graduate case presentation - tufts nemc
DESCRIPTION
Slide deck I created for a group presentation on a graduate level case study based on conditions surrounding Tufts NEMC circa 2003.TRANSCRIPT
Ford ConsultingTufts New England Medical Center
1
Belinda Degboe, Shawn Dilmore, Caitlin Motley, Kara Vass
• Internal and External Environment• Key Issues• Strategic Alternatives• Recommendation• Implementation• Conclusion
2
Overview
Current Strategy
Ellen Zane
3
4
• Threats
• Competition
• Third Party Payers
• Uninsured
• Opportunities
• Expansion
• Name Recognition
External Environment
5
• Weakness
• Sale of Assets
• Poor Margin
• Strengths
• Leadership
• New England Quality Care Alliance (NEQCA)
Internal Characteristics
6
Select Indicators
7
-54%
+16%
89.489.45.795.79 1.681.68
1.725.55.5 110.7110.7
Mass.gov 2008
Mission“We strive to heal, to comfort, to teach, to learn, and to seek the knowledge to promote health and prevent disease. Our patients and their families are at the center of everything we do. We dedicate ourselves to furthering our rich tradition of health care innovation, leadership, charity and the highest standard of care and service to all in our community.”
Tufts New England Medical Center
8
Strategic Alternative 1:Suburban Expansion
9
•Partner with New England Baptist for 190 Bed Expansion•500,000 square feet•$3,000,000 investment
•Advantages•Provides care conveniently to patients in community•Opportunity for increased market share
•Disadvantages•Other area hospitals planning suburban expansions, which increases competition•Requires a large capital investment
Rowland 2006
Strategic Alternative 2:Alignment with Tufts
University
10
•Strengthen the relationship with Tufts University•Standard meetings between marketing departments of NEMC and Tufts University•Strengthen brand to differentiate
•Advantages•Leverage position in market with name recognition
•Disadvantages•Loss of individual identity•Shared reputation•Difficult to quantify results•Cost
Strategic Alternative 3: Hospitalist Program
11
•Begin a hospitalist program•Hire 2 full time and 2 part time hospitalists•$666,000 for salaries, benefits, and malpractice
•Advantages•Improve efficiency•Improve quality•Cost savings•Incentive for PCPs and other academic physician staff
•Disadvantages•Employment resistance•Resistance from current physician staff•Difficulty recruiting physicians for employed model
Lurie and Wacher 1999. Tufts Medical Center 2008.
Recommendation:Two Pronged Approach
12
Hospitalists
• 1997 Study at Tufts
• Reimbursement structures
• Impact on patient care
• Financial effects
13
Operating Margin
Gregory, Baigelman, and Wilson 2003.
• $1.62 million added profits
• $185,000 plus benefits
• $90,000 added profit per hospitalist
Hospitalist Impact
14Gregory, Baigelman, and Wilson 2003. Laury and Wacher 1999. Merritt Hawkins 2005.
Marketing• Current marketing efforts
• Strengthen brand identity
• Positive association with Tufts Medical School
• Leverage marketing and differentiate
• Annual Costs of $475,000 over 2 years
15Anonymous 2009
Implementation Plan
Responsible parties: Administration, NEMC and Tufts University Marketing & Public Relations Departments, Human Resources, Physician Board, NEQCA, & Quality Reporting
Year 1: Base Year
Year 2
Year 3
Year 4
Year 5
Communication
22
Communication Channels: town meetings, weekly staff meetings, physician board meetings, various media
Conclusions• Alignment with values
• Financial benefit
• Competitive advantage
• Risk
23
Questions
24
ReferencesTufts Medical Center Website (2010). Our mission. Retrieved February 20, 2010 from http://www.tuftsmedicalce
nter.org/AboutUs/OurMission Patrick, D., Murray, T., Bigby, J., & Auerbach, J. (2007). Regional Health Status Indicators Boston Massachusetts. The
Commonwealth of Massachusetts Department of Public Health. Retrieved February 24, 2010 from http://www.mass.gov/?pageID=eohhs2searchlanding&sidEeohhs2&q=Regional+Health+Status+Indicators+Boston+Massachusetts&collectorName=EOHHSx
Pearson Education, Inc. (2008). Per Capita Personal Income by State. Retrieved February 23, 2010 from
http://www.infoplease.com/ipa/A0104652.html U.S. Department of Labor. (2006). Bureau of Labor Statistics: States with highest unemployment rates in 2005.
Retrieved February 23, 2010 from http://www.bls.gov/opub/ted/2006/mar/wk1/art01.htm Division of Health Care Finance and Policy (2005). Massachusetts Uncompensated Care Pool. Retrieved February 24,
2010 from http://www.umassmed.edu/uploadedFiles/ocp/MTF/12-01-05_ucp_101.pdf Moseley, G. (2009). Managing Health Care Business Strategy. Jones and Bartlett Publishers. Sudbury, MA Patrick, D., Murray, T., Bigby, J., & Iselin, S. (2008). Health Care in Massachusetts Key Indicators. Retrieved February
24, 2010 from http://www.mass.gov/?pageID=eohhs2searchlanding&sidEeohhs2&q=Regional+Health+Status+Indicators+Boston+Massachusetts&collectorName=EOHHSx
National Conference of State Legislatures [NCSL]. (2010). Certificate of Need: State Laws and Programs. State
Certificate of Need Laws 2006. Retrieved February 24, 2010 from http://www.ncsl.org/IssuesResearch/Health/CONCertificateofNeedStateLaws/tabid/14373/Default.aspx
ReferencesDelmarva Foundation (2003) “Healthcare Quality Improvement and Organizational Culture” Retrieved February 23, 2010 from
http://www.delmarvafoundation.org/newsAnd Publications/reports/documents/Organizational Culture. Shortell, S.M., Kaluzny, A.D.(2006) ‘Health Care Management Organizational’ Design and Behavior (5th ed) Thomas Delmore
learning, 5 Maxwell Drive, Clifton Park, NY. Nissan, J. (2007). NEMC, NEBH will build joint suburban facility. The Tufts Daily. Retrieved February 27, 2010 from
http://www.tuftsdaily.com/2.5511/nemc-nebh-will-build-joint-suburban-facility-1.593827 Anonymous. (2006). Boston Teaching Hospitals Expand Reach into Surrounding Areas Prompting Concerns About Competition,
Costs. Medical News Today. Retrieved February 21, 2010 from http://www.medicalnewstoday.com/articles/52798.php
Rowland, C. (2006). 2 Tufts affiliates plan hospital in suburbs. Retrieved February 23, 2010 from http://www.
boston.com/yourlife/health/diseases/articles/2006/09/08/2_tufts_affiliates_plan_hospital_in_the_suburbs/ Mass.gov. (2005) FY05 filing based on hospital's audited financial statements. Mass.gov pdf. Retrieved February
14, 2010.
MedPharma Partners, LLC. (2008). Impact of Tertiary Hospital Growth and Expansion. Massachusetts Medical Society. Retrieved on February 20, 2010 from http://www.massmed.org/AM/ Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=21922
MerrittHawkins(2005). Modern Healthcare Physician Compensation Review 2005 PDF. Retrieved from http://www.merritthawkins.com/pdf/2005_Modern_Healthcare_Physician_Compensation_Review.pdf
ECG (2009) “AMC Financial Arrangements and Affiliations” Retrieved February 20, 2010 from http://www.
ecgmc.com/services/financial_arrangements.asp
Tuft University, School of medicine (2007) Retrieved on February 22, 2010 from http://www.tufts.edu/med
U.S. News and World Report (2007) Retrieved on February 22, 2010 from http://gradschools.usnews.rankings andreviews.com/best-graduate-schools/top-medicalschools/items/04048
Hamilton, M. Samuel, O. (2005) “Why have AMC’s Survived?” JAMA. 2005; 293:1495-1500. Retrieved February 22, 2010 from
http://jama.amaassn.org/cgi/content/abstract/293/12/1495
ReferencesGregory, D., Baigelman, W., & Wilson, I. (2003). Hospital economics of the hospitalist. Health Services Research; 38(3):
905-918. Retrieved February 22, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles /PMC1360922/
Wachter, R. (1999). An Introduction to the Hospitalist Model. Annals of Internal Medicine; 130(4): 338-342. Retrieved February 20, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/10068402
Hauer, K., Wachter, R., McCulloch, C., Woo, G., & Auerbach, A. (2004). Effects of hospitalist attending physicians on
trainee satisfaction with teaching and with internal medicine rotations. Archives of Internal Medicine; 164(17): 1866-71. Retrieved February 21, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/15451761
KruResearch. (2010). Social Media ROI for Hospitals and Health Marketers. Retrieved February 27, 2010 from http://blog.kruresearch.com/category/hospital-marketing/
Maguire, P. (2009). What's the ideal number of patients to see? Today's Hospitalist. Retrieved February 26, 2010 from
http://www.todayshospitalist.com/index.php?b=articles_read&cnt=824 Tufts Medical Center. (2008). Tufts Medical Center Department of Medicine Annual Report 2008. Retrieved February
26, 2010 from http://www.tuftsmedicalcenter.org/ForHealthCareProfessionals/GraduateMedical Education/InternalMedicineResidency/DeptofMedicine/default/Tufts_Medical_Center_Dept_of_Medicine_2008_Annual_Report.pdf
Lurie, J. & Wachter, R. (1999). Hospitalist Staffing Requirements. Retrieved February 26, 2010 from
http://www.ncbi.nlm.nih.gov/pubmed/10538261
Appendix I: Exhibit of Major Systems
Appendix II: 5 Year Pro Forma
Appendix III: Key Financial Ratios
Appendix IV: Key Demographic Factors
Appendix V: Hospitalist to Patient Ratio & Salary Calculations
• Hospitalist to Patient RatioAverage Daily Census =Annual admissions x LOS / 365= 17,000 x 5.79/365 = 269.67
• Number of hospitalists =Average Daily Census / Patients per Hospitalist + 1 to cover night shift = 269.67/10 + (1) = 28 or=269.67/15 + (1) = 18
A low estimate of 10 patients per hospitalist is used to account for the extra manpower needed for coverage during vacations and other time off. The initial recommendation for Tufts-NEMC is to average 15 patients per hospitalist. As the program progresses, Tufts-NEMC can move toward a ratio of 1:10. Therefore, Tufts-NEMC would need 18 hospitalists to cover all admissions, however, the initial recommendation is to pilot this in the Department of Medicine, which has roughly 6000 inpatient admissions, and therefore, yields the need for 7 hospitalists.
• Number of hospitalists =6000 X 5.79/365 = 95.18= 95.18/10 +1 = 10.5= 95.18/15 + 1 = 7
• Hospitalist SalaryIndustry research indicates the hospitalist salary at $185,000. With this as the base salary plus 20% for benefits, Tufts-NEMC will make the following investments:Year 2 – 3 hospitalist FTEs - $185,000 x 3 + ($185,000 x .20) x 3 = $666,000Year 3 – using same formula with 4 additional hospitals FTEs = $1.5 millionYear 4-5 – if disseminated throughout organization, using same formula for 18 total hospitalist FTEs = $3.9 million
Data derived from xxiv, xxiii, xxv