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With the industry’s focus on value-based care, musculoskeletal service line leaders responsible for transforming processes and programs must be responsive both to payment reform and to the increasing expectations of healthcare consumers for ease and convenience. Everyone’s sights are set on delivering better outcomes, greater patient satisfaction, and lower costs.

The 2018 Musculoskeletal Leadership Summit brings orthopedic and spine thought leaders together to share best practices and lessons learned, presenting a unique opportunity to provide orthopedic and spine program excellence without the need to reinvent the wheel.

In Part Two of our latest series, we spoke with Bill Munley, Hospital Administrator, Shriners Hospitals for Children, about his top strategies for patient-centered care.

(If you missed Part One, you can find it here.)

Tell us about your background in orthopedics, rehab, and healthcare administration. How has the shift to value-based care and the increasing expectations of healthcare consumers influenced the work that you do?

I just took my new job six weeks ago. I’m now the CEO, officially called the Administrator, at Shriners Hospitals for Children in Greenville. Previously, I was at Bon Secours St. Francis Health System in Greenville for 30 years, where I was the Vice President of Orthopedics, General Surgery and Professional Services.

In the recent years, there’s been more and more talk about the government cutting back, about industry and insurance companies wanting to be more efficient and cut their healthcare costs. Really it’s been over the past decade that the government started toying with things like bundled payment arrangements, value-based purchasing, etc. It’s only been the last few years when it’s really picked up steam, where they’ve put penalties or rewards in place for different components of value-based purchasing. And we’ve had to adjust to that in the healthcare industry.

But what we’ve been trying to do in orthopedics – and I’ve been in it for the past 25 years and rehabilitation therapy for close to 40 – is to see how orthopedics, as a specialty, can fit into this brave new world of population health, value-based care, and bundled payments.

As much as people talk about not needing as many specialists in the future, about keeping people out of the hospitals and treating them in home-based environments, there’s still going to be increased orthopedic business coming our way, whether it’s inpatient or outpatient. The population is getting older, we can’t always prevent fractures or sports injuries, and we can’t keep the weekend warrior baby boomers from jogging or playing softball and getting hurt.

With all the joint replacements going on, my past life at St. Francis involved working with patients, half of whom were under the age of 65. These people are going to need revisions in the future. So even though some of that is shifting to outpatient, a lot of it is still going to be done on an inpatient basis.

Orthopedics is not only going to survive, but thrive, in the future; there’s going to be more business in my estimation. That’s the Bill Munley forecast, and I’ve been at it a long time.

As you know, the 2018 Musculoskeletal Leadership Summit presents an opportunity for service line leaders to connect and participate with surgeons and other clinicians. Why is this type of collaboration important for clinical transformation?

First of all, the Summit is always so well organized, and people really enjoy attending. There are a variety of speakers – physicians, other clinicians, and administrators. It’s rare that a group like that can all get in the same room – because we’re so diversified – and hear each other’s thoughts, and discuss how to collaborate and what the best way to do it is.

Normally, at the bigger conferences, it’s very segregated – the physicians go to one end of the building, the administrators go to the other end of the building, and the nurses go to a third area. And you really don’t get to hear from, or interact with, or throw ideas out to each other. The problem with this is that a lot of times the clinicians are only thinking on one end – from the quality or the patient side of things, and then the hospital administrators are only thinking from the financial end.

But in this case, it’s a small group, no more 50 people. This group is small enough that there’s interaction and sharing of ideas and networking that’s very valuable.

In all the Summits I’ve attended, I’ve always learned something new. I’m considered a subject matter expert in about four or five areas in orthopedics, yet I always have incredible takeaways. Plus, I have to admit, the cities they pick, the hotels they pick, and the meals are all superb. It’s almost like a vacation; you’re learning while you’re on vacation.

Can you tell us a bit about your speaking topic, “Trials and Tribulations of Managed Care Bundled Payments”? Why is this topic important to you personally?

At little St. Francis in Greenville, we’re the small guy in town, and I always wanted us to be recognized. I had that drive for us to achieve awards and be recognized as a Center of Excellence. I wanted a great value equation – value defined as quality and outcomes, divided by costs, all related to patient experience. I wanted us to be at the top in that.

Through the years we worked to get great scores from Premier Healthcare, from Comparion, from Becker’s, from HealthGrades, and from a number of different independent quality organizations. We had wonderful results. Insurance companies recognized that, so they approached us. They knew what it cost them, they knew our quality and outcomes, and they knew our patient satisfaction scores, because we published them. They figured out that we have the best value equation. So they approached us, and I said, “Yeah, let’s jump in.” The four reasons I jumped in are:

  1. It further recognized us as a Center of Excellence on a regional level, not just local.
  2. It was incremental new business. I did a little study, with a radius of where the patients came from, and over 75% of them came from 20 to 30 miles outside of Greenville or out of state.
  3. The way we set up all the agreements resulted in every single one of them being profitable.
  4. The press I got from this was incredible. Every time someone came from a different state, we’d make a big deal out of it and promote it as a success story. We started out with joint replacements, then we expanded to ACLs, sports injuries, shoulder replacements, gall bladders and hernias. We even had people fly in from Alaska for surgery. We used that as a big press story.

What’s happened is, these surgical tourism companies have figured out they can fly a patient and their family from Alaska to Greenville, give them a travel allowance, have the surgery done, let them stay a few days to recuperate, then fly them back to Alaska. In the end, it’s better quality, the patients are happier – Greenville’s a great city and our results are wonderful – and it was cheaper overall.

Plus there was steerage for the employees, because unlike the government side of things, they can wave the patient’s copay or deductible or both, depending on the specific plan and specific laws. They can wave it and say, “Hey, you can stay here and pay your 20% copay out of pocket or we can put you on a plane to Greenville for free, you can have a good time staying there with your family and get the surgery done with nothing out of your pocket.”

We really think this is the wave of the future, where there will be regional Centers of Excellence.

As a result of the squeeze on healthcare, there are certain hospitals that are going to close. Other hospitals are going to stop doing certain procedures, and then there are going to be regional centers where people go for elective procedures.

Achieving Center of Excellence status and being the regional Center is not only going to help on the upfront fee-for-service, and on the bundling side, it’s going to help down the road in becoming that Center of Excellence where other health system ACOs will send their business.

Can you share some examples of the work you’ve done to improve experience, outcomes and value? How will you be applying some of these strategies in your new role at Shriners?

The way I got to be recognized as a Center of Excellence in five or six programs at St. Francis was by taking services and certain procedures and making them into formal programs, then moving those to Center of Excellence status in the outsider’s eyes.

As we said at St. Francis, which is a Catholic organization, we didn’t just dip our hand in the holy water and anoint ourselves as a Center of Excellence; we had others do that for us.

After forming teams for those programs as Centers of Excellence, I created what I call the four pillars of service line management: quality and outcomes; service and satisfaction; cost containment; and volume and market share growth.

We were constantly measuring using dashboards and metrics of what’s important to the patient, the insurance companies, and the industry, and that is what kept us on track.

Now, I’m carrying that over to Shriners, implementing benchmarks, taking some of the procedures they do here and making them into formal programs. I’m looking at bundled payment arrangements and surgical tourism for things like surgical spine – we do scoliosis with incredible results. We do spina bifida, we do cerebral palsy, we do limb deficiencies, and we do the normal fracture care and sports injuries here. I want to get the word out about our quality, our outcomes, our service, and the environment here, all of which are just incredible.

I used to think it was “Shriners Hospitals for Crippled Children.” That’s how you pictured it – with just the most severe cases, but we’re a very comprehensive hospital for pediatric orthopedics. I want to get the word out, and again, take those existing services and procedures and evolve them into programs as Centers of Excellence, and get business from beyond the surrounding six states we currently serve.

What about the Summit are you most looking forward to?

I love the city, I love getting back together with Kathryne and James and some of my other colleagues. Usually at this conference I’ll see five people I know very well, and probably another handful that have heard me speak in previous years. So it’s kind of like a little reunion.

Of course, the topics are so timely, diverse, and interactive. Everyone listens and participates. It’s not the typical format of other conferences. They split it up so it’s a 45-minute talk, then a 30-minute talk, then a 15-minute panel discussion. It’s just well organized, well placed, and the people are great.

I’ve been to many conferences over my 37 years in healthcare where you go to a conference and if you’re not with someone from your own hospital, you’re kind of alone. This group, right from the beginning, is one big family. If you’re an outsider coming for the first time, you’re quickly drawn in. We say, “Hey, come sit with us, come have a drink, what’d you think about that presentation?” There’s so much interaction, you feel close and tight knit with this group even if it’s your first time.