Benchmarking and Key Metrics Utilized by HSCT Administrators. Clint Divine, MBA, MSM Administrative Director, BMT

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1 Benchmarking and Key Metrics Utilized by HSCT Administrators Clint Divine, MBA, MSM Administrative Director, BMT 1

2 When you ve seen one HSCT program, you ve seen one HSCT program Although, there are many common components! 2

3 Goals of the organization should set the focus of your Quality, Productivity & Financial Metrics Metrics need meaning! Utilize metrics and KPIs for: Staffing needs, position justifications Quality Assurance Revenue Cycle Strategic planning 3

4 Challenges Substantial variation in HSCT center characteristics Centers have different care models to optimize the use of available resources Identifying external benchmarks; Utility of comparative external benchmarks 4

5 The Value of Dashboards, Metrics (a/k/a KPIs) Provides a user-friendly, visual summary of Operational and Clinical information. Utilize to track data, improve operational and clinical performance Promotes transparency and improves accountability. Dashboards provide a means to assess and manage an center s performance, utilizing key metrics: Quality Assurance, Process Improvement Clinical Outcomes Financial Growth Strategies, Strategic Planning 5

6 The Utility of Metrics are limited without Operational Effectiveness Goals What are you trying to track and/or analyze? Evaluate resource utilization? Reduce volume variability? Use existing capacity more effectively? Create and/or track a unit P&L? Address staff stress, workflow inefficiencies? Measure an operational function that impacts quality? Address regulatory requirements? Contrast your staffing model with other departments? Goals should drive what you are measuring Measures should not drive goals! Dashboards track designated indicators after goals are adopted 6

7 Key Administrative Focus Areas Volume Capacity planning Strategic planning, Growth strategies Acuity vs Procedure-based metrics Length of Stay Mortality Re-admissions Cost and Resource utilization Managed Care / Payer reimbursement Analyze by Type of Transplant (e.g. Auto, Allo, MUD, Cord, Haplo) Analyze by Disease Type Staffing 7

8 BMT ACTUAL VS BUDGET BY FISCAL YEAR ACTUAL BUDGET FY10 FY11 FY12 FY13 FY14 FYTD15 (NOV) 55 MONTHLY TRANSPLANTS VS BUDGET TRANSPLANTED SCHEDULED TO BE TRANSPLANTED BY MONTH END BUDGET

9 # of Transplants BMT Program Annual Volume, by Type (CY06-14) Allo Related Allo Unrelated Auto Total HSCT Allo (MUD) CY08 CY09 CY10 CY11 CY12 CY13 CY14 MUD (non-cb) Cord TOTAL

10 Auto-Transplant Trends 10

11 Growth Rate Growth from Prior Rate Year from Prior Year Year Total Transplants Total Transplants Auto Auto Allo Transplant Transplant Allo Allo RelatedAllo Allo Related Unrelated Allo Unrelated Auto Growth RateGrowth Rate Auto Allo Allo RelatedAllo Allo Related Unrelated Allo Un FY FY % -9.5% -4.8% -9.5% 7.2% 7.2% -26.0% -26.0% 250.0% FY % 20.1% 8.9% 8.9% 43.8% 43.8% 77.8% 77.8% -8.6% FY % 45.9% 26.0% 45.9% -6.3% -6.3% -5.2% -5.2%-9.4% FY % 13.7% 0.3% 0.3% 47.5% 47.5% 50.5% 50.5% 37.9% FY % 10.0% 5.0% 5.0% 18.6% 18.6% 15.3% 15.3% 30.0% FY % 1.3% 1.9% 1.3% 2.9% 2.9% -0.6% -0.6% 13.5% FY % -9.9% 0.6% -9.9% 16.2% 16.2% 14.0% 14.0% 22.0% FY % 10.3% 17.2% 10.3% 25.1% 25.1% 33.0% 33.0% 5.6% FY % -17.8% -16.1% -17.8% -14.3% -14.3% -19.7% -19.7% 2.6% FY % -3.4% 7.0% -3.4% 17.1% 17.1% 2.6% 2.6% 52.6% FY % -1.6% -1.6% 4.1% 4.1% 17.3% 17.3% -17.6% FY % 3.2% 1.9% 3.2% 0.9% 0.9% -6.5% -6.5% 18.4% FY % 12.4% 8.3% 12.4% 5.1% 5.1% -10.7% -10.7% 34.5% FY % -5.5% -3.9% -5.5% -12.6% -12.6% -20.8% -20.8%-2.6% FY % 22.6% 11.1% 22.6% 13.5% 13.5% 5.3% 5.3% 21.7% FY % -1.5% 3.2% -1.5% 7.8% 7.8% 13.8% 13.8% 2.7% FY % -9.4% -1.8% -9.4% 4.8% 4.8% 3.8% 3.8% 5.8% FY % -3.3% 3.0% -3.3% 7.9% 7.9% -4.8% -4.8% 19.9% FY % 35.2% 17.7% 35.2% 5.7% 5.7% 13.9% 13.9% -0.4% FY % 4.6% 3.3% 4.6% 2.2% 2.2% 8.8% 8.8% -3.3% FY % -2.0% 2.9% 2.9% -6.4% -6.4% -23.8% -23.8% 10.3% FY % 5.9% 6.1% 5.9% 6.3% 6.3% 7.1% 7.1% 5.9% 11

12 BMT Inpt and Outpt Volume (CY14) Autologous (n=166) Inpatient 51% (n=84) Allogeneic (n=132) Inpatient 87% (n=115) Outpatient 49% (n=82) Inpatient 99 (55.3%) Outpatient 80 (44.7%) Outpatient 13% (n=17) CY10 CY11 CY12 CY13 CY (57.7%) 91 (42.3%) 150 (65.2%) 80 (34.7%) 193 (63.7%) 110 (36.3%) 199 (66.8%) 99 (33.2%) 12

13 What s missing? Transplant center benchmarks for staffing: APPs BMT Coordinators Long-term Follow-up Apheresis Staffing Quality Management Clinic staffing Data managers 13

14 ASBMT Staffing Model Working Group: Goals: Develop core measures for HSCT operational and performance metrics Serve as a resource to HSCT centers and administrators; and ultimately Payer and Accreditation Organizations 14

15 Is your HSCT program staffing for Adult, Pediatric, or both? Adult only Pediatric only Adult & Pediatric combined Some shared Adult & Pediatric staffing (e.g. Quality, financial coordinator, donor/search coordinator, etc. ) 15

16 Is your HSCT program staffing dedicated or shared with any of the below categories (choose one): BMT patients only BMT / Benign Hematology BMT / Hematological Malignancy BMT / Acute Leukemia (only) BMT / Cellular Therapeutics 16

17 How many transplants does your HSCT program perform annually?

18 Does your HSCT program perform transplants outpatient? Yes (Auto & Allo) Yes (Auto only) Yes (Allo only) No Not sure 18

19 What category best describes your institution? Academic Medical Center (DRG exempt) Academic Medical Center (non-drg exempt) Hospital and/or Health System For Profit Hospital or Health System Other 19

20 BMT New Patient Referral Volume CY10 CY11 CY12 CY13 CY14 Monthly Avg BMT Program - Monthly Referral Volume (CY14) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CY06 CY07 CY08 CY09 CY10 CY11 CY12 CY13 CY14 20

21 BMT Program Monthly Evaluations Auto Allo Donor Total /13 2/13 3/13 4/13 5/13 6/13 7/13 8/13 9/13 10/13 11/13 12/13 1/14 2/14 3/14 4/14 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 Auto Allo Donor Total Adult BMT Coord FTEs # of Transplants # of Work-ups Monthly Avg. Workups Adult BMT Coord FTEs Avg. Evals per FTE

22 Physician & APP Productivity Metrics Adult BMT Physician (Inpt + Outpt) combined 2, , , , Physician 1 Physician 2 Physician 3 Physician 4 Physician 5 Physician 6 Physician 7 MGMA wrvu Productivity Benchmark (per 1.0 cfte) CY14: 3 of 7 BMT Physicians exceed the MGMA 90 th percentile (7,429 WRVUs for a 12 month period ). 22

23 Essential Productivity Metrics BMT Provider WRVUs (rolling 12-month summary) Provider name Provider type cfte Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-14 Dec-14 Jan-14 Rolling 12 WRVUs normalized by cfte Doc1 MD , , ,392.6 Doc2 MD , , Physician sub-total , ,576.4 NP1 NP ,345.1 N/A NP2 NP N/A Nurse Practitioner sub-total Grand Total ,555.8 N/A ,301.0 Productivity Benchmark: MGMA 90th percentile is 8,230 (for 12 month time frame) Analysis: both BMT physicians exceed the MGMA 90th percentile for the 12-month reporting period 23

24 CIBMTR Data Reporting Are you proactively managing your CIBMTR reporting? Are you consistently meeting the 90% CPI requirement? Are you ready for Autologous CPI implementation? January 2015: Monitor Only Monitor Auto forms with the earliest completion date of 12/3/07 8/31/14 May 2015: Partial Implementation at 75% To meet CPI, 75% of the Auto forms with the earliest complete date of 12/3/07-12/31/14 September 2015: Fully Implemented at 90% To meet CPI, 90% of the Auto forms with the earliest complete date of 12/3/07 4/30/15 24

25 OUTSTANDING CIBMTR FORMS CURRENTLY DUE PAST DUE 3,500 3,250 3,000 2,750 2,500 2,250 2,000 1,750 1,500 1,250 1, CIBMTR Reports Submitted (CY09-CY14) 3,210 2,298 1,924 1,818 1,801 1,911 CY09 CY10 CY11 CY12 CY13 CY14 Year Monthly AVG FTE Avg. per FTE CY CY CY CY CY CY

26 UHC Benchmarking Outcomes + Resource Utilization analysis 26

27 27

28 28

29 UHC Resource Utilization Average Direct Cost per Discharge Case Time Period: Utilization Comparison Center 2 Center 3 Center Q1 to 2014-Q1 Accommodations $11,003 $29,656 $21,582 $49,098 ICU $ $1, $21, $48, Other Accommodations $ $0 1 $0 240 $ Routine Accommodations $10, $28, $ $ Ancillary Services $268 $451 $708 $810 Other Ancillary Services $36 34 $68 40 $ $ Physical Therapy $54 26 $ $ $ Respiratory $ $ $ $ Cardiac Diagnostic Services $72 $76 $88 $108 EKG/Telemetry $44 47 $18 48 $ $18 88 Other Cardiac Services $28 21 $58 32 $ $90 23 Diagnostic Imaging $221 $570 $253 $558 CT/MRI $ $ $ $ Nuclear Medicine $10 6 $0 0 $10 40 $15 8 Other Diagnostic Imaging $17 40 $23 46 $ $91 61 X-Ray $62 78 $ $ $ Laboratory $1,799 $3,276 $4,274 $6,622 Miscellaneous $120 $32 $284 $2,431 Other Spec. Dx Svcs. $64 $309 $81 $123 Surgical Services $2,547 $481 $5,474 $2,095 Anesthesia $0 0 $11 7 $38 61 $32 35 Med. Surg. Supplies $1, $ $4, $1, OR Services (Incl Labor/Del) $ $ $ $ Other Surgical Services $28 29 $15 8 $20 50 $ Transplantation $35,868 $37,200 $21,167 $48,228 Treatment $26,252 $19,075 $47,978 $39,685 Blood $5, $4, $3, $6, Dialysis $58 5 $ $ $26 2 Other Treatment $ $ $99 58 $ Pharmacy & IV Therapy $20, $13, $43, $32, Total Cost # Of Patients $78, $91, $101, $149, Expected Cost $64,320 $78,999 $72,648 $85,762 Cost Index LOS Index Mortality Index

30 2015 Tandem Meetings Making the case for additional staffing Craig Conway, Administrative Director Stem Cell Transplant & Cell Therapy Program March 12, Rising Tide

31 What is your role within your HSCT program? BMT Administration BMT Advanced Practice Professional (NP/PA) BMT (RN /non-rn) Coordinator, or other nursing personnel Quality Management Financial Coordinator / Finance Social Worker / Case Management Pharmacy Payer Other 31

32 Does your HSCT program have any capacity issues? Yes (inpatient & outpatient) Yes (inpatient only) Yes (outpatient only) No Not sure 32

33 Does your HSCT program have a dedicated Survivorship / LTFU clinic? Yes (within BMT program) Yes (separate from BMT program) No Not sure Future plans, but not implemented yet. 33

34 Which positions are most in demand for your HSCT program (rank 1 st, 2 nd & 3 rd ) Physicians Advanced Practice Professionals (NP/PA) BMT (RN / non-rn) Nurse Coordinators, and other nursing personnel Pharmacists Data Management Quality Management Administrators Cell Processing, Laboratory Financial Coordinators Social Workers, Case Managers Other 34

35 Executive communications Executive steering committee or executive champion Consensus on Stem Cell strategic and associated business operational plans Support operational needs and break down barriers to achieving strategic and operational plans and objectives Tell the evolving program story (no such thing as over-communication) Quarterly meetings Monthly reports 35

36 Executive communications: communicating staffing needs Adult BMT Program Positions Job Description FTE Fixed / Variable Reviewed / Approved by Shared Position Hard to fill (y/n) Date to Post Date to Fill Comments 1.0 (shared with Lung = 0.5 FTE) Shared with Lung transplant program 8/1/2012 Aug-12 Previously approved by the PRRC as a shared Adult BMT / Lung transplant position. Adult BMT Program Financial Coordinator Fixed Adult BMT Program Infusion Clinic Nurse Manager 1.0 Fixed y 8/1/2012 Aug-12 Set up Temp location, policies, hire staff etc...required to manage licensed professional and unlicensed staffs, manage clinical day to day operations for the outpatient infusion services for pre and post transplant patients (20 chairs and 8 infusion rooms totaling 28). Includes responsibility for financial, quality, safety, regulatory, and customer satisfaction metrics or others as defined by the organization. Adult BMT Program Outpatient Clinic Practice Manager 1.0 Fixed y 8/1/2012 Aug-12 Set up temp space and physician practice/rev cycle, etc Responsible for the structure and daily operations of the adult BMT outpatient physician practice (Hospital-based) and unlicensed outpatient clinic staff. Includes financial, quality, safety, regulatory, and patient satisfaction metrics. Medical Social Worker_T109XE 1.0 Fixed y 8/1/2012 Aug-12 Set up extensive outpatient support services. FACT (B ) - BMT programs must have designated social services staff. Will cross cover Pediatric BMT Department Health/CON requires a pharmacist experienced with the use of cytotoxic therapies, blood components, hemodynamic support of the transplant patient, and the management of immunosuppressed patients. Set up clinical drug protocols, coordination with SH pharm FACT (B ) - BMT programs must have pharmacy staff knowledgeable in the use and monitoring of pharmaceuticals used by the program. Clinical Pharmacy Specialist_T008XE 1.0 Fixed y 8/1/2012 Aug-12 Subtotal, FTEs to fill by August Shared with Pediatric transplant program Regulatory requirement for Blood and Marrow Transplant program as per the Department of Community Health/CON and the Foundation for the Accreditation of Cellular Therapy (FACT). The CON requires data management personnel designated to the BMT service. FACT:B9 - BMT programs must collect all data required to complete Transplant Essential Data Forms of the CIBMTR; by law all BMT programs must report allogeneic transplant information and outcomes to the SCTOD managed by the CIBMTR. (B ) BMT programs must have data management staff sufficient to comply with B9. BMT Program Data Manager 1.0 Fixed y 8/1/2012 Nov-12 Shared with Pediatric transplant program FACT (B3.8) - BMT programs should have at least one person, approved by the Program Director, responsible for establishing and maintaining systems to review, modify and approve all policies and procedures to monitor compliance and performance of the program; the FACT inspector will look for proof that such an individual is in place. BMT Program Quality Coordinator 1.0 Fixed y 8/1/2012 Nov-12 Adult BMT Program Care Coordinator 1.0 Fixed y 8/1/2012 Nov-12 Set up complex medical case management services. Department of Health/ CON requirements: A transplant coordinator to provide transplant coordination including follow-up and post coordination of care. Adult BMT Program Search Coordinator 1.0 Fixed Shared with Pediatric transplant program y 8/1/2012 Nov-12 Must be CHTC Certified Adult BMT Program Infusion Clinic Nurse 4.0 Variable y 8/1/2012 Nov-12 BMT outpatient infusion clinic will be open 7 days a week Nursing Assistant_W024XN 1.0 (two-0.5) Variable Sept/Oct Nov-12 BMT outpatient infusion clinic will be open 7 days a week Administrative Secretary_JV151XN1 (Infusion clinic secretary) 1.0 (two-0.5) Variable Sept/Oct Nov-12 BMT outpatient infusion clinic will be open 7 days a week RN (Physician Consults/clinic)_N049XN 2.0 Variable Sept/Oct Nov-12 Cross train to infusion Pheresis RNs & Manager Do not plan to hire for these positions. Will continue to use contract services - Mi Blood, and SH manager. Manager will be responsible for Billing, Compliance, Safety, etc. Adult BMT Program Clinical Support Associate 1.0 Variable Sept/Oct Nov-12 Subtotal, FTEs to fill by November RN (5S IP Unit)_N049XN 2.0 Variable after Jan Subtotal, FTEs to fill after January Grand total, FTEs needed to implement adult BMT program FTEs - August 2012 Acronyms: 13.0 FTEs - November 2012 CHTC Certified Hematopoietic Transplant Coordinator 2.0 FTEs - after January 2013 CIBMTR Center for International Blood and Marrow Transplant Research 19.0 Total FTEs FACT Foundation for the Accreditation of Cellular Therapy 36

37 Executive Summary: Executive Communications Executive Report: Stem Cell Transplant & Cell Therapy Program For month, year (sample template) Program Operations o Administration o Inpatient o Outpatient Financial Operations o Budget o Per patient & per FTE metrics o Charge Capture o Insurance Human Resources 37

38 Program assessment: what s going on? What has changed? Volume Acuity Services Location (to IP or OP) Safety outcomes Quality outcomes Financial outcomes Accreditation, certification, or regulatory change What type of staff support do I need to maintain or improve upon strategic or operational plans and objectives Can current staffing address the change(s)? 38

39 Program assessment: what has changed monthly and quarterly? Operational Dashboard Volume (productivity) New pt visits Return pt visits Admissions Discharges Acuity Nurse : pt ratio Pt Satisfaction (%) Physician Midlevel Nurse Care Manager Clinic Wait Time Quality Falls / pt days Serious Safety Events Precursor Safety Events Near Miss Safety Events Medication errors Financial ($) Revenue per patient Labor cost per patient Net revenue per FTE Op expense per FTE NOI per FTE July August September October November December January February March April May June 39

40 Program assessment: what has changed / what s the trend annually? Operational Dashboard Volume New pt visits Return pt visits Admissions Discharges Acuity Nurse : pt ratio Pt Satisfaction (%) Physician Midlevel Nurse Care Manager Clinic Wait Time Quality Falls / pt days Serious Safety Events Precursor Safety Events Near Miss Safety Events Medication errors Financial ($) Revenue per patient Labor cost per patient Net revenue per FTE Op expense per FTE NOI per FTE FY12 FY13 FY14 FY15 40

41 Demand data: what is the demand for program services? AML DX & TRANSPLANT DEMAND ESTIMATES Midwestern Regional Medical Center 1 AML potential AML SCT Totals tx vol 2 potential Midwestern Adult Adult Population 25,365,969 9,128,054 34,494,023 MRMC financials Transplant Demand / 100,000 population Avg Charge Transplant Demand = pop x (demand / 100,000) 1,395 1,123 2,518 $$ 2012 Allogeneic Transplants (related + unrelated) ,109 Reimb% Market Potential = demand - actual ,409 % NOI AML prevelance, 2014 SEER 3 36% $$ AML estimated volume potential 508 NOI% SCT conversion rate 4 15% % AML estimated SCT volume potential 75 Notes: Sources: NMDP, CIBMTR, SEER Census data: The NMDP provided population and estimated SCT demand data related to existing CTCA SCT program markets. The above estimates do not factor in volume driven by Western and Southeastern populations. 2 The above also assumes capacity to care for 100% of the estimated potential AML patient volume and subsequent SCT volume. In addition, timing for AML volume increases will depend on marketing, outreach, and changes in referral/practice patterns. 3 SEER: 52,280 new luekemia cases, 2014; 18,860 new AML cases, SCT converstion rate: # SCTs per CIBMTR / #New AML cases 2014 per SEER 5 MRMC experience, 82 cases between y-t-d 41

42 Program assessment: can current staffing address the change? MIDWESTERN REGIONAL MEDICAL CENTER ACTUAL PROCEDURE VS ACTUAL FTE ANALYSIS FISCAL YEAR 2014 JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE REQUIRED PROCEDURE TIME (AMPFM) PROCEDURES HOURS 1, , , , , , ,177.8 *NON - ALLOCATED PRODUCTIVE TIME TOTAL PROCEDURE HOURS 1, , , , , , , , ,719.5 PROCEDURE FTE EQUIV ACTUAL TIME (LAWSON) REGULAR FTE HOURS (Incl Contract Labor) 1, , , , , , , , , REGULAR TIME FTE EQUIV OVERTIME FTE HOURS OVERTIME FTE EQUIV TOTAL ACTUAL HOURS (LAWSON) 1, , , , , , , , , TOTAL ACTUAL FTE EQUIV (LAWSON) ACTUAL/REQUIRED VARIANCE (IN EQUIV)

43 43

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