Managing Performance in a Shrinking
Reimbursement Environment
A presentation tailored for OR Today Live! by
Tom Wessel, MBA, Vice President Business Development
September 1, 2015
Las Vegas
Objectives/Agenda
 Discuss impact of conflicting priorities
 Review options to reduce costs
 Consider options to improve performance
 Discuss critical success factors
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Healthcare Performance
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Healthcare Realities
 Reimbursement is going down
 Patient perception of care is more important
 Quality of care is being linked to reimbursement
 Change is a daily event
 Volume is more variable harder to predict
 Data is everywhere, but significance can be unclear
 Facility margins are thin and under pressure
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Quote
 According to the Centers for Medicare & Medical
Services (CMS), almost one out of the every five
dollars in America is spent on health care. Of
that, an estimated $765 billion was lost to errors
inefficiency, redundancy, waste, overutilization
and unnecessary variation in clinical practices.
Hospitals are simultaneously confronted with
payments that are not rising as fast as costs. The
American Hospital Association contends that onethird of hospitals presently have a negative
operating margin.
– Forbes, Nicole Fisher Contributor 1/12/15
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Management Realities
 Capital Budgets are tight
 Labor costs are under scrutiny
 Must improve productivity
 Must be an expert in change management
 Technology continues to evolve and training staff is
critical
 Performance pressure from administration, surgeons,
compliance, supply chain, staff, and other departments
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Potential Relief Areas
 Materials
 Supply chain
 Facilities
 Labor
 Clinical Practice
 Technology
 Information Systems
 Patient Processes
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What Has Been Tried
 Materials
 Standardization (fewer
options)
 Consolidation (less
places)
 Supplier Discounts
 Purchasing
Focus/Driven
 Buying Groups
 Labor
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Cross Training
Flexible Scheduling
Benefit Reductions
Expanding roles
Cutting Staff
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Other Areas
 Reengineering patient process flow
 Care management
 Coordination of care communication throughout
 Quality Programs
– Lean management
– Six Sigma
 Invest and train in change management
 Utilization of smart technology and data
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Impact on Staff Attitude
 Overall moral deterioration
 Frustration and confusion
 Loss of focus
 Reduced productivity
 Loss of best performers
 Four phases of managing change
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Denial
Fear and Anger
Consideration
Acceptance
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Change Check List
 Is the future state defined?
 Has change been outlined?
 Does management support the change?
 Has the need to change been explained?
 Has implementation been designed cross-functionally?
 Has the impact on staff been described?
 Has timing been shared?
 Has transitional communication been outlined?
 How will progress be measured?
 Has success been defined?
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Other Ideas
 Who provides care
 Outsourcing services
 Redesign a system of care to promote Quality
Improvement
 Outsourcing labor
– Department
– Specialty
– Professionals
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Hospital Outsourcing Example
 American Surgical Professionals assumes:
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Ortho PA Staff (12 FTEs)
High and low PA’s surgical demand
Training and development of PA’s
Performance reviews
Scheduling
Hiring
 American Surgical Professionals can bill Part B
 Reduce a portion of operational cost for Hospital
 Sharing of quality performance goals
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Expectations of Services
 First assist for requested cases
 Advanced technology utilization
 Assist in PAT and H&Ps
 Assist in pre-op support
 Assist in post-op turning the room
 On Call Support – 30 min response?
 Other ancillary procedures - Central and PICC lines
 Other Services?
– ICU Support/Coverage
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Success Factors
 Physician buy-in and support (key leaders)
 Current employee’s reaction to outsourcing
 Alignment of expectations and timing
 Agreement in key metrics for success
 Issue and resolution processes
 Documentation and IT process in place
 Support (Clinicians, OR staff, Hospital/OR leadership)
 Clear Communication Plan
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Advantages
 Flexibility
 Alignment of objectives
 Increase efficiencies
 Proper implementation to support employees
 Positive Staff impact
 SAVINGS of $500,000 or about 35%!
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Closing
 Must Focus Priorities
 Patient Satisfaction/Outcome
 Staff Impact
 Change Process
 Management Follow Up
 Find the Wins and Celebrate
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Thank you for your time
Contact: Tom Wessel
Vice President Business Development
American Surgical Professionals
832-804-8743
sales@amerisurg.com
AMERISURG.com
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