Financial Case Analysis
| Illness to Assistant Engineer Mr. Stephan W Victoria, Texas February 2 |
Case Management Cost: $ 1,763.25 PreCert Estimate Savings: $ 3,036.75 Network Costs: $ 16,415.25 Claims Savings: $ 30,485.54 |
The patient, a 54 year old male, experienced chest pain radiating down through his left arm on January 31 while onboard ship. Thinking he had indigestion Mr. W treated himself with aspirin and noted temporary improvement; however, by the time the ship arrived in port on February 2nd his condition had deteriorated and he was taken by ambulance to the emergency room at Memorial Medical Center in Port Lavaca, Texas. Mr. W stated that at this time he feared death. He was examined and given an electrocardiogram which revealed abnormalities in his heart rhythm. Because of a lack of cardiologists in Port Lavaca Mr. W was then transferred to the ICU unit at Detar Hospital in Victoria, Texas. He underwent further diagnostic testing under the principal care of Dr. Dakshesh-Kumar Parikh, cardiologist, who concluded that Mr. W had suffered a heart attack due to atherosclerotic lesions, or hardening of the arteries. Mr. W was transferred from the ICU unit to the medical floor on February 5 to await angioplasty surgery.
Future Care was notified of this case on February 4. The nurse case manager immediately contacted Mr. W by telephone, as well as the hospital treatment team. On February 6 the nurse case manager visited with Mr. W at Detar Hospital. Mr. W told the case manager that he was anxious to have the surgery completed in order that he could return home to his family in Trinidad. While at the hospital the nurse case manager met with members of the hospital medical staff to review Mr. W medical records as well as to coordinate a plan of discharge, which included discussion of post operative medication and transfer of medical records to Trinidad.
Mr. W underwent balloon angioplasty on February 6 and afterward reported to the nurse case manager that he felt better than he had in years. He was released from Detar Hospital on February 8. The nurse case manager obtained fit to travel authorization from Dr. Parikh's office on February 9 and also made the necessary travel arrangements for Mr. W return to Trinidad. Mr. W departed Texas on February 11.
Total time under medical treatment in the United States: 9 days
Medical Case Management Savings
Future Care's nurse case manager performed two primary services in this instance: she reassured Mr. W that his medical needs were being expertly looked after while in the United States, and she expedited his release from the hospital and return home, thereby reducing medical and other expenses while in the U.S. The nurse case manager's daily communication with the hospital treatment team in all likelihood reduced Mr. W stay by 3 to 5 days. By coordinating and supervising Mr. W travel arrangements; i.e. pressing for an early fit to travel authorization and obtaining the airline tickets the nurse case manager probably saved several days of lodging expenses.
Based on a conservative estimate of 3 saved days hospital stay at $1,500 per day and 2 days lodging / meals at $150 per day we estimate the shipowner saved a minimum of $4,800 through the intervention of the nurse case manager.
Future Care's case management fee was $1,763.25.
Medical Audit Savings
In addition to the above benefit Future Care's medical auditing department reviewed the invoices for physician services rendered during the hospital stay and reduced the actual billing by $46,900.79 as detailed below:
| Amount Invoiced | Amount Approved | Fee | Savings |
|---|---|---|---|
| $65,878.90 | $18,978.11 | $16,415.25 | $30,485.54 |
Conclusion
Through the combined use of Future Care's medical case management and PPO Access Program we conclude that you have netted a savings of at least $33,522.29 in medical and related expenses.
Very truly yours,
Christina DeSimone
Chief Executive Officer
Future Care, Inc.