Emory Healthcare s model for a PA based vein clinic

Transcription

1 Emory Healthcare s model for a PA based vein clinic Stephen Konigsberg PA-C No relationships to disclose Society for Vascular Surgery 2011 Vascular Annual Meeting Chicago, IL June 17, 2011 Division of Vascular Surgery and Endovascular Therapy Emory University Atlanta, GA

2 What we do in the Vein Clinic? Varicose Veins: EVLT (Endovenous Laser Treatment) and ambulatory phlebectomy Spider Veins: sclerotherapy Venous Stasis Ulcers: EVLT and ultrasound guided sclerotherapy

3 Why would most vascular surgeons want to incorporate a vein clinic into their practice? Reimbursement: to supplement your treatment of patients with life and limb threatening conditions Patient care: cutting edge treatment for patients with varicose veins and venous stasis ulcers Addresses a community need Fun

4 Reimbursement FY10 Emory Hospital Procedures (OR and cath lab) for 5 vascular attendings: Total charges $13,000,000 Collection rate of 17% Total collections $2,189,000 FY10 Emory Vein Clinic: Total charges $1,467,000 Collection rate of 40% Total collections $589,000

5 Patient Care Varicose veins: For 90% of patients with V.V. they are painful to one degree or another. Venous stasis ulcers: most stasis ulcers can be healed with the same techniques used for treating varicose veins - cutting edge treatment. If you don t treat these patients the guy down the street or across town will!

6 Addresses a community need Venous disease is four times more prevalent than arterial disease.

7 Fun! It s an endovascular skill set that is enjoyable once you become proficient. The great majority of your patients have no significant co-morbidities. You have a very grateful patient population.

8 Why a PA based clinic? Busy Practice you may not have time Focused expertise of a dedicated practitioner with consistent protocols for consistent results. Can easily pay for itself and generate significant income for your practice.

9 How our vein clinic got started I took an interest in treating varicose veins and spider veins 17 years ago. In 1994 I and one attending began doing minimally invasive saphenous vein stripping and ambulatory phlebectomy in the OR. I began doing sclerotherapy in the clinic. In 2001 the technology for doing outpatient saphenous vein endolaser ablation became commercially available. We adopted it in Our division head asked me to start an office based vein clinic and I took it from there. Purchased the equipment, learned how to use it, got our attendings and U/S lab on board and began advertising for patients.

10 How does our vein clinic function? New patient is seen in the clinic with the attending. If the patient has spider veins we simply schedule sclerotherapy with me because it is paid for out of pocket. If the patient has V.V. or a stasis ulcer we schedule an U/S study for reflux and I go over the plan with the patient. Our dedicated vein clinic secretary initiates the insurance process. After approval we schedule the patient for EVLT and/or phlebectomies and/or U/S guided sclerotherapy in the clinic procedure room under the attending s name. This is an office based procedure, NOT an OR procedure.

11 Team Approach Surgeon: sees patient on initial visit and approves plan for treatment with the PA. PA: does EVLT and phlebectomies on the scheduled date. Ultrasound technologist: provides ultrasound guidance. LPN: helps with set up, scrub nurse, circulator, etc. Surgeon: comes in the room while laser is turned on if he so chooses personal choice.

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13 Follow Up by PA PA takes care of the patient after the procedure: Walks the patient on treadmill. Goes over post op instructions. Makes sure 2 day F/U U/S is arranged. Sees patient to the door that TLC factor is important towards future word of mouth referrals. Dictates the procedure note. Sees patient on 2 nd postop day to inspect leg and address any questions or concerns. Sees patient on 2 month F/U U/S visit. Sees patient in clinic or consults over phone if there are any problems.

14 Complication Rates Nationwide DVT or EHIT (endovenous heat-induced thrombosis): 0% to 16% PE: 0% to 3% Skin burns: 0% to 5.7% Recanalization of the saphenous vein: 0.4% to 12%

15 Our complication rates After over 1000 procedures: DVT: 0 EHIT: 0.2% (2 patients) PE: 0 Skin burns: 0 Recanalization of the saphenous vein: 0.2% (2 patients)

16 Why are our stats so good? We have a dedicated team practice makes perfect. Stephen Konigsberg PA-C over 850 EVLT cases since 2004 Julie Bumgardner NP 91 cases since 2005 Tina McElderry PA-C 51 cases since U/S technologists with extensive vein experience. 2 LPNs with years of experience scrubbing on these cases.

17 A Physician Assistant is a dependent practitioner. Is all of this Kosher? Is it lawful and legally reimbursable?

18 Two ways that a practice can bill for mid-level services 1. Under the mid-level s provider number: reimbursement is 85% of physician s fee. or 2. Incident-to : the mid-level s care is billed under the physician s provider number, just as if the physician had rendered the service. Reimbursement is 100%.

19 Incident-to billing rules Medicare/Medicaid: Incident-to services are fully covered if the physician in the suite. Commercial payers: Incident-to services are fully covered if the is physician is available.

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