December 12 2019 ORTHO NURSE PRACTITIONER PROGRAM EVALUATION

December 12, 2019 ORTHO NURSE PRACTITIONER PROGRAM EVALUATION TRENDS 1

Agenda • • Average knee & hip per month Average LOS & standard deviation trends Return visits, admission rate & diagnoses Improvement reasons and next steps 2

Avg. number of surgeries per month increased 41% in post-NP period Avg. Surgeries per Month 82. 1 58. 0 Pre-NP Post-NP 3

Hip Replacement LOS is significantly better Post-NP implementation Hip Replacement Avg. LOS (Feb. 2017 to May 2019) Days Avg. LOS 4. 4 NP implementation occurred Feb. 1, 2018 4. 5 4. 4 4. 2 4. 4 4. 5 3. 9 Std. Dev. of LOS 4. 0 3. 8 3. 9 3. 7 3. 9 3. 2 3. 4 3. 3 2. 7 2. 8 2. 9 2. 8 2. 0 2. 3 1. 9 2. 0 1. 8 1. 7 1. 5 1. 3 1. 0 0. 8 16 17 0. 6 3 1. 9 1. 7 1. 5 1. 3 2 2. 3 2. 1 1. 7 1. 8 1. 7 1 3. 4 2. 8 4 5 6 7 8 9 10 11 12 13 14 15 1. 0 0. 7 18 19 1. 2 1. 1 0. 8 20 0. 7 21 22 23 24 The standard deviation tightened for most months compared to the Pre-NP period. 25 26 27 4

Knee Replacement LOS has continued to decrease, and is also significantly better in the post-NP period Knee Replacement Avg. LOS (Feb. 2017 to May 2019) Days Avg. LOS Std. Dev. of LOS NP implementation occurred Feb. 1, 2018 3. 9 3. 6 3. 4 3. 7 3. 4 3. 2 3. 5 3. 1 2. 8 2. 7 2. 8 2. 6 2. 3 2. 7 2. 2 2. 4 2. 0 2. 2 2. 1 1. 9 1. 7 2. 0 1. 7 1. 6 1. 9 1. 7 1. 5 1. 4 1. 5 1. 3 1. 4 1. 3 1. 2 1. 0 1. 1 1. 2 1. 0 0. 9 1. 1 0. 9 0. 6 1 2 3 4 5 1. 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 The standard deviation is also substantially better in the post-NP period. 24 25 26 27 5

Superpath LOS decreased significantly after the NP implementation, and has held relatively steady since Superpath Hip Replacement Avg. LOS (Feb. 2017 to May 2019) Days Avg. LOS Std. Dev. of LOS NP implementation occurred Feb. 1, 2018 3. 2 2. 7 2. 5 2. 0 2. 1 1. 9 1. 5 2. 1 2. 0 1. 8 1. 5 1. 4 1. 8 1. 7 1. 3 1. 4 1. 3 1. 1 1. 0 1. 3 0. 8 0. 6 0. 7 0. 8 0. 5 1 2 3 4 5 6 7 0. 4 8 9 10 11 12 13 14 0. 5 0. 3 15 1. 0 1. 1 0. 6 0. 5 0. 4 1. 1 1. 0 0. 7 0. 6 1. 3 1. 5 1. 2 16 17 18 0. 5 0. 4 19 0. 3 20 0. 0 21 22 0. 0 23 This was also a statistically significant improvement in the post-NP period. 24 0. 3 25 26 0. 0 27 6

Cost Savings of NP Implementation Avg. Cost per patient (Feb. 2017 to May 2019) NP implementation occurred Feb. 1, 2018 Pre-NP $1, 459. 88 27. 3% decrease $1, 061. 55 $1, 322. 07 Post-NP 22. 7% decrease $1, 022. 53 $1, 056. 99 36. 5% decrease $670. 70 Hip Replacement Knee Replacement Note: These numbers are based on the cost per patient day in 2019/20 FP 04. Superpath Hip Replacement 7

Thursday to Saturday Discharges have Increased Hip and Knee Discharges by Weekday (Apr. 2017 to Feb. 2019) Percentage Apr. 2017 to Jan. 2018 19% 19% Feb. 2018 to Feb. 2019 19% 17% 16% 15% 14% 13% 12% 10% 7% 6% Mon Tue Wed Thu Fri Sat Sun 8

There was a decrease in admit rate of the return visits w/in 30 days in the post-NP period Return Visits Admit Rate 15. 2% 8. 9% Pre-NP Post-NP 19/125 23/259 9

The top discharge diagnoses for the return visits include phlebitis and thrombophlebitis, follow-up care, and cellulitis Pre-NP (125 return visits, 696 surgeries) Post-NP (259 return visits, 1231 surgeries) 10

New team-based approach model involving the NP contributed to decreased LOS • • Optimization Clinic updates identifying potential complexity Streamlining care of minimally invasive superpath hip replacement Clinical perspective & changing practice Next steps – NP are optimizing high risk patients in Optimization clinic preop – NP seeing patients in post –op wound clinic to divert ER visits 11

Acknowledgments • • Dr. Ralph Belle Dr. Tim Kostamo Kris Juck Luke Opacic & the System Optimization / Integrated Analytics team 12

Thank You! 13