Download presentation
Presentation is loading. Please wait.
1
Deonna Moore, PhD, MSN, ACNP-BC
The Business of Transplantation: If You Can’t Keep the Lights On, You Can’t Help Anyone Edward Y. Zavala, MBA Administrator, Vanderbilt Transplant Center Vanderbilt University Medical Center Adjunct Professor of Management Vanderbilt Owen Graduate School of Management Research Professor, Department of Surgery Vanderbilt University Nashville, Tennessee Deonna Moore, PhD, MSN, ACNP-BC Administrative Director, Transplant Clinical Services Vanderbilt Transplant Center Instructor, Department of Surgery Vanderbilt University Nashville, Tennessee
2
The Business of Transplantation: How to Keep the Lights On: Watch the Money
3
Book of Business
4
Medicare
5
Medicare Transplant Approvals
Year Coverage Approved Kidney 1972 – ESRD Heart 1987 Liver 1991 Lung 1995 SPK 1999 PAK PA 2006
6
Percentage of 2017 Transplants Paid by Medicare as Primary Source of Payment
Based on OPTN data as of October 18, 2018
7
Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital
LIVER with MCC DRG 005 Mean LOS = 14.6 DRG Weight = Estimated Payment = $184,319
8
Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital
LIVER without MCC DRG 006 Mean LOS = 7.9 DRG Weight = Estimated Payment = $144,845
9
Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital
HEART with MCC DRG 001 Mean LOS = 29.1 DRG Weight = Estimated Payment = $323,252
10
Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital
HEART without MCC DRG 002 Mean LOS = 15.1 DRG Weight = Estimated Payment = $227,865
11
Phases of Transplantation
Medicare Phases of Transplantation Phase 1 Pre-transplant evaluation. Organ Acquisition Phase 2 Patient accepted and listed with UNOS and is now in the maintenance or candidacy phase. Phase 3 Patient admitted to hospital for organ transplant procedure and subsequent inpatient stay. This is typically the DRG component of the transplant process. DRG Phase 4 Patient discharged from hospital and post-transplant follow-up care period starts. APC
12
Phases of Living Donation
Organ Acquisition Phase 1 Pre-donation evaluation. Phase 2 Patient accepted as living donor and now in candidacy phase. Phase 3 Patient admitted to hospital for living donor procedure and subsequent inpatient stay. Phase 4 Patient discharged from hospital and post-donor follow-up care period starts.
13
Why Are Medicare Acquisition Cost Centers Important?
Medicare will reimburse all appropriate Medicare allowable pre-transplant expenses in Phases 1 and 2 to the point of admission for transplantation inclusive of: Transplant Coordinators Transplant Administration Social Workers Financial Coordinators Office Space Pre-Txp Testing OPO Organ Acquisition Cost of Transportation of the Organ Living Donation HLA/Tissue Typing Preservation and Perfusion Costs Organ Recipient Registration Fees (UNOS/OPTN) Communications - Pagers - Cell Phones - Land Lines - Etc. Educational Materials Etc.
14
Factors That Determine a Transplant Program’s Total Medicare Ratio:
Medicare Primary Transplant Medicare Paid as a Secondary Organ Donation in the Hospital
15
Factors That Determine a Transplant Program’s Total Medicare Ratio:
Transplant Specific Medicare Primary + Medicare Secondary + Donor Organs Total Transplants + Donor Organs
16
Transplant Business Case
Medicare Ratio Medicare Organs Ratio Annual Kidney Transplants = 50 N/A Medicare Primary Transplants = 25 25/50 = 50% Medicare Secondary Payments = 5 30/50 = 60% Kidney Donation in Transplant Hospitals = 26 56/76 = 73%
17
Transplant Business Case
Medicare Ratio and Reimbursement (Based on One Million Dollars of Annual Costs) Medicare Ratio Reimbursement Medicare Primary = 50% $500,000.00 Medicare Primary + Secondary = 60% $600,000.00 Medicare Primary + Secondary + In-house Deceased Donor Kidneys = 73% $730,000.00
18
Transplant Time Study Compliance
19
Transplant Time Sheet Knowledge and Proper Utilization
2017 Data Analysis Completed February 2018 Percentage of time staff spent in pre-transplant activities less than anticipated - 7.4% to 86.2% across programs Pre-Education Survey Lack of understanding among staff – why is it important? What counts as pre-transplant time? Education Performed July 2018 Electronic module – explaining the time sheet and its importance; how to fill out correctly Post-Education Survey Completed July 2018 Increased understanding about importance and how to properly complete 2018 Data Analysis Completed September 2018 Did education make an impact in proper utilization?
20
Managed Care / Commercial
21
Percentage of 2017 Transplants Paid by Managed Care / Commercial Payors as Primary Source of Payment
Based on OPTN data as of October 18, 2018
22
Multiple Payor Complexity Transplant Candidate/Recipient
Medicare Commercial Phases of Transplantation Facility M.D. Phase 1 Pre-transplant evaluation. Organ Acquisition Based on Contract Phase 2 Patient accepted and listed with UNOS and is now in the maintenance or candidacy phase. Phase 3 Patient admitted to hospital for organ transplant procedure and subsequent inpatient stay. This is typically the DRG component of the transplant process. DRG Part B Phase 4 Patient discharged from hospital and post-transplant follow-up care period starts. APC
23
Multiple Payor Complexity Living Donation
Medicare Commercial Phases of Transplantation Facility M.D. Phase 1 Pre-transplant evaluation. Organ Acquisition Based on Contract Phase 2 Patient accepted as living donor and now in candidacy phase. Phase 3 Patient admitted to hospital for living donor procedure and subsequent inpatient stay. Part B Phase 4 Patient discharged from hospital and post-donor follow-up care period starts.
24
Monitor Costs Per Case By Expense Category
25
Annualized Savings from Cost Reduction Initiatives
Finance Annualized Savings from Cost Reduction Initiatives Initiative Cost Savings Per Case Volume Annualized Savings Reduced blood product utilization inclusive of red blood cells, fresh frozen plasma and platelets intra-operatively and post-operatively $10,782* *Hospital Charges 117 Cases/Year $1,261,494 Eliminate use of anti-thymocyte globulin for induction $12,100** **Average Wholesale price 38 Cases/year $459,800 Reduce cost of liver procurement aviation $2,524 108 Flights/Year $272,592 Total $1,993,886
26
Stand Up and Stretch!
27
Business and Clinical Responsibilities
28
Governance Structure Collective Decision Making Clinically and Financially Physician Director Admin Director Clinical Services Transplant Administrator (Business)
29
The Business of Transplantation: How to Keep the Lights On: Know Your Metrics
30
Monitoring Volumes Consider “Growth and Finance”
31
Metrics Reflect the Health of Your Program…
Review quality metrics often Respond in real time to negative trends Make sure each program is aware of how their patients are doing!
32
Volume of Transplant Work
Referrals Evaluations Waitlist Management TXP Volume of Transplant Work TXP Short Term Follow-Up Health Maintenance Life Long Follow-Up *Courtesy of Tracy Giacoma
33
Monitoring Volumes and Reporting
Identify and measure key metrics related to: Volumes: referrals, evaluations listings, and transplants Other growth metrics: FTE growth, outreach visits, number of clinic sessions Revenue Expenses Reporting will require data and analytical support from finance, scheduling and billing, Medicare Cost Report team, etc.
34
The Business of Transplantation: How to Keep the Lights On: Monitor Quality and Performance
35
When Quality is Your Central Focus
The patient is your top priority, and you reduce the risk of harm The question: “What can we do better?” is always on your mind You recognize and embrace that change is often a good thing
36
Culture of Quality Recognition that patient safety and quality is a team sport When your transplant center works as a team, everyone feels safe and comfortable speaking up Requires: mutual respect & trust confidentiality responsiveness empathy effective listening & communication
37
Outcomes: SRTR Projections
One Year Graft Survival
38
1 Year Outcomes: Patient Survival Adult Transplants: January 1, 2016 – June 30, 2018
39
Pre-Transplant Metrics: Compliance Dashboard
40
Clinical Metrics
41
Progression Metrics: Referral to Evaluation (days)
Month Days (average) Feb 133 March 166 April 135 May 60 June 50 July 184 MEDIAN 134 days
42
Progression Metrics: Referral to Waitlist (days)
Month Days (average) Feb 225 March 156 April 149 May 202 June 167 July 230 MEDIAN 184.5 days
43
Progression Metrics: Evaluation to Committee (days)
Month Days (average) Feb 53 March 40 April 70 May 38 June 111 July 97 MEDIAN 61.5 days
44
Pre and Post Transplant Program Metrics
BENCHMARK APRIL N=1 MAY N=3 JUNE JULY AUG N=6 YTD N=25 Median txp - 35.7 58.9 65.2 33.0 34.8 45.5 OR ABO 100% 94% HCV Consent PHS Consent 88% Return to OR 24% 1 2 40% N=10 LOS Median 18 days 10 12 18 14 11 16 days ICU LOS Median (order) 6 days 3 6 15 9 days ICU LOS Median (move)
45
Pre-Transplant/Coordinator Performance Metrics
46
Process Improvement Understanding Opportunities for Improvement
Streamlining Processes Active Engagement by Key Stakeholders
47
The Business of Transplantation: How to Keep the Lights On: Get the Patients in the Door
48
Access Improving Access Decreasing Time From Referral to Appointment
Referring and Patient Online Access Outreach Clinics Transplant Patient Landing Pads
49
The Business of Transplantation: How to Keep the Lights On: Keep the Place Staffed
51
Staffing Staffing and Utilization of Resources
Impact of volumes and/or new programs Anticipating needs Developing depth, cross-training, and utilization of part-time and prn staff Participate in UNOS Annual Staffing Survey Useful Benchmarks with Some Limitations
52
UNOS Staffing Benchmarks
53
E
54
Recruitment and Retention
55
Practice of Transplant Administration Workshop - 2012
Hiring staff is like a box of chocolates …
56
2014 PTA/Transplant Administrator as Agent of Change/Ed Zavala
Culture Develop a culture that supports hiring and retention of the best and the brightest People at work are motivated by: Challenging, interesting, and meaningful work Working in a high trust environment Being personally responsible for results Opportunities for personal growth and promotion
57
2014 PTA/Transplant Administrator as Agent of Change/Ed Zavala
Culture Things to do: Develop mutual accountability Cultivate talent Celebrate success and achievement Understand Failures Be transparent
58
Building and Maintaining the Workforce
Importance of Training Programs Fellowships Residencies Interviewing and Hiring Processes Targeted Selection Team Interviews Importance of Fit Waiting for the Right Candidate
59
Monitoring Retention Rates
VUMC Overall Results of engagement 4.02 VUMC threshold goal of 82%
60
Cost of Turnover APRN for onboarding expense and lost revenue is approximately 1.5 times APRN salary or $142,500. Direct care RN for onboarding expense Range is $40-60,000 Some data indicates 1.3 x the departing RN’s salary. $70,000 x 1.3=$91,000 Specialty roles—transplant coordinators
61
Employee Satisfaction and Engagement
Understanding what motivates people Culture Surveys Shared Governance Models Understanding gaps, strengths, opportunities for improvement Listening Developing action plans
62
Advance Practice Provider Professional Development and Satisfaction Survey
VUMC Overall Results of engagement 4.02 VUMC threshold goal of 82% * 89% transplant staff response rate
63
Staff Retention Clinical Advancement Ladders
Transplant Coordinator I to II Nurse Practitioner 3 Tier Alternative Work Arrangements Implemented Shared Governance Models for NP, RN, and PSS Teams Educational and Professional Development Opportunities NP Symposium Conference and Meetings Certifications Staff Retreats Focus on Health and Well-Being
64
Staff Development Round on staff
Develop opportunities for research projects Encourage leadership and involvement in center and organizational process improvement opportunities, committees Support staff involvement in UNOS, NATCO, ITNS, etc.
65
Celebrate Staff and Teams
Employee Celebrations Acknowledgement for Work that Goes Above and Beyond Credo Awards Saying Thank You and Showing Appreciation Celebrating Successes
66
The Business of Transplantation: How to Keep the Lights On: Prepare and Plan for the Future
68
Strategic Planning Formal Strategic Planning Cycle every 3-5 years by program Strategic Business Plan Industry trends Competitive forces (suppliers, competitors, buyers, new entrants, substitutions/bridges) Transplant Center performance trends SWOT analysis Strategies and recommendations Improve awareness Improve organ availability Increase wait list Improve patient satisfaction Improve employee/physician efficiency Improve financial performance
69
Strategic Planning Formal strategic planning cycle every 3-5 years by program (continued) Strategic marketing plan Strategic communications plan Internal External Monitor strategic goals Annual business planning Annual clinical planning/retreat
70
The Business of Transplantation: How to Keep the Lights On: Embrace Innovation
71
Clinical Innovation Dual Organ Transplants
Utilizing Hepatitis-C NAT Positive Organs 102 total HCV-infected organs transplanted New Program Development Congenital Heart Transplant Program Living Liver Donor Program Kidney Paired Exchange Organ Perfusion Devices Utilization of Telehealth
72
Thank You
Similar presentations
