ECLS Program Finances Financial Implications Julie Parrish, MBA - PowerPoint PPT Presentation

ECLS Program Finances – Financial Implications Julie Parrish, MBA Business Partner Director Jonathan Delap, BS Business Partner Senior Specialist University of Kentucky

Faculty Disclosure • Nothing to disclose

Educational Need/Practice Gap A major practice gap exists in the availability of ECLS programs. Individual hospitals must determine the need for an ECLS program in their area and obtain institutional commitment prior to program development. Financial drivers of a program will include equipment and personnel costs compared to the volume and outcomes of patients.

Objectives Upon completion of this educational activity, you will be able to: 1. Discuss the financial impact of the ECLS program on the organization 2. Discuss considerations and factors in reviewing financial performance for program sustainability

Expected Outcome The desired change/result in practice is to be able to evaluate how an ECLS program fits into their institution and balance growth potential against the cost of building a sustainable program. In addition, participants will be aware of the changing paradigm in health care payments.

Understanding w here you are currently • What stage is your program in? • Planning, infant, established, growing? • Ongoing Topics • Identify Goals of the Program • Right size the program • Equipment and staff to meet Goals

Financial Impact on the Hospital • Revenue • Increase in charges due to extensive resources used • Increase in revenue due to shift in MS DRG • More to be discussed • Internal review • Professional Coding and RVU Production

ECLS Program Impact on Hospital - Revenue Provider Total Avg Covered Avg Medicare Provider Name Provider City State Discharges Charges Payments UNIVERSITY OF KENTUCKY HOSPITAL LEXINGTON 89 $ 504,957 $ 137,525 UNIVERSITY OF LOUISVILLE HOSPITAL LOUISVILLE 41 $ 570,812 $ 111,143 NORTON HOSPITAL / NORTON HEALTHCARE PAVILION LOUISVILLE 38 $ 322,693 $ 86,818 KY JEWISH HOSPITAL & ST MARY'S HEALTHCARE LOUISVILLE 28 $ 504,613 $ 124,101 PIKEVILLE MEDICAL CENTER PIKEVILLE 21 $ 591,433 $ 136,820 Chart Source: SAINT JOSEPH HOSPITAL LEXINGTON 19 $ 328,000 $ 110,302 BAPTIST HEALTH LOUISVILLE LOUISVILLE 11 $ 375,835 $ 76,741 Medicare MS DRG 003 Only (Does INDIANA UNIVERSITY HEALTH INDIANAPOLIS 91 $ 563,477 $ 132,613 ST VINCENT HOSPITAL & HEALTH SERVICES INDIANAPOLIS 42 $ 408,519 $ 101,431 include non ECMO cases) LUTHERAN HOSPITAL OF INDIANA FORT WAYNE 27 $ 534,250 $ 89,702 From Medicare Provider Utilization and FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS 26 $ 408,149 $ 110,482 IN MEMORIAL HOSPITAL OF SOUTH BEND SOUTH BEND 20 $ 408,515 $ 103,710 Payment Data for FY 2016 PARKVIEW REGIONAL MEDICAL CENTER FORT WAYNE 17 $ 494,023 $ 124,136 ESKENAZI HEALTH INDIANAPOLIS 13 $ 564,694 $ 177,526 DEACONESS HOSPITAL INC EVANSVILLE 12 $ 279,605 $ 80,945 CLEVELAND CLINIC CLEVELAND 89 $ 635,272 $ 137,076 OHIO STATE UNIVERSITY HOSPITALS COLUMBUS 65 $ 637,006 $ 133,128 UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC CINCINNATI 51 $ 566,623 $ 127,340 RIVERSIDE METHODIST HOSPITAL COLUMBUS 35 $ 372,482 $ 86,136 TOLEDO HOSPITAL THE TOLEDO 33 $ 455,129 $ 88,770 MOUNT CARMEL WEST COLUMBUS 32 $ 270,923 $ 84,593 UH CLEVELAND MEDICAL CENTER CLEVELAND 30 $ 487,108 $ 128,907 GRANT MEDICAL CENTER COLUMBUS 23 $ 431,334 $ 105,679 KETTERING MEDICAL CENTER KETTERING 23 $ 409,636 $ 88,070 OH ST ELIZABETH YOUNGSTOWN HOSPITAL YOUNGSTOWN 23 $ 283,618 $ 71,702 SUMMA HEALTH SYSTEM AKRON 20 $ 610,103 $ 75,219 MERCY ST VINCENT MEDICAL CENTER TOLEDO 20 $ 643,898 $ 102,906 MIAMI VALLEY HOSPITAL DAYTON 17 $ 375,766 $ 81,084 METROHEALTH SYSTEM CLEVELAND 15 $ 301,581 $ 123,332 MERCY MEDICAL CENTER CANTON 14 $ 162,696 $ 87,646 CHRIST HOSPITAL CINCINNATI 14 $ 567,230 $ 131,590 AKRON GENERAL MEDICAL CENTER AKRON 12 $ 386,053 $ 68,797 AULTMAN HOSPITAL CANTON 12 $ 202,001 $ 74,975 UNIVERSITY OF TOLEDO MEDICAL CENTER TOLEDO 11 $ 539,643 $ 158,166 CHARLESTON AREA MEDICAL CENTER CHARLESTON 29 $ 244,189 $ 81,925 WV WEST VIRGINIA UNIVERSITY HOSPITALS MORGANTOWN 23 $ 351,199 $ 124,736 CABELL HUNTINGTON HOSPITAL INC HUNTINGTON 11 $ 421,339 $ 116,975

ECLS Program Impact on Hospital – Charges During Stay Department Roll Up 2016 2017 2018 CV ICU Bed and Floor Charges 22.05% 17.90% 20.35% Pharmacy 15.85% 14.39% 18.92% Operating Room 13.66% 12.06% 8.76% Respiratory 10.19% 10.22% 12.04% ECMO Charges 7.63% 9.70% 8.37% Lab Charges 4.75% 5.09% 5.96% Blood 4.01% 3.26% 2.90% Organ Charges 2.43% 3.03% 3.80% Cath Lab 1.94% 3.82% 3.36% Miscellaneous Supplies 2.37% 2.88% 1.87% CV Acute Care Bed and Floor Charges 1.89% 2.31% 2.79% Trauma ICU Bed and Floor Charges 1.23% 4.70% 0.79% Medical ICU Bed and Floor Charges 1.97% 1.81% 2.47% Diagnostic Radiology 1.43% 1.70% 1.55% Other Miscellaneous Departments 1.86% 1.21% 1.13% Anesthesia 1.92% 1.57% 0.51% Other Bed and Nursing Floor Charges 1.18% 1.09% 1.29% Physical and Speech Therapy 0.83% 1.07% 1.27% Dialysis 0.94% 1.21% 0.79% Interventional Services 0.20% 0.24% 0.68% KCH ICU Bed and Floor Charges 1.18% 0.00% 0.01% Trauma Acute Bed and Floor Charges 0.20% 0.49% 0.18% CV Diagnostic Services 0.21% 0.22% 0.19% Laboratory 0.09% 0.03% 0.03%

ECMO Length of Stay Analysis • Length of stay is down by over two days but length of Fiscal Year Data runs are up by 0.42 days. Length of Stay Data FY 2016 FY 2017 Variance % Change Cases 36 42 6.00 17% Length of Stay 28.39 24.57 -3.82 -13% • Large variance remains in Length of Run 8.06 8.48 0.42 5% Pre Run Stay 3.19 10.14 6.95 218% pre and post ECMO stays Post Run Stay 18.03 6.79 (11.24) -62% ICU 18.89 16.64 (2.25) -12% Telemetry 2.53 1.55 (0.98) -39% Progressive 4.78 1.60 (3.18) -67% Acute 2.19 4.79 2.59 118% 10

Other Statistical Categories Mortalities Cannulation Mode • 36% FYTD 2017 (ended at 41% for Cannulation Mode FY 2016 FY 2017 FY 2018 full FY) VA 50 39 22 VA - VV 2 3 - • 64% FYTD 2018 VV 39 40 20 Payor Mix Discharge MS DRG Discharge MS DRG FY 2016 FY 2017 FY 2018 001 - Heart Transplant or VAD 10 10 4 33% 43% 18% 5% 2017 003 - ECMO or Trach 81 71 37 235 - CABG W/O Cath w/ MCC - 1 - 769 - POSTPARTUM POST ABORTION DIAGNOSES W O.R. PROCEDURE - - 1 24% 40% 2018 36% 0% We have submitted the case under MS DRG 769 to coding compliance 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Managed Care Medicare Medicaid Govt / Other Self-Pay / Charity 11

Questions Next Steps • Costs • Pharmaceutical Costs • Costs associated with Pre Run, ECMO Run and Post Run? • Are all costs to the program allocated correctly with correct cost center being used?

Identifying Missed Opportunities Diagnosis to Review • Review of Patients • Acute Respiratory Failure • Identify cases in which ECMO • Acute Respiratory Distress would have benefited patient Syndrome • Patients with a diagnosis from • Chronic Respiratory Failure the list on the right • Acute and Chronic Respiratory Failure • Discharge Status of Expired • Cystic Fibrosis with Pulmonary • Adjust for non-ECMO Manifestations candidates due to comorbidities • Idiopathic Pulmonary Fibrosis • Pulmonary Hypertension • What DRGs are these • Pulmonary Embolism currently being discharged • Cardiogenic Shock under?

Professional Maintenance of ECMO Professional Coding Category CPT Description RVUs 33946 Initiation, veno-venous 6.00 33947 Initiation, veno-arterial 6.63 Initiation / 33951 Insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age 8.15 Insertion 33952 Insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older 8.15 33953 Insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age 9.11 33954 Insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older 9.11 Daily 33948 Daily management, each day, veno-venous 4.73 Management 33949 Daily management, each day, veno-arterial 4.60 33957 Reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age 3.51 33958 Reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older 3.51 33959 Reposition peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age 4.47 Reposition 33962 Reposition peripheral (arterial and/or venous) cannula(e), open, 6 years and older 4.47 33963 Reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age 9.00 33964 Reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older 9.50 33965 Removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age 3.51 33966 Removal of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older 4.00 33969 Removal of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age 5.22 Removal 33984 Removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older 5.46 33985 Removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age 9.89 33986 Removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older 10.00