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Session #7:How Mayo Clinic Standardized Care Across

22 Emergency Departments

Pre-Session Poll Question

Do you work in some capacity in or for your ED(s)?

a) Yesb) Noc) Not applicable

Christopher S. Russi, DO, FACEPAssistant Professor of Emergency Medicine

Mayo Clinic College of MedicineRochester, MN

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Poll Question #2

2

What is your role in your ED(s)?

a) Physician

b) Physician / Admin (Medical Director)

c) Admin

d) Advanced Practice Provider (APP)

e) APP / Admin

f) Nurse

g) Nurse / Admin

h) Not applicable

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De

gre

es o

f in

teg

rati

on

Multiple units organized to work in concert with each other where the value of the result is greater than the sum of the individual units

Multiple units agree to utilize single definition for an established value, quality, characteristic, or process in order to produce a uniform outcome or experience

Multiple units brought together by incorporating parts into a larger whole that works in unison within a matrix organization

Multiple units merged into a single operating unitUnified

Integrated

Standardized

Coordinated

Integration Pyramid Continuum

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Why Integrate?

Affordable Care Act

Changes in Medicare reimbursement (probable commercial payer reductions as well)

Expansion of Medicaid

Leverage the “value equation”

Need to operate clinically in a synchronous fashion• “Working differently” to reduce cost and improve quality• Examples:

Patellar fracture transfer Direct admissions Best practice dissemination

Migraine management Keeping patients local

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A Gift?

June 2012

Enterprise Integration Summit / Announcement

• Suddenly we owned 21 Community Emergency Departments

• Thanks, now what?

• Urgent need to make a Division

• EMERGENT need to improve staffing

• No idea of the magnitude of what we just were gifted

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Emergency Medicine in the MCHSBackground

1992 – 1st site: Decorah

• Contract services (county-owned facility)

Next 21 years

• 78 communities served

• 21 EDs (Regional Structure)

‒ 10 Critical Access (CA) sites

‒ 3 contract services

‒ 2 Level-3 trauma centers, 1 Level-2

‒ ~ 320,000 annual visits*

• 2nd largest workforce in MCHS

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Enthusiasm Redirected

NIH KL2 Scholar

• Interested in developing a severe sepsis / septic shock treatment protocol transcending community to receiving centers

Slam on the brakes…

Why am I here?

• Non-data and analytic approach

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How do we Integrate? Where do we begin?

• 22 distinct cultures / personalities

• Geographically and economically disperse

• Variable provider (sometimes absent) workforce

• Siloed recruiting, salaries, administration, and privileges

• Staffing CRISIS

• Focus on PEOPLE

‒ Wrong people = No engagement = NO integration

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Poll Question #3

10

Do you have locum tenens routinely staffing your EDs?

a) Yes

b) No

c) Not applicable

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Immediate Strategy & Tactics

• Road Trip – Invest in knowledge acquisition and relationship building

• Salary Standardization / Correction

• Right tools in place

• EM Leadership Team / Medical Directors

• Develop people

• Eliminate locums

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My Job

• Rapid evolution from the start

• Vision and Strategy

• Recruitment

• Salary / Comp standardization

• Advocacy at the C-Suite

• Practice standardization

• Education

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Early Projects / Successes

Large, functional, productive Division

Centralized Recruiting Process

• 18 hires in two years

‒ $75K savings / FTE locum offset

‒ Heavy use of the CA position

Bedside US

APP Fellowship

‒ $210K saving / FTE physician offset

Create a shared staffing model (Mobile Workforce)

• Web-based scheduling software

• Singular privileging form

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Early Projects / Successes

• Demonstrate Value of EM

‒ Reduced Transfers

‒ Reduction of Oncall need for Ortho / Anesthesia

• Standardized Salary / Benefits

• Move to a salary model

• Midwest APP Medical Director

• Logix Health Implementation

‒ $2.2m realized + $8m estimate NOI increase

• Nursing Standardized Education / Training

• Fairmont & Red Wing ED Redesign

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Future Projects

• Begin to standardize approaches to emergent conditions

• qPath (US billing)

• Match providers to volume and acuity

‒ The APP transition

• Develop a Midwest quality team

‒ Singular focus

• Annual meeting / education event?

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Lessons Learned

16

1. Take a hard look at the current workforce. You may need to make substantial investments to correct issues.

2. Hire those with “fire in the belly.” Those who are enthusiastic and believe in your mission should be your hiring focus.

3. Put the right leaders in the right places.

4. Doing the “right thing” is ok in the absence of supportive data/analytics. Don’t be paralyzed.

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Analytic Insights

AQuestions &

Answers

17

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Choose one thing…

18

Write down one thing will you do differently after hearing this presentation

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Thank You

19

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Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?

1) Not at all satisfied

2) Somewhat satisfied

3) Moderately satisfied

4) Very satisfied

5) Extremely satisfied

2. What feedback or suggestions do you have?

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Upcoming SessionsBreakout Sessions – Wave 2 (2:30 PM – 3:15 PM)

10) Is Big Data a Big Deal…or Not?Dale Sanders, Senior Vice President, Health CatalystRichard Proctor, General Manager, Global Healthcare & Life Sciences, Hortonworks

11) Partners Healthcare Analytic Strategy for bundled Payments and Risk ManagementSreekanth Chaguturu, MD, Vice President for Population Health Management, Partners HealthCareHelen Chan, Senior Manager, Business Planning, Partners HealthCare

12) Sneak Peek: Improving Patient Engagement and Outcomes with Predictive AnalyticsGregory A. Spencer, MD, CMO & CMIO, Crystal Run HealthcareLouis G. Cervone, Jr., Director of Business Intelligence, Crystal Run Healthcare

13) How a Pioneer ACO is Using Analytics to Change Heart FailureSpencer H. Kubo, MD, CMO of BioControl Medical, United Heart &Vascular Clinic, Allina Integrated Medical Network

14) Entering Shared Risk for Community Hospitals Through Physician EngagementGreg Stock, CEO, Thibodaux Regional Medical CenterMark F. Hebert, MD, FACS, Surgical Specialist, Thibodaux Regional Medical Center

15) Panel – Children’s Hospitals: “Tike-mares”…Are the Monsters Under the Bed For Real?

Location

Grand Salon

Grand Ballroom A

Grand Ballroom D

Savoy

Murano

Venezia