1. Long Beach Memorial Measurement, Management and Sharing from Metrics Douglas Garland, MD Orthopedics & Rheumatology Conference October 2015

2. Long Beach Memorial 3 Key Questions What’s Lacking In Hospitals Today? Why Should You Manage From Hospital Metrics? What You Need to Measure That You Don’t Measure Today?

3. Long Beach Memorial 250 Orthopedic Programs Implemented Building Blocks of Superior Performance Leadership Team Accountability Strategy Teamwork / Collaboration Staff-Generated Solutions Strive for Perfection Transparency Satisfaction Clinical Operational Functional Outcomes Financial Education/ Teaching/ Learning Coordinated Care (PCP, Specialist) Pre Intervention Readiness Efficiencies (PreOp, OR, Unit) Cutting Edge Technology Dedicated Facilities Standardized Care System Ongoing Improvement & Innovation Marketing / Public Service Patient / Family Empowerment Physician Specialized Staff Access

4. Long Beach Memorial What’s Lacking in Hospitals? Collaboration Amongst all Roles Aligned Incentives / Empowered Physicians Specialization / Teamwork Therapist

5. Long Beach Memorial What’s Lacking in Hospitals? Structure to Boost Performance Service Line Leadership Structure Written Goals / Specific Performance Metrics Specific Expectations and Responsibilities

6. Long Beach Memorial What’s Lacking in Hospitals? Culture of Change Perfection Instead of Better Than Average Transparency Instead of Secrecy Focusing on Outputs Instead of Inputs Innovation Instead of “what’s always worked” Staff Empowerment Instead of “just following orders” Personality Instead of Faceless Institution

7. Long Beach Memorial Effective/Efficient Patient-Focused Processes Continuum of Care Focus Primary Care Support and Collaboration Community Service and Education Effective Risk Management and Preparation Efficient Operating Rooms Organized Consistent Delivery System Extraordinary Patient / Family Experience Constant Innovation From Patient / Family Feedback What’s Lacking in Hospitals?

8. Long Beach Memorial What’s Lacking in Hospitals? Results Hospital Reported Outcomes, Benchmarked, Best Practice Clinical Financial Operational Patient Reported Outcomes Management From Metrics

9. Long Beach Memorial Do Your Staff and Physicians Have Hospital Reported Clinical, Operational and Financial Data At Their Fingertips? Do You Benchmark That Data With Other Hospitals To Understand Best Practices? Do You Use That Data For Ongoing Improvement? Ask Yourself…

10. Long Beach Memorial Financial, Clinical Success Tied To Effective Management Service Line Development Destination Centers of Superior Performance ® Joint Replacement Inpatient Spine Geriatric Fracture The program is focused on the episode of care from the patient’s perspective: Access Community Outreach Primary Care/Physician Office Non-Operative Care Operative Care Preadmission/OR/Inpatient Care/ Discharge Inpatient Care Post Hospital Care Post Discharge/Transition Care Coordination Measurement of Outcomes

11. Long Beach Memorial Keys to Measuring Choose Vital Few Relevant Metrics Easy To Understand Drill Down To Specific Details Analyze Multiple Ways Trend and Benchmark Against Best Practice Take Action Results Can Be Communicated To Important Stakeholders

12. Long Beach Memorial Our programs focus on improving clinical, operational, financial and satisfaction metrics that include: Discharge Home Complication Rate Blood Transfusions Readmissions Flexion/Extension Distance Walked Discharge Home Complication Rate Blood Transfusions Readmissions Flexion/Extension Distance Walked Clinical Case Duration Scheduling Accuracy Prep Time Surgery Time Exit Time PACU Time Case Duration Scheduling Accuracy Prep Time Surgery Time Exit Time PACU Time Operating Room Reimbursement Contribution Margin Commercial Payor (%) Direct Cost Implant Cost Reimbursement Contribution Margin Commercial Payor (%) Direct Cost Implant Cost Financial Patient Satisfaction Likely to Refer Patient Satisfaction Likely to Refer Satisfaction Volume Lengthy of Stay Discharge Disposition Volume Lengthy of Stay Discharge Disposition Operational Choose Just a Vital Few Metrics

13. Long Beach Memorial Extract Data Into Comprehensive Dashboard

14. Long Beach Memorial Select the Measure to Improve

15. Long Beach Memorial Drill Down and Analyze – 80 Different Ways

16. Long Beach Memorial Promote Top Performers Tier Networks Based on Cost and Quality Put the Risk on the Providers Tie Reimbursement to Results Payers Testing Different Options

17. Long Beach Memorial Bundled Payments Acute Care Episode (ACE Project) Hospital Gives Medicare a Discount Hospital Receives Entire Payment Part A & B Patient and Physicians Get a Cut of the Savings Extended ACE Will Also Include Rehabilitation

18. Long Beach Memorial Share Results – Primary Care Physicians & Insurers

19. Long Beach Memorial Patient Reported Outcomes

20. Long Beach Memorial Thank You Any Questions?