Mercys Journey to Excellence; the Role of Benchmarking and Financial - - PowerPoint PPT Presentation

Mercy’s Journey to Excellence; the Role of Benchmarking and Financial and Clinical Analytics

Nancy G. Hoffman Executive Director – Financial Operations Analytics Sponsored by EPSi – hosted by John Gragg, COO, EPSi July 2019

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Catherine McAuley opened the House of Mercy on Baggot Street in Dublin, Ireland in 1827. She founded the Sisters of Mercy – one of the world's first religious orders not to be cloistered, confined to prayer and quietness within a convent. Instead the Sisters went out into the communities where they lived to feed the hungry, care for the sick and provide education.

Our Legacy

The Walking Sisters

1 Physicians & advanced practice clinicians 2 IBM Watson Health 15 Top Health System for consecutive years: 2016, 2017 & 2018

About Mercy

As the Sisters of Mercy before us, we bring to life the healing ministry of Jesus through our compassionate care and exceptional service.

Our Mission

We are the people of Mercy Health Ministry. Together, we are pioneering a new model

• f care. We will relentlessly

pursue our goal to get health care right. Everywhere and every way that Mercy serves, we will deliver a transformative health experience.

Our Vision

Dignity Excellence Justice Service Stewardship

Our Values

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We believe our long term success, as a health ministry with a strong Catholic- Christian identity, will be tied to differentiated performance and a full realization of our brand.

• Implement a consumer-centric operating model to complement our patient-centric care model;
• Implement a singular system of care that creates a seamless experience between ambulatory,

acute, and virtual care;

• Achieve sustainable advantages in quality, service and cost;
• Achieve extraordinary engagement of all 40,000 co-workers and physicians

Getting it right. We’ll change the way you feel about healthcare.

Brand Position: Brand Promise:

Mercy’s Strategy 2020 …and beyond

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• Mercy has long maintained focus on internal performance benchmarking and

continuous performance improvement

– Financial, operational and quality performance – Over time, vs. targets, and between Mercy-peers – Financial targets relative to budget, with varying degrees of “operational relevance”

• We needed an external benchmarking perspective to identify specific quality &

cost improvement opportunities & best practices

– Costs by functional area – Utilization and outcomes by DRG – Care practices by Physician

• We needed to leverage experience and proven practices through knowledge

sharing among peers across the country

Mercy Benchmarking

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Mercy Quality & Financial Performance Benchmarking Program

Financial Service Quality Considers Multiple Dimensions of Performance

Clinical Service

Drills to clinical costs per case, ALOS, procedure code & resource utilization, & practice variation

Quality

Integrates cost info with Process of Care and AHRQ measures to identify variation by quality indicator, service line, DRG, or physician

Operational Costs

Compare cost & productivity against peers to identify

• pportunities in productivity, skill mix, pay scale, non-

labor expenses, & supplies

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Mercy Quality & Financial Performance Benchmarking Program

• Rigorous, collaborative data mapping & normalization
• Tailored peer groups to ensure meaningful comparisons & credible

results.

• High-level to very detailed results, so all leaders have analyses

meaningful to them.

• An integral part of a continuous

improvement mindset

Provides Accurate, Transparent & Actionable Information

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Opportunities into Action

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Opportunities into Action – Operational

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Opportunities into Action – Operational

• Multi-disciplinary group pulled together for deep-dive
• Driven by courier services
• Initially narrowed true opportunity to about half reflected, still very significant
• Findings related to management’s low-visibility into expense and subsequent year-over-year

growth

• Expect about $3M in annual savings from reducing non-essential services now under detailed

review

Significant opportunity in Postal/Freight was common theme across our hospitals $10M total opportunity

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Opportunities into Action - Clinical

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Opportunities into Action - Clinical

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Opportunities into Action - Clinical

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Opportunities into Action - Clinical

– Springfield team assembled, meet 2x weekly

• Executive Sponsor – Chief of Critical Care Medicine
• Team Lead – VP Quality
• Team – Nursing, Care Mgmt, Emergency Dept & Finance leaders

– Goal: Identify Septic patients or those at risk as early as possible, and enhance treatment for improved outcomes with lower LOS and cost. – Findings and improvement efforts

• Complete clinical pathway review & modification to increase pathway utilization
• Focused on education for ED Physicians to increase immediate sepsis dx.
• Focused effort with lab, hospitalists & pharmacy to increase turn-around-time from lab test to revised drug orders
• Deep-dive comparison of drug utilization with Mercy peers identified lower cost abx with same effectiveness
• Patient Logistics & Care Management engage day 1, care and discharge planning

– Step-down sooner, reducing ICU days – Focused education with hospitalists regarding earlier discharge, more frequently discharging home to complete IV abx

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Opportunities into Action - Clinical

– PI teams formed in each hospital

• Physician Executive Sponsor & Quality Leadership

– Used costed patient data to developed “Sepsis Scorecard”

• Trend and compare LOS, Drug utilization, other direct costs per case
• Comparisons across hospitals and by attending physician
• Variation in cost identifies variation in care

– Ministry Quality & Financial Performance teams engaged

• Launched Mercy-wide clinical pathway redesign
• Reduce variation and optimize care /cost

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Opportunities into Action - Clinical

Initial Results

Sepsis identified and treatment delivered earlier, decreasing the volume of Septic Shock and Severe Sepsis, and contributing to decreased ALOS and cost.

10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% 55.0%

Sepsis Severity Percentages

% Septic Shock % Severe Sepsis % Sepsis

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Opportunities into Action - Clinical

Initial Results

Average length of stay (ALOS) decreased by 0.72 days, 10.3% Cost per case decreased by $1,089, 15.6%

4 5 6 7 8 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May ALOS

Sepsis DRG 871 ALOS

ALOS

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May COST

Sepsis DRG 871 Total Direct Cost per Case

Total Direct Cost

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Reassess Opportunities

Consistent Measurement

• Key to continuous

improvement mindset

• Celebrate successes
• Identify new
• pportunities
• Accountability for

results

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The Journey To Excellence at Mercy Health System

• Continue to challenge the status quo. Seek creative ways to bring

care to the people who need it most.

• Be early adopters and optimize use of new

technologies like machine learning and predictive analytics, as a data-driven

• rganization.
• Learn & collaborate with peers, inside Mercy

and across the industry

• Always ensure the right balance between cost, quality

and patient experience.