#HASummit14 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)Yes b)No c)Not applicable Christopher S. Russi, DO, FACEP Assistant Professor of Emergency Medicine Mayo Clinic College of Medicine Rochester, MN

#HASummit14 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

#HASummit14 Degrees of integration 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 unit Unified Integrated Standardized Coordinated Integration Pyramid Continuum

#HASummit14 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

#HASummit14 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

#HASummit14 Emergency Medicine in the MCHS Background 1992 – 1 st 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* 2 nd largest workforce in MCHS

#HASummit14

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

#HASummit14 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

#HASummit14 Poll Question #3 10 Do you have locum tenens routinely staffing your EDs? a)Yes b)No c)Not applicable

#HASummit14 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

#HASummit14 My Job Rapid evolution from the start Vision and Strategy Recruitment Salary / Comp standardization Advocacy at the C-Suite Practice standardization Education

#HASummit14 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

#HASummit14 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

#HASummit14 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?

#HASummit14 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.

#HASummit14 Analytic Insights A Questions & Answers 17

#HASummit14 Choose one thing… 18 Write down one thing will you do differently after hearing this presentation

#HASummit14 Thank You 19

#HASummit14 20 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?

#HASummit14 Upcoming Sessions Breakout Sessions – Wave 2 (2:30 PM – 3:15 PM) 10)Is Big Data a Big Deal…or Not? Dale Sanders, Senior Vice President, Health Catalyst Richard Proctor, General Manager, Global Healthcare & Life Sciences, Hortonworks 11)Partners Healthcare Analytic Strategy for bundled Payments and Risk Management Sreekanth Chaguturu, MD, Vice President for Population Health Management, Partners HealthCare Helen Chan, Senior Manager, Business Planning, Partners HealthCare 12)Sneak Peek: Improving Patient Engagement and Outcomes with Predictive Analytics Gregory A. Spencer, MD, CMO & CMIO, Crystal Run Healthcare Louis G. Cervone, Jr., Director of Business Intelligence, Crystal Run Healthcare 13)How a Pioneer ACO is Using Analytics to Change Heart Failure Spencer H. Kubo, MD, CMO of BioControl Medical, United Heart &Vascular Clinic, Allina Integrated Medical Network 14)Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO, Thibodaux Regional Medical Center Mark 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? 21 Location Grand Salon Grand Ballroom A Grand Ballroom D Savoy Murano Venezia