From AAHKS 2016 – Diane Doucette, President of Mount Carmel New Albany Surgical Hospital presentation touched on so many of the questions our administrators ask that we knew we needed to tracker her down and find out more. The full transcription is included below.
Dr. Brian Cunningham: Hello, welcome again, live from the 2016 AAKHS meeting. I’m here with Diane Doucette, President of Mount Carmel New Albany Surgical Hospital. She’s been kind enough to join us to chat a little bit about the business of orthopedics, especially from the hospital administrator’s side, and physician-hospital collaboration. She gave us a fantastic presentation this morning on managing costs, and some of the creative ways to have surgeons and hospitals work together. Let me just start out by asking you, how did you get to the place where you’re the president of an entire institution with an emphasis on orthopedics?
Diane Doucette: I’m a Canadian-trained registered nurse. I came down to the Ohio area in 1990. At that time I met my mentor Dr. Thomas Mallory, who was a joint replacement surgeon. I just fell in love with joint replacement surgery. Started out and worked my way up through the ranks. Dr. Mallory had said, “Hey, I want you to go out and help my friends set up.” He would have international visitors come to see our institution, and they would say, “We would like to start this.” We did consulting, and then Dr. Mallory’s dream, and the other physician leadership in our city wanted to build an orthopedic hospital. In 2003 we opened up New Albany Surgical Hospital, which is entirely devoted to musculoskeletal care.
Cunningham: One of the topics that you had touched on was cost containment and getting surgeon buy in to the idea of cost containment. Talk a little bit about how you get surgeons on board with providing an economically responsible way to take care of patients.
Doucette: Surgeons are scientists, so they love data. We are very, very transparent with our data. We’ll start at a procedural level, like for example total knee replacement. High volume procedure. We will slice and dice that from a pharmaceutical, diagnostic testing, supplies, implants, and we slice the data that we get it down to the contribution margin level so the surgeon will know, what is he contributing to our hospital. We send this data out in the mail, blinded, then that night we tell them, “In a week we’re going to have a meeting. We’re going to talk about this, and your name will be unblinded.” That’s the intrigue that gets them here to the meeting. I think that transparency of data and aligning it with outcomes. Surgeons do not want to hear all the time about cost. They want to hear about the quality outcomes. We mirror their patterns, length of stay, 30-day readmissions, infection rates, and together we develop a plan for cost containment and quality improvement in patient satisfaction.
Cunningham: How does the concept that you guys work with fall into the scaffold of the structure of the Michael Porter, Kevin Bosic value equals outcomes over cost. Do you guys track the value of individual procedures or surgeons, or do you guys look at the overall system as outcomes are readmissions and infections, or do you guys drill down even to patient-reported outcomes as far as how patients are doing after surgery?
Doucette: We meet monthly with our orthopods at all four sites. Mount Carmel Healthcare System has four sites, each site has a monthly meeting. At those monthly meetings, we track various quality outcomes, for example, every 30-day readmission, we would drill it down to the patient, what happened, where did they go, where did they return, to try and problem solve how can we prevent this from happening again. Same thing if it’s an infection or anything. We look at efficiencies of time, length of case times at the surgeon level. We try to drill everything down to make it meaningful to the surgeon. We give each surgeon their patient comments quarterly. The surgeons know independently who is bringing down that physician composite score in HCAPs. Very, very transparent with data.
Cunningham: How do you handle surgeon implant preference? I know some surgeons come out of fellowship, come out of training, or work some place and they get very attached to a rep or an implant, and maybe it’s more expensive or less expensive. Do you have a broader based structure that you work within?
Doucette: Again, going back to our surgeons. Very pro-surgeon choice, but the surgeons need to standardize the price. What is a patella worth? It doesn’t matter if it’s vendor A, B, or C, this is what a patella’s worth, and that’s how we get the surgeons involved in the negotiation. The reps will tell you, mine is cheaper. That’s not always true. We, again, are very transparent with data. We do that even with waste. Our surgeons will have a screw that’ll, say it’s stripped, it’s defective. We won’t pay for that. The surgeon calls it a waste, we tell the rep we’re not paying for this. Again, transparency of data and tracking information on a regular basis.
Cunningham: You’ll get your surgeons involved even in kind of the negotiation aspects of implants.
Cunningham: How much education do you have to do for surgeons? We come out of residency and fellowship with a wealth of medical knowledge, and we’re really good at multiple choice test taking, but very poor business education backgrounds, most of us. How do you catch people up?
Doucette: We catch people up by teaching you on how to read a financial statement. We start it very basic, very simple, because the revenue minus the expense equals the contribution margin. We do it at the procedural level divided by physician, so the physician knows what their score is. You’re scientists, you know how to read data. Which is a big issue for hospitals, we have to make sure the data is right. We work a long time scrubbing the data, pilot it on one or two physicians to see, is this intriguing to you, and then we take it to the masses using those two physicians that we pilot it with as our advocates. We have to work together like this. If we do not work together, we are not going to be successful in healthcare.
Cunningham: For groups that haven’t had as much success with collaboration, how can you help build the bridge if you’re a surgeon, or if you’re an administrator and you’re trying to reach the other side and find some common ground?
Doucette: As the independent orthopedic surgeon, you usually have a department. You go to your department of orthopedics meetings, speak with the chairman, if you want to try an efficiency model, talk about it. You do it from the grassroots. Get the surgeon involvement, get your chief medical officer involved. Usually if you can get that inertia, get away from that and get it rolling, you can really fast track an implementation. You need to have a physician champion that will work with the administrator. Administration will listen to you, because you control 95% of the expense when you hit those keystrokes. We’ve got to tell you what those keystrokes cost, and how they tie back to the quality outcomes.
Cunningham: One of the challenges I’ve personally had is, when you’re in the operating room and you want to make a decision, does your department, do your surgeons have real time access to costs? If I want to use implant A, or I want to change it and use implant B, and I say, how much more is this going to cost, do you guys have access to that information?
Doucette: Yes, we do. We share that with the physicians. Any time there’s a new product coming in, the physicians decide if that product should be coming in. It may be on our multi-system contract, 92 hospitals of Trinity Health, but nobody has used this product, so we may not want to introduce it. We try to work with the surgeons, but we are very transparent with costs.
Cunningham: Thank you very much. One of the real leaders in both cost containment, healthcare administration, surgeon collaboration. We really thank her for being a part of our conversation today, and we’ll catch up with her again later.
Doucette: Thank you very much for your time.
Cunningham: Thank you.