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| Community Budget Issue Requests - Tracking Id #49 |
| Global Liver Transplant Program |
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| Requester: |
Wil Trower, CEO/President |
Organization: |
North Broward Hospital District |
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| Project Title: |
Global Liver Transplant Program |
Date Submitted |
1/14/2003 12:07:46 PM |
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| Sponsors: |
Margolis |
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| Statewide Interest: |
| Improvement in the availability and accessibility of liver transplants to patients statewide. Equalization of access and quality of care for patients who are on Medicaid throughout the State. Reduction in cost to taxpayers due to improved health status of patients. Improvement in status of health for patients also affords them the opportunity to more readily hold gainful employment and contribute to the community. Fairer payment schedule to providers addressing the issue of inadequate payment for services to medical professionals. |
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| Recipient: |
North Broward Hospital District |
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Contact: |
Charlotte Mather |
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303 Southeast 17th Street |
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Contact Phone: |
(954) 355-5180 |
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Fort Lauderdale 33316 |
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| Counties: |
Broward |
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| Gov't Entity: |
Yes |
Private Organization (Profit/Not for Profit): |
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| Project Description: |
| Adult liver transplantation is the surgical replacement of a diseased liver with a healthy liver. The indication for this operation is end-stage liver disease, characterized by patients suffering from reduced liver function, muscle loss, fatigue, encephalopathy, signs of portal hypertension, poor blood clotting and jaundice. A variety of liver diseases can lead to end-stage liver disease.
Adult liver transplantation under the Medicaid program is currently a covered service for eligible recipients. Providing care to these Medicaid eligible, potential liver recipients in the State has become increasingly difficult due to the reluctance on the part of Florida transplant centers to accept these patients.
Florida Transplant Centers that are willing to accept Medicaid patients on the average are only receiving between 10% to 15% of the charges for these cases. The hospital is paid its Medicaid rate up to the 45 day limit, however, often times due to the extreme risk for catastrophic cases or complications a patient ends up staying beyond the 45 days and the hospital receives no further financial relief. In addition, the increased costs associated with technological changes for liver transplants have added to this financial loss.
The reimbursement methodology for liver transplantation is consistent with that used for all surgical procedures within the Medicaid program. Unfortunately, the 45 day inpatient cap with its associated per diem rate and the $1,500 outpatient cap per fiscal year do not adequately cover costs for the high expense of a liver transplantation procedure.
The Agency for Health Care Administration (AHCA) has expressed support for a global liver transplant fee payment for adult liver transplants in place of the current methodology. A global reimbursement would insure adequate and quality care for Medicaid recipients with end-stage liver disease. An all-inclusive global fee would be broken down into components representing the different phases of the transplant process.
For the 2003-2004 fiscal yeat, AHCA is projecting 80 evaluations and 60 transplants could be performed. According to the AHCA analyst, these estimates are high and since these are proposed legislative budget related issues they are not official Agency policy yet. The estimated total expected costs are as follows:
Services..........Cost per Serv........Tot. Est. Cost
Evaluations: 80 $15,000 $1,200,000
Tranplants: 60 $122,600 $7,356,000
Total $8,556,000
The total global fee would be $137,600 for the evaluation and could receive payment up to $15,000, whether the patient is accepted or denied transplant status they would then be re-evaluated at a later date, but the physician would only bill off of the physician fee schedule. Once the transplant is performed the facility would be paid the transplant fee of $12,600 and would be responsible for care related to the transplant for a year. This means follow-up physician visits, outpatient visits to the hospital and any readmissions to the hospital that would be directly related to the transplant. Drugs would be billed through the fee for service program and would not be included in the global fee. The facility or hospital would receive the global fee payment for the evaluation and transplant and then would be distribute the funds to the doctors.
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| Is this a water project as described in Chapter 2002-291, Laws of Florida? |
No |
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| Measurable Outcome Anticipated: |
| Increased access to liver transplantation procedures for patients. Improvement in the health and outcomes for individuals who loack health insurance who are in need of liver transplantation. |
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| Amount requested from the State for this project this year: |
$3,730,416 |
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| Total cost of the project: |
$8,556,000 |
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| Request has been made to fund: |
Operations |
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| What type of match exists for this project? |
Federal |
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Cash Amount |
$4,825,584 |
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| Was this project previously funded by the state? |
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No |
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| Is future-year funding likely to be requested? |
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Yes |
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Amount: |
$3,730,416 |
To Fund: |
Operations |
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| Was this project included in an Agency's Budget Request? |
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Unknown |
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| Was this project included in the Governor's Recommended Budget? |
Unknown |
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| Is there a documented need for this project? |
Yes |
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Documentation: |
North Broward Hospital District patient data, Broward County data, Transplant center statistics |
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| Was this project request heard before a publicly noticed meeting of a body of elected officials (municipal, county, or state)? |
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Yes |
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Hearing Body: |
North Broward Hospital District Board of Commissioners |
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Hearing Meeting Date: |
05/22/2002 |
