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)