Top Three Considerations When Establishing an ECMO Program 

Updated on March 13, 2024

Extracorporeal Membrane Oxygenation (ECMO) has emerged as a vital therapy offering a lifeline to critically ill patients with severe respiratory or cardiac failure. Its life-saving potential is undeniable, with survival rates improving significantly in recent years. However, the journey to establish a new ECMO program within a hospital can be a daunting and complex endeavor. This complexity often deters hospitals from providing this crucial therapy, leaving patients in need without access and hospitals without the benefits it can offer.

As hospitals consider how to build or expand ECMO programs while still managing the day-to-day pressures already facing their teams, many are turning to external partners for support. By partnering with established ECMO service providers, hospitals can jumpstart their ECMO initiatives in a streamlined and cost-effective way. However, hospitals need to be diligent in their vetting processes when it comes to selecting the right partner for their needs. Here are three areas to consider when looking to establish or expand an ECMO program with a partner:

1. Costs: Setting up an ECMO program without a clear roadmap can result in wasted time, unforeseen expenses, and overspending during the startup phase. In contrast, ECMO service providers offer a proven roadmap and clear upfront pricing to address all of the hospital’s needs. In establishing strategic partnerships, hospitals should look for a proven track record and a wealth of expertise to ensure that every dollar is allocated efficiently and transparently. 

Hospitals should be able to confidently embark on their ECMO journey without the uncertainty of trial and error, knowing that they have a reliable partner to guide them every step of the way. Prior to initiating an ECMO program, it’s essential to have a deep understanding of the facility’s current clinical capabilities as well as the skills and expertise of their healthcare providers in order to assess future training needs. Additionally, hospitals must consider the necessary equipment, its associated costs, and lead time for procurement, identify gaps in policy, procedure, and credentialing documents, and establish an internal process to address these gaps. Lastly, a comprehensive grasp of the financial aspects of the ECMO program is crucial for its successful implementation.

2. Speed: Attempting to build an ECMO program “organically” from scratch is not only time-consuming but wrought with hazards since it’s difficult to reach sufficient patient volume to maintain clinical expertise. The initial ECMO training and ongoing annual training requirements are significant and with annual ECMO volumes below 30 cases, it can be difficult to keep ECMO specialists well-trained and comfortable caring for ECMO patients. National ICU staff turnover rates of 25% only compound this problem. It is critical to start fast and build volume quickly so that a hospital can create institutional expertise that is self-sustaining.  

By utilizing an ECMO service provider to start the program, the hospital can benefit from the provider’s collective expertise. Indeed, ECMO specialists who work for ECMO service providers typically sit as many bedside shifts in a month as many hospital-employed ECMO specialists sit in a year. Armed with the ability to increase patient load quickly, hospitals can build internal expertise and successfully transition to independence.

In evaluating potential partners, hospitals should request clear timelines when it comes to the ramp-up of an ECMO program launch or expansion. These timelines will vary depending on the level and type of support being sought. However, if the proposed timelines are not substantially better than what can be achieved internally, or if they don’t outline a clear path to independence in a reasonable timeframe, hospitals should continue exploring other potential partners.

3. Operational Stability: Establishing and expanding an ECMO program requires facilities to navigate a complex landscape of program logistics and steer clear of common pitfalls. While modeling ECMO revenue is easy and always reflects a high revenue from the program, understanding how to code, bill, and collect that revenue is critical. Unfamiliarity with ECMO-specific billing and coding practices is common because it is a rare unbundled code, and this unfamiliarity can result in significant lost revenue. 

Additionally, hospitals should know in advance that an established program will yield positive net revenue, especially with its unique payer mix and costs. Hospitals should expect their partners to lay out a pathway to financial success and proactively address common pitfalls to optimize financial performance. ECMO partners should bring infrastructure and reimbursement expertise to the table and leverage it on behalf of hospitals, ensuring a smoother path to sustainability and profitability.

ECMO availability is fast becoming the standard of care for shock and cardiopulmonary failure, and hospitals need to evaluate how they can establish or expand access to this therapy. While the challenges facing hospitals today may be daunting, enlisting an experienced ECMO service provider who specializes in ECMO program start-up and management can significantly ease the path to success. By offering clear upfront costs, reducing startup times, avoiding common pitfalls, and facilitating the rapid development of a sustainable internal team, hospitals are finding that the right partner can provide an efficient, cost-effective approach to launching or expanding an ECMO program. 

Mary Albers copy
Mary Albers RN, MBA
Owner and CEO at Albers Advisors

Mary Albers is a senior healthcare executive with a proven ability to drive transformative change and sustainable growth in large, complex, matrixed organizations. Ms. Albers is the owner and CEO of Albers Advisors, currently working with Major Futures as an Executive Advisor. Mary works with healthcare companies to help them with strategic decision-making within hospitals and medical groups. Mary holds an MBA with a healthcare focus from the University of Northern Colorado, a bachelor's degree in public affairs from the University of Colorado, and an associate degree in nursing from Gwinnett College. She is a service-line expert who defines strategy and then builds the operational structures that allow physicians and health systems to flourish. Serving most recently as the system COO for Billings Clinic, she advocates passionately for physicians, associates, and patients. Ms. Albers is a mentor, trusted leader, and clear communicator able to drive operational excellence while maintaining
engagement and relationships. She is a service-line expert who defines strategy and then builds the operational structures that allow physicians and health systems to flourish. In addition to her time at Billings Clinic, Ms. Albers has previously been in multiple senior chief executive positions in both medical groups and a flagship Level I trauma tertiary care center. She is a passionate advocate for parents and children affected by transplants and congenital heart disease.