General questions
Question 1: How much
revenue does the clinic make per month by doing 100 INRs per month
before the QI intervention? (enter answers at
http://ars.sumsearch.org)
answer
Question 2: How much
profit does the clinic make per month by doing 100 INRs per month
before the QI intervention? (enter answers at
http://ars.sumsearch.org)
answer
We will revisit this scenario with a QI project in Scenario 2.
Scenario 2: Point-of-care INR testing
Restore the proportion of patients with private insurance to 63%.
Effect on 100 patients before-after the intervention. Assumptions (already in spread sheet - add/remove their usage in yellow cells):
Before intervention
(Using venupuncture INR test
sent to outside vendor) |
After intervention
(Using capillary INR test
that is CLIA-waived at the point-of-care) |
- Payment from patient for send-out test.
|
- Payment from patient for point-of-care test.
- Any other benefits? See question 2.
|
- Payment to vendor (LabCorp): $2.15 per test
|
- INR machine: $2500 spread over 5 years
- Supplies $207.00 per box of 48
- Personnel time: MA at 5 minutes per test
|
Question 1: What is the change in cost-revenue projection per 100 patients after implementing point-of-care INR testing? (enter answers at
http://ars.sumsearch.org)
answer
Question 4: While this proposal improved chronic disease management and incentives the clinic to improve care, how does the cost to the patient change? (enter answers at
http://ars.sumsearch.org)
Scenario 3: I hate writing office notes on the computer (workforce re-design)
Effect on 100 patients per before-after the intervention. Assumptions (already in spread sheet - add/remove their usage in yellow cells):
Before intervention
(you, as provider, work the keyboard) |
After intervention
(MA becomes scribe) |
|
- You no longer spend time documenting after the office visit.
|
- You, as the provider, spend 15 minutes in the room with the patient (99213 visit).
- You spend 10 minutes after each visit entering your note
|
- You, as the provider, and the MA, spend 15 minutes in the room with the patient (99213 visit).
- MA spends additional 10 minutes after each visit entering your note
- You spend 1 minute after each visit reviewing the note after the scribe.
|
Question 1: What is the change in cost-revenue projection per
200 patients (per month or 10 per full day) after implementing a medical scribe? (enter answers at
http://ars.sumsearch.org)
answer
Question 2: What can be done to make this revenue neutral or positive (Hint: will the distribution of your E&M codes be able to change?) (enter answers at
http://ars.sumsearch.org)
answer
Scenario 4: Counseling for smoking cessation
Add costs of counseling 100 patients. Assumptions (already in spread sheet - add their usage in yellow cells):
- 90% of smokers are not ready to quit. 5 minutes spent
- 10% of smokers are ready to quit. 15 minutes spent
Question 1: What is the change in profit per 100 patients counseled when increased physician time is added (only change physician time for now)? (enter answers at
http://ars.sumsearch.org)
answer
Observation: You make more money by reading chest CTs for lung cancer screening. In cell H:20 of your spreadsheet, you are paid $25.90 for > 10 minutes of counseling. This is due to this being assigned 0.5 RVU per CMS Physician Fee Schedule (
look-up tool). According to the same tool, to read a chest CT without contrast, you are paid $55 for 1.02 work RVU and 0.06 malpractice RVU.
Scenario 5: Changing perspectives - practicing in a financial-risk sharing environment
In these questions, assume you are in a global/capitated system in which the health care providers receive one payment per year to provide all health care to the enrollee.
Question 1: What is the cost to the system for one patient to quit smoking, assuming that of smokers who state they state ready to quit, 10% will actually quit) (enter answers at
http://ars.sumsearch.org)
answer
Question 3: Is it cheaper to give a QALY via smoking cessation or screening for lung cancer with CT (QALY estimate for lung cancer at PMID
25372087)? (enter answers at
http://ars.sumsearch.org)
Question 4: If you were in charge of
Kaiser or
Group Health, which are examples of "non-fee-for-service", what would you do (hint: what happened to spending and quality of care when Massachusetts reformed payment - PMID
25354104)? Justify your answer. (enter answers at
http://ars.sumsearch.org)
Scenario 6: How to increase revenue when payed with bundled payments?
In managing septic shock, your hospital wants to pay for noninvasive monitoring of cardiac output to guide fluid therapy among patients with septic shock who have hearheart failure or end-stage renal disease. How can you finance the hardware and their maintenance?
Assumptions for 100 patients:
- Length of stay averages 10 days
- 10% have CHF or ESRD (Kuan 2015 PMID 26475246)
- These patients have 4 days longer LOS without cardiac output (CO) monitoring of fluid responsiveness(Kuan 2015 PMID 26475246)
- CO monitors cost $20,000 each with $100 supplies per patient
- Your hospital is paid approximately $10,000 per episode of septic shock (MS-DRG 871 - SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC per https://data.cms.gov/)
- Cost to the hospital for one hospital day $1800 to $2075 (per CO monitor manufacturer) for a non-ICU bed
