Siemens Healthcare Consulting. Profitability analyses page 3. Our portfolio
contains solutions that address all relevant topics regarding the health care
system.
Siemens SiemensHealthcare HealthcareConsulting Consulting
Customer benefit of Siemens Healthcare profitability analyses August 2012 Bastian Helm, Jens Schneider Copyright © Siemens AG 2012. All rights reserved. Siemens Healthcare Consulting
1. Presentation of Siemens Healthcare Consulting 2. Business planning, master planning & profitability analysis 3. Project process of the profitability analysis 4. Excursus: Practical example – a German hospital
page 2
Profitability analyses
Siemens Healthcare Consulting
Our portfolio contains solutions that address all relevant topics regarding the health care system Three essential categories…
… with an explicit focus… Competence leader for sustainable service provision in the health care system
Strategy and sustainability
Clinical processes
Infrastructure
page 3
Business- und master planning Performance indicators and benchmarking Sustainability assessments and consulting Setting trends for clinical process optimization Process optimization Clinical pathways
Development of innovative concepts of technology and infrastructure Process optimized equipment concepts Technology and investment planning
Profitability analyses
Siemens Healthcare Consulting
An interdisciplinary team with an exclusive focus on health care topics Our strengths Our consultants focus only on health care topics: 50% of our consultants have previously worked in hospitals and surrounding fields Extensive experience in: health care system, consultancy and investment banking Consultants with multiple degrees and doctorates (MD, PhD, etc.) We have a high international experience in combination with a strong local presence
Managing excellence
Clinical excellence
Technological excellence
Experienced experts in: Hospital management, investment banking and health economics
Physicians specialized in: Radiology, cardiology, oncology and neurosurgery
Physicists, engineers and computer scientists
page 4
Postgraduate qualifications in management and health economics
Profitability analyses
Long-time experience in the IT- and technology industry
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Our customers and references (extract)
Strategy
Infrastructure
Clinical processes page 5
Profitability analyses
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Our interdisciplinary experienced team Clinical Competence Centers
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Cardiology
O. Ekinci Cardiology
A. Aisenbrey Business Administration
Dr. S. Dietrich Dentistry
S. Gager Health Economics
M. Haseneyer Computer Science
B. Helm Business Administration
Dr. J. Höllthaler Medicine
T. Hopmeier Business Administration
H. Kirschbaum Computer Science
Dr. J. Kirschbaum Medicine
Dr. E. Klein Medicine
S. Koos Business Administration
Dr. M. Koschnike Business Administration
I. Rebmann Psychology
C. Schmieder Care Management
J. Schneider Business Administration
Dr. D. Seidel Health Management
C. Wild Industrial Engineer
C. Windpassinger Computer Science
V. Ziebandt Business Administration
Dr. J. Kirsten Business Adm. & Biology
Dr. P. Fischer Cardiology
Neurology
Dr. B. Hofmann Neurosurgery
Dr. U. Zikeli Neurology
Oncology
Dr. W. Voigt Oncology
page 6
Dr. C. Förtsch Oncology
Profitability analyses
Siemens Healthcare Consulting
1. Presentation of Siemens Healthcare Consulting 2. Business planning, master planning & profitability analysis 3. Project process of the profitability analysis 4. Excursus: Practical example – a German hospital
page 7
Profitability analyses
Siemens Healthcare Consulting
Profitability analyses offer benefits for external customers and Siemens Healthcare sales organization Perspective of executive board Initial situation:
Initial situation:
The executive board is firmly convinced of the medical benefits and technical capability of Siemens modalities Questions:
page 8
Siemens sales organization identifies customer’s potential for a new or additional modality
Questions:
Is the investments worthwhile for my company? Can we financially afford such an investment? Do we have an adequate number of potential patients in our catchment area?
Conclusion
Sales perspective (directors and representatives)
How can we convince the customer of the benefits? What kind of economic arguments will the customer need? How can we support our customer?
Essential aspects Number of relevant patients Trends in epidemiology, demography and medical technology Competition in the catchment area Reimbursement possibilities for the hospital Required investment and running costs
A hospital can use such an analysis to convince the supervisory board, health insurance companies and the public funding organisations. Profitability analyses
Siemens Healthcare Consulting
Business planning, master planning and profitability analyses - focus … with a different focus
Three essential categories …
page 9
Master planning
One hospital or other health care provider
Business planning
One medical division/ department
Profitability analysis
One technology/ medical device
Profitability analyses
Siemens Healthcare Consulting
Business planning, master planning and profitability analysis – scope of services Three essential categories …
… with different scopes of services
Master planning Political and legal topics Functional design and space planning Implementation planning
Business planning Idea creation/ strategic planning Sales concept/ marketing Personnel resource planning
Profitability analysis
page 10
Market and competition analysis Prediction of performance development Analysis of the required resources Calculation of predicted revenues and costs
Profitability analyses
Siemens Healthcare Consulting
1. Presentation of Siemens Healthcare Consulting 2. Business planning, master planning & profitability analysis 3. Project process of the profitability analysis 4. Excursus: Practical example – a German hospital
page 11
Profitability analyses
Siemens Healthcare Consulting
Profitability analysis: project example Customer situation
German hospital of maximum medical care
Project goal Profitability analysis for the investment decision Approach
Planning of a replacement purchase of a modern angiography device for different medical departments Tense financial situation for investments at the hospital A leasing provider offered to take over the investment under special conditions Difficult market position of the hospital in an area with a high number of competitors Declining number of inhabitants in the hospital’s catchment area
Outcome Projected performance volume on the new angiography device Statement on profitability of the investment
page 12
Profitability analyses
Siemens Healthcare Consulting
Module 2 Market- and competition analysis Description
Examples
Market overview:
Market analysis
Description
Demographical und epidemiological analysis of the catchment area Identification of existing facilities in the relevant region Additional market potential
Competition analysis
Methods
Data acquisition
Outcome
Interviews
Estimation of additional market potential
Analyses and calculations
page 13
Projected development of case numbers
Profitability analyses
Siemens Healthcare Consulting
Module 3 Required resources
Description
Description
Examples
Visualization of the required resources: Spatial requirements Description of the technical equipment Personnel requirements Level of competence of the required personnel
Process of a emergency-intervention
Methods
Analyses and calculations1
Outcome
Interviews
Detailed description of required resources
1depending
page 14
Spatial situation and patients’ pathways
on available data
Profitability analyses
Siemens Healthcare Consulting
Modules 4 and 5 Revenue and cost calculation and final evaluation
Description
Description
Examples
Revenue and cost calculation: Identify reimbursement options Calculation of investment- and running costs Determine of break-even point
Financial model
SWOT-analysis
Outcome
Methods
Break-even- and sensitivity analysis Data acquisition Forecast model1 Revenue and cost determination Profitability analysis Final documentation Presentation 1depending
page 15
on available data
Profitability analyses
Siemens Healthcare Consulting
1. Presentation of Siemens Healthcare Consulting 2. Business planning, master planning & profitability analysis 3. Project process of the profitability analysis 4. Excursus: Practical example – a German hospital
page 16
Profitability analyses
Siemens Healthcare Consulting
Siemens SiemensHealthcare HealthcareConsulting Consulting
Profitability analysis of a Hybrid-OR Final presentation Hospital in West Germany, 2012 Bastian Helm, Jens Schneider Copyright © Siemens AG 2012. All rights reserved. Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 18
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 19
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
New standards in terms of diagnosis and therapy by a next generation Hybrid-OR
The combination of e.g. a Siemens Artis Zeego and an adjustable OR-table creates an ultra-modern Hybrid-OR, setting new standards in diagnosis and therapy in cardiology, neurosurgery as well as vascular- and trauma surgery
Patient
Hospital
• Optimal imaging with reduced contrast media administration, radiation burden and avoiding of repositioning • Gentle intervention by a minimallyinvasive technique: Quicker cure and reduced length of stay (LOS) • High patient-safety due to a intraoperative quality-check faster intervention
Region
• Innovation leadership in vascularand cardiac surgery • Direct quality-check reduces complication and re-operation rate (approx. 10% are faulty)1 • Incentive for innovative medical personnel • Additional reimbursement potential due to an extension of the range of treatment • LOS and operating time reduction (approx. 11%)2
1) Advisory Board Company
page 20
• Location development especially for age-related diseases (e.g. reduced contrast media administration by approx. 45%2) Treatment of patients with preexisting kidney diseases • Technological leadership and new standards of care • Medical and regulatory future trends: Future complex interventions will only be executed in a Hybrid-OR3
2) Analyses of the Hybrid-OR “Klinikum Barmherzige Brüder” Regensburg (Prof. Steinbauer) 3) Siemens Clinical Competence Center Cardiology
Profitability analyses
Siemens Healthcare Consulting
Prospectively the following diseases from different disciplines will be treated in the Hybrid-OR
Vascular surgeon
Orthopedist, Trauma surgeon
Interventional cardiologist
Interventional radiologist
Neuro- Neurosurgeon radiologist
Specialist
Hybrid-OR - AAA1 Endograft Procedure - TAA2 Endograft
- Hip surgery at multimorbid patients
- Minimal-invasive coronary arteries bypass / (PCI)
- Spinal surgery
- Minimal-invasive valve surgery
- Polytrauma
- TAVI5
- Complex peripheral cases - Quality-control of complex procedures (10% error ratio)
- Heart defect intervention
- Oncologic procedures
- Carotisangioplasty (CAS)
- Carotis stenting
- Aneurysm coiling
- kyphoplasties (stabilization of vertebrae)
- Intracranial stents
- Interventional therapy of myomas (Gynecology)
1) AAA: Abdominal aortic aneurysm Hybrid-OR necessary
2) TAA: Thoracic aortic aneurysm
Hybrid-OR suitable
3) CABG: Carotid artery stenting
Already existing In set-up
4) PCI : Percutaneous coronary intervention 5) TAVI: Transcatheter aortic valve implantation Source: Advisory Board Company
page 21
Profitability analyses
Siemens Healthcare Consulting
Practical example: A Hybrid-OR supports the treatment of aortic valve stenosis (AS)
Treatment of aortic valve stenosis – Calcification of the aortic valve
Current approach • Sternotomy (full or partial) • Use of life support machine • Removement of the degenerated valve
• Replacement by a mechanic or biologic valve
Hybrid-OR approach (TAVI)
Adoptions for the future • The number of severe AS will increase, due to the demographic trend
• No longer sternotomy and life support machine necessary
• Covering of the old valve with a
• Increasing number of patients with a high risk or contraindication
catheter-guided valve
• The intervention takes place at the beating heart
• Shorter operating-time, less
• Good long-term outcome • Few severe following
2)
complications, less painful
complications 3)
1)
1) Klinikum Dortmund: http://www.klinikumdo.de
page 22
2) Mayo Clinic: http://www.mayoclinic.org/aortic-stenosis/ 3) German heart foundation: www.deutscheherzstiftung.de
Profitability analyses
Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 23
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
The analysis of the catchment area shows a heterogeneous competitive situation and possibilities to extend the catchment area towards north and south Stream of patients of the relevant departments (neuro, cardio, vascular)1 Planned
A basis of relevant patients exists in the hospital (detailed analysis: 500 patients1) Planned
Criteria for additional patients: The catchment area is weighted by travelling-time, competition and emotional barriers We suppose a supra-regional attraction of the Hybrid-OR for polytrauma
However, there is less Hybrid-OR competition in the eastern and southern part of the catchment area, further installations are planned already2
Hybrid-OP location2
1) German hospital §21 KHEntgG-Data 2011
page 24
2) Siemens Internet research
Profitability analyses
Siemens Healthcare Consulting
Relevant ICDs for the Hybrid-OR will increase in the catchment area (I65, I70, I71, I72, I73) Projected case numbers in 20301,2
Assumptions The demographic trend in the catchment area1 shows a significant increase of elderly persons (>40 years of age)
+49% 4.942 1.622
3.320
Increase
2010
Inhabitants maintain on the same level (approx. 1.8 million inhabitants in the catchment area) Vascular diseases (ICD I70) will have the biggest share of future diagnoses
2030
Additional patients can be gained by good marketing strategies of the hospital (e.g. medical competence center)
Development of relevant ICDs for the Hybrid-OR in the catchment area1, 2 I65 Occlusion and stenosis of precerebral arteries
I72 Other aneurysm and dissection
I70 Atherosclerosis
I73 Other peripheral vascular diseases
Highly qualified personal and innovative medical technology will guarantee a high standard of care
I71 Aortic aneurysm and dissection +22%
+38%
+49%
4,942
4,567 4,065 3,320
268
293
3,435
2,668 81
243
35
2010 1) National statistics offices, 2012
page 25
111
238
2020
244
259
4,255
3,897
13
133
263
15
2025
151
275
17
Under conservative calculations, these assumptions will lead to a growth in patient numbers of 10% per year (without sideeffects)
2030
2) Federal government’s health monitoring, 2012
Profitability analyses
Siemens Healthcare Consulting
TOP 10 DRG, that should be crucial for the alignment of the hospital and the Hybrid OR, as well as strategic potentials1 DRG
Description
Development
CMI
Cases year 1 Revenue
F08A
Rekonstruktive Gefäßeingriffe ohne Herz-LungenMaschine, …
6,444
10
18.769 €
F51B
Endovaskuläre Implantation von Stent-Prothesen an der Aorta, nicht thorakal
5,121
50
14.916 €
F28A
Amputation mit zusätz. Gefäßeingriff oder mit Hauttransplantation, mit äußerst …
5,014
40
14.604 €
F08B
Rekonstruktive Gefäßeingriffe ohne Herz-LungenMaschine, ohne komplizierende …
4,260
50
12.408 €
F08C
Rekonstruktive Gefäßeingriffe ohne Herz-LungenMaschine, …
3,635
70
10.587 €
F14A
Komplexe oder mehrfache Gefäßeingriffe außer große rekonstruktive Eingriffe …
3,064
50
8.924 €
F12E
Implantation eines Herzschrittmachers, ZweiKammersystem, …
2,821
50
8.217 €
F08E
Rekonstruktive Gefäßeingriffe ohne Herz-LungenMaschine, …
2,311
150
6.731 €
B04B
Eingriffe an den extrakraniellen Gefäßen mit …
2,293
20
6.679 €
F59A
Komplexe Gefäßeingriffe ohne komplizierende Konstellation, …
2,149
200
6.259 €
F98Z
Endovaskuläre Implantation eines Herzklappenersatzes oder transapikaler …
11,502
30
33.501 €
Polytrauma
Ø 6,583
80
Ø 19.174 €
Diverse
1) Relevant existing DRG of the hospital and strategic potentials; Source: Inek DRG Browser for major departments 2011
page 26
Profitability analyses
Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 27
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
Required resources The spatial and technical requirements for a Hybrid-OR will be fulfilled after reconstruction work and investments Spatial and technical requirements1
Technical equipment (extract) Artis Zeego with large detector (30 cm x 40 cm) 2 monitor mountings (1x Large Display, 1x 3 monitor suspension system) Software TAVI and 3D imaging Hemodynamic measuring unit and FFRFunction to optimize the reimbursement Defibrillator and angiography syringe
a
Spatial requirements At least 70 sqm
Additional required space for a central control room, technics, patient locks and a common room Product example
Required height of the examination room 2,9 m – 3,1 m Radiation protection (approx. 1-2 mm Pb) Air conditioning (Class 1a) Power supply (approx. 60 KVA)
1) Siemens AG page 28
Profitability analyses
Siemens Healthcare Consulting
Required resources Both quantitative and qualitative requirements are only partially fulfilled currently Legal requirements1
Required skills of personnel
a
Commitment to respecting areas of specialty as well as qualification and knowledge of radiation protection of the physicians Quality commitment for interventional radiology is defined by the service provision regulations of the National Health Insurance (NHI) All examinations and treatments are defined in the regulations for further education of the medical association Further education2 An introducing on-site-training and a following certification is prerequisite A device-training for the assisting personnel and the treating physicians is recommended when new product features are implemented
1) Survey of the Siemens AG 2011 2) Siemens AG page 29
Profitability analyses
Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 30
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
Cost- and revenue calculation The following method was used for the cost- and revenue calculation Data basis: DRG Browser for the main departments 20111
Assumptions Identification of the relevant profit shares in the IneK DRG Browser 2011 Determination of the TOP 10 DRG by case severity and additional potential in the area of TAVI and polytrauma DRG distribution of potential patients by the nationwide frequency according to the DRG Browser 2011 Revenue = Cost weight (DRG Browser 2011) x Landesbasisfallwert 2011 Costs = According to DRG Browser 2011 Saving potential per DRG after installation of a Hybrid-OR were taken into account, conservative assumptions on basis of practical experiences2 Full cost accounting: Installation of a HybridOR is a new implementation, hence, it is recommended to be viewed as a stand-alone profit center
1) IneK 2) Practical experience Prof. Steinbauer (Regensburg) page 31
Profitability analyses
Siemens Healthcare Consulting
Cost- and revenue calculation – comparison of scenarios Under conservative assumptions, the calculation is profitable in both scenarios Prognosis (cumulated) incl. financial investment [€]
Basic assumptions Number of cases in t1 500: Existing relevant cases in the hospital Additional potential of polytrauma and TAVI is generated by the Hybrid-OR Investment costs total: T€ 3.500, including reconstruction costs T€ 2.500, medical technology T€ 800 and OR-equipment T€ 200 Assumption Scenario 1 Financial investment incl. reconstruction costs with an annual amortization over 8 years and an interest rate of 3% Assumption Scenario 2 Complete investment in medical technology and reconstruction costs in period t0
Break Even in scenario 1 in period 4, Break Even in scenario 2 in period 5.
page 32
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective in both scenarios.
Profitability analyses
Siemens Healthcare Consulting
Cost- and revenue calculation – Scenario 1 Under conservative assumptions and including all investments, the calculation is profitable in period 4 Prognosis (cumulated) incl. financial investment in T€ Cum. Outcome
Assumptions Scenario 1
Outcome incl. Financial investment
2.000 1.800
4.500 4.000 3.500
1.500
3.000 2.500 2.000
1.148
1.632 912 479
0
-835
407
1.183
1.213
1.238
484
1.500 1.000 500 0 -500
-427
-1.313
-1.000 -1.500
-1.313
2012 2013
5.500 5.000
2014
2015 2016 2017
2018
Financial investment incl. reconstruction costs with an annual amortization over 8 years and an interest rate of 3% Calculated on the basis of existing potential patients and strategically potential for an Hybrid-OR and prognosis of future growth rate based on the market-, technical- and incidence analysis Consideration of a discount for supererogation of 30% in t1 and following t2 of 70% each in year 1 and 30% in year 2 of the supererogation PHI 10,0%, NHI 90,0% Revenue PHI = NHI x 1,5 Revenue growth of 1,14% p.a. covered
2019 2020
Cost growth of 2 % p.a. covered Investment in 2012; Start in 2013 Scenario 1 is profitable in period 4. The cumulated and discounted operative result over 8 periods reaches a value of T€ 2.000 page 33
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective for scenario 1
Profitability analyses
Siemens Healthcare Consulting
Cost- and revenue calculation – Scenario 2 Under conservative assumptions and including all investments, the calculation is profitable in period 5 Assumptions Scenario 2
Prognosis (cumulated) incl. financial investment in T€ Cum. Outcome
Complete investment in medical technology and reconstruction costs in period t0
Outcome incl. Financial investment
2.500
5.000
2.300
4.000
1.648
2.100 977
897
1.393
1.621
3.000 1.671
1.688
466
0 -1.000
-807
-3.615
2.000 1.000
-1.155 -2.548
-2.000
-3.445
-3.500
Calculated on the basis of existing potential patients and strategically potential for an Hybrid-OR and prognosis of future growth rate based on the market-, technical- and incidence analysis
6.000
-4.422
Consideration of a discount for supererogation of 30% in t1 and following t2 of 70% each in year 1 and 30% in year 2 of the supererogation
-3.000
PHI 10,0%, NHI 90,0%
-4.000
Revenue PHI = NHI x 1,5
-5.000
2012 2013 2014 2015 2016 2017 2018 2019 2020
Revenue growth of 1,14% p.a. covered Cost growth of 2 % p.a. covered Investment in 2012; Start in 2013
Scenario 2 is profitable in period 5. The cumulated and discounted operative result over 8 periods reaches a value of T€ 2.500 page 34
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective for scenario 2
Profitability analyses
Siemens Healthcare Consulting
Management Summary The investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective
Initial situation
The German hospital considers an installation of a Hybrid-OR, which should be previously analyzed in terms of efficiency in respect of the current market situation.
Market potential
In addition to the existing patients there is a heterogeneous competitive situation for relevant patients in the catchment area. An ultra-modern Hybrid-OR and a targeted marketing concept could increase the numbers of patients in the regarding departments without any side-effects by 10% per year.
Resources
Economic profitability
Recommendation
page 35
Both the spatial and technical requirements for the installation of a Hybrid-OR are fulfilled by the hospital after some reconstruction work. The quantitative and qualitative requirements of the personnel are only partially fulfilled currently.
An efficient working process of the Hybrid-OR leads, on the most conservative assumptions, in both scenarios to a cumulated and discounted operative result between T€ 2.000 (scenario 1) und T€ 2.500 (scenario 2) at a 8-year period.
An investment in a Hybrid-OR is reasonable from a medical, economic and strategically perspective. However, a professional OR-management, interdisciplinary collaboration, acquisition of heart surgeons and the extension of the trauma center are required for a successful operation.
Profitability analyses
Siemens Healthcare Consulting
SWOT-Analysis A SWOT-Analysis can illustrate important fields of action for a successful establishment of an Hybrid-OR Strengths
Weaknesses
Basic utilization for an Hybrid-OR exists Personnel resources with relevant experience for the portfolio partially exist currently Spatial requirements are fulfilled after reconstruction work The hospital’s portfolio and relevant departments are already existing mainly
Opportunities
Threats
Foundation of a cardio-vascular center in a catchment area with a high amount of relevant patients, considering the demographic trend Diversification of the range of services in the areas: TAVI and polytrauma Improved image and competitive position due to investments in new and ultra-modern medical equipment Improvement of the own position in hiring new chief physician Foundation of a cooperation network with established referring physicians and other hospitals without Hybrid-Ors in the region Increase of the level of awareness with targeted marketing at referring physicians and the population A constant number of inhabitants with a growing number in the relevant target group(>40 years of age)
page 36
Geographic location near with a high number of competitors in the market segment Limited catchment area due to actual offerings and competing hospitals with an Hybrid-OR Level of awareness as a cardio-vascular center non-existent
Portfolio extension in a regional market with very strong competition Number of patients are not growing as projected Staffing of physicians and assistants for the planned departments in an rural area Foundation of the trauma center with consideration of the spatial and personnel requirements due to DGU (German foundation for trauma surgery) Bottlenecks in the Hybrid-OR have to be managed with a professional OR-management
Profitability analyses
Siemens Healthcare Consulting
Do you have any questions?
Bastian Helm Project manager Siemens Healthcare Consulting Allee am Röthelheimpark 3a 91052 Erlangen Phone: 09131 – 84 4510 Fax: 09131 – 84 3758 Mobil: 0173 – 70 72 164 E-mail:
[email protected]
page 37
Profitability analyses
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