Introduction: Extracorporeal membrane oxygenation (ECMO) is a medical procedure that bypasses the heart and/or lungs to oxygenate blood and remove carbon dioxide. It is used in cases of severe respiratory or cardiac failure, often as a
bridge to lung or heart transplant. While it can be a life-saving measure, the cost of ECMO can be enormous. This case study will examine a 19-year-old patient who was placed on ECMO for severe respiratory distress and the associated costs and reimbursement.
Background: A 19-year-old man was transferred from an outside hospital to a well-known, east coast medical center after his respiratory failure progressed beyond treatment with standard ventilator support. He was placed on ECMO, a life-saving measure that uses a machine to oxygenate blood outside the body, bypassing the lungs and/or heart. His hospitalization was 64 days, during which he was seen by 134 physicians. Unfortunately, the patient died, but the medical care he received was considered flawless.
The Case: The patient's hospitalization cost a total of $4.24MM, with ECMO charges alone amounting to $678,389 for 60 days of treatment. The high cost of ECMO reflects the complexity of the procedure and the resources required to monitor and support the patient. However, the use of ECMO, in this case, was necessary to attempt to save the patient's life.
The Reimbursement: WellRithms, a medical billing company, used Harmony™ and expert medical knowledge to determine the reimbursement for this bill. The payment to the hospital was $1.33MM, resulting in a savings of nearly $3MM.
Significantly, there was only one reconsideration for the entire bill, which came from one of the physician charges. This highlights the ability of WellRithms to accurately and fairly reimburse the provider, while minimizing the likelihood of a dispute.
Conclusion: ECMO is a life-saving measure that is critical in cases of severe respiratory or cardiac failure. However, its use comes at a high cost, as demonstrated in this case study. Medical billing companies, such as WellRithms, play a crucial role in determining fair and accurate reimbursement for providers, while also minimizing disputes. While ECMO is a costly procedure, it remains a necessary and potentially life-saving measure in critical cases.