Transcript Document

December
8-11,
2004
ISHLT
6th Fall
Education
Meeting
THE EFFECT OF A HEART ASSIST DEVICE CLINICAL STUDY ON
HOSPITAL REFERRALS AND REVENUES
JW Long, MD 1, K Nelson, MBA, RN 1, K Tong, MS 2
1 Utah Artificial Heart Program, Latter Day Saints Hospital, Salt Lake City UT; 2 Quorum Consulting, Inc., San Francisco, CA
In today’s era of cost containment, tertiary
medical centers are under a lot of pressure to
control costs while at the same time justifying
benefits of providing state-of-the-art services.
Administrators and department heads need the
knowledge and tools to evaluate the feasibility
and ROI associated with high-cost, high-visibility
technologies and services.
Abstract
Background
From May 1998 to July 2001, chronic end-stage heart
failure patients ineligible for transplantation were
recruited for a clinical study to evaluate long-term use
of a left ventricular assist device (LVAD). The
Randomize Evaluation of Mechanical Assistance for the
Treatment of Congestive Heart Failure (REMATCH) study
enrolled 129 patients, and randomized 68 patients for
LVAD implantation.
Results
Conclusions
Approximately 150 end-stage heart failure patients
were referred to LDS Hospital and underwent screening
evaluations: two outpatient clinic visits ($50 per visit)
and an echocardiography ($200). About 50 percent of
patients underwent follow-up diagnostic procedures:
oxygen consumption ($30), right heart pressure
monitoring ($2,100), and pulmonary function tests
($250). Several patients not enrolled in the REMATCH
study were referred to other departments for other
procedures: transplantation ($145,000), coronary
artery bypass grafting ($28,000), and pacemakers
($12,000). Ultimately, 12 percent (n=18) were enrolled
in the REMATCH study. Median follow-up for LVAD
patients was over one year. Patient screenings and
evaluations led to referrals to other departments, and
other incremental services. Referrals leading to
services yielded significant revenues (approximately
$850,000).
The REMATCH study had a positive effect on referrals
and follow-up care at LDS Hospital. The increased
number of referrals yielded increased revenues from
screening services, more intensive patient work-ups,
and subsequent referrals to other hospital
departments. LVAD services had an impact on hospital
revenues not only in offering the actual implantation
and related services, but also in other hospital
departments who received patients referred away from
the LVAD services.
Fig 1
Communitybased
HF Patient
E&M
Echo
Community Physicians (Cardiologists)
& Health System Referrals
Fig 3
LDS
VAD
OR
LDS VAD
Program
LDS HF
Clinic
Critical Criteria Narrow the Patient Pool for
Implantable VADs
Objective
The objective of our study was to evaluate revenues
that resulted from referrals of patients to the REMATCH
Study.
Methods
At LDS Hospital, we retrospectively reviewed clinical
report forms for all referred patients to determine the
number and types of patients referred to the REMATCH
study. We determined which patients were randomized
for LVAD implantation, and which were referred to
other services in the hospital. For patients who
received LVAD implants, we collected data on follow-up
care. For patients who were referred to other services
in the hospital, we determined revenue using
standardized fee schedules.
Fig 2
Screening, Evaluation, Work Up to Evaluate
VAD Appropriateness
E&M
O2
RH
Pulm fx
REMATCH Revenue Model
LDS Heart Failure Clinic
Initial
Meeting
Implantation
VAD Program
LDS OR
Revenue
per Unit*
Service
Evaluation
and
Work-Up
E&M
$
Echo
50
200
O2 Cons
30
RH fx
Number
Incremental
X
=
of Units
Revenue
2,100
Pulm fx
250
Transplant
145,000
CABG
28,000
Pacemaker
12,000
Using ROI modeling software,
we estimate that 150 patients
evaluated for REMATCH
generated $850,000 in
incremental revenue
* Based on average Medicare DRG and APC payments
Research supported by Thoratec Corporation