Massachusetts General HospitalMassachusetts General Hospital Anticoagulation Management ServiceAnticoagulation Management Service

Staffing, Budgets, Reimbursement Staffing, Budgets, Reimbursement and other Challengesand other Challenges

Lynn B. Oertel, MS, ANP, CACPLynn B. Oertel, MS, ANP, CACP

Clinical Nurse SpecialistClinical Nurse SpecialistPresented November 4, 2008Presented November 4, 2008

Clinic overviewClinic overview Patients = 4100+Patients = 4100+ Mean age = 69 yrs, SD Mean age = 69 yrs, SD

13.65, range 20 - 10013.65, range 20 - 100 Common indications Common indications

for treatment:for treatment:• AF AF 57% 57%• VTE VTE 15% 15%• Heart Valves Heart Valves 9% 9%

INR intensity rangesINR intensity ranges• 2 – 3 2 – 3 87% 87%• 2.5 – 3.5 2.5 – 3.5 9% 9%• By request, selected By request, selected

othersothers

Admissions:Admissions:• ~75/month~75/month• + Reactivated patients+ Reactivated patients• ~ 60% new referrals ~ 60% new referrals

from inpatient (POE from inpatient (POE Consult referral)Consult referral)

Discharges:Discharges:• ~ 90/month~ 90/month

Anticoagulation Management Service at MGHAnticoagulation Management Service at MGHStaffingStaffing

Leadership(1.6+ FTEs)

Robert Hughes, MDRobert Hughes, MD Co-DirectorCo-Director

Walter Moulaison, MS, RNWalter Moulaison, MS, RNCo-DirectorCo-Director

Lynn Oertel, MS, RNLynn Oertel, MS, RN Clinical Nurse SpecialistClinical Nurse Specialist

Administrative Support(4 FTEs)

CiCi Teixeira,CiCi Teixeira, Office ManagerOffice ManagerVivine WilsonVivine WilsonKristin NovakKristin Novak

Vinh Huynh, Vinh Huynh, Systems SpecialistSystems Specialist

Nursing Staff(9.1 FTEs)

Pat Biggs, RNPat Biggs, RNJen Chase, RNJen Chase, RN

Rachel Corneau, RNRachel Corneau, RNDiane DeTour, RNDiane DeTour, RNCorin Gigler, RNCorin Gigler, RN

Rosanne Landrigan, RNRosanne Landrigan, RNJamie Legvold, RNJamie Legvold, RN

Jen O’Neil, RNJen O’Neil, RNPalmie Riposa, RNPalmie Riposa, RN

Irina Seliverstova, RNIrina Seliverstova, RNJamie Legvold, RNJamie Legvold, RN

Donna Wolfrum, RNDonna Wolfrum, RN

ResourcesResources

AMS at MGH is largely AMS at MGH is largely hospital supported hospital supported (AMS is under Patient (AMS is under Patient Care Services, Care Services, Department of Department of Nursing)Nursing)

AMS salaries are part AMS salaries are part of hospital wage and of hospital wage and salary programs, as salary programs, as well as all other well as all other benefitsbenefits

MGH MGH

Founded in 1811Founded in 1811 33rdrd oldest general oldest general

hospital in UShospital in US 900-bed medical 900-bed medical

centercenter 46,000 patient 46,000 patient

admissionsadmissions 1.5 million outpatient 1.5 million outpatient

visitsvisits Average length of stay Average length of stay

is 5.84is 5.84

“… “… Patients are our primary focus, and Patients are our primary focus, and the way we deliver care reflects that the way we deliver care reflects that focus every day.”focus every day.”

Vision Statement, Department of Nursing, MGHVision Statement, Department of Nursing, MGH

WorkloadWorkload

At MGH, focus is on patient needsAt MGH, focus is on patient needs Currently use Quadramed Currently use Quadramed

Productivity and Benchmarking Productivity and Benchmarking System for Inpatient Classification System for Inpatient Classification (Medicus)(Medicus)

Developing classification system for Developing classification system for AMS outpatient workload measureAMS outpatient workload measure

AMS Risk AssessmentAMS Risk Assessment

Controlled (0-25)Low Watch (26-50)High Watch (51-75)Complex Care (>75)

Financial CommentsFinancial Comments

ReimbursementReimbursement – – only for initial comprehensive only for initial comprehensive outpatient education visitoutpatient education visit• Average volume 1400/year, budgeted revenue = Average volume 1400/year, budgeted revenue =

$220,000$220,000 Hospital perspectiveHospital perspective quality, safety & quality, safety &

efficiencyefficiency Costs Costs (budget)(budget)

• Personnel salaries/benefits largest percentage of budgetPersonnel salaries/benefits largest percentage of budget• Office supplies ~ $28,000/yearOffice supplies ~ $28,000/year• Postage ~ $29,000/yearPostage ~ $29,000/year• Telephone/pagers ~ $18,000/yearTelephone/pagers ~ $18,000/year

Under development: Under development: workload measure for workload measure for AMSAMS using RVUs (Relative Value Units - numeric using RVUs (Relative Value Units - numeric value of the resources needed to provide value of the resources needed to provide services)services)