Developing Successful Spine Centers Of Excellence And Managing Quality

Developing SuccessfulSpine Centers ofExcellenceandManaging QualityJanuary 16, 2013San Diego, California

Marcy T. RogersMarcy Rogers is President and CEO of SpineMarkCorporation, the premier global spine servicecompany for the development of Spine Centers ofExcellence and Spine Research Organizations.SpineMark works with physicians, hospitals, facilitycompanies, third-party payors and medicalmanufacturers in the fields of spine, pain, orthopaedicsurgery and neurosurgery.For more than 30 years, Marcy has worked withleading healthcare professionals, facilities and medicaldevice manufacturers to advance her goals ofimproving patient outcomes and satisfaction.

Headlines TodayCleveland ClinicDiagnoses HealthCare Act, Wall StreetJournal, 12/19/12Medicare DisclosesHospitals’ Bonuses,Penalties Based onQuality, KHN, 12/21/12New York City TiesDoctors’ Income toQuality of Care, NewYork Times, 1/12/13Atlanta Hospital SystemsTo Form Their OwnInsurance Company,medcitynews.com,12/18/12

The Globalization of HealthcareMedical Tourism Medical tourism global revenues for 2010 were 40 billion Patients seek international spine care optionsbecause: Healthcare too expensive at home Waiting times for surgeries are long New medical developments not yet approved inhome country“The growth of the global health care industry has resulted inincreased competition, leading hospitals to differentiate themselvesthrough international health care evaluators. Partners Harvard Medical International”

AGENDARATIONALEExamine the rational for developing a Spine Center by exploring the economicburdens imposed on both patients and physicians by the current state of Spine andhow the emergence of the multi-disciplinary care model can alleviate theseburdens.MEASURINGSUCCESSBenchmarks, process, patient thru-put and outcomesDevelopment of the business modelDEVELOPING THEBUSINESS MODELFollows the first phase of the milestones chart and discuss how to develop abusiness model for the Center along with legal factors and potential structures ofownershipADMIN & LOGISTICSFollows phases 2-5 on the milestones chart and takes you step-by-step throughessential phases.MARKETINGOverview of marketing program trends. Discuss the fundamentals of marketing asuccessful Spine Center with detailed, practical tips and best practices.Q&A

AGENDAEXAMININGExamine the rational for developing a Spine Center by exploring the economicburdens imposed on both patients and physicians by the current state of Spine andhow the emergence of the multi-disciplinary care model can alleviate these burdens.MEASURINGSUCCESSBenchmarks, process, patient thru-put and outcomesDevelopment of the business modelDEVELOPING THEBUSINESS MODELFollows the first phase of the milestones chart and discuss how to develop abusiness model for the Center along with legal factors and potential structures ofownershipADMIN & LOGISTICSFollows phases 2-5 on the milestones chart and takes you step-by-step throughessential phases.MARKETINGOverview of marketing program trends. Discuss the fundamentals of marketing asuccessful Spine Center with detailed, practical tips and best practices.Q&A

Spine CenterTumorsConservativeCare PortalincludingDiagnosticsPhysiatry,Interv Pain,NeurologyPainSpineMusculoskeletal Complex Deformity Degenerative MISS Trauma General Sports Medicine Joints Trauma General Orthopedics

In Building a Successful Spine Center Model,Everything Must Fit Together

Overview of Stages for Development of COEsPlanning & FeasibilityImplementationManagement Launch Clinical GO LIVEOperations Committee Implement QualityDashboard Metrics Implement Marketing &Operating Plans, ReviewAnnually Utilization Review, Q/APrograms Set Objectives for COEAnnual Growth Market AssessmentFeasibility Assessment& Op Plan for Establish Triage Thru-putIntegration Clinical AlgorithmsMission, Vision and Patient NavigationValues Recruit Key Staff /Team SWOT Analysis Train Staff, Management Business Plan, Budgets Implement Research Siteand Forecasts Produce Marketing Plan

Strengths of the Spine UmbrellaBroad catchment of referrals from intertwined fields leads to increased market share,diversification of referral, payor trendsCoordination of primary and ancillary careOperative non-operative integrated model delivery systemCaptures downstream and spin-off revenueQuality metrics for process and outcomesIncreased utilization of OP site of serviceCombination of multiple related departments/programsResearch

Spine Center Opportunities International, national, regional local catchment area branding and marketing PCP Education programs for when to refer and where Quality focused Spine Protocol Management System and Metrics Organized system for patient thru-put Comprehensive delivery system for conservative, operative and non-operativecare will solve outmigration issues and increase market share Clinical research drives a new class of patient referrals Alignment, accountability, collaboration model Niche specialties and expertise are the key to surviving managed care – TobyCosgrove Interview, 12/12 WSJ

AGENDAEXAMININGExamine the rational for developing a Spine Center by exploring the economicburdens imposed on both patients and physicians by the current state of Spine andhow the emergence of the multi-disciplinary care model can alleviate theseburdens.MEASURINGSUCCESSBenchmarks, process, patient thru-put and outcomesDevelopment of the business modelDEVELOPING THEBUSINESS MODELFollows the first phase of the milestones chart and discuss how to develop abusiness model for the Center along with legal factors and potential structures ofownershipADMIN & LOGISTICSFollows phases 2-5 on the milestones chart and takes you step-by-step throughessential phases.MARKETINGOverview of marketing program trends. Discuss the fundamentals of marketing asuccessful Spine Center with detailed, practical tips and best practices.Q&A

BenchmarksProtocol,Quality Metrics

Accountability and CollaborationPhysician ContributionHospital ContributionClinical Leadership Staff Participation standards Location Clinical pathways Director Clinical outcomes and quality Nurse Navigator Software foroutcome tracking MarketingHospital leadership and Spine Center physicians collaborateto manage outcomes and the cost of care.

Measuring rketPerformance LOS OR Utilization Continuum of Care Optimized Care Transitions Contribution Margin Meet Business Plan Metrics Resource Utilization ROI Patient Satisfaction CQI – Quality Initiatives Outcomes/RTW Complications Recruitment and Retention Administrative Satisfaction Physician/Staff Satisfaction Market Share Growth Referrals from WC and PCPs Volume Research & Academic Visibility(PSA, SSA & TSA) Payor Optimization

Transparency will Drive Quality, Growth and ReimbursementTransparencyPerformanceMarket Share &Maximized Reimbursement Error Prevention Clinical Outcomes Quality Dashboards Performance Metrics Spine Center Policiesand Procedures Continuous QualityImprovement Plans Report Cards Quality of Care Credentialing & Accreditation Patient Access PatientSatisfaction Patients are ‘shopping’ Payors are ‘purchasing’ bundledservices and paying for qualityand data on outcomes ACO’s are only going to GROW

Specialization in Orthopedic Surgery ShowsBetter OutcomesFewer postoperative complications, such as blood clots, infections,heart problems and death among the more specialized hospitals50% lower rate of death within the first 90 postoperative days forpatients undergoing hip or knee replacement among the morespecialized hospitals“Standardization,whether it is in manufacturing or in health care,leads to fewer errors and more predictable outcomes.The Journal of Bone and Joint Surgery , 20071: Hagen TP, Vaughan-Sarrazin MS, Cram P. Relation between hospital orthopaedic specialisationand outcomes in patients aged 65 and older: retrospective analysis of US Medicare data. BMJ.Published online 2010 Feb 11.”

Spine Protocol Management SystemInternational Standard for Spine COEs that ensures meeting businessrequirements and the broader needs of patients and societyInternational Standards include:Planning Quantifiable data to balance cost and outcomes Participation standards between IP and OP and ancillary services Prevention, screening and patient educationImplementation and Management Process to ensure data and information are accurate and reliable Making data accessible to those who need itMonitoring Clinical/Surgical Outcomes Financial Performance Metrics Operational Metrics Service and Staff Performance StandardsMeasurement Continuous monitoring of industry benchmarks

AGENDAEXAMININGExamine the rational for developing a Spine Center by exploring the economicburdens imposed on both patients and physicians by the current state of Spine andhow the emergence of the multi-disciplinary care model can alleviate theseburdens.MEASURINGSUCCESSBenchmarks, process, patient thru-put and outcomesDevelopment of the business modelDEVELOPING THEBUSINESS MODELFollows the first phase of the milestones chart and discuss how to develop abusiness model for the Center along with legal factors and potential structures ofownershipADMIN & LOGISTICSFollows phases 2-5 on the milestones chart and takes you step-by-step throughessential phases.MARKETINGOverview of marketing program trends. Discuss the fundamentals of marketing asuccessful Spine Center with detailed, practical tips and best practices.Q&A

Spine Center of ExcellenceThe Spine Center is an integrated delivery system for quality-driven, state-of-the-artoperative and non-operative care for spinal conditions.Benefits of building this program: Coordination of care Physician alignment for optimal care delivery Efficiency of provider practices Enhanced patient experience Improved patient outcomes Increased referral satisfaction Advancing care via clinical research Cost managementSpine Center

Qualifications/ReadinessMarketplaceProfile Catchment area: Population 500,000 Defined purpose for pursuing a Spine of Excellence Well-trained ER physician team 3-6 surgeons aligned with the vision for COEBroad base of primary care, neurology, Strong diagnostics, interventional radiology servicesrheumatology support ER Protocols for Spine - Ortho, Neuro Industry “heavy” area Outmigration of cases or potential market share to gain Access to international airport Facility willing to invest in COE virtual/physical infrastructure Surgeons and physicians collaborative Vesting of all stakeholders through alignment model Transportation, utilities, warehousingOpportunities for medical tourism program

Spine Center Focus on Treatment forMultiple ConditionsTypes of patients the Center will serve: Deformity Tumors MISS Complex spine (fusions, etc) General spine, trauma Total disc replacement Dynamic stabilization Diagnostic and therapeutic injections Ablative interventional pain procedures Pumps and stimulators Interventional pain

Spine CenterProgram Structure

Spine Center of ExcellenceKey Program Elements Central point of access for afull array of services, 800 number Effective triage system basedon clinically sound algorithms Improved service andcommunication through nurse navigation Clear marketing and promotion program addressing strategies forcontracting, public relations, promotion and advertising Participation in clinical research trials Outcome-driven, evidenced-base care assessment system Transparency to payors, employers, managed care organizations andphysician groups

Surgery is Only One Component ofComprehensiveSpine CareNon-surgical care accounts for 90%of volumes and 60% of spine revenue! Patient Diagnostics: 4.2 billion Spinal Injections: 2.3 billion Complementary/Alternative Medicine: 26.1 billionImaging 75 – 150K/yearPhysical Therapy 150 – 200K/yearPain Injections 250 – 350K/year