1. UMASS Memorial Anticoagulation Center Staffing, Budgets, Reimbursement Pamela Burgwinkle APRN-BC,CACP Presented November 4, 2008

2. Staffing Determine Model of Care Determine Model of Care Size Size Scope of Service Scope of Service Location Location Methodology/INR Measurement Methodology/INR Measurement

3. UMMHC ACC Staffing Nursing Model Nursing Model Medical Director Medical Director 1 FT NP-Provider on site 1 FT NP-Provider on site 4.35 FTE RN 4.35 FTE RN 1 FT Office Manager 1 FT Office Manager 2.5 FTE Patient care Assistant 2.5 FTE Patient care Assistant

4. Registered Nurse Staffing 1FTE RN/375 patients 1FTE RN/375 patients Assessment Assessment Dosing Determination Dosing Determination Next INR Dertermination Next INR Dertermination Education Education Documentation Documentation New Patient Education New Patient Education Home Monitor Training Home Monitor Training

5. Registerd Nurses Manage approximately 325 patients weekly by telephone Manage approximately 325 patients weekly by telephone No Reimbursement No Reimbursement

6. Budgets FYO8 FYO8 Actual Expenses > Budgeted Expenses Actual Expenses > Budgeted Expenses Salary/Benefits Salary/Benefits Purchased Services Purchased Services Medical Supplies Medical Supplies Non Medical Supplies Non Medical Supplies Rentals/Leases Rentals/Leases

7. UMMHC ACC Billing Revenue Revenue –99210-Level 1 Established Visit by RN –NP E/M Visit –PST Initial Education –PST interpretation Fee No Reimbursement for Telephone Management No Reimbursement for Telephone Management

8. Billing Code 99211 Definition Definition –“office or other outpatient visit for the evaluation and management of an established patient that may not require the presense of a physician” Problem is minimal Problem is minimal Typically a 5 minute visit Typically a 5 minute visit Increases Revenue Increases Revenue

9. Billing Code 99211 Guidelines Guidelines –Must be an established patient –Encounter must be face-to-face –E/M service must be provided –Service must be separate from other services provided on the same day –Direct intervention by physician not required

10. Facility Fee Hospital Based Clinic Hospital Based Clinic Operational Costs Operational Costs Covered by Medicare Covered by Medicare

11. UMASS Memorial Healthcare Anticoagulation Center Management Cost/Patient/Year $460.00 Management Cost/Patient/Year $460.00