THE EFFECT OF A HEART ASSIST DEVICE CLINICAL STUDY ON HOSPITAL REFERRALS AND REVENUES

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.

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.

December 8-11, 2004ISHLT 6th Fall Education Meeting

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

Abstract

n 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.

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.

Community Physicians (Cardiologists)& Health System Referrals

LDS Heart Failure Clinic

VAD Program

LDS OR

Evaluation

andWork-Up

Implantation

Initial Meetin

g

Community-

based HF Patient

LDS HF

Clinic

LDS VAD

Program

LDSVADOR

E&MEcho

E&MO2

RHPulm fxCritical Criteria Narrow the Patient Pool for

Implantable VADsFig 1

Screening, Evaluation, Work Up to Evaluate VAD AppropriatenessFig 2

ServiceRevenue per Unit*

E&M $ 50

Echo 200

O2 Cons 30

RH fx 2,100

Pulm fx 250

Transplant

145,000

CABG 28,000

Pacemaker

12,000

REMATCH Revenue ModelFig 3

XNumber of Units

=Increment

al Revenue

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

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