SS10. Financial Impact of Implementing Care Delivery Redesign Initiatives for Vascular Surgery in a Hospital Setting

Abstract

A fragmented health care system contributes to suboptimal resource utilization and care coordination. A Care Delivery Redesign (CDR) for the vascular surgery service was developed to improve diagnosis-related group (DRG) assignment, to decrease length of stay (LOS), and to minimize care variation through standardized care pathways. We measured the value of CDR through hospital financial metrics. The CDR consisted of a physician champion, inpatient nurse practitioner, and dedicated case manager. The vascular surgery nurse practitioner played a central role in CDR by facilitating all aspects of patient care coordination, resident education, and communication with hospital coding specialists. A real-time weekly inpatient tracker was created and reviewed weekly during vascular conference. The tracker contains patient identifier, admission and discharge date, attending, admission and discharge unit, current LOS, Centers for Medicare and Medicaid Services geometric mean LOS, and corresponding DRG. Tools created to track performance and to ensure sustainability included daily discussions of barriers and solutions on patient rounds, creation of a vascular surgery mobile app for residents, and a patient avoidable delay tracker. End points included LOS, total variable cost, case mix index, and vascular surgery contribution margin compared with pre-CDR contribution margin. Implementation of CDR resulted in a 23% decrease in LOS, reducing the gap to Centers for Medicare and Medicaid Services geometric mean LOS by 1.6 days, from 2.2 days to 0.5 day. Improvement and changes in documentation captured accurate DRGs, which resulted in an increase in case mix index of 21%. This resulted in contribution margin amounting to $1.88 million. The CDR structure as described reduces hospital LOS and improves financial service metrics. The structure is predicated on a dedicated service line advanced practitioner, weekly service tracker review, and real-time management of barriers and solutions to system-related issues. As designed, CDR provided significant financial benefit to the hospital while facilitating patient care.