As discussed in our previous article骨科云顶集团是寻找创新和转型思路的好地方.
- 近年来,CMS将全膝关节置换术(tka)和全髋关节置换术从住院患者名单中移除,促使骨科手术转向门诊和门诊护理环境.
- In addition, 商业支付方继续通过捆绑支付计划和基于风险的合同扩大基于价值的报销机会, 进一步支持降低成本和提高骨科质量结果的需求.
但是,如果护理过程没有标准化,就很难实现更低的成本和更好的结果. One study found that when using a preferred vendor, total knee and hip implant procedures realized a 23% mean cost per case decrease.[1]减少临床差异的协议驱动型护理已被证明可以提高门诊连续体的质量结果, inpatient, and post-acute settings. 这支持了减少临床变异是解决当前影响骨科云顶集团变化的重要策略的观点.
在建立目标项目的过程中,骨科领导者可以使用以下六个步骤来减少临床差异并提高骨科云顶集团线的绩效.
1. Establish Governance
首先建立一个治理结构,负责识别减少变化的机会,并批准基于过程的最佳实践. 战略性地利用现有的质量委员会治理结构,以支持由云顶集团40011官网和运营领导共同领导的基于队列的临床变异工作. The dyads will weave clinical variation design, implementation, and monitoring efforts into service line operations. 从一开始就获得云顶集团40011官网的支持对于临床变异计划实现预期结果至关重要, so include orthopedic surgeons as dyad leads to complement nursing, therapy, case management, perioperative, supply chain, and financial leadership team members. 该小组批准变更以减少骨科临床差异,并与工作人员沟通这些努力如何支持您的骨科目的地项目的长期目标.
2. Shape Strategic Vision
Use your dyads to organize your clinical operations, supply, and financial teams around shared orthopedic service line goals. Dyad leads need to create plans and communicate the desired future-state vision. Ideally, cohort-based targets are focused on cost reduction, quality improvement, 还有其他可以权衡的操作措施,这样你就可以更好地优先考虑改善临床变化的努力.
3. Categorize Cohorts
Don’t rely on coding classifications alone (i.e., ICD-10 and MS-DRG) to identify comprehensive patient populations. Some variation within coding classifications is warranted. For example, knee revisions receive the same billing code as an initial TKA, but the time, supplies, 预期的患者结果在这两组患者中并不相似. Instead, 扩展您的队列识别分析,包括患者合并症和因素,如骨科病例中使用的设备和用品以及辅助手术.
4. Chart Value Streams
确保您在每个队列的整个骨科护理连续体中识别临床变异机会. Assess variation trends along specific care pathways by comparing resources (e.g., equipment, supplies, labor), care coordination processes, cost, and quality measures by orthopedic surgeon within each previously defined cohort.
一种方法是根据当前最低的报销率或组织对每个队列看到的目标价格,设置预期的报销或每例成本目标. 价值流活动的目标是确定降低医疗费用的机会, in conjunction with potential quality implications, to achieve optimal standardized care delivery. 当您减少临床变化时,此练习允许您的组织通过基于特定程序的锚定配置文件设计流程来获得额外的利润. For example, one study from the Journal of Arthroplasty found that implant costs were reduced by 16.当标准化护理实践时,TKA程序的总膝关节部件成本降低了11%.[2]
5. Prioritize the Most Impactful Opportunities
现在你已经确定了在给定队列中每个护理路径的骨科临床变化, 对能够产生最有意义影响的机会进行分类和量化是至关重要的. For example, altering product types, supply utilization, length-of-stay management, care coordination, 急症后护理环境的偏好可能并不都能产生你所期望的相同水平的骨科临床变化改善. In addition, spend some time analyzing the codependencies of each opportunity. Will changing supply or drug utilization impact the length of stay? 增加术前实验室检查是否会提高患者的治疗效果,即使它可能会增加总体护理成本? 重要的是要获得提供者对基于证据的协议使用的同意和衡量. It is also vital to avoid looking at each opportunity in a vacuum. 优先改变骨科路径沿线影响最大的区域.
6. Design, Change, Monitor, and Iterate Initiatives
Under the guidance of your respective leadership dyads, activate improvement teams made up of project management, administrative, financial, 和临床资源,以尽量减少临床变异在一个特定的病人队列. These improvement teams will:
- Assess current-state performance.
- Design future-state processes and evidence-based pathways to reduce variation.
- 选择透明的关键绩效指标(kpi)来监控计划结果,直至提供者级别(包括临床路径依从性跟踪).
- Seek approval for people, process, and tool changes from your leadership dyads.
The cycle of improvement should be a permanent, 在您的骨科云顶集团线操作中持续努力,以便识别和解决差异. By gaining buy-in from your governance structure, 你创造了愿意支持你减少临床变异的赞助者和拥护者.
Regardless of how much leadership support you have, building a strong communication and education plan for all changes is essential to best manage change and realize optimal results. One way to further promote collaboration is to align incentive-based provider contracts to your clinical variation goals. Similarly, look for opportunities to bring your utilization, pricing, and related learnings into managed care contracting negotiations. In addition, ensure that your vendor partners are informed of your program goals and that they will be expected to collaborate with you to achieve them. Finally, continuous monitoring creates a constant “assess and iterate” cycle to always reduce orthopedic clinical variation.
临床变异管理为您的骨科目的地项目铺平道路
减少临床变化是提高您的骨科云顶集团线和建立长期竞争优势的催化剂. 成本和质量控制对于最大化利润至关重要,这些利润可以再投资到您的骨科目的地项目中,例如形成数字前门和其他以消费者为中心的云顶集团. As we’ve seen within the retail space, patients are displaying consumer loyalty patterns based on convenience, experience, quality, and cost when selecting their providers. 一致的骨科患者体验和护理交付过程建立了品牌标识.
您的组织是否试图减少骨科云顶集团40011官网之间的临床差异?
ECG’s Hospital Performance Improvement experts can help.
Learn MoreFootnotes
- 1.
Matthew R. Boylan, Anisha Chadda, James D. Slover, Joseph D. Zuckerman, Richard Iorio, Joseph A. Bosco, Preferred Single-Vendor Program for Total Joint Arthroplasty Implants, The Journal of Bone and Joint Surgery (2019, Volume 101-A, Number 15) 1381–1387.
- 2.
Christopher J. Fang, Jonathan M. Shaker, Geoffrey M. Stoker, Andrew Jawa, David A. Mattingly, and Eric L. Smith, Reference Pricing Reduces Total Knee Implant Costs, The Journal of Arthroplasty 36 (2020) 1220–1223.
Published July 6, 2021