Imaging InstituteData Driven Operations ManagementSIIM ConferenceNational Harbor, MD3 June, 2018

Goals• Review established data and reporting for use in operations

of diagnostic imaging

• Provide insight into emerging information, data use and reporting within a dynamic health system

• Discuss future information and data requirements to successfully manage in a rapidly changing market

Cleveland Clinic Imaging Institute• Blended sub-specialty academic and general radiographic practice

• Exclusive provider of professional radiology services to the Cleveland Clinic Enterprise

• Centralized management of all diagnostic imaging services

• Staffing

Professional Staff 222Cleveland Clinic – Allied Health

Technologists 488Nursing 102

Allied Health – Region & Florida 451 Administrative/Support Personnel 186

Total Personnel 1,449

Volume & Access Data

Established Volume Measures

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2012 2013 2014 2015 2016 2017

5 Year Volume Trends

Main Campus RMP Outside Hosp E-Rad

Source: Syngo Workflow

0

100,000

200,000

300,000

400,000

500,000

600,000

Main Campus Regional MedicalPractice

Regional Radiology Total Imaging

2018 2018 Budget 2017

Budget Variance -3.05%

Growth -0.05%

20182018

Budget 2017 Bud Var. Growth

Main Campus 134,436 139,091 129,992 (4,655) 4,444

Regional Medical Practice 115,434 103,839 116,335 11,595 (901)Regional Radiology 311,043 335,623 314,859 (24,580) (3,816)Total Imaging 560,913 578,553 561,186 (17,640) (273)

Emerging Volume MeasuresExam Volume Trend

5,000

5,500

6,000

6,500

7,000

7,500

8,000

8,500

9,000

120,000

130,000

140,000

150,000

160,000

170,000

180,000

190,000

Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18

Per B

usin

ess

Day

Vol

ume

Mon

thly

Exa

m V

olum

e

Monthly Volume Per Bus. Day Linear (Per Bus. Day)

Emerging ACO Leakage

Source: CC ACO Attributed Lives Outcomes

Future Volume Measures• Utilization by referring service

• Utilization by referring provider

• Appropriateness stratified volumes

• All referrals leakage

Service Level Data

Executive Monthly Operating ReviewMonth 2018 Year To Date

Patients First Status Mar Feb Jan Actual Target StatusSerious Safety Events: Total 0 1 0 1 0 Percentile: Overall Rating of Care - Imaging 58th 50th 44th 51st 90thCT Brain Attack Turnaround: Exam < 20min 98.00% 97.00% 96.00% 98.00% 100.00%Inpatient Final Report Turnaround (Hours) 4.9 4.3 3.7 4.3 6.0 Outpatient Final Report Turnaround (Hours) 5.7 5.1 5.2 5.6 6.0 ER Preliminary Report Turnaround (Minutes) 13.0 13.0 13.0 13.0 30.0 PICC Related DVT Rate 1.83 2.32 0.23 1.46 N/ADays Wait - OP PET/CT 4 4 3 5 5 Days Wait - Diagnostic Mammography 1 1 1 1 5 Days Wait - OP MR 2 3 2 2 6 Inpatient Advanced Directive % 0.00% 80.00% 33.30% 37.77% N/A

Month 2018 Year To DateCare Givers Status Mar Feb Jan Actual Target StatusBloodborne Pathogen Exposures (Count) 0 1 4 7 N/A

Month 2018 Year To DateAffordability Status Mar Feb Jan Actual Target StatusEBIDA Margin 53.70% 51.50% 57.10% 54.20% 55.60%wRVU Percentile 53rd 53rd 57th 54th 60thImaging Cost per Exam $182.54 $185.13 $168.95 $178.69 N/A

Source: CC Enterprise Business Intelligence

Professional Report Turn Around

Source: Syngo Workflow & Nuance Radwhere

March 2018

Inpatient Benchmark 1st Signoff : 360 Minutes / 6 Hours Outpatient Benchmark 1st Signoff : 360 Minutes / 6 Hours Emergency Benchmark 1st Read : 30 Minutes

CountComp. Rate

Stat Count

Facility STAT Comp Rate

<=30Mean Mins.

Mean Hrs.

Median Mins.

Median Hrs.

STD. DEV Mins

STD. DEV Hrs. Count

Comp. Rate

Stat Count

Facility STAT Comp Rate

<=30Mean Mins.

Mean Hrs.

Median Mins.

Median Hrs.

STD. DEV Mins

STD. DEV Hrs. Count

Comp. Rate

Stat Count

Facility STAT Comp rate

<=30Mean Mins

Median Mins

STD. DEV Mins

ASHTABULA COUNTY MEDICAL CNTR 676 94% 203 87% 94 1.6 18 0.3 279 4.7 3,409 94% 251 91% 223 3.7 19 0.3 1,347 22.4 1,875 93% 1,871 93% 17 5 175

CC AVON HOSPITAL 1,039 88% 489 66% 175 2.9 36 0.6 397 6.6 4,307 80% 158 67% 339 5.6 73 1.2 871 14.5 3,403 87% 3,394 87% 16 10 23

CLEVELAND CLINIC FLORIDA 3,856 85% 1,840 67% 481 8 48 0.8 2,403 40 14,051 79% 349 71% 453 7.6 79 1.3 1,420 23.7 3,781 80% 3,762 80% 28 13 140

CLEVELAND CLINIC - MAIN CAMPUS 19,806 86% 8,024 28% 295 4.9 114 1.9 1,552 25.9 58,855 84% 3,485 78% 340 5.7 71 1.2 1,007 16.8 8,285 91% 8,275 91% 13 7 46

EUCLID HOSPITAL 970 90% 377 84% 158 2.6 20 0.3 460 7.7 872 87% 51 90% 303 5.1 53 0.9 783 13.1 2,714 92% 2,714 92% 12 7 16

FAIRVIEW HOSPITAL 3,687 88% 1,726 72% 184 3.1 32 0.5 536 8.9 4,552 84% 176 76% 248 4.1 69 1.2 546 9.1 7,372 88% 7,370 88% 14 8 20

HILLCREST HOSPITAL 4,333 96% 1,473 80% 130 2.2 19 0.3 1,223 20.4 5,550 93% 277 88% 147 2.4 42 0.7 635 10.6 6,647 92% 6,632 92% 13 6 36

LUTHERAN HOSPITAL 595 93% 167 80% 99 1.6 29 0.5 225 3.8 1,409 88% 26 85% 225 3.8 62 1 656 10.9 2,165 90% 2,162 90% 17 7 121

MARYMOUNT HOSPITAL 1,618 96% 333 77% 113 1.9 26 0.4 650 10.8 1,623 92% 127 87% 193 3.2 32 0.5 1,048 17.5 3,016 89% 3,000 89% 18 8 178

MEDINA HOSPITAL 1,322 92% 238 75% 169 2.8 39 0.7 1,001 16.7 3,007 79% 127 72% 424 7.1 102 1.7 1,112 18.5 2,519 89% 2,512 89% 18 8 64

SOUTH POINTE HOSPITAL 1,458 92% 391 76% 119 2 26 0.4 353 5.9 1,618 79% 67 88% 637 10.6 39 0.7 1,426 23.8 2,361 91% 2,361 91% 13 7 29

Institute Total: 39,360 89% 15,261 50% 254 4.2 56 0.9 1,431 23.8 99,253 84% 5,094 79% 340 5.7 66 1.1 1,061 17.7 44,138 89% 44,053 89% 16 8 83

Institute STAT All Studies: 15,261 93% 142 2.4 31 0.5 1,003 16.7 5,094 98% 71 1.2 12 0.2 716 11.9 44,053 89% 15 8 77

Service ProvisionIP & OP TAT (Average Hours)

Source: Syngo Workflow & Nuance Radwhere

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

2013 2014 2015 2016 2017 Jan-18 Feb-18 Mar-18

TAT Target Compliance

CC IP CC OP Enterprise IP Enterprise OP

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0Average Hours

CC IP CC OP Enterprise IP Enterprise OP Goal

Service ProvisionED TAT (in Minutes)

Source: Syngo Workflow & Nuance Radwhere

0

10

20

30

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Report Turnaround TimeED (Average MINS)

CC ED Enterprise ED Goal

84.0%85.0%86.0%87.0%88.0%89.0%90.0%91.0%92.0%93.0%

2013 2014 2015 2016 2017 Jan-18 Feb-18 Mar-18

TAT Target ComplianceED

CC ED Enterprise ED

Future Service Level Measures

• Impact to care

• Impact to ALOS

• Impact to time to treat

2018 Financial Indicator Data

Established Financial Measures

50.0%

52.0%

54.0%

56.0%

58.0%

60.0%

62.0%

2014 2015 2016 2017 Q1 2018

EBIDA27.0%

27.5%

28.0%

28.5%

29.0%

29.5%

30.0%

30.5%

31.0%

2014 2015 2016 2017 Q1 2018

Realization Rate

EBIDA: Earning ratio to Net Revenue

Realization Rate: Net Revenue ratio to Gross Charges

Established Payer Mix Trending

46.5%

14.4%

39.2%

5.0%

15.0%

25.0%

35.0%

45.0%

55.0%

65.0%

Commercial Medicaid Medicare Linear (Commercial) Linear (Medicaid) Linear (Medicare)

Late 2019

Emerging Cost/Exam Trend

$125.0

$135.0

$145.0

$155.0

$165.0

$175.0

$185.0

$195.0

Cost/Exam 6-Month Moving Avg Linear (Cost/Exam)Source: Lawson Financials & Syngo Workflow

Established Productivity to Budget

Source: CC Labor Productivity Dashboard

97.0 97.5 98.0 98.5 99.0 99.5

100.0 100.5 101.0 101.5 102.0

Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7

Q1 2018 VisionWare Productivity - Imaging Enterprise

2018 Productivity 2018 Wage Index Target

2018 Productivity 2018 Wage Index YTD 99.2 99.1

Emerging Labor Efficiency to National BenchmarkingAction OI Productivity Q1 2018

Source: CC Management Engineering & Action OI Benchmarks

Action OI BenchmarkingActual FTEs 25th Quartile Variance

Imaging InstituteMRI 53.6 51.7 (1.8)CT 49.2 44.8 (4.4)Interventional 26.5 32.5 6.0 General Radiology 181.2 162.2 (19.0)Ultrasound 43.6 34.0 (9.6)Nuclear Medicine 27.7 28.5 0.8 Imaging Nursing 87.6 61.9 (25.7)Imaging Admin. 137.1 150.1 13.0

Total Imaging Institute 606.3 565.7 (40.6)

Regional HospitalsAvon Total 42.2 51.9 9.7 Euclid Total 25.3 26.9 1.6 Fairview Total 92.2 101.8 9.5 Hillcrest Total 85.3 99.2 13.9 Lutheran Total 28.0 24.5 (3.5)MMH Total 37.4 42.0 4.6 Medina Total 36.9 39.0 2.2 South Pt Total 27.8 31.0 3.3 Regional Nursing 37.1 10.4 (26.6)

Regional Hospitals Total 412.1 426.8 14.7

Imaging Enterprise Total 1,018.4 992.5 (25.9)

0.0

200.0

400.0

600.0

800.0

1,000.0

1,200.0

Imaging Institute Regional Hospitals Enterprise Totals

Action OI - Productivity Benchmarking

Actual FTEs 25th Quartile

ProductivityBudget Trending vs. Benchmark Trending

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

102.0%

Q12012

Q22012

Q32012

Q42012

Q12013

Q22013

Q32013

Q42013

Q12014

Q22014

Q32014

Q42014

Q12015

Q22015

Q32015

Q42015

Q12016

Q22016

Q32016

Q42016

Q12017

Q22017

Q32017

Q42017

Q12018

Actio

n O

I Per

cent

ile

Visi

on W

are

Prod

uctiv

ity S

core

Axis Title

FTE Based Productivity Productivity Target Action OI Productivity Benchmark Target

Care affordability

Source: CC Management Engineering & Labor Productivity Dashboard

Resource Utilization Data

Emerging MRI Utilization by Product Line

Source: Syngo Workflow & EPIC Cadence

Emerging MRI Utilization by Day of Week & Hour of Day

Source: Syngo Workflow & EPIC Cadence

Emerging MRI Utilization by Location

Source: Syngo Workflow & EPIC Cadence

Decision Making

OVE

RVIE

W

CT – Brunswick Urgent Care

Slots / Exams Tech FTE

Average Drive Time

1.54

7.9 minutes

3724 Center Road, Brunswick

78% CCF or Affiliated, 85% scans from Physician who orders to multiple CC locations

9,880 / 417

Tech EBIDA

$86,258

Equipment Profile

Hitachi CXR 4

Machine Hrs Total / Used

3,971 / 158

Realization

30.8%

Competition w/in 5 miles

SW General Brunswick SW General Strongsville

Pro: 100821407720Tech: 248824407744Centers

Charge / Exam$2,253

Rev/Exam

$694

KEY METRICS

b

Slot Utilization

Exam / FTE

Cost / Exam

Productivity 180 Day Volume Trend

HPU Peer Median

% from Median

4% 271 $487 1.159 0.233 -398% -17%

!!

!

! !

!

!

!!

!

!!

!

!

!

!

!

!!

!

!

!

!

!

!

!!

!!!

!

!

!!

!! !

!

!!!

!

!!

!!!

!

!

!

!

!

!

!

!

!

!!

!

!

!

!

!

!

!! !

! !

!

!! !

! !

!

! !!!

!

! !!! ! ! !

!

!

!!

!

!!

!

!(

44256

44044

44035

44281

44273

44090

44203

44275

44028

44050

44287

44333

44254

4423344280

44253

44141

44039

44235

44286 4426444212

44011

44133

44146

44319

44130

44067

44321

44223

44131

44145

4421744214

44138

44125

44074

44270

44136

44313

44147

44230

44054

44122

44149

44070

44880

44012

44052

44135

44320

44134

44105

44056

44128

44236

44142

44276

44109

44111

44216

44017

44055

44102

44129

44144

44107

44118

44120

44137

4410444116

44126

44314 44306

44053

44310

44140 44113

44301

44106

44224

44685

44215

44115

44001

4430744311

44127

441244410344114

44866

44121

4422

44139

44303

44304

44312

44302

44087

44022

44308

44805

Medina

Lorain

Summit

Cuyahoga

WayneAshland

Brunswick Urg Care Origin1 - 10

10 - 25

25 - 100

100 - 250

250 - 340

80% Market

Patient Source –Ordering Physician

Medina44256

44028

442334428044212

441334413644149

Brunswick Urgent Care – CTVolume Transfer

Brunswick – Urgent Care

Strongsville FHC (7 miles)

Medina Hospital (10 miles)

AlternateCCHS

Locations

Current Hours: 7:30AM to 5:00PM M-F

20%Loss 60%

20%

If CT removed from BUCC&

Patients were Re-Mapped to Closest Location

10 Minute Drive Radius

Brunswick UC

Strongsville FHC

Medina Hospital

Available Slots 9,880 9,672 69,888Exams 417 4,595 13,601Utilization 4.20% 47.50% 19.46%

2012 Volumes

Brunswick UC

Strongsville FHC

Medina Hospital

Available Slots 0 9,672 69,888Exams 0 4,843 13,686Utilization - 50.07% 19.58%

Projected Volumes (20% Loss to Competition)