Existing Commitments

1
Existing Commitments

• Surgical Improvement Project
• Team 5 Meeting
• Lisa Brandenburg, C.O.O.
• Ed Walker, M.D., Medical Director
• May 3, 2005

2
UWMC Strategic Planning

• UWMCs program planning over the last 4-5 years
  has focused on promoting growth of the services
  lines
• Therefore, existing UWMC commitments relate
  largely to supporting the growth development of
  the service lines

3
UWMC Strategic Planning

• Examples commitments to support the growth in
• Transplant, Regional Heart Center (includes CV
  Surgery), Orthopedics through recruitment of new
  surgeons, Oncology, Oto Neurosurgery through
  the recruitment of new surgeons

4
Current Service Lines at UWMC

• Cardiovascular (UWRHC)
• Oncology - includes the SCCA
• Orthopaedics and Sports Medicine
• Organ Failure and Transplant
• Otolaryngology
• Neurosurgery
• Criteria High-volume and/or High-charge
  Services Program Profitability Program
  Readiness

5
UWMC Departments
SERVICE LINES CANCER PATIENT CARDIAC PATIENT
Operating Room
Short Stay Units
Radiology
Inpatient Units
Outpatient Clinics
Lab/Path Services
Data tracking
Business systems
External market information
6
Structure of Service Lines at UWMC

• Organizational Priority
• Service lines heart of Quality Improvement
  activities
• Structure used as collaborative physician and
  Medical Center vehicle to manage growth
• Service Line Administrator and Physician Partner
• Committee Structure Team Membership
• Strives for multidisciplinary representation
  along the continuum
• Works together to develop annual goals and
  implement strategies
• Designated support resources (CDS, Q1, etc.)

7
Are All Hospitals Growing?
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Is All Growth Good for the Bottom Line?

• Profitability data isnt perfect at the encounter
  level
• Reimbursement is estimated based on actual
  payments and spread across like populations.
• Direct costs are allocated based on gross charges
  in specific areas.
• Indirect costs are allocated based on gross
  charges and are spread according to assumed
  utilization.
• The costs of the finance department are spread
  across all encounters.
• Department support for a program such as Oncology
  is spread across all oncology encounters.
• All of these graphs on the following slides
  generally need about 100 footnotes each.

10
Service Lines/Areas Per Patient Day
Why Support Service Line Growth?
profitable/large
unprofitable/large
Service lines and areas are defined by APR-DRGs,
DRGs and departments and reflect IP and OP
operations. Encounter assignment is hierarchical
beginning with service lines and then by service
areas. As such, General Medicine and Surgery
exclude encounters that are assigned to Oncology,
Transplant, Heart Center, Ortho and Oto.
profitable/small
unprofitable/small
11
Essential Services
profitable/large
unprofitable/large
unprofitable/small
profitable/small
12
Payor Profitability IP and OP
13
Payor Profitability IP
14
Payor Profitability OP
15
Implementation Issues

• Transplant how do you accommodate
  urgent/emergent cases, how do you support 2 rooms
  at the same time
• Cardiac Surgery same issue w/ urgent/emergent
  cases
• Ortho how do you support standardization while
  bringing in new faculty
• All surgical services how do we plan for time
  in the OR for new surgeons when they may not have
  full case loads to start

16
What have we learned?

• Cant predict every issue that will surface as we
  try to grow various programs, but we could do
  better
• New business planning process developed by UWMC
  Finance will seek to evaluate impact on related
  services such as Anesthesia, Radiology,
  Pathology, Lab, etc. and related departments

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