Level 3 - Acute Care Section-APTA

Report
ACUTE CARE THERAPISTS
CAN SURVIVE AND THRIVE
IN UNCERTAIN TIMES
Combined Sections Meeting 2015
February 6th, 2015 Indianapolis, IN
Speakers
Baylor Institute for Rehabilitation System
Directors of Acute Care Therapy Services:
• Brian Hull, PT, MBA
• Cathy Thut, PT, DPT, MBA
• Donna Fitch Kaufhold, OTR
• Sharon Cheng, PT, MBA, MSPT
Course description
The current environment of health care reform and cost cutting
require hospital therapists take significant steps to manage their
culture and actual practice patterns. The physical therapy
profession consistently promotes advancement, but are hospital
therapy programs consistently following through with true best
practice top to bottom? Are hospital therapists aware of health care
system politics? Do hospital therapists have strategies to
successfully navigate politics and influence change? How is a
therapy department viewed by executive leadership in a hospital?
How can hospital therapy programs ensure they are seen in a
positive light? This course will discuss the urgent need to manage
culture to help lead health care reform change in today’s hospitals
to avoid becoming irrelevant.
Objectives
Upon completion of this course, you will be able
to:
1. Recognize the impact of health care reform on
acute care therapy practice.
2. Determine the correlation between hospital
finances and therapy productivity.
3. Evaluate perceptions and its implications to the
future of therapy programs.
4. Create strategies to advance professionalism
within hospital practice.
What Problems
are we Facing Today?
The
Harsh
Reality
International Comparison
of
Spending on Health
Health Care Expenditure
as % of GDP
United States
17.7
Norway
11.6
Switzerland
11.6
Canada
Denmark
Germany
France
11.3
11.5
11.6
11.8
2012 The Organisation for Economic Co-operation and Development (OECD)
USA Health Care Outcomes
Uninsured Rates for
Adults Ages 18-64
The Baker Institute 2014 Health Reform Monitoring Survey
Texas % Uninsured
by Federal Poverty Level
The Baker Institute 2014 Health Reform Monitoring Survey
Disproportionate Share Hospital
Allotments
Kaiser Family Foundation 2014
More People
and
Better Service
and
Higher Quality
and
Better Outcomes
with
Less Money to Pay for it all???
This Is Too Much!
How much of this
$
is from PT?
Where does all the money go?
Margin
4.5%
Non-Medical Supplies
100.0
Leases, Utilities, Operations
90.0
Depreciation/Interest
80.0
70.0
Medical Services
60.0
Drugs
50.0
Other Expenses
40.0
Physician Expenses
30.0
Medical Supplies
20.0
Purchased Services
10.0
0.0
Salaries/Benefits
Hospital Expense Breakdown
Where does all the money go?
Margin
$816
$18,000
Non-Medical Supplies
$16,000
Leases, Utilities, Operations
$14,000
Depreciation/Interest
$12,000
Medical Services
$10,000
Drugs
$8,000
Other Expenses
$6,000
Physician Expenses
$4,000
Medical Supplies
$2,000
Purchased Services
$0
$ Per Discharge
Salaries/Benefits
Money in my Wallet
How much raise do you expect each year?
2%
3%
5%
7%
The Universal Equation
Total Value Added
______________________________
Total Cost of Services
The Universal PT Equation
Uncertainty of Total Value Added
______________________________
$92,000 per Acute PT
*Source: APTA. http://www.apta.org/WorkforceData/
The Universal Acute PT Equation
Uncertainty of Total Value Added
______________________________
$1,988,764,000
The Universal Acute Care Equation
Uncertainty of Total Value Added
______________________________
$3,380,908,000
Health Care Expenditure
as % of GDP
United States
17.7
Norway
11.6
Switzerland
11.6
Canada
Denmark
Germany
France
11.3
11.5
11.6
11.8
2012 The Organisation for Economic Co-operation and Development (OECD)
The Universal PT Equation
Uncertainty of Total Value Added
______________________________
$92,000 per Acute PT
*Source: APTA. http://www.apta.org/WorkforceData/
Productivity!
Pop Quiz!
When was the theory behind
productivity first developed?
1881
1909
1934
1953
The Impressive History
of
Productivity Measurement
Does This Encourage
Quality Outcomes?
Level 1
Level 2
Level 3
Level 4
Doing
What
We Do
True
Best
Practice
Ideal
Hospital
Stay
Population
Management
Level 1
Doing
What
We Do
Level 2
Level 3
Level 4
Level 1
Level 2
True
Best
Practice
Level 3
Level 4
Level 1
Level 2
Level 3
Ideal
Hospital
Stay
Level 4
Level 1
Level 2
Level 3
Level 4
Population
Management
Value added
Level 1
Level 2
Level 3
Level 4
Doing
What
We Do
True
Best
Practice
Ideal
Hospital
Stay
Population
Management
What Do Other People Say About You?
What Are You Going to do About It?
How other professions see you
How do doctors and nurses ask about how
patients are doing?
How do many PTs answer these simple
questions someone asks about the pt?
How are
you
branded?
SBAR
Situation
Background
Assessment
Recommendation
Low Potential Referrals
The Universal PT Equation
Uncertainty of Total Value Added
______________________________
$92,000 per Acute PT
Value added
Level 1
Level 2
Level 3
Level 4
Doing
What
We Do
True
Best
Practice
Ideal
Hospital
Stay
Population
Management
Best
Practice?
Clinical
Practice
Guidelines?
Evidence
Based
Practice?
Changing
Practice
Patterns
May
2013
June –
Oct 2013
Dec
2013
Have we
achieved
Value –
Added
Therapy?
The Outcome Measure Hierarchy
Health status
achieved
Process of
Recovery
Tier 1
Tier 2
• Survival
• Degree of Health/Recovery
• Time to recovery and return to
normal activities
• Disutility of care or treatment
Recurrences
Sustainability
of health
Tier 3
• Sustainability of health/recovery
Care induced illness
• Long term consequences of
therapy
Porter, 2010
An Example from our BPG on Falls
TiTer
Tier 1 1
Tier
Tier 2 2
Tier
Tier 3 3
• Survival
• Degree of
Health/Recovery
• Time to recovery and
return to normal activities
• Disutility of care or
treatment
• Sustainability of
health/recovery
• Long term consequences
of therapy
•
•
•
•
•
•
•
•
•
•
Mortality
Functional level achieved
Pain level achieved
Return to Prior level of Function
Time to treatment
Time to return to PLOF
Pain, LOS, PE, DVT, delirium
Maintain functional level
Ability to live independently
Loss of mobility due to recurrent
falls
• Risk of fracture
• Reduced mobility
Comparison of Pre & Post Data: Falls
October &
November 2013
January &
February 2014
January thru
February 1-17,
2014
February 18-28,
2014
Education
Education
Education
Education
PT: 0/80 (0.00%)
OT: 1/59 (1.69%)
PT: 33/77 (42.86%)
OT: 12/71 (16.90%)
PT: 27/67 (40.30%)
OT: 7/63 (11.11%)
PT: 6/10 (60.00%)
OT: 5/8 (62.50%)
Special Test
Special Test
Special Test
Special Test
PT: 0/80 (0.00%)
OT: 0/59 (0.00%)
PT: 39/77 (50.65%)
OT: 28/71 (39.44%)
PT: 31/67 (46.27%)
OT: 21/63 (33.33%)
PT: 8/10 (80.00%)
OT: 7/8 (87.50%)
Pre & Post-Data Results for Falls:
Graph
Falls Special Testing
Falls Education
70%
100%
90%
60%
80%
50%
70%
40%
60%
30%
PT
50%
PT
OT
40%
OT
30%
20%
20%
10%
10%
0%
0%
Oct &
Nov 2013
Jan &
Feb 2014
Feb 18 - 28, 2014
Oct &
Nov 2013
Jan &
Feb 2014
Feb 18 - 28, 2014
National Stats on CPGs
•
•
•
•
1/3 are aware of CPGs
13% know how to access
9% have “easy” access
< 50% use them frequently
Culture Changes
Every minute
= value
It’s all
about me
It’s only me….
Strategy vs Culture
“Culture eats strategy for lunch”
~Peter Drucker
“Culture Eats Strategy for
Breakfast, Lunch, Dinner
and a Midnight Snack”
~Sharon Cheng
“In reality, culture does not trump strategy,
rather they work together to enhance the
success of one another.”
~Mike Myatt
Definition of Culture
“Culture is the deeper level of basic
assumptions and beliefs that are shared by
members of an organization, that operate
unconsciously and define in a basic ‘taken for
granted’ fashion an organization's view of its
self and its environment.”
~Edgar Schein
Polynesian Culture
White Star Lines
Best Practice Guidelines
Why were we more successful
than literature suggests?
Roadblocks
• Group leaders didn’t understand the goal
• Team members new to reading research
• Team members were assigned 40-50
articles to read per week
Roadblocks
• Staff didn’t use existing clinical practice
guidelines and systematic reviews
• Staff didn’t implement guidelines
because too busy and didn’t see the
need for them
Shifting Culture
• Partner therapists strategically
• Select your groups purposefully
• Keep groups small, 6 to 8 people
Shifting Culture
• Members should be skilled in critical
thinking and group dynamics
• The leader should be skilled in keeping the
group on task
Delancey Street Foundation
• Started in 1971
• No government funding
• Average resident:
– convicted felon
– high school dropout
– substance abuser
– illiterate
Delancey Street Foundation Results
• Over 10,000 people have received high
school equivalency degrees
• Over 1000 graduates from their state
accredited vocational three-year
program
How Was It Done?
• Teach people to find and develop their
strengths
• The best way to learn is to teach
• Function as an extended family, a community
in which every member helps the others
Teach people to find and develop
their strengths
• Who is good at reading research?
• Who is clinically experienced?
• Who can help these two groups communicate
with each other?
The best way to learn is to teach
• Let your staff do the teaching
• You may need to train your staff to teach
Function as an extended family, a
community in which every member
helps the others
• The each-one-teach-one process
• Use a diverse group of trainers by discipline
and generation
The
Blame Game
It’s All Healthcare
Reform’s Fault
Reality Check
• US healthcare is not the best
• We cannot sustain the current percentage of
GNP for substandard results
It’s management’s job
to tell us
what we need to do
Reality Check
Therapists have the most knowledge about
how to best prioritize patient care
I can’t do
any more than
what I’m doing now
Reality Check
• You probably can’t do more if you continue to
do things the way you have always done them
• Are you still focusing on units/visits?
• Are you consistently using evidence-based
practice?
This Change is All About YOU
“If you do not change direction,
you may end up where
you are heading.”
~ Lao Tzu
No More Blame Game
• Successful people focus on their strengths
• The best way to learn is to teach
• Function as an extended family, a community
in which every member helps the others
Therapists Can Add Value
• Active participation in decreasing
Average Length of Stay (ALOS)
• Active leadership in fall reduction
• Minimize low potential referrals and
treatments
• Intervene purposefully using our strengths
How YOU Can
Survive and Thrive
•
•
•
•
Define your passion
Share with your manager
Share with your work support system
Share with your home support system
What if You
are a Team of One?
What if You
are a Team of Many?
How YOU Can
Survive and Thrive
•
•
•
•
Find out if you are a team of one or many
Pick your first project
Figure out what support you need
Ask for support
“The
greatest danger in
times of turbulence is not
the turbulence – it is to act
with yesterday’s logic.”
~Peter Drucker
Contact Info
•
•
•
•
[email protected]
[email protected]
[email protected]
[email protected]
References
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Pictures: 1980.
By the Numbers. (2014, July). PT in Motion, 64-64.
Dunleavy J, Steffes, L. Managing the Transition from Volume to value:
Productivity Standards. APTA Webinar Series: April 17, 2014
Federal Medicaid Disproportionate Share Hospital (DSH) Allotments. (n.d.).
Retrieved May 5, 2014, from KFF.Org
Francke, A. L., Smit, M. C., de Veer, A. J., & Mistiaen, P. (2008). Factors
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References
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Monitoring Survey – Texas, Issue Brief #3. Houston, Texas: 2014.
Jette, A. M. (2012). Face into the storm. Physical therapy, 92(9), 1221-1229.
K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall,
2014 Update: How the U.S. Health Care System Compares Internationally,
The Commonwealth Fund, June 2014
Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in health
care. Harv Bus Rev, 89(9), 46-52.
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Care Act: paying for coordinated quality care. JAMA, 306(16), 1794-1795.
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Our Accomplishments. Delancey Street Foundation Web site.
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Ploeg, J., Davies, B., Edwards, N., Gifford, W., & Miller, P. E. (2007). Factors
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