The future of hospitals in conditions of financial constraint.The case of a large Italian Hospital

Pietro Grasso

Athens, June 5 th, 2019

Topics

▪ The Context

▪ Policlinico Gemelli Hospital

▪ The istitutional evolution

▪ The organizational changements

▪ Principals results

▪ Next challenges

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❖ Good health indicators ( life expectancy in good health conditions)

❖ Good healthcare coverage, but

❖ Reduced rates of universal coverage & equity (-13,4 % = 8,1 mln);

❖ Increasing waiting list

❖ Economic sustainability of Italian health Service

❖ Insufficient capacity of investments

❖ Increased costs on new technologies, drugs and medical devices

❖ Block of public fundings

❖ Disparty between the services provided in the different Regions

❖ Increasing number of people who forego the treatments

❖ Increasing out-pocket health spending ( +9% from 2013 to 2018)

THE NATIONAL CONTEXT

\

❖ A big debt burden for Health Care❖ The Commissioner for the Regional goverment❖ The aid package❖ The hiring freeze❖ The budget squeeze on Hospitals ❖ The spending cuts on pharmaceuticals❖ Increased controls and economic sanctions on inappropriate

admissions

THE REGIONAL CONTEXT - LAZIO

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Net loss€ -100.000.000

201

1

Next projects

201

9

Third Change

management

Foundation

Gemelli-IRCCS

2018

Second Change

management.

The birth of the

Foundation Gemelli

201

5

First Change

management

The slimming diet

The steps of our route

2012

No financial agreement.

2011 Problems

Relationship problems with regional health authority

New standards in hospital bed equipment

Gemelli had to reduce costs

Rigid organization & management

Gemelli had to reduce 100 beds.

Strategic Plan 2012-2016

01

02

03

04

Increase efficiency &

appropriateness in performing

hospital activitiesDevelop Gemelli recovery plan in

the regional, national

&international context.

Develop revenues from

private activities .

Develop the bridge between

research and heathcare .

THE HR COST CUTTING MEASURES (2012-2014)

Results at the end of actions: Cutting staff (490 fte units) Saving € 30 M

• Include reduction of the duration of seasonal contracts equivakent to 25 FTE

• Breakdown 5/10% of severance pay on the exit year; 90 % the following year

)- 490FTE

8819075

36

100

FTE Aggregate

At the end in 2015 savingfor € 29,5 M

Gli interventi sui costi esterni

Results at the end of measures : Saving € 25 M on external costs(reduction of 12%)

Cost items Costs 2011 (M€)Impact of

interventions• Renting, leasing

• Energy & water

• Manteinance

• Outsoursing

• Chemicals

• Purchasing

• Medical devices

• Fharmacy (except File F)

61

14

18

28

12

16

11

56

211

8%

11%

11%

15%

22%

19%

26%

7%

12%

Pharmacy provides the medical supplies;Purchasing provides Oxigen, Laboratory & Trasfusional materials

Goods , Raw materials, Consumables

12,1M€

Outsursing Services& Utilities

7,7 M€

OTHER COST CUTTING MEASURES (2012-2014)

L’evoluzione dell’offerta di posti letto SSN

Hospital Bed Equipement Gemelli + Columbus 2011-2016

Cut 240 hospital bed in 5 years , 205 inpatients and 35 day hospital

-242 PL

Gli interventi di ottimizzazione della degenza media SSN

TARGET: REDUCE 240 BED WITHOUT NEGATIVE IMPACT

Enhancing performances for reducing the averege lenght

stay of one day (-1,0)

Riduzione complessiva degenza 1,0gg

• Improving the appropriateness of hospital treatment: Shifting from inpatient to outpatient treatment and day hospital

• Enhancing the hospitalizationefficency for reducing the averagelenght stay:

Reducing pre-op stay;

Reducing waiting time of radiological examinations;

Discharging and moving patientswho need long term care;

The new hospital organization

01 02

03

0405

06

01

02

03

04 CardiovascularHub

05

06

NeurologicalHub

DepartmentsProgramsCentersPathways

Cancer Hub

EmergencyHub

WomenHub

Hubs and Centers/Programs the interfaces between hospital organization and patients

PoloOncologico

PoloCuore

PoloDonna

PoloNeuro

PoloEmergenza

Hubs Centers and programs

Departments

Department 1 Department 2 Department 3 Department 4 ...

Management of the academic staff according to the teaching classes

Patient

Policlinico A. Gemelli – 5 Hubs

Policlinico “Agostino Gemelli”Strategic Evolution 2012-2016

Oncologic diseases’ clinics

Emergency Department’s clinic

Neurological diseases’ clinic

Cardiovascular diseases’clinic

Woman's hospital clinic

0,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

45,00

50,00

0,00 2,00 4,00 6,00 8,00 10,00 12,00

Ma

rke

t s

ha

re L

azio

Re

gio

n(

% )

ISI H-INDEX Average

Competitiveness and attractivenessStrategic area of development

Hub Tools

HUB

Medical Chief

Case/Care Manager Clinical

PathwaysCoordinator

OperationPlanning Center

Information System

ManagerialControl

Gemelli Foundation Strategy 2015-19FPG birthday is August, 1st 2015

Lease contract of company branch

with Columbus Hospital,

November, 1st 2015 .Increase extra budget for

“patient admission mobility”

from other Regions

Consolidation/Improveme

nt of cost containment

measuresNew employment contract

Apply to Ministry of Health to recognize

Gemelli as a Research Institute

Our MissionCare as a valueLOOKING TO THE FUTURE

VISION 2021

• TO ESTABLISH AS A POLE OF

EXCELLENCE IN ATTRACTING

PATIENTS & PROFESSIONALS

• COMMITTING ONESELF TO BEING A

HOSPITAL AT THE SERVICE OF

EVERYONE WHO CARE FOR PEOPLES

AND JUST NOT THEIR ILLNESSES

Award IN MARCH 2018

POLICLINICO GEMELLI FOUNDATION WAS AWARDED AS

ISTITUTE OF SCIENTIFIC CHARACTERIZATION & TREATMENT (IRCCS)

FOR “PERSONALIZED MEDICINE” AND “INNOVATIVE BIOTECHNOLOGIES”

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TREEMAP - GEMELLI

38

Strategic Plan 2018-2021

Enhance the

economic performance

01

02

03

04

Consolidate the achieved

results

Improve the operational and

managerial processes

New strategic Projects

Goals

03

01 Increase the

revenues ofhospital activity

Achieve a

sustainable

growth

Improve EBIT

Increase Net Worth

Improve Net Financial

Position

02

Growth Perspective

Option 01Option 02

Option 03

Option 05

Option 04

01

02

Network

Gemelli

New

Aquisitions

04 Increase

private

revenues

05 New

generations

of Clinical

leadersJoint

Commission

Accreditation03

thanks

Success is not final, failure is not fatal.

it is the courage to continue that counts.W. Churchill