SOUTHCOAST HEART FAILURE CLINIC

Sylvia KrickNate MedunickElena TsonosMay 2014

MARKET RESEARCH•Heart disease = 2nd leading cause of death in MA (23%)

•49% of Americans have 1+ risk factors for heart disease.

•92.3% of Massachusetts adult residents (18-64) have health care coverage.

•Medicare reimburses $6,000 for CHF; average LOS = 5.8 days.

•In 2000, the average cost of a CHF admission = $15,293• In 2008, one study reported that the average cost = $18,086.

•The national CHF 30-day readmission rate is ~25% (26% in MA)

THE SOUTHCOAST REGION

• A socioeconomically depressed area• Largest Portuguese population in the country• Popular Portuguese foods: chourico, salted cod and sweet breads• Numerous fast food restaurants• Few areas in the city that allow for safe physical activity • Concerns following patient interviews:

• poor understanding of how to or lack of access to preparing healthy meals

• ease of access and frequency of poor food choices such as fast food• an indifference towards appropriate diet chances• perception of healthy foods being bland• lack of support network.

 

STATISTICS• In the 2013 Fiscal Year, ~1,200 d/c for CHF @ SHG• In the 2013 Fiscal Year, ~225 patients seen in HF Clinic

(750+ visits)• Majority of heart failure re-admission patients come

from home or home with services according to the clinic Manager, Robin Ferguson.

• Per Medicare, Southcoast CHF re-admission rate: 24.5 – 27.9%.

• “Heart Failure Survey”• Providers spend 5 – 20 minutes discussing nutrition,

100% of participants agree that incorporating an RD in the CHF Clinic & RD home visits will be “very effective” in reducing CHF readmission rates

• Opportunity

Mission Statement To provide the highest quality of

cardiovascular patient-centered nutrition care and education while serving the needs of our community

 Goal To reduce CHF readmission rates through

additive nutrition care Objective To provide nutritional education through

personal counseling, cooking classes, home visits, and supermarket tours

WHERE & WHO?

Location St Luke’s Hospital - New

Bedford, MA Charlton Memorial Hospital -

Fall River, MA

Target Market Those who suffer from

Congestive Heart Failure Existing Southcoast service

area 33 communities +700,000 people 928.5 square miles

SERVICE HIGHLIGHTS Registered Dietitian (RD) initial in-patient visit Individual nutrition counseling sessions post d/c

First session within one week after discharge Second session scheduled two weeks later Additional counseling at patient request

Bi-weekly cooking classes Monthly supermarket tours Home visits Appointment reminder mailed to patients with

Southcoast logo and complementary recipe

COMPETITIO

N

MARKETING & ADVERTISING RD to function within existing health system & Heart Failure

Clinic Program participation requires physician referral

Target audience: both physicians & CHF patients within communities already served by Southcoast

• Brochures• Social media:• Exclusive CHF website• Twitter• Facebook

• Radio• Newspaper/Newsletters• Appointment Reminders• Community Events

FINANCIALS

ProductNumber on Hand Cost/unit Start-up Yearly

Portable Gas Stove 22 $28 $616 $0 Butane Cans 29 $27.00 $783 $783 Non-stick Frying Pan 22 $16.49 $363 $0 Cooking Utensils 22 $15 $330 $0 Laptop 2 $398 $796 $0 Room for Cooking Class $0 $0 Supermarket Store Tour $0

 $0

Appointment Reminders* 100 $34.99 $1,259 $1,259 Food Cost** 22 $5 $2,640 $2,640 Room for RD Counseling $0 $0 Paperware 384 $29 $58 $58 Plasticware 3 $4 $72 $72 Gas*** 5,200 $0.56 $2,912 $2,912Miscellaneous     $500 $500Rental Tables 4 $10 $960 $960Igloo Cooler 2 $45 $90 $0Dollie Carts 2 $50 $100 $0Storage Containers 2 $50 $100 $0Mixing Bowls 44 $4 $176 $0Nutrition Education Paper Materials 3000 $0.05 $150 $150

TOTAL $11,905 $9,334

STAFFING2 RDs: CMH & SLH• Responsibilities• work as a contributive member of the interdisciplinary team• Recruit patients to the Heart Failure Clinic• Educate CHF patients during hospitalization at his/her respective site and

provide outpatient nutrition counseling & home visits• Plan, organize, & implement supermarket tours and cooking classes

Existing Heart Failure Clinic Staff• 2 Nurse Practitioners at each Heart Failure Clinic site • RN who also helps at each site

Hours: Monday through Friday 8AM - 4PM

STAFFING COSTS

HoursStaff # hours Start-up YearlyRegistered Dietitian $31.25 40 $0 $65,000 Registered Dietitian $31.25 40 $0 $65,000

TOTAL     $130,000

• Start-up Costs: $11,905• Budget for 1st Year: $141,905• Budget for subsequent years: $139, 334

Note: Start-up costs will be negotiated, approved, and obtained through the Southcoast Health Board of Directors.

COMPENSATION FOR SERVICES• Cooking Classes

• $20 per participant per class• Forecasted Revenue: 24 weeks with 20 participants -- $9,600

• Supermarket Tours• $10 per participant per tour• Forecasted Revenue: 12 weeks with 10 participants -- $1,200

• Home Visits• $60 per visit• Forecasted # Home Visits: 50• 25 non-Medicare: $1,500

• Individual Outpatient Nutrition Counseling• 1- 60 minute initial visit ($184) & 1- 30 f/u minute visit ($92)• If 225 patients utilize, ~ 50% Medicare (~113 patients)• For the other 50% (~112 patients)- will not get reimbursed if seen in same day

as clinic• If 15% of these patients (~17) come in for 1 initial visit and f/u visit on a DIFFERENT DAY,

this will generate $4,692• In-patient Visits

There is currently no reimbursement available for in-patient visits with an RD.

• Total Forecasted Revenue in 1st Year: $16,992

• ~8.5 years to break even (approximately $141,905)

• 1,200 d/c in 2013 & 24.5% readmitted = 294 readmits

• One study showed that a HF Clinic with an RD reduced hospital admissions by 30% (or 88 readmissions)

• Cost of readmission = $18,086• Cost of Readmission to SH (294)= $5,317,284• Suggested business plan & nutritional services

have potential to save Southcoast at least $1,591,568 per year

BREAKING EVEN & JUSTIFYING THE COST

SWOT

STRENGTHS - Top 100 nationally ranked

hospital for cardiac services by Healthgrades®

- Servicing Southeastern region of Massachusetts

- Focused on patients with recent incident

- Provides two easily assessable locations

- Respectful of and tailoring to individual needs

- Only rehabilitation facility to offer dietetic services in the Southeastern region

- Ability to address other health concerns of patients as well

- Family support and participation

 

WEAKNESSES - Perception of larger city, such

as Boston and Providence, offering better services

- Affordability- Timeliness of establishing a

rapport with physicians- Website- Securing space for cooking

classes, maintenance and storage of kitchen equipment, food and utensils

- Literacy level- Language barriers

OPPORTUNITIES- ~1,200 admissions at Southcoast- Establishing a rapport with physicians - Reaching out via social media- Expansion to neighboring cities- Technological advances such as smart phones and wearables

THREATS- No shows from weather,

forgotten appointments, indifference to change

- Food handling practices at cooking classes

- Lack of social support of patients

- Economic disadvantages- Lack of referrals 

QUESTIONS?