Profitability of Medical Procedures without the Use of Transfusion Support.
Authors: Ford Patricia , Mastoris Jason , Badani Kajal , Columbus Michael 
Published: April 2020

Abstract
A growing number of hospitals worldwide are developing programs in Bloodless Medicine and Surgery. Initially, these programs were created with the goal of providing healthcare for those patients who refused blood products based on religious convictions. With increasing public concern over blood safety, blood shortages and the need to reduce health care costs, alternatives to transfusion are now being considered as a goal for all patients. Healthcare providers have been concerned that eliminating or reducing transfusions would not only lead to increased morbidity and mortality, but it would also lead to higher costs associated with the use of alternatives such as epoietin, IV iron and cell salvage techniques. The Center for Bloodless Medicine and Surgery (CBMS) at Pennsylvania Hospital (PAH) provides transfusion free care including high-risk procedures such as cardiac, urologic and orthopedic surgeries to approximately 1,200 patients per year. In a 6-year period, approximately 6,000 Jehovah Witness (JW) patients were treated with only 2 mortalities attributed to hematological complications. In addition to this success, the program appears to be cost efficient, which justifies growth for the future. A sample of 262 patients was taken over a 6-month period and compared to the general hospital population that underwent the same procedures outside of the Bloodless Center. The patient population represented a fairly even distribution of 25 medical service lines, which, in turn, represented approximately 18 Diagnosis-Related Groups (DRGs) for use in comparison. The DRGs were isolated and compared to the equivalent procedures done at PAH in patients that were transfused without restrictions. Contribution margin on a per-case basis was selected as a measure of profitability; this is the amount of revenue that remains after deducting the direct costs of procedure(s). The calculation for contribution margin (CM) is derived using the following algorithm: CM = Net Patient Revenue (NPR) minus total direct expenses (fixed, labor, and supplies). Results of this study indicate that, overall, the CM for a CBMS patient is profitable, in fact, 16% more profitable than the general hospital population. Furthermore, the Net Margin—total revenue less all expenses—on a per-patient basis was 17% more favorable as well. The collective CBMS population illustrates that the service is financially valuable to the Hospital, and provides direction for further investigation to capitalize on strengths and address areas of opportunity. Having a Center for Bloodless Medicine and Surgery specifically attracts a previously unseen population of patients to PAH. Therefore, all profit from the CBMS population, regardless of its magnitude can be considered as an incremental gain to the Hospital’s net margin. By creating and successfully running this program in today’s increasingly competitive healthcare environment, the CEO has strategically placed PAH in the forefront of modern health care. Development of centers that have expertise in transfusion alternatives may expand as the public demands increased safety standards and hospital administrators seek financially gainful opportunities.