We do use the repless model at our Organization. First, I should tell you that I am very impressed with the leader of our Supply Chain. He is amazing and has really transformed our Organization. From our experience:
1. Yes, with the correct marketing we can take our program savings ($4M-6M) and higher quality outcomes both to Large Companies and to individuals. Statistically we have reduced LOS from 3 days to 1 day for 60%+ of Ortho cases, we are showing employees returning to work almost twice as fast. You get a lower cost for your total knee or hip, and return to significantly faster with equal quality. Add to this the fact that CMS is now allowing us to gain share with our doctors which will allow the program to continue to grow and add even more opportunities.
2. You don’t just have to use generics even though the quality we have seen over 20 years has been equal to any other manufacture. We believe all vendors will eventually participate. We have two of the largest vendors close to finalizing contracts.
3. Our model retrains scrub techs to totally replace reps for 60% + of cases. Doctors are happier and cases are running more efficient and faster. We have reduced the seven or eight trays of instruments down to two for reduced processing time and cost of instruments. This is saving the Vendors million of dollars in lost, broken, and/or stolen instruments. Vendors are writing off 5-20 % of their implant and instruments each year. We have eliminated that for them. Additionally, our Ortho CarePathway has helped reduce around 75% of all the post 90 day episode cost. Lastly, our new software supports the whole process and captures all data points for research and continuous learning. We are ready to roll it out to other organizations to help us to continue to drive cost down even further.
At our Organization, we implemented several initiatives around reducing falls with harm. Two key initiatives are hourly nurse rounding and bedside communication handoff. Both have had a positive impact on reducing falls with harm (we have seen a 40% reduction year over year in falls with harm).
We have found that the electronic medical record has such amazing qualities including but not limited to: transparency, accessibility of information to all physicians involved in the care, better coordination of testing, etc. However, at times, we have seen a decrease in the quality of the documentation. Some physicians are utilizing the copy/paste functionality despite a policy that forbids it. In doing so, the documentation of the patient’s care can fall below the quality that is warranted. This deterioration in the communication of the patient’s condition/deterioration/progress/etc could result in lower quality outcomes than expected.
I believe that the shared governance model is great in theory but agree with jrsjr that there are so many that would rather “sit in the stands and throw fruit than get in the arena and solve problems” (great saying by the way). We have a model where we have department chair meetings and they have a say in how the organization works; however, ultimately, there is a business to run and that can’t always be done by concensus.
We have many providers in a variety of specialties that allow for on-line scheduling and are currently opening up more physician schedules to allow for this. We have several options for on-line scheduling including our portal, website and a link from external sources such as Healthgrades to do this. The on-line scheduling function is working well. We have found that 67% of the patients utilizing this functionality have commercial insurance. We have also found that patients utilizing this functionality have a lower no show rate than patients booking via other methods.