Issue link: https://beckershealthcare.uberflip.com/i/627546
22 PRACTICE MANAGEMENT B usinesses across the spectrum have created better products and services at lower costs with the lean process. But is it possible to follow the lean production mindset in healthcare for meaningful value change? "e first thing we need to realize is we do have similarities to other industries," said Lloyd A. Hey, MD, a spine surgeon at Hey Clinic Scoliosis & Spine Surgery in Raleigh, N.C., in a presentation titled "Surgeon Leadership for Improving Quality and Decreasing Cost in Clinic and Operating Room" at the North American Spine Society Annual Meeting in October 2015. e automotive industry is a prime example. Toyota revolu- tionized automobile production in the 1950s to create a better product for lower cost. at resulted in material flow going one way and information flow coming back to improve the process. e healthcare industry has a service flow and feedback from patients to perfect the appointment and healthcare delivery process. But to implement lean, phy- sicians oen need to change their mindset. Dr. Hey recommended the following books for surgeons interested in learning more about leadership and the lean process: • "Out of the Crisis" by Edward Deming • "e Machine at Changed the World" by James P. Wom- ack, Daniel T. Jones and Daniel Roos • "e Fih Disci- pline" by Peter Senge "We are all very com- fortable with the patient/ doctor relationship and how we do whatever we can to help the patient but we are less aware of how our actions actually impact society through hospitals, vendors, insurance companies, government agencies and employers and eventually to the next generation," said Dr. Hey. "is is what systems thinking is all about because the choices we make now have a ripple effect in the long run." Dr. Hey implemented ELIs — error, learn, improve — in his practice. Every day, surgeons see errors in their practice and instead of blaming others Dr. Hey proposes using those errors as opportunities to learn and improve. "is leads to an upward cycle of improved quality over time," said Dr. Hey. e ELI approach is important at the individual level as well as the clinical level. Dr. Hey has weekly meetings with the staff and hospital administration to discuss opportunities for improvement. "What we really need is process control information sys- tems because that's your conveyor belt for your practice. You can take the things you're learning from your ELIs and actually integrate that into your information system to help prevent that from happening again." Do You Have a Lean OR? How to Improve Quality & Cut Costs in Spine From Dr. Lloyd Hey By Laura Dyrda How ICD-10 Affects 2 Spine Practices By Anuja Vaidya Two spine surgeons discuss how ICD-10 has affected their respective practices. Question: Are you planning to make additions to your practice staff in the coming year as a result of ICD-10 implementation? Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: We have added one additional staff member to the billing department. We split functions, in general, to include records custodian, billing and coding, collecting and posting, insurance verification with scheduling and appeals/oversight. We are adding an FTE so that each individual while having a general knowledge of all functions also has an area of focus. We hope that this will address the additional time required to document ICD-10 details. Jeffrey R. Carlson, MD, President, Orthopaedic and Spine Center, Newport News, Va.: We are not planning on adding personnel as a result of ICD-10 but have added a significant cost to our EMR through enhancements. These costs will not be recovered. The idea that ICD-10 will increase our revenue is based on the notion that our coding was bad while using ICD-9. We have multiple coding FTEs that have been added over the years to keep up with the implemen- tation of each new program. Our practice has kept current on the coding through courses and updates to stay ahead of each change because it is vitally important to get the coding correct, legally and financially. This diligence means that any new changes that add cost to our current budgets will not be made up with new revenues based purely on the coding model. There has been no increase in the reimbursement for a discectomy or a spinal fusion with implementa- tion of ICD-10. It has only added another expense to our bottom-line. n