Neela Wilson COO - Rittenhouse Medical Center ( RMC) RMC è Orthopedic Servicè Group 1 - Surgeon ** 10 Surgeons

Dr Robert BoothChief Of Orthopedic Surgery è FACULTY Practice

This would slightly increase the LABOR COST ( Slightly ) - Faculty in the RMC ( A primary Teaching Institution )
This would initiate a sense of disparity between staff - Teaching + Research + Patient Care
Dr Robert Boothè Nurses & techniciè Significant Merit based pay increase - Received Salaries based on seniority & not on number
Reson è Staff Was integrat To The Efficiency and Quality Of The Care of patients provided with care
They worked as a highly integrated teams
** 7 Surgeons è Group 2 - 3B Ortho ( Booth + Bartolozzi+Balderstom )
è Knee Surgery Is Highly Specialised and require standardised practices - No Formal Teaching Responsibility
Other surgoen took 1-2 hrs - Treated High Volume Of Patients
Dr Booth Took 30 min - This Practice of 3B Ortho was also highly profitable
His way was VOLUME and STANDARDISATION OF THE PRACTICES è Rented office Space in RMC building
è Surgeons Sub Specialised into one speciality
è Accounted for 22% RMC revenue
è
è

RMC è Net Revenue

è $ 335 M
350 Beds Orthopedic Surgery è Knee Surgery è 95%
20000 Inpatient Addmission Anually è Hip Surgery è 5%
5 Operating rooms
è Hospital Provided
è Diagnostics and Theraputic Services 1970 è 2006
è Service Include - Obstetrics + Orthopedics + Surgical Specialities Start 2500
è Teaching & Research Joint Repl per yr
è Training New Physicians and Other Medical Professionals
è RMC Offered Residency Program To Train New Physicians
As of 2006 - RMC - Leader iN terms of Education Research and patient Care
Issue in 1990s è Hospitals Had Financial Pressures due to declining reimbursements è To respond Hospital Did - M&A and Affiliations - To Create a larger Health Care system
from managed care organisations and Insurers Thereby - Economics in scale of both scope and health care

Payment è Insurer 1 è MEDICARE INSURER MEDICARE INSURER

>65 yrs Largest Payer For Orth Sur in RMC è 500 Diagnosis Related Group
è Insurer 2 è MEDICAID INSURER Flat Fee Per Patient Addmission For Each Group
è Insurer 3 è Private Insurance Companies Private Insurance Followed the Same
è Direct è Direct Payment By Patients Issue 1 HOSPITAL HAD NO ABILITY TO SET ITS OWN PRICES
è FOC è Free Care è Provided by Hospital RMC at their Expense Issue 2 THESE RATE DID NOT REFLECT THE ACTUAL COST TO PERFORM

Rev 3B(22%) Grp1(78%)

2002 275422 60593 214829.2 3B(22%) Grp1(78%)
2003 279692 61532 218159.8 Operating Room Common Common
2004 306159 67355 238804 Operating Staff Common Common è Physician Assistant è Hospital Employe è Hourly Rate
2005 322348 70917 251431.4 RMC Central Deptt Common Common Nurses è Hospital Employe è Hourly Rate
2006 337544 74260 263284.3 Anethetic Technicians è Hospital Employe è Hourly Rate
â
Private Practicioners è Saperately Billed for services

1st è Pre admission tests

è info of surgery Issue 1 Instrument sets specific for particular type of implant and implant manufascturer
è post surgical rehabilitation Issue 2 Last minutes changes in the surgery schedule & delivery of specific sets
è placement of order for central supply deptt along with lead time of sterlization
è Sterlising & delivering the instrument sets for the procedure è
è knee surgery - require - diverse set of reusable instruments
è post procedure - re sterlise the instruments
è **** Any sterlisation required 3 hrs
45 min - washing
60 min = heat sterlising
75 min = cooling
2nd On Day of procedue
è Addmission
escorted to pre operative area
nurse/anesthetic getting briefs

3B ortho model
è End to end patient care
è Efficiency is the goal è 100% time the focus to be on surgery
è Lower surgical time è Surgical time increase per hr $1200 - $1500 New tool should be handed over precisely by the staff
è Stadardise the practice è Avoid Innovation & Changes â
è Standardise the parts This required substaintial commitment by the resource
è Simplify instrumentations è 100 % focus over only knee replacement
è Perform each step singly and completely â
è Cpnsolidate supplies
Pre-reqiuistire â
è Dedicated Operating room Nurses Thereby consolidated SUPPLIERS TOO
è Dedicated Anesthetic team â
è Having patients in a single saperate area - A single anesthetic cam manage many patients Zimmer supplier - RMC

recommendation of surgery is based on

Issue 1 Saperate admitting area for 3B ortho surgery
â
Reason - bottle neck process is addmission office paper works