Southcoast heart failure clinic

1. Southcoast heart failure clinic Sylvia Krick Nate Medunick Elena Tsonos May 2014

2. 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)

3. 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.

4. 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

5. 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

6. 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 Southcoastservice area • 33 communities • +700,000 people • 928.5 square miles

7. 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 Southcoastlogo and complementary recipe

8. competition

9. 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

10. financials

11. Staffing • 2 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

12. Staffing costs • 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 SouthcoastHealth Board of Directors.

13. 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 VisitsThere is currently no reimbursement available for in-patient visits with an RD. • Total Forecasted Revenue in 1st Year: $16,992

14. Breaking even & justifying the cost • ~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

15. SWOT

16. Questions?