The Sutter Medical Network: Nearly 5,000 physicians focused on care around the patient.

Transcription

1 The Sutter Medical Network: Nearly 5,000 physicians focused on care around the patient. 1

2 About the Sutter Medical Network Our Mission The Sutter Medical Network provides a leadership role in the development of a physician and provider network, coordinating patient care as well as creating a culture of quality, service and affordability throughout the Sutter Health system. Our Standards Physician organizations commit to these five performance standards for participation in the SMN: Quality pay for performance Patient satisfaction Reducing patient wait times Patient enrollment in online services Involvement in clinical variation reduction projects Electronic physician communication 2

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4 One driver = physician practice patterns the power of the pen 4

5 5 Prices displayed are not actual, but standardized.

6 How it works 1. Face-to-face,facilitated meeting of 5-15 clinicians Explore visual data as a group Personal feedback on variation Stimulates curiosity and learning 2. Select focus area Agree on new clinical standard Define performance metrics 3. Monthly metrics Measure & report ongoing improvement efforts 6

7 Clinical Variation Reduction Process A face-to-face, facilitated meeting with a department where unblinded, individual clinician data is shared in a safe environment Variation Reduction Standard(s) are developed by the clinicians at this meeting A Variation Reduction Standard is a specific clinical decision or behavior at the point of care that clinicians develop together The Variation Standard becomes a project and clinicians change their behavior as soon as the next day 7 Some examples: prescribe generic instead of a brand medication order or not order diagnostics perform or not perform a procedure

8 In the last 24 months, The Results 105,883 patients were touched by Variation Reduction through the involvement of 712 clinicians. Since inception, savings from variation reduction projects has totaled over $30 million across the medical network. 8

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10 Variation Reduction Success Stories 10

11 Success Story: Hypertension 11

12 12 David Duncan, M.D., Family Medicine Lodi Avenue Care Center, Lodi, CA

13 13 Topic Selected: Hypertension

14 Lodi Family Practice ARB Prescribing 14 Prices displayed are not actual, but standardized.

15 15 Lodi Internal/Family Medicine: Preferred ARB Prescribing Rate Project Start Date: Mar 01, 2011 P - Chart

16 GMG Lodi Internal/Family Medicine Average ARB Cost Per Month-Long Supply Project Start Date: Mar 01, 2011 I - Chart 16 Prices displayed are not actual, but standardized.

17 GMG Lodi Internal/Family Medicine Percent on an ARB at Goal for Blood Pressure Project Start Date: Mar 01, 2011 P - Chart 17

18 18 Prices displayed are not actual, but standardized.

19 19 GMG Lodi Internal/Family Medicine: Preferred ARB Prescribing Rate Preferred: Losartan Non-Preferred = Diovan, Micardis, Benicar, Avapro, Atacand

20 Success Story: Knee Injections 20

21 21 Todd Smith, M.D., Orthopedics Modesto, CA

22 Topic Selected: Knee Injections Topic Selected: Knee Injections 22

23 Cost and Volume for Gel Injection Cycles Sutter Gould Medical Foundation 23 Prices displayed are not actual, but standardized.

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25 Gould Medical Group, Modesto Orthopedics: Preferred Gel Injection Rate Project Start Date: Apr 04, 2011 P-Chart Preferred Gel Injection Rate shoots up after Orthopedists decide to switch to SynviscOne 25

26 Gould Medical Group, Modesto Orthopedics: Average Cost of Gel Cycles Project Start Date: Apr 04, 2011 I - Chart Average cost of gel injections falls from $722 to $638 reducing spend by $46, Prices displayed are not actual, but standardized.

27 Gould Medical Group, Modesto Orthopedics: Preferred Gel Injection Rate Project Start Date: Apr 04, 2011 P-Chart 814 appointment slots are freed up because SynviscOne requires one visit instead of three 27

28 Success Story: Reducing Variation in the Evaluation of Postmenopausal Bleeding 28

29 29 Beth McClure, M.D., Ob-Gyn Sacramento, CA

30 Three Ways to Evaluate Postmenopausal Bleeding Ultrasound Endometrial biopsy Hysteroscopy $$ $$ $$$$ 30

31 31 Prices displayed are not actual, but standardized.

32 Hysteroscopy rate 14% 9% $18,000 saved 32

33 33 Project Spread

34 Success Story: Reducing Variation in the Treatment of Actinic Keratosis 34

35 35 Karen Nishimura, M.D. Dermatology, Roseville, CA

36 Actinic Keratosis Cryotherapy Topical 5-FU cream 36

37 Treatment Options for Actinic Keratosis 37 Prices displayed are not actual, but standardized.

38 38 Prices displayed are not actual, but standardized. Hold for tnt of AK

39 Percent treated with 5-FU: 11% 9% Savings: $80, Prices displayed are not actual, but standardized.

40 40 Malaika Stoll, M.D., Department Chair Primary Care East Bay Physicians Medical Group

41 Documenting Advance Directives / POLST in Epic 30% of Medicare expenditures are for care delivered in the last year of life Advance Directives or POLST documents help ensure patient centered care at the end of life Some physicians in East Bay Physicians Medical Group make end-of-life discussion part of their routine practice while others have room to improve 41

42 Primary Care: Advance Directives EBPMG Primary Care: Percent of Patients Aged 65 and Over with POLST or Advanced Directive Scanned

43 Primary Care: Advance Directives EBPMG Primary Care: Estimated Savings from Increase in Percent of Patients Aged 65 and Older with Adv Dir or POLST Cumulative Savings $165,000 Prices displayed are not actual, but standardized.

44 44 Gary Misslbeck, M.D. Project Lead Urgent Care Gould Medical Group

45 Imaging for Abdominal Pain From April 2012 through March of 2013, 21% of patients with abdominal pain in the urgent care setting received either a CT Scan or X-Ray. 45

46 46 Prices displayed are not actual, but standardized. Abdominal Pain Average Cost For Ancillary Services

47 47 Abdominal Pain Percent of Patients with CT Scans

48 48 Abdominal Pain Percent of Patients with X-Rays

49 Use of Imaging Studies in the Management of Abdominal Pain Standard For patients with a diagnosis of abdominal pain, the urgent care department committed to doing less imaging and developed the following local standard: The use of CT scans should be based on the clinical condition suspected. The use of X-Rays rarely provides useful additional information in abdominal pain. 49

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52 52 Imaging rate before/after by MD

53 Behavior Impact of Project GMG Urgent Care: Percent of Patients with Abdominal Pain who Received an Imaging Study Project Start Date: Jun 12, 2013 P-Chart Project start 53

54 Financial Impact of Project GMG Urgent Care: Average Imaging Cost for Patients Evaluated for Abdominal Pain Project Start Date: Jun 12, 2013 I - Chart Project start 54 Prices displayed are not actual, but standardized.

55 Work In Progress 55

56 INPATIENT & ED DIAGNOSTIC ORDERING 56

57 Variation by Facility

58 Rate of ordering of CT by ED physicians 58

59 TIMING OF DISCHARGE ORDERS 59

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61 61 INPATIENT LAB ORDERING

62 Hospital Medicine 1. Don t place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for noncritically ill patients 2. Don t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications. 3. Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke. 4. Don t order continuous telemetry monitoring outside of the ICU without using a protocol that governs continuation. 5. Don t perform repetitive CBC and chemistry testing in the face of clinical and lab stability. 62

63 CBC, Metabolic panel Repeat daily until discharge

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67 67 BLOOD TRANSFUSIONS

68 To transfuse or not, is the question PRBC Sequence Asc DRG Count of Hemoglobin Order Result (Numeric) 1400 Hgb Value Just Before Transfusion of PRBCs Do transfuse Hgb 7.9 or less Hgb 8.0 or more Don t transfuse Hemoglobin Order Result (Numeric) 68

69 69 Transfusion Guidelines?

70 70 TELEMETRY

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72 Reactions from Physicians I haven't had this much fun since residency I have been waiting for this for ten years That was a lot more fun than I expected from the title of the meeting When are you guys coming back? 72

73 73 DETAILED TRACKING

74 Which projects were effective? Success Measure Name Reporting Period Baseline Rate After Rate Current Rate Reduced Spend 74

75 75 Library of 350+ Projects

76 For More Information Please contact: Michael van Duren, MD, MBA Vice President, Sutter Medical Network (916)