Altrus Bariatric Center

Situation Assessment 2012

This report helps us develop a clearer understanding of the Bariatric Center and what, if any, affect advertising may have on the Centers patient volume.

Current Situation
Discharges for OR procedures for Obesity
Discharges for O procedures for O!esity" #C$%&'', $%()*, $%(&+, $%(&), have decreased !y -&. over the last three years.

/verage length of stay for these patients has decreased slightly to ).)( days in &+))
from ).&( days in &++*.

Altrus Bariatric Center

npatient Origin

Situation Assessment 2012

0n &+)), -+. of the !ariatric inpatients were from our primary mar1et of 2rand 3or1s County and the city of 4ast 2rand 3or1s, down from -*. the previous year. /lso in &+)), &*. of our patients were from our secondary mar1et, and &(. were from our referral mar1et. 3our patients #or 5., were from outside of our seventeen county area in &+)). %ome trends at the county level are worth noting6 ). 0n &++*, there were )( patients from 7ol1 County #e8cluding 4ast 2rand 3or1s,. That num!er dropped to )) in &+)+ and 5 in &+)). &. 0n &++*, there were )- patients from amsey County. 9ast year there were no patients from this county.

Altrus Bariatric Center

Situation Assessment 2012

olette County has grown from

:. On a positive note, the num!er of patients from three in &++* to seven in &+)).

/ltrus Bariatric Center is still seeing referrals for patients come from these areas. /nd, contacts with patients who have attended a seminar or sought information have remained steady. These are !eing documented !y the coordinator on contact sheets, not in 4pic. ;o conversations have occurred !etween the Bariatric Center staff and referring physicians of Croo1ston and Devils 9a1e regarding the decrease.

Altrus Bariatric Center

!atients by payer

Situation Assessment 2012

7atients with BCB% #either BCB%;D or BCB%$;, ma1e up the largest group !y payer. 3or the last two years, (+. of !ariatric patients had this payer< in &++*, =5. of the patients had BCB%. The ne8t largest payer #as a percent of the total, is other commercial payers. This group has grown from )+. of the total patients in &++* to &:. of the total last year. $edicare and $edicaid accounted for )5. of the !ariatric patients in &+)), up slightly from )&. in &++*. Only one patient in each of the last three years has !een self>pay. #?&+,+++ out>of> poc1et,

%urgery costs !efore insurance total ?:5,+++.

Altrus Bariatric Center

Bariatric !rocedures " #e$ !lacements Only

Situation Assessment 2012

This graph shows !ariatrics procedures, new placements only, from @anuary &+)+ through $ay &+)&. Ahile we did have a few outpatients in &+)+ and &+)), the maBority fall into the more recent months of &+)& when new lap !and placements !ecame e8clusively outpatient. /verage charge per inpatient procedure was ?)=,5:* #&+)+,, ?)*,&'& #&+)), and ?)*,:(+ #CTD &+)&,. /verage charge per outpatient procedure over the same three year period was ?&*,)'+ #&+)+,, ?&*,+)& #&+)), and ?&*,=-: #CTD &+)&,. ). The increased average charges that are nota!le in the outpatient procedures are due to the !illing applied to C7T code -:==+ and the ?)(,5** applied to each. During the inpatient procedures, surgery is !illed at ?5-.++ per minute. Ahile the average cost per procedure increased slightly from ?5,+++>=,+++ #inpatient, to ?',+++>?*,5++ #outpatient,. /ltrus Bariatric Center staff are not directly involved in patient financial matters, unless it is a cash payment. There is well>defined cash pay process, !ut it has not !een utiliDed yet.

Based on the num!ers availa!le through 470C, we !elieve that the transition of
inpatient to outpatient procedures had a negative impact on reim!ursement< however it is too soon to draw a firm conclusion, therefore we will continue to monitor. 3rom the data availa!le to date, !ariatric surgery is profita!le< margins are somewhat smaller however, than when cases were classified as inpatient.

Altrus Bariatric Center

!hysician Referral nfo

Situation Assessment 2012

0n addition to understanding the patients we have seen through the Bariatric Center, we want to understand the opportunity with potential patients from within our system. 0n reviewing the data on patients with principle and non>principle diagnosis of mor!id o!esity, there are appro8imately )+++ uniEue patients that /ltru providers saw in &+)). %ome of these patients could !e candidates for !ariatric surgery. The providers who have the highest num!er of uniEue patients with this diagnosis are6 %hellie Aright, 7/< 9ynn Folum< 4llen Doe!ler< Dr. Fape 7roviders who have ten or more patients who match the criteria, include6 Dr. Christina Calin Dr. 7aul Chan Dani1a Aarner>;oreen Dr. olf Fanson Dr. 7aul 3etterly %ue %treitD /nn $ason, ;7 Dr. ita ;alu!ega Dr. /li /r!a!i Tamra Bauduin, 7/ Dr. @eff 4ic1man Dr. @oanne 2aul Dr. %ue Thompson Dr. @ames Brosseau Dr. 7odduturu Dr. Ailliam Ga1s Dr. 4ri1 Ba11e Dr. Fenri Caoili Dr. Deere Dr. De!orah 4ric1son Top referring physicians, provided !y the Bariatric Center coordinator, are as follows6 Dr. 2omeD Dr. ;ygaard Dr. Ga1s Dr. 4ic1man Dr. 4ric @ohnson Dr. 9yste Dr. o8as Dr. Deere Dr. 2aul Over the last three years, the a!ove providers have consistently referred patient to /ltrus Bariatric Center. eferrals range from 5>)) patients per year.

Altrus Bariatric Center

Situation Assessment 2012

The difference !etween self>referrals and physician referrals is difficult to determine, !ecause even self>referral patients must Eualify with a physicians sign off.

!atient !rocess
/ppro8imately ::. of all individuals who attend a community meeting !ecome a !ariatric patient. Faving only one>third of patients follow through with the process remains consistent with the national average. 0t ta1es appro8imately &>: months from first point of contact through surgery. 7atient process6 o 4ither @anet receives a call, or she calls the patient !ased on a referral. o @anet screens the patient on the phone. o 7atient attends Community 0nformation $eeting #0f una!le to attend meeting, they watch the video online and fill out health history form., o 7atient fills out paperwor1 and provides five year records. o @anet reviews paperwor1 and calls to set up assessments and surgeon appointment. o Based on reEuirements, patients paperwor1 is su!mitted to insurance. o 0f approved, @anet arranges a date for surgery< if not approved, she evaluates for appeal options. o %urgery is completed. o 3ollow>up appointments %ometimes, individuals choose to wait or lose weight on their own, not pursuing surgery. Ae do not trac1Hfollow>up with patients who choose to do it on their own.

$ore li1ely, however, patients have !een denied for various reasons during the
insurance approval process. %ome do not have coverage on their policy. %ome havent completed supervised weight loss #most times this will !e completed and go on for approval,. 0f there is something that @anet can appeal, she does.

!atient Satisfaction
Based on the patient satisfaction survey results #9ap>Band Total Care 7rogram, &++'> &+)+,, our satisfaction dropped on average .5= #in every single category there was a decline in score,. /ltrus Bariatric Center on average ran1ed .5-5 points !elow the national average in every category. %ome statistics worth noting #where scores dropped most significantly, ). /re practice and support group meetings helpful as a part of your weight loss planI #-.5( J :.((, &. 0s the physical layout of the office sensitive to your needs as a patient in terms of6 a. /ppropriately siDed chairsI #-.'>-.+), !. Aide doorwaysI #-.*: J -.+-, c. /ppropriate scaleI #-.'>:.**,

Altrus Bariatric Center

Situation Assessment 2012

:. Ahen you called for an appointment was the person answering the phone friendly and courteousI #-.=: J :.*-, /s a result, the data #lower scores, was !rought to a group meeting and action plans were developed. The results of the action plans were never reviewed.

Altrus Bariatric Center

Ad%ertising Results

Situation Assessment 2012

Based on the charts a!ove, there does not seem to !e a direct correlation !etween advertising and meeting attendance.

Altrus Bariatric Center

Competitor Re%ie$

Situation Assessment 2012

$ar1et research was completed on the following competitors6 %anford #3argo K Thief iver 3alls,< $edCenter One K %t. /le8is #Bismarc1,< Trinity #$inot,< %t. @osephs #CF0 in 7ar1 apid, /fter chec1ing with some of our regional competition, it appears that while our charges may !e a !it higher than the average reported of &+L>:+L, they are not su!stantially higher. Competitors consistently reEuested to see patients within in &->-' hours for a consultation appointment. 0n addition, some organiDations offer info sessions &>: times monthly. They also provided registration information and a video of the info session online #= min.,.

Summary $ith Conclusions

7atient 7rocedures6 Ae 1now that volume is low, !ut that the surgical cases are profita!le. Ae also understand that 9ap>!and surgery helps reduce overall health care costs for Eualifying patients. Conversion ateH7atient 7rocess6 3ollow through, from initial contact to surgery, is appro8imately ::.. /lthough that is consistent with the national average, it still means that two>thirds of patients are not having surgery, which provides us an opportunity within our health system. Fowever, the length of time in which the conversion ta1es place is appro8imately &>: months. 7atient %atisfaction6 /ccording to a survey from &++'>&+)+, patient satisfaction ratings of /ltrus Bariatric Center were !elow the national average in every category and declined over the three year period. /ction plans were developed for the group, however results were not reviewed. /dvertising esults6 Based on the data collected, there does not seem to !e a direct correlation !etween advertising and patient volume. Competition6 Competitors consistently reEuested to see patients within in &->-' hours for a consultation appointment. Based on our scheduling of community sessions once monthly and the long wait time to receive a provider consult, it may !e causing patients to see1 care elsewhere. Therefore, the entry into the program may !e a !arrier to patients.

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Altrus Bariatric Center

Recommendations

Situation Assessment 2012

Our recommendations for a &+)&>&+): communication plan cover three main goals6 encourage, participate and engage. &ncourage fellow medical staff. Ae already have a captive audience with our referring physicians, lets form a physician champion group and encourage all providers to !e more proactive with patients who meet the criteria for !ariatric surgery. ). /s1 top referring providers to discuss referral process #what wor1s, what should !e changed, etc.,. &. Ta1e these individuals to departmentalH$D presentations to offer advice. $eet with providers whose patients meet the mor!id o!esity criteria" in a one>on> one setting, to !uild relationships. 4ncourage them to tal1 to their patients. ). 2ive overview of what wor1s for top )+ referring $Ds. $eet with Occupational $edicine staff. 7rovide them with information to give to individuals or !usiness that we wor1 with. Build and participate in relationships. eview how the community meeting is presented. ). Mideo tape and provide online. Discuss process and develop a standard of meeting with an interested patient within &->=& hours of initial contact to help !uild the relationship. Designate one or two representatives who understand !ariatrics that @anet can put patients in direct contact with for payment planning and Euestions. ). Determine !est option for payment planning #i.e. Care Credit, Develop a trac1ing system for patients from initial contact. 0f a patient decides to decline surgery, @anet gets a flag three months later to follow up with that individual. ). 0f the patient decides to lose weight on their own, a recommendation to Boin ;4A start should !e made. Develop process to receive patient feed!ac1 ). 7rovide rapid cycle survey to patients on their Bariatric Center e8perience &. Develop inpatient survey and patient satisfactionHlead trac1ing system :. eport performance measures on Euarterly !asis to monitor the programNs success on an ongoing !asis -. 3ollow>up focus groups with those who didnt follow through with surgery to help determine !arriers. Fold focus group with patients who completed the process to get input of what wor1ed and compare. &ngage with past and potential patients. City !riefs #/ugust, Digital !ill!oard on interstate and -&nd %treet, !y /lerus Center 7rovide info to Clear Channel Cares radio segment to announce community meetings Continue e;ews K develop plan to increase participants $a1e additional updates to we!site to reflect current servicesHsituation #7ost revised info session video and add success rate of program compared to national average, patient comments, 1eywords, etc., %tart 3ace!oo1 page #private group J invite only, to interact with past, present and future patients J maintained !y Bariatric Center coordinator, with CDs assistance,<

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Altrus Bariatric Center

Directory advertising

Situation Assessment 2012

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