 `21 `22 Total Planned Savings `17-22 Medical Center $309 Faculty Practice 7 $7 Langley Porter 3 $3 BCHO Turn-Around Plan $40 Totals $81 $105 $96 $34 $21 $21 $

5 FY18 West Bay Value Improvement Initiatives 76 Value Improvement Initiatives # of Initiatives by Net Benefit 189 Total <$0 $0 - $100k $100 - $250k $250k - $500k $500k - $1M $1M - $2M >$2M 189 initiatives, including 136 cost reductions ranging from $880 to $6.6M 50+ initiatives with budgeted net benefits of $250K+ 12 initiatives deliver > $2M in net benefit for a total of $50M 21 initiatives with negative net benefit 5

6 FY18 West Bay Value Improvement Plan Highlights Cost Reductions: Supply standardization, contracts, professional services, labor management Clinical Pathways: Reducing unnecessary variation and service utilization Revenue Optimization: Improving charge capture, revenue reconciliation, pre-authorizations, clinical documentation Asset Utilization: Utilizing current assets more efficiently, utilizing new assets for net benefit 6

7 Target (Periop Pathways Example) Total targeted savings: $2.7M By June 2018: save 1,170 bed days through reduction in LOS ($1.5M); and backfill with 123 incremental cases ($1.2M) Impact âcost Intermediate Outcomes LOS Opioid Reduction Process Metrics áambulation ámultimodal Analgesia áquality Outcomes SSI Patient Experience Bowel Prep Pre-admission Education

8 Tactics (Safe Transition Pathways Example) Measurement Satisfaction Patients 6L/PACU Nurses Outcomes LOS Costs Adverse Outcomes Systems APeX Dedicated APeX addendum sets based on level of care Eligibility pop-up? Weekly case list communication Education Patient Pamphlets Tumor Chiari Workflows Surgeons Residents NPs 8

9 Measurement (Age Friendly Inpatient/ Delirium Example) Patient Experience Quality & Safety Our People Financial Strength Strategic Growth Learning Health System 93% of pts enjoy ACEercise Volunteers average 43 visits/month Ortho Bundled Payment discharges home Delirium days (per 1000 pt-days): -all UCSF: 95 -ACE: 342 -Hip Fx: % compliance with NuDesc 96% compliance with AWOL 42% compliance with orderset 85% of RNs felt delirium screening helped them take better care of pts Sent >100 Delirium thank you cards $150,000 $100,000 $50,000 $0 ($50,000) ($100,000) ($150,000) ($200,000) ($250,000) Cont to focus on $ loss on fracture pts Fx w/ MCC Q1: LOS in delirious pt by 1.1 days ( 10%) ACE pts: 4-8 daily Hip Fx: 0-4 daily Fx w/o MCC Delirium training: all units RN, PCA, rehab, pharmacy 5 Grand rounds 20 faculty/ resident trainings 10 hearing loss, unit based table top sessions 39 RN CE Delirium modules completed FY16 Variance FY17 Variance 9

10 Measurement (Central Line example) July 17 through Dec 17: 4 PCXR 10 patients 5 PCXR 7 patients 6 PCXR 1 patient 7 PCXR 3 patients In 3 weeks 46% reduction of confirmatory CXRs related to PICC placements. 92% reduction of time from insertion to release. Reduction of PICC insertions 10

11 Visibility/ Tracking Initiative/ Executive Sponsor FY18 Budget Q1 Actual Q2 Actual Q3 Forecast Q4 Forecast FY18 Actual + Forecast FY18 Actual + Forecast better/ (worse) than Budget Alan $ 4,223,948 $ 1,869,270 $ 2,454,958 $ 1,790,696 $ 1,790,696 $ 7,905,620 $ 3,681,672 Mt. Zion Infusion Center Expansion $ 1,903,226 $ 443,269 $ 79,013 $ 677,462 $ 677,462 $ 1,877,205 $ (26,021) MB Infusion Center Expansion $ 1,320,721 $ 436,807 $ 608,288 $ 613,234 $ 613,234 $ 2,271,563 $ 950,842 Rad Onc Revenue Cycle Improvements $ 1,000,000 $ 989,195 $ 1,767,657 $ 500,000 $ 500,000 $ 3,756,852 $ 2,756,852 Barrie $ 288,000 $ 131,847 $ 111,601 $ 107,327 $ 107,327 $ 458,101 $ 170,101 Revenue Optimization (in lieu of Lab lost charges) $ 288,000 $ 131,847 $ 111,601 $ 107,327 $ 107,327 $ 458,101 $ 170,101 Cynthia $ 1,000,000 $ 478,327 $ 173,891 $ 173,891 $ 173,891 $ 1,000,000 $ - Consultant Utilization $ 1,000,000 $ 478,327 $ 173,891 $ 173,891 $ 173,891 $ 1,000,000 $ - David $ 950,750 $ 70,148 $ 69,697 $ 719,599 $ 152,926 $ 1,012,370 $ 61,620 Be Smart About Safety $ 500,000 $ - $ - $ 561,620 $ - $ 561,620 $ 61,620 Occupational Health $ 450,750 $ 70,148 $ 69,697 $ 157,979 $ 152,926 $ 450,750 $ (0) Joe $ 2,325,110 $ 532,292 $ 292,785 $ 335,965 $ 753,185 $ 1,914,227 $ (410,883) IT Sourcing Savings $ 2,325,110 $ 532,292 $ 292,785 $ 335,965 $ 753,185 $ 1,914,227 $ (410,883) Josh $ 12,123,179 $ 3,906,968 $ 6,831,586 $ 2,737,260 $ 3,461,096 $ 16,936,910 $ 4,813,731 Periop Pathways $ 2,175,214 $ 396,844 $ 555,952 $ 772,198 $ 772,198 $ 2,497,192 $ 321,977 Clinical Services Professional Fee Reduction $ 1,400,000 $ 457,588 $ 857,517 $ 165,858 $ 455,063 $ 1,936,026 $ 536,026 Age-Friendly Health System - Inpatient $ 1,302,043 $ 195,965 $ 162,749 $ 87,151 $ 65,692 $ 511,556 $ (790,486) Delirium Reduction $ 1,095,045 $ 923,305 $ 530,346 $ 273,761 $ 273,761 $ 2,001,173 $ 906,129 Safe Transitions Pathway $ 1,200,000 $ 81,413 $ 50,862 $ 140,000 $ 217,500 $ 489,775 $ (710,225) 11

12 FY18 Q1-Q2 Results & Q3-Q4 Forecast Value improvement initiatives are exceeding the expected Q1-2 target and the FY18 forecast indicates that we are on track to exceed the annual goal. However, risk remains and continued engagement is needed, especially in light of Q3-Q4 forecasts. 12

13 Looking Ahead: FY19 Value Improvement Category Millions Revenue Optimization 40 Labor Management 20 Supply Chain/ Implant Variation Reduction 15 BCHO Turnaround 10 Clinical Pathways/ Variation Reduction Adult 5 Children s TBD Pharmacy 4.5+ East/ West Bay Value Improvement Goal

14 FY19 Value Improvement: Revenue Optimization Working Groups 1. Faculty Practice 2. Med Center Charge Capture/ CDM 3. BCHO Rev Cycle 4. Insurance Proper Payments/ Payment Variance 5. Eligibility/ Authorizations/ Denials 6. Back-End Billing: Improve patient collections and reduce controllable write offs 7. CDI Coding 8. LPPI 14

15 FY19 Value Improvement: Clinical Programs 1. Delirium Reduction 2. Age Friendly Health System 3. Heme Malignancy 4. Periop Pathways Colorectal Ortho/Neuro spine C-section Arthroplasty Gyn/Gyn Onc Hepatobiliary Cystectomy OHNS Free Flap 5. Outpatient Palliative Care 6. Heart & Vascular on 10CVT 7. TBD Pediatrics 15