Newton-Wellesley Hospital Provider Dashboard NESHMM March 29, 2007

1. Newton-Wellesley Hospital Provider Dashboard NESHMM March 29, 2007

2. NWH Stats and Figures • Newton-Wellesley Hospital • Newton, MA • 250 Beds • 1,750 FTEs • 16,000 Discharges • 50,000 ED Visits • 65 Staffed Physicians • Affiliated with Partners Healthcare Systems, 2001

3. Important NWH Stats and Figures

4. Important NWH Stats and Figures

5. Important NWH Stats and Figures

6. Background • SDSM was implemented in 2002 • No real Decision Support before SDSM • Surgical supply cost per case were on the rise, with more orthopedics on the way • New Chief of Surgery in 2003 with an MBA

7. National Trend, not just NWH Expense Growth Rates, 2002 - 2004 Source: Solucient, “Supply Costs for U.S. Hospitals Show Substantial Three-Year Rise,” Healthcare Financial Management, August, 2005; Financial Leadership Council Interviews

8. Approach Taken: Idea to Product • Attended presentation by Noel Sousa, UC Davis Health System (EUN 2003) • Recreated reports at NWH, developed additional reports (June 2005) • Met with Chief of Surgery to explain concept, discuss additional features • Contracted with outside programmer (NWH IS resources were committed to CPOE, other priorities) • Went live in January 2005

9. Idea: UCDavis Physician Profiles

10. Product: NWH Provider Dashboard Screen Shot 1: Home Screen

11. Product: NWH Provider Dashboard Screen Shot 2: Qualification Screen

12. Product: NWH Provider Dashboard Screen Shot 3: Provider Report

13. Product: NWH Provider Dashboard Screen Shot 4: Procedure Report (for one surgeon)

14. Product: NWH Provider Dashboard Screen Shot 5: Surgeon Report (for one procedure)

15. Product: NWH Provider Dashboard Screen Shot 6: Utilization Report

16. Product: NWH Provider Dashboard Screen Shot 7: Encounter Detail Report

17. Range of $5,874 of supply cost per case for the same procedure. NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon NWH Surgeon

18. SDSM Access DB SQL DB ENCR Data UTIL Data Data Flow: SDSM to NWHPD Two KIT reports provide Encounter and Utilization data – these files are updated monthly, T - 180

19. ENCR Data UTIL Data The SDSM Data In Detail Quals: IPD Number = 6230 UB Code = 360 Act Total Cost is GT 100 • Encounter Number (Row 1) • Inout Code • Discharge Date • Principal Procedure Surgeon • Principal Procedure Code • Age • DRG Weight • Length of Stay • HCFA Mean ALOS • Admit Source • Observation Patient Flag • Actual Direct Cost • Encounter Number (Row 1) • UB Code (Row 2) • Chg Dtl: Act Direct Cost

20. NWHPD Maintenance • Data Management • Data is added monthly, refreshing two most recent months for late charges, coding changes, etc. • New data is scrubbed for missing codes; examples sent to Medical Records • New surgeons are identified and added to dictionary table • User Management • Usernames and passwords maintained • “Last view” available

21. NWHPD Maintenance • Dictionary Tables • Physician Table – Name, Specialty • UB Code Table – UB Code Groupings • ICD9 Procedure Table – Procedure Groupings

22. Other NWHPD Features • Export any report to Excel, for additional math or graphing • “Printer Friendly” function for producing reports • Email webmaster for questions

23. Lessons Learned • Speed is King – Early versions were too slow; still not lightning quick, but better. • Scrub data each month – Missed a large number of cases when a new busy surgeon came on board. • Billing compliance is a risk. The supply cost data is only as good as the billing capture rate. (More on this next slide.) • Grouping procedures helpful – Group like-procedures together to minimize redundancy and increase N. • If designed well, web-based reporting can be very useful. NWH plans to explore future reporting in same environment.

24. Understanding Variation in Measurement System Actual Variation in Process Actual Variation in Measurement System Observed Variation

25. Success Story Use of Observation with Laparoscopic Cholecystectomy

26. Laparoscopic Cholecystectomy: endoscopic removal of the gall bladder 2nd most common outpatient general surgery procedure (Breast Lesion Excision), about 180 per year. General surgery provides the third highest aggregate direct margin per case (Ortho, GYN) to the hospital. Cholecystectomy has the highest direct margin per case of all outpatient general surgeries Background Information

27. Laparoscopic Cholecystectomy: Net Revenue vs. Direct Margin

28. Laparoscopic Cholecystectomy: Utilization by surgeon Average Observation Stay is 21.1 Hours

29. 24.9% of cases are reimbursed for observation Who reimburses for Observation?

30. Cutting 50% of observation utilization will result in an immediate increase of about $40K of direct margin to the Hospital. This change in practice will also free up about 90 medical/surgical days that could be used for other cases. The Key is the Opportunity Cost

31. Estimates indicate that a surgical day is valued at about $850 to the Hospital. We can then say that these freed up beds could be worth an additional $76,500. In addition to the initial $40K, a total increase of direct margin could reach $116,500. The Key is the Opportunity Cost

32. Dr. Millham to presented data at Grand Rounds; gain support of surgeons. Our busiest general surgeon agreed to reduce observation use. Revisit financials 6 months and 1 year after change to track progress. Actionable Items

33. Results: Lap Chole by Patient Type Shift away from Observation for this surgeon has been initiated and sustained.

34. Return on Investment, FY05

35. Using Background Data for Strong Analysis

36. Using Background Data for Quicker, Stronger Analysis Data “behind the scenes” can be accessed for analyst use.

37. Using Background Data for Quicker, Stronger Analysis “Analyst view” of $1,800 range in pacemaker costs.

38. Questions & Answers