1. Massachusetts General Hospital Anticoagulation Management Service Staffing, Budgets, Reimbursement and other Challenges
Lynn B. Oertel, MS, ANP, CACP
Clinical Nurse Specialist
Presented November 4, 2008

2. Clinic overview Patients = 4100+
Mean age = 69 yrs, SD 13.65, range
Common indications for treatment:
AF  57%
VTE  15%
Heart Valves  9%
INR intensity ranges
2 – 3  87%
2.5 – 3.5  9%
By request, selected others
Admissions:
~75/month
+ Reactivated patients
~ 60% new referrals from inpatient (POE Consult referral)
Discharges:
~ 90/month

3. Anticoagulation Management Service at MGH Staffing
Leadership
(1.6+ FTEs)
Robert Hughes, MD
Co-Director
Walter Moulaison, MS, RN
Lynn Oertel, MS, RN
Clinical Nurse Specialist
Administrative Support
(4 FTEs)
CiCi Teixeira, Office Manager
Vivine Wilson
Kristin Novak
Vinh Huynh, Systems Specialist
Nursing Staff
(9.1 FTEs)
Pat Biggs, RN
Jen Chase, RN
Rachel Corneau, RN
Diane DeTour, RN
Corin Gigler, RN
Rosanne Landrigan, RN
Jamie Legvold, RN
Jen O’Neil, RN
Palmie Riposa, RN
Irina Seliverstova, RN
Donna Wolfrum, RN

4. Resources
AMS at MGH is largely hospital supported (AMS is under Patient Care Services, Department of Nursing)
AMS salaries are part of hospital wage and salary programs, as well as all other benefits

5. MGH Founded in 1811 3rd oldest general hospital in US
900-bed medical center
46,000 patient admissions
1.5 million outpatient visits
Average length of stay is 5.84

6. “… Patients are our primary focus, and the way we deliver care reflects that focus every day.”
Vision Statement, Department of Nursing, MGH

7. Workload At MGH, focus is on patient needs
Currently use Quadramed Productivity and Benchmarking System for Inpatient Classification (Medicus)
Developing classification system for AMS outpatient workload measure

8. AMS Risk Assessment Controlled (0-25) Low Watch (26-50)
High Watch (51-75)
Complex Care (>75)

9. Financial Comments
Reimbursement – only for initial comprehensive outpatient education visit
Average volume 1400/year, budgeted revenue = $220,000
Hospital perspective  quality, safety & efficiency
Costs (budget)
Personnel salaries/benefits largest percentage of budget
Office supplies ~ $28,000/year
Postage ~ $29,000/year
Telephone/pagers ~ $18,000/year
Under development: workload measure for AMS using RVUs (Relative Value Units - numeric value of the resources needed to provide services)