Page 138 - CombinedTest_Neat

Site Performance Summary:
St. Elizabeth Youngstown's expense is under budget $1.01M (14%) due to
inventory adjustments that were booked in December. Excluding these
adjustments St. Elizabeth's expense is over budget by $172K (2.5%), in line
with gross revenue that exceeded budget by 2.7%. The primary driver of
this variance was Medical Surgical supplies, which totaled $297K, 12.5%
under budget. O/P registrations came in 1.4% under budget while O/P
revenue exceeded the target by 7%. A portion of this increase was due to
Cath Lab volumes exceeding budget by 5% and prior-year by 15%. Overall
surgical volume was down considerably compared to budget, with case
volume falling 18% below plan, this contributed significantly to the
comparatively low Medical Surgical supply expense (OR was $250K under
for the period). TAVRs continued to drive the variance related to heart
valve expense, with eight installed during the month (2017 average is 7).
Implant Other exceeded budget by $100K, mainly driven by CardioMEMS
($39K) and Occluder PFO expense ($20K). Soft orthopedic volume resulted
in lower than anticipated total joint expense ($14K, 13%). Drug expense
exceeded budget by $195K driven by increased chemotherapy and infusion
spend.

Key Challenges: 2-3 key contributors for each expense subaccount
Overall low OR volume (18% under budget) was main driver of the facility-
wide positive expense variance (OR down $250K, 35%).
Chemistry over budget by $40K - $21K in ProBNP, $14K in D-Dimer received
St Elizabeth Leader's Summary
Med/Surg at EOM. Increased order quantities for specific flu-season related tests,
Microbiology was down $27K on reorder timing
CT was over budget by $12K (48%) - department ordered contract direct
from Bracco using wrong exp code $15K - should have hit Contrast Media
expense.
Oncology meds totaled $428K, top 5 variance vs. PY include Herceptin
$187K, Perjeta $49K, Opdivo $41K, Keytruda $41K and Abraxane $39K
Outpaitent infusion meds increased $67K including Krystexxa $56K, Ocrevus
Rx
$33K, Nucala $25K and Xolair $9K
Implants Other exceeded budget by $100K. Notable Cath Lab expenses
included CardioMEMS, 2 ea. totaling $39K, 2 ea. Occluder PFO devices
totaling $20K. One EVAR (AAA) procedure was paid out of period totaling
~$15K
CRM implants overall exceeded budget due to TAVR impact (eight
procedres, $260K impact). TAVR volume remains consistent. In discussion
with Medtronic to introduce their self-expanding device (Evolut) - minimal
savings opportunity, has potential to increase TAVR volume as can be used
where current Edwards device is contraindicated.
Implants Pacers and ICDs were significantly under budget for the period on
comparatively lighter ICD volume to PY (15 cases vs. 28 PY) . Pacers,
however did not follow this trend (27 cases vs. 15 PY).

Spinal implants exceeded budget by $9K (3.7%) on increased fusion volume
(29) vs YTD run rate (28) and PY (17). Kyphoplasty volume (17) was down vs
YTD rate (23) and PY (18). We are devleloping a construct analysis, by
provider/case type that will assist with contracting and analysis, hardware -
biologics mix.
$118K in daVinci reposable instrument inventory was removed from the OR
perpetual inventory resulting in a $118K impact in December (inventory
adjustment not related to physical count - has not been excluded from this
analysis).
Other Expenses

Actions Taken/Planned:
Procedure expense tracking needs improvement in order to meet reporting
Volume Data
timelines.
Lightswitch process has been implemented and is redirecting requests as
Alt Sourcing
planned.
Capital Avoidance