Business Management, Consulting and Information for Healthcare Systems and Hospitals

1. 1 Business Management, Consulting and Information for Healthcare Systems and Hospitals

2. GOMLA (ISRAEL)ltd - Our Experience: 2 • Implementation of profitability in Israel’s leading business corporations: • IEC (Israel Electric Company) • Cellcom (Israel’s largest cell-phone company) • Tnuva (Israel’s largest dairy manufacturer) • El-Al (Israel’s national airline) • Sheba - Israel’s largest (1350 bed) hospital • Enhanced hospital profitability by: • Wards • Illness category • Insurance carrier • Other cross- sections defined by hospital management.

3. 3 Analysis of managerial, operational and financial information; reporting to management and decision makers TMR DATAWARE HOUSE Accessibility to operational data by managers at all levels Hospital Operational Information System – Medical, Financial and Logistical data Processing of managerial, financial and operational data: budget, pricing, control, management and organization Defining and assimilating the accounting method Hospital Data Uses

4. The TMR Software 4 The TMR allows users to define business scenarios and detailed budgets, easily update budget data and separately analyze the performance and profitability of each organizational subunit. Users can select a pricing method of their choice, including ABC pricing, and combine several pricing methods in a single system. TMR meets the complex and multi-dimensional needs of hospitals by providing an “X-ray” image of the organization which allows management to improve organizational profitability.

5. TMR Serves Hospital Management : 5 Informed profitability management Knowing the cost and profitability of each illness category Knowing the per patient profitability (insurer) Knowing the profitability of each population segment Decentralization of Organizational Subunits into Profit Centers Knowing the costs and profitability of each profit center; Supervising profit center budget compliance Allows benchmarking for profit center improvements (corresponding period in previous year) Definition of future scenarios for simulation Constructing and updating current budget Constructing and updating multi-annual budget Defining “What if” scenarios under uncertainty

6. Leading Examples of TMR’s Utilities in Organizations 6 1 Positive incentives for departments Who meet budgetary goals 2 Who show improvement over last year Positive incentives for department 3 Which lead to losses on a regular basis Restricts areas of hospital operations 4 Expansion of clinics That are profitable 5 Reduce clinics That are not profitable 6 Release bottlenecks To increase profitability

7. Leading Examples of Benefits Outside the Organization 7 1 Provide evidence to regulators Of the need to increase rates 2 Amend agreements with insurance carriers Which lead to losses 3 Encourage expansion of collaborations with Profitable insurance carriers

8. 8 Data Import from all Hospital Information Systems Hosp` system Clinics Financial accounting Diagnostic and therapeutic services All data enter TMR surgery logistics laboratories Payroll system

9. 9 TMR is Unlimited in Data Import TMR imports data from all existing information systems in the hospital Data import is performed from all types of hardware and software, including excel spreadsheets Both quantitative and financial data are imported

10. 10 General and specific report generator BudgetedquantitativeD.W.H. Pricing-based budget Pricing of effective performance EconomicSimulator Quantitative D.W.H. Data import generator Data from all systems Structural Elements of the TMR Simulator E.I.S & Olap System Excel report archive Analysisof deviations Oracle Database

11. 11 TMR uses the Patient Medical File as the starting point in identifying a hospital’s centers of profitability or loss

12. 12 Revenue from insurance carrier Surgery Laboratories Imaging Hosp’ inrehabilitativeward Checksby ER staff Hosp’ insurgicalward Hosp’ inICU Release Admission 2 days 6 days 4 days 3 hours A Patient’s Medical File Contains:

13. 13 Profitability per Individual Patient Medical File qty Per unit cost in USD Total cost In USD Hours in ER for examination and tests 3 40 $ 120 $ Days of hospitalization in ICU 2 750 $ 1,500 $ Days of hospitalization in surgical ward 6 250 $ 1,500 $ Days of hospitalization in rehabilitative ward 4 140 $ 560 $ Surgical procedures in OR 1 950 $ 950 $ X-rays 9 18 $ 162 $ Laboratory tests 17 5 $ 85 $ Total cost 4,877 $ Total revenues 5,100 $ Total profit per individual medical file 223 $

14. 14 ? How to Identify Costs

15. 15 IntermediateProducts InpatientMedicalandSurgicalServices Surgical procedures Ward Ward Angioplasty Diagnostic imaging Ward ER visits Ward Laboratory tests Ward CalculatingCosts HR Materials Misc. Medical Fixed medical equipment Operating costs Administrative costs Administration and Housekeeping Consumable medical equipment Non medicalequipment Nursing Computerization and security Para-medical General Food, cleaning and engineering systems

16. 16 50 10 20 15 30 55 20 12 3 5 4 6 8 2 30 2 2 6 8 7 5 92+ 5 3 15 19 30 20 40 + Surgical procedures 40 30 + X-rays 10 15 5 20 + Labs 7 10 3 =300 80 165 + 55 + Total: Recovery ICU Surgery Attribution of Costs – through Hospitalization Wards Surgical procedures Surgical Ward Rehabilitative Ward ICU Operating Labs X-ray Expense Payroll 200 Materials 40 Misc. 60 300 Total

17. 17 W1- W4- W2- W3- No. of examinations x normative duration per examination Salaryrecords Hours of surgery performed All other hours of physician’s work Complex Work of Physicians on Wards I.E, Orthopedic Specialist On the Orthopedic Ward Orthopedic Specialist At the Orthopedic Clinic On ER Duty In Surgery W An orthopedic specialist work Salary S1- S2- Benefits

18. 18 Cumulative Costs in Surgical Procedures Patient physicians Anesthesiology unit materials operating nurses procedure Physicians of the ward procedure para OR procedure materials c A operating B materials Post-Surgery Recovery Room nurses

19. CalculatingCosts of Outpatient Clinics 19 Physical Examination Cast Removal Injections Outpatient Clinics H1 Examinationbyspecialist H3 Removalofcast Scopeof ClinicServices H3 Injection Standard Quantities Q11 Q21 Q31 Hoursofphysician’s labor Loading cost of physicians Physicians Q12 Q32 Q22 Hoursof nurses’ labor Nurses Loading cost of nurses Q13 Q23 Q33 Hoursofparamedical stafflabor Loading cost of paramedical staff Para Q24 Q34 Q14 Costofmaterial Loading cost of materials Materials

20. Deviations of Performance from Budget 20 Simulationofperformance Projected performance Actual volume Actual volume Projected prices Actual prices Actual product process Projected product process Deviation inprices Deviationin effectiveness Deviation involume Actual data Actual performance Original budget Actual volume Projected scope Actual prices Projected prices Actual product process Projected product process Total Deviation

21. 21 Approval of model Specifications meetings Set-up and Assimilation Pilot\ Approval of specification Completion Activation by Gomla Set up and assimilation Data entry Datacalibration Users training 3 weeks 12 weeks 4-12 weeks The system is fully operational in three months

22. 22 TMR–The Economic Simulator