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TRANSCRIPT
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Physician Performance Analytics: A Key to Cost Savings
Session #90, February 21, 2017
Jim Gera, SVP of Business Development, Signature Medical Group, Inc.
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Speaker Introduction
Jim Gera, MBA
SVP of Business Development
Signature Medical Group, Inc.
BPCI Awardee Convener
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Conflict of Interest
Jim Gera, MBA
Has no real or apparent conflicts of interest to report.
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Agenda
• Signature Bundled Payment Overview
• Technology and Analytics
• Physician Engagement and Reporting
• Results and Next Steps
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Learning Objectives
• Identify factors impacting physician performance
• Examine development of a physician performance analytics tool
• Analyze the benefits of physician performance analytics
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Signature Medical Group• Multi-specialty physician group in Missouri (150 physicians)
• Vision – Physician-led healthcare
• Value-based payment activity
– ACO
– Maternity Care Home
– Medicare Advantage
– Bundled Payment for Care Improvement (BPCI)
• Why participate
• Awardee Convener
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Signature BPCI Overview
• BPCI Awardee Convener
• 50+ orthopedic groups
• 2,000 physicians
• Geography – 26 states and 60 cities
• 50,000+ annual episodes
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BPCI overview• Retrospective bundled payment covering 90 days
• Major orthopedic cases including total joints, spine, and trauma
• Historically orthopedic physicians have not been responsible for care beyond the surgery
• Bundled payments align with CMS goals to reduce costs, improve outcomes, and improve quality of care
• Goal = care redesign to achieve better outcomes at a lower cost
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Care Redesign Goals• Shift paradigm from specific clinical focus (surgery) to comprehensive focus
(episode)
• Establish integrated biopsychosocial care model through out the entire episode
• Use evidence-based medicine to reduce/eliminate over utilized and unnecessary services, reduce adverse outcomes, and lower cost
• Use best practices to support standardized care pathways while maintaining physician decision making and individualized care plans
• Health IT value proposition
– Improve care management and reduce fragmentation with care management platform
– Improve physician performance with unbiased, targeted, and actionable analytics
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Case management model• Patients receive case management throughout episode
• Biopsychosocial care model designed to comprehensively address patients needs through a physician-led care model
Pre-operative phase Acute phase Post acute phase
• 2-8 weeks
• Risk assessments
• Care plan development
• 1-4 days
• Surgery
• Discharge plan
• 90 days
• Care coordination
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BPCI Results• Based on 2015 data for Signature BPCI participants
• Post acute care cost reduction – 33% nationally
• Adverse outcomes reduction – 18% to 41% nationally
• Variety of pricing benchmarks high and low
• No change in patient population
12Baseline 2009-12
No Changes in Patient Population
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Technology Needs1. Care management system
– Track patient
– Record patient information
– Initially outsourced brought in house (CareMosaic)
2. Analytics
– Medicare claims data
– Clinical data
– Initially outsourced brought in house (CareAnalytics)
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Analytical Needs and Solution• Identify opportunities to reduce overutilization and unnecessary cost
• Identify which episodes to enter into risk
• Focus areas and key performance indicators
• Solution – outsourced data analytics to outside company
– Data files large and complex
– Experience
• Reports
– Broad and general dashboards
– Static information
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Early Report Examples• Pros
– Provide information on major areas which needed focus
– Identified general comparisons and benchmarks
• Cons
– Too broad not specific
– Did not provided information to recommend specific actions
– Overwhelming and difficult to manipulate
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MS-DRG 470 Volume = 1,188
Readmission % SNF % IRF % HH % SNF LOS
Current = 6.1% 47.0% 8.6% 72.1% 23.5
National % 14 71 60 55 35
Acute $ Readmission $ SNF $ IRF $ HH $ Other PAC $ Total
$11,907 $525 $5,008 $1,020 $1,973 $1,956 $22,388
Readmission* SNF IRFUtilization = 6.1% 25.3% 1.5%
ALOS = 22.3
# Patients 72 301 18
$ per Patient $8,663 $10,108 $11,876
$ per Day $454
Total $ $623,721 $3,041,714 $211,630 Total Savings at Top Quartile = ($3,289)
$ per Episode $525 $2,560 $178 Adjusted Episode Spend at Top Quartile = $19,100
Savings per Episode $0 ($2,447) ($842) Reduction in Total Spend = -14.7%
METRICS
EPISODE BREAKDOWN
GOAL - TOP QUARTILE
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483 0% 0% 0% 0% 13% 10%
484 0% 0% 0% 0% 6% 0%
TOTAL 9% 2% 0% 4% 7% 14% SNF
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3 YEAR RATE
469 0% 50% 33% 40% 52% 58%
HHA 470 23% 29% 0% 22% 34% 27%
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483 0% 100% 0% 33% 25% 40%
469 0% 100% 0% 40% 70% 58% 484 0% 0% 0% 0% 13% 17%
470 80% 76% 65% 75% 71% 79% TOTAL 21% 32% 5% 22% 34% 28%
483 0% 100% 0% 33% 63% 65%
484 33% 0% 0% 33% 44% 48%
TOTAL 74% 77% 52% 71% 70% 77% SNF
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3 YEAR RATE
469 0% 50% 33% 40% 52% 46%
OUTPATIENT 470 20% 27% 0% 19% 33% 24%
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483 0% 100% 0% 33% 25% 35%
469 0% 50% 0% 20% 87% 69% 484 0% 0% 0% 0% 13% 17%
470 67% 54% 18% 51% 80% 79% TOTAL 18% 30% 5% 20% 33% 25%
483 0% 0% 0% 0% 63% 95%
484 0% 0% 0% 0% 81% 93%
TOTAL 59% 52% 14% 46% 80% 79% SNF
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 AVERAGE 3 YEAR AVERAGE
469 - 18.0 11.0 14.5 36.2 16.3
LTCH 470 26.3 16.5 - - 24.8 14.5
MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483 - 4.0 - - 39.0 13.9
469 0% 0% 0% 0% 0% 3% 484 - - - - 24.0 16.8
470 0% 0% 0% 0% 0% 0.11% TOTAL 26.3 15.7 11.0 17.7 25.9 14.8
483 0% 0% 0% 0% 0% 0%
484 0% 0% 0% 0% 0% 0%
2014 MONTH
INCIDENCE RATE
2014 MONTH
INCIDENCE RATE
INCIDENCE RATE
2014 MONTH
INCIDENCE RATE
DIRECT DISCHARGE INCIDENCE RATE - SNF CLAIM WITHIN THREE DAYS OF IP DISCHARGE
NON-ZERO AVERAGE LOS
AVERAGE COST PER DAY
2014 MONTH
2014 MONTH
2014 MONTH
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Analytics Improvements• Brought analytics in-house
• Hired IT and developers with prior managed care experience
• Integrated IT, clinicians, and admin into workgroups
• Used focused personnel
• Identified information which would
– Motivate physicians
– Impact case managers
– Assist management
• Address specific analytic needs and provide real time analytics
• Integrated analytics, reporting, and care management into one platform
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Key Performance Indicators
• Categories - incident rate and frequency
– IRF (inpatient rehab facility)
– SNF (skilled nursing facility)
– HHA (home health agency)
– OPT (outpatient physical therapy)
– Readmit
• Incident rate – the percentage of patients utilizing a service
• Frequency – the number of occurrences when a service is used
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Reports1. DRG/Episode
2. Physician scorecard
3. PAC Facility (post acute providers)
4. Readmission detail
5. Utilization management
6. Post acute provider scorecards (SNF, HHA, and OPT)
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DRG/Episode analysis
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Compare Physicians• Compare KPIs to determine differences
• Review patient episodes
• Deeper dive and case studies of specific patient episodes
Provider Total Cases Total Spend Avg Spend
IRF
Incidence
Rate
IRF
Average
LOS
IP Rehab
Average
Cost/Case
SNF
Incidence
Rate
SNF
Average
LOS
SNF
Average
Cost/Day
HH
Incidence
Rate
HH
Average
LOS
HH
Average
Cost/Case
Readmit
Incidence
Rate
Readmit
Average
Cost/Case
Physician 12 63 1,274,752.54 20,234.17 0.0% 0.0 0.00 30.2% 13.7 495.22 69.8% 9.3 3,219.98 3.2% 5,402.25
Physician 13 66 1,575,309.93 23,868.33 0.0% 0.0 0.00 40.9% 38.6 460.50 36.4% 14.1 2,752.40 10.6% 9,299.08
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Provider Total Cases Total Spend Avg Spend
IRF
Incidence
Rate
IRF
Average
LOS
IP Rehab
Average
Cost/Case
SNF
Incidence
Rate
SNF
Average
LOS
SNF
Average
Cost/Day
HH
Incidence
Rate
HH
Average
LOS
HH
Average
Cost/Case
Readmit
Incidence
Rate
Readmit
Average
Cost/Case
Physician 13 66 1,575,309.93 23,868.33 0.0% 0.0 0.00 40.9% 38.6 460.50 36.4% 14.1 2,752.40 10.6% 9,299.08
Patient #13064 1 37,913.84 37,913.84 0.0% 0.0 0.00 100.0% 39.0 518.27 0.0% 0.0 0.00 0.0% 0.00
Patient #13068 1 43,891.54 43,891.54 0.0% 0.0 0.00 100.0% 59.0 218.58 0.0% 0.0 0.00 100.0% 12,222.19
Patient #13071 1 23,814.15 23,814.15 0.0% 0.0 0.00 100.0% 27.0 463.49 0.0% 0.0 0.00 0.0% 0.00
Patient #13072 1 11,990.00 11,990.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.00
Patient #13073 1 14,903.62 14,903.62 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.00
Patient #13074 1 50,951.54 50,951.54 0.0% 0.0 0.00 100.0% 79.0 472.62 0.0% 0.0 0.00 0.0% 0.00
Patient #13082 1 19,032.86 19,032.86 0.0% 0.0 0.00 100.0% 9.0 384.97 0.0% 0.0 0.00 0.0% 0.00
Patient #13085 1 21,904.61 21,904.61 0.0% 0.0 0.00 100.0% 16.0 368.00 100.0% 1.0 0.00 0.0% 0.00
Patient #13092 1 36,944.49 36,944.49 0.0% 0.0 0.00 100.0% 45.0 415.21 100.0% 31.0 4,790.09 0.0% 0.00
Patient #13093 1 32,221.54 32,221.54 0.0% 0.0 0.00 100.0% 42.0 451.70 0.0% 0.0 0.00 0.0% 0.00
Patient #13094 1 25,986.65 25,986.65 0.0% 0.0 0.00 100.0% 20.0 482.17 100.0% 14.0 3,247.81 0.0% 0.00
Patient #13095 1 54,591.05 54,591.05 0.0% 0.0 0.00 100.0% 54.0 492.42 100.0% 15.0 2,602.01 100.0% 3,511.65
Patient #13096 1 39,325.01 39,325.01 0.0% 0.0 0.00 100.0% 45.0 493.27 100.0% 16.0 3,671.86 0.0% 0.00
Patient #13097 1 31,657.60 31,657.60 0.0% 0.0 0.00 100.0% 33.0 510.22 0.0% 0.0 0.00 0.0% 0.00
Patient #13101 1 31,667.61 31,667.61 0.0% 0.0 0.00 100.0% 48.0 521.14 100.0% 1.0 1,621.54 0.0% 0.00
Patient #13102 1 53,856.54 53,856.54 0.0% 0.0 0.00 100.0% 90.0 453.94 0.0% 0.0 0.00 0.0% 0.00
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Row Labels Episode Ct Total Spend Ave LOS Cost per Case Cost per Day
#1 Location Home Health 14 24,828.72 5.43 1,773.48 326.69
#10 Location Home Health 7 15,472.78 7.57 2,210.40 291.94
#100 Home Health Location 1 2,739.17 11.00 2,739.17 249.02
#101 Home Health Location 6 17,764.21 18.00 2,960.70 164.48
#102 Home Health Location 2 5,570.10 13.50 2,785.05 206.30
#103 Home Health Location 11 35,328.40 16.82 3,211.67 190.96
#104 Home Health Location 9 25,157.34 13.89 2,795.26 201.26
#105 Home Health Location 3 6,883.82 11.00 2,294.61 208.60
#106 Home Health Location 13 35,929.56 14.85 2,763.81 186.16
#107 Home Health Location 2 4,857.55 10.50 2,428.78 231.31
Data Source
Home Health
IRF
SNF
EPI MS DRG with Desc
461 - BILATERAL OR ...
462 - BILATERAL OR ...
466 - REVISION OF ...
467 - REVISION OF ...
468 - REVISION OF ...
469 - MAJOR JOINT ...
470 - MAJOR JOINT ...
472 - CERVICAL SPIN...
Acute Provider
Hospital East
Hospital North
Hospital South
Hospital West
Mountainrange Medical...
Northeast Hospital
Northeast Medical Center
Northern Health Care
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Star Rating
1
2
3
4
Surgery Type
Elective
Shoulder
Trauma
(blank)
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Facility Report• Identify differences between PAC providers
• Review in conjunction with scorecards
• Determine is it physician or PAC driven
Provider Episode Ct Total Spend Ave LOS Cost per Case
#1 Location Home Health 14 24,828.72 5.43 1,773.48
#103 Home Health Location 11 35,328.40 16.82 3,211.67
#106 Home Health Location 13 35,929.56 14.85 2,763.81
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Provider Engagement • Initial engagement
– Face-to-face meeting with potential client/provider
– Review DRG/Episode analysis to demonstrate opportunity
• Ongoing engagement
– Regular webex meetings every 2 weeks
– Attendees – physician champion, case manager, clinical lead, and/or admin
– Review reports 1-5
– Identify focus area of call and align data review
• i.e. desire to reduce IRF utilization for Physician 10. Provide information on similar physicians and patient populations and show comparable data. Demonstrate alternatives and the benefits.
– Bi-annual or quarterly face-to-face meetings
– Monthly case studies with patient sub-claim level detail. Reviewed with physician, physician champion, case manager and clinical lead
– Quarterly meetings for case review and best practices with other providers either regionally or nationally
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Multi-layered Physician Engagement
Physician Physician
Admin
Case Mgr. or Clinical Lead
Peer-to-peer:
With similar or well respected peers compare:
benchmarks, goals, resources
• Provide easy to follow data analytics reports
• Always have detailed data available to address any question
• Meets regularly to review data and outcomes.
• Offer suggestions for improvement and alternatives
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Physician alignment
• Physicians are key to successful bundled payment programs
• Communication is essential
– Communicate results once a month
– Timely performance results
– Actionable solutions
– Tied to bonus and money
– Transparency
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Factors Impacting Physician Performance• Align care pathway to care plan to outcome
• Adverse outcomes
• Discharge disposition
• Cost savings
• Key performance indicators
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Key Performance IndicatorsClinical• Adverse outcome
– Readmission
– Infection
– UTI
– AMI
– Sepsis
– Pneumonia
• Patient reported outcome
– Satisfaction
– Functional level
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Benefits of Physician Performance Analytics and Tools
Identify
• Opportunities for improvement
• KPIs
Drive Change
• Use unbiased data
• Increase physician engagement
Results
• Reduce adverse outcomes
• Cost savings
• Physician engagement – Meet them where they are at
– Not all physicians will view or use the same reports
– Identify the “hook” which will get a physician engaged
• Competition
• Financial incentive
• Improved patient care
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Impact on Adverse Outcome • 26% reduction in Readmissions within 30 days of discharge
• 54% reduction in Pulmonary Embolisms during Index Admission
• 29% reduction in DVT during Index Admission
• 41% reduction in Urinary Tract Infection during Acute stay
• 41% reduction in Acute MI within 7 Days
• 36% reduction in Surgical Site Infection
• 39% reduction in Pneumonia during Index Admission
• 18% reduction in Sepsis/Shock during Index Admission
Reductions based on all Signature BPCI participants 2015 to Q1 2016
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STEPS: Savings
Cost
Savings of
33%
Increase
standardized
care pathways
and physician
performance
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Physician Benefits
• Pathways follow best practices and are supported throughout the episode
• Engaged in meetings
• Financial incentive
• Happier and healthier patients
“BPCI and my engagement in this program has made me a better doctor”
– John Tessier, MD
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STEPS™ Impact
• Improved communication of physician performance.
• Improved physician assessment tools.
• Improved patient outcomes.
• Improved care pathways.
• Improved unbiased assessment of performance data.
• Increased communication of performance data.
• Increased implementation of evidence-based protocols.
• Improved assessment of physician performance.
• Increased savings through protocol modification.
• Increased cost transparency.
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Signature Next Steps• Linking CareMosaic and CareAnalytics into research platform and
medical literature
• Refining and further validation of internal algorithms and modeling
• Furthering the success of our current provider groups
• Accelerating success of new provider groups
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Questions
Jim Gera, MBA
SVP of Business Development
Twitter - @jimgera
• Please complete online session evaluation