Malignant Ascites Management Economics

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1 Malignant Ascites Management Economics Peri Booth Sr. Manager-Health Economics 75 N Fairway Dr., Vernon Hills, IL cell office 2015 CareFusion Corporation or one of its subsidiaries. All rights reserved.

2 Discussion Who is the ascites patient CareFusion s insight Ascites management; 3 perceptions Clinical discussion Final thoughts Questions 2

3 Routine Paracentesis ROOM SCHEDULE Proc Room TIME PATIENT/AGE* IR NAME ATTENDING ANES TYPE PROCEDURE REMARK RN Powers, John M-45 Kumar, O Sendler, T Local Liver Biopsy Tomey, J Smith, Francine: F-67 Jones, F Richter, S Local Paracentesis repeat Wilson, B Kelly, Linda F-61 Logan, L Ward, W Local Lumbar Puncture Latex allergy Larsen, E *Hypothetical names 3

4 Repeat Paracentesis Patients 4

5 This Is The Reality 5

6 20 Taps < 5 months 6

7 Patient Perspective 7

8 How is CareFusion Addressing the Issue? CareFusion is working with facilities to provide value analysis tools they need Clinical protocol Patient engagement Financial impact Reviewing hospital claims data Sharing best practices Insight in why facilities choose protocols 8

9 Not all Indwelling Tunneled Catheters are the same 4 indwelling tunneled catheter products are available on the market today CareFusion PleurX Bard Aspira B. Braun Asept Rocket Medical Carefusion s Pleurx catheter system provides clinically proven results The only system with a pleurodesis indication CareFusion Corporation or one of its subsidiaries. All rights reserved.

10 200+ Hospitals: What Have We Learned? 75% are losing $$ on outpatient paracentesis Avg $600 loss per procedure Over 50% of total cost is tied to time No facility performing outpatient PleurX procedures lost $$ Avg. $1000 Higher Medicaid/Medicare %, tend to have higher costs Ahd.com/2012

11 3 Perceptions in Regard to Placing PleurX : Performing a paracentesis costs the facility less Paracentesis is a more efficient use of time The patient out-of-pocket for PleurX bottles is too high 11

12 Paracentesis Costs a Facility Less to Perform? Large Volume Paracentesis (LVP) can tie up room and staff 3 hours Paracentesis supplies may cost less but they cost more to perform Re-Encounters increase risk of HACs and re-admissions Patients often present in the ED to be drained 1. Courtney, A, Nemcek AA, Rosenber S, Tutton S, Darcy M, Gordon G. Prospective Evaluation of the PleurX Catheter When Used to Treat Recurrent Ascites with Malignancy. J Vasc Interv Radio 2008;19: Rosenberg S, Courtney A, Nemcek Jr AA, Omary R. Comparison of Percutaneous Management Techniques for Recurrent Malignant Ascites. J Vascular Interv Radiol 2004;15: MTG9 PleurX peritoneal catheter drainage system for vacuum assisted drainage of treatment resistant recurrent malignant ascites: Issued March London: National Institute for Health and Clinical Excellence. 111.cms.gov 12

13 Typical 2013 Example CPT Insert tun ip cath perc CPT Abd paracentesis w/imaging Total Payment # Patient Claims Units of Service Average Charge per Unit Average Cost per Unit Average Payment per Unit Total Payment # Patient Claims Units of Service Average Charge per Unit Average Cost per Unit Average Payment per Unit $26, $3,230 $1,315 $2,403 $25, $2,327 $1,087 $

14 More Efficient Use of Time and Space? Large volume paracentesis can tie up space up to 3 hours PleurX system (IPC) Medicare Work RVUs are more than double paracentesis work RVUs Patient bonding? 14

15 What Does it Take to Get this Patient to the Hospital? Near end of life Exhausted Difficult to move Difficult to breathe Bathing hurts They hurt in every position Just touching them hurts

16 Patient Out-of-Pocket for Pleurx Placement Too High? Copay/co-insurance for every encounter Only one percutaneous access with PleurX Catheter Patient responsibility for one admission due to paracentesis complication is far greater than an outpatient PleurX placement Potential loss for the facility $600 X

17 Patient Out-of-Pocket for Pleurx Bottles Too High? Review of 29 claims from a major cancer center 25 patients were covered at 100% 4 of 29 patients had a co-pay (avg. < $100) Data per EdgePark 11/ /2013 for MSKCC 17

18 PleurX Proven catheter system Highly effective with low complication rates Symptom relief % of patients, weekly declaration of ascites symptom control (34 malignant ascites patients, Courtney 08) Infection rates 1% (2 / 188) patients with peritonitis additionally, 1.6% (3/188 patients had cellulitis (188 ascites patients, Lungren 13) o o 0% (0 / 28) patients with peritonitis Additionally, 5 cases of erythema resolved with 7 day antibiotics course (28 malignant ascites patients, Tapping 11) Occlusion / Blockage 10% (3/34) occlusion (34 malignant ascites patients, Courtney 08) 2.5% (5/188) catheter malfunction (188 ascites patients, Lungren 13) Patient Quality of Life: Nutritional State Minimal protein loss with PleurX, compared to large volume paracentesis; Study showed no change in serum albumin over 12 weeks of PleurX drainage (34 malignant ascties patients, Courtney 08)

19 What About Patient Quality of Life? Patients prefer PleurX* Fewer visits More quality time with family Fewer needle sticks Continual control helps avoid discomfort instead waiting until next scheduled para visit. Repeat Paracentesis = more encounters & risk of HACs *PleurX Peritoneal Catheter Drainage System for Vacuum-Assisted Drainage of Treatment-Resistant, Recurrent Malignant Ascites: A NICE Medical Technology Guidance Judith White and Grace Carolan-Rees Cedar, Cardiff and Vale University Health Board, Cardiff, Wales 19

20 What About Patient Quality of Life? Difficulty coordinating logistics for repeat paracentesis. Caregiver to drive them Family member who takes a day off from work Cost of parking, taxis, gas Often patients wait until they need emergency care Additional complications Ambulance costs ER space *PleurX Peritoneal Catheter Drainage System for Vacuum-Assisted Drainage of Treatment-Resistant, Recurrent Malignant Ascites: A NICE Medical Technology Guidance Judith White and Grace Carolan-Rees Cedar, Cardiff and Vale University Health Board, Cardiff, Wales 20

21 Ascites Management via Repeat Paracentesis: What this means to a patient 20% or 2.5 weeks Life Expectancy = 12 weeks Quality Time with Family Draining at a Facility Based on 2 days spent of every 10 days draining via a Facility

22 Some Clinical Considerations 2015 CareFusion Corporation or one of its subsidiaries. All rights reserved.

23 PleurX Catheter PleurX Catheter Pleural Peritoneal 15.5 Fr. silicone catheter conforms to the pleural space Valve prevents inadvertent passage of air or fluid through the catheter Polyester cuff promotes tissue ingrowth to reduce infection risk and hold the catheter securely in place Fenestrated portion promotes drainage

24 Drainage kit components Vacuum bottle with drainage line attached Blue wrap (not shown) Latex-free gloves, qty. 2 Gauze pads, qty. 4 Alcohol pads, qty. 3 Foam pad Waterproof dressing Valve cap Blue emergency clamp

25 Potential PleurX System Team Members Physicians Thoracic Surgeons Interventional Radiologists Interventional Pulmonologists Medical Oncologists Nurses Clinic/office nurse Nurse navigator CNS/nurse educator Case managers Home care/hospice Interventional radiology Member of palliative care team

26 Checklist For Success Have you provided: Patient teaching: Use of the catheter, drainage procedure, troubleshooting, frequently asked questions and obtaining supplies? Warnings about the catheter and drainage procedure (such as not reusing supplies)? An opportunity for patient and caregiver to watch the drainage? Time for the patient or caregiver to verbally review the drainage procedure, correcting any mistakes? Discharge supplies to bridge the period between discharge and delivery of supplies from DME provider?

27 Supplemental Patient Resources Brochures & DVD Step-by-step instructional wall chart Drainage log

28 PleurX Patient Starter Kit Patient information kit components Starter kit components Patient education DVD Introductory letter with ordering information Frequently asked questions (FAQ) brochure Instructions for Use booklet Reference wall chart Emergency information card Drainage log PleurX drainage kits, including 1,000 ml bottles and procedure packs (qty. 4) Convenient carrying box Patient information kit

29 Educational Resources Clinical Education Clinical Consultants Work to develop and execute a training and education plan Per-diem Nurse educators, Provide PleurX product in-servicing in your hospital. CNE Programs - There are accredited CNE programs about Ascites/Effusion Management that can be used for Grand Rounds, Interventional radiology nurses, ONS Chapter Meetings, and other venues Contact your CareFusion Sales Representative to Discuss Assistance with Policy and Procedures

30 PleurX Support Team Customer service: To order educational materials For clinical questions, ask to be connected to a clinical nurse consultant or your local sales rep EdgePark Medical Supplies: To order patient supplies for home drainage Ask to speak with a PleurX Specialist PleurX website Patients: carefusion.com/pleurxpatient Nurses: carefusion.com/medical-products/interventionalprocedures/drainage/pleurx/nurses/

31 Patient Perspective This option is saving them time and keeping him more comfortable. My dad s abdominal catheter has been in place slightly over 2 weeks. He has said that draining it incrementally instead of once weekly makes him feel better

32 Patient Perspective

33 Final Thoughts Patients prefer PleurX* Fewer visits More quality time with family Fewer needle sticks Continual control helps avoid discomfort instead waiting until next scheduled para visit. Fewer co-pays and insurance claims. Repeat Paracentesis = more encounters & risk of HACs Can help streamline process for facilities Can assist in keeping patients out of the facility Helps get patients off the repeat cycle CareFusion Corporation or one of its subsidiaries. All rights reserved.

34 Questions? Peri Booth Sr. Manager-Health Economics 75 N Fairway Dr., Vernon Hills, IL cell office Bradley Archer, RN BSN Senior Quality Care Consultant Interventional Specialties. Mobile: CareFusion Corporation or one of its subsidiaries. All rights reserved.

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