24. Length of Stay Reduction 1.3 Breast Recon Spann .5 Iliac Crest Walker .5 Mastectomy Jacobs/Morrison 1 Colorectal Thorson 1 Hand assist Nephrectomy Patel 1-3 CABG Dowling 1 Foot and Ankle 1.5 CABG White 2 Abd. Hysterectomy Zimberg LOS Savings (days) Procedure Investigator
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26. PCA Economics $600+ Total 3 day cost ? Narcotic Complications $100+ PONV Meds $50 Nursing Labor to maintain $50-200/2days Pharmacy Fill of Narcotic Bag $10/day Flushing supplies $10-60 IV catheter and tray $3-5 Admin Set $20-50/day Pump Costs Description
28. Actual Costs for One Hospital $3,005 10.59 $31,821 AAA $1,424 5.00 $7,124 Thoracotomy $1,548 13.63 $21,101 Colectomy $2,720 7.59 $20,646 CABG $1,929 3.73 $7,187 TAH $3,765 4.34 $16,326 Total Hip Average Cost/Day Average LOS Average Total Cost Procedure
29. Projected Savings With ON-Q *Assumes last day is only 25% of Average Cost/Day **Assumes ON-Q costs $300 and a 1 day LOS reduction $241,000 Total $8,000 $6,000 $4,000 $53,000 $29,000 $141,000 Annualized Savings $3,005 $1,424 $1,548 $2,720 $1,929 $3,765 Average Cost/Day $451 $751 AAA $56 $356 Thoracotomy $87 $387 Colectomy $380 $680 CABG $182 $482 TAH $641 $941 Total Hip Savings with ON-Q ** 25% Last Day Cost * Procedure
30. Projected Savings With ON-Q *Assumes last day is only 25% of Average Cost/Day **Assumes ON-Q costs $300 and a 1 day LOS reduction $241,000 Total $8,000 $6,000 $4,000 $53,000 $29,000 $141,000 Annualized Savings $3,005 $1,424 $1,548 $2,720 $1,929 $3,765 Average Cost/Day $451 $751 AAA $56 $356 Thoracotomy $87 $387 Colectomy $380 $680 CABG $182 $482 TAH $641 $941 Total Hip Savings with ON-Q ** 25% Last Day Cost * Procedure
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32. Higher Patient Volumes: Example TAH Hypothetical example using LOS savings only. Additional profitability can come from reduced medications and complication treatments $37,810 $7005/case $266,190 $304,000 38 2.73 ON-Q +$161,040 +$13,420 -$182/case $50,580 +$64,000 8 1 Difference Annual Profit Gain $24,390 Monthly Profit $7187/case $215,610 Costs per Case per Month $240,000 Revenue ($8,000/case) 30 Monthly Patient Volume 3.73 LOS days PCA
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35. Total Billed Charges Capitation fixed negotiated rate paid per member per month for health care services Case Rate flat negotiated rate for a defined procedure & length of stay Per Diem flat negotiated daily rate defined by level of care Discounted Fee for Service % of total gross charges PPO Indemnity POS/EPO HMO % of All Payments <5% <10% Approx.30% Approx.30% Approx.30% The hospital will generate a bill for all charges for all services during a patient’s entire confinement, including ON-Q. Whether they will receive payment for billed charges for ON-Q will depend upon the particular payment arrangements in place with the particular payor .
49. VAS Values During Mobilization ** ** # ** ** ## ** ** # **p<0.005 vs. Gr. S; ## p<0.005, # p<0.05 vs. Gr. R2 Gottschalk A, Anesth Analg 2003; 97: 1086-91
51. White, Open Heart 0.5% Bupivacaine 0.25% Bupivacaine Saline Postoperative Time (h) Postoperative Time (h) White P, Use of a Continuous Local Anesthetic Infusion for Pain Management after Median Sternotomy, Anesthesiology, V99, No. 4, Oct 2003
52. Patient Satisfaction % of patients satisfied with pain management Saline 0.5% Bupivacaine 0.25% Bupivacaine
62. Schell, Breast Cancer Shoulder Pain and Disability Index Mean Follow-up: 2.4 ±0.01 years 0: No Difficulty 100: Requires Help SPADI Item p < 0.05 * p = ns * * * * *