February 27, 2014

HFMA Dixie Institute 2014Improving the Performance of Hospital Owned

Physician Practices

Mr. Joshua D. Halverson, Principal

Mr. Frank Panzarella FACHE, CMPE, Vice President

Speaker Introduction

• Mr. Halverson has more than 15 years of experience in healthcare strategic and business planning and financial management.

• He possesses extensive knowledge of strategic, operational, and financial best practices among large physician groups and in the context of their integration within health systems.

• Mr. Halverson specializes in economic alignment between physicians and hospitals involving acquisition, group development, compensation planning, and operations improvement.

• He leads ECG’s Dallas office.

20100.014\301090(pptx)-E2

• Frank Panzarella is Vice President of Operations for the Bassett Medical Group (BMG). • Since 2008, Mr. Panzarella has been the executive leader for BMG’s professional staff

of 435 providers and 900 employees. • He is co-chair of the BMG’s governing body, which directs operational and strategic

initiatives. • Prior to Bassett, Mr. Panzarella spent 6 years in progressively responsible positions at

Partners Healthcare System. He completed a MHSA at the University of Michigan.

30100.014\301090(pptx)-E2

Agenda

I. Setting the StageII. High-Functioning Physician OrganizationsIII. Performance Improvement ToolboxIV. Case Study – Bassett Healthcare Network

40100.014\301090(pptx)-E2

I. Setting the Stage

50100.014\301090(pptx)-E2

• Budgetary constraints of federal and state programs are compressing reimbursement to providers.

• Consolidation of commercial payors and their resulting market power contribute to minimal revenue growth.

• As a result, operating margins of integrated healthcare systems across the country are under pressure.

• The sustainability of the current configuration of physician organizations without structural change is being questioned.

I. Setting the StageAnatomy of a Crisis

The healthcare system in the United States is on the trajectory of insolvency.

The nation is looking to healthcare organizations to innovate and improve care delivery through better coordination and more efficient use of resources.

60100.014\301090(pptx)-E2

I. Setting the StageIncreased Physician Employment

Growing Trend• Newly trained physicians see

health systems as a “safe haven” from uncertainty.

• Health systems see primary care as a necessary investment to lock in future business.

• Smaller multispecialty groups are dissolving as select specialties pursue hospital employment to improve compensation levels.

As professional service reimbursement flattens or falls and uncertainty over reform continues, physicians are increasingly

becoming employed by hospitals and health systems.

“More than half of practicing U.S. physicians are now employed by hospitals or integrated delivery systems, a trend fueled by the intended creation of accountable

care organizations and the prospect of more risk-based payment approaches.” – The New England Journal of Medicine, May 2011.

Percentage of U.S. Physician Practices Owned by Physicians and Hospitals, 2003 to 20111

1 Source: Medical Group Management Association (MGMA) Physician Compensation and Production Surveys, 2003 to 2011 reports based on 2002 to 2010 data.

2003 2004 2005 2006 2007 2008 2009 2010 20110%

10%20%30%40%50%60%70%80%

Hospital-Owned Physician-Owned

70100.014\301090(pptx)-E2

I. Setting the StagePhases of Physician Employment

Employed physician networks tend to migrate through the four phases shown below. The phase that your organization is in will shape your planning efforts.

Low High

High

Car

e D

eliv

ery

Focu

s

Network Maturity

Phase 1 – Recruitment

Phase 2 – Growth

Phase 3 – Service Expansion

Phase 4 – Value- Based Network

Four Phases of Physician Network Evolution

Low

Objective Meet Community Need

Secure Market Share

Expand Clinical Expertise Manage Population

80100.014\301090(pptx)-E2

I. Setting the StageImplications of Physician Employment

Practice Expenses• Salaries and benefits typically, though not always, increase.• Infrastructure requirements are significant and will be higher

than in the private practice setting.

Hospitals need to have clear and realistic expectations of how practices will change after employing physicians.

Practice Revenue• Physicians’ payor mix is likely to be less favorable than pre-

acquisition as independent physicians refer Medicare, Medicaid, and uninsured patients to employed physicians.

• A loss in physician productivity is common.• The level of physician engagement in the business may

decline.

I. Setting the StageInvestment Per Physician Increases

90100.014\301090(pptx)-E2

Notwithstanding these trends, hospitals/health systems are experiencing increasing losses in physician organizations.

Source: ECG 2013 surveys.

Integrated Health System Investment/(Loss) Per Physician

$(200,000)

$(150,000)

$(100,000)

$(50,000)

$-

-100.0%

-90.0%

-80.0%

-70.0%

-60.0%

-50.0%

-40.0%

-30.0%

-20.0%

-10.0%

0.0%

$(138,724)$(148,791) $(148,025)

$(181,407)

-29.7%

-33.2%-28.3% -33.6%

Investment Per Physician Percentage of Net Collections

20122010 20112009

100100.014\301090(pptx)-E2

II. High-Functioning Physician Organizations

110100.014\301090(pptx)-E2

Integrated Model

Pract.A

Pract.B

Pract.C

Pract.D

Pract.E

Pract.F

Pract.G

SharedGovernance

andServices

Strong Central Governance and

Management

II. High-Functioning Physician OrganizationsOrganization Models

Limited Central Governance and

Management

Federated Model

LimitedCommon

Governance and Shared

Services

Pract. A

Pract. B

Pract. C

Pract. D

Pract. F

Pract. E

Pract. G

Multispecialty Model

Common Governance, Management, and

Finances

CommonGovernance

Centrally ControlledPolicies and

Finances

Pract.A

Pract.B

Pract.CPract.

D

Pract.E

Pract.F

Pract. G

Organizations with aligned/employed physicians are seeking to reorganize themselves in order to establish high-functioning “systems of care” that create

value by demonstrably improving quality outcomes and reducing costs.

The market appears to recognize that high-functioning, integrated multispecialty group practices are most likely to be successful in a value-based reimbursement system.

120100.014\301090(pptx)-E2

II. High-Functioning Physician OrganizationsMechanisms for Group Integration

Structure MechanismGovernance and Management

• Common vision and shared direction with physician participation.

• Clearly articulated roles and authorities of governing bodies.

• Delegated leadership with a strengthened governance structure to facilitate efficient and effective decision making.

• Consolidated leadership for key functions and overall physician enterprise.

Operations • Implementation/enforcement of standards for patient care processes, practice characteristics, and administrative functions.

• Electronic medical records (EMRs) that provide a common platform to collect information and coordinate care.

Financial Arrangements

• Consolidation of compensation methods.• Consistent incentives among physicians.• Financial alignment between providers of

care (i.e., hospitals and physicians).

Practice Management

Physician Leadership/Governance

Revenue Cycle Performance

IT(e.g., EMR)

Clinical Integration

Compensation Plan

Patient Access and

Scheduling

Performance Monitoring

(Data-Driven)

Integrated Physician Network

Physician group integration is achieved through the following elements:

130100.014\301090(pptx)-E2

II. High-Functioning Physician OrganizationsViewing Physicians as Strategic Assets

Underlying Causes of ConflictExcessive focus on what they want to gain out of the relationship instead of what they can contribute to it.

Naive and unrealistic expectations about how the relationship should work.

Failure to discuss needs and expectations in advance.

Not knowing how to be a couple.

Lack of preparedness to be a good partner in a mutually beneficial relationship.

In any type of relationship, the things people argue over often are not the real issue.

140100.014\301090(pptx)-E2

II. High-Functioning Physician OrganizationsViewing Physicians as Strategic Assets

Clear decision-making processes and shared governance can improve the “relationship” between physicians and hospitals.

Limited Governance Ad Hoc Committee Standing Committee

Governance Council

Overview • No established mechanism for governance. Individuals informally consulted.

• Formed to discuss specific issues (e.g., new products, workforce planning) as they arise.

• Established governance body responsible for wide range of oversight functions.

• Council maintains complete accountability for service line performance, reporting directly to the health system CEO.

Strategic Planning

• No role. • Informed. • Advisory. • Advice, direction, and approval.

Management Selection

• No role. • Input on hiring. • Input on hiring and performance review.

• Accountability for hiring and termination.

Budgeting • No role. • Occasional advisory. • Advisory. • Advice and approval.

Physician Compensation

• Individual physicians may be consulted.

• Limited physician involvement.

• Significant physician composition.

• Balanced physician and executive composition.

150100.014\301090(pptx)-E2

II. High-Functioning Physician OrganizationsPhysician Compensation

Because physician compensation is by far the largest expenditure, special attention should be paid to align compensation with organizational goals. The

elements listed below represent an example physician compensation philosophy.

Median compensation for median work effort.

Emphasis on individual and/or group productivity.

Payor-neutral compensation.

Introduction of nonproductivity-based incentives over time.

Income protection for specialties only on an as-needed basis.

A common compensation methodology across specialties wherever possible.

160100.014\301090(pptx)-E2

III. Performance Improvement Toolbox

III. Performance Improvement ToolboxOverview

Lean• Considers any activity that does not directly create value for the customer to be a target for

improvement or elimination.• Often known for the principle of “waste reduction.”• Valued as a tool for cultural change as well as cost reductions.

Six Sigma• Targets perfection by identifying the causes of errors and reducing process variation.• Focused on quality improvement, with cost reduction as a benefit of reaching that goal.• Establishes a threshold of acceptable performance at the “six sigma” level (i.e., 3.4 defects

per million opportunities).

170100.014\301090(pptx)-E2

“Americans would be better served by a more nimble health care system that is consistently reliable and that constantly, systematically, and seamlessly improves.”

– Institute of Medicine, September 2012

Many organizations are turning to Lean and Six Sigma as tools to address cost and quality simultaneously. They are complementary and often

overlapping philosophies that make the patients’ needs the top priority.

18

III. Performance Improvement ToolboxSix Sigma Process (DMAIC)

0100.014\301090(pptx)-E2

• Determine scope, goals, and key stakeholders.• Estimate timeline, budget, and resources.

• Map the current state through interviews and observation.

• Define key process metrics (CTQs).

• Assess data accuracy.

• Identify waste.

• Locate internal and external sources of variability.

• Ascertain causes of redundancy and errors.

• Prioritize potential changes based on impact and risk.

• Implement process changes.

• Review outcome and CTQ performance in order to understand the impact of changes.

• Repeat “Analyze” and “Improve” phases until desired outcomes are achieved.

• Establish ongoing accountability and measurements.• Monitor performance to ensure the sustainability of improvements.

Define

Measure

Analyze

Improve

Control

Impr

ovem

ent P

roce

ss

Many organizations struggle with the “Control” phase, which requires sustained focus on gains that have been made through an improvement effort.

19

III. Performance Improvement Toolbox Lean Daily Management

0100.014\301090(pptx)-E2

To achieve improvement goals, providers and staff must have visibility into daily variability and be held accountable for performance so they can react in real time.

Many providers are interested in this approach because of real-time feedback and improvements.

Month

Step 2 – Visually Track Performance in Comparison to the GoalStep 1 – Measure Performance

Step 3 – Understand Reasons for Deviations

Step 4 – Make an Action Plan for ImprovementIntervention Responsible Individual Due Date Progress

Create a policy that requires providers to notify the practice manager of planned vacation days.

Practice Manager 10/15/2012 Complete.

Develop a program to ensure that new patients receive their paperwork 7 days prior to their scheduled appointment and establish a policy that requires patients to have the completed paperwork with them at the time of their appointment.

Practice Manager 10/1/2012 In progress.

Date

Perf

orm

ance Goal

X

X

X X

X

XX

X

XDate Reason for Missed Goal

9/1/2012 Appointments had to be rescheduled for 9/2/2012 because a provider failed to notify the practice manager of a planned vacation day.

9/7/2012 New patients did not complete the required paperwork and were not seen by the provider until 30 minutes after their scheduled appointment time.

20

III. Performance Improvement ToolboxValue Stream Mapping

0100.014\301090(pptx)-E2

A value stream map (VSM) is a tool used to assess work flow, identify waste, and plan for the reduction/elimination of the waste within a

given time frame. All process steps are identified from start to finish.

To improve a process, you should focus on establishing flow, eliminating waste, and adding value to the patient.

• VSM provides a common language that helps stakeholders visualize the future vision.

• Identifies value-added and non-value-added time for the patient.

• Identifies deviations between the actual process and the intended process.

• This tool is useful as part of a process-mapping exercise.

Scheduling Registration Patient Assessment

Patient Treatment Checkout

Patient Patient

Value Stream

TimelineNon-Value-Added (wait time) Value-Added

21

III. Performance Improvement ToolboxRapid Improvement Events

0100.014\301090(pptx)-E2

A rapid improvement event (RIE) is a 3- to 5-day event that brings together a team of stakeholders with the objective of improving a

specific process. The goals of the event are to identify improvement opportunities, develop solutions, and implement them quickly.

RIEs can provide immediate benefits, but the organization must develop an action plan and arrange for ongoing monitoring in order to ensure sustainment.

Goal Tools

Preparation • Scope the problem.• Select a team.• Collect outcomes data.

• Observations.• Stakeholder interviews.

Day 1 Identify the current state. • Current-state VSM.• Observation and time studies.

Day 2 to 3 Identify opportunities to improve the process.

• Turnover reduction.• Fishbone diagram.• Five whys.

Day 4 to 5 Design and test the future state. • Future-state VSM.• Pilot/trials.• Potential problem analysis.

Action Plan Clarify required next steps to achieve the desired future state.

Action plans.

• May be integrated into existing projects.

• Can obtain leadership buy-in with quick results.

• Can be condensed if resources are needed on clinical duties.

• Are an efficient use of client resources.

III. Performance Improvement ToolboxStandard Work

Elements of Standard Work• Takt Time – The rate at which a

process must be completed in order to meet customer demand.

• Work Sequence – The order in which tasks are performed.

• Standard Inventory – The number of units1 required to keep the process operating smoothly.

220100.014\301090(pptx)-E2

“Standard work” is the best known way of doing something. It is one of the most powerful Lean tools and forms the baseline for continuous improvement.

Standard work is a continuous effort and relies on feedback from staff and providers.

Inconsistent Process

Staff doing whatever they can to get results (aka workarounds).

Inconsistent Results

Staff using standard work to get results.

Consistent Process

1 Units may be patients, instrument trays, charts, lab tests, etc.

Desired Results

23

III. Performance Improvement ToolboxControl Charts

0100.014\301090(pptx)-E2

Control charts provide a visual method for distinguishing between normal process variability and special-cause process variability.

Control charts supplement management dashboards by providing statistical and trending insights.

Traditional Scorecard Control Charts Conclusions

Collections Rate

Visits Per Day

Patient Satisfaction

Month YTDPerformance is above target, but appears to be deteriorating.

Improvement efforts do not appear to be having any effect.

This month’s performance was an anomaly and requires investigation.

Time

Upper Limit

Average

Lower Limit

24

III. Performance Improvement ToolboxSustainment

0100.014\301090(pptx)-E2

Without providing the tools to monitor and meet best practices, it is unreasonable to expect sustained improvement over time.

Best Practices Standards Habits Sustained Improvement

Strong Sustainment Weak/No Sustainment

Perf

orm

ance

Time

• Many organizations forget to allocate time for the sustainment phase of the project.

• Lean daily management is one of the most common accountability tools in healthcare.

• EMR reporting tools may need to be leveraged to support performance improvement efforts.

250100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare Network

0100.014\301090(pptx)-E2

Overview• Bassett Healthcare Network is an integrated

healthcare system that provides care and services to people living in an eight-county region covering 5,600 square miles in upstate New York.

• The organization includes:– Six corporately affiliated hospitals.– Skilled nursing facilities.– Community and school-based health

centers.– Home health.– DME companies.– Medical school.– Health partners in related fields.

26

IV. Case Study – Bassett Healthcare NetworkOverview and Mission

Mission – “Who we are…"Bassett Medical Center is an academic medical center that exists to advance the healthcare of rural populations through:• Providing excellence in the continuum

of care.• Educating physicians and other health

care professionals.• Pursuing health research.

270100.014\301090(pptx)-E2

20131984

IV. Case Study – Bassett Healthcare NetworkLocation Growth

280100.014\301090(pptx)-E2

1940 1950 1960 1970 1980 1990 20130

50

100

150

200

250

300

8 1630

42

72

150

260

Number of Physicians

IV. Case Study – Bassett Healthcare NetworkPhysician Growth

Similar to other organizations across the country, Bassett has significantly increased its number of employed physicians.

0100.014\301090(pptx)-E2

Strategies in Play• Insurance partnership• NEWCO IPA Expansion of network• Value-based insurance: ACO, ACQA, MA,

EXG• Medicaid Health Home• Bassett Health Plan• PCMH, the Care Team Model, and Care

Coordination• Business Intelligence

29

IV. Case Study – Bassett Healthcare NetworkInitiatives

Effective Operations• ECG – Medical Group Efficiency and

Performance• Inpatient Efficiency, Capacity, and Flow• External Benchmark and Regional Peer

Comparisons• Systematic Cost Reductions• Health Plan Management• Targeted Program Reviews• Unity (Epic) Optimization

0100.014\301090(pptx)-E2

Growth (Traditional/Insurance-based)• Primary Care providers• Primary Care sites• Rome, Utica• IPA with other physicians• Insurance products• The Manor

30

IV. Case Study – Bassett Healthcare NetworkInitiatives

Finance – Difficult Transition from FFS to Capitation

• Volume• Capital• Reserves• Transitional funding

0100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkProcess Mapping

31

High-Level Clinic Process and Control Points

Reg

istra

tion/

Cha

rge

Ent

ryB

asse

tt C

linic

s/D

epar

tmen

tCa

ll Ce

nter

Control Gap

Control Gap

Patient Visit

Arrive Patient; Collect Auth/

Referral

Post Professional

Charge

REGISTRATION BALANCE COLLECTIONSCHEDULING CARE EVENT

Auto label print in clinical areas to Communicate Patient Arrival

= Automatic input/transfer of data.

= Manual input/transfer of data.

Provider Documentation;Select CPT/DX

Codes

Missing Charge Reporting?

Surgeries and Procedures:

Code and Post Charges by

Charge Entry Unit

Post Technical Fees

Work Standards

and Controls

Performance Gap

Write out paper receipt

Flowcast Centricity Business

Manual Process

Performance Gap

Schedule Appointments

Performance Gap

Access RevRunner to

check eligibility

Limited System

Functions

Surgery/CTC: Arrive Patients

for Clinics

Epic

Post Payment

Nursing Documentation; Enter Technical

Charges

Obtain Patient from Waiting Area;

Vital Signs and Assessment

Performance Gap

Electronic Encounter Forms

Electronic Encounter Forms

Manual Forms;

Training Needs

Schedule Return

Appointments

Auto Split of E&M by Payor Rules

Meditech for Supplies

Paper or Reports Meditech

Work Standards;

Care Model

SCHEDULING

Schedule Return

Appointments

CHARGE ENTRY

Schedule Return

Appointments

Schedule Appointments

Automatic Account

Generation

0100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkMajor Findings

Optimization of Clinical Time:• Maximize the productivity of existing provider time in the clinic through the implementation

of:– More effective master schedules.– Efficient and effective scheduling processes.– A reduction in lost capacity due to no-shows and last-minute cancellations.

Staffing for Throughput:• Identify the ideal staffing model for each clinic, with redefined responsibilities for each

support role. • Then develop a training and transition plan to maximize the use of existing staff and ensure

they are working to the top of their license.Access and Patient Satisfaction: • Capture return and follow-up visits before the patient leaves the clinic space in order to

improve patient service and reduce the need for duplicative work.

32

There were three major areas of opportunity to create a more productive clinic environment.

0100.014\301090(pptx)-E2 33

IV. Case Study – Bassett Healthcare NetworkLoad Balancing

Orthopedics ClinicMiddle Surgery Clinic

While there is time available for more patients in existing schedules, volumes may not be possible if they are added to the busiest days in clinic.

0

1

2

3

4

5

6

7

8

Prov

ider

s in

Clin

ic

0

1

2

3

4

5

6

7

Prov

ider

s in

Clin

ic

NOTES: In both figures, the lines indicate the maximum/minimum values; the bars represent the 25th and 75th percentiles. Standard practice in an orthopedic clinic is three exam rooms per physician in the clinic, plus one additional room if that physician is supervising an APC.

0100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkStandard Work

34

To increase appointment availability, session durations could be established. A 4-hour expectation could be standardized while maintaining independent

decision making for the provider in relation to start/stop times.

Status Quo 4-Hour Standard7 a.m.

8 a.m.

9 a.m.

10 a.m.

11 a.m.

12 p.m.

1 p.m.

2 p.m.

3 p.m.

4 p.m.

5 p.m.

6 p.m.

Provider 1 Provider

3

Provider 2

Provider 1

Provider 3

Provider 2

Provider 1

Provider 1

Provider 1

Provider 1

Provider 1

Provider 1

350100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkProcess Redesign

Nursing Pool

• Team-Based Care• MA Assignment • RN Scope of Practice• Appropriate Staff Levels

• Team-Based Care• MA Assignment • RN Scope of Practice• Appropriate Staff Levels

• Team-Based Care• MA Assignment • RN Scope of Practice• Appropriate Staff Levels

Current State Future State

RN Triage

and Clinical Support

• Utilization of Whomever Is Available• Limited Clinic Prep• Limited Clinic Discharge • High Staff Dissatisfaction• Provider-Centric vs. Patient-Centric

0100.014\301090(pptx)-E2 36

IV. Case Study – Bassett Healthcare NetworkOpportunities for Error

Unnecessary complexity in scheduling creates opportunities for error, difficulty finding appropriate slots, and challenges for planning staff schedules.

SpecialtyNumber of Visit Types

Types With Volumes <100

Visit Types With Volumes <10

Allergy 3 - -

Cardiology 22 6 2

Endocrinology 12 6 3

General Surgery 20 15 5

Opportunity – Visit Type Utilization

• In many specialties, there are visit types with extremely low utilization.

• In general surgery, 95% of all cases are scheduled into the top five visit types.

Specialty Visit Type Arrived VisitsUrology Procedure 3 73

Plastic Surgery Procedure 4 60

Ophthalmology (blank) 177

Opportunity – Unclear Visit Types

• Without clear appointment types, it is difficult to ensure accuracy in central scheduling.

Provider Arrived VisitsSCHED, USE479 817

SCHED, USE97 1,157

(blank) 10,819

Opportunity – Undefined Providers

• Without clear schedules, clinic managers find it difficult to plan ahead.

0100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkLost Capacity

• The ability for schedulers to maximize available provider time varies by clinic.

• All the clinics have some loss of capacity due to same-day no-show rates, with most clinics in the 8% to 10% range.

• Some clinics may have inherent inefficiencies due to their physical space, such as the GI physicians needing to travel between buildings throughout the day.

37

Improving the scheduling process could increase volumes without needing to change provider time in the clinics or physician behavior.

Approximately 28% of existing appointment times were underutilized due to scheduling inefficiencies and no-show rates.

NOTE: Assumed 46 weeks per year. Calculations include only physicians who were or are currently employed.

Existing Clinic Slot Utilization

0100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkProjected Impact

Key Assumptions• Staffing schedules are able to be adjusted as needed.• Scheduled visit durations are accurate to reality.• Scheduled visit durations and visit type mix remain consistent.

38

Scenario Description Constraint Variance

2012 Actual Actual 2012 visit volumes. N/A.

75% Appointment Slot Utilization

Assumes provider schedules remain as they are, but with an increase in slot utilization up to 75%.

Hours per week. +12%

4-Hour Session Standard

Assumes provider sessions remain as they are, but are extended to a full 4-hour session where they are not already.

Sessions per week. +20%

Based on benchmarks and existing resources, it was estimated physicians can increase productivity in patient volumes without opening

new clinic sessions or changing provider clinical practices. 

0100.014\301090(pptx)-E2 39

IV. Case Study – Bassett Healthcare NetworkRapid Improvement

Component ProposedProblem Statement Many patients are leaving the clinic building without the necessary follow-up appointments scheduled,

creating additional work for the patient, opportunities for miscommunication, appointment volumes not being captured, and additional calls through the call center.

Scope Redesign of checkout function after provider clinical visit has been completed.

Measure Definition Portion of patients leaving the clinic building with all follow-up appointments scheduled.

Goal Performance TBD.

Tasks The team will work to establish a reliable measurement for both current performance and the reasons for failure. This information will be utilized to conduct an RIE that ultimately culminates in a new checkout process.

Timeline and Plan 45 to 60 days. Change management plan, TBD.

Bassett utilized Lean management tools to improve operations.

Develop project

goals and charter.

Define process

and outcome

measures.

Map current state.

Identify barriers

and opportuni

ties.

Design future state.

Develop training

and transition

plan.

Implement

Sustain.

One-Week Rapid Improvement Event

400100.014\301090(pptx)-E2

IV. Case Study – Bassett Healthcare NetworkPerformance Dashboard

Metric BHC

Square Feet Per FTE 775

On-Time Registrations 80%

Lead Time 44 Days

No-Show Rate 11.7 Per Day

Add-On Volumes 3.5 Per Day

Actual Visit Durations

Actual Sessions

Maximum Providers

-10.0-8.0-6.0-4.0-2.00.02.04.06.08.0

10.0

Exam

Roo

ms,

Var

ianc

e

Projected Exam Room Needs

Projected Staffing Needs

Provider Time Utilization

Performance

-5.00

-3.00

-1.00

1.00

3.00

5.00

Benchmark Per Provider FTE Benchmark Per 10,000 WRVUs

Staf

f, Va

rianc

e

Allergy

Cardiol

ogy

Endoc

rinolo

gy

Infec

tious

Dise

ase

Nephro

logy

Neurol

ogy/S

leep

Pulmon

ary

Rheum

atolog

y0%

20%

40%

60%

80%

Clinic Percentage of Total Percentage Scheduled Percentage Arrived

Perc

enta

ge o

f FTE

Cap

acity

IV. Case Study – Bassett Healthcare NetworkOutcomes

410100.014\301090(pptx)-E2

Across-the-board changes have yet to be implemented; however, pilots of key enhancements have demonstrated significant results.

Quality Access

CostPatient and

Staff Satisfaction

Balanced Scorecard Domains Expected Outcomes

Increase access. Team-based care. Integrate ARNPs.

Reorganize care model. Increase patient satisfaction. Enhance economic sustainability.

420100.014\301090(pptx)-E2

Mr. Frank Panzarella

frank.panzarella@bassett.org

Mr. Joshua D. Halverson972-663-0100

jhalverson@ecgmc.com