The Business of Patient Blood Management in Adults and Pediatrics

1. The Business of Patient Blood Management in Adults and Pediatrics Dominic Sanfilippo M.D. Richard Melseth Conflict of Interest Statement

2. Ten-Year Experience 670 Beds (100 ICUs) Level 1 Trauma Center 1800 physicians (50 specialties) 36,000 inpatients/year Teaching Hospital Surgery, IM, FP, OB/GYN, Ortho, Med/Ped 16 Operating Rooms Transplants Kidney, Pancreas, Liver, BMT High-Risk OB Competition for Capital $$$

3. Key Elements of a Business Proposal • Use hospital capital planning format and process • Use SABM Business Plan resources • Align with Hospital/System Strategic Plan • Fundamentals - why, what, who, when, how? • Include proposal and business elements ~ See Handout ~

4. Find the Opportunity – Quality and Money • Data collection on current transfusion, blood loss, lab draw practice variations • Find cost of transfusion locally • Benchmark with literature: cost savings, decrease in complications and utilization • Make case for efficient care – less cost, lower LOS, better outcomes • Align with quality initiatives of your hospital ; which are becoming national via “the commission” and CMMS – value based purchasing

5. Quality Measures to Be Used under Medicare’s Hospital Value-Based Purchasing Program • Clinical process • AMI, heart failure, pneumonia, infections, surgery (beta blockers…) • Patient experience (communications…) • Patient mortality • Hospital-acquired conditions • Patient safety

6. Adult Program vs. Pediatric • Pre-op Anemia Clinic value/cost savings • Decreased LOS allows more efficient use of OR and inpatient beds • Decrease transfusion cost, complications ~ See Handout ~

7. Properly Structured Business Plan will: • Justify additional $$ resources (staff, Pre-op Surgical Assessment Clinic) • Share PBM vision w/multiple disciplines & hospital services • Ensure customer satisfaction (i.e., physician, patient and employees) • Serve as roadmap for annual evaluation & process improvements (e.g., strategic objectives)

8. Pediatric Challenges • Smaller volumes of patients and blood • Less preoperative anemia in elective surgeries • Fear and loathing of health care reform • Competition for capital • All make revenue enhancement difficult in a performa for a Pediatric Program

9. “Classic” Justification: in Peds not just a performa • Lower transfusion/lab incidence and cost • Decrease complications, decrease LOS, vent days, etc. • Support of surgical services, more patients • Decrease practice variation, comply with evidence based medicine • Enhance reputation of institution, innovation • Research value = quality = comparative effectiveness

10. Pediatric Advantages • Mission driven – “what’s best for kids” • Foundation support • Recognition of research value • Support because it is important to the clinicians to improve care, impact community • Dollar, performa justification “the least important thing” to my up reports • The value of the program is beyond the initial dollar impact of transfusion thresholds, microsampling, lab frequency as it adds to our care in multifaceted ways