Journey to the Center of Excellence

January 4, 2016


Do you want to take your clinical services to the next level in 2016? Follow the example of Bon Secours St. Francis Health System to develop centers of excellence.

Quality Compass

Step 1: Evaluate Current State

Beginning in 2004, most of Bon Secours Saint Francis’ (BSSF) orthopedic services were organized into formalized programs, including shoulder and osteoporosis programs. But while it offered some surgical programs, like breast and colorectal, the majority of its surgical offerings, including surgical oncology and endoscopy services, were standalone services.

Between 2004 and 2012, the health system developed recognized centers of excellence in joint replacement, hip fracture, sports medicine, spine care, hand program, and bariatrics. It considers these centers to be the keys to its future success under healthcare reform.

Step 2: From Services to Programs

To have success as a smaller health system in Greenville, SC, BSSF developed a 4-pillar model of service line management that straddles the worlds of volume- and value-based reimbursement:

  • Quality/Outcomes
  • Cost
  • Service/Satisfaction
  • Volume/Market Share Growth

Monitoring these pillars allows your organization to see the benefits of transitioning from piecemeal services to formalized programs: quality improvement, cost and other efficiencies, enhanced teamwork, increased patient volume, enhanced market share, and the ability to realize value.

How do you know if you have service lines or programs? Do the math. A service line-based business model relies on performing a large volume of uncoordinated individual procedures and services. But in a future of value-driven healthcare, more isn’t better. Combine those services into larger, overarching programs. BSSF rolled its general surgery services into programs like thoracic/lung and wound care.

Step 3: From Programs to Excellence

Develop centers of excellence one at a time, as they can be resource-intensive. Determine which designation is most important for your organization based on volume, reputation, or market opportunity. Then obtain the criteria for that designation and develop your program specifics accordingly. Monitor your progress by developing a dashboard for each program. BSSF dashboards contain 12-45 metrics, emphasizing those most important to regulators, quality ratings organizations, insurers, employers, and patients:

  • Quality: The key driver of the value equation, quality includes metrics for mortality, complications, readmission rates, clinical pathway usage, and CMS indicators.
  • Long-Term Outcomes: These include indicators of interest to patients and their employers, like pain, functional status, and the ability to return to work and former activities.
  • Financial Metrics: For example, total cost, volume, and length of stay.
  • Service: Surgeon, patient, and staff satisfaction are measured through on-time surgery starts, OR turnover time, surgery block utilization, and patient satisfaction.

How do you know when you have achieved a center of excellence? You apply for it (BSSF is currently applying to be one of three Joint Commission Designated Center for Excellence for Colorectal Surgery hospitals), or you qualify for a third-party designation. BSSF has been recognized as one of Healthgrades Top 100 Best Hospitals for Orthopedic Surgery, and has earned a Service Excellence Award for Joint Replacement, both for four consecutive years. It was ranked #1 in South Carolina for orthopedic services for two years. The health system has also earned a Healthgrades 100 Best Hospitals designation for Gastrointestinal Care and for General Surgery.

Step 4: Differentiate through Continuous Improvement

Delivering higher quality care for less cost to more satisfied customers is a standard for success in a value-based environment. Track, publish, and actively market your results to establish your brand as a regional leader. In addition to its quality accolades, BSSF can also claim orthopedic surgeon and patient satisfaction, and employee engagement, that all rank above the 90th percentile in Gallup surveys. That’s rare.

BSSF now also performs the most joint replacements in South Carolina (over 8,500 in 2014). It has achieved 65% market share in joint replacement, 45% in hip fracture, and 40% in spine care. Its cost metrics are notably low. By reducing joint replacement length of stay and OR time, it now has the lowest implant costs of all Bon Secours hospitals, and the lowest DRG-based implant cost in upstate South Carolina.

These successes position the health system for success under bundled payment and narrow network agreements. So do its efforts to continue differentiating its centers of excellence versus others through innovative features. For example, the Joint Camp and spine care center offer prehabilitation, a spine triage center, program navigators, a coaching program, and newsletters. It also communicates quality to patients, physicians, employers, and insurers through comprehensive marketing strategies.

Developing and marketing clinical quality are the keys to success in 2016 and beyond. The journey to centers of excellence will get you there.

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