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HOW IS TERUMO BUSINESS EDGE DIFFERENT THAN THE SERVICES OTHER VENDORS ARE PROVIDING?

Our team is composed of highly skilled and experienced healthcare professionals that have worked in many of the cardiac and interventional radiology procedural, operating room, and prep and recovery areas. Members of our team have managed the lab, directed the service line, managed purchasing, worked with payers and providers, and have a deep understanding of healthcare economics and the challenges facing hospitals today. Our team is like no other, our customers will testify to that. We bring a unique and experienced perspective that gets to the heart of how your program can not only lower costs, drive quality, increase revenues, but become more efficient. The newly proposed OPPS rule changes supports reimbursement for elective PCI in the ASC. The time is now for acute care facilities to right size care for elective PCI.

IS YOUR PROGRAM PREPARED FOR THE CHANGING REIMBURSEMENT MODELS FROM MEDICARE OR PRIVATE PAYERS? WHAT ABOUT ENGAGING DIRECTLY WITH EMPLOYERS?

Alternative Payment Models (APM) whether it be CMS episodic bundle payments, Accountable Care Organizations (ACOs), direct to employer, etc. will be the future most hospitals will have to consider. Regardless of who and what methods, you must be able to make sound decisions on relevant and detailed data. We can help. Working in conjunction with our Medicare Convener partner Archway Health, we can provide the most detailed analyses on all your cardiac procedures down to the provider/patient level data. Imagine being able to understand exactly where every dollar is going as it relates to procedures, readmissions, post-acute care, and mortality rates. You can’t make informed decisions if you don’t know your data, let us help identify, analyze, and assist you where there are opportunities to succeed and to also avoid or reduce exposure where your costs are high.

HOW CONFIDENT ARE YOU IN YOUR ORGANIZATIONS CODING, BILLING, AND COLLECTIONS?

The Advisory Board Company1 in a 2017 press release announced that the average 350-bed hospital has an overlooked opportunity of up to $22 million in revenue capture. The announcement pointed out that increased claims denials has meant commercial contracts no longer provide the growing margins that used to offset lower Medicare and Medicaid reimbursement for many hospitals. Hospitals are losing, on average, five percentage points of their margin to underpayments and denials. Denied claims are lost money, especially when claims never get resubmitted. Sifting through the denial codes to identify and correct coding-related errors is complex and often in-house resources lack the training or simply don’t have the capacity to tackle this significantly important task. Terumo Business Edge has partnered with Enhanced Revenue Solutions, a full-service Revenue Cycle Management company in an effort to help hospitals identify, quantify and correct their coding related denials.

WE ARE INTERESTED IN OPTIMIZING ONE OR MORE OF OUR PROCEDURAL AREAS. WHY WOULD WE NEED TERUMO BUSINESS EDGE TO ASSIST WITH OUR EFFORTS?

Terumo has been consistently dedicated to expanding and educating on procedural techniques that can provide new opportunities and tailor the procedural approach to the patient’s clinical needs. Terumo brings a wealth of knowledge, experience, expertise, education and training that will help your program create the care pathways that deliver operational and cost-effective measures to maximize patient outcomes and deliver on an optimal patient experience in the procedural areas of your program. And now with the healthcare landscape continuing to evolve, our processes can help you focus your program on even greater cost saving processes and operational efficiency through optimizing scheduling, staffing, reimbursement yet leading our work with quality and safety. Terumo Business Edge has assessed numerous cardiac, interventional radiology and open heart programs across the country. We have created best-practice care pathways that can assist your organization with rapid implementation to achieve immediate results, including higher-quality outcomes, improved operational efficiencies, and true cost savings. Results that are quantified and actionable.

WHAT DOES THIS OPTIMIZATION WORK ENTAIL AND WHAT WOULD WE PLAN FOR? WHAT IS OUR COMMITMENT?

Your commitment begins with a “no charge” assessment by signing a letter of understanding (LOU) with Terumo Business Edge. We would plan for and conduct an assessment of your program. The assessment is detailed and customized which is essential to understand how your program currently performs. Upon review of the assessment with your leadership team, recommendations will be provided on how implementing an optimization process would benefit your program. These recommendations are prioritized to highlight the value and effort of each opportunity. The report is comprehensive and reviews all patient populations that are cared for in the procedural space(s) assessed. If your institution desires to move forward with an implementation, we will discuss contractual arrangements, expectations, deliverables, etc. Specifics include the following:

  • The assessment work begins with an off-site analysis of some very specific volume, quality, staffing, and operational data — performing a baseline analysis to compare your current performance to other high performers across the country. This analysis is followed with several days on site by our team to perform direct observation of all the clerical and clinical processes that surround the procedural area, prep & recovery, live registration and discharge, as well as to interview the key stakeholders. The live assessment concludes with a preliminary detailed debriefing and prioritization of opportunities for cost savings and changes in your operation.
  • Within two weeks you are provided a professional, detailed overview of our findings in a PowerPoint presentation suitable for use with senior administrators. At this time, or any time going forward, should your organization determine it needs our assistance in achieving any optimization work, we can provide you a written estimate and detailed outline of how we would conduct and carry out the specified work. The monetary investment on your part will be weighed and compared against the ROI we believe is achievable. A proposal outlining the work we would conduct and how we would go about achieving the results will be provided.

HOW HAS YOUR OPTIMIZATION WORK AFFECTED STAFFING AT SOME OF YOUR MORE SUCCESSFUL CLIENT ENGAGEMENTS?

Process improvement and optimization of the workflows that surround the patient inherently makes staff more efficient and satisfied. Patients are well educated and prepared in advance of their procedure day, including being aware of the particular procedure and planning for same-day discharge, for example. This work streamlines the patient processes making pre-procedure preparation quick and disposition of the patient very automatic. In this regard, employee man hours can be reduced. The goal of process improvement is efficiency not job elimination. Reduction in staff hours can mean that valuable and qualified clinical FTEs can be redeployed to other CV specialty areas within the health system like nurse education/training, EP or TAVR programming.

WE USE THE TRANSRADIAL TECHNIQUE AS OUR PRIMARY TECHNIQUE FOR BOTH ANGIOGRAPHY AND PCI SERVICES, WHY DO I NEED TO CONSIDER HELP FROM TERUMO BUSINESS EDGE TO OPTIMIZE OUR SERVICES?

Hospitals around the country are using transradial access increasingly to manage reduction in complications, higher patient satisfaction, and improved quality outcomes, all of which bring greater value to all stakeholders within the healthcare system. High adoption of the radial technique doesn’t necessarily mean that all processes surrounding the patient selection, scheduling, preparation, and rapid discharge have been redesigned to optimize the patient experience and deliver true cost savings. Our experience with many transradial service organizations has proven that process redesign is necessary to achieve true cost, efficiency and patient satisfaction goals. And now with the advent of the expert consensus document from SCAI, programs have the learnings and opinions from interventional cardiologists who have the experience and understanding of the value of a same day discharge program.

WHAT ARE THE TRUE SAVINGS ESTIMATES IN AN OPTIMIZED TRANSRADIAL PROGRAM?

While early results were estimated to be between $800 and $1200 (Amin AP et al. JACC Cardiovasc Interv. 2013 Aug; 6 (8):827-34) of cost avoidance from reduced complication rates and same day discharge, the latest published results from Dr. Amin (Amin AP et al. JACC Cardiovasc Interv. 2017 Feb; 10 (4):342-51) indicate it is considerably greater, over $3600 in cost savings from rooming, nursing care, reductions in site complications, drugs, labs, etc. Terumo Business Edge delivers a comprehensive service to assist programs with an understanding of their true costs and achievement of these economic and operational goals through the implementation of standardized clinical pathways. However, it is important to note that in the economic studies conducted to date, the greatest savings comes from same day discharge. So, this does not necessarily mean abandoning femoral approach; as it is neither practical or feasible but tailoring the access approach to your patient and optimizing your care pathways to manage either radial or femoral.

SOME OF OUR OPERATORS HAVE TRAINED ON THE TRANSRADIAL ACCESS TECHNIQUE, BUT WE HAVE BEEN UNABLE TO ACHIEVE FULL SCALE ADOPTION, HOW CAN YOU HELP US?

We recommend working with program leadership and aligning the transradial strategy with overall system goals. Simply adopting the technique is not implementation of a programmatic change, and until a plan with tactics and metrics are applied, little overall benefit will be gained by the healthcare organization. Terumo Business Edge can provide the training and care pathway modification that will assist in facilitating greater adoption of same day discharge and transradial access. Facilities should prepare for the likelihood that PCI will undergo continued cost scrutiny by CMS, whether via some type of bundle program or migration to the ASC or OBL environment. Without optimizing the transradial potential hospitals will not achieve the cost savings and quality requirements payers and CMS are demanding.

WE HAVE ADOPTED TRANSRADIAL ACCESS AS PRIMARY TECHNIQUE FOR OUR PATIENTS AND IT HAS NOT MATERIALIZED INTO ANY SAVINGS, HOW CAN YOU ASSIST?

Trading one form of access (femoral versus radial) in of itself will achieve minor cost savings in terms of reducing complications compared to larger, more significant cost savings from a care pathway modification. For greater realized cost savings, a cath lab must consider making programmatic changes and realizing where significant costs savings are buried. We now know from recent literature (Amin AP et al. JACC Cardiovasc Interv. 2017 Feb; 10 (4):342-51) that same day discharge accounts for significant cost savings with an additional costs savings (~$900.00) favoring transradial. We have worked with high volume transradial programs and identified that redesign of all the patient processes that surround the patient from selection to pre-procedure preparation to post-procedure care, must occur for true cost savings to be obtained. Adoption of the transradial care technique means redesign of care to meet the future cost and outcomes requirements as outlined by CMS and any potential payment models that will be tied to lower costs and quality.

OUR HOSPITAL HAS ITS OWN LEAN OR PROCESS IMPROVEMENT TEAM, HOW IS THIS ANY DIFFERENT?

We recognize that many hospitals have invested in creating their own lean teams to manage various clinical or process improvement projects around the hospital. We realize that these teams serve a vital role in hospitals looking to improve their processes and we embrace their participation in our program. Our team has decades of experience in and around the cardiac and radiology procedural areas, recovery, operations, and physician practice management. This makes us uniquely qualified to address the entire care pathway continuum from doctor’s office to discharge. We can and will involve them in the process and they will serve as a valuable adjunct to the program once we have established the necessary improvements.

1. https://www.advisory.com/research/Revenue-Cycle-Advancement-Center/at-the-margins/2017/06/22-million-opportunity