The Medical University of South Carolina (MUSC) has been awarded an $800,000 grant from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services. The award marks MUSC as one of only two national Telehealth Centers of Excellence in the United States. As a national telehealth coordinating center, MUSC will continue to provide a range of telehealth services at more than 200 locations statewide, leading and modeling the way for health care delivery through advanced technology. Telehealth is an innovative, convenient and effective way for health care providers to deliver acute primary and specialty medical care and support to patients located in all areas of the state - even rural areas, where often meeting those needs can be nearly impossible. Now, in seconds, through the use of high-tech videoconferencing equipment, doctors miles away can be virtually at the bedside of a patient with endstage kidney disease, in the ER with an ischemic stroke victim or at the school nurse's office assessing a child suffering with asthma. Covering over 70 clinical services, MUSC provides nearly a quarter million telehealth interactions to more than 300 sites in 46 counties, 28 hospitals, more than 100 community clinics, and 50 schools, as well as alternative sites such as nursing facilities, prisons, and patients' homes. Seventy-eight percent of sites are located in completely or partially medically underserved areas of the state. One area for telehealth services development and expansion is stroke care. Stroke is the fifth leading cause of death in the United States and is a major cause of serious disability of adults. Time-sensitive treatment is essential for patient survival and recovery. Timely access to stroke care is crucial. The Medical University of South Carolina (MUSC) Telestroke Network provides remote acute consultations and treatment recommendations for patients with suspected strokes. Through our affiliation with rural/community hospitals and medical centers, patients can receive high-quality, evidence-based care while remaining at their local facility. Through the increased access to healthcare, this virtual network has proven to provide quality, that is equal to or better than traditional face-to-face care. The MUSC Telestroke Program offers our partners, comprehensive support through the following: • Rapid, virtual access to MUSC specialists for stroke consultations (24/7/365). • Treatment recommendations for Alteplase (tPA). • Identification of potential endovascular candidates. • Transfer for treatment and higher level of care, when necessary. • Guidance for the development and advancement of best practices in stroke care. • Support for the creation of evidence-based protocols, guidelines and policies. • Education to expand the availability of evidence-based stroke care for all team members. More information about the MUSC Telestroke Network is provided in the attached annual report. Assignment You are a consultant for a boutique consulting firm in Charleston, SC. The MUSC Telehealth Director has asked your consulting team to transition the program to a new and enhanced model in 3 years. Specifically, he would like to know how much to charge each partner site for telestroke services. Make an equitable daily on-call pricing model to charge the remote hospital sites (spokes) for telestroke services. The sites will eventually have to pay for their monthly software fees; but the grant could offset some of those upfront expenses. There are currently 12 telestroke sites in South Carolina, with some being in urban settings. You will need to make a payment model to pay the physicians "availability/on call," and you need one physician on-call at all times. Attached is an Excel spreadsheet with the ED volume, bed size, annual telestroke volume, and physician call coverage rates for the existing 12 sites. In addition to the existing 12 sites, the grant expectation is to add 3 new sites. The 3 new site names, ED volume, and bed size have been added to the attached Excel spreadsheet. Below is a list of revenues and expenses for the Telestroke Network. Revenue • Grant - $800,000 award (3 years) • Case mix = 34% Medicare, 33% Private, 33% Medicaid Each payer pays = assume an average of $45/consult • In-kind support from MUSC will cover expenses for: operational personnel (telestroke manager, coordinator, local IT support, credentialing, billing) Expenses: • Cart Costs = $12,000 per site • Software = $2,000/per partner site/per month; $3,000/per hub (MUSC)/per month • $5,000 training fee per new site • $5,000 implementation fee per new site • Annual medical director expense = $20,000 Objectives: 1. Provide an overview of the expanded Telestroke Network and explain how the expanded Telestroke Network will impact the state of South Carolina. 2. Construct an equitable daily on-call pricing model to charge the Telestroke spoke sites. 3. Project MUSC's revenues and expenses for the Telestroke Network over the next 3 years. 4. Explain any advantages and disadvantages of your model. Explain why you chose this model over other options. 5. Demonstrate whether and, if so, how the new telestroke care model will lead to a reduction in hospital care costs, preventable hospital stays, and hospital readmissions. If you project that will be an increase in costs or outcomes, support your estimates. Present your proposal in a PowerPoint presentation to the MUSC Telehealth Director and team. Your presentation should be 15 minutes in length. There will be 5 minutes for questions and answers after the presentation. ** Note: because this assignment is based on fictitious numbers and the annual report represents actual data, if at any point you identify a discrepancy, you should always refer to the fictitious values provided in the case. 

 

Existing Site Information Existing Site Coastal Carolina Pines Dillon Georgetown Kershaw Loris Seacoast Marion McLeod Self Waccamaw Williamsburg Annual Tele Stroke Volumes Existing Site Coastal Carolina Pines Dillon Georgetown Kershaw Loris Seacoast Marion McLeod Self Waccamaw Williamsburg New Site Information New Site Hospital # 1 - Horry Hospital # 2 - Anderson Hospital #3 - Sumter Annual ED Vol. # Hospital Beds 16,227 33,000 21,746 31,990 24,000 20,000 20,000 20,692 63,000 40,000 24,000 9,655 2009 0 0 0 38 0 0 0 18 67 0 53 38 Annual ED Vol. 21,135 39,954 64,125 45 116 79 131 121 105 50 124 453 354 140 25 2010 53 0 18 47 44 0 0 42 90 0 74 42 # Hospital Beds 108 322 485 2011 85 37 59 101 83 50 34 63 118 31 88 47 2012 93 47 108 113 84 63 46 35 145 85 129 30 2013 48 40 112 95 66 58 42 25 220 60 127 29 Week Days/Nights Weekend Days/Nights Physician Call Coverage Rate #Days Stipend Paid $600.00 260 $1,000.00 105 Total $156,000 $105,000 $261,000