Pe rio pe rative Surg ic al Ho me DR RAMANI PE RUVE MBA F I - - PowerPoint PPT Presentation

Pe rio pe rative Surg ic al Ho me

DR RAMANI PE RUVE MBA F I RST COL ONI E S ANE ST HE SI A ASSOCI AT E S

Alig nme nt Strate g ie s- Physic ian/ Ho spital

 Development of a Physician Alignment Agreement should include these five elements:  An articulated vision that is strategic, patient-centered and quality driven.  A clear rationale for physician health system alignment, along with a description of

which physicians (or all) are part of the alignment.

 Establishment of roles and responsibilities for the affected physicians and health system.  Establishment of quantitative and measureable goals, along with an appropriate timeline.  A plan for the equitable sharing of economic gains and risks, that is defined up front.

Oppo rtunitie s

E xisting Ac c o unta ble Ca re Org a niza tio ns-I nte g ra te d Ca re Mo de ls Ho spital/ Physic ian c o llabo ratio ns- g ainsharing / share d saving s

• ppo rtunitie s

Go a l- c o ntro l Me dic a re pe r c a pita c o st g ro wth ra te thru c a re c o o rdinatio n and pro c e ss impro ve me nt alo ng the surg ic al c are c o ntinuum.

Ho w wo uld this wo rk

sha re d de c isio n ma king

c o o rdinate c are

I ntra -o p c a re po st-o p c a re

disc harg e planning

pa tie nt sa fe a nd sa tisfie d

PSH PCMH

da ta AQI NACOR

PSH-Disruptive I nno vatio n

 E

xte nsio n o f PCMH- 29% o f 2 trillio n he alth c are e xpe nditure s o n surg ic al c are .

 Ane sthe sio lo g ists as pe rio pe rative physic ians  Optimal pre o pe rative te sting and pre paratio n  I

ntrao pe rative e ffic ie nc y-L E AN

 I

mpro ve d patie nt satisfac tio n and e ng ag e me nt

 I

mpro ve d c linic al o utc o me s and fe we r c o mplic atio ns

 Applic atio n o f e vide nc e base d princ iple s  lo we r c o st fo r physic ia n pre fe re nc e ite ms  po st pro c e dural c are initiative s  c a re c o o rdina tio n a nd tra nsitio n pla nning -de c re a se re a dmissio n ra te s

Ane sthe sia Quality I nstitute -NACOR



Qualifie d Clinic al Data Re g istry- Data to impro ve pe rio pe rative pro c e sse s and impro ve patie nt safe ty



Pro mo te s Value in pe rio pe rative se rvic e s



Outc o me s- me asure s that matte r to patie nt. Po sto pe rative nause a and vo miting . Ade quate pain c o ntro l. T ime to re turn to no rmal ac tivitie s



Co st- De c re ase le ng th o f stay. Standardize pre o pe rative te sting . De c re ase c ase po stpo ne me nt/ c anc e llatio n rate s. Diminish de lays in flo w alo ng the e xpe c te d arc o f pe rio pe rative c are .



AQI data will se rve to pro mo te be st prac tic e s in pe rio pe rative c are

E xample s-Hip frac ture pathway



Cre atio n o f Ane sthe sia sc re e ning and triag e pathway fo r patie nts with hip frac ture s. DO O R T

O O R in 36 hrs. Co o rdinate thru HI

E / CRI SP/ PCMH to e liminate te st duplic atio n/ pre ve nt re admissio n/ future fall pre ve ntio n

• ptimize

L E AN

e liminate duplic atio n

HI E CRI SP de c re ase

c anc e llatio ns

E xample -Co lo re c tal E nhanc e d Re c o ve ry Pathway



Studie s at Mayo Clinic c o nfirm impro ve d patie nt satisfac tio n and de c re ase d le ng th o f stay by instituting fluid manag e me nt strate g ie s, ag g re ssive pain c o ntro l, and e arly ambulatio n. E RP’ s fo r minimally invasive c o lo n surg e ry have be e n sho wn to spe e d the re c o ve ry o f bo we l func tio n and de c re ase ho spital le ng th o f stay by 24 ho urs. At Shady Gro ve Me dic al Ce nte r patie nts e nro lle d in this pathway will be g in ambulating the e ve ning

• f surg e ry and be g in a so ft die t o n po st-o p day two . We antic ipate that

patie nts will be disc harg e re ady o n po st-o pe rative day 3.

PSH-T riple Aim



Minimize re admissio ns Be tte r He alth



Minimize c o mplic atio ns Be tte r Po pulatio n He alth



E vide nc e Base d Care L

• we r Co st