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
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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
n todayâ€™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.
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.
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.
The objective of our study was to evaluate revenues that resulted from referrals of patients to the REMATCH Study.
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.
Screening, Evaluation, Work Up to Evaluate VAD Appropriateness
Community-based HF Patient
Critical Criteria Narrow the Patient Pool for Implantable VADs
Community Physicians (Cardiologists)
& Health System Referrals
REMATCH Revenue Model
LDS Heart Failure Clinic
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