Sutter Medical Foundation A Sutter Health Affiliate AMGA CFO Council Increasing Care Team Productivity April, 2014 About Sutter Health Our system includes: Physicians 3,500 Hospitals 24 Employees 47,941 Philanthropic Foundations 17 Ambulatory Surgery Centers 12 Cardiac Centers 8 Cancer Centers 9 Acute Rehabilitation Centers 5 Behavioral Health Centers 9 Trauma Centers 4 Neonatal ICUs 10 Sutter Express Care Medical Clinics 3 Volunteers (approx.) 5,000 1
Sutter Medical Foundation Tom Blinn Title: CEO, SMF/SPA and SHSSR Ambulatory Care Years in Position: 11 Years with Sutter: 11 Sutter Medical Foundation Sutter Medical Group (SMG) Sutter North Medical Group (SNMG) Sutter Express Care Medical Group (SECMG) Sutter Independent Physicians (SIP) 2010 Consolidated Quick Facts Patient Visits: 3.9M Aligned MDs Medical Groups: 563 SIP: 566 Employees: 2,574 Payroll: $108.1M 2010 Community Benefit Contribution: $35.5M Active Patients: 650,000 Sutter Medical Foundation Ancillaries Surgery Centers (3 sites) Sutter Fairfield Surgery Center Sutter Surgical Hospital North Valley Sutter North Ambulatory Surgery Center Diagnostic Imaging (20 locations) Laboratories (30 locations) Physical Therapy (15 locations) Sutter Express Care (3 locations) 3/25/2 014 California Medical Foundation Structure Since the early 1980s, the medical foundation structure has been widely utilized by California providers due to the state s corporate practice of medicine statute. Regional Board SMF Clinical Services PSA SMG Board SMG Compensation for Professional Services As a separate legal entity and the employer of physicians and allied health providers, SMG controls its own compensation plan; the system has the power only to set the rates in the aggregate PSA payments to the group. 785\90\187005(pptx)-E2 15 2
Funding the Model The group receives funding from a variety of sources. Managed Care (MC) Revenue QIP Risk Share Admin. FFS Revenue SMG Other Prof. Income and Credits Physician Revenue Admin./ Other Clinical Compensation Incentives/ Bonus 785\90\187005(pptx)-E2 17 Operational Priorities Revenue and Operational Improvement Total Care Accountability Access /Growth 3
2MA Scribe Model Goals Improve practice efficiency Improve patient satisfaction and access Improved clinician satisfaction with practice & work/life balance Improve clinician productivity 2 MA Scribe Model Physician Compact My average wrvu productivity, as reported by Decision Support, for the past 6 months is least at the 50 th %tile of MGMA productivity. If currently below the 75 th percentile for productivity: I agree to open my practice schedule to a minimum of an additional 2-3 patients per day, and be at or above the 75 th %tile of MGMA productivity within 6 months of being on this program. This requirement will be FTE adjusted for clinical hours worked, with data provided to me and monitored using current reporting tools, including the most recent monthly activity report of wrvu and the latest MGMA benchmarks for my specialty. If currently at or above the 75 th percentile for productivity, I agree to maintain my current productivity level, while improving the quality, access, service and coding accuracy of my practice. 4
Physician Compact key points Closed practices: agree to open practice to managed care and Medicare Advantage insurance plans by the end of the 6 month program. Dictation: if applicable, reduce to and maintain my transcription rate at 20% or less of my patient office appointments Close office encounters: close at least 95% of my office encounters within 3 days of the date of service. Mentoring: utilize and support through mentoring the additional MA staff to perform the tasks as outlined in the pilot project task list attached to this compact. Standard Work: Agree to formulate and adopt physician and MA standard work (including MHO patient enrollment) and exam room standardization to improve efficiency. SMF to provide timely updates: SMF decision support will provide updates to participants at regular intervals on program performance towards targets. After 6 months if qualifying criteria not met for the program this may result in the loss of the additional MA support allocated to my practice. SMF Commitment Staff Training in Standard Work Utilize Lean principles to support changes in practice, development and adoption of standard work Effective communication & care team huddles Ensure identified Medical Assistants are competent in EPIC documentation and MA rooming standard. Provide sufficient staff to ensure the 2 MA support is consistent. Ensure supervisors and EPIC staff mentors are trained to support the model with ongoing EPIC workflow updates. 5
MA Scribe Workflow MA does the normal MA work/ pre-work for the day prepping charts, collecting lab/di results etc, reviewing health maintenance, pending orders, to ensure all in EPIC; Will work the EPIC In Basket. They will room patient according to normal MA workflow then leaves room and reports out to Doctor on reason for visit. The MA and Doctor enter room together; MA scribes notes as Doctor dictates Review of systems and physical exam; Doctor dictates orders and instructions then signs chart and leaves; MA stays and reviews After Visit Summary instructions then discharges the patient. While doctor is in the room with the first MA the second is rooming next patient; then doctor enters 2 nd room to see patient with 2 nd MA. Co locating their workstations allows for quick discussions of In Basket work to respond to patient, call center or other requests. 2013 MA Pilot Summary Closed Encounter% Annu. wrvu per cfte Visits/cFTE Adj Workdays Physician Clinical FTE Baseline Program Target Met Target Target Baseline Program 75th %tile 90 %tile Var% to Target Baseline Program Target Var% to Target ADAMS MD,RUENE 0.60 99% 100% 95% YES 4,666 6,166 5,999 7,286 3% 16.1 19.2 19.1 1% AUYEUNG MD,TER 1.00 96% 96% 95% YES 5,943 5,537 5,999 7,286-8% 19.2 18.9 22.2-15% BLAIR MD,STEVEN 1.00 73% 77% 80% NO 5,932 5,762 5,999 7,286-4% 16.8 15.0 19.8-24% BRAR MD,GURMA 1.00 99% 99% 80% YES 7,877 8,670 5,999 7,286 45% 30.5 32.1 30.5 5% BROUTSKI MD,VA 1.00 94% 98% 80% YES 6,584 8,324 5,999 7,286 39% 26.0 27.4 27.0 1% DENAPOLI DO,RIC 1.00 100% 100% 95% YES 4,800 4,682 5,999 7,286-22% 18.5 18.2 21.5-15% DIAZ DO,MANUEL 1.00 100% 100% 95% YES 4,873 5,563 5,999 7,286-7% 14.7 17.2 17.7-3% HOFFMAN MD,WIL 0.99 98% 98% 80% YES 9,231 8,335 5,999 7,286 39% 23.2 20.9 23.2-10% HUDNUT MD,ANDR 0.40 100% 99% 95% YES 5,188 5,898 5,999 7,286-2% 16.7 19.4 19.7-1% KOURDONI MD,HA 1.00 92% 99% 80% YES 8,137 10,436 5,999 7,286 74% 22.1 27.6 22.1 25% LIWANAG MD,EUG 0.80 95% 100% 80% YES 7,801 8,850 5,999 7,286 48% 24.5 27.7 24.5 13% SARINGAN MD,GE 1.00 96% 92% 80% YES 8,409 9,440 5,999 7,286 57% 25.6 26.6 25.6 4% THOMSON MD,JO 0.81 89% 97% 95% YES 5,588 6,001 5,999 7,286 0% 16.6 18.3 19.6-7% 6
Expanded 2MA Model Service Area Productivity % tile FTE Open/Close Roseville HMO/MA Dr Lugo 61 1 Open/Open Dr Katuin-Dr Planta (SP).5/.5 Dr Spinelli 81 0.5 Close/Close Dr S. Reddy 86 0.75 Open/Open Dr. Baur 53 0.97 Close/Close Dr Kanwar 90 0.61 Close/Close Laguna/DT (Apr) 61 1 Open/Open (Apr) 61 0.81 Open/Close (Apr) 56 0.6 Close/Close Dr Lin 66 0.8 Close/Close Pediatrics Dr MacNeil/Dr Ward (SP).65/.65 Close/Open Yolo Dr Smith (Apr) 86 0.7 Open/Open Dr Clary (Apr) 59 0.67 Open/Open Solano Dr Chan(Mar) 49 1 Open/Open Sullivan (Mar) 72 1 Open/Open Auburn None North Dr Serrano 77 1 Dr Rose 81 0.6 Questions? 7