Business Case Analysis
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1 Business Case Analysis SAMMC Interventional Radiology Program Expansion of Selective Internal Radiation Therapy (SIRT) with Yttrium-90 Army-Baylor University Graduate Program in Health and Business Administration POC: CPT James F. Beheler MAJ Philip J. Durando CPT Stephanie K. Kessinger BSN, CCRN CPT Ted P. Walker Presented: (UNCLASSIFIED)
2 Slide 2 of 21 Disclaimer The views expressed in this presentation are those of the authors and do not reflect the official policy or position of the Army-Baylor faculty, Baylor University, or the Department of Defense.
3 Slide 3 of 21 Agenda Introduction Methods Business Impacts Sensitivity and Risks Recommendation
4 Slide 4 of 21 Introduction Proposed Action Problem: SAMMC seeks evaluation of the cost and reimbursement fees of Selective Internal Radiation Therapy (SIRT) with Yttrium-90 treatment prior to establishing a resources sharing agreement with STVHCS. Purpose Statement: To evaluate the financial metrics, assess contingencies, and analyze the program expansion of SIRT with Y-90.
5 Slide 5 of 21 Background SIRT with Y-90 expected to become first-line treatment for liver cancer Multiple small studies indicate potential improved patient outcomes FOXFIRE & SIRFLOX international clinical studies expected in
6 Background SAMMC IR Department, sole Y-90 Program in the MHS 47 patients treated (FY12-Current) 5%* are VA patients SAMMC currently not reimbursed by the VA No Medicare rate for Y-90 isotope (device) SAMMC cannot bill for Y-90 treatment High volume workload potential Max 143 RVUs and 475 APCs per treatment Billing the VA will result in a net loss ($7,418) per treatment Opportunity for SAMMC MHS leader in Y-90 treatment *information provided by SAMMC IR department CPT James Beheler (301) / james.f.beheler.mil@.mail.mil Slide 6 of 21
7 Scope Time Period: 01 October September 2019 Geography Joint Base San Antonio, TX and STVHCS Organization San Antonio Military Medical Center VA and TRICARE Beneficiaries Departments involved Department of Radiology Interventional Radiology Nuclear Medicine Nuclear Pharmacy Health Physics CPT James Beheler (301) / james.f.beheler.mil@.mail.mil Slide 7 of 21
8 Slide 8 of 21 Scope 5-year cost benefit analysis Breakdown of the costs Dollar value for one treatment of SIRT with Y-90 Reimbursement analysis Qualitative Factors No additional Staff or Equipment required Opportunity to maximize IR Department Capacity
9 Slide 9 of 21 Possible Courses of Action COA #1: Continue with current operations (Status Quo) COA #2: Enter into a resource sharing agreement with the STVHCS COA#3: Expand service throughout the MHS with TDY to SAMMC
10 COA # 1 Status Quo (25% Growth) COA #1 Status Quo (25% Growth) FY14 FY15 FY16 FY17 FY18 FY19 # of Patients Annual Revenues RVU/APC Revenues $ 1,174, $ 1,464, $ 1,900, $ 2,400, $ 3,060, $ 3,937, Billed Revenues $ - $ - $ - $ - $ - $ - Total Revenues (SQ) $ 1,174, $ 1,464, $ 1,900, $ 2,400, $ 3,060, $ 3,937, Annual Cost Personnel Cost $ 41, $ 51, $ 66, $ 84, $ 107, $ 138, Equipment Cost $ 19, $ 24, $ 31, $ 40, $ 51, $ 66, Supplies Cost $ 669, $ 834, $ 1,083, $ 1,368, $ 1,744, $ 2,245, TDY Cost $ - $ - $ - $ - $ - $ - Total Cost (SQ) $ 730, $ 910, $ 1,182, $ 1,493, $ 1,903, $ 2,449, Total Net Revenues $ 443, $ 553, $ 718, $ 906, $ 1,156, $ 1,487, RVU/APC NPV $4,473, Inflation Rate: 2% Growth Rate: 25% Cost of Capital: 2.2% Revenues Per Treatment: $43,496.58* see appendix 2 Total Cost: $27,061.10* see appendix 1 (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 10 of 21
11 COA # 1 Status Quo (25% Growth) Inflation Rate: 2% Growth Rate: 25% Cost of Capital: 2.2% Revenues Per Treatment: $43, Total Cost Per Treatment: $27, NPV: $4,473, $4,500, $4,000, $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, $500, $- COA #1 Status Growth (25% Growth) FY14 FY15 FY16 FY17 FY18 FY19 RVU/APC Revenues Total Cost (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 11 of 21
12 COA # 2 Sharing Agreement FY14 FY15 FY16 FY17 FY18 FY19 # of Patients (DoD/VA) 25/2 30/3 38/4 46/6 55/10 67/15 Annual Revenues RVU/APC Revenues $ 1,087, $ 1,330, $ 1,719, $ 2,123, $ 2,589, $ 3,217, Billed Revenues $ 39, $ 60, $ 81, $ 125, $ 212, $ 325, Total Revenues $ 1,126, $ 1,391, $ 1,801, $ 2,248, $ 2,802, $ 3,542, Annual Cost Personnel Cost $ 41, $ 51, $ 66, $ 84, $ 107, $ 138, Equipment Cost $ 19, $ 24, $ 31, $ 40, $ 51, $ 66, Supplies Cost $ 669, $ 834, $ 1,083, $ 1,368, $ 1,744, $ 2,245, TDY Cost $ - $ - $ - $ - $ - $ - Total Cost $ 730, $ 910, $ 1,182, $ 1,493, $ 1,903, $ 2,449, Total Net Revenues $ 396, $ 480, $ 618, $ 755, $ 898, $ 1,092, Sharing Agreement NPV $3,573, (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil COA #2 Expand VA Patients w/ Sharing Agreement Inflation Rate: 2% Growth Rate: 25% VA Growth Rate: 50% Cost of Capital: 2.2% Revenues Per Treatment: $43, Billable Revenues Per Treatment: $19,642.11*see appendix 2 Total Cost Per Treatment: $27,061.10* see appendix 1 (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 12 of 21
13 COA # 2 Sharing Agreement Inflation Rate: 2% Growth Rate: 25% VA Growth Rate: 50% Cost of Capital: 2.2% Revenues Per Treatment: $43, Billable Revenues Per Treatment: $19, $4,500, $4,000, $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, COA #2 Expand VA Patients w/ Sharing Agreement Total Cost Per Treatment: $27, $500, $- FY14 FY15 FY16 FY17 FY18 FY19 NPV: $3,573, RVU/APC Revenues Billed Revenues Total Revenues (SQ) Total Cost (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 13 of 21
14 COA # 3 Expand Service to MHS FY14 FY15 FY16 FY17 FY18 FY19 # of Patients (DoD/TDY) 25/2 31/2 39/3 49/3 61/4 76/6 Annual Revenues RVU/APC Revenues $ 1,174, $ 1,464, $ 1,900, $ 2,400, $ 3,060, $ 3,937, Billed Revenues $ - $ - $ - $ - $ - $ - Total Revenues $ 1,174, $ 1,464, $ 1,900, $ 2,400, $ 3,060, $ 3,937, Annual Cost COA #3 Expand Service to all MHS w/tdy to SAMMC Personnel Cost $ 41, $ 51, $ 66, $ 84, $ 107, $ 138, Equipment Cost $ 19, $ 24, $ 31, $ 40, $ 51, $ 66, Supplies Cost $ 669, $ 834, $ 1,083, $ 1,368, $ 1,744, $ 2,245, TDY Cost $ 5, $ 6, $ 9, $ 9, $ 12, $ 19, Total Cost (w/tdy) $ 736, $ 916, $ 1,191, $ 1,502, $ 1,916, $ 2,469, Total Net Revenues $ 437, $ 547, $ 708, $ 897, $ 1,143, $ 1,468, TDY NPV $4,420, Inflation Rate: 2% TDY Growth Rate: 25% Cost of Capital: 2.2% Revenues Per Treatment: $43,496.58* see appendix 2 Total Cost Per Treatment: $30,024.10* see appendix 1 (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 14 of 21
15 COA # 3 Expand Service to MHS Inflation Rate: 2% TDY Growth Rate: 25% Cost of Capital: 2.2% Revenues Per Treatment: $43, Total Cost Per Treatment: $30, NPV: $4,420, $4,500, $4,000, $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, $500, $- COA #3 Expand to all MHS w/ TDY to SAMMC FY14 FY15 FY16 FY17 FY18 FY19 Total Revenues Total Revenues (SQ) Total Cost (SQ) Total Cost (w/tdy) (1)MHS Management Analysis & Reporting Tool (M2) Encounter data (2)OBM Circular No. A-94 (3)Office of Personnel & Management (OPM) General Schedule 2015 (4)Defense Finance and Accounting Service (DFAS) Military Pay Chart 2015 CPT James Beheler (301) / james.f.beheler.mil@.mail.mil (5)Integrated Resourcing and Incentive System (IRIS) APC and RVU Rates (6)Defense Medical Logistics Standard Support (DMLSS) (7)U.S. General Service Administration City Pairs Program Slide 15 of 21
16 Slide 16 of 21 Qualitative Factors COA 1 Status Quo COA 2 VA Sharing Agreement COA 3 MHS wide Expansion Pros - No change in practice - Continue to provide quality care to beneficiaries Cons - Limits access to care for other beneficiaries - Potential to harm relations with STVHCS Pros: - Partner with the VA for quality care for veterans - Increase patient volume to maintain medical skills - Increase access to VA population Cons - Change of practice Pros: - Increase training to medical providers - Premier institution in the DoD - Improve quality of care of MHS beneficiaries - Maintain continuity of care within the MHS Cons: - Patient travel
17 Slide 17 of 21 COA Comparison COA 1 Status Quo COA 2 VA Sharing Agreement COA 3 MHS wide Expansion Total Revenue: $12.76 M Total Revenue: $11.78 M Total Revenue: $12.76 M Cost: $7.94 M Cost: $7.94 M Cost: $7.99 M Net Revenue: $4.82 M Net Revenue: $3.84 M Net Revenue: $4.76 M NPV: $4.47 M NPV: $3.57 M NPV: $4.42 M Qualitative Factors: Neutral Qualitative Factors: Positive Qualitative Factors: Positive Each COA represents a 5-year cost/benefit analysis
18 NPV CPT James Beheler (301) / james.f.beheler.mil@.mail.mil Slide 18 of 21 Sensitivity Analysis Sensitivity Analysis of COAs Growth Rate (COA #1) VA Growth Rate (COA #2) TDY Growth Rate (COA #3) $10,000, $9,000, $8,000, $7,000, $6,000, $5,000, $4,000, $3,000, $2,000, $1,000, $- -100% -67% -33% 0% 33% 67% 100% % Change from Base Case Level What assumptions have the most impact on returns? Growth Rate of program w/ DoD Beneficiaries (25%) Growth Rate of VA patients (50%) Growth Rate of sending Beneficiaries TDY (25%)
19 Slide 19 of 21 Scenario Analysis Worst Case: 20% probability of 0% growth rate: NPV $2,079, Most Likely Case: 60% probability of 25% growth rate: NPV $4,473, Best Case: 20% probability of 50% growth rate: NPV $9,339,747.13
20 Slide 20 of 21 Recommendation COA 1 Status Quo COA 2 VA Sharing Agreement COA 3 MHS wide Expansion Total Revenue: $12.76 M Total Revenue: $11.78 M Total Revenue: $12.76 M Cost: $7.94 M Cost: $7.94 M Cost: $7.99 M Net Revenue: $4.82 M Net Revenue: $3.84 M Net Revenue: $4.76 M NPV: $4.47 M NPV: $3.57 M NPV: $4.42 M Qualitative Factors: Neutral Qualitative Factors: Positive Qualitative Factors: Positive Each COA represents a 5-year cost/benefit analysis
21 Slide 21 of 21 Questions
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